September 2020 - Promises Healthcare
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Alcohol Use Disorder Diagnosis & Treatment

Alcohol Use Disorder Diagnosis & Treatment

What comes to mind when someone mentions alcohol? For many, alcohol is often associated with the temporary avoidance of daily struggles. Whether or not we have the habit to drink, it is a known fact that people may tend to have “blackouts” whenever they’re really drunk – and are unable to recall anything during these periods of time. As for young adults, perhaps it could also be attributed to their keen desire to look “cool” and to show off their high alcohol tolerance to their friends. However, alcohol can be addictive, and frequent heavy drinkers run the risk of becoming alcohol-dependent and hence developing alcohol use disorders. But what actions can we take if we find ourselves constantly wanting to submit to such an altered state of being, and seeing the appeal in losing control of ourselves as a form of escapism?

 

What is an Alcohol Use Disorder?

According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; 

DSM–5; American Psychiatric Association, 2013), an alcohol use disorder is essentially characterised by “a problematic pattern of alcohol use leading to clinically significant impairment or distress as manifested by at least two of the following, occurring within a 12-month period”: 

  1. Alcohol is often taken in larger amounts or over a longer period than was intended.
  2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
  3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
  4. Craving, or a strong desire or urge to use alcohol.
  5. Recurrent alcohol use resulting in a failure to fulfil major role obligations at work, school, or home.
  6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
  7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
  8. Recurrent alcohol use in situations where it is physically dangerous.
  9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
  10. Tolerance.
  11. Withdrawal.

In regards to the disorder’s severity, it is safe to say that an individual categorised under the ‘mild severity’ category would display two to three of the above symptoms, while those under ‘Moderate’ would display four to five. For persons who develop six or more of such symptoms, they would, unfortunately, be diagnosed to be severely alcohol-dependent. 

In the development of alcohol abuse, we need to recognise that the physiological and psychological reward system in our brains are what contributes to the clouding of negative consequences and effects associated with alcohol dependence and addiction. In other words, the possibility for change is tough, and the learnt habit can be hard to kick. Positive and negative reinforcements play a major role, especially in the beginning stages of alcohol abuse. Positive reinforcement occurs when the chances of an individual performing an activity (in this case, drinking) is heightened due to his previous experience of feeling rewarded by the “high” he or she obtains when getting drunk. On the contrary, negative reinforcement occurs when the probability of alcohol-seeking behaviour increases upon allowing the drinker to avoid certain situations or negative stimuli. Therefore, it can be said that alcohol abuse is fuelled by the physiological and psychological reward system, thus increasing one’s motivation to consume more alcohol, though sometimes a little too much. 

Alcohol addiction can be greatly detrimental to our lifestyles, as well as to our physical and mental health. Known to be a depressant, alcohol can have a significant impact on our brain’s activity. If you’re drinking unhealthy levels of alcohol in an attempt to manage other mental health conditions such as anxiety or depression, stop it immediately! Alcohol affects neurotransmitters in your brain, potentially worsening your pre-existing condition. As such, it is crucial that we help people with alcohol use disorders to move past their addiction to a more fulfilling lifestyle. 

 

What forms of treatment can I consider?

Alcohol abuse can be treated with psychiatric or psychological intervention, sometimes a combination of both. 

When it comes to psychiatric medications, psychiatrists may prescribe medications used primarily to treat alcohol withdrawal by targeting the GABA neurotransmitters in the brain, allowing the brain to restore its natural balance when the person abstains from alcohol. Another common medication prescribed mainly affects the individual’s alcohol metabolism. The drug increases the concentration of acetaldehyde, a product formed when alcohol is broken down. The buildup of this acetaldehyde induces undesirable effects such as vomiting, hence holding the person back from consuming large amounts of alcohol. However, despite these drugs being the commonly prescribed medications, it is extremely dangerous for one to source and consume them without first consulting a professional psychiatrist. Everyone’s case is different, and people may have differing medication needs. 

