Monday, July 21, 2014

DRUG ABUSE AND ADDICTION

 

Signs, Symptoms, and Help for Drug Problems and Substance Abuse

Some people are able to use recreational or prescription drugs without ever experiencing negative consequences or addiction. For many others, substance use can cause problems at work, home, school, and in relationships, leaving you feeling isolated, helpless, or ashamed.
If you’re worried about your own or a friend or family member’s drug use, it’s important to know that help is available. Learning about the nature of drug abuse and addiction—how it develops, what it looks like, and why it can have such a powerful hold—will give you a better understanding of the problem and how to best deal with it.


Understanding drug use, drug abuse, and addiction

People experiment with drugs for many different reasons. Many first try drugs out of curiosity, to have a good time, because friends are doing it, or in an effort to improve athletic performance or ease another problem, such as stress, anxiety, or depression. Use doesn’t automatically lead to abuse, and there is no specific level at which drug use moves from casual to problematic. It varies by individual. Drug abuse and addiction is less about the amount of substance consumed or the frequency, and more to do with the consequences of drug use. No matter how often or how little you’re consuming, if your drug use is causing problems in your life—at work, school, home, or in your relationships—you likely have a drug abuse or addiction problem.

Why do some drug users become addicted, while others don’t?

As with many other conditions and diseases, vulnerability to addiction differs from person to person. Your genes, mental health, family and social environment all play a role in addiction. Risk factors that increase your vulnerability include:
  • Family history of addiction
  • Abuse, neglect, or other traumatic experiences in childhood
  • Mental disorders such as depression and anxiety
  • Early use of drugs
  • Method of administration—smoking or injecting a drug may increase its addictive potential

Drug addiction and the brain

Addiction is a complex disorder characterized by compulsive drug use. While each drug produces different physical effects, all abused substances share one thing in common: repeated use can alter the way the brain looks and functions.
  • Taking a recreational drug causes a surge in levels of dopamine in your brain, which trigger feelings of pleasure. Your brain remembers these feelings and wants them repeated.
  • If you become addicted, the substance takes on the same significance as other survival behaviors, such as eating and drinking.
  • Changes in your brain interfere with your ability to think clearly, exercise good judgment, control your behavior, and feel normal without drugs.
  • Whether you’re addicted to inhalants, heroin, Xanax, speed, or Vicodin, the uncontrollable craving to use grows more important than anything else, including family, friends, career, and even your own health and happiness.
  • The urge to use is so strong that your mind finds many ways to deny or rationalize the addiction. You may drastically underestimate the quantity of drugs you’re taking, how much it impacts your life, and the level of control you have over your drug use. 

 

 

How drug abuse and addiction can develop

People who experiment with drugs continue to use them because the substance either makes them feel good, or stops them from feeling bad. In many cases, however, there is a fine line between regular use and drug abuse and addiction. Very few addicts are able to recognize when they have crossed that line. While frequency or the amount of drugs consumed don’t in themselves constitute drug abuse or addiction, they can often be indicators of drug-related problems.
  • Problems can sometimes sneak up on you, as your drug use gradually increases over time. Smoking a joint with friends at the weekend, or taking ecstasy at a rave, or cocaine at an occasional party, for example, can change to using drugs a couple of days a week, then every day. Gradually, getting and using the drug becomes more and more important to you.
  • If the drug fulfills a valuable need, you may find yourself increasingly relying on it. For example, you may take drugs to calm you if you feel anxious or stressed, energize you if you feel depressed, or make you more confident in social situations if you normally feel shy. Or you may have started using prescription drugs to cope with panic attacks or relieve chronic pain, for example. Until you find alternative, healthier methods for overcoming these problems, your drug use will likely continue.
  • Similarly, if you use drugs to fill a void in your life, you’re more at risk of crossing the line from casual use to drug abuse and addiction. To maintain healthy balance in your life, you need to have other positive experiences, to feel good in your life aside from any drug use.
  • As drug abuse takes hold, you may miss or frequently be late for work or school, your job performance may progressively deteriorate, and you start to neglect social or family obligations. Your ability to stop using is eventually compromised. What began as a voluntary choice has turned into a physical and psychological need.
The good news is that with the right treatment and support, you can counteract the disruptive effects of drug use and regain control of your life. The first obstacle is to recognize and admit you have a problem, or listen to loved ones who are often better able to see the negative effects drug use is having on your life.

5 Myths about Drug Abuse and Addiction

MYTH 1: Overcoming addiction is a simply a matter of willpower. You can stop using drugs if you really want to. Prolonged exposure to drugs alters the brain in ways that result in powerful cravings and a compulsion to use. These brain changes make it extremely difficult to quit by sheer force of will.
MYTH 2: Addiction is a disease; there’s nothing you can do about it. Most experts agree that addiction is a brain disease, but that doesn’t mean you’re a helpless victim. The brain changes associated with addiction can be treated and reversed through therapy, medication, exercise, and other treatments.
MYTH 3: Addicts have to hit rock bottom before they can get better. Recovery can begin at any point in the addiction process—and the earlier, the better. The longer drug abuse continues, the stronger the addiction becomes and the harder it is to treat. Don’t wait to intervene until the addict has lost it all.
MYTH 4: You can’t force someone into treatment; they have to want help. Treatment doesn’t have to be voluntary to be successful. People who are pressured into treatment by their family, employer, or the legal system are just as likely to benefit as those who choose to enter treatment on their own. As they sober up and their thinking clears, many formerly resistant addicts decide they want to change.
MYTH 5: Treatment didn’t work before, so there’s no point trying again. Recovery from drug addiction is a long process that often involves setbacks. Relapse doesn’t mean that treatment has failed or that you’re a lost cause. Rather, it’s a signal to get back on track, either by going back to treatment or adjusting the treatment approach.

