Anxiety disorders are much more than just nervousness and worrying. They can cause terrifying fear about things that other people wouldn't give a second thought to.

Learn about anxiety and depression, symptoms, and how anxiety can often lead to depression.

People with anxiety disorders — social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder — or phobias spend most of their lives in an agitated state. After a while, that can take a huge emotional toll, and depression often sets in. There’s no conclusive explanation as to why anxiety and depression so often co-exist, according to the Anxiety and Depression Association of America, but you can find relief from both with the right treatment.

Introduction

Anxiety disorders are much more than just nervousness and worrying. They can cause terrifying fear about things that other people wouldn't give a second thought to. Many people with anxiety disorders understand that their thoughts are irrational, but they still can't stop them.

"It's a cycle," says Sally R. Connolly, LCSW, a therapist at Couples Counseling of Louisville in Kentucky. "When you get anxious, you tend to have this pervasive thinking about some worry or some problem and you feel bad about it. Then you feel like you've failed, and you move to depression."

The two conditions have a complicated relationship. The incidence of developing depression in addition to an anxiety disorder is high — almost half of all people with major depression also suffer from severe and persistent anxiety, Connolly notes.

"People who are depressed often feel anxious and worried, so one can trigger the other," she says. "Anxiety often comes before depression." There may be a biological predisposition to both depression and other anxiety disorders. People who have post-traumatic stress disorder (PTSD), an anxiety disorder, are particularly likely to also develop depression, according to the National Institute of Mental Health (NIMH). "Especially with anxiety, more so than depression, there often is some family history, and so therefore we think that there may be some genetic predisposition to this," Connolly explains. "Some people are just worriers and pass it down."

Why Anxiety Leads to Depression

These are signs that a person may suffer from both anxiety disorder and depression:

- Constant, irrational fear and worry
- Physical symptoms like rapid heartbeat, fatigue, headaches, hot flashes, sweating, abdominal pain, and difficulty breathing
- Insomnia
- Changes in eating, either too much or too little
- Difficulty with memory, decision making, and concentration
- Constant feelings of sadness or worthlessness
- Loss of interest in hobbies and activities
- Feeling tired and cranky
- Inability to relax
- Panic attacks

Symptoms of Anxiety and Depression

Anxiety 101

Learn about treating anxiety and depression, and how you can help a loved one.

Cognitive-behavioral therapy (CBT), which is often used to treat anxiety disorder with depression. CBT can teach people to manage their fears, anxieties, and depressive symptoms by figuring out what's really causing them; people also learn how to take control of their emotions.

Antidepressant medications, which may be prescribed to help treat both conditions. These drugs are often used in conjunction with CBT. Selective serotonin reuptake inhibitors (SSRIs) are newer, commonly used antidepressants that offer fewer side effects than older antidepressants, according to the NIMH.

Exercise, which can also help both depression and anxiety disorders. Exercise releases chemicals in the body that make you feel good, and it can help you relax. Taking just a 10-minute walk may alleviate symptoms for several hours, the Anxiety and Depression Association of America states.

Relaxation techniques, which include practicing meditation and mindfulness. Both can ease symptoms of both anxiety and depression and improve your quality of life, according to a large research review published in the March 2014 issue of JAMA Internal Medicine.

Organizations offering mental health services, which can include a hospital or support group in your community. Check out the National Institute of Mental Health or the Anxiety and Depression Association of America for more resources.

Treatment Strategies

Loved ones of those struggling with anxiety and depression should be on the lookout for these warning signs of a mental health crisis:

- Poor daily self-care, such as refusing to perform personal hygiene habits, get out of bed or eat
- Sudden and extreme changes in mood
- Becoming violent, threatening, or aggressive
- Abusing substances
- Appearing confused or having hallucinations
- Talking about suicide or about not having a reason to live

Treatment for anxiety disorders and depression needs to be administered and managed by a psychiatrist, Connolly says. "It's really crucial for people with both [anxiety and depression] to have a good assessment to rule out bipolar disorder," she says. Bipolar disorder, a condition in which emotions can swing from very low to very high levels of mania and depression, is treated much differently than anxiety disorder with depression. No one has to suffer from an anxiety disorder or depression, and certainly not both. People with anxiety disorder should speak with a psychiatrist, therapist, or other healthcare professional about their symptoms, and start treatment before depression has a chance to set in.

Warning Signs You Shouldn't Ignore

The Road to Recovery

Anxiety and Depression

Being in a community organization has positive impacts on your mental health. Learn about the benefits of a community.

It is a well-known fact that physical activity and a nutritious diet can improve health and well-being. Most of us know that we are supposed to eat more vegetables and consume fewer fats, that we need at least 30 minutes of exercise per day, and that we need to engage in strength training and recreational activities to maintain our physical health. While these things are undeniably good for us and do contribute to being healthier and reducing chronic disease, it’s important to note that these recommendations don’t cover every aspect of health and wellness. In addition to being physically healthy, we also need to consider the mental components of health and wellness.

According to the National Institute of Mental Health (NIMH), mental illness affects approximately 13 million American adults each year. Mental health plays a major role in people’s ability to maintain good physical health and participate in health-promoting behaviors. People who are mentally healthy are happier, have lower levels of depression and anxiety, maintain healthier relationships with others, and feel that they are making a contribution to society. Several studies support the idea that more green space (e.g., community parks) results in greater mental health for communities. A recent study from England’s University of Exeter titled Longitudinal Effects on Mental Health of Moving to Greener and Less Green Urban Areas illustrates just how important parks are for long-term mental health and well-being. The study determined that people who moved to urban areas with more green space reported higher mental health scores — meaning they were happier and had lower levels of depression and anxiety. Interestingly, the study also showed that the mental health scores continued to improve each year for the duration of the study. In the United States, another study titled “Exposure to Neighborhood Green Space and Mental Health: Evidence from the Survey of the Health of Wisconsin” found similar results. This study examined the relationship between environmental green space and mental health in both urban and rural areas and found that “higher levels of neighborhood green space were associated with significantly lower levels of symptomology for depression, anxiety, and stress.” Both of these studies provided significant evidence that parks have a positive impact on the mental health of their communities.

Recreation and Mental Health

Parks can help to improve mental health in a variety of ways, from simply providing the actual green space for people to engage in their natural surroundings to facilitating programs like tai chi, yoga and qigong classes that engage the mind and body, to sponsoring and developing neighborhood gardens that reduce stress and anxiety. Many park and recreation agencies already foster programs that help support mental health. The San Diego Park and Recreation Department provides “open-space parks” within their community. These parks provide community members with opportunities to engage in nature through hiking, walking, biking and other activities. In addition to the open-space parks, San Diego offers popular tai chi and yoga classes in their parks and community centers. Tai chi, an ancient Chinese practice, uses a combination of physical movements, deep breathing, focus, and energy flow to reduce stress and anxiety. With these open-space parks and through its classes, San Diego’s community is experiencing both physical and mental health benefits.

Engagement Activities

Gardening is another tool that parks can use to help stimulate mental health. Researchers have found that gardening can help to lower blood pressure, reduce stress, increase brain activity and produce endorphins. The Portland, Oregon, Parks and Recreation Department’s community gardens program has offered gardening opportunities since 1975. The program provides the chance for community members to garden, volunteer, engage socially with neighbors, learn from other cultures and give back to the community. Heading into its 40th year, the program features 50 community gardens located throughout the city with more than 2,180 individual garden plots. The program is facilitated by four staff members and more than 2,300 annual volunteers. Another large part of their garden program, Produce for People, provides produce for food pantries in an effort to help combat Portland’s high poverty rate. In 2014, Produce for People donated 36,545 pounds of produce to food pantries across the city. Both San Diego’s and Portland’s efforts to provide environments and programming that encourage mental health are prime examples of how park and recreation agencies across the country can make a difference.

Community Gardening

Get Involved in Your Community

Community Recreation

The terms lesbian, gay, bisexual, and transgender (LGBT) describe distinct groups within the gay culture.

The terms lesbian, gay, bisexual, and transgender (LGBT) describe distinct groups within the gay culture. The early initiatives for people who were gay focused mostly on men. So, in an attempt to draw attention to issues specific to gay women, "lesbian" is often listed first. People who are bisexual or transgender have been traditionally left out of, or underrepresented in, research studies and health initiatives. It is now considered standard to include these two groups along with gay men and lesbians.

What is the Meaning of LGBT?

According to researchers Susan Cochran and Vickie Mays, sexual orientation includes the following dimensions: 

- sexual attraction
- sexual behavior
- sexual fantasies
- emotional, social, and lifestyle preferences
- self-identification

What is Sexual Orientation?