Another form of treatment one can consider is Cognitive Behavioural Therapy (CBT). CBT is an effective method which focuses on helping one identify and uproot negative or irrational thoughts and/or behaviours. Being highly solution-focused, such forms of therapy can include trying to help these individuals to recognise situations in which they are inclined to drink, and how they can better repress themselves. As such, the main goal would be for these people to recognise their problematic behaviour, and subsequently cut down on and adhere to healthy alcohol consumption levels. Since the impact of alcohol abuse is usually not limited to the individual, family therapy may also be recommended at times, especially if the individual’s alcoholic behaviour causes others distress. 

All in all, alcoholism is not a matter to be taken lightly, as alcohol can certainly bring harm to both our physical and mental health if not consumed in moderation or at healthy levels. Do seek treatment immediately if you find that your alcohol-use patterns are interfering with your quality of life, or if you constantly find yourself craving higher doses each time.

 


References

1 DiClemente, C.C.. (2006). Addiction and change. How addictions develop and addicted people recover. New York, NY: The Guilford Press.

2 Gilpin, N.W., & Koob, G.F. (2008). Neurobiology of alcohol dependence. Focus on motivational mechanisms. Alcohol Research & Health, 32, 1850195. 

 

Drinking & Alcohol-Related Harm Among Young Adults Especially Since COVID Measures

Drinking & Alcohol-Related Harm Among Young Adults Especially Since COVID Measures

With economic growth and increased globalisation, alcohol consumption generally increases as it gets more affordable and popular as a drink for celebratory or social occasions, and even for stress-relief. This same trend has been observed in Singapore – where the per capita alcohol consumption in Singapore has nearly trebled from 2005 to 2015, and a study released in 2016 estimated the prevalence of binge drinking in Singapore to be 9.6 per cent of the population. Among young adults in the recent decade or so, the number of alcohol-related incidents including verbal abuse, physical abuse, domestic violence, as well as property damage and vandalism have also increased. According to the Institute of Mental Health, a nation-wide study in 2010 found that one in 19 of those aged 18 to 34 struggle with alcohol dependence, abuse and disorders. The study also highlighted that the chances of alcohol-use disorders in this age group were twice that of age groups above 35. In this article, we will thus explore why drinking is becoming more prevalent, and the types of alcohol-related harm that young adults are increasingly vulnerable to. 

 

For sure, individuals don’t become an alcohol addict overnight – they usually start with binge drinking, which is the worrying trend among young adults. Binge drinking is defined as the heavy consumption of alcohol within a short span of time with the intention of being inebriated. Binge drinking can be classified under mainly two categories: extensive drinking on a single occasion, or continuous drinking over days or weeks. It isn’t a rare sight to see youths gathering on a Friday night or weekends to go clubbing – places where most drinks have high alcohol content. Even with the COVID19 pandemic at present, young adults can still be seen to gather in small groups to drink and socialise. As a matter of fact, more people have turned to drinking in order to cope with the COVID19 situation. On a global scale, studies have shown that alcohol sales and consumption has risen. As an example, according to a recent study conducted by the USA Nielsen Company, there has been a 240% increase in internet alcohol sales, including hard liquor. Needless to say, it is not surprising that more Singaporeans would pick up drinking in order to cope with their unpleasant emotions and distress as well.

 

Frequent binge drinking may lead to alcohol dependence or addiction, especially when these individuals start consuming larger amounts of alcohol in order to obtain the same “high”. So why are more young adults exposed to alcohol drinking? Firstly, Singapore’s progress and prosperity have brought about lifestyle changes of youths and young adults compared to their parents’ generation. The increasing independence and thrill-seeking behaviours of these younger people might also include experimenting with alcohol. Secondly, globalisation has undermined many of the traditional controls on alcohol, making it widely available and aggressively marketed and promoted throughout society. 

 

People who begin drinking early in life run the risk of developing serious alcohol problems, including alcoholism, later in life. They also are at greater risk for a variety of adverse consequences and poor performance in school or at work. 

