December is National Impaired Driving Prevention Month

December 2010

By presidential proclamation, December is National Impaired Driving Prevention Month. This month seems particularly suited to this observation because traffic fatalities that involve impaired drivers increase significantly during the Christmas and New Year’s holiday periods.[i] But impaired driving is a roadway hazard that exists throughout the year. In 2009, nearly 11,000 people were killed in crashes involving impaired drivers[ii]—or about one death every 49 minutes. As a Nation, as communities, and as individuals, we need to take stronger action to help ensure that our roads and those who drive on them remain safe throughout the holidays and every day.

In an average year, 30 million Americans drive drunk, and 10 million Americans drive drugged. SAMHSA’s new survey on impaired driving, State Estimates of Drunk and Drugged Driving, found that nationally 13.2 percent of all people aged 16 or older drove under the influence of alcohol and 4.3 percent drove under the influence of illicit drugs during the past year. Some States recorded rates of drunk driving higher than 20 percent.

Furthermore, rates of impaired driving differed dramatically by age. While 11.8 percent of people aged 26 and older drove drunk, 19.5 percent of people aged 16 to 25 drove drunk. While 2.8 percent of the older group drove drugged, 11.4 percent of younger drivers did so.

President Barack Obama has made combating drugged driving a priority of drug control and has set a national goal of reducing drugged driving prevalence by 10 percent by 2015. To help achieve this goal, SAMHSA is working with the Office of National Drug Control Policy and the National Institute of Drug Abuse to develop standard screening methods to help detect the presence of drugs among drivers. SAMHSA also is advancing its primary strategic initiative: to prevent substance abuse and mental illnesses by creating prevention-prepared communities that can reduce the likelihood of these often-related problems and their consequences.

In issuing his proclamation, President Obama asked all Americans “to recommit to preventing the loss of life by practicing safe driving practices and reminding others to be sober, drug free, and safe on the road.” Talk openly about this issue and set a good example for others, especially young people, by making “one for the road” a nonalcoholic beverage. For evidence-based approaches on preventing underage drinking, visit the Too Smart To Start and Stop Underage Drinking Portal of Federal Resources Web sites.

SAMHSA wishes a safe and healthy new year in 2011 to all.


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[i] National Highway Traffic Safety Administration. (2007). Fatalities related to alcohol-impaired driving during the Christmas and New Year’s Day holiday periods. Traffic Safety Facts. From

http://www-nrd.nhtsa.dot.gov/Pubs/810870.PDF (accessed December 16, 2010).

[ii] National Criminal Justice Reference Service, U.S. Department of Justice. (2010). Impaired driving. From http://www.ncjrs.gov/impaireddriving (accessed December 16, 2010).

MFT CEUs

Stress Less during the holidays

Too often, the holiday season is a very stressful time, followed by a post-holiday letdown that can take us the rest of the winter to recover from. Learn more about the causes of holiday stress and what you can do to avoid it. MFT Continuing Education
Causes of holiday stress
Many factors can contribute to holiday stress. Some of the most common include:

•Too much of a good thing: eating, drinking and spending too much. An overabundance of parties and gift-giving may lead people to eat, drink and be merry – often to excess. Overindulging in rich foods, alcohol and spending can burden many people with the additional stress of dealing with consequences (weight gain, memories of embarrassing behavior and debt) that linger after the season is over.

•Family fatigue: too much togetherness. The holidays are a time when families tend to gather. While this can be a wonderful thing, even the most close-knit families can overdose on togetherness, making it hard for family members to maintain a healthy balance between family-time and alone-time.

•Not enough togetherness. For those who don’t have family, loneliness can be just as difficult. When everyone else seems to be getting together with family, those who rely more on friends for support can feel left out and alone.

•SAD can make you sad. As daylight diminishes and the weather causes many of us to spend more time indoors, many people are affected to some degree by a type of depression known as seasonal affective disorder (SAD). It’s a subtle, but very real condition that can be a source of stress and unhappiness during a time when people expect to feel just the opposite.

