Vol. 12, No. 5
Welcome to all the new readers of Tips and Topics and to all our longtime readers as well. Thanks for joining us for the August edition.
David Mee-Lee M.D.
I recently was in a rush and jumped in the car to get to an appointment. Once on the road, I reached down to my cell phone belt holder and realized I had left my cellphone on my desk at home. I noticed a little twinge of panic…..somewhat like when you suddenly realize your wallet, with all your money and credit cards, is not in your pocket. Have I dropped it? Did I leave it on the store counter?
But this is just my mobile phone. I know where it is. If I miss a call or a text, my voice mail and the message will still be there. So no big issue…right? Well it is worth taking a look at your own reactions if you find yourselves without your mobile device or smartphone. Or, even if you have it with you, what is your usual behavior?
- Can you sit alone at a restaurant, bus stop or airport departure gate without picking up your phone to check messages or email?
- For that matter, can you sit anywhere even with friends, partners and loved ones and not look at your phone’s screen?
- Even if you don’t look at your phone, look around. Observe how many people have heads down, fingers tappingthe little screens on the device cupped in their hand.
A group of young, passionate, mission-driven young adults has recently been challenging the relationship we have with our digital devices. Take a look at what “digital detox” is all about at http://thedigitaldetox.org. They’ve been getting a lot of attention in the mainstream press. There’s a shift in the culture…a little shift. They don’t just blog about it; they’ve been introducing people to the experience of digital detox at what they call Camp Grounded (and other such device-free events.) Take a look at http://blog.thedigitaldetox.org/camp-grounded-official-video/
By the way, catch a glimpse of my son, Taylor in the box titled “Talent Show. ” It is one of a collage of images halfway down the page, with the main title- “CAMP GROUNDED IS.” At Camp, he leads singing, songwriting and a capella groups (proud father speaking).
What’s So Bad About Being Alone With Your Thoughts?
This is the title of a July 11, 2014, segment on Public Radio International’s Science Friday radio program. “Researchers at the University of Virginia were recently amazed to discover that many people would rather self-administer painful shocks than sit quietly with their own thoughts for 15 minutes. They also found that men were significantly more likely to shock themselves than women. So what’s so bad about sitting alone and thinking? One of the study authors, Erin Westgate, talked about a fascinating experiment you can hear more about at:
It is worth the 10 minutes to listen to. If you don’t have the time right now, here are a few excerpts from that program and other news items about this study:
Excerpts and Tidbits
In the year 1654, scientist and philosopher Blaise Pascal said “All of humanities problems stem from man’s inability to sit quietly in a room alone.” This age long premise was tested in experiments that were published in the journal Science. Here is the Abstract of that published paper:
“In 11 studies, we found that participants typically did not enjoy spending 6 to 15 minutes in a room by themselves with nothing to do but think, that they enjoyed doing mundane external activities much more, and that many preferred to administer electric shocks to themselves instead of being left alone with their thoughts. Most people seem to prefer to be doing something rather than nothing, even if that something is negative.”
“Now the big question is, ‘Why would someone do this?’” Erin says. “Why is it so hard to entertain ourselves with our thoughts that we’re willing to turn to almost anything, it seems, to avoid it?”
College Students in a study
Studies at universities often start with college students. College volunteers were asked to sit alone in a bare laboratory room and spend six to 15 minutes doing nothing but thinking or daydreaming. They were not allowed to have a cellphone, music player, reading material or writing implements and were asked to remain in their seats and stay awake. Most reported they did not enjoy the task and found it hard to concentrate.
The researchers experimented to see if the student volunteers would even do an unpleasant task rather than just sit and think:
- In one of the studies they offered students a chance to rate various stimuli:ranging from seeing attractive photographs to the feeling of being given an electric shock about as strong as one that might come from dragging one’s feet on a carpet.
- After the participants felt the shock (which Westgate described as a mild shock of the intensity of static electricity) some even said they would prefer to pay $5 rather than feel it again.
- Volunteers were asked whether, if given $5, they would spend some of it to avoid getting shocked again. The ones who said they would be willing to pay to avoid another shock became a subject in the experiment.
- Each subject went into a room for 15 minutes of thinking time alone. They were told they had the opportunity to shock themselves, if desired, by simply pushing a button.
College Students- The Results
- Two-thirds of the male subjects — 12 out of 18 — gave themselves at least one shock while they were alone.
- Most of the men shocked themselves between one and four times. However, one “outlier” shocked himself 190 times.
