February 2021 - Promises Healthcare
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Breaking Free from the Tentacles of Addiction as a Family Unit

Breaking Free from the Tentacles of Addiction as a Family Unit

Written by: Julianna Pang

Confronting the problem of addiction is almost always daunting and exhausting. The layers of complexities increase tenfold when the family system is also trying to preserve its stability and normal functioning despite the disruptions that addiction brings.

Family members are often exasperated that the usual admonishments of “how could you do this to…?”, “why can’t you see that you are hurting…?” or “how long do you think you can keep doing this…?” seem to bounce off the walls.  No amount of shaming, guilt-laying or threats seems to wake the affected person up to see the realities of the wreckage that has been inflicted on the family.

What is Addiction?

Fundamentally, this approach does not work due to a miscomprehension of what addiction is. Addiction is neither a moral issue nor is it a flawed character problem which can be corrected.

According to the American Society of Addiction Medicine:

“Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviours that become compulsive and often continue despite harmful consequences.”

Addiction is a disease.  As a family member, it is important to recognise that “you did not cause the disease, you cannot cure it and you cannot control the outcome of the disease”.   The person affected needs to learn to manage their own recovery and family members need to learn effective responses towards the affected person to support the recovery of the family system.

Recovery is a life-long process that may and often include a series of relapses both on the part of the individual and on the family system.

How Does One Know When Addiction Strikes?

Symptoms of addiction are manifested by:

  • Compulsion – an absolute and overpowering urge towards substance use or behaviour.
  • Craving – an increase in usage and/or frequency to a point of necessity for survival.
  • Control – loss of ability to manage manner of use, to reduce or to stop.
  • Consequences – the use or behaviour continues despite relationship, work, school, legal and money problems.
How can Family Members get the Affected Person into Treatment?

The first step to bringing the affected person towards professional help can either motivate or unsettle the recovery process.

As professional therapists working in this field, we witnessed many instances where one of the first steps by family members would be to call the authorities.  This is a painful first step that often inflicts hurt on both the affected person and the family member.  The outcome could turn out to be a sharp wedge between family members which may take a long time for repair and reconciliation. Many a time, the affected person may attempt to run and hide, taking them even further away from the treatment help that they need.

The next most common first step is an intervention. This is a meeting convened to confront the person affected and interventionists may include family members, close friends and/or religious leaders.  Each member shares with the person about their observations of specific negative behaviours and how these behaviours have affected them.  The group then presents options to the target person and encourage the entry into rehab immediately.

An intervention is a double-edged sword. When done well, members expressed their love and care for the target person, while maintaining an uncompromising position about the person’s problem with addiction and need for treatment.  When executed poorly, the target person receives a shock and feels a deep sense of betrayal from the group. The feelings of bitterness and resentment towards the whole intervention experience wipe out the initial good intentions. This, in turn, makes for poor motivation to accept and adhere to treatment. Trust towards the family system is broken which would likely take a long time to mend.

A 3rd strategy is known as CRAFT – which advocates for positive communication, positive reinforcement and allowing for natural consequences to happen. This approach takes a longer time to implement and focus on identifying actions by the affected person which are helpful towards recovery, expressing empathy towards the person’s suffering and offering to work with the person to find a solution.  An example of positive reinforcement could be to engage the person in activities within the family system that the person still values. The 3rd aspect is counter-intuitive; to allow the person to bear the natural consequences of their actions, instead of covering up for them or trying to make everything “all right”.  In so doing, the realities of the consequences of the addiction is experienced fully by the affected person which can create the turning point to seek treatment.

Is the Family’s Job Done When They Ship Off the Affected Person?

Addiction is a life-long recovery process and parallel to the individual’s recovery is the family system’s rebalancing process.

In broad terms, the individual’s stages of recovery are as follows:

  • Withdrawal – Detoxing
  • Honeymoon – Addiction Stops
  • The Wall – Protracted Abstinence
  • Adjustment – Working through Underlying Issues
  • Resolution – Acceptance of lifelong Abstinence
What is the Parallel Journey for the Family System?
Pre-treatment and Withdrawal

At the initial stage, the affected person will test the limits of the system by engineering and re-engineering their way to get to their addiction.  A person in active addiction is usually not rational, nor are they conscious of the effect of their actions on others.  There may be many false promises made in order to get to the addiction or manipulation of family system dynamics to garner support for their continued addiction.