Minimizing holiday stress

Unlike many other types of stress, holiday stress is predictable. We can make plans to reduce the amount of stress we experience and the impact it has on us. Here are some tips to help you reduce holiday stress:

•Set your priorities. The flurry of baking, shopping, sending cards, visiting relatives and other activities can leave you exhausted by January. Pick a few favorite activities and really enjoy them. Skip the rest.

•Cut corners. If you can’t imagine the idea of skipping all some of the activities that usually run you ragged, find ways to simplify. For example, only send cards to those you’re in regular contact with or don’t include a personal note in each one.

•Watch your finances. Before you go shopping, plan a reasonable budget for holiday spending. Then, stick to your budget. King County’s Making Life Easier Program can help. The program offers financial consultation on issues such as budgeting and financial planning and 8 free counseling sessions with a licensed professional per problem per year.

•Change your expectations for togetherness. Think back to previous years and try to pinpoint the amount of togetherness with family and friends you can handle before feeling stressed out. Then, look for ways to minimize the stress. Try limiting the number of parties you attend or the time you spend at each. Or, reduce the time you spend with family to an amount that will feel special without leaving you exhausted.

•Nurture your heart. If holidays tend to make you feel lonely or depressed, make plans to meet with a friend, spiritual leader or counselor to get the support you need. If virtually everyone you know is with family during the holidays, consider volunteering to help others. Helping others can be rewarding and help fill the void you may be feeling.

•Take care of yourself. Your holiday plans should include steps to take care of your physical and emotional health. Remember to get enough sleep and eat nutritiously. Also, be sure to exercise daily if possible. Exercise and exposure to daylight can help reduce or even eliminate the symptoms of SAD.

Seasonal Affective Disorder

Seasonal affective disorder (SAD), also known as winter depression or winter blues, is a mood disorder in which people who have normal mental health throughout most of the year, experience depressive symptoms in the winter or, less frequently, in the summer,spring or autumn, repeatedly, year after year. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), SAD is not a unique mood disorder, but is "a specifier of major depression". Once regarded skeptically by the experts, seasonal affective disorder is now well established. Epidemiological studies estimate that its prevalence in the adult population of the US ranges from 1.4 percent (Florida) to 9.7 percent (New Hampshire). Social Worker Continuing Education
The US National Library of Medicine notes that "some people experience a serious mood change when the seasons change. They may sleep too much, have little energy, and may also feel depressed. Though symptoms can be severe, they usually clear up."[4] The condition in the summer is often referred to as reverse seasonal affective disorder, and can also include heightened anxiety.

SAD was first formally described and named in 1984 by Norman E. Rosenthal and colleagues at the National Institute of Mental Health.

There are many different treatments for classic (winter-based) seasonal affective disorder, including light therapy with sunlight or bright lights, antidepressant medication, cognitive-behavioral therapy, ionized-air administration,and carefully timed supplementation of the hormone melatonin.

Symptoms

Symptoms of SAD may consist of difficulty waking up in the morning, morning sickness, tendency to oversleep as well as to overeat, and especially a craving for carbohydrates, which leads to weight gain. Other symptoms include a lack of energy, difficulty concentrating on completing tasks, and withdrawal from friends, family, and social activities. All of this leads to the depression, pessimistic feelings of hopelessness, and lack of pleasure which characterize a person suffering from this disorder.

Diagnostic criteria

According to the American Psychiatric Association DSM-IV criteria, Seasonal Affective Disorder is not regarded as a separate disorder. It is called a "course specifier" and may be applied as an added description to the pattern of major depressive episodes in patients with major depressive disorder or patients with bipolar disorder. The "Seasonal Pattern Specifier" must meet four criteria: depressive episodes at a particular time of the year; remissions or mania/hypomania at a characteristic time of year; these patterns must have lasted two years with no nonseasonal major depressive episodes during that same period; and these seasonal depressive episodes outnumber other depressive episodes throughout the patient's lifetime. The Mayo Clinic describes three types of SAD, each with its own set of symptoms. In the popular culture, sometimes the term "seasonal affective disorder" is applied inaccurately to the normal shift to lower energy levels in winter, leading people to believe they have a physical problem that should be addressed with various therapies or drugs.

