DSM 5: Simple Procedure for Evaluating Addiction 

August 15, 2016

The DSM 5 allows clinicians to specify how severe the substance use disorder is, depending on how many symptoms are identified.
MILD: Two or three symptoms indicate a mild substance use disorder;
MODERATE: Four or five symptoms indicate a moderate substance use disorder, and
SEVERE: Six or more symptoms indicate a severe substance use disorder. 

DSM: Severe Addiction
SEVERE: six or more symptoms indicate a severe substance use disorder. Clinicians can also add “in early remission,” “in sustained remission,” “on maintenance therapy,” and “in a controlled environment.” 
Here are the eleven symptoms (DSM Criteria):

Substance use disorders span a wide variety of problems arising from substance use, and cover 11 different criteria:
1. Taking the substance in larger amounts or for longer than the you meant to

2. Wanting to cut down or stop using the substance but not managing to

3. Spending a lot of time getting, using, or recovering from use of the substance

4. Cravings and urges to use the substance

5. Not managing to do what you should at work, home or school, because of substance use

6. Continuing to use, even when it causes problems in relationships

7. Giving up important social, occupational or recreational activities because of substance use

8. Using substances again and again, even when it puts the you in danger

9. Continuing to use, even when the you know you have a physical or psychological problem that could have been caused or made worse by the substance

10. Needing more of the substance to get the effect you want (tolerance)

11. Development of withdrawal symptoms, which can be relieved by taking more of the substance.

Take an alcohol and drug use history. Then ask the patient if he/she has ever experienced this (the symptom/criteria). Keep going between the patient’s discussion of each criteria and what they reported in the alcohol and drug use history. 
Then you can add a recovery specifier. They offer four options: 

Clinicians can also add one of four specifiers 

1. In early remission,

2. In sustained remission,

3. On maintenance therapy (such as methadone or Suboxone);

4. In a controlled environment (such as detox, residential living, sober living home, jail/prison, etc.)

Try it with patient or in a group and let me know how it goes by posting on my Facebook Page: www.facebook.com/GorskiRecovery 


Thought Terminating Cliches

October 3, 2015

by Terence T. Gorski

No Need To Think!

A thought terminating cliché is something that we memorize and start to use automatically that keeps us from thinking clearly and deeply about something. For example: “Screw it, I don’t need this now!” 

The key to identifying a thought terminating cliché is to recognize that we don’t really understand what the thought means and it turns off our thought process when we are confronting a problem that we really need to think through. As a result we become trapped using this thought terminating clichés to shut down our mind whenever we start thinking about something that makes us feel uncomfortable but that we need to confront in order to grow in our recovery.

We need tp recognize the difference between thought terminating clichés that stop us from thinking about issues we need to face, and healthy thought stopping commands that we use to turn off habitual irrational thinking, ruminations, and resentments.

In my definition of a thought stopping cliché presented above, it says very clearly tat it is: “something that we memorize and start to use automatically that keeps us from thinking clearly and deeply about something.” This is very different from thought redirecting phrases that have a deep personal meaning and change our way of thinking from old addictive thought patterns to new recovery supportive ways of thinking.

The slogans in 12-Step programs are a perfect example of thought redirecting phrases if they are used properly. And this is a big if! 

It is both “what we say to ourselves” and “how we have conditioned our brain / mind to respond to what we say to ourselves.” Let me explain. 

If our response to the slogan “Easy does it!” activates the belief “It’s OK to do nothing at all if I don’t feel like it!” the slogan is being used a a thought terminating cliche – a form of thinking without thought that gives us permission to only do what we feel like doing and not what we need to do to recover.  

If the same slogan “Easy does it!” helps us to start thinking about: 

• The need to slow down and lower stress;

• The importance of not biting off more than we can chew to avoid choking (Father Joe Martin’s concept of “not feeding spiritual steak to spiritual infants); 

• The real danger of running down as hill as fast as you can because it feels good in the moment while ignoring the long term consequence of falling flat on our face as gravity and momentum compel us to run faster than out legs can carry us; 

• Don’t take on so much that it takes us away from our recovery program and distracts us with other things we believe we must do now;; 

• We are not what we do! We are who we are as sober human beings. We are good people and it is OK to “just be and grow” in response toour spiritual voice within that tells us sobriety is necessary for us to stay alive and grow so staying sober need to come first.

If the phase Easy does It helps is to stop obsessively thinking addictive compulsive thoughts by telling ourselves to “do more and more and do it now or else” it gives us permission to slow down, turn off the mental chatter, practice patience, and just be.”

