The Link Between Mood Disorders and Addiction

About 20% of Americans with an anxiety or other mood disorder (like depression) also have an alcohol or other substance use disorder.

Do you get anxious when you have to speak in front of an audience, take a test, or talk with a superior? Or maybe when you are facing debt, in an argument with someone you care about or at the precipice of a potentially life-altering decision? Every human being faces experiences that cause anxiety, but some feel it more than others. Research indicates that there is a genetic predisposition to anxiety; some of our nervous systems are more prone to anxiety than others. According to the National Institute of Mental Health, nearly 40 million people in the United States have suffered from some kind of anxiety disorder, including panic attacks and phobias. When you face anxiety, how will you handle it?

(Note: While this blog post focuses primarily on the link between anxiety and addiction, I have witnessed, with my clients, that this information can be generalized to other mood disorders as well.)

Individuals who come from unstable families and lack secure attachment often experience generalized anxiety; they may turn to drugs to calm themselves down. Many teens begin to abuse alcohol in their adolescence; it is their way of managing social anxiety.  A friend of mine abused prescription medications after her brother’s suicide; it was her way of muting her overwhelming feelings of loss. Many addicts relapse; it is their way to escape reality. Several of my clients suffering from post-traumatic stress disorder (PTSD) experience major anxiety; they have a difficult time regulating their nervous system responses and often turn to addictive substances for comfort.  Some people, however, face anxiety head on with exercise, self-care, hobbies, a balanced diet, etc. While everyone experiences some form of anxiety or a mood disorder (like depression) during their lives, only some individuals combat their anxiety with addictive substances.

The question begging to be asked is–does a mood disorder like  anxiety or depression cause addiction? No. So is there a link between anxiety and addiction? That answer is a resounding yes. Can it lead to it? Absolutely.

Anxiety consists of the excessive need for control; ignoring psychological and physical signs of stress; the unending need for approval; perfectionism; and strong reactions within the body and mind. The physical and psychological symptoms of anxiety are similar to withdrawal symptoms from drugs and alcohol. An addict will turn to substances, or other addictive behaviors to calm an anxious state. The avoidance of uncomfortable physical agitation and painful emotions are some of the key components that maintain the connection between addiction and anxiety. Both anxiety and addiction strengthen as the addictive behavior continues. Substance abuse can mask anxious feelings preventing the addict from receiving proper treatment for anxiety.

People who experience anxious moments, but who do not have anxiety disorders, will be able to go about their day when the crisis passes; people with anxiety disorders cannot stop the effects of their anxiety disrupting their everyday life. Professional, social, familial, and academic obligations will be interrupted and damaged by the sense of panic, stress, and foreboding that comes as a part of the condition. Social anxiety disorder frequently “travels in the company” of alcohol or drug abuse, as people with social anxiety disorder might try to make use of alcohol or cocaine to help make them feel more comfortable and less inhibited in social settings.

For individuals struggling with anxiety, substances offer an escape. For others, substances bring a feeling of relative normalcy (self-medication). For some, anxiety is a factor of their personality that also includes aspects like impulsivity that make the anxious person more likely to use substances.  Although not entirely understood, there is a connection between anxiety disorders and substance abuse. About 20% of those with an alcohol or substance use disorder also have an anxiety or mood disorder. In fact, many of my clients with an addiction (mostly sex addiction) are self-medicating their anxiety and depression with their addiction! It is also important to note that addiction can happen without any substances; you can be addicted to an eating disorder, gaming, sex, exercise, etc. The point is that mood disorders can either reinforce or be reinforced by addictive substances.

Treating substance abuse without treating the anxiety that causes it is a fruitless endeavor. 

Treating substance abuse without treating the co-occurring disorder can lead to higher rates of relapse. Due to the similarity of drug and alcohol withdrawal symptoms and anxiety symptoms, both need to be treated at the same time. The treatment for anxiety and addiction is referred to as dual diagnosis and it is important to find an addiction treatment facility, or a therapist, that can address both the addiction and the anxiety.

