Category Archives: Alcohol Dependence

Q & A Mood disorders with substance abuse

By: James E. DelGenio MS, LCPC
Senior Staff Therapist
The Family Institute at Northwestern University

Mood Disorders and relationships disorders.
Questions and Answers

1. What is a mood disorder?
2. Why shouldn’t you drink alcohol if you are not an alcoholic?
3. Why are depression and alcoholism often found in the same individual?
4. What is dual diagnosis?
5. What is addiction?
6. What are the symptoms of a mood disorder?
7. What are the symptoms of addiction?
8. How do these disorders interact with one another?
9. Can a mood disorder be compared to a physical illness?
10. How does a mood disorder affect thinking and behavior?
11. What should you report to your psychiatrist?
12. Will you have to be in treatment the rest of your life?
13. Why is medication compliance so important?
14. How do you cope with the past?
15. Why are recreation, exercise and socialization so important?
16. What if you don’t feel motivated to do the things suggested here?
17. What are relapse warning signs aka positive symptoms?
18. What are the negative symptoms of depression and mood disorders?
19. What are the causes of relapse and regression to symptoms?
20. When should you call your doctor, 911 or go to the hospital?
21. What do you do if you can’t sleep?
22. What is the role of the family in treatment?
23. What can family members do to minimize the risk of relapse?
24. How can family members learn to cope?
25. Who is responsible for your happiness?
26. What are the goals of treatment?
27. Why is psychiatric medication useful in controlling symptoms of depression?
28. What if you are inconsistent in taking your medication?
29. What are the possible side effects of psychiatric medication?
30. What are the benefits and purpose of psychiatric medication?
31. What does one do if there is a medical emergency?
32. Where does one go with questions about psychiatric medications?
33. Should the client or family adjust medication dosage if symptoms reappear?
34. How does one learn to make healthy choices?
35. How to be well.

1. What is a mood disorder?
Mood disorders are defined as people experiencing mild to severe depressive.
disorders, bipolar disorders, anxiety disorders, phobias, personality disorders and
other disorders including alcohol or drug abuse or dependence. (Brown, Wang and
Safran, 2005)
Depression and other mood disorders have become more commonly accepted by society generally and thanks, in part, to high profile actors and professional athletes who have disclosed their disorders to the public. Clinical depression and mood disorders are biological/genetic problems that you most likely inherited and are considered no different than the diagnosis of other medical conditions such as diabetes or epilepsy. All require education, medication and ongoing treatment. These disorders are usually manifested in the teens and as late as mid 30’s.
I use two very different definitions to describe these disorders. The first reflects denial of a problem and the second reflects acceptance of what is. Which one will you choose?

The first definition is as follows:

A Mood Disorder is a lifelong disability, episodic in nature that may cause chronic dysfunction, asocial behavior and failed relationships. A breakdown of this definition is as follows:
Lifelong means there is no cure to date, though new medications, if taken as prescribed, have made people symptom free.
Episodic means that sometimes the symptoms are worse than at other times for no apparent reason though stressful life events can also have an impact on symptoms.
Chronic dysfunction includes inability to manage day-to-day events, unemployment and often failed relationships.
Asocial Behavior is that behavior which is irrational, inappropriate showing poor judgment and a lack of insight into one’s own behavior. This can include poor self-care and appearance. It may also include behavior that is harmful to self or others. Failed relationships include social dysfunction, isolation, withdrawal, marital conflict and divorce.

The second definition is as follows:

A Mood Disorder is a lifelong disability, episodic in nature that the individual can learn to manage with medication, if necessary, education and coping skills.

In some severe instances, denial of these disorders can create frequent psychiatric hospitalization which can result in a revolving door syndrome in which a person spends their life going in and out of hospitals.

The two definitions are separated only by education, psychiatric treatment and ongoing therapeutic support. The key here is management of a disability. You manage it or it will manage you! How do you want to live your life?

2. Why shouldn’t you drink alcohol if you are not an alcoholic?
Where mood disorders are concerned use is the same as abuse! It impairs functioning and it affects thinking, behavior and relationships. Alcohol and substances such as marijuana and cocaine also affect thinking and behavior. Don’t do anything that would make you relapse to active symptoms. It is known fact that alcohol and substance abuse make the symptoms of a mood disorder worse and vice versa. Alcohol is a depressant; one drink at a family gathering may affect one’s mood for days.

Alcohol also washes out and therefore may negate the usefulness of the medication. Remember, it takes four to six weeks to get the medication to a therapeutic level. When you drink heavily you affect that level. It may even precipitate a hospitalization. In addition, one should never use alcohol or substances when taking prescription medication. This can be fatal. It goes without saying that if you are an alcoholic, you can’t have any alcohol. If you are not an alcoholic, check with your Dr. for approval of one or two drinks on very special occasions. In the days after, monitor yourself to see if it has affected your mood. If it does, use is the same as abuse!

3. Why are mood disorders and alcoholism often found in the same individual?

The answers here are not completely understood. Some doctors have told me that the sites in the brain that are affected by mood disorders are the same sites affected by addiction. Regardless of the chemistry, just casual use of alcohol by a person with a mood disorder may eventually result in abuse or dependence. If you have a mood disorder, you shouldn’t have any! The consequences are just not worth it.

4. What is Dual diagnosis?
Dual Diagnosis means that two or more independent disorders exist in the same individual. Specifically, for our purposes, when I speak of dual diagnosis, I am referring to mood disorder and alcohol dependence. Each exists independently of one another and yet each makes the other worse. Both are biological and psychosocial disorders with similar symptoms. They are lifelong disorders, which cause the person to be prone to relapse. Both require integrated treatment that includes psychiatric treatment, medication, psychotherapy, education, symptom management and additional supportive treatment such as Alcoholics Anonymous or Narcotics Anonymous.

5. What is addiction?
An Addictive Disorder is the preoccupation with acquiring alcohol and/or drugs,
compulsive use of alcohol and drugs despite adverse consequences and a pattern of relapse to alcohol and drug use despite the reoccurrence of adverse consequences (Miller, 1991).

6. What are the symptoms of Depression/Mood Disorder?
Depression and bipolar disorders is a biological disorder that can usually be traced through family history whether it was formally diagnosed or undiagnosed. Check the symptoms under A and B with a check mark. If you have five or more related symptoms, discuss these symptoms with your psychiatrist or Therapist.

A. Symptoms of Depression
1. Lack of pleasure, loss of interest and energy.
2. Lack of goal directed behavior.
3. Lack motivation, lethargy.
4. Inability to structure time, poor concentration.
5. Anger, hostility, irritability.
6. Strained relationships, marital issues, divorce, loss of friends.
7. Withdrawal, isolation, would rather be alone.
8. Difficulty in getting along with people.
9. Sleeping to much or too little.
10. Anxiety, worry, sadness, low mood.
11. False beliefs, negative thinking, rumination.
12. Feeling guilty, stressed or hopeless.
13. Poor self-care including hygiene and diet.
14. Aches, pains, dizziness, headaches, or stomach aches.
15. Unintentional weight loss, gain.
16. Crisis prone, police involvement.
17. Low sex drive.
18. Thoughts of suicide, homicide.

