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Transcript

Holiday Advice Week: Safe Celebrations -- Handling Addictions, Maintaining Sobriety, Coping with Depression and Loneliness and Stress During the Holiday Season

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Dr. Harris Stratyner
Addiction and Mental Health Treatment Specialist
Thursday, December 11, 2008; 12:00 PM

The special stresses of the holiday season -- not to mention the abundance of alcohol at parties -- can make this time of year especially difficult for people struggling with substance abuse and other such issues.

Addiction and mental health treatment specialist Dr. Harris Stratyner, a psychologist and regional vice president for the Caron New York Recovery Center was online Thursday, December 11 at 12 noon ET to offer advice to those dealing with stress and addiction themselves, or in their families or workplaces.

The transcript follows.

For ideas and guidance on holiday gifts, entertainment, entertaining and much more, visit washingtonpost.com's 2008 Holiday Guide.

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Dr. Harris Stratyner: Welcome everyone. I'm happy to be here today to address your questions and concerns about substance abuse during the holiday season. Let's get started.

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Austin, Texas: My fiance likes to smoke marijuana occasionally and I don't usually worry about it, but since the holidays have begun, I have noticed he is smoking more than usual. Is there a way I can confront him about it without accusing him of having a problem?

Dr. Harris Stratyner: I don't believe in confronting but I do believe in "Carefronting." First off, never speak to your boyfriend when he is stoned. However, when do you speak to him when he is not using -- do so without shaming or blaming. And simply come from a position of caring and love.

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Seattle: Hello. I have a friend who I think has a drinking problem, but I don't know how to approach her about it. She drinks excessively almost every night of the week, sometimes alone, and I just do not know what to do.

Any advice for approaching the situation would be great. Thanks!

Dr. Harris Stratyner: Speak to your friend as a friend. Let her know how concerned you are about her drinking and make sure that she knows that her drinking is not a judgment about her but concern about the potential of a life-threatening illness.

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Arlington, Va.: Not only is it the holidays, but it's the end of the semester for us students. I'm a part-time student, full-time employee, and I can feel my nerves race thinking about my to-do list.

Do you have any suggestions of breathing exercises? I would do yoga, but really, my time doesn't allow for it this week. I've been getting headaches and my doctor prescribed chlorobenzaprine, a muscle relaxer. I'd prefer to not take it; I don't like taking drugs unnecessarily. Thanks!

Dr. Harris Stratyner: It's not a good idea to take muscle relaxants. However, it is a great idea to do yoga and it doesn't have to take much time. Even five minutes a day of yoga can be effective. Start by getting into a relaxed sitting up position and concentrate on something in your environment -- a focal point if you will. Notice your breathing and breathe slowly inhaling through your nose and exhaling through your mouth. Feel your muscles relax in your chest and your stomach and notice that we breathe correctly when we breathe from our stomachs. Do this for 5 minutes a day and you will feel a lot better.

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Arlington, Va.: I have to cook Christmas dinner for eight when I can just barely function. How can I do this?

Dr. Harris Stratyner: Ask yourself why you can barely function? Is it related to anxiety, perhaps depression or perhaps substance abuse or is it an overlapping combination of all three? Know you are capable of doing anything you put your mind to -- but you'll do it a lot better if you give yourself positive messages and don't abuse alcohol or drugs.

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Wheeling, W.V.: Hi, Dr. Stratyner. I normally have a glass of wine with dinner, and recently it's been turning into two or three glasses. I've been getting very stressed with work lately, and wine seems to be my only release. I don't think I have a drinking problem, but some of my friends have started making comments about my drinking. Does two or three glasses a night make me an alcoholic?

Dr. Harris Stratyner: If your intake of wine has increased, it could be a sign that you are building up a tolerance to alcohol. You certainly may want to consider going to see an addiction counselor for an assessment or simply log on to our website at www.caron.org to speak with a professional.

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Denver, Colo.: I have a friend who started taking Xanax to help her sleep at night. Now she is addicted, and can't sleep without it. Every time she tries to taper, she can't sleep. She's tried Ambien and other sleep drugs before. Any better way to taper off the Xanax than just trying to half the pills?

Dr. Harris Stratyner: Xanax is a highly dangerous benzo. Coming off it abruptly can lead to seizures and needs to be done under medical supervision.

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San Diego, Calif.: My holiday party is next week and I am concerned that everyone will be drinking a lot. I don't like to drink because it makes me feel sick. Is there anything I can drink that maybe looks like a real drink so I won't be teased?

Dr. Harris Stratyner: Absolutely; However, ask yourself why are you afraid of people teasing you about drinking. Ask yourself would friends really tease someone because they choose not to consume alcoholic beverages that can lead to vehicular accidents, hangovers and general feelings that one does not want to experience during a happy holiday season. But if you can't seem to deal with your insecurities around this, stick with ginger ale or cranberry juice and seltzer.