Physiology

Seasonal mood variations are believed to be related to light. An argument for this view is the effectiveness of bright-light therapy. SAD is measurably present at latitudes in the Arctic region, such as Finland (64º 00´N) where the rate of SAD is 9.5%. Cloud cover may contribute to the negative effects of SAD.

The symptoms of SAD mimic those of dysthymia or even major depressive disorder. There is also potential risk of suicide in some patients experiencing SAD. One study reports 6-35% of sufferers required hospitalization during one period of illness. At times, patients may not feel depressed, but rather lack energy to perform everyday activities.

Various proximate causes have been proposed. One possibility is that SAD is related to a lack of serotonin, and serotonin polymorphisms could play a role in SAD, although this has been disputed. Mice incapable of turning serotonin into N-acetylserotonin (by Serotonin N-acetyltransferase) appear to express "depression-like" behavior, and antidepressants such as fluoxetine increase the amount of the enzyme Serotonin N-acetyltransferase, resulting in an antidepressant-like effect. Another theory is that the cause may be related to melatonin which is produced in dim light and darkness by the pineal gland, since there are direct connections, via the retinohypothalamic tract and the suprachiasmatic nucleus, between the retina and the pineal gland.

Subsyndromal Seasonal Affective Disorder is a milder form of SAD experienced by an estimated 14.3% (vs. 6.1% SAD) of the U.S. population. The blue feeling experienced by both SAD and SSAD sufferers can usually be dampened or extinguished by exercise and increased outdoor activity, particularly on sunny days, resulting in increased solar exposure. Connections between human mood, as well as energy levels, and the seasons are well documented, even in healthy individuals. Mutation of a gene expressing melanopsin has been implicated in the risk of having Seasonal Affective Disorder.

Take Your Holiday Spirit into the New Year by Linda Davis

The holiday season is a time of great generosity as people reflect on the previous year, think about why they are thankful, and look for ways to support those in need. It is important to remember that homelessness organizations need your help year-round. When you feel like donating your time or money this holiday season, consider waiting until another time next year. If you are a provider, don’t be afraid to ask volunteers and donors to extend their generosity into the New Year. Here are some ideas. Content:

Consider throwing a holiday party at a local homeless service agency in January, February or March, rather than in November or December. The holidays are often a time of abundance for these programs. Many special meals, donations and services are provided by an army of volunteers that are eagerly anticipated, and soon disappear after December.

If you are considering volunteering during the holiday season, why not put it off until later in the winter, or even in the spring or summer? The months after the holidays can be especially trying for people who are homeless and your volunteer efforts would be a true gift.

At any time of year, join forces with colleagues from work, civic groups or spiritual communities. You could create and serve meals, develop care packages, or raise money to help a family with first and last month’s rent and a security deposit.

Not sure what to do and when to do it? Contact your local homeless service provider network. Decide which program you want to support and contact them to determine what they need, and when it would be most helpful.

Here are some links to help you do your holiday homework:

Continuum of Care Contacts (organized by state/region):
http://hudhre.info

United Way:
www.211.org

VolunteerMatch
www.volunteermatch.org

Idealist
www.idealist.org

Volunteers are essential to many homeless service agencies. Whether you are new to an organization or a seasoned pro, these tips will help you to make the most of your time as a volunteer. If your organization counts on volunteers, share these tips with the team – and add your own! Social Worker Continuing Education
1. Dress comfortably.
You will probably be on your feet so make sure that your shoes and clothes can go the distance.

2. Show up on time and ready to work.
Chances are your program relies on volunteers, so be punctual and let someone know when you will be late or absent.

3. Let your supervisor know when you arrive.
Even if you are a regular volunteer, check in at the beginning of your shift to find out where you can pitch in.

4. Don’t be afraid to ask questions.
Staff appreciate the gift of your time and want you to feel comfortable. Asking questions helps to clarify expectations for everyone.

5. Know where and when to have conversations with consumers and staff.
Many programs have rules about loitering in certain areas and prefer that volunteers finish their assigned tasks before spending time talking with consumers and team members.