B. What are the symptoms of a bipolar disorder?
Bipolar Disorder formerly known as manic depressive disorder is a mood disorder in which people may have mixed episodes of mania and depression.
These symptoms may also include some of the above and in addition.
1. Rapid mood fluctuations.
2. Feeling high, euphoric or having inflated self-esteem.
3. Irritability, hostility, aggressive or risky behavior.
4. Pressured, fast speech, more talkative than usual.
5. Racing thoughts, skidding from subject to subject.
6. Delusions of grandeur, grandiose beliefs or behavior.
7. Poor judgment, lack of insight, false beliefs.
8. Poor self-control.
9. Little or no need for sleep.
10. Increased activity, sexual drive and impulsivity including spending.
11. Easily distracted, poor concentration.
12. Alcohol and substance abuse.
13. Bizarre dress and appearance.
14. Thoughts of suicide, homicide.

The above symptoms of depression and bipolar mood disorders are widely accepted. Since these disorders have a biological basis; a psychiatrist manages the medication while the therapist provides treatment and support. The therapist support often includes psychoeducation, symptom reduction and management, increased coping skills and management of other day to day stressors such as job loss, school failure and relationship issues. The psychiatrist, therapist, family, friends and of course, the patient must work together as a team to construct an effective approach to these disorders. The most important aspect of this is good communication.
There are two types of bipolar disorders. They are Bipolar I and Bipolar II. Bipolar I is considered the more severe of the two disorders and has more extreme episodes of mania or depression. It may also have psychotic features.
Bipolar II is characterized by milder swings of mania and depression and may have less serious effect on daily routines, relationships and employment issues associated. Both forms need treatment and medication to manage the symptoms well.

7. What are the symptoms of addiction?

Depression, anxiety and panic
Psychosis – hallucination, delusions, thought disorder.
Irritability, mood changes, racing Thoughts
Memory Loss, confusion,
Drowsiness, slurred speech
Euphoria
Constipation, itching, hives
Restlessness, Insomnia, tremor
Diarrhea, cold sweats
Dilated pupils, tearing, nausea, vomiting

8. How do these disorders interact with one another?

Depression/mood disorder and alcohol and substance abuse do not interact well. In fact, each makes the other worse, especially when one is using and/or not taking medication as prescribed. One must manage both disorders simultaneously and treatment must be a collaborative effort with the level and the array of services necessary to maintain stability, sobriety and consistency.

9. Can a mood disorder be compared to a physical illness?
It is helpful to think of someone you know who is diabetic and what it means to be a diabetic. Some years ago, a friend of mine named Mark had a heart attack. Fortunately, there was little or no damage to his heart. What was discovered, however, was that Mark’s blood sugar was elevated. He was diabetic. When Mark moved out of intensive care, they began to teach him how to cope with his newly discovered disability. They taught him how to measure his blood sugar and give himself insulin injections. They taught him what he could eat and what he could not
eat. They even taught him what to do if he had a reaction to food or his medication. When he was discharged from the hospital, they had a nurse visit him at home several times a week for several weeks just to make sure that what he had learned in the hospital, he continued at home.

Mood Disorders, addiction and diabetes are comparable in many ways. Each is a lifelong, biological problem that requires daily attention, education and support. Medication, when taken as prescribed, stabilize each condition but knowledge and training play a very important role in healthy functioning. The comparisons demonstrate that mental illness, like other physical handicaps, can become manageable handicaps; not the global disability it is for some. It is a result of genetics, an imbalance in the chemistry of the brain. No one is at fault, and no one is to blame. Mental illness is a lifelong disability, episodic in nature that one can learn to manage, with hope and with dignity.

10. How does a mood disorder affect thinking and behavior?

The symptoms of mood disorder and addiction are very similar. In fact, the treatment is also similar. Once medically detoxified, a person with mood disorder may be prescribed some of same medications as in the treatment of substance abuse. It often takes a year or more of sobriety to determine if the person is suffering the effects of addiction or mood disorder or both as in dual diagnosis. You may have heard of the term dry drunk. This refers to someone who is alcohol free but has not addressed the accompanying mood disorder. This includes irritability, hostility and relationship issues.

11. What should you report to your psychiatrist?

The Doctor is part of the team. S/he needs your honest input to best help you. If any of the following are problematic, report them to the doctor. Write things down. See Stability, Symptoms, Medication, and Education Review)

Report on:

1. Medication education needed and compliance.
2. Changes in your symptoms including:
A. Sleep patterns
B. Mood
C. Concentration, poor short-term memory
D. Disturbing thoughts
3. Drug and alcohol use.
4. Medication side effects or allergic reactions.
5. Social activity or isolation.
6. Poor self-care.
7. Physical activities, hobbies, chores.
8. Poor money management.
9. Unusual behavior.
10. Thoughts of self-harm or threats to others.

12. Will you have to be in treatment the rest of your life?
I would like to say no but many remain on medication their entire life. Therapeutic support may or may not be necessary after a time, depending on how well one learns to manage their disability. I have clients who see me a few times per year just to check in and reinforce their self-management. Some people with severe mood disorders may go in and out of the hospital their entire life if they remain in denial. This is usually a result of non-compliance with treatment and medication combined with alcohol and/or substance abuse. I try to point out that though you are not sitting in a wheelchair; it is not as visually obvious a disability but if you have a mood disorder you do have a disability. Mood disorders and addiction can be a global disabilities or manageable handicaps. Which one will you choose? Medication and ongoing supportive treatment may be essential for maintaining healthy functioning.

13. Why is medication compliance so important?
The number one cause of regression and reoccurrence of symptoms is not taking medication as prescribed. This is not like having a headache. When you have an ordinary headache, you take two aspirin and twenty minutes later your headache is gone. In order for antidepressant medications to work effectively, one must maintain a certain level in the body. When that level in not maintained, debilitating symptoms reappear. These medications take four to six weeks to reach their peak level effectiveness. When you miss doses of medication you negatively affect that level.

14. How do you cope with the past?
Many people with mood disorders have difficulty coping with the past. Sometimes they appear to be living in the past, unable to get over some stressful life event. This needs to be explored with your doctor and therapist. Once this is done, I suggest one simply moves on. When one dwells on the past, they often have difficulty coping with the present. Yesterday is done; worry about today and tomorrow will take care of itself.

15. Why are recreation, exercise and socialization so important?
It is good to have fun. Have fun! People with mood disorders often become engrossed in the past, their illness and problems. Recreation and exercise (especially walking) are good for depression and anxiety and are a great distraction when one is experiencing symptoms. Distraction from symptoms is an important coping skill. Internet, video games, TV or reading generally do not qualify as distraction or most individuals.