The term "gay" has traditionally been used to represent a diverse group of people who are attracted to people of the same gender or are in a relationship with someone of the same gender. It is important to recognize, however, that different groups within the gay community exist, and that the term "gay" is not all-inclusive.

For example, transsexuals and some people who are bisexual do not consider themselves to be gay. Also, research has found that men who have had relationships with other men do not always identify themselves as gay. There is also a tremendous ethnic diversity among our lesbian, gay, and bisexual communities, and this contributes to the different perceptions of the term "gay." 

Heterosexual, or straight, refers to people whose sexual and romantic feelings are mostly for the opposite gender: Men who are attracted to women, and women who are attracted to men.

Homosexual, or gay, refers to people whose sexual and romantic feelings are mostly for the same gender: Men who are attracted to men, and women who are attracted to women.

Lesbian refers to women who are homosexual.

Bisexual or "bi" refers to people whose sexual and romantic feelings are for both genders.

Transgender is an umbrella term that encompasses a diversity of gender expressions including drag queens and kings, bi-genders, crossdressers, transgenderists, and transsexuals.

Transvestites are people who like to dress like members of the opposite sex.

Transsexuals are people who feel that their anatomical sex does not match the gender with which they identify.

Bigender refers to people who define themselves as having the behavioral, cultural, or psychological characteristics associated with both the male and female genders.

Transgenderist describes someone who is gender variant or transgresses gender norms as part of their lifestyle or identity.

Definition of Terms

LGBT individuals encompass all races and ethnicities, religions, and social classes. Sexual orientation and gender identity questions are not asked on most national or State surveys, making it difficult to estimate the number of LGBT individuals and their health needs. Research suggests that LGBT individuals face health disparities linked to societal stigma, discrimination, and denial of their civil and human rights.

Discrimination against LGBT persons has been associated with high rates of psychiatric disorders, substance abuse, and suicide. Experiences of violence and victimization are frequent for LGBT individuals and have long-lasting effects on the individual and the community. Personal, family and social acceptance of sexual orientation and gender identity affects the mental health and personal safety of LGBT individuals

Why Is LGBT Health Important?
Eliminating LGBT health disparities and enhancing efforts to improve LGBT health are necessary to ensure that LGBT individuals can lead long healthy lives. The many benefits of addressing health concerns and reducing disparities include reductions in disease transmission and progression, increased mental and physical well-being, reduced health care costs, and increased longevity.

Lesbian, Gay, Bisexual, and Transgender Health

In order to effectively address LGBT health issues, we need to securely and consistently collect SOGI information in national surveys and health records. This will allow researchers and policymakers to accurately characterize LGBT health and disparities. Understanding LGBT health starts with understanding the history of oppression and discrimination that these communities have faced. For example, in part, because bars and clubs were often the only safe places where LGBT individuals could gather, alcohol abuse has been an ongoing problem.

Social determinants affecting the health of LGBT individuals largely relate to oppression and discrimination. Examples include:

- Legal discrimination in access to health insurance, employment, housing, marriage, adoption, and retirement benefits
- Lack of laws protecting against bullying in schools
- Lack of social programs targeted to and/or appropriate for LGBT youth, adults, and elders
- Shortage of health care providers who are knowledgeable and culturally competent in LGBT health

The physical environment that contributes to healthy LGBT individuals includes:
- Safe schools, neighborhoods, and housing
- Access to recreational facilities and activities
- Availability of safe meeting places
- Access to health services

Understanding LGBT Health

A number of issues will need to continue to be evaluated and addressed over the coming decade, including:

- Nationally representative data on LGBT Americans
- Prevention of violence and homicide toward the LGB community, and especially the transgender population
- Resiliency in LGBT communities
- LGBT parenting issues throughout the life course
- Elder health and well-being
- Exploration of sexual/gender identity among youth
- Need for an LGBT wellness model
- Recognition of transgender health needs as medically necessary

Continuing Issues in LGBT Health

LGBT Health

LGBT Community

Moderation is everything. Learn about the effects of Alcohol.

Learn about the effects and the health risks of alcohol consumption.

Alcoholic drinks have different amounts of alcohol in them. Beer is about 5% alcohol, although some beers have more. Wine is usually 12% to 15% alcohol. Hard liquor is about 45% alcohol. Alcohol gets into your bloodstream quickly. The amount and type of food in your stomach can change how quickly this occurs. For example, high-carbohydrate and high-fat foods can make your body absorb alcohol more slowly. Certain types of alcoholic drinks get into your bloodstream faster. Stronger drinks tend to be absorbed faster. Alcohol slows your breathing rate, heart rate, and how well your brain functions. These effects may appear within 10 minutes and peak at around 40 to 60 minutes. Alcohol stays in your bloodstream until it is broken down by the liver.

The amount of alcohol in your blood is called your blood alcohol level. If you drink alcohol faster than the liver can break it down, this level rises. Your blood alcohol level is used to legally define whether or not you are drunk. The legal limit for blood alcohol usually falls between 0.08 and 0.10 in most states. Below is a list of blood alcohol levels and the likely symptoms:

0.05 -- reduced inhibitions
0.10 -- slurred speech
0.20 -- euphoria and motor impairment
0.30 -- confusion
0.40 -- stupor
0.50 -- coma
0.60 -- breathing stops and death

You can have symptoms of being drunk at blood alcohol levels below the legal definition of being drunk. Also, people who drink alcohol frequently may not have symptoms until a higher blood alcohol level is reached.

The Effects of Alcohol

Alcohol increases the risk of:

- Alcoholism
- Falls, drownings, and other accidents
- Head, neck, stomach, colon, breast, and other cancers
- Heart attack and stroke
- Motor vehicle accidents
- Risky sex behaviors, unplanned or unwanted pregnancy, and sexually transmitted infections (STIs)
- Suicide and homicide

Drinking during pregnancy can harm the developing baby. Severe birth defects or fetal alcohol syndrome are possible.

Health Risks of Alcohol

Alcohol

Learn about some tips to drink responsibly, if you choose to drink alcohol.

If you drink alcohol, it is best to do so in moderation. Moderation means the drinking is not getting you intoxicated (or drunk) and you are drinking no more than 1 drink per day if you are a woman and no more than 2 if you are a man. A drink is defined as 12 ounces (350 milliliters) of beer, 5 ounces (150 milliliters) of wine, or 1.5 ounces (45 milliliters) of liquor. Here are some ways to drink responsibly, provided you do not have a drinking problem, are of legal age to drink alcohol, and are not pregnant.

Never drink alcohol and drive a car. If you are going to drink, have a designated driver, or plan an alternative way home, such as a taxi or bus. DO NOT drink on an empty stomach. Snack before and while drinking alcohol. If you are taking medicines, including over-the-counter drugs, check with your health care provider before drinking alcohol. Alcohol can make the effects of many medicines stronger. It can also interact with other medicines, making them ineffective or dangerous or make you sick.

If alcohol use runs in your family, you may be at increased risk of developing this disease yourself. So, you may want to avoid drinking alcohol altogether. CALL YOUR HEALTH CARE PROVIDER IF:

- You are concerned about your personal alcohol use or that of a family member
- You are interested in more information regarding alcohol use or support groups
- You are unable to reduce or stop your alcohol consumption, in spite of attempts to stop drinking

Moderation

You can take steps to increase your safety in situations where drinking may be involved. These tips can help you feel safer and may reduce the risk of something happening. Though it is best to stay safe while under the influence of alcohol, it’s important to remember that sexual assault is never the victim’s fault, regardless of whether they were sober or under the influence of drugs or alcohol when it occurred.

1. Keep an eye on your friends.
If you are going out in a group, plan to arrive together and leave together. If you decide to leave early, let your friends know. If you’re at a party, check in with them during the night to see how they’re doing. If something doesn’t look right, step in. Don’t be afraid to let a friend know if something is making you uncomfortable or if you are worried about their safety.

2. Have a backup plan.
Sometimes plans change quickly. You might realize it’s not safe for you to drive home, or the group you arrived with might decide to go somewhere you don’t feel comfortable. Keep the number for a reliable taxi company saved in your phone and on a piece of paper in your wallet and try to have cash on hand. It is also a good idea to download a few different rideshare apps on your phone. Having multiple options helps ensure that you will be able to get a ride home or to a safe location, even if the app you typically use is not functioning. To help keep your phone charged so you can stay in communication with friends or call a ride, consider bringing an external cell phone charger that can be used without an electrical outlet. 