The question that determines the difference between thought stopping and thought redirecting is:

• “Does the memorized phrase stop me from thinking and reflecting on important issues that I need to face to move on in my recovery?. or

• Does the memorized phrase give me permission and motivational to go on doing self-defeating things that can lead to relapse? 

If the memorized word or phrase reminds me to stop and think about the new principles of recovery and personal responsibility it is a positive thought redirecting phrase because by thinking about it I am learning and growing in my recovery program.

If the memorized word or phrase keeps me locked into a pattern of addictive, compulsive and self-defeating ways of thinking it is a negative thought stopping cliché.

The difference between the two can be subtle and difficult to judge in the moment. This is why discussing our thinking with our sponsor, fellow members of our program, and at meetings is so important. These conversations about how to evaluate what we are thinking should, in the best tradition of recovery, teach us to think more clearly and rationally about addiction oriented versus recovery oriented thinking and behavior. This distinction is difficult to understand and even more difficult to explain (I feel I have not done the concept justice here and will keep working on an explanation that is more clear and easy to understand). It is a distinction, however, that is critically important to make in our own minds so we can learn how to manage our mental and emotional life in recovery. 

I will end with the words of one of my favorite singers and song writers, Harry Chapin, when he says in one of his songs: “Sometimes words can serve me well and sometimes words can go to hell!”

To Start Using Thought Redirecting Phrases In The Workbook

The Cognitive Restructuring for Addiction: http://www.relapse.org/custom/cart/edit.asp?p=92050 

Gorski Books: http://www.relapse.org

Gorski Home Studies: http://www.cenaps.com 


Thank God for the Atom Bomb

August 7, 2015

 Nuclear Weapons: A Time-Lapse History 

By Terence T. Gorski 

All people with a conscience have mixed feelings about war and the weapons of mass destruction used in modern day warfare. 

The fear of nuclear war is once again raising its head. Many of us would prefer to ignore the issue and pretend “it can never happen again.” The current deal with Iran over nuclear weapon development and the possibility of widespread nuclear proliferatio in the Middle East is raising the issue and the fear of the real possibility of nuclear war. 

People without a conscience (i.e. psychopaths/sociopaths) are not hobbled in their decision making about nuclear weapons by issues of morality, empathy, and fighting for the good. When making decisions involving the use of weapons of mass destructions psychopathic/sociopathic leaders will do anything necessary to expand their power even if it means destroying humanity in the process. 

In my opinion, the reality is that people of conscience need to come to terms with the need for violence to protect personal freedom. This means facing the issue of using violence on all levels to protect individual freedom. This includes, of course, coming to terms with the production and use of nuclear weapons. If they don’t, people motivated by high moral standards will eventually be killed, imprisoned, or controlled by psychopaths/sociopaths who are well armed and organized. This is especially true if evil intent can be cloaked by a religious ideaology. 

People of good will must recognize and name the true nature of the enemy –those who don’t are usually condemned to be defeat by the enemies they refuse to name. 

The following article was forwarded to me by Buck Yancy, a friend and mentor who keeps challenging me to face and think about the hard issues of life. It is the reprint of an essay written in 1981by the late Paul Fussell, a cultural critic and war memoirist. 

Reading this essay was unsettling. It contrasted two perspectives of making decisions about using nuclear weapons: the anstract perspective of those who make and critique policy; and the personal perspective of the troops whose lives were spared because the land invasion of Japan became unnecessary because the use of nuclear weapons forced Japan to surrender. 

Here is an article by the same name in The New Republic

Below is the original essay I received:

Thank God for the Atom Bomb  

 

Wed Aug 5, 2015 7:36 pm (PDT) . Posted by: “Jim Baker” baycur on Aug 5, 2015, at 11:42 AM, by Jeff Murray tamu73@sbcglobal.net [CHAT_281AHC] <CHAT_281AHC@yahoo groups.com> who wrote:

The headline of this column is lifted from a 1981 essay by the late Paul Fussell, the cultural critic and war memoirist. In 1945 Fussell was a 21-year-old second lieutenant in the U.S. Army who had fought his way through Europe only to learn that he would soon be shipped to the Pacific to take part in Operation Downfall, the invasion of the Japanese home islands scheduled to begin in November 1945. 

Then the atom bomb intervened. Japan would not surrender after Hiroshima, but it did after Nagasaki.

I brought Fussell’s essay with me on my flight to Hiroshima and was stopped by this: “When we learned to our astonishment that we would not be obliged in a few months to rush up the beaches near Tokyo assault-firing while being machine-gunned, mortared, and shelled, for all the practiced phlegm of our tough facades we broke down and cried with relief and joy. We were going to live.”