Signs and symptoms of drug abuse and drug addiction

Although different drugs have different physical effects, the symptoms of addiction are similar. See if you recognize yourself in the following signs and symptoms of substance abuse and addiction. If so, consider talking to someone about your drug use.

Common signs and symptoms of drug abuse

  • You’re neglecting your responsibilities at school, work, or home (e.g. flunking classes, skipping work, neglecting your children) because of your drug use.
  • You’re using drugs under dangerous conditions or taking risks while high, such as driving while on drugs, using dirty needles, or having unprotected sex.
  • Your drug use is getting you into legal trouble, such as arrests for disorderly conduct, driving under the influence, or stealing to support a drug habit. 
  • Your drug use is causing problems in your relationships, such as fights with your partner or family members, an unhappy boss, or the loss of old friends.

Common signs and symptoms of drug addiction

  • You’ve built up a drug tolerance. You need to use more of the drug to experience the same effects you used to attain with smaller amounts.
  • You take drugs to avoid or relieve withdrawal symptoms. If you go too long without drugs, you experience symptoms such as nausea, restlessness, insomnia, depression, sweating, shaking, and anxiety.
  • You’ve lost control over your drug use. You often do drugs or use more than you planned, even though you told yourself you wouldn’t. You may want to stop using, but you feel powerless.
  • Your life revolves around drug use. You spend a lot of time using and thinking about drugs, figuring out how to get them, and recovering from the drug’s effects.
  • You’ve abandoned activities you used to enjoy, such as hobbies, sports, and socializing, because of your drug use.
  • You continue to use drugs, despite knowing it’s hurting you. It’s causing major problems in your life—blackouts, infections, mood swings, depression, paranoia—but you use anyway.

 

 

Warning signs that a friend or family member is abusing drugs

Drug abusers often try to conceal their symptoms and downplay their problem. If you’re worried that a friend or family member might be abusing drugs, look for the following warning signs:

Physical warning signs of drug abuse

  • Bloodshot eyes, pupils larger or smaller than usual
  • Changes in appetite or sleep patterns. Sudden weight loss or weight gain
  • Deterioration of physical appearance, personal grooming habits
  • Unusual smells on breath, body, or clothing
  • Tremors, slurred speech, or impaired coordination

Behavioral signs of drug abuse

  • Drop in attendance and performance at work or school
  • Unexplained need for money or financial problems. May borrow or steal to get it.
  • Engaging in secretive or suspicious behaviors
  • Sudden change in friends, favorite hangouts, and hobbies
  • Frequently getting into trouble (fights, accidents, illegal activities)

Psychological warning signs of drug abuse

  • Unexplained change in personality or attitude
  • Sudden mood swings, irritability, or angry outbursts
  • Periods of unusual hyperactivity, agitation, or giddiness
  • Lack of motivation; appears lethargic or “spaced out”
  • Appears fearful, anxious, or paranoid, with no reason

Warning Signs of Commonly Abused Drugs

  • Marijuana: Glassy, red eyes; loud talking, inappropriate laughter followed by sleepiness; loss of interest, motivation; weight gain or loss.
  • Depressants (including Xanax, Valium, GHB): Contracted pupils; drunk-like; difficulty concentrating; clumsiness; poor judgment; slurred speech; sleepiness.
  • Stimulants (including amphetamines, cocaine, crystal meth): Dilated pupils; hyperactivity; euphoria; irritability; anxiety; excessive talking followed by depression or excessive sleeping at odd times; may go long periods of time without eating or sleeping; weight loss; dry mouth and nose.
  • Inhalants (glues, aerosols, vapors): Watery eyes; impaired vision, memory and thought; secretions from the nose or rashes around the nose and mouth; headaches and nausea; appearance of intoxication; drowsiness; poor muscle control; changes in appetite; anxiety; irritability; lots of cans/aerosols in the trash.
  • Hallucinogens (LSD, PCP): Dilated pupils; bizarre and irrational behavior including paranoia, aggression, hallucinations; mood swings; detachment from people; absorption with self or other objects, slurred speech; confusion.
  • Heroin: Contracted pupils; no response of pupils to light; needle marks; sleeping at unusual times; sweating; vomiting; coughing, sniffling; twitching; loss of appetite.

Warning signs of teen drug abuse

While experimenting with drugs doesn’t automatically lead to drug abuse, early use is a risk factor for developing more serious drug abuse and addiction. Risk of drug abuse also increases greatly during times of transition, such as changing schools, moving, or divorce. The challenge for parents is to distinguish between the normal, often volatile, ups and downs of the teen years and the red flags of substance abuse. These include:
  • Having bloodshot eyes or dilated pupils; using eye drops to try to mask these signs
  • Skipping class; declining grades; suddenly getting into trouble at school
  • Missing money, valuables, or prescriptions
  • Acting uncharacteristically isolated, withdrawn, angry, or depressed
  • Dropping one group of friends for another; being secretive about the new peer group
  • Loss of interest in old hobbies; lying about new interests and activities
  • Demanding more privacy; locking doors; avoiding eye contact; sneaking around

 

 

Getting help for drug abuse and drug addiction

Finding help and support for drug addiction

  • Visit a Narcotics Anonymous meeting in your area. See Resources & References below.
  • Call 1-800-662-HELP in the U.S. to reach a free referral helpline from the Substance Abuse and Mental Health Services Administration.
Recognizing that you have a problem is the first step on the road to recovery, one that takes tremendous courage and strength. Facing your addiction without minimizing the problem or making excuses can feel frightening and overwhelming, but recovery is within reach. If you’re ready to make a change and willing to seek help, you can overcome your addiction and build a satisfying, drug-free life for yourself.