3. Know what you’re drinking.
Don’t recognize an ingredient? Use your phone to look it up. Consider avoiding large-batch drinks like punches that may have deceptively high alcohol content. There is no way to know exactly what was used to create these drinks.

4. Trust your instincts.
If you feel unsafe, uncomfortable, or worried for any reason, don’t ignore these feelings. Go with your gut. Get somewhere safe and find someone you trust, or call law enforcement. 

5. Don’t leave a drink unattended.
That includes when you use the bathroom, go dancing, or leave to make a phone call. Either take the drink with you or throw it out. Avoid using the same cup to refill your drink.

6. Don’t accept drinks from people you don’t know or trust.
This can be challenging in some settings, like a party or a date. If you choose to accept a drink from someone you’ve just met, try to go with the person to the bar to order it, watch it being poured, and carry it yourself.

7. Check in with yourself.
You might have heard the expression “know your limits.” Whether you drink regularly or not, check in with yourself periodically to register how you feel. If you think you have had too much, ask a trusted friend to help you get water or get home safely. Remember, if someone offers you a drink, you can always say no.

8. Be aware of sudden changes in the way your body feels.
Do you feel more intoxicated than you are comfortable with? Some drugs are odorless, colorless, and/or tasteless, and can be added to your drink without you noticing. If you feel uncomfortable, tell a friend and have them take you to a safe place. If you suspect you or a friend has been drugged, call 911, and tell the healthcare professionals that you suspect you or a friend has been drugged so they can administer the right tests.

Quick Tips to Help You Stay Safe

Responsible Drinking

Alcohol Safety

Volunteering is a win-win situation - it improves your mood and helps other people out!


Learn about volunteering benefits and opportunities.

Dummy Title: Part 1 - video

Part of being a great volunteer is loving what you're doing. Find something that you're passionate about or something that inspires you, and then find a need in your community. There are dozens of reasons why you should volunteer - you just need to find the one that feels right.

20 GREAT REASONS TO VOLUNTEER:
- Help others
- Make a difference
- Find purpose
- Enjoy a meaningful conversation
- Connect with your community
- Feel involved
- Contribute to a cause that you care about
- Use your skills in a productive way
- Develop new skills
- Meet new people
- Explore new areas of interest
- Meet good people
- Impress your mom
- Impress yourself
- Expand your horizons
- Get out of the house
- Make new friends
- Strengthen your resume
- Feel better about yourself

Why Volunteer?

VolunteerMatch
Idealist.org
Network for Good
Points of Light Volunteer Opportunities
Points of Light’s HandsOn Network
Peace Corps
AmeriCorps
Senior Corps

Places to Find Volunteering Opportunities

Volunteering 101

Volunteering

S.U.D affects a family's well-being in many aspects. Often, physical, psychological, and financial health are compromised.

Learn how S.U.D affects all members of a family.

Every single person in an addict’s immediate family (and at times extended family) is affected in some way by the individual’s substance abuse. Addiction impacts a family’s finances, physical health, and psychological wellbeing. In recent years, our society has moved further and further away from the traditional nuclear family. There are single-parent homes, blended families, and homes headed by grandparents, just to name a few family unit variations. Each of these family structures and more will affect the addict’s overall impact on the family. If young children are a part of the family, their ages must also be factored into the effect of substance abuse. The same can be said for older adults who have adult children.

The severity of addiction and the type of substance dependence also factor into the overall impact of addiction on a family. Addiction impacts a family’s finances, physical health, and psychological wellbeing Lastly, each addict’s situation is different, which means that each family’s situation is unique. This makes it impossible to assign a universal causal relationship between substance abuse and family functioning. It is worth noting that in most families, the impact of addiction is overwhelmingly negative, with few exceptions.

Addiction and Family Roles

Learn about how addiction affects families in various family roles.

In every family unit, each person plays a role (or multiple roles) to help the family function better and to maintain a level of homeostasis, stability, and balance. When substance abuse is added to this dynamic, the family roles naturally shift to adjust to the new behaviors associated with drug or alcohol use and to continue maintaining order and balance. Including the addict, there have been six roles developed to understand how the family functions around the substance abuser. They are “the enabler,” “the mascot,” “the hero,” “the scapegoat,” “the lost child” and “the addict.

The Enabler
This role is often assumed by a non-addicted spouse or an older child in single-parent homes. The enabler takes care of all of the things that the addict has left undone, including taking care of finances, ensuring children get to school, and making justifications for the addict in social and business situations. The enabler is frequently in denial about the severity of the addict’s problem and will continually make excuses for him or her.

The Hero
This role is generally assumed by an older child in the family who overachieves and appears confident and serious. Heroes take on responsibilities in the home that seemingly exceed their developmental stage, often assuming parental roles. The hero is obsessed with perfection, which makes the role increasingly difficult to maintain as the addiction progresses and responsibilities continue to mount.

The Scapegoat
This is the child in the family who habitually misbehaves and displays defiant tendencies in the face of authority. These individuals often get into trouble in school and at home. As these children move toward adulthood, many get into trouble with the law as well. These behaviors are reflective of a poisonous and chaotic atmosphere in the house.

The Lost Child
The person in this role is isolated from other members of the family and has trouble developing relationships as a result. The lost child has difficulty in social situations and often engages in fantasy play to distract themselves both emotionally and physically from the negative home environment.

The Addict
Many chronic substance abusers feel great shame, guilt, and remorse about the pain and distress they’ve caused their families. However, there are also many addicts who do not want to cease their substance abuse, causing great anger and resentment throughout the family. When these roles are established during childhood, they become behavioral patterns that continue to play out and evolve throughout adulthood. The late development of an addiction (when adult children are present) creates another set of issues, as many family roles have already been firmly set. The blurred line between parent/child relationships and parent/friend relationships also makes the situation more difficult to remedy.

Among all of the family members who are impacted by an addict’s disease, perhaps no one suffers as much as children. The effects of living with an addicted parent can be felt long after childhood and well into adulthood. Parental alcoholism and drug addiction can create poor self-image, loneliness, guilt, anxiety, feelings of helplessness, fear of abandonment, and chronic depression in children. Maternal substance abuse during pregnancy can also lead to a host of behavioral and developmental disorders in children.

One in five adult Americans lived with an alcoholic relative at some point during their childhoods. Overall, these individuals are at a greater risk for behavioral and emotional problems when compared to children of non-alcoholics. Children of alcoholics are four times more likely to develop alcoholism than individuals who were not raised by alcoholics. They are also more likely to have difficulty dealing with stress and highly likely to marry an alcoholic or abusive spouse later in life. The financial damage of addiction can also lead to a child being undereducated and malnourished. Children of alcoholics and other substance abusers are also likely to grow up in a highly unstable home. Children in these situations are unable to determine which parent they will get (sober or intoxicated) on a moment-to-moment basis and are often left to fend for themselves at times when adult supervision would be considered necessary.

The financial damage of addiction can also lead to a child being undereducated and malnourished.
Going to school and having three meals a day is not as important as an addict’s next score. Basically, a person who grows up in a home with one or more addicts is often robbed of important aspects of his or her childhood. When illicit substances are involved, children are often unfairly exposed to illegal activities and may in some cases be asked to aid in these activities by lying about what their parents are doing. Additionally, parents abusing any substance are more likely to be involved with divorce, mental illness, unemployment, and legal problems, severely compromising their abilities to effectively parent.

Children of Substance Abusers

Substance abuse and committed relationships do not make for a very cohesive mix. Especially in relationships where only one partner has a substance abuse problem, alcohol and drugs can ruin a marriage or long-term relationship. Alcoholism has been linked to higher divorce rates, and one partner’s addiction can lead to the other partner having to shoulder an unfair share of the household responsibilities. A relationship with two addicts allows each partner to feed off of and enable the other. When both spouses are equally addicted to drugs or alcohol, it may not increase the chance for divorce, but the household’s atmosphere will become much more toxic as a result.

One sober partner can at least try to keep the house in order and encourage the substance abuser to see the help. A relationship with two addicts allows each partner to feed off of and enable the other. This too will likely lead to the slow deterioration of the relationship, as both addicts will be primarily focused on feeding their addictions rather than cultivating the relationship or handling any household responsibilities. Codependency is also an issue that often arises in spouses of substance abusers. The concept of codependency became widely popular during the 1980s. Broadly, it refers to an individual who is overly involved with another person to the point of dysfunction. Early on, the term was often reserved for the wives of alcoholics and drug addicts who relied on their husbands for financial wellbeing. Though codependent people are usually spouses, anyone who has an established relationship with an addict can become codependent.