In all the cant that will pour forth this week to mark the 70th anniversary of the dropping of the bombs—that the U.S. owes the victims of the bombings an apology; that nuclear weapons ought to be abolished; that Hiroshima is a monument to man’s inhumanity to man; that Japan could have been defeated in a slightly nicer way—I doubt much will be made of Fussell’s fundamental point: Hiroshima and Nagasaki weren’t just terrible war-ending events. They were also lifesaving. The bomb turned the empire of the sun into a nation of peace activists.

I spent the better part of Monday afternoon with one such activist, Keiko Ogura, who runs a group called Hiroshima Interpreters for Peace. Mrs. Ogura had just turned eight when the bomb fell on Hiroshima, the epicenter less than 2 miles from her family home. She remembers wind “like a tornado”; thousands of pieces of shattered glass blasted by wind into the walls and beams of her house, looking oddly “shining and beautiful”; an oily black rain. 

And then came the refugees from the city center, appallingly burned and mutilated, “like a line of ghosts,” begging for water and then dying the moment they drank it. Everyone in Mrs. Ogura’s immediate family survived the bombing, but it would be years before any of them could talk about it. 

Because Hiroshima and Nagasaki were real events, because they happened, there can be no gainsaying their horror. Operation Downfall did not happen, so there’s a lot of gainsaying. Would the Japanese have been awed into capitulation by an offshore A-bomb test? Did the Soviet Union’s invasion of Manchuria, starting the day of the Nagasaki bombing, have the more decisive effect in pushing Japan to give up? Would casualties from an invasion really have exceeded the overall toll—by some estimates approaching 250,000—of the two bombs?

We’ll never know. 

— We only know that the U.S. lost 14,000 men merely to take Okinawa in 82 days of fighting. 
— We only know that, because Japan surrendered, the order to execute thousands of POWs in the event of an invasion of the home islands was never implemented. 

— We only know that, in the last weeks of a war Japan had supposedly already lost, the Allies were sustaining casualties at a rate of 7,000 a week. 

— We also know that the Japanese army fought nearly to the last man to defend Okinawa, and hundreds of civilians chose suicide over capture. 

Do we know for a certainty that the Japanese would have fought less ferociously to defend the main islands? We can never know for a certainty. 

“Understanding the past,” Fussell wrote, “requires pretending that you don’t know the present. It requires feeling its own pressure on your pulses without any ex post facto illumination.” Historical judgments must be made in light not only of outcomes but also of options. Would we judge Harry Truman better today if he had eschewed his nuclear option in favor of 7,000 casualties a week; that is, if he had been more considerate of the lives of the enemy than of the lives of his men?

And so the bombs were dropped, and Japan was defeated. Totally defeated. 

Modern Japan is a testament to the benefits of total defeat, to stripping a culture prone to violence of its martial pretenses. 

Modern Hiroshima is a testament to human resilience in the face of catastrophe. It is a testament, too, to an America that understood moral certainty and even a thirst for revenge were not obstacles to magnanimity. In some ways they are the precondition for it.

For too long Hiroshima has been associated with a certain brand of leftist politics, a kind of insipid pacifism salted with an implied anti-Americanism. That’s a shame. There are lessons in this city’s history that could serve us today, when the U.S. military forbids the word victory, the U.S. president doesn’t believe in the exercise of American power, and the U.S. public is consumed with guilt for sins they did not commit.

Watch the lights come on at night in Hiroshima. Note the gentleness of its culture. And thank God for the atom bomb.


Lying and Second Chances

January 18, 2015

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By Terence T. Gorski
Author (The Books of Terence T. Gorski)

“For every good reason there is to lie, there is a better reason to tell the truth.” ~ Bo Bennett

When you catch someone telling a lie, should you give him or her a second chance? Or should you follow the advice of William Shakespeare: “Trust not him that hath once broken faith.”

This question, when approached thoughtfully, is more difficult to answer than it first appears.

When I ask people whether they should give a second chance to someone who tells them a lie, the answers I get range from “absolutely yes” to “absolutely no.”

Other people have developed rules for when to give a second chance and when to cut their losses by getting the person out of their life, or at least out of their box of sensitive secrets.

The answer to the question of what to do when you discover they are lying depends upon how we define the idea of telling lies and telling the truth. So let’s ask the tough questions that are not as easy to answer as they may seem.

What is a lie?

Here’s the dictionary definition: “a false statement made with deliberate intent to deceive; an intentional untruth; a falsehood.
Synonyms include prevarication and falsification. Antonyms include truth.