 

Overall, alcohol-related harm doesn’t merely include alcohol poisoning or eventual liver failure. Rather, it can also refer to:

  • Other related long-term diseases due to chronic heavy drinking
  • Unintended sexual behaviours, including sexual assault
  • Accidents such as those caused by drunk-driving
  • Suicide
  • Crime, including violent crimes and homicide

 

To reiterate, binge drinking can very well lead to alcoholism and it shouldn’t be taken too lightly. Identifying people at greatest risk can help stop problems before they develop. Young people are at greater risk of alcohol-related harm than adults. Excessive alcohol drinking as a teenager can greatly increase the risk of damage to the developing brain and also lead to problems with alcohol later in life. For those of you that find yourselves increasingly inclined to drink high amounts of alcohol, do consider taking proactive steps to reduce your intake. It may require strong willpower and determination initially, but things will be easier once you take the first step. Go for alcohol addiction treatment therapy or counselling,  if it can give you the push you need to counter your drinking habits, or connect with like-minded people through peer support groups such as Alcoholics Anonymous. By curbing and reducing your alcohol consumption to safe levels, you will be doing both your physical and mental health a favour.

 


References:

Dr. Barry L. Jackson, 2016, Drinking & Alcohol-Related Harm Among Young Adults, video recording, Mental Health Academy 

<https://www.mentalhealthacademy.co.uk/dashboard/catalogue/drinking-and-alcohol-related-harm-among-young-adults?start=true> (Accessed 13/08/2020)

https://www.straitstimes.com/singapore/alcohol-abuse-worse-among-younger-people (Accessed 13/08/2020)

https://www.imh.com.sg/wellness/page.aspx?id=1224 (Accessed 14/08/2020) 

Chodkiewicz J., Talarowska M., Miniszewska J., Nawrocka N. (2020) ‘Alcohol Consumption Reported during the COVID-19 Pandemic: The Initial Stage’, Int. J. Environ. Res. Public Health 2020, 17(13), 4677; https://doi.org/10.3390/ijerph17134677  (Accessed 22/08/2020)

Gaming Addiction: What It Is and How Can You Self-Regulate?

Gaming Addiction: What It Is and How Can You Self-Regulate?

Predictive algorithms, the creation of alternate realities in which we are unlimited by the constraints of the real world we live in – such methods are extensively practiced by the gaming industry to draw players in. Gaming is undeniably a popular and widely-adopted mode of de-stressing, but how much is too much?

In May 2019, the World Health Organisation officially recognised “gaming addiction” as a mental health condition. It is diagnosed when a person displays a gaming behaviour pattern that causes significant disruption to their daily life for a period of 12 months. Meanwhile, a study showed that Singaporeans aged 18 and above spend a weekly average of 7 hours and 26 minutes playing video games, and that approximately 10 percent of Singaporeans game for more than 20 hours per week. This ranks us as the highest in Asia, and third highest in the world, falling only behind Germany and the United States. 

What leads these addicted individuals to their compulsive gaming behaviour? Besides the prevalence and ease of access to games on various gaming platforms, video games often act as a form of escapism for many players. As a shining proponent of the alluring, edge-cutting virtuality, games allow for players to throw themselves into a virtual landscape that is contrasted from their – comparatively –  mundane everyday lives, and can serve as a distractor from real-life problems that they are unconfident or reluctant to face. Moreover, it can be easy to fall into the trap set by game creators. Game designers construct games in a way that applies principles of behavioural economics as well as psychological mechanisms to explore stages and levelling up processes that trigger the brain’s reward system. In-game statuses matter a lot to gamers – the higher the rank you possess, the more pride and self-esteem you hold, knowing that you can show it off to your friends or gaming counterparts. As a result, individuals are often inclined to continue striving to climb the virtual hierarchy. 

Naturally, excessive gaming has its consequences. When an individual develops a gaming disorder, his lifestyles can be disrupted in more ways than one. What is also important to take note of, is that the harmful effects of gaming addiction is not only limited to the individual alone, but could also affect the people in his or her social circle. Some of these adverse effects can include:

  • Obsessive Behaviour
    Individuals who are addicted to video games are always anxious to get back to games and will often display irritable, bad-temper aggressive behaviour whenever they are separated from their games unwillingly.
  • Increased Social Isolation
    With extended periods of intense gaming, these individuals become more withdrawn and disconnected from family, friends and colleagues, causing them to drift away from their loved ones.
  • Other Mental Health Conditions
    Gaming addiction can eventually lead to other issues that include depression or anxiety disorders. Sometimes, depression may follow due to the prolonged social isolation.
  • Other Physical Health Conditions
    A gaming addiction can also have a number of physical effects. When one devotes an excessive amount of time to the gaming activity, this can lead to physical conditions such as the carpal tunnel syndrome, migraine, back-aches or eye-strain. Extreme addiction may cause gamers to skip meals and rest, or neglect their personal hygiene as they lose control of themselves and can’t resist the desire to play more and more.