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Seattle: What do you suggest as coping strategies for someone who already suffers from anxiety and depression which is compounded by the usual holiday stress? I've already been to a therapist, only to find out the prescribed medications did not help, and had side effects which actually increased the anxiety and depression.

Dr. Harris Stratyner: Instead of seeing a psychopharmacologist, why not see a psychologist or other type of therapist and try talking about your stress with a professional? Cognitive therap, which helps you to change the way you think on its own and at times in conjunction with medication, is quite effective.

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Albuquerque, N.M.: My alcoholic kid brother just got out of detox and is reportedly attending meetings and living a sober life. I haven't seen him in years for two reasons. First, his treatment of other people was unacceptable. Second, it was not humanly possible to interact with him in a way he didn't somehow spin into an excuse to drink and abuse other people or "proof" that he was getting away with it. Odds are he'll be sprung on me at a family gathering before long. If so, how do I interact with him? Also, how do I know that this "sobriety" isn't just one more ruse in an ongoing chain of lies and drama?

Dr. Harris Stratyner: Sounds like your brother is working on himself and it sounds like from what you wrote, you need to do the same. Some centers such as Caron, where I work, have programs specifically for family members since addiction is a family disease. Give the kid a chance.

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Wilton, Conn.: With the economy as bad as it is right now, my daughter is stressing about whether she's going to get laid off from her job. She used to smoke cigarettes occasionally but now I see her smoking more often. Should I be concerned?

Dr. Harris Stratyner: Indeed, I see the economy effecting many of my patients in terms of their various addictions. Smoking is perhaps the most addictive substance (nicotine). Try to be understanding and suggest to her that she may want to consider a nicotine gum or the patch; a good place to start would be with her family physician. You might also want to tell her that the economy will turn around and she will be okay.

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Washington, D.C.: This isn't about substance abuse, but about holiday stress. Many people have had to deal with sadness during the holidays, but this is only the first year that I've faced it. My family (70-something parents, three grown kids, spouses and a few teen-aged grandkids), has always enjoyed a happy and festive holiday season, but my 47 year-old sister passed away from a heart attack last year on Christmas Eve day and I'm worried about how we're all going to survive Christmas this year. We decided to go about the holidays in our usual way, but I'm worried about it becoming a depressing and maudlin event. Do you have any suggestions for marking but not mourning (too much) her passing on this first anniversary and keeping Christmas a positive experience for us and the kids?

Dr. Harris Stratyner: My sincere condolenses on your loss. Life is a very precious thing and a celebration. Try to focus on the wonderful things in your sister's life that she accomplished. It is also always helpful at this time of year to reach out and help others, be it a soup kitchen, wrapping presents for toddlers, etc.

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Milwaukee, Wisc.: I recently moved away from all my friends to support my husband's new job. I am lonely for the holidays which makes me want to drink more. Any suggestions on how I can stay occupied and not lean on alcohol for warmth?

Dr. Harris Stratyner: One of the best things that you can do when adjusting to a new neighborhood, especially during the holiday season, is to get involved in a mutually supportive self-help group such as AA. If self-help programs are not your thing, try reaching out through your local house of worship.

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Lancaster, Pa.: This will be the first Christmas that I will be alone, since my brother and his wife will be spending the holidays in another country. This didn't bother me at first but as the days go by, I'm feeling more sad knowing that I'll be alone. I'm in my mid-forties and I guess I should just look at Christmas day as just another day, but it's rather hard to do. Any advice?

Dr. Harris Stratyner: Loneliness truly is a state of mind. One could be lonely in a crowded room or all by themselves. Ask yourself why do you feel lonely beyond the obvious? Have you reached out to other people? The most important thing that one can do to feel connected is service.

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Frederick, Md.: Where can someone on active duty go for alcohol addiction without hurting their career? Are there facilities that can assist and accept Tricare payment without impacting the person's career?

Dr. Harris Stratyner: First of all, addiction treatment like all medical treatment is protected under a federal HIPPA law. If you reach out to a local veterans administration hospital, you will get excellent care in a totally confidential environment that should not impact your career under the HIPPA law.

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Arlington, Va.: My dad is an alcoholic, sober for about about five years now. Prior to this, we had thought he was still on the wagon, but he was hiding alcohol all around the house in flavored water bottles. Both my brother (28) and I (26) live away from home, and during the holidays, when we get together, it's tough because we always wonder if he has fallen off the wagon again, and we snoop the house inconspicuously. Will there ever be a time when we trust him again? We feel guilty traipsing around the house. My mom is at home, and she wonders/snoops too. FWIW, he was sober from basically my birth until I was 14/15, and that's when he fell of the wagon unbeknownst to us until five years ago.

Dr. Harris Stratyner: Alcoholism is a disease. It's primary, progressive, chronic and, if untreated, fatal. It makes liars of those people who fall victim to the disease unless they actively work on staying sober -- treatment, 12-step programs, etc. Instead of going behind your dad's back, realize that relapse is often part of this disease and speak to your dad about your concerns. For more information, you can visit the caron website at www.caron.org.

