The Developing Brain, ADHD, and Recreational Drug Use 

  Jun 05, 2018   Brian Ward   

For some of my therapeutic work I am employed in Kent prisons delivering 1:1 CBT therapy. This is rather interesting work. Prison populations were surveyed between 2012 and 2014 in the UK for the prevalence of mental health conditions, and findings disclosed that 66% of the prison population nationally has a diagnosed personality disorder; 45% are diagnosed with a depressive disorder; 45% are drug dependant, and 30% are alcohol dependant.

These figures initially staggered me, but, in retrospect, I wasn’t actually that surprised. As a retired Kent Police Drugs Expert and Trainer, for many years I worked with people whose lives had descended into chaos through these mechanisms, and sadly I attended funerals of some who had been unable to make sense of their personal emotions, behaviours and actions.

Similarly, when it comes to ADHD (Attention Deficit Hyperactivity Disorder), the figures are no more encouraging. A Canadian survey in 2011 found that up to 45% of their prison populations had diagnosed ADHD. ADHD increased their likelihood of imprisonment by nine times compared to the rest of the population.

A UK survey of prison populations published in 2012 reported that 45% of male adolescents and 24% of male adults in the criminal justice system have diagnosed ADHD. In a survey in Sweden published in 2012, which surveyed 25,000 diagnosed ADHD sufferers, they found that 37% of the men and 15% of the women had criminal convictions (compared to a national average of 9% men and 2% women). They observed from their research that 30% - 40% of long serving criminal populations were suffering from diagnosed ADHD. So what is going on?

In my experience, early use of recreational and prescription psychotropic drugs are often taken to palliate any emotional disturbance which results from interpretations that young people have made of their life experiences and relationships. Often it is not the actual events that we experience that result in mental health disturbance, but our interpretations of them.

In young minds, the cortex brain ability to emotionally detach from perceived environmental stressors is not yet fully developed, along with the ability to regulate emotions felt. In adolescent brain development, the cortex – the executive functioning of the brain – is just starting to come ‘on-line’. We learn the executive skills of controlling impulsivity; learning to maintain attention; learning to control disinhibition; learning to control emotions; developing our short term memory, - all cortex functions. Interestingly, these are also the key areas that define ADHD

Included in the DSM-5 diagnostic criteria for ADHD is: failing to pay close attention to details, difficulty sustaining attention, trouble getting organised, difficulty following instructions. As well as outward behaviours such as fidgeting, excessive running or climbing, excessive talking, trouble waiting or taking turns, interrupting others.

With this in mind, another finding from that Canadian survey of one million school children from 2011 looked at medical diagnosis that they had received over a one year period. The results were initially baffling. 5.7% of boys born in January had a likelihood of being diagnosed with ADHD. But startlingly, from the same school year, if they were born in December, they now had a 30% likelihood of being diagnosed with ADHD! Eventually it was realised that the younger boys had a greater likelihood of being diagnosed with ADHD because of their relative immaturity, compared to the actions and behaviours of those just a few months older.

The developing brain

Our brain develops throughout adolescence and we gradually get better at regulating those executive skills, and accordingly, also at making sense of the troubling interpretations we may have made of our life and circumstances. The trouble is, if, during that time, we start regularly using recreational or prescription psychotropic drugs to palliate or manage emotions or behaviours, then our brain will have to compensate for that.

The body, including the brain, is designed to maintain absolute homeostasis. This is an evolutionary survival function. When we cut ourselves, damaged skin cells carry out a process called apoptosis, and macrophage cells – the ‘waste disposal experts’ of the body - come along and dispose of the debris. Stem cells are then produced to replace the damaged tissue and the wound is repaired. The same is true of bone and ligament. The same is true of the functioning brain.