Spouses of Substance Abusers

No matter how old a parent’s kids are, discovering that your children have an addiction problem can be an unpleasant, rude awakening. It may cause mothers and fathers to question their parental abilities or decisions they’ve made. Parents of addicts, much like children of addicts, often blame themselves for the development of the substance use disorder. For teenagers and adolescents struggling with addiction, the problem can be perceived as being potentially more dangerous, with the child not evenly fully matured and so much of his or her life left ahead. This is also a critical time for addiction to be stopped before its grip is too strong.

- Nine out of 10 Americans who meet the criteria for addiction began smoking, drinking or using other drugs before age 18.
- 75 percent of all high school students have used an addictive substance. One in five of those students meet the criteria for addiction.
- 46 percent of all high school students currently use an addictive substance, with 33 percent of them meeting the criteria for addiction
- 10 percent of all youth aged 12 to 17 are current illicit drug users.
- An estimated 6 percent of 16- and 17-year-olds and 17 percent of 18- to 20-year-olds reported driving under the influence of alcohol within the last year

At least when parents have teens and adolescents who have substance use disorders, they have some level of power in that they control the finances and the household
This power can be wielded to get them to accept treatment and cease substance abuse. With parents of adult addicts, however, the ability to impose consequences for substance abuse or the unwillingness to seek treatment is greatly diminished. This holds even truer when the parents live separately from the addicted daughter or son. When the addict has young children, the grandparents or other extended family members are often the ones who pick up the slack in parental duties. According to the U.S. Census, the number of children being raised by their grandparents skyrocketed from 2.4 million in 2000 to 4.9 million in 2010. Two of the primary causes of this are addiction and mental disorder.

Parents of Alcoholics and Drug Addicts

Family and S.U.D.

Empathy is different from sympathy. Sympathy reflects understanding another person's situation - but viewed through your own lens.

It's possible that you're among the large number of people who suffer from EDD. No, that isn't a typo -- I don't mean ADD or ED. It's EDD, which stands for "Empathy Deficit Disorder." I made it up, so you won't find it listed in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. Normal variations of mood and temperament are increasingly redefined as new "disorders," so I'm hesitant to suggest a new one. But this one's real, and it's becoming more pronounced in today's world. I've identified it from my decades of experience as a business psychologist, psychotherapist, and researcher in adult development. From that triple vantage point, I've concluded that Empathy Deficit Disorder is a pervasive but overlooked condition.

In fact, our increasingly polarized social and political culture of the past few years reveals that EDD is more severe than ever. It has profound consequences for the mental health of both individuals and society. Yet it's ignored as a psychological disturbance by most of my colleagues in the mental health professions. First, some explanation of what I mean by EDD: When you suffer from it you're unable to step outside yourself and tune in to what other people experience, especially those who feel, think, and believe differently from yourself. That makes it a source of personal conflicts, of communication breakdown in intimate relationships, and of adversarial attitudes - including hatred - towards groups of people who differ in their beliefs, traditions, or ways of life from your own.

Take the man who told me that his wife always complained that he didn't spend enough time with their children; that she had most of the burden despite having a career of her own. "Yeah, I see her point," he said in a neutral voice, "but I need time for my sports activities on the weekends. I'm not going to give that up. And at night I'm tired, I want to veg out." As we talked further, it became clear to me that he simply didn't experience what his wife's world was like for her, on the inside. His own reality - his own needs - were his only reality. Or the computer executive who prided himself on having a stable family life, then casually told me that, even though he recognized the environmental threats posed by worldwide climate change, he couldn't care less. "I'll be long gone when New York is underwater," he said. And when I asked him whether he cared about the consequences for his kids or grandkids, he replied with a grin: "Hey, that's their problem." Then there's the woman who works in the financial industry, who told me she's indifferent to how American Muslims might feel in today's environment, or to being profiled when boarding airplanes: "I think they're all terrorists," she said, "and would like to kill us all, anyway."

These may sound like extreme examples, but I hear variations of those themes all the time. EDD keeps you locked inside a self-centered world, and that breeds emotional isolation, disconnection, and polarization. That's highly dangerous in today's interconnected, globalized world, and it plays out in ways both small and large: For example, you see it in troubled intimate relationships - when partners become locked into adversarial and oppositional positions. In warfare between groups with different beliefs - like the current polarization over political and social issues. And in current global threats - Tribal and religious groups killing each other; Palestinians and Israelis locked into a death-grip. Not to mention looming worldwide disasters or continued depletion of the resources and health of the only planet we have.

Introduction to Empathy

Discover the differences and similarities between Empathy and Sympathy.

Sympathy reflects understanding another person's situation - but viewed through your own lens. That is, it's based on your version of what the other person is dealing with. ("Yeah, I can sympathize with your problem with your elderly mother, because I have my own problems with mine ..."). The narcissist can be sympathetic in this way. That self-centered focus is similar to what some people think love is when they're really enthralled with their own feeling of being "in love," rather than in love with the reality of who their partner is.

Sympathy

In contrast, empathy is what you feel only when you can step outside of yourself and enter the internal world of the other person. There, without abandoning or losing your own perspective, you can experience the other's emotions, conflicts, or aspirations from within the vantage point of that person's world. That's not telepathy - it's a hard-wired capacity in all of us, as I explain below. And that kind of connection builds healthy, mutual relationships - an essential part of mental health.

Empathy

Empathy vs. Sympathy

Learn how you might develop Empathy Deficit Disorder and how to prevent it.

Most people are socially conditioned into believing that acquiring and achieving things are "normal" - even "healthy" - ways to live. EDD grows when people focus too much on acquiring power, status, and money for themselves. Nearly every day we hear or read about more extreme examples: people who go over the edge in their pursuit of money, power or recognition, and end up resigning their jobs, in rehab, or behind bars. But many of the people I see every day, whether in psychotherapy or executive consulting, struggle with their own versions of the same thing through too much emphasis on acquiring - both things and people. That's going to promote vanity and self-importance. Then, you become increasingly alienated from your own heart and equate what you have with who you are. And that's a killer for empathy because then you're ripe for the delusion that you're completely independent and self-sufficient. You lose touch with the true reality, that all humans are interconnected and interdependent - all organs of the same body, so to speak. Your sense of being a part of the larger interwoven community - which is absolutely necessary for survival in today's world - fades away. And so does your awareness that we have to sink or swim together, help each other, and sustain the planet we inhabit - or else we're all in deep trouble.

The net result of this social conditioning is the decline of empathy for other human beings who are on the same boat you are. You don't recognize that we're all one, bound together. You only see yourself. And I think that's a bona fide emotional disorder in our times. Sometimes, a person's sudden awakening of interconnection jump-starts their empathy. At such times, people automatically respond from the heart. For example, look at the response of citizens to the massive earthquake in Haiti, or to Hurricane Katrina. Or what I witnessed recently when some passers-by stopped to help the victims of an auto accident. When empathy is aroused, you let go of your usual attachment to yourself and you want to help; connect in some way.
I often suggest to people to think of this, as an example: When you cut your finger, you don't say, "That's my finger's problem, not mine." Nor do you do a cost-benefit analysis before deciding whether to take action. You respond immediately because you feel the pain. It's part of you.

How Do You Develop EDD?

Overcoming EDD is easier than you may think. In fact, considerable research shows that the capacity to feel what another person feels is "hard-wired" through what are called "mirror neurons." Functional magnetic resonance imagery (fMRI) shows that regions of the brain involving both emotions and physical sensations light up in someone who observes or becomes aware of another person's pain or distress. Literally, you do feel another's pain or other emotions. Similar research shows that generosity and altruistic behavior light up pleasure centers of the brain usually associated with food or sex.

Just as you can develop EDD by too much self-absorption, you can also overcome EDD by "retraining" your brain. That is, research also shows that your brain is capable of being trained and physically modified through conscious practices. This is known as neuroplasticity. You can "grow" specific emotions and create new brain patterns that reinforce them. As you redirect and refocus your thoughts, feelings, and behavior in the direction you desire, the brain regions associated with them are reinforced. What's more, changing your brain activity reinforces the changes you're making in your thoughts and emotions. The result is a self-reinforcing loop between your conscious attitudes, your behavior, and your brain activity. This may sound like science fiction, yet such studies show that you can learn to "reprogram" your brain. In effect, what you think and feel is what you become. And it means you can learn to grow empathy and overcome EDD.

Overcoming EDD

"Empathy Deficit Disorder"

The writer Jeremy Rifkin's recent major book, The Empathic Civilization, provides a strong argument for an emerging empathic civilization in human consciousness.
He presents evidence that counters the usual assumption that self-interest and greed are dominant forces among humans. In light of all the new research, here are a few practices you can do to help overcome your EDD in everyday life - whether with your intimate partner, friends, strangers...or enemies.

