The entries in this blog are about psychology. I have to confess, however, that many current political events make me want to apply psychological coping principles to them. I mean let’s face it, the Tweeter-in-Chief is a psychological gold mine! Still, I try to resist because I don’t want to drift into partisan political discussions.

A recent conversation with a friend who works in the mental health field, however, is causing me to rethink my position about politics and psychological coping. My friend mentioned that conversations with her colleagues — counselors, psychologists, social workers, psychiatrists, etc., — reveal a disturbing trend. The professionals are finding a mushrooming of anxiety-based problems that are driving more folks to therapy and to psychiatric medication. International pressures, health insurance, suspicious shenanigans of a partisan election fraud committee, the emotional stability of our leadership…….these and other issues are weighing heavily on a growing number of people.

Worse yet, as the anxiety infects more and more on a daily basis, professionals find their clients are beginning to disengage, give up, and withdraw. Any undergraduate student of psychology, and readers of our blog entries, will recognize that this sequence of fear, learned helplessness, and withdrawal inevitably leads to serious psychological consequences, notably depression.

Should this psychological descent into despair and depression continue to expand at a national level, we will have a serious problem. Not only will our fellow citizens be troubled with personal crises, but they will also become more vulnerable to messages from powerful others who tell them, “I have the answer.” They will succumb to the most convincing propaganda, and our government of checks and balances bound by Constitutional laws could be damaged.

We’re not really talking partisan politics here, folks. That has been a reality since the days of Adams and Jefferson and the other Founders. No, we’re talking about facing up to, coping with, pressures being put in place to sow psychological distress in the populace and make people more malleable.

You might wonder, “If this psychological undermining is so manifest, why aren’t the TV ‘talking heads’ and others talking about it?” Good question! All I can say is, as events continue to unfold I will more readily offer possible psychological explanations for what is going on, in the hopes of giving readers specific coping possibilities to combat tendencies to feel helplessness and to refuse to withdraw from it all. Many of our previous blog entries, of course, provide such coping suggestions.

There is absolutely no reason, psychologically speaking, that any of us cannot find appropriate coping actions to determine the aspects of any situation that we can control, and develop actions to effect change. That may be our new challenge at a national level. I bet many of you have some suggestions to make along these lines.


I recently received an email from a former student who reads our blog now and then. I  modified some details in the email to protect the individual’s identity, and have permission to share the story on the blog.

“Hey DrB. Give me some advice on coping with my crazy supervisor. She’s in her late 60s and all of us in her department are hoping every day that she’ll retire. She thinks she is god’s gift — I have never seen such an ego. She’s paranoid as hell, always sending out emails to someone and accusing them of trying to undercut her. Recently she told me, ‘Make sure you come to me; I don’t want to see you talking to (her supervisor) and bad mouthing me.’ She’s overweight and is beginning to harass everyone about losing weight. Yesterday she sent out an email telling us all about the weight program she has joined and suggested we all join her. She’s a germ phobe. The other day I handed her a report she wanted from me and she put it down on her desk and proceeded to lather up her hands with sanitizer. This woman is a walking case study, DrB. Any thoughts? We’re all scared to death and worried she can fire us and even ruin our careers. I remember enough from my psyc major to know that she’s not likely to change, right? Actually, she’ll probably get worse, right?”

She sounds a lot like J. Edgar Hoover, Director of the FBI for decades, who struck fear into US Presidents! OCD about germs and weight, paranoia, narcissism. I would be walking on egg shells, too! I agree with you that she’s not likely to change and that her issues are likely to get worse as you said. I would assume she is watching all her workers quite closely, maybe even monitoring emails. So be vigilant and cautious. Like Hoover she may have a special file (enemies list) on each worker to use either to get you fired or to blackmail you into giving her unqualified support.

I don’t think I would disagree with anything you said. Her power, anger, internal insecurities, paranoia, narcissism, OCD tendencies and lord knows what else are toxic combinations. Those tendencies will likely expand and intensify. She will possibly go to any lengths to get her way and use you. So go the sycophant road and “kiss butt.” When she mentions the weight say how much your (spouse) has lost and that your whole family is more aware of their health. Be careful whom you talk to at work; assume that your emails are not private; keep a detailed log of all your work meetings, both with her and others. Watch your back, keep your head down, and keep detailed records.

It would be nice to do a job search, too, and get your resume’ out there. Of course, if vicious supervisor learns of it, you’re dead meat!