It is only through therapy that clients can make tangible strides towards restoring a sense of balance and stable mental health to their lives. Simply walking away from treatment after detox is ineffective…and might even prove more harmful. Now is the time to address the symptoms of anxiety and addiction that feed off of each other and keep you in the self-defeating cycle. Allow me to help you break the dependence on the substance or behavior, you have used to manage your anxiety and distress, as well as provide sustainable ways to cope with your mood disorder. Happiness is possible. Healing is possible. Contact me today to get started.

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.


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Self-Care is a Family Matter

“Family is not an important thing. It’s everything.” –Michael J. Fox

When you think of self-care, you might envision yourself with cucumbers on your face getting a massage. Or maybe you think of axe throwing, running several miles, or playing an instrument for fun. Self-care has been in the limelight with endorsements from celebrities and other influencers on their social media accounts. Self-care is important because it helps you maintain a healthy relationship with yourself and others, it produces positive feelings, improves confidence and self-esteem…the benefits to practicing self-care are endless (additional sources on the benefits of self-care are included below). But what about family self-care? What are you doing to make sure your family wellbeing is maintained and functioning optimally?

At the end of September, I wrote about fun family activities to get everyone involved in the nationwide holiday Family Health and Fitness Day. When practiced individually, self care can benefit you and I emotionally, spiritually, mentally, practically and socially. In like manner, when implementing on family self-care strategies, it will greatly benefit you to focus on each of these areas; it will keep your family healthy, happy, and united. The following are some suggestions for each of those areas:

Emotional:

  • Watch a move
  • Write each other positive notes
  • Discuss each others’ talents/gifts
  • Verbalize and talk about feelings
  • Draw self-portraits
  • Say, “I love you”
  • Spend time writing
  • Try a new craft

Spiritual

  • Write a gratitude list
  • Go outside
  • Talk about forgiveness
  • Write thank you notes
  • Volunteer
  • Spend time outdoors in nature
  • Plant a tree
  • Practice positive self-talk

Mental

  • Read together
  • Draw or write stories
  • Meditate
  • Find shapes in clouds
  • Practice belly breaths
  • Go on a walk to find new things
  • Make vision boards
  • Try Headspace for Kids
  • Create mandalas
  • Make mindfulness jars
  • Mind strength games like “Memory”

Practical

  • Clean up
  • Declutter old toys
  • Assign chores
  • Make a grocery list
  • Learn about money
  • Make a weekly budget check-in
  • Make a weekly cleaning check-in
  • Do homework/study
  • Establish a morning/evening routine

Social

  • Play in the park
  • Call or visit relatives
  • Have family dinner
  • Play boardgames
  • Host a sleepover
  • Invite friends over
  • Plan a BBQ
  • Join a team
  • Organize a food drive
  • Discuss friendship and how to be a friend

Maybe by reading this list you have thought of your own ideas for one or more of these areas. Figure out what works for you and your family; what leaves you feeling recharged, connected, and happy? Do those things. And do them regularly. Individual self-care is a daily effort; staying balanced and connected as a family is no different. Carve out time for your family, make it a priority, be consistent, make it fun, and you will find that family self-care is the answer you have been needing for your family. Should you find you need help in increasing your family togetherness, please contact me today to schedule a session. 

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.


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Bulimia Nervosa at a Glance

“For me, the bulimia was about stuffing my emotions. So I stopped suppressing my feelings.” ~Cheryl James

My friend’s dad is a dentist; within the first minute of looking into someone’s mouth, he can tell if the person struggles with bulimia nervosa. This is because bulimia–the binging and purging of food–wreaks havoc on a person’s teeth. The acid from the stomach visibly destroys the enamel of the teeth and causes noticeable discoloration. But this particular side-effect of bulimia is only the tip of the iceberg among much more serious consequences that come from this eating disorder and mental illness. Continue reading to learn what it is, what causes it, as well as the symptoms, consequences, and recovery options for bulimia nervosa. 

Even though Derek Zoolander downplays the significance of bulimia nervosa, it is a very serious, potentially life-threatening eating disorder. People with bulimia secretly binge and then purge to get rid of extra calories in an unhealthy and unnatural way. Binging includes discretely eating a large amount of food, within a small amount of time, accompanied by a lack of control during this episode. Purging methods vary from regularly self-induced vomiting, misusing laxatives, weight-loss supplements, diuretics or even enemas after bingeing. Other ways include denying calories to prevent weight gain through fasting, strict dieting or excessive exercise.  The severity of bulimia is determined by the number of times a week that a person purges, usually at least once a week for at least three months. 