- A quarter of the women, six out of 24, decided to shock themselves, each between one and nine times.
- All of those who shocked themselves had previously said they would have paid to avoid it.
Next: Different subjects- not college students
The researchers wondered: were the young college subjects just overly fidgety, not being allowed to tweet or text or check their e-mail? So they reached out to the wider community for non-college volunteers. New subjects ranged in age from 18 -77, recruited from a church and farmers’ market.
- Researchers asked them to sit alone in an unadorned room in their home – without the shock, since “we weren’t there to supervise them.” They were asked to do the same thing: just sit there at a time of their own choosing, with no mobile phone, reading or writing materials. They were to report back on what it was like to entertain themselves with their thoughts for between six and 15 minutes. The researchers got pretty much the same results.
“These were adults,far past college age,” Westgate says, “and again they were terrible at it!”
- 57percent found it hard to concentrate; 89 percent said their minds wandered.
- Over half of the participants confessed to cheating. They weren’t supposed to get on their phones or talk to other people, but over half said they had. “And those were just the ones who were honest with us,” Westgate says.
- About half found the experience was unpleasant.
Thoughts from the researchers- Westgate & Wilson
Erin Westgate said she is still astounded by those findings.
“I think we just vastly underestimated both how hard it is to purposely engage in pleasant thoughts and how strongly we desire external stimulation from the world around us, even when that stimulation is actively unpleasant.”
She added that the research showed, by and large, that people prefer some positive stimulation, like reading a book or playing a video game.
“Many people find it difficult to use their own minds to entertain themselves, at least when asked to do it on the spot,” said University of Virginia psychology professor Timothy Wilson, who led the study. “In this modern age, with all the gadgets we have, people seem to fill up every moment with some external activity.”
“I think they just wanted to shock themselves out of the boredom,” Wilson said. “Sometimes negative stimulation is preferable to no stimulation.”
Whether the effects seen in the experiment are a product of today’s digital culture or not is a matter of debate.
So try this experiment at home!
All you need is a timer and an empty room. Tell your friends and loved ones how you did. You could lie (if you want) that you sat perfectly calm and serenely.
Timothy D. Wilson, David A. Reinhard, Erin C. Westgate, Daniel T. Gilbert, Nicole Ellerbeck, Cheryl Hahn, Casey L. Brown, Adi Shaked: “Just think: The challenges of the disengaged mind” Science 4 July 2014: Vol. 345 no. 6192 pp. 75-77
SKILLS & STUMP THE SHRINK
Here is a combined Stump the Shrink question and Skills section this month.
Kurt Snyder, Executive Director of Heartview Foundation in Bismarck, North Dakota asked about treatment planning and The ASAM Criteria assessment dimensions.
“We are wanting to list random drug and alcohol screens as a method and strategy on the treatment plan. Our treatment plans are organized using the structure of the ASAM Criteria six Dimensions. We develop goals and objectives for the high severity dimensions. So as people progress through treatment the severity risk scores tend to fall in Dimensions 1, 2, and 3. Would you suggest we list the random tests in Dimension 1 or Dimension 5?”
Now for readers unfamiliar with The ASAM Criteria six assessment dimensions, here is a brief overview (The ASAM Criteria 2013, pp 43-53):
Assessment and Treatment Planning Focus
|1. Acute Intoxication and/or Withdrawal Potential
|Assessment for intoxication and/or withdrawal management. Withdrawal management in a variety of levels of care and preparation for continued addiction services
2. Biomedical Conditions and Complications
|Assess and treat co-occurring physical health conditions or complications. Treatment provided within the level of care or through coordination of physical health services
|3. Emotional, Behavioral or Cognitive Conditions and Complications||Assess and treat co-occurring diagnostic or sub-diagnostic mental health conditions or complications. Treatment provided within the level of care or through coordination of mental health services
4. Readiness to Change
|Assess stage of readiness to change. If not ready to commit to full recovery, engage into treatment using motivational enhancement strategies. If ready for recovery, consolidate and expand action for change
5. Relapse, Continued Use or Continued Problem Potential
|Assess readiness for relapse prevention services and teach where appropriate. If still at early stages of change, focus on raising consciousness of consequences of continued use or problems with motivational strategies.
6. Recovery Environment
|Assess need for specific individualized family or significant other, housing, financial, vocational, educational, legal, transportation, childcare services|
You can obtain a great working knowledge of The ASAM Criteria dimensions by doing the eTraining module for continuing credit “Multidimensional Assessment”. See http://www.ASAMcriteria.org and click on Resources & Training.
