Monday, April 5, 2021

 



A recent article in the Journal of Addiction Medicine reported on changes in alcohol consumption in response to the COVID-19 pandemic in the United States. The researchers found that during the pandemic there has been a 29% increase in the number of alcoholic drinks that people are consuming, a 20% increase in those exceeding the recommended drinking limits, and a 21% increase in binge drinking. Among the researchers conclusions is that there is an association among the COVID-19 pandemic and the amount of alcohol consumption and that public health monitoring is warranted.[i]

If you have found yourself drinking more during the pandemic, you are not alone. Here are ten questions to ask yourself to help you determine if your drinking may have become harmful: 

1    How often do you have a drink containing alcohol? Never/Monthly or less/2-4 times a month/2-3 times a week/4 or more times a week (A drink is defined as 12 ounces of beer, 8-9 ounces of malt liquor, 5 ounces of wine, or 1.5 ounces of 80-proof hard liquor)

2.      How many drinks containing alcohol do you have on a typical day when you are drinking? 1-2/3-4/5-6/7-9/10 or more

3.      How often do you have 6 or more drinks on one occasion? Never/Less than monthly/Monthly/Weekly/Daily or almost daily

4.      How often during the last year have you found that you were not able to stop drinking once you had started? Never/Less than monthly/Monthly/Weekly/Daily or almost daily

5.      How often during the last year have you failed to do what was normally expected from you because of drinking? Never/Less than monthly/Monthly/Weekly/Daily or almost daily

6.      How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session? Never/Less than monthly/Monthly/Weekly/Daily or almost daily

7.      How often during the last year have you had a feeling of guilt or remorse after drinking? Never/Less than monthly/Monthly/Weekly/Daily or almost daily

8.      How often during the last year have you been unable to remember what happened the night before because you had been drinking? Never/Less than monthly/Monthly/Weekly/Daily or almost daily

9.     Have you or someone else been injured as a result of your drinking? Never/Yes, but not in the last year/Yes during the last year

10   Has a relative, or friend, or a doctor or other health worker been concerned about your drinking or suggested you cut down? ? Never/Yes, but not in the last year/Yes during the last year

Scoring:

Item 1: Never=0/Monthly or less=1/2-4 times a month=2/2-3 times a week=3/4 or more times a week=4

Item 2: 1-2=0/3-4=1/5-6=2/7-9=3/10 or more=4

Items 3-8: Never=0/Less than monthly=1/Monthly=2/Weekly=3/Daily or almost daily=4

Items 9-10:  Never=0/Yes, but not in the last year=2/Yes during the last year=4

 Maximum possible score=40. A score of 8 or more indicates a likelihood of harmful drinking behavior and warrants more careful assessment.

If you scored above 8, or even if you didn’t but  feel that you sometimes drink too much alcohol, or that your drinking is causing problems, or your family is concerned about your drinking, talk to your clergy person or your doctor. They can help you determine if you need to cut back or quit altogether, and steer you in the right direction.

Some resources for you also might consider are:

·        Alcoholics Anonymous (national site): CLICK HERE

·        Dry January (tools and information about taking a one month break from drinking--it can be any month, not just January): CLICK HERE

·        Consider reading: Quit Like a woman: The Radical Choice to Not Drink in a Culture Obsessed with Alcohol by Holly Whitaker

We close with the full version of the Serenity Prayer attributed to Reinhold Niebuhr (a shortened version is used in many 12-step programs):

God grant me the serenity

To accept the things I cannot change;

Courage to change the things I can;

And wisdom to know the difference.

Living one day at a time;

Enjoying one moment at a time;

Accepting hardships as the pathway to peace;

Taking, as He did, this sinful world

As it is, not as I would have it;

Trusting that He will make things right

If I surrender to His Will;

So that I may be reasonably happy in this life

And supremely happy with Him

Forever and ever in the next.

Amen.

 

This article was originally written for the Episcopal Diocese of San Diego. 