If we regularly expose ourselves to substances that affect the way we think or feel, then the nervous system will make adaptions to accommodate. If you feel cold, you get goose-bumps and put a coat on – back in homeostasis again. Or if you feel hungry, your stomach rumbles, and you eat some food – back in homeostasis again. Or if you feel tired, you yawn, and go to sleep – back in homeostasis again. Or if you use cannabis regularly, then the brain will compensate by reducing the number of dopaminergic receptors in your brain (the ‘happy shop’ in your brain – your ability to feel good – to feel ‘normal’). It does this because it recognises that you’re getting this ‘happy overload’ from the cannabis, and it has to balance that out.

This means that, pretty soon, your ability to feel ‘normal’; to enjoy the simple things of life; not to get annoyed over silly things, is reduced. So now, you only feel ‘good’ when you smoke cannabis - because this is now your normalised homeostatic state. And if you’re using ADHD medication, this will likely be methylphenidate or a similar amphetamine-based substance. The good news is that it will ‘stimulate’ your mind to help you maintain attention for as long as the drug remains in your nervous system. It’s imitating a fully developed cortex brain that is able to maintain attention naturally. But the bad news is that, once again, the brain has to compensate for this regular dopaminergic ‘rush’. So, once again, you will find that you may start to feel ‘flat’ and find it harder to get pleasure from the simple things around you.

The key here is to recognise that it’s not the substance that is critical, so much as what your brain has to do to compensate for it. Just the same as it not being the event that you experience that is critical as much as the interpretation that you make. As therapists, we need to understand these processes and dynamics, because their effects are intimately linked and directly causal in gradually developing mental health conditions.

this article evocatively illustrates the effect of severe depression, not only on the individual, but on the family and friends. Seeking help may no be a cure, but it engenders hope. Whilst this might not have been a case of "men don't cry", it offers the insight into the emotional effects of psychiatric health and suicide.
"One moment everything was fine. Our whole lives had gone by in a smooth wave of success, opportunity and privilege, and then we hit this seemingly unassailable wall. People speak of resilience, of teaching your children to cope with hardship so they are better able to overcome it. But there are no training exercises for grief or loss of this magnitude. The only thing that pulled us through those first few weeks and drew us closer than our fraternal genetics would allow was the shared experience of now having a Dad-sized hole in our lives. It’s strange how you bond over not having a father much more than you do when you had one.

Read the article at:

https://www.theguardian.com/commentisfree/2018/jan/10/men-do-seek-help-for-depression-i-wish-my-dad-...

Men’s Mental Health – Accessibility is a start to addressing the issue

 

Raising the profile of Men and their mental health has been recently highlighted by Prince Harry and his promotion of the “Heads Together” campaign. The many theories and statistics relating to men’s mental health and their willingness to seek help are at once concerning and frightening. Statistics show that men particularly aged under 50 are at high risk of suicide. In most of the articles on this subject there are well-rehearsed theories, most relating to the psychological and sociological perception of men by themselves, and indeed without any doubt these are valid and relevant.

 

There is another interesting statistic which is worthy of analysis, and it relates to the number and availability of male counsellors – is there a correlation to the number of men seeing a counsellor?  In 2014 out of 40,000 counsellors registered with the BACP, only 20% are male.

 

In addition to their presenting problems, men come with an additional agenda – their masculinity and how it is being challenged. The sociological conditioning which is cited most often for men not seeking counselling – such notions as “big boys don’t cry” and that men are encouraged to be “strong and successful”, seeking help through counselling is therefore seen as a failure in the concept of “being a man”. Crucially men need to break free from these stereotypes, and seek to understand themselves as individuals.

 

Does this also apply to men considering a career as a counsellor? The rigorous self-examination required during a counselling training course, including experiential groups, role play and personal therapy are challenging for all students, but demand a particularly strong self-belief amongst men to overcome the resistance instilled by their social conditioning.