What is the truth?

The dictionary tells us that it is “the true actual state of a matter. That which is really happening or going on. Conformity with the facts or reality.” The the concept of the truth is further clarified as: “the real facts about something: the things that are true: the quality or state of being true: a statement or idea that is true or accepted as true; A statement that is supported by evidence.”

Wow! These are really circular definitions that essentially tell us “the truth is what is true!”

These definitions of truth beg a very important issue: the truth is rarely absolute and is usually relative to what is accepted as truth at the time and the “truth as we see it from our point of view.”

Most of the time to “tell the truth” means to “explain our best understanding given our point of view, the extent of our knowledge, and the currently best known and most widely accepted evidence.”

Honesty and lying are as much about the intent to deceive as it is about giving mistaken information.

If you make an honest mistake in solving a mathematical problem, it is usually not considered a lie. It is a mistake or unintentional error. It might be a lie if you deliberately falsify the answers for some secondary gain.

So, in my opinion, it would make sense to make the distinction between an honest mistake (I believe that what I am saying to be factual or true) and a lie (I know what is true and deliberately try to tell you something else).

I find that most people who tell one lie (i.e tell others that something is true when they know that it is not), tend to tell other lies as well. They use lies as an habitual tool to gain things of value in life or to deny some painful truths.

Sometimes the habitual liar can convince themselves that a lie is actually true. This can be a useful skill if you have to pass a lie detector test. Some people are skilled at catching people who are telling lies. This can be a useful skill to recognize and avoid getting hurt by con men and habitual liars.

Most actively addicted people tell lies about their alcohol and other drug use. They minimize how much they use and try to cover up the damage caused by their use.

Some addicts don’t actually lie, they just block out some aspects of reality so they are intentionally ignorant. This is called being sincerely deluded.

Must alcoholics, for example, never count the number of drinks they have or add up how much money they are spending on alcohol or drugs. They keep themselves willfully or intentionally ignorant in order to avoid facing the truth.

The truth is a continually evolving thing based upon our best understanding at the time. All we can really tell someone is our best understanding of the truth as Wevsee it at the current time and then explain why we believe it to be true (i.e. Present the evidence we have that makes us believe that it is true).

In the everyday world we operate on a common-sense definition of truth.

– I did or did not do this!
– I was or was not at a certain place at a specific time!
– This is what has happened in the past !
– This is what is happening now!
– This is what I believe will happen in the future!

Anyone who tells you they know exactly what will happen in the future is guessing or is sincerely deluded. No one can be certain about the future.

Many people have beliefs without evidence. They accept things are true without any real proof. Every culture teaches thousands of truths, both little and big, that people are supposed to accept as true.

So what should you do if you believe someone is lying to you?

The first step is to ask the question again and make sure you are understanding their answer. Many accusations of telling a lie are based in poor communication and misunderstanding.

Tell the other person very clearly that you don’t believe it is true and present your evidence. Tell them you are open to reconsider if they have better evidence. This gives the people their day in court. They get to describe the “truth as they see it from their point of view.”

Before jumping to conclusions it is helpful to detach, back up, observe, and investigate. The serious problem is not a single lie told in isolation to deal with a specific situation. The most serious problem is the person who uses deceit and dishonesty as a habitual way to cope with life.

If there is a pattern of lying, it is foolish to trust. Many people are habitual liars. In other words they are in the habit of twisting the truth to get what they want.

Trust must be earned. It must be built little by little, one step at a time. When building a relationship, it is best to self-disclose a little bit at a time. If the person responds by self-disclosing at the same level to you, go back a try again. If they continue self-disclose at the level that you are they are, they are probable trustworthy. If they don’t reciprocate, be wary and ask yourself if they are trying to hide something or to get you at a disadvantage by knowing more about you than you know about them.

If what you told them in confidence ends up on the grapevine, run the other way. People who gossip and tell you the secrets of others that were told to them in confidence will almost certainly do the same to you.

Recovery demands a policy of rigorous honesty this means:

– The willingness to look honestly at yourself and your past behavior;
– The intent to be honest by reporting the truth as you believe it to be while acknowledging that “I might be wrong.”
– To promptly admit mistakes and be willing to correct them;
– To look with a critical eye at what you believe and the evidence you have to support that belief; and
– To be willing to act in faith upon your best understanding of the truth until you find new and more compelling evidence that causes you to change your mind.

Rigorous honesty is a skill that needs to be learned and practiced. This is because, as fallible human beings we are prone to lie to ourselves and it others. It is also because the truth is hard to find.

