Cognitive Behavioral Strategies

Lynne S. Gots, Ph.D.
Licensed Psychologist

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“Study Drugs” Give Meds a Bad Rap

By Lynne Gots, posted on November 28th, 2011.

When it comes to disseminating mental health information, newspapers often do more harm than good.  Take today’s Washington Post story headlined, “Colleges fear rise of study drugs.”

The story raises legitimate concerns about the abuse of prescription stimulants, most commonly Adderall, by students purchasing them illegally to gain an edge.  The drugs make it possible to stay awake and hyper-focus on studying. College students have always relied on chemical aids such as caffeine and energy drinks to pull all-nighters during exam crunch time.  But the increasing prevalence on campuses of students with diagnoses of ADHD (five percent of incoming freshmen, according to the article) and legitimate prescriptions for medications to manage it has made it much easier for undergraduates to score the drugs from the prescription cache of friends and roommates.

For the record, I’m not endorsing this practice.  But the way the Post article describes the medications does a disservice to those who have a legitimate need for them.  And it perpetuates an already pervasive, anti-medication bias in the media, which keeps many of my patients from taking advantage of the full range of treatment options available to them.

Although an analysis of drug and alcohol cases at DC-area universities revealed very few documented problems related to prescription stimulant medications compared to marijuana and alcohol, the reporter makes the following misleading statement:  “These prescription medications are similar to cocaine and can be addictive.”  She then goes on to contradict herself by adding that experts haven’t found a widespread crisis; nor are the rates of addiction increasing.  While it’s true that cocaine and the drugs prescribed for ADHD are both classified as stimulants, that’s pretty much where the similarities end.  Students are taking Adderall and Ritalin to hit the books, not to get high.

Suggesting that students use study drugs to help them catch up because too much partying causes them to fall behind in their schoolwork, the reporter cites a University of Maryland survey, which found that stimulant users had a lower GPA, studied less, socialized more, and missed more classes than non-users  But without knowing more about the study, you can’t draw any conclusions from these results.  Were the “users” taking the drugs illegally?  If so, were their grades and study habits compared to those who were prescribed the drugs for ADHD?  We know many people with ADHD also have learning disabilities and poor organizational skills, which medication alone does little to ameliorate. So it wouldn’t be surprising to find they goof off more and do worse academically than their more focused peers.

By far the most damaging assertion for those who need medication is that ADHD drugs may be “a kind of academic steroid.”  Unfortunately, this is a widespread misconception—one I’ve seen even among health professionals.

Consider the experience of a young relative of mine.  Although he was diagnosed with ADHD when he was seven, he didn’t start taking Adderall until his sophomore year of high school, when he and his parents decided it would make sense to try it.  He’d always been a very motivated student, but his poor attention and impulsivity interfered with his performance on tests.  After starting on the stimulant drug, his grades improved dramatically, and his self-esteem soared.  There was no doubt that the medication was extremely beneficial.  However, if he hadn’t already been serious about studying, it wouldn’t have enhanced his performance.  It simply removed the obstacles and leveled the playing field for him.

Yet when he went for his college physical, the pediatrician who’d been writing his prescriptions for three years made the steroid comparison and suggested he might try to get along without the drug.  The teenager felt embarrassed, as if he were being accused of cheating.  And, in fact, that’s exactly what the doctor was implying.

I doubt a physician would tell a college-bound youngster with diabetes to stop his insulin injections and work on controlling his blood sugar through diet and willpower alone.  So why does taking medication to correct faulty brain chemistry seem like a cop-out?

To be sure, stimulant medications are sometimes misused by students who don’t really need them.  But the advantages they confer are largely insignificant, not at all like the superhuman feats of strength made possible by steroid abuse.  To suggest otherwise is unfair to those who use stimulants as prescribed.  Maybe reporters need to pay more careful attention to these distinctions.

 

 

 

 

 

 

 

 

 

 





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Posted in Mental Health and the Media |

Are We Too Sensitive?

By Lynne Gots, posted on November 28th, 2011.

 

In my clinical practice, I specialize in treating Obsessive Compulsive Disorder and the so-called OC spectrum disorders. One of the most common is health anxiety, which is better known by the older and more negatively loaded term, “hypochondriasis.” Whatever you call it, this excessive worry about illness can overtake the lives of those who have it.