 

Some of the answers I believe also lie behind the closed doors of the counselling room, the creation of a secure therapeutic space, and a comfortable therapeutic alliance between the counsellor and the client, is important with all clients, but particularly for men who are taking this journey for the first time. If the exposure of emotions is perceived as weakness, the presence of another male who can share to some degree these sensitivities, will offer re-assurance and safety.  The exposure of emotional vulnerability to a neutral male does not carry the same sensitivities as with a female where the presence of maternal attachment influences as well as the sociological concept of “being a man” could both discomfort the client.   There is less pressure on the male client to fulfil the expectations of “being a man” when sitting with another male. It is perhaps a function of the male to male chemistry which is unspoken, but understood, coming in to play.

 

The potential of erotic transference and occasionally more blatant sexual tensions  are often discussed, the presence of these feelings in the counselling room will be an additional issue which can be largely avoided in a male-male counselling dyad. My experience has led me to the conclusion that in many cases there is a deliberate selection by men in the counsellor they will be comfortable working with, this I believe reflects the needs of men to have some degree of control.

 

If there exists some hesitation towards seeking help, additional complicating factors will make this decision even harder.

 

A change in attitude towards the particular needs of men is long overdue, recent reports about male domestic abuse again highlight the differential in support offered to men and this needs to be addressed. Ultimately counselling services need to be able to reflect the needs of the community it serves, the more that men seek out counselling services, and experience positive outcomes, this will reflect positively in more men taking up counselling training to make a career in this area.

 

In a sector which is so dominated by the female gender, it is surely incumbent upon the professional institutions, and training organisations and employers to make every attempt to redress the balance. The promotion of Counselling as a viable and rewarding career for males, and potentially the positive selection of male counsellors into public sector roles wherever possible would be a move in the right direction.

 

Nigel Beaumont MBACP

helps2talk.me.uk

 

Learning to Love Yourself

We are all looking for love and acceptance of some kind; however that can prove hugely difficult for some of us, particularly if we aren’t able to love or accept ourselves. Low self-esteem can cause terrible emotional pain and self-doubt.

The great news is that we can overcome these issues; we can learn to think more positively about ourselves whatever our age or situation in life. We can develop confidence in our abilities and accept those things we aren’t so good at without punishing ourselves. We can choose to put the past behind us and move towards the future with a more positive approach.

“It’s not what you are that is holding you back; it’s what you think you are not.” Anon

When I began training as a counsellor the tutor impressed upon our group the importance of loving ourselves. At first this concept felt extremely uncomfortable — loving myself didn’t sit well with me at all, I was nothing special, not particularly pretty, or particularly clever. I could love other people — that came easily to me — but to love myself seemed self-indulgent.

Over time, I came to understand that what my tutor meant was that we need to believe in, and think well of ourselves. It is fine to be aware of our faults but it’s not okay to let those overwhelm us to such an extent that we aren’t able to see or acknowledge the good that exists within us. If we aren’t able to love ourselves then we won’t be truly able to accept love from others — or in turn, fully love.

For some of us, learning to love ourselves can seem an insurmountable goal; however there are some changes you can make which should help you on your journey.

1. Think about how might it feel to stop focusing on the things you aren’t good at and be positive about the things you can do?

2. Begin to respect yourself by cutting down on the self-criticism and muffling your inner-critic.

3. Show yourself the same compassion you would show someone else. Be kind when you are suffering, give yourself a break when you going through a rough time.

4. Validate your own decisions and actions instead of being so focused on external validation from other people.

5. Stop comparing yourself to others and appreciate the special things that make you an individual.

6. Have faith in your abilities and don’t be disheartened by failure. Failure is a necessary part of life and personal growth. It makes us stronger!

“The greatest discovery of my generation is that human beings can alter their lives by altering their attitudes of mind.” William James (1842–1910)

Men and mental health

As with many mental health statistics, it is difficult to know if mental health figures represent what is truly happening. This is because these numbers can only tell us about mental health problems that have been reported or admitted to. It is expected that many cases go unreported and undiagnosed.