6. Be open-minded.
As a volunteer, you may be asked to assist with a variety of tasks, depending on the changing needs of your agency. Don’t be afraid to step outside of your comfort zone and try something new.

7. Know your boundaries.
Burnout is an issue for direct service providers and volunteers. Be a sensitive listener, but understand the limitations of your role. Volunteers are not expected to do the work of case managers or clinicians.

8. Have a sense of humor.
Working in homeless services brings many challenges and rewards. When you are faced with a tough situation, a little humor goes a long way.

9. Don’t be afraid to make suggestions.
You bring a different perspective that can be very valuable.

10. Remember that your contribution matters.

Winter Wellness Planner

Developed by CSP-NJ Institute for Wellness 2
and Recovery Initiatives – John Garafano, BS, CPRP, CFT , Jay Yudof, MS, CPRP & Peggy Swarbrick, PhD, OT,CPRP -December 2010

Winter Memories

Many of us may have good memories of winter/holiday gatherings, and/or outdoor winter recreation. Some people face challenges including isolation, limited ability to exercise, memories of losses, overeating, and overspending. This wellness planner is designed to help you plan ahead so you can maintain a sense of wellness during the winter season.

Describe a positive winter memory.
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What do you see as the benefits of the winter season?
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Holidays

The holiday season, (the holidays) is an annual festive period. Various studies have shown that the winter holiday season can have some impacts on health (social, emotional, physical etc).

What do you like to do during the Holiday Season?
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How do you celebrate the Holiday season?
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Winter Challenges

Winter is the coldest season of the year in temperate climate, between autumn and spring. At the winter solstice, the days are shortest and the nights are longest, with days lengthening as the season progresses after the solstice.
Challenges during the holidays Many holidays occur during the winter months when people are already more susceptible to the common cold, flu, and depressed mood Holidays usually involve the obligation of spending money on gifts or food Alcohol is typically served during holiday functions which can be a trigger for some Holiday travel can be a major source of contention and stress. Dealing with traffic and the short-tempers of other travelers can also be quite challenging Social anxiety may be heightened when we are invited to parties with large gatherings of people.

General Stressors and Triggers

Physical
o Diet and nutrition, physical activity, sleep, Emotional
o Losses may impact harder during winter time Social
o Too much stimuli or may not have a support network so sense of loneliness becomes overwhelming
o Drinking can be a trigger for some people Financial
o Spending can become out of control Spiritual
o Sense of purpose and meaning can be impacted Occupational
o Work routines are altered which can impact rhythm and – over or under productive

What triggers do you face during the holidays?
(Examples include large groups of people, overspending, and alcohol at parties)
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5.

List supporters and how you can connect with them during the holidays?
Supporter Methods to Connect
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Diet and Nutrition Eat several small meals so that you are not starving when it comes time to eat a holiday feast. Drink water before your meal so that you get full faster. Watch portions. Aim to eat mostly vegetables and fruit on your plate and opt out of breads and biscuits. Opt for water instead of soda, alcoholic beverages, or caffeinated drinks. Be aware that many of us get less fresh fruit and vegetables during winter months – look for healthy ways to replace these vital nutrients.
Physical Activity and Environment: Walk around a mall with friends Join an exercise class or fitness group in the community Clean your living area Enjoy outdoor winter activities Exercise extra care to prevent slips and other winter injuries, and make sure that kids and elders do the same Health Care Practice good prevention for colds and flu such as frequent hand washing If you follow self-management for a chronic health condition, don’t let holiday events, meals. Travel, etc. let you get derailed
Family, Friends, and Supporters: Consider who in your support network is a positive supporter and who might be unhealthy for you Decide on how much socialization time you need in order to feel well Make holiday get-togethers a positive opportunity to renew acquaintances with family and friends you may not see or speak with very often Make attempts to “give back” whenever possible

Finances: Plan ahead in terms of spending and know your limits Consider ways to give gifts other than spending money

Rest/Relaxation: Know your limits and plan ahead for proper balance of sleep, relaxation, and activity. Try to get enough sleep/rest each night, and avoid oversleeping during the winter months