The exact cause of bulimia is unknown. Many factors could play a role in the development of eating disorders, including genetics, biology, emotional health, societal expectations and other issues.  Women are more likely to struggle with bulimia than men, but the latter are still susceptible. Bulimia typically begins in the late teens or early adulthood.

Bulimia shares several symptoms with other mental illnesses: Negative self-esteem, problems with relationships and social functioning, difficulty concentrating, poor sleep patterns, withdrawal from friends, etc. Symptoms specific to bulimia nervosa include extreme preoccupation with self-image, body shape and weight; fear of gaining weight; feeling uncomfortable eating around others; trying to “fill up” by ingesting unsubstantial food (ie. condiments), drinking excessive amounts of water or non-caloric beverages, or trying to chew food for an unnecessarily long amount of time; hoarding food in strange places; disappearing after eating (often to purge in a private place); frequently using mints, mouthwash and gum to cover unnaturally bad breath; and maintaining a rigid exercise regimen to “burn off” calories ingested. 

Bulimia nervosa affects far more than how an individual perceives him- or herself or what he/she eats. This eating disorder truly harms a person’s body in the following ways:

  • Unusual swelling of the cheeks or jaw area  
  • Calluses on the back of the hands and knuckles from self-induced vomiting 
  • Bloating from fluid retention  
  • Stomach cramps and other gastrointestinal issues (constipation, acid reflux, etc.) 
  • Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate) 
  • Dizziness 
  • Fainting/syncope 
  • Feeling cold all the time 
  • Dental problems like enamel erosion, cavities, and tooth sensitivity 
  • Dry skin 
  • Dry and brittle nails 
  • Swelling around salivary glands 
  • Thinning of hair on head, dry and brittle hair (lanugo) 
  • Muscle weakness 
  • Yellow skin (in context of eating large amounts of carrots) 
  • Cold, mottled hands and feet or swelling of feet 
  • Menstrual irregularities
  • Poor wound healing 
  • Impaired immune functioning
  • Dehydration (leading to kidney failure)
  • Heart problems, such as an irregular heartbeat or heart failure
  • Severe tooth decay and gum disease
  • Absent or irregular periods in females
  • Digestive problems
  • Anxiety, depression, personality disorders or bipolar disorder
  • Fertility issues (in women)

Many people with bulimia nervosa also struggle with co-occurring conditions, such as self-injury (cutting and other forms of self-harm without suicidal intention), substance abuse, impulsivity (risky sexual behaviors, shoplifting, etc.), and even diabulimia (intentional misuse of insulin for type 1 diabetes). 

While bulimia nervosa is a very serious mental illness, the good news is that it is not a life sentence. There are many options available for treatment, including medication, support groups and group therapy, and individual therapy. By identifying your triggers, I can help you manage stress and avoid the cycle of binging and purging. Getting support and help often gives you extra strength to fight your eating disorder.  Because bulimia is related to self-image–and not just about food–bulimia can be hard to overcome on your own. Effective treatment can help you feel better about yourself, adopt healthier eating patterns and reverse serious complications. Contact me today to get started.

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

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On Love and Affection: When PDA is Okay

“A healthy amount of PDA allows the couple to express their affection to each other, and also to the world. Best practices include using ‘on and off switches.’ Continual PDA loses its importance, and makes others uncomfortable.” ~ Susan Winter

How do you feel about public displays of affection? Are you the type of person that loves snuggling, holding hands or kissing your lover, no matter where you are and who might be watching? Or does the mere thought of holding hands in public give you actual anxiety? Odds are that you fall somewhere in the middle. It is completely natural and okay to want to be affectionate with someone you love. In fact, when you cuddle with someone you care about, oxytocin–the hormone that fosters feelings of love, bonding, and connection–is secreted, thus earning its nickname as the “cuddle” or “love” hormone. But even though PDA is normal and feels good, just keep in mind that there is a time, a place, and a limit for what is appropriate!