Here are a few pointers that family members can keep in mind at this stage:

  • Get an Accurate Understanding of Addiction.
  • Create Unison in the Family Approach.
  • Relinquish Control of Outcome of Addiction.
  • Self-Care and Emotional Coping for Shame, Anger and Blame.
  • Learn How to set and Communicate Boundaries.
  • Find Family Support Groups to Brainstorm Strategies – Link to Visions Programme.
Honeymoon

During this stage, the affected person would have stopped the active addiction. The person reverts to their pre-addiction persona that the family was used to and readily embraced.  There is a delusion that all is victorious, and the person is cured.  Some people would even deny that there was ever an addiction in the first place.  Family members and individual alike start to make wonderful plans for a new future, unaware of the undercurrent of the recovering person’s vulnerabilities to triggers, anxieties, and relapses.

Here are a few pointers that family members can keep in mind at this stage:

  • Maintain Boundaries.
  • Adjust Family Life to Reduce Triggers.
  • Rebuild Trust and Learn To Discern Through Observations.
  • Learn About Adjustment Process and Strategies with Other Families – Link to Visions Programme.
The Wall

By the time the recovering person reaches this stage, his/her body is trying very hard to stabilise and find its new baseline. The struggle without their past go-to coping mechanism manifests in depression, irritability, and inability to find pleasure in the usual activities.   Family members may take things personally when their overtures to reintegrate the person into their lives are rejected. Some family members may start to prefer the “happy” person who was previously addicted or start being highly suspicious that the person has relapsed.

Here are a few pointers that family members can keep in mind at this stage:

  • Maintain Unison in The Family Approach.
  • Learn Emotional Coping to Rejection, Anxieties and Tolerance for Uncertainty.
  • Share and Validate Family Experiences with Other Families – Link to Visions Programme.
Adjustment

When the recovery process reaches this stage, both the individual and the family have crossed some major milestones (It is typical that some 6 months would have passed from the start of journey.).  The most daunting challenges are now bubbling up in the horizon.  Family relationships, lifestyles and values may be examined at a fundamental level and permanent changes may need to be made for recovery to be sustainable over the long haul.  Past hurt and traumatic experiences would need to be resolved for both individual and family to move forward to a new way of interaction.

Here are a few pointers that family members can keep in mind at this stage:

  • Commit to Family Approach Without Complacency.
  • Address the Emotional Well-Being of Other Neglected Members.
  • Learn Emotional Coping on Forgiveness, Grieving, Acceptance and Letting Go.
  • Learn Goal Setting and Strategies to Create a New Family Life Experience with Other Families – Link to Visions Programme.
Resolution

The last stage is not a phase per-se but a continual process for the lifetime of the individual and for the family system that has learnt and grown alongside him/her.  The individual is practicing commitment to his/her sober life free from addiction every single day.  The family system has likely been permanently transformed by the recovery process and is now reintegrating the member into its new dynamics.

Here are a few pointers that family members can keep in mind at this stage:

  • Embrace the New Family System, Lifestyle, Values and Norms.
  • Celebrate Successes and All Learning Experiences as A Family Unit.
  • Offer to Be a Supportive Family System to Other Families – Link to Visions Programme.
Visions of Recovery

This article is not intended to be exhaustive in addressing all aspects of family system disruptions when addiction strikes.  Working with professional therapists at any point along the recovery pathway helps manage the diverse challenges and provide a sounding board to create more effective strategies.  The emotional and structural resilience of the family system and its members ultimately creates the critical strength to sustain all members in this marathon towards sobriety.

Write to visions@promises.com.sg to get in touch with an addictions specialist or for more resources and information, click on the relevant links:

 


  1. Asam.org. 2021. ASAM Definition of Addiction. Available at: https://www.asam.org/Quality-Science/definition-of-addiction
  2. Brown, R., Brown, M. and Brown, P., 2014. Families and addiction. Create Space Independent Publishing Platform. USA.

  3. This is notwithstanding a citizen’s duty to alert authorities in times of criminal activity. It is a consideration of how the process can be better executed.

  4. Hilary S. Connery. and Thomas F. Harrison., n.d. The Complete Family Guide to Addiction: Everything You Need to Know Now to Help Your Loved One and Yourself. The Guilford Press. London.

  5. Hilary S. Connery. and Thomas F. Harrison., n.d. The Complete Family Guide to Addiction: Everything You Need to Know Now to Help Your Loved One and Yourself. The Guilford Press. London.