Gaming addiction is a serious matter, and can be degenerative if not addressed in the early stages with the initial symptoms and signs. Habits, including unhealthy gaming habits, can be formed anytime between 1 to 3 months, and it will be significantly easier to curb such self-destructive behaviour the earlier we try to tackle it. 

While we are concerned with the various health risks and conditions commonly associated with gaming addiction, we cannot deny that video games are also undoubtedly entertaining and can be a good way to de-stress. However, as the risk of gaming addiction increases with increasing time spent gaming, what we want to advocate is moderation, rather than complete avoidance. With that said, if you are someone who is battling gaming compulsion, try to keep the amount of time spent gaming under control by setting time limits for play and stick to them. If possible, try reducing your playtime gradually by setting a timer on your phone, or use softwares such as ‘Cold Turkey Blocker’ to help you do this by blocking access to websites or applications so that you can get offline when you need to.

Like other forms of addictions, don’t try to go cold turkey at one go. Stopping altogether may cause you to feel as though there is a huge void in your life, hence increasing the likelihood of a relapse instead.  

Facing your addiction alone can be a daunting and lonely experience. If it comforts you, try joining peer support groups or online communities where like-minded people are going through the same experiences. One example of a global online video game support community would be ‘Game Quitters’, a forum specially designed to help gaming addicts connect and support each other on their road towards a normal life. And of course, don’t be afraid to go for professional help for addiction treatment like counselling or psychotherapy (therapy) if things get tough. Choosing to struggle alone is never a sensible option. 

 


References: 

https://www.channelnewsasia.com/news/singapore/more-people-in-singapore-seeking-help-for-gaming-addiction-video-11974600 (Accessed 09/08/2020)

Photo by Patrik Larsson on Unsplash

What is Obsessive-Compulsive Disorder and When Do You Need Treatment?

What is Obsessive-Compulsive Disorder and When Do You Need Treatment?

Written by: Fred Chin, Psychologist

 

What is Obsessive-compulsive Disorder?

Think of the following scenario: you have friends over at your place and you serve them drinks. Before they can place their cups on your beautiful coffee table, you exclaim and dart out coasters underneath the ice-cold glasses before the first drop of dew can drip on that expensive rosewood. Your lightning-fast reflexes have intercepted what would have been a disaster. Your friends are startled at first, then they laugh and tease you. They say you have OCD – obsessive-compulsive disorder.

This, or a similar instance, may have happened at some point in our lives before. We tidy up a mess in the presence of others, or when our belongings are organised ever so neatly, and we end up joking about OCD.

But in truth, OCD is far from such behaviours that could be written off so light-heartedly.

A person with OCD will have compulsions – they feel the need to perform certain repeated behaviours to reduce emotional distress or to prevent undesirable consequences. These compulsions are so intense that they cannot carry out other daily routines without acting on them. Some common ones include:

  • Excessive washing or cleaning – They fear contamination and clean or wash themselves or their surroundings many times within a day.
  • Checking – They repeatedly check things associated with danger, such as ensuring the stove is turned off or the door is locked. They are obsessed with preventing a house fire or someone breaking in.
  • Hoarding or saving things – They fear that something bad will happen if they throw anything away, so they compulsively keep or hoard things, usually old newspapers or scraps of papers which they do not actually need or use.
  • Repeating actions – They repetitively engage in the same action many times, such as turning on and off a light switch or shaking their head a numerous number of times, up 20 to 30 times.
  • Counting and arranging – They are obsessed with order and symmetry, and have superstitions about certain numbers, colours, or arrangements, and seek to put things in a particular pattern, insisting to themselves that the layout must be symmetrical.