Falling in love is wonderful. When it happens, you may want the world to know. At the beginning of a romantic relationship, you are likely to always hold hands and exchanging loving glances. Most onlookers will admire your newfound love fondly. I have written before about how all human beings have an innate need to be loved and have meaningful physical interactions with others.  But there is such a thing as too much of a public display of affection while anyone/everyone is watching. Here is a safe, and slightly humorous, rule of thumb: Ask yourself if your grandmother would approve. 

Let’s talk about the specific ways to display affection and whether or not they are appropriate in public:

  • Kissing. There are certain times it is completely okay to kiss the person you love–such as when you are greeting someone or saying goodbye. However, long, drawn-out kissing in front of others can make them feel like they are involuntarily watching a scene from a RomCom. 
  • Touching. The resources at the end of this post were unanimous in saying that it is always okay to hold hands with someone. An arm draped around someone is okay when you are sitting or casually strolling through the park. It is never okay to touch anyone in a private area in public.
  • Groping. Groping is never acceptable in public. Certain gestures are even illegal in public.
  • Tasting and nibbling. Reminder: Your face is not a lollipop, and you are not a vampire, so experts kindly ask you to refrain from licking or biting the person you love in front of others.
  • Electronic Affection. You should never text, post, or communicate anything intimately personal in a public forum or on any social media platform. Not only can this make others uncomfortable, but you may also embarrass the person you love.

PDA is commonplace in many places –like during your engagement or wedding day, at farewells and homecomings, at the airport when one is about to be deployed, at the movies (especially romantic ones), on the dance floor, and when the clock strikes 12 on New Year’s Eve. I would venture to say that if you stay within the boundaries for the above actions, PDA is welcomed pretty much anywhere. But remember to ask yourself if Grandma would approve of how you are expressing your affection!

Showing appropriate levels of PDA can be healthy for a relationship. Being affectionate in public strengthens your love, shows a level of comfort with your partner, and allows others to identify you as a unit. Additionally, if things are not perfect in your relationship, PDA might be a way to spark connection again. PDA is really an unconscious form of staying connected; a brief kiss on the cheek, a hand placed gently at the small of the back, and an exchanged glance can get the heart pounding. This might even be the healing touch that can lead to amends or forgiveness in a relationship.

I would be remiss if I failed to mention that not everyone wants to receive PDA. I have written at length about love languages (see sources below) because I believe in them. The fact is that, for some people, physical touch is the last way they communicate or receive love. For these people, touching in public may be very unwelcomed! Certain factors like personality, general comfort in public, safety, and regard for others’ feelings play a role in how someone interacts with their significant other in social situations.  I highly encourage you and your partner to openly discuss to what degree you wish to give and receive touch in public, and then to respect those wishes. That might sound counterintuitive, or even scarier than simply reaching out to hold his/her hand, but figuring out someone’s PDA comfort level is an important step toward understanding their love languages. Unwelcome touching can potentially damage a relationship and push your partner away–especially where abuse or addiction is associated with PDA. 

Even after the beginning stages of a relationship, PDA can help couples reaffirm their love and commitment to each other whether life is breezy or if it is a time of disconnect. All humans need reinforcement. If you and your partner are struggling in your relationship, please contact me to schedule a session. I am here to help. Remember that, when PDA is consensual, well-timed public displays of affection can provide a spark of hope and connection in relationships. 

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

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Beware the Sting of the Internet: Simple Ways to Protect Your Home from Porn

“There is no dignity when the human dimension is eliminated from the person. In short, the problem with pornography is not that it shows too much of the person, but that it shows far too little.”  ~ Pope John Paul II

Every second…

  • 28,258 users are watching pornography on the internet
  • $3,075.64 is being spent on pornography on the internet and
  • 372 people are typing the word “adult” into a search engine.

Every day…

  • 37 pornographic videos are created in the United States
  • 2.5 billion emails containing porn are sent or received
  • 68 million search queries related to pornography (25% of total searches!) are generated, and 
  • 116,000 queries related to child pornography are received.