  6. The exception to the rule is where the person is unsafe or at risk of seriously hurting themselves.

  7. Brown, R., Brown, M. and Brown, P., 2014. Families and addiction. Create Space Independent Publishing Platform. USA.

The Power of Happiness

The Power of Happiness

A sad soul can kill you quicker, far quicker, than a germ,” John Steinbeck, an American author, once wrote. True enough, regardless of the stage of life we’re in, everyone strives to seek gratification and success – and to many, that is what makes life worth living for. People often perceive happiness as the achievement of certain materialistic accomplishments (such as a nice house, a big salary, career advancement, etc). Work hard, become successful, earn lots of money, then you’ll be happy. At least, that’s how most of us think about happiness, with such a notion instilled upon us from young. Indeed, these achievements can make us feel great and happy at first, but the thrill often doesn’t last very long. The good news, however, is that researchers in the field of positive psychology have found that we can genuinely increase our happiness and overall satisfaction with life, and all that it takes is just an inner change of perspective and attitude. Happiness shouldn’t be seen as an end goal or a destination, but rather as a continuing practice. 

Importance of being happy in the workplace

According to studies conducted, researchers posit that happiness can in fact precede success, thereby highlighting its desirability. At the workplace, the optimism showcased by happy people often translates into increased self-confidence, as well as better task performance. Especially in the case of business transactions, happy people are more likely to make negotiations palatable and successful, as compared to their unhappy counterparts. In a sense, positive emotions brought to the table may just be the spoonful of sugar needed to nudge them towards mutually beneficial solutions and concessions. 

A person with a high positive affect is more likely to be associated with additional desirable traits as well. Subconsciously, people around him (both colleagues and superiors) may endow him with traits such as stronger job performance and social skills, since he already possesses a socially desirable trait (i.e happiness). In other words, a halo effect is created, where a favourable impression in one area influences opinion in another area. Happy people are also known to be more productive. They are less likely to skip work habitually, procrastinate or shirk their responsibilities. Due to this, happy people are likely to receive more encouraging peer and supervisor evaluations, hence further increasing their chances of success. 

In reality, the pressures of contemporary society can be enormous, and therefore it is completely understandable that the average person is inclined to live life in a mere “survival mode”. As with many other notions, there is no universal prescription for attaining total, authentic happiness. However, there are certain things we can take note of to make us happier. 

Social relationships 

One of the most important things that matters in life is relationships. Human beings are inherently social creatures, and forming deep meaningful connections with the people around us can greatly fulfil our basic need for belonging and social intimacy. Investing sufficient time and energy with family members, friends and romantic partners can hence be a central component of finding happiness. However, we also need to pay attention to the type of friendships we form. Finding the right birds to flock with can also be a stepping stone towards a greater sense of happiness. How we look for happiness may depend on where we look for it – and the key lies in surrounding yourself with happy people. Some of us may be biologically predisposed or prone to depression, but that doesn’t necessarily mean that you are predestined to a life of negativity. Akin to how one’s bad mood may rub off on another, one’s sunny disposition can be contagious too. The emotional closeness you feel with these happy people and the effect it has on you has a positive correlation. Social contagion allows for positive emotions to pulse through social networks – just like a chain reaction – and interacting with happy people often will greatly boost your sense of well-being. 

Positive thinking

Our next tip may come off as rather cliché, but we cannot stress this enough. One of the most important steps to attaining happiness is to count your blessings and to express gratitude. Many a time, individuals would be left with feelings of dissatisfaction and wanting more, even after they have achieved their goals. However, regardless of how small your achievements may seem compared to others, it is essential that you remember to thank yourself for the effort you put in and for what you have. Express your gratitude to the people around you who have been ever so supportive, and while you make their day, you’ll make yours too.

Do good, feel good

Have you ever noticed that when you do something good, you feel happy? Studies have shown that helping others, along with other types of social interaction, is associated with positive mental  outcomes. To start small, you might want to offer help around the house, or to help your friends whenever you deem fit. Why would helping make you happy? It would seem that trading favours are important innate adaptive goals. By helping others, happiness is the psychological reward obtained upon the successful solving of an adaptive problem. Performing such acts of kindness  – even to strangers – boosts happiness and well-being. Increasing happiness all around you would undoubtedly make you a happier individual, and such a virtuous cycle is worth fostering.

By increasing your long-term happiness, you’ll find yourself achieving success with greater ease. A note of caution though, is to remember that this doesn’t mean avoiding negative emotions that may arise throughout your life. Happiness and inner peace can come from embracing the bad, and tackling any negative emotions head on. Whenever you find yourself struggling, don’t be afraid to turn to your support networks or a mental health professional. 