Support is essential to addiction recovery

Don’t try to go it alone; it’s all too easy to get discouraged and rationalize “just one more” hit or pill. Whether you choose to go to rehab, rely on self-help programs, get therapy, or take a self-directed treatment approach, support is essential. Recovering from drug addiction is much easier when you have people you can lean on for encouragement, comfort, and guidance.
Support can come from:
  • family members
  • close friends
  • therapists or counselors
  • other recovering addicts
  • healthcare providers
  • people from your faith community

When a loved one has a drug problem

If you suspect that a friend or family member has a drug problem, here are a few things you can do:
  • Speak up. Talk to the person about your concerns, and offer your help and support, without being judgmental. The earlier addiction is treated, the better. Don’t wait for your loved one to hit bottom! Be prepared for excuses and denial by listing specific examples of your loved one’s behavior that has you worried.
  • Take care of yourself. Don’t get so caught up in someone else’s drug problem that you neglect your own needs. Make sure you have people you can talk to and lean on for support. And stay safe. Don’t put yourself in dangerous situations.
  • Avoid self-blame. You can support a person with a substance abuse problem and encourage treatment, but you can’t force an addict to change. You can’t control your loved one’s decisions. Let the person accept responsibility for his or her actions, an essential step along the way to recovery for drug addiction. 

But Don’t

  • Attempt to punish, threaten, bribe, or preach.
  • Try to be a martyr. Avoid emotional appeals that may only increase feelings of guilt and the compulsion to use drugs.
  • Cover up or make excuses for the drug abuser, or shield them from the negative consequences of their behavior.
  • Take over their responsibilities, leaving them with no sense of importance or dignity.
  • Hide or throw out drugs.
  • Argue with the person when they are high.
  • Take drugs with the drug abuser.
  • Feel guilty or responsible for another's behavior.
Adapted from: National Clearinghouse for Alcohol & Drug Information

When your teen has a drug problem

Discovering your child uses drugs can generate fear, confusion, and anger in parents. It’s important to remain calm when confronting your teen, and only do so when everyone is sober. Explain your concerns and make it clear that your concern comes from a place of love. It’s important that your teen feels you are supportive.
Five steps parents can take:
  • Lay down rules and consequences. Your teen should understand that using drugs comes with specific consequences. But don’t make hollow threats or set rules that you cannot enforce. Make sure your spouse agrees with the rules and is prepared to enforce them.
  • Monitor your teen’s activity. Know where your teen goes and who he or she hangs out with. It’s also important to routinely check potential hiding places for drugs—in backpacks, between books on a shelf, in DVD cases or make-up cases, for example. Explain to your teen that this lack of privacy is a consequence of him or her having been caught using drugs.
  • Encourage other interests and social activities. Expose your teen to healthy hobbies and activities, such as team sports and afterschool clubs.
  • Talk to your child about underlying issues. Drug use can be the result of other problems. Is your child having trouble fitting in? Has there been a recent major change, like a move or divorce, which is causing stress?
  • Get Help. Teenagers often rebel against their parents but if they hear the same information from a different authority figure, they may be more inclined to listen. Try a sports coach, family doctor, therapist, or drug counselor.

 

Tuesday, June 3, 2014

SONG DEDICATED TO AMANDA TODD BY ELISE ESTRADA



This song is dedicated to Amanda Todd AND every other person who has ever been a victim of bullying.
All of the proceeds of the sale of "Wonder Woman" are going to 'The Amanda Todd Legacy Fund' which will help aid many Anti-Bullying Campaigns as well as Suicide Prevention.
It is our hope that this song inspires you to stand up to stop bullying. Please support the cause.
Stand up to stop bullying and download Wonder Woman on iTunes now: https://itunes.apple.com/ca/album/wonder-woman-dedicated-to/id573018676


100% of the proceeds will be donated to the Amanda Todd Legacy Fund towards anti bullying initiatives.


GUIDE ENGLISH: http://www.woman.ch/uploads/19nov/guide/WWSFpreventionGuide-2011-en.pdf    SHARE IT !!


GUIA EN ESPAÑOL:  http://www.woman.ch/uploads/19nov/guide/WWSFpreventionGuide-June09-es.pdf     COMPARTELA !!


SUBSCRIBE,  SUSCRIBETE: https://www.youtube.com/user/TvLibertad/videos?view=0&flow=grid

Monday, May 26, 2014

TRUE COLORS (SONG AND LYRICS) Bully Awareness.



https://itunes.apple.com/ca/album/true-colors-single/id577296407
Together we can shine the spotlight on bullying, and together we can work to overcome this global issue." Canada Artist.
You can download the song "True Colors" from iTunes, and 100% of the proceeds go to Kids Help Phone.

http://org.kidshelpphone.ca//en/homepage-new (English)
http://org.jeunessejecoute.ca//fr/homepage-new (Français)
True Colors - Single
Artists Against, Hedley, Simple Plan, Kardinal Offishall, Lights, Alyssa Reid, Fefe Dobson & Walk Off the Earth.