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To Lancaster: Regarding being alone at Christmas -- I want to second the idea of service during a holiday. Family and close friends were gone during last year's Thanksgiving, so I volunteered with a local service organization to coordinate and serve Thanksgiving dinner to homeless people in D.C. It was a great experience. I'm sure that you could get hooked up with something similar and serve Christmas dinner or visit elderly folks in a nursing home, etc.

Dr. Harris Stratyner: Thank you for your thoughts and agreement.

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Lacrosse, Wisc.: During this economy I have found out that I will only have about 300 dollars to spend between around seven people. I don't know what to do because I love them all but I don't want them to think that I am not trying to get them something when I know they are going to get me something in return.

Dr. Harris Stratyner: This year, given the economy, my wife and I decided to donate money to various charities and do it in honor of our relatives collectively. You will find that most charities will send your relatives a card saying that you have made a charitable gift in their name and trust me -- it is indeed better to give than to receive.

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Not Necessarily Helpful: "Ask yourself would friends really tease someone because they choose not to consume alcoholic beverages that can lead to vehicular accidents, hangovers and general feelings that one does not want to experience during a happy holiday season."

Wow, smug much?

Yes, it is out of line to tease someone for not drinking. It's out of line to ask why someone isn't drinking. But that level of judgment just doesn't seem like a very helpful attitude, though it is certainly reflective of a lot of American attitudes toward alcohol.

I remember once when my mom was drinking cranberry juice at a formal event. She just looked at me and said, "Well, would you rather your mom was an alkie?"

The attitude that substance abuse is a binary state -- either you're a non-drinker or you have a drinking problem -- is one I find highly destructive.

And advising the poster with the increased wine consumption with dinner to go to an addiction counselor? That's not even a little bit of an overreaction? Wouldn't it be a good first step to cut yourself off after one glass (put the bottle away so it's out of sight?) and deliberately find an alternate outlet for the stress, such as taking a walk? Actually, I find that exercising makes me not want any alcohol -- I'm too interested in water!

Dr. Harris Stratyner: It is obvious that the person who asked the original question had some genuine concerns. Nobody ever said that you're either an alcoholic or you're not. Know that alcohol is not the enemy. However, the disease of alcoholism can be devastating.

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Washington, D.C.: I think my roommate is drinking too much. OK, I know he is drinking too much. At least 2-3 drinks before bed every night, excess over the weekends to the point he doesn't remember what happened the night before. I've mentioned to him I'm concerned, but get the response that if he doesn't drink he can't sleep. I know I can't help him if he doesn't want it, but what else can I do? Other than the drinking he gets to work every day, pays his bills and eats a healthy diet. He is the definition of a 'functional alcoholic'.

Dr. Harris Stratyner: Your concerns are warranted. Using alcohol as a sleep agent could be a significant sign that your roommate has a problem. Sooner or later your roommate may need more alcohol to accomplish the same effect. Perhaps discussing this with your roommate -- and the fact that a professional is responding to your question with this answer -- would help make your case.

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Maryland: Hi there -- looking for something of a third opinion from you. I am 15 weeks pregnant and for the last few weeks I've been back on Zoloft. (I had very surprising case of postpartum depression when my first son was born -- this past June!) Now that I'm pregnant again, I'm again surprised to be feeling the same feelings, this time a bit compounded by financial worries and of course, caring for my son. It was my OB that prescribed the Zoloft initially, and a psychiatrist reaffirmed that I should go back on it, and in fact increased the dosage to 100mg. Both said that it's not contraindicated in pregnancy. But there are warnings all over the bottle saying that it should not be taken in pregnancy, so I'm still a little concerned. Can you confirm either way?

Dr. Harris Stratyner: If you do not have faith in your OBGYN or current psychiatrist, seek a third opinion; it's always very helpful.

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Charity donations as presents: I think that's a really nice idea, but exercise caution in the charities you select. If they are of a political nature, some family members may be upset at the thought of having contributed to something they disagree with.

Dr. Harris Stratyner: I would stick to charities that are appealing to everyone such as helping kids or helping hungry people.

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Anywhere, US: What do you recommend for someone who knows they have a drinking problem and wants to cut back? This person won't go to AA because the people there skeeve them out -- they seem to be overly friendly in an off-putting, cultish way.

This person is glad he didn't ask his doctor for help, and has no plans to, now that he has applied for a new job with the government and the application forms grant the government a release so that questions about alcohol abuse may be asked of that person's doctor.

Dr. Harris Stratyner: Again, alcoholism is a disease and "cutting back" will not work if the person truly has that disease. If they are a social drinker/problem drinker, they should seek help from a professional.

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Dr. Harris Stratyner: Thank you for your time today. Please visit www.caron.org for more information about substance abuse or to continue a chat with an expert for free.

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Editor's Note: washingtonpost.com moderators retain editorial control over Discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions. washingtonpost.com is not responsible for any content posted by third parties.


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