Envision a characteristic or behavior of yours that you know your partner dislikes. Imagine shifting your consciousness into your partner's perspective and mentality, even though you may disagree with that perspective or are convinced it's "wrong." Immerse yourself in your partner's perceptions of you. Try to experience them fully. At the same time, hold on to your own views. Don't let either negate the other. Then, try to understand your partner's feelings or attitudes as a reflection of who he or she is, based on all the forces and influences and choices that have shaped him or her. Don't judge.

Empathy For Your Partner

It's especially challenging to generate empathy towards someone you flat-out dislike - maybe even hate. Or, with whom you've had big-time conflicts: perhaps an ex-spouse, or someone at work. But you can do it by extending the above practice. Tell yourself how or why that person might have developed negative attitudes or feelings about you. Imagine what the conflict feels like from within his or her perspective. Entertain the idea that you are only partially right; perhaps wrong altogether. Next, open yourself to seeing yourself through the eyes of that person. Just observe, without judging him or her, defending yourself, or agreeing with any of it.

Empathy For Someone You Dislike

You can expand your capacity for empathy by practicing it towards people you don't even know. Identify a situation or encounter with someone who's a stranger, especially one who may be very different from yourself. Try to put yourself within the consciousness of that stranger. The checkout person at the grocery store could be an example. Think of ways that he or she is probably like you - someone who desires love, who's probably experienced some kind of loss or disappointment along the way, or who has aspirations he or she hopes to fulfill. Focus on those commonalities that show you how this person is much like yourself - beneath the surface differences.

Empathy For Strangers You Encounter

Building Empathy

How do you move forward with your career goals?

Brainstorm where to improve your skills and hone your craft for advancing your career.

Not sure what you want to do? Your first step is to understand who you are and what you want – both from your work and your life. Here are some key questions you can ask yourself to help decide on your next steps.

Who am I?

Whether you’re mid-career or still in study, you need to approach any career move in the same way. Your first step is to understand who you are and what you want – both from your work and your life. Consider your interests, skills, values, and qualities. You should also ask yourself:

- What am I good at?
- What do I like to do in my spare time?
- What have I achieved already?
- What things am I passionate about?
- What are my interests? Knowing what your interests are can help you plan or change your career.  If you are able to find an environment that suits your interests, you are likely to be happier in what you do.
- What are my values? Knowing what is important to you in a job can help you narrow down your career options, and finding a career that fits with your values can help you feel more satisfied in your work.
What are my skills? Working out what skills you have, then matching them to different jobs, can open up career options you may never have thought of. Think of examples of the skills you've learned in work and other areas of your life such as sport, community work, and hobbies.
Where am I? The people around you and your personal circumstances also play a part in your career choices. Being aware of this will help you in your decision-making.

Things to consider include:
Family expectations
perhaps your parents have a strong opinion about what career you should choose, or what course you should study.

Your commitments
sporting or community group activities could mean you have to be free at certain times, or you may have other commitments such as needing to look after or financially support family members.

Your career readiness
If you’re just starting out, you may be willing to spend more time and effort on training or studying than if you’ve been working for 15 years already.

Obstacles or challenges:
Maybe you feel your age is a barrier to moving into a new job, or maybe you live in a rural area where there are fewer training or study options.

Where do I want to be?
Where do you see yourself in five years' time, and beyond? 
What do you want to be doing, and what do you want to be like as a person? 

Knowing your answers to questions like these can affect your career choices, for example:

Do you want a job that earns you a lot of money?
Do you want a job that will allow you a certain amount of free time, so you can continue to take part in other activities?
Do you like being in charge, giving advice, or having people come to you for help?

Thinking about what you want to be doing will help you with your career ideas, but so will thinking about how you will get there.
What's involved in getting to the place that you want to go? Are you prepared to take the necessary steps to get there?
Where can I go for help?

Once you've explored your own ideas about yourself and narrowed down some career options, it's good to talk through your thoughts with others. Bouncing your ideas off someone else can help things become clearer to you. Other people may also have some insights into your character or situation that you had not considered. Talk to people who know you well and who you can trust. Ask them what they think are your strengths and skills. These may include family/whānau, friends, church leaders, or teachers. If you have a part-time job or you do volunteer work, think about asking your employer which parts of the job they think you do well.

Questions to Ask Yourself

Being able to identify all the skills you have can open you up to more career options. It can also help you work out if you have any skill or knowledge gaps that can be addressed with further training.

What are skills? 
A skill is the ability to do something. We are not born with skills – we develop them through experiences in life and work. Skills can be simple, such as making toast, or more complex, such as playing a musical instrument.

What different types of skills are there? 
In the workplace, you will use a combination of different skills. These skills are employability skills, transferable skills, and specialist skills. Employability skills are the skills, qualities, and attitudes that employers say are essential for their workplace. The skills are Positive attitude, Communication, Teamwork, Self-management, Willingness to learn, Thinking skills, and Resilience.

A transferable skill is one that can be used in a variety of situations or jobs - you transfer them from one job to another. For example, being able to use a drill is a job-specific skill – but one that involves hand-eye coordination, which is a transferable skill. Examples include being able to motivate and organize others, being able to work with facts and figures, having good verbal and communication skills, and having accuracy and/or an eye for detail.

Specialist skills usually relate to a specific job or group of jobs.
Examples include fluency in a language, a heavy vehicle driver's license, and the ability to use specific computer programs and technical equipment.

Figure Out Your Skills

The seven essential employability skills are:

- Positive attitude
- Communication
- Teamwork
- Self-management
- Willingness to learn
- Thinking skills
- Resilience

Positive attitude
Having a positive attitude is like showing up to your team’s game ready to give it your best, excited, and ready to go even if the chances of winning are low and it’s going to be hard work.

Communication
You have good communication skills if you can listen well, you don’t swear at work or have a bad attitude, you can ask for what you want clearly and you’re not afraid to ask if you don’t understand something.

Teamwork
Teamwork is just like when you’re playing netball or performing in your band. You help each other to get what you want, you make sure you do your part, you get on with everyone and you respect your coach or manager.

Self-management
When you manage yourself you are in control of what you do and say in a way that doesn’t harm yourself or others. You turn up to school or work on time, in the right clothes, and ready to start, and people can rely on you.

Willingness to learn
Willingness to learn is showing that you’re happy to learn new things and what you need to know to do your job.

Thinking skills (problem-solving and decision making)
Using thinking skills means that if you see a problem, you don’t wait for someone else, you find a way to fix it.

Resilience
Resilience is accepting that life does get hard at times and does change. It’s about being able to change, ask for help, and keep going.

Skills Employers Are Looking For

Skills that you develop in your day-to-day life are often transferable skills - that is, skills that are useful to many types of jobs. Here are some examples:

Household activities
Activities that may help you develop skills include evaluating and purchasing food, furniture, and appliances; household maintenance, or repairing and maintaining cars; managing the household budget and general bookkeeping; planning and organizing parties, holidays, entertainment, and children's activities.

Skills you may develop include evaluation, analysis, and problem-solving skills; skill in doing precise, detailed, and accurate work; book-keeping, budgeting, and maths skills; skill in organizing and coordinating activities and other people.

Voluntary or community work
You may do things such as work as an elected officer of an organization, where you might chair meetings, organize speakers or events, do fundraising, keep books, write reports or make submissions on reports
teach or counsel children or adults; provide physical and/or emotional support for groups of people with disabilities or special needs. 

Skills you may develop include planning and organizational skills; writing skills, including report writing; problem-solving; people and communication skills; bookkeeping, budgeting, and maths skills.

Recreation and hobbies
Participating in and organizing sporting activities. Using creativity to produce floral art, fine arts, music, drama. Participating in clubs and organizations: environmental, religious, service, youth, etc.
Skills you may develop include planning, organizational skills, problem solving, and people skills

Skills Gained Outside the Workforce

What are your work options?
Work without qualifications
You can still get jobs that take you based on your experience or readiness to work. To increase your chances of getting a job without qualifications, consider offering to work on trial or do work experience.

Earn qualifications while working
Some jobs don't require any specific skills because you learn skills on the job. In many industries, you can also earn qualifications while you're working.

Start your own business
Many businesses start out in people's kitchens or garages. Starting a business doesn't require qualifications. 

Certificate courses
Certificate courses can give you the qualifications you need for a trade or give you credits to enter a university degree or apprenticeship training.

Did You Leave School Without Qualifications?