16. What if you don’t feel motivated to do the things suggested here?
Lack of motivation is a direct result of the disorder. If you wait to feel motivated, it may never happen. Walk 40 minutes per day at least 3-4 days per week with your doctor’s permission. Pick your days and let the day of the week make the decision for you. Do your chores and exercise on the days you have picked to do them. Try to have at least one social activity per week. Plan to have fun. Adding structure to your life addresses many common symptoms of mood disorder but especially lack of motivation. (See how to be well.)

17. What are relapse warning signs or positive symptoms?
Relapse warning signs are also known as positive symptoms. They are positive because they are present, active and uncontrolled by medication. These symptoms are typically a result of medication noncompliance or alcohol use. Without intervention these symptoms can have serious impact on thinking, judgment, and behavior and may also include: psychiatric hospitalization, self injury and harm to others or the community.

Relapse Warning Signs reflect symptoms that include:
1. Thoughts about hurting oneself or others.
2. Changes in one’s sleep/wake cycle, especially little or no sleep.
3. Inability to concentrate, rapid speech, skidding from subject to subject.
4. Rapid mood fluctuations, mania or depression.
5. Poor judgment and risky behavior.

18. What are the negative symptoms of depression & mood disorder?
They are the symptoms that are most often missing in the individual. They are characterized by the absence of:
1. Lack of motivation or goal directed behavior.
2. Lack of pleasure.
3. Lack of Insight.
4. Poor judgment.
5. Poor self care.
6. Poor hygiene, self care.
7. Lack of emotional expression.

These symptoms are only partially controlled by medications. They are often what are left when positive symptoms are controlled. It is for this reason that persons with a mood disorder still need education, psychotherapy and supportive therapy.

19. What are the most common causes of relapse and regression to symptoms?
1. Medication noncompliance
2. Alcohol and/or substance use or abuse
3. Little or no sleep
4. Social isolation
5. Family conflict

20. When should you call your doctor, 911 or go to the hospital?
Call your doctor or pharmacist if you are experiencing medication side effects or an allergic reaction. When you are thinking of hurting yourself or someone else call your doctor and therapist. If you are actively considering hurting yourself call 911, go to the emergency room, or call the National Suicide Prevention Helpline, 1-800-SUICIDE (1-800-784-2433).

21. What do you do if you can’t sleep?
Little or no sleep is a relapse warning sign. Depression, mood disorders and dual diagnosis cause sleep/wake problems. First stop drinking caffeinated beverages or foods containing caffeine. Don’t nap during the day. Take your medication as prescribed. Maintain abstinence from alcohol and substance abuse. Always discuss your sleep issues with your doctor. Insomnia can be a precipitating event for relapse to active symptoms and possibly self harm or harm to others. In this event, call 911 and/or your doctor.

22. What is the role of the family in treatment?
The role of the family in treatment is simply to monitor and report. The family should
observe the patient’s behavior and report anything that may be important to the stable functioning and health of the patient. The patient should not be interfered with directly unless, of course, s/he is a danger to themselves or others. The family’s role in treatment is a collaborative effort in communication. The family should think of themselves as team members. We are all on the same team! Keeping secrets from the doctor or therapist interferes with treatment and may ultimately have serious consequences. Families should call a health care professional or the police immediately if you or a family member has any of the following symptoms, especially if they are new, worse, or worry you:

1. When the person does not take their medication as prescribed.
2. The abuse of alcohol, substance abuse or medications not prescribed by a doctor.
3. Depressed mood, irritability, thoughts of suicide or dying.
4. Behavior which may result in injury or harm to the individual, family or
community.
5. The presence of any relapse warning signs, especially no sleep.
6. Panic attacks, uncontrolled anxiety or restlessness.
7. Feeling very angry, agitated, or violent behavior.
8. Acting on dangerous impulses.
9. Unusual behavior that is out-of-character for this individual.
In most cases I have treated over the years, I have seen the client get annoyed with friends and family when they say, “You seem crabby, did you take your medication today”? The typical response is “just because I’m angry or upset doesn’t mean I’ve skipped my meds”. The way I see it, if you have a history of noncompliance, you don’t have the right to be angry when asked! Take the medication as prescribed so your family doesn’t worry about compliance or need to be intrusive in your life. They should be relatively assured that you are compliant with medication. Regardless, it is the responsibility of the family to ask because the consequences of not taking it as prescribed can lead to injury and possibly suicide.

23. What can family members do to minimize the risk of relapse?

1. Monitor and report on medication compliance.
2. Monitor and report on the use of alcohol and drugs.
3. Avoid critical comments. Use “I feel” statements.
4. Avoid over involvement unless there is alcohol and substance abuse,
medication noncompliance.
5. Avoid excessive pressure to achieve.
6. Avoid trying to help motivate compliance.
These are frequent causes of family conflict and should be discussed with the doctor and therapist.
24. How can family members learn to cope?

Mental illness is no one’s fault. It is a bio-psycho-social problem.
1. Avoid placing blame or guilt.
2. Don’t enable! You are not responsible for the patient’s wellness. S/he is!
3. Make regular opportunities to get away from each other. Have outside interests, hobbies and social activities.
4. Get regular exercise. Join a health club or walk at least 40 minutes on
regularly scheduled days each week. In the winter, use a treadmill or
stationary bicycle.
5. Learn all you can about mood disorders but do not try to be a therapist.
25. Who is responsible for your happiness?

Who owns the problem? Don’t blame others for your disorder or problems.
Remember, a mood disorder is a biological problem like diabetes. If you don’t manage it, it will manage you.
26. What are the goals of treatment?
The goals of treatment of mood disorders are typically as follows:
1. Be evaluated by a professional to identify if a disorder is present.
2. Have a psychiatrist identify the need for medication, if any
3. Take medication as prescribed.
4. Learn about the disorder and to recognize active of symptoms of the
disorder.
5. Learn symptom management.
6. Learn coping skills, especially distraction through structure. Structure
is created by having regularly schedule of activities, hobbies and social
support.
A. Encourage regular socialization.
B. Encourage regular exercise at least 4 times per week
Take a brisk walk at least 40 minutes.
C. Encourage hobbies and attention to daily chores.
7. Be consistent in the use of coping skills.
8. Learn to identify regressive symptoms, i.e., relapse warning signs and
triggers.
9. Learn how to make healthy choices.
10. Learn how to be well.

Generally goals fall into five overlapping areas:
See which ones may apply to you in addition to the ones described above:
1 Medical
2 Social skills and support
3 Coping skills
4. Daily living skills
5. Personal

1. Medical
1 Take medication as prescribed.
2 Report the presence of symptoms, suicidal or homicidal thoughts.
3 Maintain abstinence from alcohol and substance abuse.
4 Avoid caffeinated beverages, especially if sleep is poor.
5 Maintain a healthy diet and daily living skills.
6 Get medical and dental check-up annually.
7 Maintain psychiatric and therapeutic contact.
8 Have lab testing as directed by your doctor.
9 Report your sleep/wake cycle to your doctor.
10 Report medication side effects and allergic reactions to your doctor or ER.