References:

  1. Walsh LC, Boehm JK, Lyubomirsky S., Does Happiness Promote Career Success? Revisiting the Evidence. Journal of Career Assessment. 2018;26(2):199-219. doi:10.1177/1069072717751441 (Accessed 03/01/2020)
  2. https://www.businessinsider.com/happiness-doesnt-follow-success-its-the-other-way-2019-5 (Accessed 03/01/2020)
  3. https://hms.harvard.edu/magazine/science-emotion/contagion-happiness (Accessed 03/01/2020)
  4. Oliver Scott Curry, Lee A. Rowland, Caspar J. Van Lissa, Sally Zlotowitz, John McAlaney, Harvey Whitehouse., Happy to help? A systematic review and meta-analysis of the effects of performing acts of kindness on the well-being of the actor, Journal of Experimental Social Psychology, Volume 76, 2018, Pages 320-329,ISSN 0022-1031, https://doi.org/10.1016/j.jesp.2018.02.014. (Accessed 03/01/2020)

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Working From Home (WFH) aka Remote Working : How can managers get ahead of it

Working From Home (WFH) aka Remote Working : How can managers get ahead of it

Written by: Fred Chin, Psychologist

In times of the current Covid-19 pandemic, “Working from Home”, otherwise abbreviated to “WFH”, has become a term so synonymous with our new working lifestyle that it has recently been included in the expanded list for Oxford Word of the Year, as 2020 comes to an end.

This switch in the working arrangement, from being physically present at the workplace to carry out tasks from one’s home has been brought forth by the pandemic, as precautionary measures to prevent the coronavirus from spreading.

However, prior to the pandemic, remote working as a working arrangement has already existed. It has only been because of the recent pandemic that this has become normalised and more popular and that the majority of people are now aware that carrying out work from the comfort of one’s home is actually possible. However, the situation has also shed light on the detrimental effects remote working has on one’s wellbeing.

What Really is Remote Working?  

Remote working may be described as a working arrangement where employees are not physically present at the workplace, or as one where employees work flexibly such that they do so both from the home and the workplace. This flexible work arrangement is considered desirable and is even encouraged by the Ministry of Manpower to be adopted by companies. Although it might seem that having a flexible working arrangement is a recent practice evolving from the current pandemic, it has existed since 1967, where German employees were the first in some companies to choose their starting and knock-off timings to work. Not long after, the Swiss adopted this practice to appeal to women with family responsibilities. Flexible working arrangements were therefore introduced for the purpose of accommodating to the needs of the employees while still maintaining productivity, which today has become more of a necessity in these times of a pandemic.

Working from home is an approach to organising work that aims to drive greater efficiency and effectiveness in achieving job outcomes through a combination of flexibility, autonomy and collaboration, in parallel with optimizing tools and working environments for employees (CIPD, 2017). For many of us, this may seem to be the perfect way to work – we allow ourselves maximum flexibility, convenience, autonomy, trust, and empowerment. However, to others, especially the many who cannot get used to it and were forced into this arrangement, they experience feelings of isolation, loneliness and abandonment.

Humans, by nature, are social creatures, and even if working from home can provide enhanced levels of performance and productivity, it also may create feelings of demoralisation. Working from home is not so straightforwardly beneficial at all.

Working from Home has its Challenges

There are apparent challenges for managers to lead a virtual workforce, but there are less obvious challenges too. What is for certain is that there has not been any meaningful synthesis of the role of managing a flexible workforce, and it appears that managers need to become better skilled at this relatively new role that they may find themselves thrust into. The role of the manager changes from person to the task. This means that the manager often concentrates their efforts and attention to the outcomes and results, rather than the employees themselves. This is difficult to do in an office environment, where personality plays its part significantly. This is why we often see people with huge personalities getting away with doing less work, and the resultant productivity or outcome may be questionable. Other managerial challenges involve assessing workload, performance, and ensuring some socialisation with the business, giving them a sense of a working identity. Managers who have a remote or virtual workforce need to adopt different approaches in terms of communicating, assessing the varying needs of their direct subordinates, and looking into how productivity or performance will be measured or assessed.

How Managers May Help

As we work through this conundrum, it is easy to see why wellbeing plays such an important part, especially when it comes to finding meaning and purpose. What managers could do, which should form part of the wellbeing strategy for remote workers, is to foster a sense of belonging, even though they are not present physically. This includes holding constant meaningful communication with the remote workforce, whether that be in-person, phone texts, or over web meetings.