What is work-life balance?
Work-life balance is about having the right amount of time for work and for your lifestyle. If you have a work-life balance you feel that you have enough time for your work and career as well as for your family,  wellbeing, community life, and interests.

How do you know if your work-life balance isn't right?
Getting the right mix of work to other activities in your life can be a challenge. Have a look at the list below and think about your own situation. Are you:

- working long hours?
- working at night and sleeping most of the day?
- not getting enough leisure time?
- not spending enough time with the people who are important to you?
- eating badly, not exercising, not sleeping, and not having quiet time?
- taking your laptop or work cellphone to bed with you?
- taking work with you on holiday?

If you answered yes to most of the questions above, you may be overworked or trying to juggle too many things. Take time to reflect on what small things you can do to create more balance in your life.
Why is work-life balance important? When you have a work-life balance, you're more likely to have better health, enjoy better relationships and do things that make you happy. Without work-life balance, you are in danger of working too hard and suffering from stress and bad health as well as neglecting your relationships and community life.

How Does Work Fit in With Your Life?

Where To Start

Plan Your Career

Co-dependency, also known as “relationship addiction” because people with codependency often form or maintain relationships that are one-sided, emotionally destructive and/or abusive. 

Source: https://www.mhanational.org/co-dependency

Co-dependency is a learned behavior that can be passed down from one generation to another. It is an emotional and behavioral condition that affects an individual’s ability to have a healthy, mutually satisfying relationship.

Co-dependency often affects a spouse, a parent, sibling, friend, or co-worker of a person afflicted with alcohol or drug dependence. Originally, co-dependent was a term used to describe partners in chemical dependency, persons living with, or in a relationship with an addicted person. Similar patterns have been seen in people in relationships with chronically or mentally ill individuals. Today, however, the term has broadened to describe any co-dependent person from any dysfunctional family.

Who Does Co-Dependency Affect?

A dysfunctional family is one in which members suffer from fear, anger, pain, or shame that is ignored or denied. Underlying problems may include any of the following:

- An addiction by a family member to drugs, alcohol, relationships, work, food, sex, or gambling.
- The existence of physical, emotional, or sexual abuse.
- The presence of a family member suffering from a chronic mental or physical illness.

Dysfunctional families do not acknowledge that problems exist. They don’t talk about them or confront them. As a result, family members learn to repress emotions and disregard their own needs. They become “survivors.” They develop behaviors that help them deny, ignore, or avoid difficult emotions. They detach themselves. They don’t talk. They don’t touch. They don’t confront. They don’t feel. They don’t trust. The identity and emotional development of the members of a dysfunctional family are often inhibited.

Attention and energy focus on the family member who is ill or addicted. The co-dependent person typically sacrifices his or her needs to take care of a person who is sick. When co-dependents place other people’s health, welfare and safety before their own, they can lose contact with their own needs, desires, and sense of self.

What Is A Dysfunctional Family?

Co-dependents have low self-esteem and look for anything outside of themselves to make them feel better. They find it hard to “be themselves.” Some try to feel better through alcohol, drugs or nicotine - and become addicted. Others may develop compulsive behaviors like workaholism, gambling, or indiscriminate sexual activity.

They have good intentions. They try to take care of a person who is experiencing difficulty, but the caretaking becomes compulsive and defeating. Co-dependents often take on a martyr’s role and become “benefactors” to an individual in need. A wife may cover for her alcoholic husband; a mother may make excuses for a truant child; or a father may “pull some strings” to keep his child from suffering the consequences of delinquent behavior.

The problem is that these repeated rescue attempts allow the needy individual to continue on a destructive course and to become even more dependent on the unhealthy caretaking of the “benefactor.” As this reliance increases, the co-dependent develops a sense of reward and satisfaction from “being needed.” When the caretaking becomes compulsive, the co-dependent feels choice-less and helpless in the relationship, but is unable to break away from the cycle of behavior that causes it. Co-dependents view themselves as victims and are attracted to that same weakness in the love and friendship relationships.

How Do Co-Dependent People Behave?

Characteristics Of Co-Dependent People Are:

- An exaggerated sense of responsibility for the actions of others
- A tendency to confuse love and pity, with the tendency to “love” people they can pity and rescue
- A tendency to do more than their share, all of the time
- A tendency to become hurt when people don’t recognize their efforts
- An unhealthy dependence on relationships. The co-dependent will do anything to hold on to a relationship; to avoid the feeling of abandonment
- An extreme need for approval and recognition
- A sense of guilt when asserting themselves
- A compelling need to control others
- Lack of trust in self and/or others
- Fear of being abandoned or alone
- Difficulty identifying feelings
- Rigidity/difficulty adjusting to change
- Problems with intimacy/boundaries
- Chronic anger
- Lying/dishonesty
- Poor communications
- Difficulty making decisions

Characteristics Of Co-Dependent People

The first step in changing unhealthy behavior is to understand it. It is important for co-dependents and their family members to educate themselves about the course and cycle of addiction and how it extends into their relationships. Libraries, drug and alcohol abuse treatment centers and mental health centers often offer educational materials and programs to the public.

A lot of change and growth is necessary for the co-dependent and his or her family. Any caretaking behavior that allows or enables abuse to continue in the family needs to be recognized and stopped. The co-dependent must identify and embrace his or her feelings and needs. This may include learning to say “no,” to be loving yet tough, and learning to be self-reliant. People find freedom, love, and serenity in their recovery.

Hope lies in learning more. The more you understand co-dependency the better you can cope with its effects. Reaching out for information and assistance can help someone live a healthier, more fulfilling life.

When Co-Dependency Hits Home

Learn about how to identify signs of co-dependency and how someone is treated for co-dependency

This condition appears to run in different degrees, whereby the intensity of symptoms are on a spectrum of severity, as opposed to an all or nothing scale. Please note that only a qualified professional can make a diagnosis of co-dependency; not everyone experiencing these symptoms suffers from co-dependency.

1. Do you keep quiet to avoid arguments?
2. Are you always worried about others’ opinions of you?
3. Have you ever lived with someone with an alcohol or drug problem?
4. Have you ever lived with someone who hits or belittles you?
5. Are the opinions of others more important than your own?
6. Do you have difficulty adjusting to changes at work or home?
7. Do you feel rejected when significant others spend time with friends?
8. Do you doubt your ability to be who you want to be?
9. Are you uncomfortable expressing your true feelings to others?
10. Have you ever felt inadequate?
11. Do you feel like a “bad person” when you make a mistake?
12. Do you have difficulty taking compliments or gifts?
13. Do you feel humiliation when your child or spouse makes a mistake?
14. Do you think people in your life would go downhill without your constant efforts?
15. Do you frequently wish someone could help you get things done?
16. Do you have difficulty talking to people in authority, such as the police or your boss?
17. Are you confused about who you are or where you are going with your life?
18. Do you have trouble saying “no” when asked for help?
19. Do you have trouble asking for help?
20. Do you have so many things going at once that you can’t do justice to any of them?

If you identify with several of these symptoms; are dissatisfied with yourself or your relationships; you should consider seeking professional help. Arrange for a diagnostic evaluation with a licensed physician or psychologist experienced in treating co-dependency.

Questionnaire To Identify Signs Of Co-Dependency

Because co-dependency is usually rooted in a person’s childhood, treatment often involves exploration into early childhood issues and their relationship to current destructive behavior patterns. Treatment includes education, experiential groups, and individual and group therapy through which co-dependents rediscover themselves and identify self-defeating behavior patterns. Treatment also focuses on helping patients getting in touch with feelings that have been buried during childhood and on reconstructing family dynamics. The goal is to allow them to experience their full range of feelings again.

How Is Co-Dependency Treated?

Identification and Treatment

Co-dependency

Cardiovascular workouts are designed to balance three factors for maximum effectiveness and safety: frequency, intensity, and duration.

Learn about Cardiovascular Exercise and how to effectively perform Cardiovascular Exercises.

Cardiovascular workouts are designed to balance three factors for maximum effectiveness and safety: frequency, intensity, and duration. You will also need to include a warm-up period before you enter the target intensity period of your workout and a cool-down period before the end of your workout.

Cardiovascular exercise raises your heart rate and breathing rate into the moderate-to-vigorous intensity level for 10 minutes or more. Common cardio exercises are:

- brisk walking
- running
- cycling
- rowing
- swimming
- cross-country skiing
- elliptical training
- step machine training

What Is Cardio Exercise?

Introdution

Learn about different parts of performing cardiovascular exercises.