This posting is provided by Michael Mariano a Licensed Professional Counselor and a Licensed Clinical Alcohol and Drug Counselor. He has worked at First Hospital Wyoming Valley in Pennsylvania, Beth Israel Medical Center Methadone Maintenance Treatment Program in New York City, and is currently at Bergen Regional Medical Center in Northeast New Jersey.


The strong stigma our society attaches to drug and alcohol addiction often deters victims from seeking treatment. You must remember that addiction is a disease, not a moral failing. Both sufferers and family and friends must resist seeing addiction as moral weakness. Doing so will make recovery nearly impossible. Advocating for more funding and services for those suffering from addiction is paramount. The prison system jail primarily those suffering from substance abuse issues and receive little treatment with poor

reintegration programs that are understaffed. Majority of addicts don’t need jail time, they need treatment to give them the skills and support to live a healthier more productive life.

The addiction stigma often extends to even among those who treat them. Working in the addiction field can be extremely difficult and frustrating. If those aren’t empathetic when working in the field of addiction they don’t usually last long working in the field. I have learned that genuine compassion is what allows someone to be more open and receptive to treatment.  I have heard others say, “Oh, they are an addict or alcoholic. I don’t deal with those types.” Such comments overlook the reality that the addict has untapped potential that are stifled by their substance abuse.

These are not morally corrupt victims; they are sufferers who have taken an inappropriate coping path, and who need help getting on a path to recovery. Before that is possible, however, they need compassion to help them deal with their feelings of fear, anxiety, depression, helplessness, and despair. Helping such victims is not easy. Unfortunately, without support and empathy, sufferers are more likely to relapse, which will bring more suffering for them, family and friends, and the larger community. I encourage you to continue educating yourself and others on how addicts deserve your empathy and understanding of their struggles.

If you think you have a problem with drugs or alcohol, or if you just want to have a more fulfilling life, I encourage you to seek treatment as soon as possible. Addiction provides instant gratification for long-term suffering, and recovery is a long uphill battle. There are a variety of treatments that are free or covered by most insurance plans.

Regardless of your level of motivation to quit using drugs and alcohol, I encourage everyone to attend an open self-help meeting. This action will allow you to be exposed to many other people you may be able to identify with. You will see how social support and compassion is valuable in an atmosphere of understanding, not one of criticism over moral shortcomings.

Addiction Counseling Resources

SAMHSA’s National Hotline 1-800-662-HELP (4357)


Recently I attended a high school graduation ceremony. The class president and also valedictorian was making his speech. I noticed that he began speaking critically about the school administration and how it abused its authority with an authoritarian style that tended to ignore student opinion. He complained that unnecessary restrictions were placed on the students, restrictions that tended to stifle students’ right to be heard and their educational development. Suddenly, his microphone went dead. A school official approached and told him to stop the speech, and the student proceeded to walk off stage. Most of the students appeared to cheer their president, as did many in the audience.

The event burst on social media and also went national with coverage on outlets like CNN, The New York Times, and The Washington Post. The student was also interviewed on Jimmy Kimmel Live. I found all this attention interesting, a relatively small occurrence  gaining such national attention. It all raised a lot of questions in my mind, though.

Some say the school essentially censored the student. Hmm. Maybe. But perhaps there was some justification. The student admitted he had to submit a speech for prior approval, but he did not include the brief critical section, knowing the administration would not approve it. During the speech he chose to go off-script, clearly violating the stated arrangement. This is interesting!

Our system includes many Constitutional freedoms bestowed on an individual, such as freedom of speech, and we value them dearly. But then again, “There is a time and a place for everything.” Why did he choose to make his point at a ceremony honoring the graduates and their families?

I also can’t help but wonder if the entire class agreed with him. In fact, I doubt many even knew of his plan other than a few classmates really close to him. Seems as though he kept everything “close to the vest,” knowing that he might get shut down. Could this be a bit of self-indulgence on his part? Of course, if he wanted maximum exposure for his point, he sure succeeded.

How about the school officials? One could argue they had every right to shut him down because he intentionally “blindsided” them by going off-script. He chose to do what he wanted to do instead of honoring the previously-arranged agreement (standard procedure at the school).

Many will give this young man a pat on the back for this, highlighting his gusto and fervor. They might also note that the school officials missed a great “teaching moment.” What are we teaching here? What is the real message? Do we tell our youth that rules and authority matter? Or, should freedom of speech be held to the highest importance, and in some circumstances rules and authority don’t matter? If we have a point to make, should we not make it despite circumstances and prior arrangements? It is something to think about here.