DOWNLOAD GUIDE ENGLISH: 

BAJA ESTA GUIA EN ESPAÑOL:

Saturday, April 5, 2014

THE LIFE-CHANGING BENEFITS OF EXERCISE



Exercise is not just about aerobic capacity and muscle size. Sure, exercise can improve your health and your physique, trim your waistline, improve your sex life, and even add years to your life. But that’s not what motivates most people to stay active. People who exercise regularly tend to do so because it gives them an enormous sense of well–being. They feel more energetic throughout the day, sleep better at night, have sharper memories, and feel more relaxed and positive about themselves and their lives. And it doesn’t take hours of pumping weights in a gym or running mile after mile to achieve those results.
By focusing on activities you enjoy and tailoring a regular mild to moderate exercise routine to your needs, you can experience the health benefits of exercise and improve your own life by:
  • Easing stress and anxiety. A twenty-minute bike ride won’t sweep away all of life’s troubles, but exercising regularly helps you take charge of anxiety and reduce stress. Aerobic exercise releases hormones that relieve stress and promote a sense of well-being.
  • Lifting your mood. Exercise can treat mild to moderate depression as effectively as antidepressant medication. Exercise also releases endorphins, powerful chemicals in your brain that energize your spirits and make you feel good.
  • Sharpening brainpower. The same endorphins that make you feel better also help you concentrate and feel mentally sharp for tasks at hand. Exercise also stimulates the growth of new brain cells and helps prevent age-related decline.
  • Improving self-esteem. Regular activity is an investment in your mind, body, and soul. When it becomes habit, it can foster your sense of self-worth and make you feel strong and powerful.
  • Boosting energy. Increasing your heart rate several times a week will give you more get-up-and-go. Start off with just a few minutes of exercise a day, and increase your workout as you feel more energized. 

Obstacles to exercise: What’s holding you back?

Despite all the life-changing benefits, many of us still think of exercise as a chore, either something that we don’t have time for, or something that’s only suitable for the young or the athletic.
There are many commonly-held myths about exercise that make it seem more arduous and painful than it has to be. Overcoming obstacles to exercise starts with separating fact from fiction.

 

Why we don’t exercise

“I don’t have enough time to exercise.”
Even short low-impact intervals of exercise can act as a powerful tool to supercharge your health. If you have time for a 15-minute walk with the dog, your body will thank you in many ways.
“Exercise is too difficult and painful.”
Consider “no pain, no gain” the old fashioned way of thinking about exercise. Exercise doesn’t have to hurt to be incredibly effective. You don’t have to push yourself to the limit to get results. You can build your strength and fitness by walking, swimming, even playing golf or cleaning the house.
“I’m too tired to exercise.”
Regular exercise is a powerful pick-me-up that can significantly reduce fatigue and make you feel much more energetic. If you’re feeling tired, try taking a brisk walk or dancing to your favorite music and see how much better you feel afterwards.
“I’m too old to start exercising,” “I'm too fat,” or “My health isn’t good enough.”
It’s never too late to start building your strength and physical fitness, even if you’re a senior or a self-confessed couch potato who has never exercised before. And exercise is a proven treatment for many diseases—from diabetes to arthritis. Very few health or weight problems make exercise out of the question, so talk to your doctor about a safe routine for you.
“I’m not athletic.”
Do you hide your head when the tennis ball approaches? Are you stumped at the difference between a foul ball and a free throw? Join the ranks. Don’t worry if you’re not sporty or ultra-coordinated. Instead, find an activity like walking, jogging, or yoga that makes you feel good to be in your body.
“Exercise is boring.”
Sure, pounding on a treadmill for an hour may not be everyone’s idea of a good time. But not all exercise has to be boring; just about everyone can find a physical activity they enjoy. Try playing ping-pong (table tennis) or activity-based video games with your kids. So-called “exergames” that are played standing up and moving around—simulating dancing, skateboarding, soccer, or tennis, for example—can burn at least as many calories as walking on a treadmill; some substantially more. Once you build up your confidence, try getting away from the TV screen and playing the real thing outside.
 

Reaping the benefits of exercise is easier than you think

To reap the benefits of exercise, you don’t need to devote hours out your busy day, train at the gym, sweat buckets, or run mile after monotonous mile. You can reap all the physical and mental health benefits of exercise with 30-minutes of moderate exercise five times a week. Two 15-minute exercise sessions can also work just as well.
If that still seems intimidating, don’t despair. Even just a few minutes of physical activity are better than none at all. If you don’t have time for 15 or 30 minutes of exercise, or if your body tells you to take a break after 5 or 10 minutes, for example, that’s okay, too. Start with 5- or 10-minute sessions and slowly increase your time. The more you exercise, the more energy you’ll have, so eventually you’ll feel ready for a little more. The key is to commit to do some moderate physical activity—however little—on most days. As exercising becomes habit, you can slowly add extra minutes or try different types of activities. If you keep at it, the benefits of exercise will begin to pay off.
 

Do I need different types of exercise?

While any kind of exercise offers tremendous health benefits, different types of exercise focus more on certain aspects of your health. You can concentrate on one type of exercise or mix them up to add variety to your workouts and broaden the health benefits.
  • Aerobic activities like running, cycling, and swimming strengthen your heart and increase your endurance.
  • Strength training like weight lifting or resistance training builds muscle and bone mass, improves balance and prevents falls. It’s one of the best counters to frailty in old age.
  • Flexibility exercises like stretching and yoga help prevent injury, enhance range of motion, reduce stiffness, and limit aches and pains. 