Traditionally, you are coached to stretch the primary muscles to be used in the workout after your warm-up. There are several schools of thought on the use and effectiveness of stretching, but we will cover the traditional view here. A warm-up of 5 to 10 minutes at low intensity will prepare your muscles for exercise and steadily raise your heart rate. Start at an intensity of 50 to 60% of your maximum heart rate, doing whatever activity will be your workout method. If you are walking or running, start by walking or running at an easy pace that puts you into this heart rate zone -- one where you can still carry on a full conversation.
Now is the time to stretch the muscles you will use in your workout. They are warmed up and may benefit from flexibility stretches or drills specific to the muscle groups you will be using in the workout.

Warming Up and Stretching

After you have completed your workout in your target heart rate zone, you should cool down with 5 to 10 minutes of lower intensity. Aim for a heart rate of 50 to 60% of maximum heart rate for 5 to 10 minutes for your cool down. Traditionally, you would end your workout with gentle stretching of the muscles used in the workout.

Cooling Down

How often should you exercise? The American College of Sports Medicine recommends three to five days a week for most cardiovascular exercise programs. Alternating days of more intense exercise with a day of rest or easy exercises such as walking and stretching or yoga will give the body time to build and repair muscles.

Frequency

How long should you exercise in each exercise session? For cardiovascular benefits, aim for 20 to 60 minutes in your target heart rate zone, apart from the time you spend in warm-up and cool-down. At this duration, your body burns through its available glycogen energy and begins to burn stored fat. While you will still have the benefits of burning calories, if you exercise for less than 20 minutes in your zone, the best fitness benefits come from setting aside the 20 to 60 minutes to spend in the aerobic zone.

Duration

When beginning a fitness program, concentrate on increasing your duration with good posture and form before you work on increasing the intensity of your workout. If you are using walking for your workout, work on increasing the number of minutes walked in each session. A general rule of thumb is that it is safest to increase this by 10% per week. Once you are walking comfortably and with good posture and form for 60 minutes at a time, then work on increasing the intensity by adding speed, hills, or intervals.

Intensity

Cardiovascular Exercise

Medication-Assisted Treatment (MAT) is the use of medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders.

Medication-Assisted Treatment (MAT) is the use of medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders. Research shows that a combination of medication and therapy can successfully treat these disorders, and for some people struggling with addiction, MAT can help sustain recovery. Learn about many of the substance use disorders that MAT is designed to address. MAT is primarily used for the treatment of addiction to opioids such as heroin and prescription pain relievers that contain opiates. The prescribed medication operates to normalize brain chemistry, block the euphoric effects of alcohol and opioids, relieve physiological cravings, and normalize body functions without the negative effects of the abused drug. Medications used in MAT are approved by the Food and Drug Administration (FDA), and MAT programs are clinically driven and tailored to meet each patient’s needs. Combining medications used in MAT with anxiety treatment medications can be fatal. Types of anxiety treatment medications include derivatives of Benzodiazepine, such as Xanax or valium.

Learn about some programs and therapy used for MAT.

Opioid treatment programs (OTPs) provide MAT for individuals diagnosed with an opioid use disorder. OTPs also provide a range of services to reduce, eliminate, or prevent the use of illicit drugs, potential criminal activity, and/or the spread of infectious disease. OTPs focus on improving the quality of life of those receiving treatment. OTPs must be accredited by a SAMHSA-approved accrediting body and certified by SAMHSA. The Division of Pharmacologic Therapies (DPT), part of the SAMHSA Center for Substance Abuse Treatment (CSAT), oversees accreditation standards and certification processes for OTPs. Learn more about the certification of OTPs and SAMHSA’s oversight of OTP Accreditation Bodies. Federal law requires patients who receive treatment in an OTP to receive medical, counseling, vocational, educational, and other assessment and treatment services, in addition to prescribed medication. The law allows MAT professionals to provide treatment and services in a range of settings, including hospitals, correctional facilities, offices, and remote clinics. Learn more about the legislation, regulations, and guidelines that govern OTPs. As of 2015, OTPs were located in every U.S. state except North Dakota and Wyoming. The District of Columbia and the territories of Puerto Rico and the Virgin Islands also had OTPs in operation.

Opioid Treatment Programs

Under federal law, MAT patients must receive counseling, which could include different forms of behavioral therapy. These services are required along with medical, vocational, educational, and other assessment and treatment services. Learn more about these treatments for substance use disorders.

Counseling and Behavioral Therapies

In 2013, an estimated 1.8 million people had an opioid use disorder related to prescription pain relievers, and about 517,000 had an opioid use disorder related to heroin use. MAT has proved to be clinically effective and to significantly reduce the need for inpatient detoxification services for these individuals. MAT provides a more comprehensive, individually tailored program of medication and behavioral therapy. MAT also includes support services that address the needs of most patients. The ultimate goal of MAT is full recovery, including the ability to live a self-directed life. This treatment approach has been shown to:

- Improve patient survival,
- Increase retention in treatment,
- Decrease illicit opiate use and other criminal activity among people with substance use disorders,
- Increase patients’ ability to gain and maintain employment,
- Improve birth outcomes among women who have substance use disorders and are pregnant. 

Research also shows that these medications and therapies can contribute to lowering a person’s risk of contracting HIV or hepatitis C by reducing the potential for relapse. Learn more about substance misuse and how it relates to HIV, AIDS, and Viral Hepatitis. Learn more about common comorbidities that occur with substance use disorders.

MAT Effectiveness

SAMHSA’s Partners for Recovery Initiative produced a brochure designed to assist MAT patients and to educate and inform others. This Medication-Assisted Treatment Know Your Rights Brochure – 2009 presents and explains the federal laws that prohibit discrimination against individuals with disabilities and how they protect people receiving MAT for opioid addiction. Under the Confidentiality Regulation, 42 Code of Federal Regulations (CFR) 2, personally identifiable health information relating to substance use and alcohol treatment must be handled with a higher degree of confidentiality than other medical information.

MAT and Patient Rights

FDA has approved several different medications to treat opioid addiction and alcohol dependence. A common misconception associated with MAT is that it substitutes one drug for another. Instead, these medications relieve the withdrawal symptoms and psychological cravings that cause chemical imbalances in the body. MAT programs provide a safe and controlled level of medication to overcome the use of an abused opioid. And research has shown that when provided at the proper dose, medications used in MAT have no adverse effects on a person’s intelligence, mental capability, physical functioning, or employability. Medications used in MAT for opioid treatment can only be dispensed through a SAMHSA-certified OTP. Some of the medications used in MAT are controlled substances due to their potential for misuse. Drugs, substances, and certain chemicals used to make drugs are classified by the Drug Enforcement Administration (DEA) into five distinct categories, or schedules, depending upon a drug’s acceptable medical use and potential for misuse.

Medications Used in MAT

Programs and Therapy

Learn about the different medications used during Medication Assisted Treatment.

Methadone tricks the brain into thinking it’s still getting the abused drug. In fact, the person is not getting high from it and feels normal, so withdrawal doesn’t occur. Learn more about methadone. Pregnant or breastfeeding women must inform their treatment provider before taking methadone. It is the only drug used in MAT approved for women who are pregnant or breastfeeding. 

Methadone

Like methadone, buprenorphine suppresses and reduces cravings for the abused drug. It can come in a pill form or sublingual tablet that is placed under the tongue.

Buprenorphine

Naltrexone works differently than methadone and buprenorphine in the treatment of opioid dependency. If a person using naltrexone relapses and uses the abused drug, naltrexone blocks the euphoric and sedative effects of the abused drug and prevents feelings of euphoria.

Naltrexone

FDA approved naloxone, an injectable drug used to prevent an opioid overdose. According to the World Health Organization (WHO), naloxone is one of a number of medications considered essential to a functioning health care system.

Naloxone

Disulfiram is a medication that treats chronic alcoholism. It is most effective in people who have already gone through detoxification or are in the initial stage of abstinence. This drug is offered in tablet form and is taken once a day. Disulfiram should never be taken while intoxicated and it should not be taken for at least 12 hours after drinking alcohol. Unpleasant side effects (nausea, headache, vomiting, chest pains, difficulty breathing) can occur as soon as ten minutes after drinking even a small amount of alcohol and can last for an hour or more.

Disulfiram

Acamprosate is a medication for people in recovery who have already stopped drinking alcohol and want to avoid drinking. It works to prevent people from drinking alcohol, but it does not prevent withdrawal symptoms after people drink alcohol. It has not been shown to work in people who continue drinking alcohol, consumes illicit drugs, and/or engage in prescription drug misuse and abuse. The use of acamprosate typically begins on the fifth day of abstinence, reaching full effectiveness in five to eight days. It is offered in tablet form and taken three times a day, preferably at the same time every day. The medication’s side effects may include diarrhea, upset stomach, appetite loss, anxiety, dizziness, and difficulty sleeping.