All these questions make me wonder about the messages we are sending our youth, and the future implications of these from an aggregate viewpoint. Maybe this is small potatoes in the scope of larger issues going on around us today, but maybe not. Is there an accumulation of messages all around us that is potentially shaping the future society we live in? Is the aggregate message healthy or not? Things to consider.  I look forward to any feedback.

FYI, following link includes a video of Kimmel’s interview, plus the text of the speech that was almost delivered.


This posting is provided by Michael Mariano a Licensed Professional Counselor and a Licensed Clinical Alcohol and Drug Counselor. He has worked at First Hospital Wyoming Valley in Pennsylvania, Beth Israel Medical Center Methadone Maintenance Treatment Program in New York City, and is currently at Bergen Regional Medical Center in Northeast New Jersey.

No counseling program for drug/alcohol addiction will work without a committed and motivated client. Family members who drag the addict kicking and screaming into counseling learn this harsh fact very quickly. If, however, you are convinced you have a drug problem and are ready to devote yourself to hard work in dealing with the problem, there are many successful counseling/rehab programs and strategies that can serve you well.

Medically Managed Intensive Residential Treatment. This level of care is what most programs call “detox.” There are some drugs such as cocaine, marijuana, and hallucinogens that don’t have physical withdrawal symptoms and thus don’t require this level of care. However, those who actively use opioids (Heroin, Percocet, Codeine), alcohol, and benzodiazepines (Xanax, Klonopin, Ativan) require this level of care before they are referred to any other program because these substances result not only in painful withdrawals, but can be fatal.

Residential Inpatient Treatment. This level of care can be anywhere from 14 days to a year depending on type of payment for services, willingness to remain in treatment, access to available treatment, and appropriateness. Short term programs are typically 14 to 60 days. Any program more than two months is long-term treatment. These programs are in controlled environments that involve a structured schedule of group and individual counseling, recreational therapy, self-help meetings, and possibly psychiatric medication under the care of a psychiatrist.

Intensive Outpatient (IOP) and/or Partial Hospitalization Program (PHP).  IOP programs are mostly 3 days a week 3 hours a day. They include group and individual counseling, random drug testing, and weekly Alcoholics- and/or Narcotics-Anonymous meetings. PHPs are mostly 5 days a week 8 hours a day with group and individual counseling,  random drug testing, required weekly AA or NA meetings, medication management, transportation, and meals. Both of these programs typically have step procedures, which is when the treatment team determines someone no longer has to come to a day of treatment because they are making progress. PHPs are appropriate if you have mental health issues like depression, bipolar disorder, or schizophrenia.

Outpatient Counseling. Outpatient treatment is a one day session that focuses on relapse prevention, medication management, and random drug testing to help victims maintain their recovery. I have found that most clients also benefit greatly from individual counseling.

Early Intervention. The purpose of this level of care is to take preventive measures to reduce the probability of addiction, and to engage those with early substance abuse issues. For example, I have conducted outreach programs at high schools to increase drug and alcohol awareness. It is especially important with teenagers to show them how to identify problematic drug use and get help.

Self-Help Meetings. Some individuals are able to detox on their own and attend self-help meetings such as Alcoholics or Narcotics Anonymous. In my opinion, most of these folks should also get professional help to identify unresolved conflicts that are causing their addictive actions. We noted some of these issues earlier under risk factors. Many of them, like schizophrenia or sexual abuse, can be quite complex and require the assistance of a trained mental health professional to deal with them.

Mindfulness Exercises . Mindfulness can be loosely defined as being aware, focusing on the present, and approaching that moment with compassion. The more we are mindful, the less we are mindless. When we are able to focus on the present, the more we have control in our choices. I have taught many clients meditative practices from breathing exercises to full body scans to strengthen their mind-body connection. Most individuals in substance abuse treatment crave instant gratification, and I have had individuals with decades of drugs and alcohol abuse feel relaxed after a 40-minute meditation session. Often clients tell me that they are able to relax for the first time without an outside substance.

Medication Assisted Therapy. This approach uses medication like suboxone or methadone while engaged in counseling. Vivitrol can also help addicts maintain their sobriety while in an outpatient treatment. Whatever the medication used, the client must also be engaged in some form of additional treatment to receive the full benefit.

Relapse Prevention Plan. Recovering addicts must acquire the tools to help them deal with the stress of everyday life. You can start your own plan by identifying triggers to substance abuse that are around you, such as particular people, places, things, and emotions. You can also work on developing coping skills like those covered in this blog to help you avoid a relapse. It is important to remember, however, that following a prevention plan does not give you permission to relapse any more than wearing a seatbelt  gives you permission to get in an accident.