LIVE SOBER – BE RESPONSIBLE -LIVE FREE

Don’t miss Terry Gorski’s books and workbooks on recognizing and managing denial.

Denial Management Counseling (DMC)

The Books of Terence T. Gorski


My Depression Management Plan

January 16, 2015

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By Terence T. Gorski
Author

Read Terry Gorski’s Book: Depression and Relapse

Major depression is a serious problem for many people, including people in recovery from alcoholism and other chemical addictions. Many people suffer from depression in recovery and I was no exception. After more than twenty-five years of sobriety, depression nearly took me down.

I figured out a way to manage it. Part of the process of figuring out what to involved researching depression and writing a book about what I learned from the process. The book Depression and Relapse.

I wrote this blog today because I have friend suffering from depression in recovery. I wrote a summary of the things I did to help myself get through the dark times. I thought it might be helpful to others.

Let me know what you think. If you have survived serious depression and used some tools or techniques that helped but aren’t listed here, add them in a comment and be sure to identify yourself and a link to your blog or website so I can properly reference the source. It might help send some traffic your way. So, let’s get on with it.

To manage my severe depression I had to self-monitor it’s severity four times per day (breakfast, lunch, dinner, and before bed).
I used a ten point scale:

0 = No Depression/Normal Mood;

1 – 3 = Mild Depression: It is a nuisance, but I can put it out of my mind and do all of my acts of daily living.

4 -7 = Moderate Depression: It is a nuisance but at times is so severe and drains so much energy that at times I can’t stay focused on my normal daily tasks. At other times I can.

7 -9 = Severe Depression: I get yo and try to function but I usually can’t complete my daily acts of living so I shrink my world by avoiding things.

10 = Disabling: The depression is so bad that I can barely function at all. I can’t get out of bed, I can’t do basic tasks, and no matter what anyone says or does I feel buried by the depression.

I kept a log four times per day and started looking for pattens. I noticed my depression would move through my life in up-and-down cycles. There were times of the day when I was more depressed no matter what was going on. There were other times of the day when the depression wasn’t as bad. I began to see that there were predictable cycles to the severity of my depression symptoms.

I noticed that the depression started to increase and get worse at certain times of the day. Knowing this allowed me to anticipate when I would be the most depressed and avoid scheduling important things during those times. I also learned the times when I tended to be the least depressed and most functional. This allowed to plan my most important activities during those time.

I also noticed weekly cycles. On certain days of the week I would be more depressed than on others. In other words, I could anticipate the really bad days and the better days.

I began doing things to try and manage the depression symptoms. I kept it simple:

– I scheduled alone time for 15 – 30 minutes a day and just distracted myself with pleasant mindless things.

– I took a twenty minute walk each day.

– I started to do brief (3 – 5 minute) sessions of mindfulness meditation.

Here is how I did it: https://terrygorski.com/2013/12/30/mindfulness-made-https://terrygorski.com/2013/12/30/mindfulness-made-https://terrygorski.com/2013/12/30/mindfulness-made-simple/

I also used a meditation technique called Magic Triangle Relaxation Methof. It is described here: https://terrygorski.com/2014/05/08/magic-triangle-relaxation-method/

It wasn’t easy to manage the depression and most people didn’t understand what I was going through. They would ask me: “Why don’t you just snap out of it?” The answer was easy: “I can’t because I have a depressive illness!”

Many of the people I knew were really angry because I wasn’t able to work as hard or be there for them in the ways I was before I got depressed.

One of the things that kept me going was the research that showed how serious episodes of clinical depression tend to run a course of about nine to eighteen months. Each major depressive episode tends to go through three stages:

Stage 1: Gradual increase in the frequency and severity of depression symptom episodes.

Stage 2: The period of most frequent and intense symptoms. This is the stage where most people seek help because the depression is causing life problems. It’s much better to recognize depression in stage one and make managing the emerging symptoms as a top priority. When I did this I found stage 2 would to be shorter and the depression symptoms less severe and disabling. Yes, I had more than one ride on this roller coaster to dark side of depression. I learned from each ride and used it to make the next ride shorter and more manageable.

Stage 3: A period of gradual Symptom reduction until a normal mood (whatever that is) returns.

What I found is that I had always suffered from a chronic low-grade form of depression called Dysthymia. I also discovered depression ran in my family so I considered low grade depression to be normal.