When Does OCD Become Chronic and What Should You Do If That Happens?

OCD is a chronic disorder, so it is an illness that one will have to deal with for the rest of his or her life. It is difficult to tell when the disorder becomes chronic, as it presents the individual with long-lasting waxing and waning symptoms. Although most with OCD are usually diagnosed by about age 19, it typically has an earlier age of onset in boys than in girls, but onset after age 35 does occur.

A cognitive model of OCD suggests that obsessions happen when we perceive aspects of our normal thoughts as threatening to ourselves or to others, and we feel responsible to prevent this threat from happening. These misperceptions often develop as a result of early childhood experiences. For example, a child may experience living in a dirty and dusty environment, while being subjected to some form of trauma at the same time. He associates a lack of hygiene with suffering from the trauma. At a later stage in life, he may start to feel threatened upon seeing the unhygienic behaviours of someone he lives with, be it his parents, romantic partner, or flatmates. This leads to the reinforcement of the association and to the development of his beliefs that suffering is inevitable when unhygienic conditions are present, giving him compulsions to improve these unsanitary conditions through washing and cleaning. 

If one is affected by OCD to the extent that he or she is unable to hold down a job and to manage household responsibilities, then there is a need for clinical treatment as the symptoms have become severe. Like in the above-mentioned example, recurrent and persistent thoughts of dirt will give the individual compulsions to neutralise these thoughts, resulting in repetitive washing, and checking behaviours. This causes distress and significantly affects one’s functioning.

When OCD has become a chronic illness, through a formulation of intervention strategies, the psychologist should extrapolate the client’s pattern of behaviour and expect a positive prognosis for functional improvement.

 

How Can OCD Be Treated?

A person diagnosed with OCD may seek treatment through a treatment plan that consists of cognitive strategies. These cognitive strategies involve consciously implementing sets of mental processes in order to control thought processes and content. Through these cognitive strategies, we can examine and restrict the thoughts and interpretations responsible for maintaining OCD symptoms. This is conducted in the initial stages of therapy.

Thereafter, Exposure Response Prevention (ERP) methods are carried out once a client is able to understand and utilise these cognitive strategies. ERP requires the client to list out their obsessive thoughts, identify the triggers that bring about their compulsions and obsessions and rate their levels of distress on each of these. Starting with a situation that causes mild or moderate distress, the client is exposed to their obsessive thoughts and simultaneously tries to resist, engaging in any identified behaviours that they have been using to neutralise these thoughts. The amount of anxiety is tracked each time the process is repeated. When anxiety levels for this particular situation eventually subside, over several repeated processes, and when they no longer feel significant distress over this situation, the same method is repeated for the next obsessive thought with the next level of distress.

A client who is able to demonstrate strength in coping with the symptoms has a better likelihood for sufficient recovery.

 

OCD is Becoming More Prevalent in Singapore: How has it Been Accepted in Society?

In recent years, OCD has topped the list of mental disorders in Singapore, with the greatest number of people experiencing it in 2018, compared with other mental illnesses.

The disorder has been found to be more prevalent among young adults than those aged 50 and above. In terms of socio-economic status, OCD is more likely to occur amongst those with a monthly household income of less than S$2,000 than those who earn above that amount.

It has also been found that the prevalence of people experiencing OCD at least once in their lifetime is higher in Singapore than in South Korea, Australia and New Zealand.

In addition to becoming more prevalent, people who experience OCD are also becoming increasingly reluctant to seek psychiatric help or counselling, making matters worse. There is some acceptance of the condition as normal and trivial by society, because people who do not understand the disorder well enough misconceive OCD as a quality of being clean and tidy, as being clean and tidy is usually seen as a good thing. This misconstrual by society is dangerous for the undiagnosed, and their condition will further deteriorate if they continue to put off addressing their disorder.

The disorder will get worse if treatment is ignored, and there is a need to realise it in its early stages through observing how one’s life is being disrupted. Awareness about its onset of symptoms is important.

Do seek out a psychiatrist,  psychologist, psychotherapist (therapist) or counsellor to get professional help for a better recovery journey. Early intervention is crucial to prevent escalation of the condition.