I Barbosa, C., Cowell, A. J., & Dowd, W. N. (2020). Alcohol consumption in response to the COVID-19 pandemic in the United States. Journal of Addiction Medicinehttps://doi.org/10.1097/adm.0000000000000767


Thursday, March 25, 2021

After a Suicide...


If you are considering suicide, seek help immediately. Call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). There is also a Crisis Text Line: Text HOME to 741741. For crisis support in Spanish, call 1-888-628-9454.

Two Sundays ago I had the privilege of speaking at a forum in a congregation that had just experienced the loss of a member by suicide. While mental health struggles are always common in the US, with COVID we are seeing a rise in depression, anxiety, PTSD, substance use, and insomnia. Over the coming weeks, I will be addressing mental health concerns as we all strive to maintain our mental, physical, and spiritual health in these trying times. In the past I've posted on what to do if you or someone you know is considering suicide. Today, I'm sharing some tips for what to do in the aftermath of a completed suicide.

It can be hard to know how to help someone whose life has been impacted by suicide. Knowing what to say, and what not to say, is important. Specifically:

  • Avoid clich├ęs about God’s plan, or God’s need for another angel in heaven
  • Do NOT ask for the specifics about the death
  • Do not assume the person who completed suicide, or the survivor(s), were/are angry
  • Do not assume the survivor(s) are guilty
  • Avoid saying, “God never gives us more than we can handle” to the grieving survivors
  • Avoid saying “I know how you feel”. Really none of us ever really knows exactly how another feels. We can experience similar losses, but the impact and experience is never exactly the same. Instead you can consider saying, “I don’t know what to say, I have no idea what you’re going through, but I care about you and I want to be here for you.”
  • Avoid saying, “I can’t imagine”. This can make the survivor feel even more isolated.
  • Avoid saying, “Let me know if I can help”. It is hard for people to ask for help in even the best of circumstances, and following a suicide it is even harder. Instead do something specific for the survivors, like shop for groceries, bring dinner, etc.
  • Be cautious when saying “I’ll be praying for you.” If this is truly your commitment, is heartfelt and you are going to follow through then it is a welcome message that can be comforting. But if insincere, or used as filler when you don’t really know what to say, it can feel dismissive.
  • Do not assume your theology about suicide is the same as the survivors.

 There are also tangible things that you can do following a suicide. Specifically, you can:

  • Organize a team in the person’s name to walk in the next AFSP walk in San Diego (Out of the Darkness Walks—Overnight and Day) https://www.theovernight.org/index.cfm?fuseaction=cms.page&id=1359&eventID=518
  • Consider starting a scholarship fund for education in lieu of flowers if the person had children—assist the survivors by setting this up at a local bank for the family or as a GoFundMe page.
  • Read about suicide loss (AFPS site has a list of resources: https://afsp.org/books-for-loss-survivors )
  • Assist those touched by the suicide to connect with other suicide survivors (AFSP has a Healing Conversations program and bereavement support groups. You can offer to accompany them to an event or sit with them if it is online so that they don’t feel so alone. https://afsp.org/healing-conversations )
  • Encourage counseling/seeking mental health help.
  • Just be there (walking, watching a movie, etc)
  • Be patient. Months after the event are often the most difficult. Continue to check in, let them know you are thinking of them, that you’re there for them, and that you want to list.
  • Remind survivors of the importance of self-care—rest, eating well, excercise

I close with a prayer written by The Rev. Talitha Arnold for the National Action Alliance for Suicide Prevention:

God of all mercy, from whose love nothing can separate us, we pray this day for all persons dealing with mental illness and those who love and care for them. Especially this day, we pray for all whose lives have been touched by suicide, for those who have died by suicide and those who have attempted it. We pray for those who, because of mental health challenges such as depression, PTSD, or bipolar disorder, live with thoughts of suicide. We pray for those who live in despair and without hope because of poverty or discrimination. We pray for families and friends, colleagues and co-workers, who have been touched by the suicide of a loved one. We pray for counselors and therapists, psychologists and psychiatrists, for pastors, rabbis, priests, and imams, and for all who seek to help. And we pray, too, that you might give us the courage and wisdom to be there for others in distress, to offer your love and our care, to help break the silence and change the conversation about suicide, to be your listening ear, your hands, and your heart for others. Amen.