2. Social skills and support
1 Have at least one social activity per week
2 Try to avoid napping during the day
3 Join a club, call a friend, take a class
4 Make plans for the weekend

3. Coping Skills
1 Read goals daily, put a copy on the refrigerator at home
2 Take a brisk walk 40 min at least 4 times per week.
Note: Always consult with your Doctor before starting any exercise regimen.
3 See your doctor, especially when you are experiencing symptoms
4 See your therapist regularly for support.
5 Check in with family and friends regularly and express your feeling
appropriately. Try to avoid conflict.
6 Work on a hobby a half an hour every day or when you are experiencing
symptoms as a distraction.

4. Daily Living Skills
1 Bathe daily
2 Dress appropriately
3 Do chores on assigned days
4 Do volunteer work on assigned days
5 Go to work, be on time
6 Manage your finances

5. Personal
1 Always maintain civility and respect
2 Make healthy choices.
3 Spend quality time with your family and friends.
4 Improve your self-esteem with your therapist.

27. What medications do you take?
You should always know the name of the medication, the amount of medication and the frequency of the dosage. For example: “I take 20 mg of Lexapro in the morning”. This will help to ensure that medications given by other physicians will not be contraindicated. In addition, you should always ask your pharmacist about possible drug interactions. A list of medications and dosages should also be carried on one’s person in the event of an emergency.
28. Why is psychiatric medication useful in controlling symptoms of Mood Disorders?
Mood disorders are considered bio-psycho-social disorders. They affect thinking and behavior and often times create relationship issues. Medication and medication management are typically essential in the management of the biology or the chemistry of the disorder. I consider this to be the foundation of treatment. It is difficult if
not impossible to treat a mood disorder without medication. You can’t build a house without a good foundation. Medication provides that solid foundation.
Therapy addresses the psychosocial treatment issues including: identification and management of symptoms, daily living skills, coping skills and it addresses the relationship issues which often accompanying these disorders.

I do on occasion have clients who refuse medication. In the past, I have either chosen to discontinue treatment or say “we will have five sessions and see if it makes an impact on your symptoms.” If it does, that’s great. If it does not, I will try to deal with the denial. In my experience, I have found that men have more difficulty with the notion of taking medication then do women. What if I told you that, “you are a diabetic and will have to be on insulin injections the rest of your life? Of course, most people wouldn’t like it, but chances are they would take it. Why is this any different? I will also not hesitate to point out that alcohol is a drug and you are self medicating. This may lead to alcoholism or substance abuse and addiction. At some point, I may give up and discontinue treatment. That doesn’t happen very often because I can be very convincing but it does happen.

29. What if you are inconsistent in taking your medication?

The key word here is consistency. The medication is extremely important to
maintaining mental health. It is the foundation of treatment. If you are not consistent taking the medication, you will have difficulty functioning effectively on a day-to-day basis. This is not a headache. You take two aspirin and twenty minutes later your headache is gone. These medications don’t work that way. Remember, it takes four to six weeks to maximize the therapeutic effect of the medication. You have to build up to a therapeutic level. When you miss medication, you affect that level. You may need to ask for assistance from family or friends. If you miss more than five pills a year, I consider you to be noncompliant. Always take the medication as prescribed. If you have concerns, contact your doctor.

30. What are the possible side effects of psychiatric medication?

Know that all medications have side effects. Even aspirin can cause ringing in the ears if you take too much. The pharmacy must list all side effects but that does not mean you will experience them. Most of the common psychiatric medications for depression and mood disorder have very few if any side effects after the first week or so. First, ask your doctor about allergic reactions and possible side effects and what to do in the event of a serious reaction. Always read the medication information given to you by the pharmacist. S/he is also a good source for questions about medications.

The most common and less serious side effects are typically: nausea, diarrhea, blurred vision, sleepiness, insomnia, dizziness, or headache. These usually go away in the first few weeks. If any side effect becomes severe or you simply have concerns, contact your doctor or go to the ER. Know the possible side effects and allergic reactions of your medications. You should always know the name of your medication, frequency and the dosage in milligrams. Care a card in your wallet which will tell emergency personnel exactly what you are taking. If you have questions or concerns, direct your questions to your doctor or pharmacist. Dial 911 or go to the Emergency Room for serious allergic reactions and side effects. Ultimately, the more you know the safer you will be.

31. What are the benefits and purpose of psychiatric medication?

Mental Illness is a disease very much like diabetes. It takes insulin to manage diabetes; it takes psychiatric medication to manage depression and mood disorders. Some say you just have to be tough. “You just have to pull yourself up by your bootstraps and try harder”. This is false. In my opinion, the only way to successfully manage a mood disorder is with education, medication, ongoing treatment and support.

32. What does one do if there is a medical emergency?
Call 911 immediately!

33. Should the client or family adjust the medication if symptoms reappear?

Always contact the doctor when faced with positive (active) symptoms. Do not self-medicate. A doctor never operates on himself or his own family. Don’t play doctor! Remember, the leading cause of relapse is medication non-compliance and drug and alcohol use. The doctor can’t possibly medicate you properly if he does not know honestly what the patient is or is not taking including alcohol or substance use! Rule of thumb: never lie or withhold information from your doctor or therapist.

34. How does one learn to make healthy choices?

Sometimes people do not recognize the choices they make may not be healthy. Once stable and consistent, some clients simply need to check-in with me a few times per year. Others need ongoing supportive therapy every two to four weeks to remain consistent. The frequency will depend on the individual and how well one manages their disorder. Together with your doctor and therapist and ancillary supports if necessary for dual diagnosis, you can learn to manage your symptoms and cope with the day to day stress of depression, mood disorder or dual diagnosis. This is the reason that ongoing support from your doctor and therapist is essential for management.

35. How to be well.

Coping with depression or mood disorders is no easy task! It takes professional support, medication, psycho-education and experience to manage the debilitating symptoms. With the necessary supports and monitoring, persons with mood disorders can learn to:
1. Take your medication as prescribed.
2. Control symptoms.
3. Remain stable.
4. Have a network of friends and supports and
5. Maintain employment.
I have also found that it takes an average of about one year to reach those goals. In addition, most people will need some level of support on and off for their entire lives. The bottom line is you can’t do it alone! You need a psychiatrist to manage your medication and a therapist to provide ongoing support. The following is a brief summary of the 10 steps of How to be Well:

How to be Well

1) Take the medication as prescribed by your doctor.
This is definitely a tough one. Many people don’t like to take medication, especially, every day for the rest of your life but remember, clinical depression is a lifelong disease and it’s all about body chemistry. It is a biological problem first and foremost. It’s like being a diabetic; you must take the medication as prescribed in order to be well.

2) No caffeine, substance abuse or alcohol.
People with depression and mood disorders often have problems with sleep. I do not recommend using caffeine. It interferes with the sleep/wake cycle. I also don’t recommend working the night shift i.e., midnight to 8 AM. It is too hard to get adjusted to a night shift and it also wreaks havoc with the sleep/wake cycle. Tell your doctor or your therapist if you are not sleeping.