Easy exercise tip 1: Move more in your daily life

If you're not ready to commit to a structured exercise program, think about physical activity as a lifestyle choice rather than a single task to check off your to-do list. Look at your daily routine and consider ways to sneak in activity here and there. Even very small activities can add up over the course of a day.
  • In and around your home. Clean the house, wash the car, tend to the yard and garden, mow the lawn with a push mower, sweep the sidewalk or patio with a broom.
  • At work and on the go. Look for ways to walk or cycle more. For example, bike or walk to an appointment rather than drive, banish all elevators and use the stairs, briskly walk to the bus stop then get off one stop early, park at the back of the lot and walk into the store or office, take a vigorous walk during your coffee break. Walk while you’re talking on your cell phone.
  • With friends or family. Walk or jog around the soccer field during your kid’s practice, make a neighborhood bike ride part of weekend routine, play tag with your children in the yard or play exercise video games. Walk the dog together as a family, or if you don’t have your own dog, volunteer to walk a dog from a shelter. Organize an office bowling team, take a class in martial arts, dance, or yoga with a friend or spouse.

Easy exercise tip 2: Start slowly—a little is better than nothing

Exercise doesn’t need to be an all or nothing commitment. If you haven’t exercised before or you’ve tried an exercise program in the past and been unable to stick with it, it’s important not to set unrealistic goals. Committing to exercise for an hour a day in a gym may be too challenging at first, whereas committing to 10 minutes just three or four times a week is more manageable. Once these short windows of activity become a habit and you start experiencing the benefits, it’s easier to progress to the next level.

Tips for getting started in an exercise program

  • Focus on activities you enjoy. If you hate jogging, you won’t be able to maintain a jogging program no matter how good it is for you. On the other hand, if you love to swim, dance, or play tennis you’ll find it easier to sick with an exercise program that’s built around those activities.
  • Take it slow. Start with an activity you feel comfortable doing, go at your own pace, and keep your expectations realistic. For example, training for a marathon when you’ve never run before may be a bit daunting, but you could give yourself the goal of participating in an upcoming 5k walk for charity.
  • Focus on short-term goals, such as improving your mood and energy levels and reducing stress, rather than goals such as weight loss or increased muscle size, as these can take longer to achieve.
  • Make exercise a priority. If you have trouble fitting exercise into your schedule, consider it an important appointment with yourself and mark it on your daily agenda. Commit to an exercise schedule for at least 3 or 4 weeks so that it becomes habit, and force yourself to stick with it. Even the busiest amongst us can find a 10-minute slot to pace up and down an office staircase or take the dog for a walk.
  • Go easy on yourself. Do you feel bad about your body? Instead of being your own worst critic, try a new way of thinking about your body. No matter what your weight, age, or fitness level, there are others like you with the same goal of exercising more. Try surrounding yourself with people in your shoes. Take a class with others of a similar fitness level. Accomplishing even the smallest fitness goals will help you gain body confidence.
  • Expect ups and downs. Don’t be discouraged if you skip a few days or even a few weeks. It happens. Just get started again and slowly build up to your old momentum. 

Easy exercise tip 3: Make exercise fun

You are more likely to exercise if you find enjoyable, convenient activities. Give some thought to your likes and dislikes, and remember that preferences can change over time.

Pair an activity you enjoy with your exercise 

 There are numerous activities that qualify as exercise. The trick is to find something you enjoy that forces you to be active. Pairing exercise with another activity makes it easier and more fun. Simple examples include:

  • Take a dance or yoga class.
  • Blast some favorite music and dance with your kids.
  • Make a deal with yourself to watch your favorite TV shows while on the treadmill or stationary bike.
  • Workout with a buddy, and afterwards enjoy coffee or a movie.
  • Enjoy outdoor activities such as golf, playing Frisbee, or even yard work or gardening. 

Make exercise a social activity

Exercise can be a fun time to socialize with friends and working out with others can help keep you motivated. For those who enjoy company but dislike competition, a running club, water aerobics, or dance class may be the perfect thing. Others may find that a little healthy competition keeps the workout fun and exciting. You might seek out tennis partners, join an adult soccer league, find a regular pickup basketball game, or join a volleyball team.
For many, a workout partner can be a great motivator. For example, if you won’t get out of bed to swim yourself, but you would never cancel on a friend, find a swim buddy.

Easy exercise tip 4: Stay motivated

No matter how much you enjoy an exercise routine, you may find that you eventually lose interest in it. That’s the time to shake things up and try something new, add other activities to your exercise program, or alter the way you pursue the exercises that have worked so far.

Set yourself goals and rewards

Rewarding yourself for reaching an exercise goal is one of the best ways to stay motivated. Set an achievable goal regarding your participation and effort, not necessarily how much weight you can lift, miles you can bike, or pounds you can lose lost. If you stumble in your efforts, regroup and begin again. Reward yourself when you reach your goals—a new pair of shoes, a dinner out, whatever works to motivate you.