Acamprosate

When used as a treatment for alcohol dependency, naltrexone blocks the euphoric effects and feelings of intoxication. This allows people with alcohol addiction to reduce their drinking behaviors enough to remain motivated to stay in treatment, avoid relapses, and take medications.

Medication Assisted Treatment

Learn about the most important muscle in the body and how to take care of it!

Learn about the heart and how it changes over time.

Your heart is a strong muscle that pumps blood to your body. A normal, healthy adult heart is about the size of your clenched fist. Just like an engine makes a car move, the heart keeps your body running. The heart has two sides, each with a top chamber (atrium) and a bottom chamber (ventricle).
 
The right side pumps blood to the lungs to pick up oxygen. The left side receives blood rich with oxygen from the lungs and pumps it through arteries throughout the body. An electrical system in the heart controls the heart rate (heartbeat or pulse) and coordinates the contraction of the heart\'s top and bottom chambers.

How Does the Heart Work?

People age 65 and older are much more likely than younger people to suffer a heart attack, to have a stroke, or to develop coronary heart disease (commonly called heart disease) and heart failure. Heart disease is also a major cause of disability, limiting activity, and eroding the quality of life of millions of older people. Aging can cause changes in the heart and blood vessels. For example, as you get older, your heart can't beat as fast during physical activity or times of stress as it did when you were younger. However, the number of heartbeats per minute (heart rate) at rest does not change significantly with normal aging.
Changes that happen with age may increase a person's risk of heart disease. A major cause of heart disease is the buildup of fatty deposits in the walls of arteries over many years. The good news is there are things you can do to delay, lower, or possibly avoid or reverse your risk.

The most common aging change is increased stiffness of the large arteries, called arteriosclerosis (ahr-teer-ee-o-skluh-roh-sis), or hardening of the arteries. This causes high blood pressure, or hypertension, which becomes more common as we age. High blood pressure and other risk factors, including advancing age, increase the risk of developing atherosclerosis (ath-uh-roh-skluh-roh-sis). Because there are several modifiable risk factors for atherosclerosis, it is not necessarily a normal part of aging. Plaque builds up inside the walls of your arteries and, over time, hardens and narrows your arteries, which limits the flow of oxygen-rich blood to your organs and other parts of your body.

Oxygen and blood nutrients are supplied to the heart muscle through the coronary arteries. Heart disease develops when plaque builds up in the coronary arteries, reducing blood flow to your heart muscle. Over time, the heart muscle can become weakened and/or damaged, resulting in heart failure. Heart damage can be caused by heart attacks, long-standing hypertension and diabetes, and chronic heavy alcohol use. Age can cause other changes to the heart. For example:

- There are age-related changes in the electrical system that can lead to arrhythmias—a rapid, slowed, or irregular heartbeat—and/or the need for a pacemaker. Valves—the one-way, door-like parts that open and close to control blood flow between the chambers of your heart—may become thicker and stiffer.

- Stiffer valves can limit the flow of blood out of the heart and become leaky, both of which can cause fluid to build up in the lungs or in the body (legs, feet, and abdomen).
The chambers of your heart may increase in size. The heart wall thickens, so the amount of blood that a chamber can hold may decrease despite the increased overall heart size. The heart may fill more slowly.

- Long-standing hypertension is the main cause of increased thickness of the heart wall, which can increase the risk of atrial fibrillation, a common heart rhythm problem in older people.

With increasing age, people become more sensitive to salt, which may cause an increase in blood pressure and/or ankle or foot swelling (edema). Other factors, such as thyroid disease or chemotherapy, may also weaken the heart muscle. Things you can't control, like your family history, might increase your risk of heart disease. But, leading a heart-healthy lifestyle might help you avoid or delay serious illness.

How Your Heart Changes with Age

The Heart

Learn about Heart Disease, signs of Heart Disease, and how to prevent Heart Disease.

Heart disease is caused by atherosclerosis (ath-uh-roh-skluh-roh-sis), which is the buildup of fatty deposits, or plaques, in the walls of the coronary arteries over many years. The coronary arteries surround the outside of the heart and supply blood nutrients and oxygen to the heart muscle. When plaque builds up inside the arteries, there is less space for blood to flow normally and deliver oxygen to the heart. If the flow of blood to your heart is reduced by plaque buildup or is blocked if a plaque suddenly ruptures, it can cause angina (chest pain or discomfort) or a heart attack. When the heart muscle does not get enough oxygen and blood nutrients, the heart muscle cells will die (heart attack) and weaken the heart, diminishing its ability to pump blood to the rest of the body.

What Is Heart Disease?

Early heart disease often doesn't have symptoms or the symptoms may be barely noticeable. That's why regular checkups with your doctor are important. Contact your doctor right away if you feel any chest pain, pressure, or discomfort. However, chest pain is a less common sign of heart disease as it progresses, so be aware of other symptoms. Tell your doctor if you have:

- Pain, numbness, and/or tingling in the shoulders, arms, neck, jaw, or back
- Shortness of breath when active, at rest, or while lying flat
- Chest pain during physical activity that gets better when you rest
- Lightheadedness
- Dizziness
- Confusion
- Headaches
- Cold sweats
- Nausea/vomiting
- Tiredness or fatigue
- Swelling in the ankles, feet, legs, stomach, and/or neck
- Reduced ability to exercise or be physically active
- Problems doing your normal activities

Problems with arrhythmia are much more common in older adults than younger people. Arrhythmia needs to be treated. See a doctor if you feel a fluttering in your chest or have the feeling that your heart is skipping a beat or beating too hard, especially if you are weaker than usual, dizzy, tired, or get short of breath when active.

Signs of Heart Disease

Try to be more physically active. Talk with your doctor about the type of activities that would be best for you. If possible, aim to get at least 150 minutes of physical activity each week. Every day is best. It doesn't have to be done all at once—10-minute periods will do. 

If you smoke, quit. Smoking is the leading cause of preventable death. Smoking adds to the damage to artery walls. It's never too late to get some benefit from quitting smoking. Quitting, even in later life, can lower your risk of heart disease, stroke, and cancer over time.

Follow a heart-healthy diet. Choose foods that are low in trans and saturated fats, added sugars, and salt. As we get older, we become more sensitive to salt, which can cause swelling in the legs and feet. Eat plenty of fruits, vegetables, and foods high in fiber, like those made from whole grains.

Keep a healthy weight. Balancing the calories you eat and drink with the calories burned by being physically active helps to maintain a healthy weight.
Keep your diabetes, high blood pressure, and/or high cholesterol under control. Follow your doctor's advice to manage these conditions, and take medications as directed.

Don't drink a lot of alcohol.

Manage stress. Learn how to manage stress, relax, and cope with problems to improve physical and emotional health. Consider activities such as a stress management program, meditation, physical activity, and talking things out with friends or family.

How To Prevent Heart Disease?

Heart Disease

Heart Health

Learn about digital fasting and how digital fasting can improve your well-being.

See what a digital fast is, who likes to digital fast, and how to do a digital fast.

Also known by various other terms like “digital detox,” “digital Sabbath,” and “unplugging”, the idea behind a digital fast is to voluntarily and deliberately stop using all connected devices – smartphones, computers, tablets, and so on – that plug you to the internet for a pre-specified amount of time. The abstention could be for as little as a few hours (say, from 7 pm until the next morning). However, most digital fasts are at least a day-long event, and many span an entire weekend or even longer. 

Like food fasts, longer digital fasts are thought to be more effective (up to a point) in weaning oneself away from digital connectivity, and in regaining self-control. Some versions of the digital fast recommend off-line activities you should perform instead (with all the spare time freed up from not texting and Facebooking): going on a walk or a hike, or organizing a pot-luck meal with friends who are also digitally fasting. 

In theory, the idea of a digital fast has generated a lot of interest, with organizations such as Adbusters and the Huffington Post each promoting their respective versions of digital fasts. It is especially popular among Silicon Valley employees of tech companies like Facebook and Google. But in practice, digital fasting really hasn’t moved beyond the fringes of our culture. One reason is that there is a raging debate about whether a digital fast is desirable. Advocates take the digital stance that digital technology has addictive properties that cause harm in various ways, and we need to regain control over its use. Its opponents counter with the argument that digital technology satisfies our fundamental needs today and is irreplaceable. So, they say, there is no need for anyone to fast or unplug.

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