The use of technology is ever so important, and Zoom calls carried out regularly provide a good example. Having Zoom “social time” allows for a virtual social community, so that web meetings are not always associated with work, and this mirrors an office environment to some degree. Managers may ensure employees are kept updated with organisational events, policies, and direction, so feelings of isolation that gradually arise may be reduced.

Hot-desking facilities are common among organisations these days, which accommodate short-stay visits, meetings, and gatherings unrelated to work. The use of these facilities for these non-work-related events is important for employee wellbeing because these increase loyalty and feelings of belonging. Therefore, managers may look at innovative ways of bringing the office to the home, recreating a virtual office environment as much as possible, such as birthday and anniversary celebrations, coffee breaks and water cooler talks. By doing so, the traditional office environment is replicated to empower employees in feeling part of a bigger team. This allows them to mitigate feelings of social isolation and loneliness.

Nevertheless, remote working provides opportunities for flexibility. The working day could be distributed – it may begin early in the morning, start later in the afternoon and last into the evening. The appeal is in the flexibility and in giving permission for this flexibility to work. Research suggests that remote workers are far more productive and in fact, end up working longer hours than doing the same in the office. Managers should pay careful attention to this, ensuring employees have workplace wellness i.e. adequate rest and that breaks are taken; more importantly, that they enjoy downtime. Employees ultimately need to feel a sense of empowerment, and only then the detrimental effects of remote working on an employee’s wellbeing may be minimised.


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Suicide Risks for Persons with Addictions

Suicide Risks for Persons with Addictions

Written by: Juliana Pang, Therapist

Caregivers with a family member affected by addiction problems are often exhausted, drained dry of their empathy and compassionate capacities.

They recount countless cycles of suspended hope followed by just as many broken promises as they watch the affected person return time and again to their compulsive addiction despite a seemingly obvious trail of destruction behind them.

Caregivers learn to cope with the endless demands on their energies by blending the words uttered by the affected persons as a cocktail of lies, manipulation and attention-seeking antics to get what they want.  In time, the cries for help from the affected person turn into cries for help by the boy who cried wolf and eventually fading into indistinguishable white noise.

Professor Lisa Firestone of the Glendon Association observes that there is a natural tendency for caregivers to minimise any suicide expressions in general.  Responses such as, “Well, his past attempts weren’t serious.” or “He is just manipulating to get something.” are commonly observed.  There is also a general tendency to not want the expressions to be true.  In the case of addicts, words such as “I want to die” or “I am going to end my life” no longer convey the same meaning or gravity of their sense of desperation.

Why should we want to pay attention to an addict’s cry for help?

In Singapore, we lose 1.1 lives every day to suicide.  It is still the leading cause of death for youths aged 10 to 29.  While direct correlation evidence is still being researched on, studies in America have shown that more than 90% of people who kill themselves suffer from depression have a substance abuse disorder or both. Suicidality and addiction share a high concordance relationship.

When we overlay the statistics with a physiological lens, we note that both groups of persons have been observed in studies to have a dysfunctional hypothalamic-pituitary-adrenal (HPA) axis which essentially controls our body’s response to stress.

In a person with a normal functioning HPA axis, on the reception of a stressor, the hypothalamus in our brain instructs the secretion of the corticotropin-releasing factor (CRF) and vasopressin to stimulate our pituitary glands to produce the adrenocorticotropic hormone (ACTH).  The ACTH, in turn, stimulates glucocorticoid synthesis and release (commonly referred to as cortisol) from the adrenal glands.  This chain reaction provides a person the increased energy to handle the stress event and to do so without suffering from the pain and fatigue.  When the stress event is gone, the body produces a negative feedback loop which then brings the body system back to homeostasis.

In a person exposed to a persistent or extreme level of stress, or in a person who frequently activates the HPA axis through substance use, the body starts to blunt the sensitivity of the HPA axis and blunt cell receptivity to cortisol in its efforts to return to and maintain homeostasis.  This alteration to the sensitivity of the HPA axis affects our ability to tolerate physical and mental stresses and creates a need for a much bigger stimulus to activate the HPA axis (which may mean higher dosage of substance use); and when the HPA axis does react, produces a much bigger and exaggerated response (which may translate to more aggressive behaviours).

What Does This Mean In Practical Terms?

Many suicidal persons described having a voice in their head which is constantly there; telling them how much they need to seek fulfilment and comfort by reaching for the desired stimulus, whether it be a substance or a behaviour, of which one is killing themselves.  Their mind starts to command them to constantly plan, to seek out and to take actions to soothe the unbearable lack that they are feeling.  Eventually, the voice in the head goes from coaxing and persuading to being more intensive and aggressive towards the self to take immediate drastic actions.