The above lists of suggestions come from a variety of sources, including those from the insightful members of a congregation that suffered the loss of one of their community by suicide, the American Foundation for Suicide Prevention website, and my own experience following the death of my spouse. This article was originally written for and published by The Episcopal Diocese of San Diego. 

Monday, March 1, 2021

Mental Health Resources

 Helping Hand Loan - IH Credit Union

 

For help if you are living with a mental health diagnosis:

Link to NAMI: click HERE (Links to an external site.) 

NAMI Support Warmline: 775.241.4212 (Stigma-free, non-crisis phone service patients can call or text to speak with a peer for support, respect, understanding and encouragement.)

Suicide: 

If you are experiencing thoughts about suicide, please call 911 or go to your nearest emergency room for further evaluation. 

Link to National Suicide Prevention Lifeline: click HERE (Links to an external site.) 

For those who have lost a loved one to suicide: 

Link to AFSP: click HERE (Links to an external site.) 

Grief: 

Link to Hospice Foundation of America for grief resources: click HERE (Links to an external site.) 

Addictive Disorders: 

Link to national AA site: Click HERE

Link to today's AA Meetings in Reno: Click HERE (Links to an external site.)

Northern Nevada Intergroup of Alcoholics Anonymous: 775.355.1151

Link to NA meetings in Reno: Click HERE (Links to an external site.) 

Link to national Gamblers Anonymous site: Click HERE (Links to an external site.) 

Sunday, January 3, 2021

God, COVID, and Vaccines

 


On December 28, 2020 I was fortunate to receive the COVID-19 vaccine. Since no pictures were allowed at our immunization site (it was run by the National Guard) I posted the card verifying my receipt of the injection on social media. 

The response to posts from health care workers about the vaccine has been interesting. Responses generally fall in one of four categories. 

First are the responses that are congratulatory or express thanks. This was the most common sentiment that people expressed to me personally. 

But other people have concerns about receiving this life saving preventative treatment. People are truly struggling because they want to do the right thing, but are also worried about the possible long term effects that we don't know about yet. Because the vaccine was developed so quickly it’s expected that there will be some concerns about long term unknown consequences. The CDC is monitoring it closely (I get a text every day). Regardless, the real and known risk of continued deaths and possible long term side effects from contracting COVID far outweigh any possible unforeseen vaccine consequence in my opinion. With more than 1 out of 1000 people in the US now dead from this virus we must do all we can. I cannot fathom that there will be an as of yet unknown side effect or death rate from the vaccine that would even come close to affecting 1:1000 Americans. For credible information on the COVID-19 vaccination click HERE.

Then there are the conspiracy theories that, quite frankly, are very disheartening because they do so much damage. Some of the ones I've seen on TikTok, Instagram and other places include that the vaccine:  

  • contains a microchip
  • alters your DNA
  • will give you COVID-19
  • is less effective than our own immune system
The best way to counter these conspiracy theories is to approach the person with compassion, remember that they truly believe these things which must be very scary, and try to educate/redirect to a reliable source of information. 

The fourth category of responses is one that as both a spiritual leader and a physician I find particularly difficult. A dear friend was posting his disappointment that he could no longer gather with his faith community due to a spike in cases in his area. He went on to say he would not even consider receiving the vaccine because to do so would mean he did not have faith in God to protect him. He was firm in his belief that not only would God protect him from the virus, but that God would protect his pastor and all those that gathered in their faith community for worship from contracting COVID. While I admire his faith, I think that it is actually the answers to our fervent prayers that God worked through the minds and hands of our scientists, helping them to develop a safe and effective vaccine with unprecedented speed. 