I can’t say for sure if the prevalence of health anxiety has increased in the last decade, but judging from my admittedly unscientific personal experience and a cursory scan of the data, it seems to be on the rise. In the days before the Internet, a person with health worries might have read the Merck manual to assess symptoms or gone to the doctor for reassurance. Now we’re all diagnosticians, taking cell phone photos of troublesome moles to compare with online examples of cancerous lesions, typing symptoms into WebMD, and using Internet forums to share stories about medical mishaps and exotic illnesses. But without the depth and breadth of information and the context for interpreting it that comes with medical training, it’s easy to misinterpret physical sensations and overestimate the seriousness of a problem or the likelihood of its occurrence.

I thought about this as I read a story in Sunday’s New York Times Magazine about how General Mills has jumped on the gluten-free bandwagon, using the latest health fad to kick start a marketing campaign for their GlutenFreely line of products. Celiac disease, the inability to digest the gluten found in wheat and several other grains, is a serious, even life-threatening, illness. It is five times more common today than it was fifty years ago, and an estimated 18 million Americans suffer from some degree of gluten sensitivity, if not full-blown celiac disease. But the explosion of gluten-free options on supermarket shelves and restaurant menus makes it seem even more prevalent.

For those with a true gluten sensitivity, this is a welcome trend. But for those prone to health anxiety, it’s just one more trigger for unnecessary worry. As the Times article points out, athletes have embraced the gluten-free diet, claiming it gives them more energy and enhances performance. So have several celebrities, including Gwyneth Paltrow, who touts it as a weight-loss method and Jenny McCarthy, who believes it cured her son’s autism. No matter that scientists dismiss such claims because there’s no research backing them. If you’re overly attuned to your body, as people with health anxiety are, you’re likely to focus on every physical sensation and are highly suggestible.  And if you buy into the celebrity endorsements—and a lot more people follow Us Weekly than the New England Journal of Medicine—going gluten-free will seem like a panacea for whatever ails you.

I’m a little embarrassed to admit to my own brief, three-day experiment with the gluten-free lifestyle. Drawn in by the promise of clear-headedness and boundless energy, I decided to test it out for myself. I replaced sandwiches with salads at lunch and pasta with potatoes at dinner. And for breakfast, I tried a great recipe I found in Bon Appetit for the Garmin cycling team’s gluten-free pancakes. My husband and I both agreed we felt less weighed down and more energized than we do after eating our usual whole wheat variety.

There was only one problem. The Garmin pancakes weren’t gluten-free. They contained spelt flour, which is a wheat product, and oat flour, which gluten-free purists eschew.

As it turned out, the regimen wasn’t for me. It made me feel deprived, which caused me to overindulge in too many inferior wheat substitutes, like peanut butter cookies made with teff flour. I’m back to eating pizza and muffins, and I feel much more satisfied, albeit a little more sluggish. But maybe that’s the result of Thanksgiving, not gluten.

Without a compelling medical reason to go gluten-free, proponents of this newest dietary trend may be showing symptoms of a sensitivity not to wheat, but to health concerns.  And for that, I’d say a gluten-free diet would be contraindicated.

 





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Posted in Mental Health and the Media |

Decisions, Decisions

By Lynne Gots, posted on November 23rd, 2011.

For tomorrow’s Thanksgiving dinner, I’m preparing three kinds of potatoes:  mashed, sweet, and roasted.  It’s my way of making everyone happy.  The mashed are for a first-time guest who’d feel homesick without them; the sweets (prepared with chipotles, not the conventional marshmallow topping) are a vehicle for me to try something different; and the roasted are for my husband, who won’t eat the other kinds.  This will create a decision overload for everyone else.  Buffets are like that, especially if you want to avoid piling your plate too high and regretting the food coma afterwards.

Research tells us the more options available to us, the harder it is to choose, even with trivial selections like shampoo (or Thanksgiving side dishes).   When consumers were presented with an array of gourmet jams, they were less likely to purchase a jar if they had 28 varieties to choose from than if they had only six.  We enjoy having an extensive range of options at our disposal.  But when we have too many choices, we’re likely to feel less satisfied with our decision afterwards.

Three types of potatoes, though, are not too many.  Especially since this year I’m only making two kinds of pies.

 





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This blog is intended solely for the purpose of entertainment and education. All remarks are meant as general information and should not be taken as personal diagnostic or therapeutic advice. If you choose to comment on a post, please do not include any information that could identify you as a patient or potential patient. Also, please refrain from making any testimonials about me or my practice, as my professional code of ethics does not permit me to publish such statements. Comments that I deem inappropriate for this forum will not be published.

Contact Dr. Gots

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If you don't receive a response to an email from Dr. Gots in 48 hours, please call the office and leave a voicemail message.

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