I also paid attention to my automatic thoughts that made my depression worse. I figured out how to actively challenge my automatic depressive thinking. Both my personal experiences and the research I reviewed on the cognitive therapy of depression were the same:

1. There are automatic thoughts that made my depression worse.

2. When I let these depressive thoughts bounce around in my brain my depression kept getting worse.

The depressive thoughts that make depression worse are:

1. This is awful (Awful means worse than it could ever be).

2. This is terrible (terrible means that there will be serious losses of everything that I value).

3. It’s always been this way, I’ve never had a single moment in my life when I wasn’t depressed.

4. It will always be this way. I won’t ever be able to feel better.

5. I can’t stand the way I feel! (Although it is obvious I could stand it because what else could I do?)

6. I can’t do anything about it. There is nothing I can do to make the symptoms even in a little bit better.

7. I am helpless and hopeless in the face of my depression.

8. There is nothing I can do! I can’t do anything to manage the depression or make myself feel even a little bit better for a few minutes.

9. Being depressed proves that I am no good as a person.

10. My depression has robbed me of everything I value and has made me a helpless, useless, crazy person.

Before I figured all of this out, I became suicidal. I felt the compulsion to end myself. The impulse to commit suicide was so strong and persistent it was difficult to resist.

I had to tell close friends about it. I put all potential suicide tools in the hands of friends with clear instructions not to let me have them back. This included my guns, and anything in the medicine cabinet that could be lethal. There are many over-the-counter medications that can kill you with as few as thirty pills. 

How did I know this? The Internet is a wonderful tool for the suicidal. I put the prescription medications I was taking in the hands of someone else who would give me the daily doses of prescribed medication.

Recognizing and managing my suicidal preoccupations and compulsions is a story for another time.

I also used prayer and meditation. This helped me to transcend or rise above the worst symptoms of depression and to find a meaning in my suffering.

It is important to remember that THIS TO SHALL PASS. Depression is not forever and there are things you can do to reduce the severity and duration of depressive episodes.

Read Terry Gorski’s Book: Depression and Relapse

The exercises in the COGNITIVE RESTRUCTURING FOR ADDICTION WORKBOOK can be easily applied to depression.

The principles of 12-Step Programs can also be helpful. See Understanding the Twelve Steps.


Violence Against Women: Fact Sheet 2014

January 12, 2015

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Intimate partner and sexual violence against women
Fact sheet N-239
Updated November 2014
http://www.who.int/mediacentre/factsheets/fs239/en/

Key facts:

Violence against women – particularly intimate partner violence and sexual violence against women – are major public health problems and violations of women’s human rights.

Recent global prevalence figures indicate that 35% of women worldwide have experienced either intimate partner violence or non-partner sexual violence in their lifetime.

On average, 30% of women who have been in a relationship report that they have experienced some form of physical or sexual violence by their partner.

Globally, as many as 38% of murders of women are committed by an intimate partner.

Violence can result in physical, mental, sexual, reproductive health and other health problems, and may increase vulnerability to HIV.

Risk factors for being a perpetrator include low education, exposure to child maltreatment or witnessing violence in the family, harmful use of alcohol, attitudes accepting of violence and gender inequality.

Risk factors for being a victim of intimate partner and sexual violence include low education, witnessing violence between parents, exposure to abuse during childhood and attitudes accepting violence and gender inequality.

In high-income settings, school-based programmes to prevent relationship violence among young people (or dating violence) are supported by some evidence of effectiveness.

In low-income settings, other primary prevention strategies, such as microfinance combined with gender equality training and community-based initiatives that address gender inequality and communication and relationship skills, hold promise.

Situations of conflict, post conflict and displacement may exacerbate existing violence and present additional forms of violence against women.
Introduction

Defining Violence Against Women

The United Nations defines violence against women as “any act of gender-based violence that results in, or is likely to result in, physical, sexual or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life.”

Intimate partner violence refers to behaviour by an intimate partner or ex-partner that causes physical, sexual or psychological harm, including physical aggression, sexual coercion, psychological abuse and controlling behaviours.

Sexual violence is any sexual act, attempt to obtain a sexual act, or other act directed against a person’s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting. It includes rape, defined as the physically forced or otherwise coerced penetration of the vulva or anus with a penis, other body part or object.

Scope of the problem

Population-level surveys based on reports from victims provide the most accurate estimates of the prevalence of intimate partner violence and sexual violence in non-conflict settings. The first report of the “WHO Multi-country study on women’s health and domestic violence against women” (2005) in 10 mainly low- and middle-income countries found that, among women aged 15-49:

– Between 15% of women in Japan and 71% of women in Ethiopia reported physical and/or sexual violence by an intimate partner in their lifetime;

– Between 0.3–11.5% of women reported experiencing sexual violence by someone other than a partner since the age of 15 years;

– The first sexual experience for many women was reported as forced – 17% of women in rural Tanzania, 24% in rural Peru, and 30% in rural Bangladesh reported that their first sexual experience was forced.
A more recent analysis of WHO with the London School of Hygiene and Tropical Medicine and the Medical Research Council, based on existing data from over 80 countries, found that globally 35% of women have experienced either physical and/or sexual intimate partner violence or non-partner sexual violence. Most of this violence is intimate partner violence.