No matter what your program, it is important for your recovery to find and nurture meaningful connections with others. Such connections will greatly facilitate your recovery. It is basic human nature to want to feel needed and loved. Feeling connected to those around you, whether in group therapy or life in general, will keep you motivated toward your goals. In self-help groups like AA and NA, getting a trusted and supportive sponsor is an essential step in helping you feel connected. Those feelings will make you more engaged in your recovery and at a lower risk of relapse. Once you feel connected you will feel more open and honest in your communication with others. Throughout your recovery, having meaningful connections with others will give you support and validation needed when coping with cravings for drugs and alcohol.


A lady friend of ours just had new cabinets and countertop installed in her kitchen. The guaranteed two-week job stretched to nearly five weeks, and most days were filled with inactivity. You know the drill: “The supplier was out of parts.” “The plumber had an emergency call.” “A section of the granite was not cut right.”

In the fourth week our friend lost her patience, and told the contractor, “I am a company executive. I have overseen numerous construction projects at our facilities. I’m no novice and I’ve had it with this inefficiency. Get your crew moving and finish this job by the end of the week.” Two days later the job was complete.

We were helping our friend inspect the final product, and at one point she said, “You know, he deserves a taste of his own medicine. I think I’ll take a few weeks getting the final payment to him.” (The comment surprised me because this woman is not at all vindictive.)

She paused about ten seconds after the comment, and then added, “No, I won’t sit on it. That’s not who I am. I’ll mail the check tomorrow.”

“Not who I am.” I just nodded and smiled at her look in the mirror, and the resulting perfect example of effective coping. I imagine she slept well that night!


This posting is provided by Michael Mariano a Licensed Professional Counselor and a Licensed Clinical Alcohol and Drug Counselor. He has worked at First Hospital Wyoming Valley in Pennsylvania, Beth Israel Medical Center Methadone Maintenance Treatment Program in New York City, and is currently at Bergen Regional Medical Center in Northeast New Jersey.

Addiction can be loosely defined as a behavior that you cannot manage, is done impulsively, and results in major areas of your life becoming unmanageable. The longer and more often you use drugs and alcohol will make it increasingly more difficult to have a stable and healthy life.  

Most drugs are physically addicting (presence of physical withdrawals) while others are more psychologically addicting, such as cocaine and marijuana. No matter what the substance, recovery from addiction requires developing a recovery plan uniquely designed for you. Regardless of how you became addicted, there is a high probability it started with some form of physical, emotional, or spiritual pain. Other than that common core, there is no discrimination when it comes to addiction. I have treated those from all socio-economic backgrounds, races, ages, vocations, and educational levels.  

Addiction is a progressive disease that gets drastically worse before most sufferers seek treatment. It can start as innocently with having a drink after work to take the edge off a stressful day. Before you know it, whenever you feel stress you reach for a drink and develop a physical dependence. It can start from getting injured and receiving narcotic medication for pain. When the prescription runs out, you go through withdrawal symptoms and resort to buying them illicitly on the street.  

Street purchasing becomes expensive, and a “friend” tells you about heroin, how it is a fraction of the cost but with all the “bang.” The downward spiral begins into the pits of addiction, where many struggle and die before making it out alive. The facility where I work has lost over 30 patients in the last 5 years, mind you, this only accounts for those that we know of and only account for the ones that I have directly worked with. The number is much higher considering we lose over a 100 individuals a day to drugs and alcohol. Believe me when I say, we are dealing with a life and death issue that requires effective coping skills.

The more risk factors you have, the higher your risk for addiction. Here are some of the more common risk factors I have seen over the years: Lack of formal education, family history of drug and alcohol problems, poverty, lack of parental supervision, unstable parental relationships, sexual abuse when young (one of the strongest risks), and mental health issues. Three other clear warning signals are: using drugs at an early age, little social support from reliable friends and family, and a lack of available treatment programs and facilities. 

There are also protectors that can reduce and even cancel out the adverse effects of  risks. These are like a protective armor that shield and strengthen you. Examples would be: successful formal education, emotional support from a financially stable family, exposure to drug educational programs in school, engaging and healthy hobbies, social support from mentors and peers, self confidence, and presence of meaningful relationships. 

One of the hardest things about addiction is that it is almost impossible to treat if you don’t want the help. Finding that motivational kick is a highly individual matter, but again, many of the other entries in this book give you specific actions to take charge of your life. One thing is certain: the earlier you begin treatment, the better your prognosis for success.

 For many, the strongest motivator to seek help is the legal system. Unfortunately, that motivation usually lasts only as long as the legal issue itself. Fortunately there are other, more permanent strategies and I will discuss these in Part II.