Determine why the drug and alcohol testing is needed. Then decide which ASAM Criteria dimension the random testing strategy relates to.
As regards your question, Kurt: Let’s look at all the possibilities when random drug and alcohol testing might be used.
Dimension 1, Acute Intoxication and/or Withdrawal Potential
If you want to verify what drugs a person may be intoxicated with, or go into withdrawal from, then the random testing would be under Dimension 1.
If you want to be sure a client is taking their maintenance medication to prevent going into withdrawal (methadone or buprenorphine), then random testing can check and monitor that. These are 2 examples of Dimension 1 strategies.
Dimension 2, Biomedical Conditions and Complications
Perhaps you have concerns about the drug interaction with a client’s physical health medications- e.g. drinking while taking anti-hypertensive or diabetes medication. Or you have concern about a person using heroin while also on chronic pain narcotics. This would put the random testing under Dimension 2.
Dimension 3, Emotional, Behavioral or Cognitive Conditions and Complications
As with Dimension 2, you might have concerns with the person drinking and drugging along with their psychotropic medication. In assessing whether a patient’s psychosis or depression is substance-induced, random testing would be a diagnostic strategy under Dimension 3.
Dimension 4, Readiness to Change
Clients will often say: “I can stop anytime, I don’t have an addiction problem.” In trying to engage the person, you might try a motivational “Discovery” plan. Such an approach would have the client try the “I can stop any time” plan. Random testing would track and monitor the client’s success or not.
Dimension 5, Relapse, Continued Use or Continued Problem Potential
In a Relapse Prevention plan, random testing would track how well a person’s coping skills are working. Are they maintaining abstinence or not?
Dimension 6, Recovery Environment
The Department of Transportation (DOT) and other employers require everyone to be drug-free. Random testing in this situation would be a Dimension 6 example.
Perhaps someone is enrolled in a Drug Court program where random testing is part of the Court expectations.
Some parents have children who are playing high-level sports with costly equipment and travel expenses. As a condition for ongoing financial and emotional support, they require their child to be drug-free. Using random home-testing kits would be another Dimension 6 example. This is the same expectation as in professional and college sports.
So drug and alcohol screening has many purposes. It is a lab test to help track the effectiveness of treatment. It is not a “gotcha” spying activity as part of an adversarial relationship based on mistrust and suspicion.
What a tragedy that Robin Williams is dead. This month he killed himself in his home about two hours from my home. It is a grim reminder that celebrities, so talented and creative, are nevertheless people who can suffer the same addiction and mental health problems, of which we are all vulnerable. But their very celebrity status can be a curse, aggravating their vulnerabilities and even inhibiting reaching out for help.
I have gotten a glimpse of how celebrity can be a blessing and a curse, not because I consider myself a celebrity, but because I travel a lot. I have been on planes for over 18 years due to my full-time training and consulting work.
Here’s what I get just because I travel a lot:
- Priority boarding at the front of the line because I am approaching 3 million lifetime miles on United Airlines. I have flown over 100,000 miles every year with them for 20 years.
- Free upgrades to first class domestically and business class internationally – oh it is such a let down to be on another airline and be up the back with all the “common” people! (LOL)
- Even the Transportation Security Administration (TSA) often lets me skip the long lines and zip through TSA PreCheck. I can keep my shoes, belt and coat on and just show them my computer, wallet and cellphone. No stripping down and going through those big fancy security machines.
- When I hit 2 million miles with United Airlines, I received an engraved 160 gigabyte Apple iPod and lifetime membership in the United Clubs at airports around the world. I wonder what I’ll get when I hit 3 million miles next year….a new BMW car?
- On some trips, the pilot has even come to greet me by name. On occasion I have received a personalized note from the pilot thanking me for my loyalty. All I’ve done is buy airline tickets, not entertained millions of people like Robin Williams.
Anyway, you get the picture.
The problem with all this ‘special treatment’ is it’s easy to start thinking you arespecial and deserve this all the time. You can see why celebrities start acting like entitled celebrities. (My wife quickly reminds me I am not a celebrity, so there isn’t too much danger.)
This is so insidious for real celebrities who are always in the public eye, with fans and swooning groupies paying homage to them. And their money can buy almost any material desire or best seat in the restaurant……
Reality starts to become very distorted. So have some sympathy for celebrities. For many it is a curse that can kill you. Who knows, for Robin Williams, it just may have.
Until next time
I’m glad you could join us this month. See you in late September.