– Worldwide, almost one third (30%) of all women who have been in a relationship have experienced physical and/or sexual violence by their intimate partner, in some regions this is much higher. Globally as many as 38% of all murders of women are committed by intimate partners.

– Intimate partner and sexual violence are mostly perpetrated by men against women and child sexual abuse affects both boys and girls. International studies reveal that approximately 20% of women and 5–10% of men report being victims of sexual violence as children. Violence among young people, including dating violence, is also a major problem.

Risk factors

Factors found to be associated with intimate partner and sexual violence occur within individuals, families and communities and wider society. Some factors are associated with being a perpetrator of violence, some are associated with experiencing violence and some are associated with both.

Risk factors for both intimate partner and sexual violence include:

– Lower levels of education (perpetration of sexual violence and experience of sexual violence);

– Exposure to child maltreatment (perpetration and experience);
witnessing family violence (perpetration and experience);

– Antisocial personality disorder (perpetration);

– Harmful use of alcohol (perpetration and experience);v

– Having multiple partners or suspected by their partners of infidelity (perpetration); and
attitudes that are accepting of violence and gender inequality (perpetration and experience).

Factors specifically associated with intimate partner violence include:

– Past history of violence;
marital discord and dissatisfaction;

– Difficulties in communicating between partners.

Factors specifically associated with sexual violence perpetration include:

– Beliefs in family honour and sexual purity;
– Ideologies of male sexual entitlement; and
– Weak legal sanctions for sexual violence.

The unequal position of women relative to men and the normative use of violence to resolve conflict are strongly associated with both intimate partner violence and non-partner sexual violence.

Health consequences

Intimate partner and sexual violence have serious short- and long-term physical, mental, sexual and reproductive health problems for survivors and for their children, and lead to high social and economic costs.

Violence against women can have fatal results like homicide or suicide.
It can lead to injuries, with 42% of women who experience intimate partner reporting an injury as a consequences of this violence.

Intimate partner violence and sexual violence can lead to unintended pregnancies, induced abortions, gynaecological problems, and sexually transmitted infections, including HIV.

The 2013 analysis found that women who had been physically or sexually abused were 1.5 times more likely to have a sexually transmitted infection and, in some regions, HIV, compared to women who had not experienced partner violence. They are also twice as likely to have an abortion.
Intimate partner violence in pregnancy also increases the likelihood of miscarriage, stillbirth, pre-term delivery and low birth weight babies.

These forms of violence can lead to depression, post-traumatic stress disorder, sleep difficulties, eating disorders, emotional distress and suicide attempts.

The same study found that women who have experienced intimate partner violence were almost twice as likely to experience depression and problem drinking. The rate was even higher for women who had experienced non partner sexual violence.

Health effects can also include headaches, back pain, abdominal pain, fibromyalgia, gastrointestinal disorders, limited mobility and poor overall health.

Sexual violence, particularly during childhood, can lead to increased smoking, drug and alcohol misuse, and risky sexual behaviours in later life. It is also associated with perpetration of violence (for males) and being a victim of violence (for females).

Effect On Children

Children who grow up in families where there is violence may suffer a range of behavioural and emotional disturbances. These can also be associated with perpetrating or experiencing violence later in life.
Intimate partner violence has also been associated with higher rates of infant and child mortality and morbidity (e.g. diarrhoeal disease, malnutrition).

Social and economic costs

The social and economic costs of intimate partner and sexual violence are enormous and have ripple effects throughout society. Women may suffer isolation, inability to work, loss of wages, lack of participation in regular activities and limited ability to care for themselves and their children.

Prevention and response

Currently, there are few interventions whose effectiveness has been proven through well designed studies. More resources are needed to strengthen the prevention of intimate partner and sexual violence, including primary prevention, i.e. stopping it from happening in the first place.

Regarding primary prevention, there is some evidence from high-income countries that school-based programmes to prevent violence within dating relationships have shown effectiveness. However, these have yet to be assessed for use in resource-poor settings. Several other primary prevention strategies: those that combine microfinance with gender equality training; that promote communication and relationship skills within couples and communities; that reduce access to, and harmful use of alcohol; and that change cultural gender norms, have shown some promise but need to be evaluated further.