In addition to these frightening numbers, 40 million Americans regularly visit porn sites; 35% of all internet downloads are related to pornography; 34% of internet users have experienced unwanted exposure to pornographic content through ads, pop up ads, misdirected links or emails; and 33% of porn viewers are women. There is no doubt, pornography is everywhere. It is accessible just as it is addictive. So how can you protect yourself and your home from pornography? Since the web is accessible on so many devices nowadays, I want to go over some free and relatively easy ways to block pornography in your home.

DNS

The Domain Name System (DNS) is the Internet protocol that converts website names (domain names) to IP addresses. Filters at this level prevent the DNS resolution for the blocked sites, so their content never loads. This is the fastest way to block sites. Every device needs DNS to connect to the Internet, so this type of filtering works everywhere. All you have to do is open the device Settings, look for Network Settings or Wifi Settings and change the DNS servers (also called NameServers) to the IP address provided by your Internet Filter. Click here and refer to step one for specific instructions on how to open the settings, get to the appropriate filters, and block the known IP addresses. This article also has incredibly clear and helpful steps for setting up “clean” server providers on each of your devices. (It is important to note that if you are using your phone’s internet, versus wifi, you can bypass any filtering settings on DNS.)

PARENTAL CONTROL

When you make changes or set up filters on your device(s), you will need to set up parental control options that will disable your children from altering any of your settings or removing the filters you have put in place. This can be done on most TVs and devices like Roku, Amazon Fire Stick, and Chromecast. Each device might have a different name for Parental Control, but it is generally called Parental Control or Restrictions. On IOS (iPhone/iPad), you can do it by going to Settings-> General-> Restrictions and filtering the content you do not want to allow your children to see. On that page, if you scroll down to Allowed Content, I would recommend setting:

  • Movies: PG-13
  • TV Shows: TV-14
  • Books: Restrict explicit content
  • Apps: 12+
  • Siri: Explicit language filtered
  • Websites: Restrict adult content

ROUTER

Too many families miss the significant step of controlling their wireless router. You are responsible for every digital click that occurs on your WiFi network–every babysitter, every relative, every friend. Please make sure you have eliminated the bad stuff before they even decide to connect their device to your home’s network!

BROWSER HISTORY

Once you set up a filter to block pornographic content and enabled parental control, I recommend doing spot checks every day or every couple of days to see what online sites are being visited in your home. Older kids will learn to clear their browser history, but younger kids are not aware of that trick. Some devices (like Mac), even allow parents a way to prevent browser history from being deleted! Be aware of “incognito mode,” which is an internet browser setting that prevents browsing history from being stored. If you want to prevent this and have iOS, delete the app store to prevent more apps from being downloaded and ensure Safari is the only browsing app–Safari does not allow private browsing.

SPONTANEOUS FOLLOW-UP

Every few days, go through your children’s messages and social media apps like Instagram, Facebook, Whatsapp, etc. Look at the photos they are viewing and sharing, as well as with whom they are talking. Scan the photo library on your child’s cell phone as well; although younger kids may not be sexting yet, by the time they hit their tweens they may begin participating in this type of behavior. Be sure to look at your children’s deleted photos and messages because kids these days are smart! 

USE YOUR WORDS

At the end of the day, parents ultimately want their children to make good choices on their own–without filters or blockers or any kind. No parent wants to feel like a bossy, overseeing nag. Having a solid foundation where mutual trust and communication are employed will be the best way to help your kids be open with you. If they know they can come to you with questions, concerns, or mistakes without you getting upset, they will be more likely to be honest and open. So start today. Talk with them. Be real with them. Tell them that you will always be there to help them in any way you can.

Other practical tips include paying for ad blockers that potentially have offensive material, limiting or disabling data on your child’s device, restricting the YouTube app on your/your child’s device, enabling the PIN and call your Cable provider to block porn pay-per-view, and being sure to report offensive material if you do see it in a browser search (this will help improve their filtering). Be sure to keep in mind that whatever filtering tools you choose to go with will need to be installed on every device your child may use to go online: game consoles, cell phones, tablets, Kindles, personal laptops, computers, etc. 

One final tip: Lean on the many available resources to protect your home. Though the internet is full of pervasive material, there is also so much information on how to avoid and protect your family against it. You don’t have to do this alone; feel free to contact me with any questions, or to schedule a session. My door is always open!

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

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