When I think about my friends position, I'm reminded of the old and well known "two boats and a helicopter" story. To refresh your memory: 

A storm descends on a small town, and the town soon begins to flood. As the water rises, the local pastor kneels in prayer on the front steps of the church, surrounded by water. 
Soon one of the townspeople comes by in a canoe and says, "You better get in pastor, the water is rising fast." "No" says the pastor, "I have faith, the Lord will save me."
Still the waters rise. The pastor has had to move up to the balcony because the stairs are now underwater. A motorboat comes by, and the driver shouts, "C'mon, get in. We need to get you out of here. The levee is about to give." Once again the pastor says, "I shall remain, God will see me through."
Finally the levee breaks, and the flood rushes over the church and only the steeple is visible. The pastor has climbed to the top, and is clutching the cross. A helicopter descends and over the loudspeaker the pilot says, "Grab the ladder. This is your last chance." The pastor again refuses help and says God will deliver him. 
And predictably he drowns. 
When he reaches heaven he sits down with God and asks, "Lord, I had unwavering faith in you. Why didn't you deliver me from that flood?" To which God answers, "What else did you want from me? I sent you two boats and a helicopter." 

Our prayers have been answered friends. God has sent two boats and a helicopter in the form of safe and effective vaccines. Have faith, roll up your sleeve, and do the right thing. 

Saturday, November 14, 2020

COVID-19, alcohol and other substances

 


Unfortunately for mariners, the total amount of wave energy in a storm doesn't rise linearly with wind speed, but to its fourth power. The seas generated by a forty-knot wind aren't twice as violent as those from a twenty-knot wind, they're seventeen times as violent. 

-from Sebastian Junger, The Perfect Storm: A True Story of Men Against the Sea

The September edition of The American Journal of Psychiatry has a commentary on the effects of alcohol and substance use disorders and susceptibility to COVID-19 infection and its sequelae. The authors point out that a "perfect storm" exists between the combination of COVID-19 factors and alcohol and substance use. These factors include: 

  • both alcohol and substance use decrease the immune response which increases the risk of lung infections and other complications from COVID-19
  • there are reports that COVID-19 infection can involve the brain in some people, which makes it conceivable that neurological changes related to substance use could combine deleteriously in people infected with COVID-19 and and make both disorders worse
  • cannabis and nicotine consumption are linked to specific COVID-19 risk factors (i.e. smoking anything is bad for the lungs, especially during COVID-19!)
  • inability to purchase alcohol and other substances may lead to withdrawal, as well as risky behaviors to use to counteract withdrawal symptoms
  • COVID-19 is a huge stressor, leading to increased fear, anxiety and social isolation. I am seeing this first hand everyday on the inpatient psych unit. Increased stress is related to increased substance craving, consumption, and risk of relapse. The authors make the point that it is crucial to remember that stress-, alcohol-, and drug-related alterations in brain chemistry persist even after the stressor resolves
If you would like to talk to someone about being isolated, if you are questioning if  your substance use is something to be concerned about, or have any other mental health concerns, telemedicine offers an easily accessible option. Both psychiatrists and therapists see patients virtually (check your insurance plan).  For more information on alcohol use, visit the National Institute on Alcohol Abuse and Alcoholism by clicking HERE. For more information on drug use/abuse, click HERE

For access to the full article, click HERE.

Tuesday, October 20, 2020

Sympathy vs. Empathy






Today's post was written by my current attending, Steven Berger, MD. He wrote it for the residents to discuss. Something to ponder. (Goodness I am blessed to work with such wonderful compassionate attendings!)


Sympathy vs Empathy

Sympathy means similar. It consists of being similar to another person. For example, at a funeral, you express sympathy and say things such as: "You must feel awful," "I’m sorry for your loss," or "I can’t imagine what it’s like for you to lose a child." In a funeral setting, you are saying that you are supportive of the person in his sadness and that you stand beside him in his time of need. A friend feels and expresses sympathy.

Empathy means same. It consists of having the same feelings as the other person and being one with the other person. As a psychiatrist, you are the authority of thoughts and feelings. With the patient, you identify the thoughts and feelings the patient is having. You bestow credibility and acceptability to the person’s thoughts and feeling. You endure those thoughts and feelings with the patient. You become one (same) with the patient in his thoughts and feelings. Instead of saying sympathetic things, you say empathic things, for example: "You feel awful," "The loss of your child is unfair," or "I know you feel unconsolably grieved. I will endure that inconsolable grief with you."