As far as alcohol and substance use, it is as simple as it is hard. Don’t use it! Alcohol is a depressant. You are already depressed. There is a negative correlation between casual use of alcohol, drug use and mood disorder. The increased chance of dependence and risk of relapse to symptoms are just not worth it. The bottom-line is USE IS THE SAME AS ABUSE! Don’t use, ever! If you already have a problem, get professional help and go to your Alcoholics Anonymous or Narcotics Anonymous meetings as often as it is necessary to maintain sobriety.

Note: Some Doctors and even therapists say that it is OK to have one or two drinks if you have no alcohol abuse or dependence issues. I still question this because alcohol is a depressant. Why would you take a depressant when you are taking an anti-depressant under any circumstance?

If you chose to disregard my position, I strongly recommend that alcohol use be infrequent and on special occasions. The use of alcohol should be limited to one or two drinks at most. I suggest that you to monitor your mood in the days that follow. Look for increased depression, disturbing thoughts, anger or irritability. This will tell you if you can have one or two or none.

3) Take care of your physical health.

Be sure to have annual dental and physical exams. Some medications require regular blood testing. Some physical ailments can cause depression. See your doctor regularly.

4) Be social, outside of the family.
Mental illness tends to make people isolated and withdrawn. People need contact with other people to remain grounded in reality. Even family cannot take the place of social contact in its benefit concerning reality testing. People with mood disorders cannot always trust what they feel, see or hear. They need to “check it out” with other people.
We all use our friends to test reality; you just don’t think of it in that way. For example, you call up your friend and say, “Do you know what happened today? I had an argument … She said… I said …” Who do you think was right?” It’s over simplified but you get the idea. People need other people for many reasons. For people with a mood disorder, reality testing or “checking it out” is just one of them. I recommend at least two social activities per month with people other than family.

5) Be active.
People with mood disorders tend to be sedentary. They need to walk and get exercise as much or more than any of us. I recommend taking a brisk walk, weather permitting, at least 4 times per week for forty minutes. Pick your days and stick to them as much as you can. It is widely accepted today that walking reduces anxiety and improves your mood so get out there and walk.
Note: Always consult with your doctor before starting any exercise program.

6) Plan to have fun.
When you were a child, it didn’t take much to have fun. You simply go outside and find some other kids and the party is on, so to speak. As adults, we need to plan to have fun. For example, if you had a boring weekend you might say to your spouse, “This was a lousy weekend. Next week we need to plan to get together with …” Get the idea? People with mood disorders tend to become consumed with their symptoms. Planning is a very important part of meeting your social goals.

7) Work on a hobby daily.
A hobby is a wonderful way to cope and help structure your day. When no one else is around or when you are experiencing negative thoughts, feeling low or just plain bored, a hobby fills the bill. The key word here is coping. People often complain about too much free time and yet they will say, “I don’t have a hobby,” but they will sit for hours ruminating about their symptoms. That is just not healthy. So don’t tell me why you can’t work on a hobby. Tell me what hobby you are going to choose and get to work. Hobbies should be worked on at least a half an hour any time you are having difficulty coping with your symptoms.

8) Do your chores on assigned days.
Household chores are also a way of coping with free time. First, list all your chores and make a schedule for each day of the week. Once written, tape it on your refrigerator or someplace where you will see it every day, and then, stick to your schedule. This is not about how you feel. If you felt good, you wouldn’t need to do this. If it’s Monday and you are scheduled to clean the bathroom – do it. It is a coping skill and it also gives you the added benefit of a healthy environment in which to live.

9) Get at least 5 to 7 hours of sleep per night.
As I stated earlier, sleep is very important to maintaining your mental health. Too much sleep is not healthy. No sleep is a quick ticket to active symptoms or psychiatric hospitalization. I could take anyone in the world; if I kept them awake long enough, they would lose touch with reality. Lack of sleep usually indicates that the person is not taking their medication as prescribed. Remember Goal # 1. Take the medication as prescribed by your doctor. If you’re still not sleeping, notify your doctor. It only takes a few sleepless nights to lose touch with reality and relapse to active symptoms.

10) Make healthy choices!
This is my generic one. This one may very well be different from person to person. A healthy choice for one person may not be healthy for you. For example, if you have a mood disorder, poor sleep, alcohol use, medication compliance and exercise are mental health issues. Remember! You manage it or it will manage you.

Issue 1 Sleep
Typical response: “It’s not the caffeine. I like coffee. It doesn’t affect me. I’ve always drank coffee.” Whether it’s coffee, soda or tea, caffeine interferes with sleep. It is the most obvious reason for poor sleep. I would certainly recommend gradually discontinuing caffeine before asking the doctor for a sleep aid. Avoid caffeine for one week and see if you don’t feel and sleep better.

Issue 2 Alcohol
Typical response: “What? I can’t have a glass of wine with dinner? I don’t do it often. It’s just one glass. It’s not like I’m an alcoholic.”
Alcohol is a depressant. It may affect your mood for days, even weeks. Don’t deny the obvious. This is just not a healthy choice.
So remember, what is healthy for one person, may not be a healthy for you. Make healthy choices!

Issue 3 Medication Compliance:
Typical response: “I don’t miss often; maybe once per week.” This is not headache; for the medication to be effective it must be taken daily as prescribed.

Issue 4 Exercise:
Typical response: “I just don’t feel like doing it; you know I’m tired when I get home.” Walking or cardiovascular work for forty minutes at least four times per week or anytime you fell low or anxious lifts your mood and reduces anxiety. Take responsible for your wellness. Always check with your doctor when starting an exercise program.

Zoom!

Now I can work via zoom with anyone, anywhere in the country and it will still be covered by BCBS Insurance.

Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

http://manageyourmood.net
http://family-institute.org
http://takenotelessons.com   Effective online, one on one, SAT, ACT, GRE, test preparation, via face time or skype.

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.

The use of alcohol can be the same as abuse when you have depression.

By: James E. DelGenio MS, LCPC
Senior Staff Therapist,
The Family Institute at Northwestern University

Mood disorders and alcohol just don’t go together.

Where mood disorders are concerned use may very well be the same as abuse! Alcohol impairs functioning and it affects thinking, behavior and relationships. Alcohol and substances also affect thinking and behavior. Don’t do anything that would make you relapse to active symptoms.  It is known fact that alcohol and substance abuse make the symptoms of a mood disorder worse and vice versa.  Alcohol is a depressant; one drink at a family gathering may affect one’s mood for days. If you have depression, why would you exacerbate it by using alcohol?!  To me, continued alcohol use at this point would indicate that you are already alcohol dependent and are in need of professional help.

Alcohol also “washes out” and therefore may negate the usefulness of anti-depressant medication. Remember, it takes at least four to six weeks to get the medication to the prescribed therapeutic level in your body.  When you drink you affect that level. In addition, one should never use alcohol or substances when taking any prescription medication. This can be fatal.