Spiritual: Attend spiritual gatherings and celebrate in the holiday season Find ways to express gratitude each day

Expressive Art: Art can be a great way to express yourself during the holidays Consider attending a museum or holiday light show Attend a play with a holiday theme Think about combining friends/family and expressive arts – do a project or go to a show with some of the kids (young and old) in your life. MFT Continuing Education
When considering our holiday/winter wellness, it is a good idea to think of the self-care practices that we need in order to feel well and maintain/improve our overall health status. Activities like exercise, spiritual connection, social contact, and reading can all be tools that help us to stay well during the winter season. List your top five strategies for staying well this season:

Wellness Strategy How often I will do it When I will start
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Coping with Grief During the Holidays

For many people who have experienced a loss, holidays can be a very difficult time. "If only I can get through the holidays" is often a continued refrain during this season. In the roller coaster of grief, holidays are, for many people, a low point.

According to the Hospice Foundation of America, there are many reasons why the holidays can be so difficult. Kenneth Doka says the holidays are full of memories. We often pause to reflect on all the holiday experiences we've had, both good and bad. We remember all the people who have been part of our lives.

Second, holidays are not only times for past memories, but for fantasies of the present and future, as well. As we shop, we may see things that would be perfect gifts for the person who has died. We envision how that person would be so delighted when the gift is opened.

Third, holidays are stressful. There are so many things to do and so much to accomplish. In a time when one is already experiencing low energy, this can be overwhelming.

Finally, we can feel out of sorts with the season. Everyone seems so happy and cheerful; it is easy to feel alone. Recognizing that the holidays can be painful often helps ease that sense of isolation. We can acknowledge that this is a normal reaction to grief.

There are strategies to make holidays easier. They won't take your grief away, but they may help.

1. Be kind to yourself. Only do as much as you can comfortably manage. Honor your own feeling and needs.

2. Express your feelings. According to Judy Tatelbaum, the surest road through grief is to feel it, not deny it. When you are hurting, the best advice is cry if you need to cry.

3. Ask for what you need. If you want privacy or companionship or a shoulder to cry on, say so. Other people don't know how you feel unless you tell them. Helping you can be satisfying for someone else.

4. Don't overwhelm or over commit yourself. Give yourself a reprieve. Take time for yourself and take care of yourself. Take it slow and easy.
MFT Continuing Education

Coping with the Holidays After the Death of a Loved One or when you Are a Victim/Crime Survivor

You Can Make It Through the Holidays
Many among us have struggled with the cloud of sadness that may surround the holidays when a friend or family has experienced a tragedy such as a sudden violent death or a serious physical or emotional injury. The onslaught of holiday cheer may seem too much to bear. Holidays may give rise to new or returning bouts of depression, panic attacks, and other forms of anxiety for those whose lives have been affected. Victims of crime, family members, friends, and work colleagues may re-experience life-changing traumas through flashbacks, nightmares, and overwhelming sadness. Some have trouble sleeping, while others don't want to get out of bed. Tears may come easily, often when least expected. Old ailments, including headaches, gastrointestinal problems, and other aches and pains may return.

Many victims and families, however, have found that holidays can be manageable if they take charge of the season, rather than letting it take charge of them.

Families who have made this difficult journey offer some suggestions to help those who may be just starting down this path.

Change Traditions

Trying to make this holiday seem like holidays of the past can intensify the difference. Gather the family together early and decide which traditions to keep and which to let go. Change holiday plans to accommodate the needs and wishes of those who are hurting the most. Pay particular attention to the physical needs of someone who has acquired a disability as a result of victimization.

Create a Special Tribute

Some families light a special candle and place it on a holiday table to honor the memory of a loved one who has died. Others keep a chair empty and place a flower or other memorial on the seat. Some write treasured remembrances and place them on a special plate or in a bowl for those who wish to read them. Families of a surviving victim may want to honor that person by openly expressing gratitude for his or her presence.