 


reference(s)

https://www.todayonline.com/singapore/mental-illness-more-prevalent-among-young-adults-ocd-one-of-top-disorders-spore

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Psychological Testing (Part 1)

Psychological Testing (Part 1)

Written by: S C Anbarasu, Senior Clinical Psychologist

Psychological evaluation is often helpful in understanding the strengths and challenges an individual may have in their cognitive, behavioural, learning and socio-emotional functioning. 

At Promises Healthcare, we believe that “one size fits all” is not an approach that is applicable to the treatment of psychological disorders and challenges. We provide tailored recommendations for parents, teachers, and therapists so that interventions and accommodations allow each child to reach their potential.

IQ and academic testings can provide important information about a child’s cognitive strengths and weaknesses, academic needs, and preferred learning style. These can assist parents and children in making educational choices and implementing strategies to ensure that the child’s learning is appropriately supported. 

Specific reasons for testing include:

  • Learning difficulties or delays (e.g. difficulties with spelling, writing, maths and/or reading)
  • Giftedness
  • Underachievement
  • Emotional and/or behavioural problems presenting in the classroom and/or at home
  • Admission to special educational programs
  • Increasing understanding of a child’s learning style
  • Concerns regarding possible attentional difficulties

 

What is IQ testing?

Intelligence testing is a method used by psychologists to measure a child’s intellectual capabilities. Intellectual assessment is a good indicator of a child’s potential. We use the Wechsler Intelligence Scale for Children, fifth edition (WISC- V). This is an individually administered instrument for assessing the cognitive ability of children aged 6 years to 16 years.

The WISC V is one of the most reliable and valid IQ testing instruments available and is the most widely used measure of IQ. The WISC V provided scores that represent intellectual functioning in four specified cognitive domains: Verbal Comprehension, Perceptual Reasoning, Processing Speed and Working memory.  During the testing session, a child is asked to solve problems and puzzles and to answer a range of questions. Generally, most children enjoy the testing session as it is an engaging process involving novel and fun tasks. Should parents have worries about their child’s emotional wellbeing during the assessment, raise it with us and, we can explore a workable collaborative plan to support you and your child during the testing process.

 

What is Academic Testing?

Academic Testing provided an overview of a child’s current performance across a range of academic domains. We use the Wechsler Individual Achievement Test (WIAT-III) with subtests including:

  • Oral Expression
  • Listening Comprehension
  • Written Expression
  • Spelling
  • Pseudoword Decoding
  • Word Reading
  • Reading Comprehension
  • Numerical Operations
  • Maths Reasoning

The assessment provides a rich source of information about a child’s achievement skills. Information obtained can then be utilized for intervention decisions. 

 

The Assessment Process

The assessment is conducted in several stages:

  • An initial assessment with parent(s) is an integral part of our assessment procedure.
  • A time is set to administer the WISC 5 and the WIAT-III and other relevant tests. Usually, you may have to set aside about two or more sessions for approximately 6 to 12 hrs (excluding initial consult session) for testing, depending on the capacity and the needs of the child/person. Spacing out testing over several days can help some children overcome fatigue and stress. 
  • A comprehensive written report will be prepared after all the testings are completed, based on the outcome of the assessment and testing process. The report will highlight relative areas of strengths and difficulties, with recommendations for home and school settings. 
  • A feedback session will be provided to parents after the completion of the report. During this session, parents can be given an opportunity to clarify and discuss any concerns regarding the report. 

 

Fees for assessments

  • The Psychologist conducting the tests will inform parents of the charges involved during the initial consultation session, based on the needs of the child/person and the different tests required. 

 

Payment Plans

  • Payment plans are available for our testing procedures. Clients may choose to pay the full amount for testing at the end of the initial consultation or they may elect to pay in two payments. Like most of the private practices, reports will not be released prior to receipt of full payment. 

 

Referrals/ For Information

Please do not hesitate to speak to our friendly reception staff at +65) 6397 7309 , if you wish to make an initial appointment. Alternatively, should you wish to clarify matters with me personally, you can leave your name and contact details with the reception or e-mail me at anba@promises.com.sg .

 


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