The relief of death, a final refuge, becomes alluring and pleasurable and the fear of dying eventually transforms into the fear of not dying and becoming the loser, disappointment, and burden that they already believe themselves to be to their caregivers.  This dual push towards drastic action and the need for an ever-increasing amount of substance in addicts leads to an increase in the risk level of suicidality.

What Can We Look Out For?

How then does the caregiver separate the wheat from the chaff amid the chaos that addiction has already wrought onto the family system to detect the risks of suicidality?

Below are some, though not exclusive, common markers to look out for. It is particularly useful to note changes in the content of the affected person’s expressions and any escalation or sudden extinction of intensity.

  • Mood
    • Intense Emotional Outbursts
    • Extreme Isolation or Withdrawal
    • The feeling of Being a Misfit in Every Way
  • Speech
    • Hopelessness
    • Helplessness
    • Worthlessness
  • Behaviour
    • Researching or Procuring Means of Suicide.
    • Self-Harm, Including Risky Substance Use or Behaviours.
    • Planning of Affairs.
  • Presence of Trigger Events
    • Loss of Primary Relationship.
    • Physical or Mental Health Conditions That Debilitate.
    • Abuse or Trauma Events.
What Can Caregivers Do On Observing The Signs?

Ask the Suicide Questions:

  • In the past few weeks, have you ever wished that you were dead?
  • In the past few weeks, have you felt that you or your family would be better off if you were dead?
  • In the past week, have you made plans about killing yourself?
  • Have you tried to kill yourself?

If the answers are yes to any or to all the questions, caregivers are encouraged to take the following first steps:

  • Be empathetic towards the suicidal wish.
    • The objective is not to agree with the act of suicide but to understand what has happened to lead the affected person to the conclusion that suicide is the only solution.
  • Find a genuine connection with the affected person.
    • However difficult that person might have been in your life, express what this person means to you personally and how the loss of this person would affect you.
  • Make a safety plan.
    • Ask the affected person to agree to not take or delay any action to harm themselves until they get to or you get them to professional help.

In these situations, working with professional therapists can help the affected person build up their sense of self, adjust unhelpful beliefs towards the whole life experience, reignite their sense of being a valued part of humanity and community, develop skills to cope with life’s stresses and build a treatment and recovery plan for any inter-connected problems such as their addiction problems.

Professor Lisa Firestone observes that suicidal persons are generally ambivalent: a part of them wants to die but a part of them wants to live as well.  There is often a process of the dividing up of the self within the person, between an aspect which is life affirming and engaging with the outer world; and the anti-self, which is self-critical, self-hating and ultimately suicidal.  The key to recovery is to connect with and help strengthen that part of them that wants to keep on living.


1 Glendon.org. 2021. Understanding & Preventing Suicide – DVD « The Glendon Association. [online] Available at: https://www.glendon.org/product-post/understanding-preventing-suicide-dvd0/

2 Sos.org.sg. 2021. Suicide Facts and Figures | Samaritans of Singapore (SOS). [online] Available at: https://www.sos.org.sg/learn-about-suicide/quick-facts

3 Addiction Center. 2021. Addiction and Suicide – Addiction Center. [online] Available at: https://www.addictioncenter.com/addiction/addiction-and-suicide/

4 Goeders, N., 2003. The impact of stress on addiction. European Neuropsychopharmacology, 13.

5 Glendon.org. 2021. Understanding & Preventing Suicide – DVD « The Glendon Association. [online] Available at: https://www.glendon.org/product-post/understanding-preventing-suicide-dvd0/

6 Dazzi, T., Gribble, R., Wessely, S., & Fear, N. (2014). Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine, 44(16), 3361-3363. doi:10.1017/S0033291714001299

7 Glendon.org. 2021. Dynamics of Suicide: An Interview with Dr. Israel Orbach « The Glendon Association. [online] Available at: https://www.glendon.org/product-post/dynamics-of-suicide-an-interview-with-israel-orbach/

8 Glendon.org. 2021. Understanding & Preventing Suicide – DVD « The Glendon Association. [online] Available at: https://www.glendon.org/product-post/understanding-preventing-suicide-dvd0/

9 Glendon.org. 2021. Firestone, R.W. – The “inner voice” and suicide « The Glendon Association. [online] Available at: https://www.glendon.org/resource/firestone-r-w-the-inner-voice-and-suicide/

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