Consider Carefully Where to Spend the Holidays

Many people think going away will make the holidays easier. This may be helpful if you are traveling to a place where you will feel loved and nurtured. However, if travel is arranged as a means of trying to avoid the holiday atmosphere, remember that American holidays are celebrated throughout this country and in many parts of the world. It is impossible to escape holiday reminders.

Accept grieving friends and family members as they are; don't try to tell them how they should feel or state that you "understand" how they feel. Focus on giving unconditional support.

Balance Solitude With Sociability

Rest and solitude can help renew strength. Friends and family, however, can be a wonderful source of support. If you are invited to holiday outings, make an effort to go. Attend concerts or other cultural events that lift your spirits. You may surprise yourself by enjoying special outings, even if you feel like crying later.

Relive Fond Memories

Attempting to go through the holidays pretending that nothing has happened can be a heavy and unrealistic burden. Think about holiday seasons you have enjoyed in the past and identify memories you want to hold in your heart forever. No one can take those away from you. Celebrate them and be grateful. If feelings of sadness pop up at inappropriate times, such as at work or in a public gathering, try thinking about what you have, rather than what you have lost. Focus on the blessing of the memories in your heart.

Set Aside Some "Letting Go" Time

Schedule time to be alone and release sad and lonely, pent-up feelings. You may want to cry or write about your thoughts and feelings. If someone has died, you may choose to write a letter to say "goodbye," "I love you," or "I'm sorry." Even though it may feel strange, allow your loved one to write back to you through your pen. You may be surprised at what you write. By setting aside special times to allow painful feelings to surface, it becomes easier to postpone expressing them in public.

Counter the Conspiracy of Silence

Family members may consciously or unconsciously conspire to avoid mentioning the tragedy in your family. This is usually a well-intentioned but misguided attempt to protect your feelings. If this seems to be happening, take the initiative and talk to your family about the importance of talking openly about what has happened and sharing your feelings of loss or sadness. Encourage them to tell stories about your loved one and to look for opportunities to refer to him or her by name.
LPC Continuing Education
Notice the Positive

Some people conclude that facing the holidays is simply "awful." But deciding prematurely that "everything about life is awful" is too strong a generalization from a personal tragedy. Although you may have difficult times during the holidays, you also may experience joy. Accept the love and care of others. Reach out to someone else who is suffering. Give yourself permission to feel sad and to experience joy.

Consider shopping online as an alternative to the frenzy of mall shopping-but don't try to "buy" your way out of sad feelings.


Find a Creative Outlet

If you have difficulty talking about your feelings, look for a creative way to express yourself. Write a poem or story that you can share with others. Buy watercolors or oils and put your feelings on paper or canvas, even if only splashes of color. Contribute to a favorite charity or organization in your loved one's memory-either financially or by volunteering to help. Buy gifts for less fortunate children, a hospital, or a nursing home.

Remember the Children

Listen to them. Celebrate them. Cherish them.

Children may have deep feelings that can be overlooked if you spend all your time focusing on yourself. Putting up holiday decorations can be a draining emotional experience, but these symbols are very significant to children. A friend or relative likely will be happy to help decorate or purchase and wrap gifts.


Protect Your Health

Physical and emotional stress changes the chemical balance in your system and can make you ill. Eat healthy food and avoid over-indulging in sweets. Drink plenty of water, even if you don't feel thirsty. Avoid alcohol, which can be a depressant. Take a multivitamin. Get 7 to 8 hours of sleep each night. Talk with your doctor about an antidepressant or anti-anxiety medication if you think it will help. If you are unsure how a medication will affect you, talk to your doctor about your concerns.


The most valuable help usually comes from someone who shares a common experience or understands something about what you're going through.


Call Upon Available Resources

People of faith are encouraged to observe services and rituals offered by their church, synagogue, mosque, temple, or other faith community. Many "veterans of faith" offer serenity, a quiet presence, and healing wisdom. You may want to look for a support group of persons who have suffered similar experiences. The Mental Health America has affiliates around the Nation that keep lists of such local groups. If a group does not exist in your area, you can establish your own short-term group to focus on getting through the holidays. Spend as much time as possible with the people you love the most.

Most important, remember that you can't change the past, but you can take charge of the present and shape the future.