Other ways to keep your exercise program going

  • Be consistent. Make your workouts habitual by exercising at the same time every day, if possible. Eventually you will get to the point where you feel worse if you don’t exercise. That dull, sluggish feeling fitness buffs get when they don’t work out is a strong incentive to get up and go.
  • Record your progress. Try keeping an exercise journal of your workouts. In a matter of months, it will be fun to look back at where you began. Keeping a log also holds you accountable to your routine.
  • Keep it interesting. Think of your exercise session as time dedicated to you. Enjoy that time by listening to music, chatting with friends, and varying locations. Exercise around natural beauty, new neighborhoods, and special parks.
  • Spread the word. Talking to others about your fitness routines will help keep motivation strong and hold you accountable to your exercise program. You’ll be delighted and inspired hearing ways your friends and colleagues stay active and on track.
  • Get inspired. Read a health and fitness magazine or visit an exercise website and get inspired with photos of people being active. Sometimes reading about and looking at images of people who are healthy and fit can motivate you to move your body.


Saturday, October 5, 2013

INDICATORS OF CHILD SEXUAL ABUSE


Sexual abuse may result in physical or behavioral manifestations. It is important that professionals and the public know what these are because they signal possible sexual abuse. However, very few manifestations (e.g., gonorrhea of the throat in a young child) are conclusive of sexual abuse. Most manifestations require careful investigation or assessment.
Unfortunately, early efforts at cataloging indicators of sexual abuse were problematic. They included extremely rare findings, such as blood in a child's underpants and signs that could be indicative of many problems or no problem at all, such as "comes early to school and leaves late." Recent efforts to designate signs of sexual abuse are more helpful.

  • They differentiate between physical indicators and psychosocial indicators. Although physical indicators may be noted by many people, a definitive determination is generally made by a medical professional. Similarly, anyone may observe psychosocial indicators; however, often but not always, a mental health professional is responsible for forming an opinion that the symptoms are indicative of sexual abuse.
  • A differentiation is made between higher and lower probability indicators. That is, some indicators are diagnostic of sexual abuse, whereas others may be consistent with or suggestive of sexual abuse but could indicate other circumstances or conditions as well.
In this chapter, higher probability findings and lower probability physical indicators are discussed first. A comparable discussion of psychosocial indicators will follow. It should not be surprising that the indicators specified in this chapter are similar to the effects described in the previous chapter since indicators are to a large extent the effects of sexual abuse before disclosure. Therefore, these indicators should become a focus of treatment and not simply used to support or rule out an allegation of sexual abuse.


   

Medical Indicators of Child Sexual Abuse

Significant progress has been made in the medical field in the determination of sexual abuse. Medical professionals are no longer limited to the presence or absence of a hymen as the indicator of possible sexual abuse. A variety of types of genital findings have been documented. In addition, notable progress has been made in identifying anal findings. Moreover, physicians are able to describe the effects of different kinds of sexual activity, and subtle findings can be documented using magnification (a colposcope or otoscope).
However, this progress is not without its controversies. Knowledgeable and conscientious physicians may differ regarding conclusions about certain physical findings. This difference of opinion is primarily due to the fact that data collection regarding the physical signs of sexual abuse has preceded careful documentation of characteristics of genitalia and anal anatomy of children who have not been sexually abused and of variations among normal children. These legitimate differences of opinion have been augmented by challenges to the medical documentation from defense attorneys, their expert witnesses, and alleged offenders.
It is also important to appreciate that for the majority of sexually abused children there are no physical findings. These findings, particularly vaginal ones, are most useful with prepubertal victims. As children become older, the possibility of consensual sexual activity needs to be considered. Further, changes that occur with puberty render insignificant some symptoms that have great significance in young children.

Two High-Probability Physical Indicators

Despite the progress noted above, the highest probability indicators are ones identified over 10 years ago. They are:

  • pregnancy in a child and
  • venereal disease in a child.
The reason these findings are high probability is because there is little dispute over the fact that they require sexual activity.
Some professionals assume that pregnancy in a child less than age 12 signals abuse although others designate the age of 13 or 14. Of course, not all situations in which children of these ages become pregnant are abusive, and pregnancy in older adolescents can be a consequence of sexual abuse.
Venereal disease may be located in the mucosa of the vagina, penis, anus, or mouth. The upper age limits for venereal disease raising concern about sexual abuse are similar to those for pregnancy. In addition, there is a lower age limit, usually of 1 or 2 months, because infants may be born with venereal disease acquired congenitally if the mother has the disease.
Interestingly, variations are found within the medical community regarding the certainty that sexual activity causes particular venereal diseases in children. Specifically, there is consensus that syphilis and gonorrhea cannot be contracted from toilet seats or bed sheets, but some differences of opinion exist about other venereal diseases (genital herpes, condyloma acuminata or venereal warts, trichomonas vaginalitis, and urogenital chlamydia), despite the conclusion that such infections are caused by sexual contact in adults.45 In a recent review of the research, Smith, Benton, Moore, and Runyan conclude that there is "strong evidence" that all of these venereal diseases are sexually transmitted, except for herpes, for which there is "probable evidence." They also review the evidence on human immunodeficiency virus (HIV) and conclude that there is strong evidence it is sexually transmitted as well, unless contracted pre- or perinatally.46

Genital Findings

High-probability findings specific to the genitalia include the following:

  • semen in the vagina of a child,
  • torn or missing hymen,
  • other vaginal injury or scarring,
  • vaginal opening greater than 5 mm, and
  • injury to the penis or scrotum.
Semen in the vagina is the highest probability finding, but it is uncommon.
Although there is a fair amount of variability among girl children in the extent, shape, and other characteristics of hymens,47 the complete absence of or a tear in the hymen of a young girl is indicative of sexual abuse. In older girls, it is important to determine whether other sexual activities may account for the absence or the tear. Conditions such as bumps, friability, and clefts in the hymen may be a result of sexual abuse, but they are also found in girls without a reported history of sexual abuse.48
Health care professionals document and describe injuries to or bleeding from the vaginal opening by likening it to a clock face, 12 o'clock being the anterior midline and 6 o'clock the posterior. Abrasions, tears, and bruises to the vagina between 3 and 9 o'clock, or to the posterior, are more likely to be the result of penile penetration, whereas injuries between 9 and 3 o'clock, or anteriorly, are more likely the consequence of digital manipulation or penetration.49
There is some controversy regarding what transverse diameter to use as a guideline for differentiating between girls with genital evidence consistent with penetration and those with no genital evidence, with measures ranging from 4 to 6 mm being advocated as indicative of sexual abuse.50 One factor that may affect findings is the age of the child, with the expectation that older girls will have larger vaginal openings. Heger, an expert in physical findings related to sexual abuse, discounts the importance of hymenal transverse diameter, noting that it varies in size depending on the position in which the child is examined.51 It is also important to note that not all girls who have a reported history of penetration evidence enlarged vaginal openings, tears, abrasions, or bruising.
Absent another explanation for an injury to the penis, which is consistent with the child's account of the abusive incident, the injury should be considered indicative of sexual abuse. Bite marks, abrasions, redness, "hickeys," scratches, or bruises may be found.
Lower probability genital findings are as follows:

  • vaginal erythema,
  • increased vascularity,
  • synechiae,
  • labial adhesions,
  • vulvovaginitis, and
  • chronic urinary tract infections.
Erythema or redness and swelling might be caused by genital manipulation or intrusion perpetrated by a significantly older person. However, it might also be the result of poor hygiene, diaper rash, or perhaps the child's masturbation.52 Increased vascularity, synechiae, and labial adhesions may be a consequence of sexual abuse, but they are common findings in children with other genital complaints.53
Vulvovaginitis and chronic urinary tract infections can be sequelae of sexual abuse but also can be caused by other circumstances, such as poor hygiene, a bubble bath, or, in the case of urinary tract infections, taking antibiotics.

Anal Findings

The following are high-probability findings:

  • destruction of the anal sphincter,
  • perianal bruising or abrasion,
  • shortening or eversion of the anal canal,
  • fissures to the anal opening,
  • wasting of gluteal fat, and
  • funneling.
Very occasionally there will be a finding of total absence of anal sphincter control, indicative of chronic anal penetration. If there has been forceful anal penetration, it may result in bruising and scrapes. A shortening or eversion of the anal canal has been found in very young children who have been chronically anally penetrated.54 Perianal fissures and scars from fissures are thought to be indicative of sexual abuse except when they occur at 12 o'clock and 6 o'clock,55 in which case they may be the result of a large stool. If the fissure is wider externally and narrows internally, this is consistent with object penetration of the anus. The converse finding is consistent with the passage of a large, firm stool.56 Funneling and wasting of the gluteal fat around the anal opening can occur from chronic anal penetration. This is a rare finding in children but may be found in male adolescent prostitutes. The following anal findings are lower probability:

  • perianal erythema,
  • increased perianal pigmentation,
  • perianal venous engorgement, and
  • reflex anal dilatation.
Perianal erythema, increased pigmentation, and venous engorgement are all physical findings noted in children who have a history of anal penetration. However, these conditions also have been reported in substantial numbers of children with no reported history of sexual abuse, suggesting that they can be caused by other conditions.57 In the case of the first two findings, these conditions could be a consequence of poor hygiene.
A finding that is in some dispute is reflex anal dilatation, that is, gaping of the anus or the twitching of the anal sphincter at the time of physical exam. Some physicians believe that it is a consequence of anal penetration,58 but others have noted this finding in children whose lower bowel is full of stool. However, gaping of 20 mm or more is thought to be indicative of anal penetration.59

Oral Findings

Generally oral sex leaves little physical evidence. The only physical findings that have been noted are the following:

  • injury to the palate or
  • pharyngeal gonorrhea.
Sometimes the child will sustain an injury to the soft or hard palate from being subjected to fellatio. This may cause bruising, especially pinpoint bruises called petechiae, or abrasions.60 Children may also contract pharyngeal gonorrhea as a consequence of oral sex, as described above.



 

 Psychosocial Indicators of Child Sexual Abuse

Comparable efforts to identify the psychosocial indicators of child sexual abuse have been made by mental health professionals. In 1985, 100 national experts in sexual abuse met to develop criteria for the "Sexually Abused Child Disorder," in the hope that it would be included in the Diagnostic and Statistical Manual Three-Revised (DSMIII-R). It was not, but the effort remains important. The criteria of the "Sexually Abused Child Disorder" differentiate three levels of certainty (high, medium, and low) and vary by developmental stage. These criteria include both sexual and nonsexual indicators.61
The work of Friedrich focuses on sexualized behavior, indicators unlikely to be found in other traumatized or normal populations. His Child Sexual Behavior Inventory has been field-tested on 260 children between 2 to 12 years of age, who were alleged to have been sexually abused and 880 children not alleged to have been sexually abused. It was found to reliably differentiate the two types of children. However, a substantial proportion of children in Friedrich's research, determined sexually abused, are not reported to engage in sexualized behavior. Moreover, children who learn about sex from nonabusive experiences may engage in sexualized behavior.
In this manual, a two-category typology of behavioral indicators is proposed:

  • sexual indicators, generally being higher probability indicators; and
  • nonsexual behavioral indicators, usually considered lower probability.