To achieve lasting change, it is important to enact legislation and develop policies that:

– Address discrimination against women;
– Promote gender equality;
support women; and
– Help to move towards more peaceful cultural norms.

An appropriate response from the health sector can play an important role in the prevention of violence.
Sensitization and education of health and other service providers is therefore another important strategy.

To address fully the consequences of violence and the needs of victims/survivors requires a multi-sectoral response.

WHO actions

WHO, in collaboration with a number of partners, is:

– building the evidence base on the size and nature of violence against women in different settings and supporting countries’ efforts to document and measure this violence and its consequences.

This is central to understanding the magnitude and nature of the problem at a global level and to initiating action in countries;

– Strengthening research and research capacity to assess interventions to address partner violence
developing technical guidance for evidence-based intimate partner and sexual violence prevention and for strengthening the health sector responses to such violence;

– Disseminating information and supporting national efforts to advance women’s rights and the prevention of and response to violence against women; and

– Collaborating with international agencies and organizations to reduce/eliminate violence globally.

http://www.who.int/mediacentre/factsheets/fs239/en/

Gorski Books


Burn Out: What I Do To Avoid It

January 11, 2015

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By Terence T. Gorski
Author, my books can be found at www.relapse.

“The two most important days of your life are the day you were born and the day you find out why.” – Mark Twain

I keep myself from burning out and becoming jaded by doing my best to focus my mind on the following things:

1. Praying: My primary repetitive prayer is: “God teach me of your will for me and give me the courage to carry that out.”

2. Renewing My Commitment To Help: I keep reinforcing that “we keep it by giving it away.” When we help others without trying to control those we are helping and without allowing ourselves to be exploited it helps me keep a balanced perspective.

3. I Dream Big: I see myself as a part of the revolution of the human spirit and human consciousness that will slowly, one person at a time, create a sober and responsible world.

4. I Manage My Expectations: I hope for the best when doing my work. I am prepared for the worst.

5. I Keep Perspective: I can’t do it alone, I can only do my part. I realize the power of a team of people working in harmony towards the same goal is powerful. I strive to stay focused on building a sober and responsible world one day at a time with the help of others.

6. I Take Time For Myself: I have areas of interest that focus my mind on many other things that I find inspiring or helpful. I read voraciously and take the lessons from everything I read that can lift my spirits and give me a positive and heroic fantasy life — kind of like I am “The Walter Mitty of the Addiction Field.”

7. I Dream Big: I strive work day-by-day to contribute things to others that will leave the world a better place. This is called building a legacy in the minds and hearts of others.

8. I Deal With Reality: I Deal With the immediate reality that confronts me by trying to do the next right thing to keep moving toward creating my life goal.

9. I Transcend Fear: I have developed the habit of facing fear without letting the fear control me. My favorite tool for this is Frank Herbert’s Litany Against Fear: “I must not fear. Fear is the mind killer – the little death that brings total obliteration. I will face my fear. I will permit my fear to pass over me through me. When it has gone past I will turn my inner eye to see its path. Where the fear has gone there will be nothing. Only I remain.

10. I copiously reflect upon the deep meaning of The Serenity Prayer: God grant me the serenity to accept the things I cannot change, to change the things I can, and the wisdom to know the difference.”

11. I Collect Quotable Quotes: My two favorites are: “One person can make a difference and every person should try.” ~ John F. Kennedy; and “Great spirits have always encountered violent opposition from mediocre minds. ~ Albert Einstein.

12. I Don’t Take Myself to Seriously: I try to learn something from everyone I meet and everything I do. I strive to be humble by “accepting the things I cannot change, changing the things that I can, and learning to know the difference.” I act upon my strengths without asking for permission. I overcome or compensate for my weaknesses by asking for and receiving help.

To sum it up, I recognize that I am a fallible human being; that I will die and have limited time to live; and that it’s up to me to do the best I can with the cards I am dealt in life. I know that I might be wrong so I stay open to learning, changing and growing. I accept the fact that I am responsible for my life, what I choose to do and not do, and what U choose to focus my mind upon. I look up all words I read or hear to understand what they mean. I realize that language programs the brain/mind so I careful about what I say to myself and others.

Carpe Diem!

Illigitimi non carborundum!

I also renew myself by escaping into Criminal Minds (Spencer is my favorite character) and NCIS (my two favorite character are Gibbs and McGee).

I want to leave a positive legacy and have given a lot of thought to what I want to pass forward to future generations. Here are twenty-five Ideas I want to pass forward to the next generation.

Gorski Books: www.relapse.org

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