This is believed to be especially true when it comes to men's mental health.

At any one time it is believed that one in five women (19.7%) and one in eight men (12.5%) are diagnosed with a common mental illness, such as anxiety, depression, panic disorder or obsessive compulsive disorder.¹

According to the Men's Health Forum, 73% of adults who 'go missing' are men and 87% of those sleeping rough are men. Looking at the prison system, the forum says men make up 95% of the prison population, with 72% of male prisoners suffering from two or more mental disorders.

In terms of substance abuse men are more likely to develop a problem. Men's Health Forum found that men are almost three times more likely than women to become dependent on alcohol. This equates to 8.7% of men, compared to 3.3% of women. Men are also three times as likely to report frequent drug use than women.

Depression in men

Depression is often found to be more difficult to diagnose in men. This is because men don't tend to complain about the typical symptoms, more often than not, it's the physical symptoms of depression that lead them to visit their doctor.

According to netdoctor.co.uk, the lifetime rate of depression is 12% in women and 8% in men. This marked difference could however be due to fewer men seeking help for depression.

Postnatal depression

Commonly associated with new mothers, postnatal depression can also affect new fathers. In a 2010 meta-analysis looking at 43 studies, it was estimated that 10% of new fathers around the world suffer from postnatal depression.²

A survey was carried out by the National Childbirth Trust between 2013 and 2014. This found that among the 296 new fathers surveyed, over a third (38%) said they were concerned about their mental health.³

Men and suicide

The main reason experts suspect more men are affected by mental health problems than is reported is the high number of male suicide.

Statistics compiled by the Men's Health Forum (July 2014) reveal the following:

In the last five years the suicide rate in males aged 45-59 has increased significantly to 22.2 deaths per 100,000 population.

A 2012 study carried out by The Samaritans looked into the factors that might help to explain why certain groups of men are more likely than women to commit suicide.⁴

Two important risk factors found were age and socioeconomic status. As we can see in the above statistics, middle-aged men are particularly at risk, with numbers of suicides in males aged 45-59 increasing over the last five years.

Middle-aged men today face being in two very different generations, the pre-war 'silent' and the post-war 'me' generation. This means they may feel stuck somewhere between the strong, silent male stereotype of their father's generation and the more progressive and open generation of their son's.

On top of this, middle age is a time when the weight of previous long-term decisions reveal themselves. Making changes can come with a hefty cost, financially and socially. Feeling trapped under choices made earlier in life can seriously compromise mental well-being.

The study also revealed that the suicide rate was 10 times higher in men who have a lower socioeconomic status than affluent males. There has been a well-known link between unemployment and suicide for some time, but in this study the authors discuss why, beyond losing a job, socioeconomic status might affect suicide rate.

One potential factor the authors identified was the "femenisation" of employment, where there is a shift towards a service-orientated economy. It is thought that this may lead some men feeling like they have less of a purpose in the professional world. It is also hypothesised that men may feel as if they’ve lost a sense of masculine identity and male 'pride'.

The authors highlight that we do not yet know enough about the actual 'psychological routes' that lead to depression in men and suicide. For example, we do not know why or how personal problems, financial difficulties etc. lead to suicide more often in men than women.

One suggestion from the study is to develop effective interventions for young boys at risk as many of the patterns seen to lead to suicide in middle age often begin in youth.

How can counselling help?

The high rate of male suicide illustrated in the above section points to a concern that men are less willing to seek counselling than women. So, why is this? Experts agree that it is likely to be a combination of factors, from society's expectation of 'men' to a desire to solve one's own problems.

Mental health charities and the media have looked to change the stigma surrounding mental health and particularly the stigma of asking for support. The truth is, all of us need the support of others at some point in our lives - regardless of gender.

Talk therapy has been shown to help with many of the key mental health issues experienced by men, including stress, anxiety, addiction and depression. The key is recognising that you need support and seeking help before these problems get on top of you.