Sexual Indicators

Sexual indicators vary somewhat depending on the child's age. The discussion of these indicators will be divided into those likely to be found in younger sexually abused children (aged 10 or younger) and those likely to be found in older sexually abused children (older than age 10). However, this distinction is somewhat arbitrary, and within these two groups there are children at very different developmental stages. Finally, indicators that are important for children of all ages are noted.

Sexual Indicators Found in Younger Children
These behaviors are high-probability indicators because they represent sexual knowledge not ordinarily possessed by young children.

  • Statements indicating precocious sexual knowledge, often made inadvertently.
    • A child observes a couple kissing on television and says that "the man is going to put his finger in her wee wee."
    • A child comments, "You know snot comes out of Uncle Joe's ding dong."
  • Sexually explicit drawings (not open to interpretation).
    • A child draws a picture of fellatio.
  • Sexual interaction with other people.
    • Sexual aggression toward younger or more naive children (represents an identification with the abuser).
    • Sexual activity with peers (indicates the child probably experienced a degree of pleasure from the abusive activity).
    • Sexual invitations or gestures to older persons (suggests the child expects and accepts sexual activity as a way of relating to adults).
  • Sexual interactions involving animals or toys.
    • A child may be observed sucking a dog's penis.
    • A child makes "Barbie™* dolls" engage in oral sex.
The reason sexual knowledge is more compelling when demonstrated by younger children than older ones is that the latter may acquire sexual knowledge from other sources, for example, from classes on sex education or from discussions with peers or older children. Even younger children may obtain knowledge from sources other than abuse. However, children are not likely to learn the intimate details of sexual activity nor for example, what semen tastes like and penetration feels like without direct experience.
Another indicator often cited is excessive masturbation. A limitation of this as an index of sexual abuse is that most children (and adults) masturbate at some time. Thus, it is developmentally normal behavior, which is only considered indicative of sexual abuse when "excessive." However, a determination that the masturbation is excessive may be highly subjective. The following guidelines may be helpful.

  • Masturbation is indicative of possible sexual abuse if:
    • Child masturbates to the point of injury.
    • Child masturbates numerous times a day.
    • Child cannot stop masturbating.
    • Child inserts objects into vagina or anus.
    • Child makes groaning or moaning sounds while masturbating.
    • Child engages in thrusting motions while masturbating.

Sexual Indicators Found in Older Children
As children mature, they become aware of societal responses to their sexual activity, and therefore overt sexual interactions of the type cited above are less common. Moreover, some level of sexual activity is considered normal for adolescents. However, there are three sexual indicators that may signal sexual abuse.

  • sexual promiscuity among girls,
  • being sexually victimized by peers or nonfamily members among girls, and
  • adolescent prostitution.
Of these three indicators, the last is most compelling. One study found that 90 percent of female adolescent prostitutes were sexually abused.62 Although there has not been comparable research on male adolescent prostitutes, there are clinical observations that they become involved in prostitution because of sexual abuse.63

A High-Probability Sexual Indicator for All Children
Finally, when children report to anyone they are being or have been sexually abused, there is a high probability they are telling the truth. Only in rare circumstances do children have any interest in making false accusations. False allegations by children represent between 1 and 5 percent of reports.64 Therefore, unless there is substantial evidence that the statement is false, it should be interpreted as a good indication that the child has, in fact, been sexually abused.

Nonsexual Behavioral Indicators of Possible Sexual Abuse

The reason that nonsexual behavioral symptoms are lower probability indicators of sexual abuse is because they can also be indicators of other types of trauma. For example, these symptoms can be a consequence of physical maltreatment, marital discord, emotional maltreatment, or familial substance abuse. Nonsexual behavioral indicators can arise because of the birth of a sibling, the death of a loved one, or parental loss of employment. Moreover, natural disasters such as floods or earthquakes can result in such symptomatic behavior.
As with sexual behaviors, it is useful to divide symptoms into those more characteristic of younger children and those found primarily in older children. However, there are also some symptoms found in both age groups.

Nonsexual Behavioral Indicators in Young Children
The following symptoms may be found in younger children:

  • sleep disturbances;
  • enuresis;
  • encopresis;
  • other regressive behavior (e.g., needing to take transitional object to school);
  • self-destructive or risk-taking behavior;
  • impulsivity, distractibility, difficulty concentrating (without a history of nonabusive etiology);
  • refusal to be left alone;
  • fear of the alleged offender;
  • fear of people of a specific type or gender;
  • firesetting (more characteristic of boy victims);
  • cruelty to animals (more characteristic of boy victims); and
  • role reversal in the family or pseudomaturity.

Nonsexual Behavioral Indicators in Older Children

  • eating disturbances (bulimia and anorexia);
  • running away;
  • substance abuse;
  • self-destructive behavior, e.g.,
    • suicidal gestures, attempts, and successes and
    • self-mutilation;
  • incorrigibility;
  • criminal activity; and
  • depression and social withdrawal.

Nonsexual Behavioral Indicators in All Children
Three types of problems may be found in children of all ages:

  • problems relating to peers,
  • school difficulties, and
  • sudden noticeable changes in behavior.

Summary

Sexually abused children may manifest a range of symptoms, which reflect the specifics of their abuse and how they are coping with it.
Suspicion is heightened when the child presents with several indicators, particularly when there is a combination of sexual and nonsexual indicators. For example, a common configuration in female adolescent victims is promiscuity, substance abuse, and suicidal behavior. Similarly, the presence of both behavioral and physical symptoms increases concern. However, the absence of a history of such indicators does not signal the absence of sexual abuse.

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