It goes without saying that if you are an alcoholic, you can’t have any alcohol. If you are not an alcoholic, but you do have a mood disorder, check with your psychiatrist for approval of one or two drinks on very special occasions. In the days after, monitor yourself to see if it has affected your mood. If it does, use is the same as abuse!

  • Drugs and alcohol make mood disorders worse.
  • If the doctor approves of one or two drinks, monitor your mood in the days that follow.
  • If your mood is off, you need to consider abstinence from alcohol.

Zoom!
Now for the first time, I can work via Zoom with anyone, anywhere in the country and it may be covered by BCBS Insurance. Check with your BCBS carrier for details.  Call 847-733-4300 Ext 638 for more information.

http://jamesdelgenio.com
http://family-institute.or

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.

Weekly Review of Consistency for management of Depression!

By: James E. DelGenio MS, LCPC
Senior Staff Therapist,
The Family Institute at Northwestern University

How to build structure for consistency in management of mood disorders!

This form helps you monitor your progress towards goals each week. Consistency is key when you have a mood disorder. People with mood disorders need planning and structure to help manage their symptoms. You can also track your marital/relationship goals if you choose. This tool helps track progress toward goals by adding structure to your week. Make multiple copies. Modify as needed; feel free to add or delete goals. Rate mood 1 through 10. Ten is best – 1 worst. Place copy on your refrigerator or someplace where you can check it daily. Mark the goals each day so that you can see the week in review. Note alcohol/drug use and your mood rating in the 3 days after use. Being consistent in your goals makes a huge difference in managing your mood. Try it!

Week of _________________

Goal:                                      Mon       Tues        Wed        Thurs        Fri        Sat       Sun
Medication compliance
Cardio/walking
Social activity
Hobbies
Chores
Date night
Civility and respect
Sleep # of hours
Drug, alcohol use
AA/NA meetings
Time out called
Time out respected
Mood
Family meetings
Psychiatric appt

Note: Always consult with your doctor before starting any exercise program.

Zoom!  Now I can work via Zoom with anyone, anywhere in the country and it is currently covered by BCBS Insurance.  Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

http://manageyourmood.net
http://family-institute.org
http://psychologytoday.com
http://takenotelessons.com    Highly effective online, one on one, SAT, ACT, GRE, test preparation, via face time or skype.

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.

What you should know about dual diagnosis?

By: James E. DelGenio MS, LCPC
Senior Staff Therapist,
The Family Institute at Northwestern University

What is dual diagnosis?

Dual Diagnosis means that two or more independent disorders exist in the same individual. Specifically, for our purposes, when I speak of dual diagnosis, I am referring to mood disorder and alcohol abuse or drug dependence. Each exists independently of one another and yet each makes the other worse. Both are biological and psycho-social disorders with similar symptoms. They are lifelong disorders, which cause the person to be prone to relapse. Both require integrated treatment that includes psychiatric treatment, medication, psychotherapy, education, symptom management and additional supportive treatment such as Intensive outpatient (IOP), group therapy and Alcoholics Anonymous as needed.

Mood disorders and alcohol and substance abuse do not interact well. In fact, each makes the other worse, especially when one is using and/or not taking medication as prescribed. One must manage both disorders simultaneously and treatment must be a collaborative effort with the level and the array of services necessary to maintain stability, sobriety and consistency.

It is helpful to think of someone you know who is diabetic and what it means to be a diabetic. Mood disorders may not be as visible as sitting in a wheelchair, but you do have a disability. Mood Disorders, addiction and diabetes are comparable in many ways. Each is a lifelong, biological problem that requires daily attention, education and support.

Medication, when taken as prescribed, stabilize each condition but knowledge and training play a very important role in healthy functioning. The comparisons demonstrate that mental disorders, like other physical handicaps, can become manageable handicaps; not the global disability it is for some. It is a result of genetics, an imbalance in the chemistry of the brain. No one is at fault, and no one is to blame. Management of a Mood disorder may well be a lifelong pursuit.

  • Manage both disorders simultaneously.
  • Take medication as prescribed by your doctor.
  • Use coping skills, ie., cardio, socialization, hobbies.
  • Limit or abstain from alcohol use.
  • Your ability to maintain sobriety and manage your mood determines. the level of support needed.
  • Each failure requires an increased level of support, esp around alcohol or substances.

Zoom

Now I can work via zoom with anyone, anywhere in the country and it may still be covered by BCBS Insurance. Check with your BCBS representative.

Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

http://manageyourmood.net
http://family-institute.org

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.

What are the causes of relapse to symptoms of depression

By: James E. DelGenio MS, LCPC
Senior Staff Therapist,
The Family Institute at Northwestern University

What causes relapse?  

The causes of relapse to active symptoms of mood disorder have been well documented over the years. It’s no surprise that these reflect the relapse warning signs listed below.
They are:
• Medication non-compliance (Not taking the medication as prescribed).
• Alcohol and substance use and abuse.
• Little or no sleep.
• Lack of social support, isolation.

Non-compliance with medication and alcohol or substance use or abuse are by far the leading causes of relapse to symptoms. These are self-explanatory. However, little or no sleep and lack of social support also need to be addressed.

Alcohol and/or substance abuse will cause relapse to active symptoms of depression, panic and anxiety. If you are not an alcoholic, I recommend no more than 2 drinks twice per week but never in back to back days. If you mood dips in the days following you should consider abstinence.

Sleep is an important issue for most with mood disorders. People with Bipolar disorders usually report that they don’t need much sleep. They have a tendency to play with their sleep/wake cycle. They like the euphoric hypomanic feeling that lack of sleep creates. It is very much like the moth and the flame. There is an attraction to the high that one gets when they are sleep deprived. Unfortunately, you can take anyone in the world and keep them awake for two, three or four days, they will become actively psychotic. For people with a mood disorder, sleep is a mental health issue.

Social support is also very much a part of maintaining good mental health. Even if one is compliant with medication and not using or abusing alcohol and drugs, social isolation can create considerable stress and ultimately cause a relapse to symptoms. It is imperative that people with mental disorders, have an avenue to combat their tendency to isolate and withdraw from people. I encourage my clients to maintain regular social contact. This contact creates reality testing. We don’t think of socialization as reality testing but it is. For example: You have an argument with your spouse; you call a friend and say here is what happened. What do you think? You get feedback on your situation and behavior. That is reality testing. Lack of social support may result in an inability to test the accuracy of what one is feeling or experiencing. This is obviously a very important component of maintaining good mental health.

Zoom!   Now I can work via Zoom with anyone, anywhere in the country and it may be covered by BCBS Insurance. Check with your BCBS representative for more information.   Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.  I am currently doing Zoom only.

http://manageyourmood.net
http://family-institute.org
http://takenotelessons.com   Effective on line, one on one, SAT, ACT, GRE, standardized test preparation, via face time or skype and much more.