In being sympathetic, you act as a friend standing beside the person. In being empathic, you act as a holy spirit co-existing with the patient in his experiencing his thoughts and feelings. You experience the patient’s thoughts and feelings with him. You demonstrate to him that he is not alone, that you are with him, that you are bearing his burden with him, you are on his side to deal against his struggles with him. You are more than just a team with him. You are one with him.

As a psychiatrist, you side with the patient against whatever devils he is fighting. Instead of opposing the patient by saying, “Those voices you hear are not real”, you side with the patient by saying, “How are you and I (together) going to deal with those voices?”


Personally, one of my favorite pieces on the difference between empathy and sympathy is a short, two minute cartoon by Dr. Brene' Brown. I first saw it during medical school orientation at Wake Forest. The images from this short clip have stayed with me since. It's definitely worth watching (click HERE to view), but in a nutshell Dr. Brown proposes that empathy consists of four key steps:

1. Perspective Taking, or putting yourself in someone else's shoes.

2. Staying out of judgement and listening.

3. Recognizing emotion in another person that you have maybe felt before.

4. Communicating that you can recognize emotion.

A way to understand empathy is one that I carried with me throughout my active ordained ministry and still use today. When I express empathy towards another who is hurting (whether spiritually, physically, or mentally) I picture the person who is hurting in a deep dark well (kind of like the one in the Brown cartoon above). I picture myself empathetically entering the well with the person to sit with them in their pain, but I also always picture the rope that maintains a connection to the outside. I picture that rope tied securely outside the well, and I hold onto while in the well. If you as the helper/healer do not maintain the grounding lifeline, the way out of the well, you will both just be wallowing in the darkness.

Thank you Dr. Berger for the thought provoking writing!

Saturday, October 3, 2020

Is it time for the house church to re-emerge?

 




Is it time for the re-emergence of the house church in mainline denominations?

Despite not being able to worship in person during the COVID pandemic, I’ve really enjoyed attending different churches virtually—from the grandeur of Easter morning, morning prayer, and even a weekly Covid-19 memorial service at the Washington Cathedral (click here to visit), to the familiar faces at Sunday worship at my mom’s congregation, St. Peter’s Del Mar (click here to visit), to the memories sparked by Sunday services at my sponsoring parish, St. James Paso Robles (click here to visit)--all with out leaving my office.

I have loved this and applaud the creativity of these big and small worshipping communities to find new and innovative ways to proclaim God’s never ceasing love in a time when we need it so desperately. As my congregation in New Zealand used to say, “Good on ‘ya.”

As I’ve thought about where we are, and where we are going, I wonder if we might need to push ourselves even further outside of the mold of what we know. While these virtual experiences work, there will always be something missing from not being able to gather in person as a community. And after COVID is over (yes, that will happen one day) I worry about the financial state of congregations and their ability to continue to afford “church” the way we’ve always done it--aging buildings and full time, seminary trained clergy in a society with declining interest in mainline Christian denominations are all  concerns. My fear is that COVID has accelerated the unsustainable nature of our current model.  

I wonder if it is time to think about the house church again, and how the first models we have of the “ecclesia” might inform how we do church. The description of the house church appears multiple times in the bible (Corinthians 16:19, Philemon 1:2, Romans 16 to name a few). The practice in these house churches is best described in Acts 2:42-47, They devoted themselves to the apostles’ teaching and fellowship, to the breaking of bread and the prayers (NRSV).

What if we were to go to a model, maybe even just during COVID, where congregational hubs supplied materials and creative ideas for gathering that could occur in people’s homes with proper social distancing. These could be like the “learning pods” that are springing up for educating children. We could offer “worship pods” or “spiritual growth pods” that focus on authentic and relevant biblical teaching that is applicable to these very difficult times we are living through. These pods could be a way to safely be together, break bread safely, and support one another. And we could pray...

House churches could allow us to reclaim some of the best of the early church in a new, evolved way.