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.

Issues to discuss before Marriage. What you will learn in premarital counseling?

By: James E. DelGenio MS, LCPC
Senior Staff Therapist
The Family Institute at Northwestern University

Premarital Counseling is a really good idea! 

Premarital counseling can help ensure that you and your partner have a strong, healthy relationship. This will give you a better chance for a stable and satisfying marriage. Premarital counseling can also help you identify weaknesses that may become larger problems during marriage. Good marriages don’t happen by accident. Many issues can be resolved prior to marriage with the help of a therapist. Common issues addressed may include work, finances, lifestyle, spending habits, credit card balances, student loans, savings, retirement planning, roles and responsibilities, children, parenting, in-laws, and leisure and fun. Marriage requires an understanding of yourself, your future spouse, and the tools and skills you need to make it work.

Does your significant other have a Mood Disorder?
Some moodiness is a part of everyone’s life; sometimes we feel happy, other times we are sad; some days we have lots of energy, while at other times we may be fatigued and unmotivated. When mood changes interfere with your ability to function, work or go to school, when they harm your relationships significantly, when they cause you to miss sleep, abuse drugs, or behave in ways you later regret, or when they lead to risky behaviors, thoughts of suicide, or losing touch with reality, your mood requires professional attention.

If this sounds like you’re intended. All is not lost. The key factor in this decision is Denial. If your partner tends to deny issues now, do you really think it is going to get better later?
I find that most premarital couples are well aware of their intended’s mood and alcohol/substance issues. My main questions are as follows:
Is he/she:
• Willing to seek help?
• In need of psycho-education and symptom management?
• Willing to take medication, if prescribed?
• Willing to honestly address alcohol and substance abuse issues?
• Willing to see a therapist for relationship issues and support?
It’s not going to get better if your intended is in denial. Get out while you still can!

Civility and Respect
Work on resolving conflicts in a civil and respectful way. Lack of civility and respect will eventually be the undoing of any relationship. It is possible to argue, resolve conflicts, and agree to disagree in a respectful manner. In order to do this, all couples need rules of engagement for conflict. It is important that couples express how they feel, but this needs to be done in a very caring and respectful manner. This definitely means there should be civility and respect when conflict occurs. That means no hitting (of course), no yelling, no swearing, no screaming or name calling or sarcasm. I encourage you to look at yourself and your relationship with your intended. Are you holding onto resentments? If so, you will need a therapist to help resolve this and teach you how to fight with civility and respect.

Zoom!

Now I can work via Zoom with anyone, anywhere in the country and it may still be covered by BCBS Insurance. Check with your BCBS representative for more information.

Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

http://manageyourmood.net
http://family-institute.org

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.

Symptoms of Bipolar Mood Disorders and how to cope.

By: James E. DelGenio MS, LCPC
Senior Staff Therapist,
The Family Institute at Northwestern University

Negative rumination i.e. negative thoughts on repeat often cause conflict in relationships.  Physical distraction of any kind will help some, i.e. cardio work, chores, walking, hobbies. If these don’t help you will need to consider medication.

Overwhelmed with anxiety, panic, depression. This causes lack of motivation and loss of interest.  Need for medication is a must.

Changes in the sleep wake cycle esp. little or no sleep.  Could be heading for a manic episode. Often caused by non-compliance with the medication or alcohol use and abuse.

Isolation and withdrawal from friends and family.  We all need social contacts for good mental health. Look at the pandemic!

Alcohol use or abuse. Either way alcohol and mood disorders do not mix. Alcohol is a depressant and it will increase your anxiety. Don’t drink; you will feel better!

Little or no impulse control; Risky behavior, such as sex, reckless driving.

Uncontrolled spending w/o regard for ability to pay.

Racing thoughts and speech, grandiosity, invincibility.

Verbally abusive to others.  Conflictual relationships. Never permit physical abuse; report it. Get out!  Go to a shelter but get out.

Denial, No need for help or medication! Can’t trust your own thoughts. Need reality testing with friends and family to get past denial.

Hopelessness, thoughts of suicide.

Medication is as necessary as insulin is to a diabetic.  It’s just genetics with faulty chemistry.

The Family Institute at Northwestern University

James DelGenio LCPC is a senior staff therapist who offers remote teletherapy and accepts BCBS PPO Insurance.  Teletherapy is HIPPA approved via Zoom.com 

His services include: Individual and family counseling, marital and premarital counseling, and treatment of mood disorders and substance use and dependence.

Offering Teletherapy anywhere in IL via zoom.  HIPPA approved and accepted by BCBS PPO Insurance.

TFI is a unique not-for-profit organization that is leading the way in all facets to strengthen and heal families from all walks of life through clinical service, education and research. No other institution brings together such a concentration of knowledge, expertise and academic credentials to help improve the lives of people in the Chicago area and around the globe.

As a practicing Psychotherapist for over 40 years, I employ a variety of clinical approaches including Cognitive Behavioral Therapy (CBT) in the treatment of couples, families and individuals.

Individual Practice: Assessment and treatment of anxiety, stress, panic, trauma, anger, grief, depression, mood disorders, mental illness and alcohol/substance abuse.

Marriage and Family Practice: Lack of intimacy, infidelity, poor communication, conflict over finances, lack of trust, parenting and behavior issues, premarital and divorce issues.

Specialization: Treatment of couples, depression and its impact on relationships and the family.

Zoom! Now I can work via Zoom with anyone, anywhere in the country and it may still be covered by BCBS Insurance. Check with your BCBS representative for more information. Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

http://manageyourmood.net
http://family-institute.org
http://takenotelessons.com   Highly effective on line one on one, SAT, ACT, GRE, standardized test preparation, via face time or skype.

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.

Why depression and alcohol just don’t go together?

By: James E. DelGenio MS, LCPC
Senior Staff Therapist,
The Family Institute at Northwestern University

Why are mood disorders and alcoholism often found in the same individual?
The answers here are not completely understood. Some doctors have told me that the sites in the brain that are affected by mood disorders are the same sites affected by addiction. Regardless of the chemistry, research has shown that just casual use of alcohol by a person with a mood disorder may eventually result in abuse or dependence. If you have a severe mood disorder, you shouldn’t have any!

At least see how drinking affects your mood in the 3 days that follow alcohol use. Track it; give yourself a mood score from one to 10, ten being the best. Maybe you can limit alcohol use to one or two drinks twice per week and see if that helps. If you see in charting your mood that it does effect you negatively, than you shouldn’t have any. The consequences are just not worth it. If you can’t stick to two twice a week, you may need alcohol treatment.

Zoom! Now I can work via zoom with anyone, anywhere in the country and it may still be covered by BCBS Insurance.  Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

http://jamesdelgenio.com
http://family-institute.org
http://takenotelessons.com  Highly effective online, one on one, SAT, ACT, GRE, standardized test preparation, via face time or skype.

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy.  Always share this material and your questions about this material with your doctor and therapist.

What are the Benefits of Premarital Counseling?

By: James E. DelGenio MS, LCPC
Senior Staff Therapist,
The Family Institute at Northwestern University

The Benefits of Premarital Counseling.

Premarital counseling can help ensure that you and your partner have a strong, healthy relationship. This will give you a better chance for a stable and satisfying marriage. Premarital counseling can also help you identify weaknesses that may become larger problems during marriage. Good marriages don’t happen by accident. Many issues can be resolved prior to marriage with the help of a therapist. Common issues addressed may include: mental health issues, work, finances, drug and alcohol use, lifestyle, spending habits, credit card balances, student loans, savings, retirement planning, roles and responsibilities, children, parenting, in-laws, and leisure and fun. Marriage requires an understanding of yourself, your future spouse, and the tools and skills you need to make it work.

Does your significant other have a Mood Disorder?
Some moodiness is a part of everyone’s life; sometimes we feel happy, other times we are sad; some days we have lots of energy, while at other times we may be fatigued and unmotivated. When mood changes interfere with your ability to function, work or go to school, when they harm your relationships significantly, when they cause you to miss sleep, abuse drugs, or behave in ways you later regret, or when they lead to risky behaviors, thoughts of suicide, or losing touch with reality, your mood requires professional attention.

If this sounds like you’re intended. All is not lost. The key factor in this decision is Denial. If your partner tends to deny issues now, do you really think it is going to get better later?

I find that most premarital couples are well aware of their intended’s mood and alcohol/substance issues. My main questions are as follows:
Is he/she:
• Willing to seek help?
• In need of psycho-education?
• Willing to take medication, if prescribed?
• Willing to honestly address alcohol and substance abuse issues?
• Willing to see a therapist for relationship issues and support?

Rules of Engagement
All couples need rules for fighting. The most important rule is civility and respect. This, of course, means no hitting or throwing ever. If there is physical violence, you must call the police. Beyond that essential rules are no screaming, swearing, or name calling ever. This is destructive and may lead to your undoing as a couple. Couples need to work on resolving conflicts in their relationship with civility and respect so that bitterness and resentments can not build. It is possible to argue, resolve conflicts, and agree to disagree. In order to do this, all couples need rules of engagement for conflict. Establish your rules!

Finances and Spending
One of the biggest causes of problems in relationships is differences in values and goals and habits when it comes to money, and especially communication about money issues. That old saying is true …. money can’t buy you love, but it sure can tear it apart.

This makes a discussion of finances necessary before marriage. Learn how to talk about money, and align your financial goals such as retirement, savings, spending, debt, and disposable income. If you can do those two things, you’ve done more than most couples, and you’ve done a lot to start your relationship off on solid ground.

I therefore, recommend meeting with a financial planner to discuss issues such as spending, use of credit cards and financial goals. Goals should include the following: savings, pension contributions, retirement planning, debt, discretionary spending, school loans and the use of credit cards. How will you handle school loans and debt brought into the marriage? How much money can be spent without consulting the other. I usually recommend $100 to $300.

Family Ties and In-laws
A family is made up of many unique individuals, each with a range of thoughts and opinions on almost every subject and situation. Add to the mix extended family with their countless beliefs and personal opinions and there is no wonder there are disagreements from time to time. Conflict is simply the natural and healthy progression of any relationship

Some questions to explore – What sort of relationship do you have with your extended family? Are they local? Do they like your fiancée? Are they affectionate? Are they over-involved or critical? Have there been any major conflictual issues?

I suggest that couples begin to see themselves as their own family unit. When addressing family of origin, always say that “we” will have to discuss the event or holiday and that he or she should respond to their own family unit. This is especially true once children enter the picture. Now consider, if you want to see us come over………  This way the kids don’t have to get up open presents and get in the car! Now your doing what is best for family.

Religious Beliefs
This potentially contentious issue should always be discussed in premarital counseling. The first step is to seek a better understanding of your future spouse’s religious and spiritual background.
Topics to look into are:
• How to reconcile differing ideologies and practices
• How to observe and celebrate each other’s holidays
• How to raise children so that they are exposed to both partners’ traditions without being overwhelmed and/or confused
• How to integrate both extended families, especially during the wedding/holidays

Case Study:

Mark is not religious; Eileen is and expects to go to Church every week. What if they did marry and had children; would Mark go to Church then?
What if Mark is Catholic and Eileen is Jewish? Will one of you convert? Does it matter at all? What will the respective families say? That is a big question especially in regard to child rearing.

“What do you mean; you are not going to raise the baby Catholic? Jewish?” For some, the consequences of that decision may be long lasting or a deal breaker. It is clearly better to decide before marriage and tell both families about your decision. In discussions with the extended families, always use the phrase “we” have decided.

Children and Parenting
Do you want children? How many and when? Are there already children from previous relationships? Have you discussed blended family issues? What do you expect from your spouse regarding parenting/step parenting roles? When a problem arises, how does my partner communicate? What are the responsibilities of each parent in raising a child?

I strongly recommend that you have two to four years together as a couple before you have children. This time is critical, it gives you the opportunity to get to know one another as a married couple.

Children don’t bring you closer together; they create stress and sometimes distance especially if you and your intended are not on the same page regarding roles and responsibilities. And even more stress when ex’s and step in-laws are in the picture.

Blended families have a lot to discuss: the ex, custody issues, the in-laws, parenting, finances, loans, debt, child support, etc.. They especially need premarital counseling. I am surprised at how often these have not been fully addressed.

I believe that the children don’t come first; your relationship comes first. Now I know that is not true but if you divorce, it will be children that suffer most. Of course, my point is don’t forget to make time for your relationship after you have children. Planning for alone time or date night is a key component in addressing this issue. Take turns planning so the wife isn’t doing it all. But above all – Parent as a team! Be consistent with consequences. Discuss issues prior to discussing them with the children. What to say and how to say it.

Work, Lifestyle, Leisure and Fun
What sort of lifestyle do you want? Will you both continue to work when children are born? Do you have the same idea of what is fun? Where will you want to live?

Today most couples are comprised of two working parents. Couples want to maintain or improve the lifestyle they had going into the marriage. This is difficult in today’s economy and job market. For the first time in history, couples may not meet or exceed their parents’ lifestyle. The common expectations of employment today are long hours and work from home in the evening and on the weekend. This reduces quality time together. These forces necessitate compromise and making the most of the time you have together. Planning mutually enjoyable activities and social events and balanced with appropriate alone time is a key component in maintaining a strong relationship.

Final Thought
You may not feel you NEED premarital counseling, but it is still wise choice to consider. You may be on cloud nine with the impending marriage but counseling may help bring up and resolve some difficult topics. Better to discuss issues before marriage then with a divorce attorney later.

Zoom!

Now I can work via zoom with anyone, anywhere in the country and it may still be covered by BCBS Insurance. Check with your BCBS representative for more information.

Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

http://manageyourmood.net
http://family-institute.org
http://psychologytoday.com

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material with your doctor and therapist.