Women on the Verge

Are you on the verge of substance addiction? Here are the warning signs to watch out for.

Listen up if you’ve been using these words: ‘I’m functioning fine so what’s the problem?’ or ‘I can quit any time!’ Maybe you can – but what if you can’t? Being on the verge of a problem, whether it’s substance addiction, an eating disorder or a mental condition, is unsettling. You feel vague disquiet but it’s not quite fear, and it’s tempting to take refuge in denial – especially if family and friends are not yet anxious enough to say anything. There’s little to stop you pursuing the path to disaster – except awareness of what that means, and the early warning signs to watch for.

Recreational User – Or Addict?
The Dividing Line:
‘Substance abuse is excessive or problem use,’ says Carol du Toit, director of The South African National Council on Alcoholism and Drug Dependence (Sanca) centres in Durban. ‘Addiction is dependence on the substance.’ Both abuse and addiction have serious health and social consequences for the users and those around them. But while users and abusers are able to change their drinking or drugging habits, alcoholics or addicts cannot, however hard they try. You’re at special risk of crossing the line to abuse or addiction if you’re into instant gratification, have poor impulse control and lack problem – solving skills.

The Dangers:
Many young people are unaware that alcohol is the most widely abused substance, says Du Toit. ‘And it’s lethal,’ she says. Alcoholism can lop 10 years off your life or kill you – or others – through accidents or violence. Drinking regularly or excessively (more than two units a day for women, three for men) damages almost every organ in the body. One in three heavy drinkers suffers from liver inflammation and one in five of these develops cirrhosis, a hardening of the liver that can be fatal. Heavy drinkers are also prone to cardiovascular disease, gastrointestinal problems and cancer. Even moderate drinking slows a person’s reaction times, affects verbal memory and brings headaches and insomnia. Indirect costs include relationship, work and financial problems, and increased risk of accidents, arguments, criminal activity and unsafe sex.

The Warning Signs:
Having a couple of drinks or hits after work becomes a habit and you start to think about them during the day, says Du Toit. ‘You start arranging your life around the habit, becoming preoccupied by it and lying to protect it – perhaps telling your boss you’re sick and can’t stay late.’ Deep down you also feel concern about how much you’re drinking or using, or that you’re doing it more often. ‘Any increase in frequency or amount used should ring alarm bells,’ she says. So should waking the next day and thinking ‘I shouldn’t’ have done that’ – even if you don’t have physical side effects. You already have a problem if you are withdrawing from other people, losing interest in what once mattered, having problems at work, mood swings, anxiety, depression and changes in your sleeping or eating habits.

What To Do:
‘Tell yourself you need to put the breaks on,’ says Du Toit. Then test yourself: resolve not to have whatever you are using that night, or any night until Friday. ‘If it’s too difficult and you find yourself on the slippery slope of denial – justifying your use to yourself as “just this once” or telling yourself you’ll “start being good” another day – you’re in danger.’ Try telling a trusted friend about it, says Du Toit, asking her to monitor you. But your best option is an assessment with a specialist in substance addiction at Sanca or a private substance-abuse clinic. ‘People are often reluctant to come before they’re convinced they have a real problem. They think clinics are for hardcore addicts only, or they’re afraid they’ll be put on a treatment programme. But we assess people at any stage, and the earlier the better!’ Often all you need is one or two sessions to establish when and why you use a substance, which is often related to dealing with stress or anger, she says. ‘We show you other ways to manage these, from relaxation techniques to exercise, which gets feel-good endorphins going and boosts self-image. When you start looking after your body you tend to cut down on substance use.’ You will also be guided to alternative activities for times when you usually use. ‘And we recommend using the money you would spend on your habit on a massage or facial. You’ll still have a treat to look forward to, but with a positive spin!’

It Worked For Me:
‘As work got more pressured, I found I couldn’t wait to get home to a glass or two of wine,’ says Janine*, a 32-year-old Durban businesswoman. ‘Soon I was flattening a bottle a night. I stopped answering the phone after 8pm incase it was a colleague – I knew I was slurring. Then I started turning down invitations. The clincher was a company trip last year, when I found myself scrounging for excuses not to meet the others for dinner, and ordering room service. My concentration wasn’t what it used to be either, though no-one at work seemed to notice. My self-esteem got shaky. I wasn’t sleeping well, my skin was bad and I picked up weight.

One day I got off the bathroom scale and called Sanca. I was embarrassed sitting at reception. I didn’t think I should be there and was thinking of leaving when they called me. I’m so glad I didn’t! The counsellor went through my drinking pattern and history, and told me I didn’t need an in-treatment programme, just tools to run my life better. I’ve gone from yoga to kick-boxing and I feel great. I still have a few drinks on weekends but only when I go out – I don’t keep anything at home. And I still call my Sanca counsellor now and then. Not because she asked me to – I just like to touch base.’

For Help:
Call Sanca on 011 482 1070, 021 945 4080 or 031 202 2241
Or visit www. Sancanational.org. za
The Cape Town Drug Counselling Centre on 021 447 8026 or visit www. Drugcentre.org.za; and Narcotics Anonymous South Africa on 083 900 6962 (national 24-hour helpline) or visit www.na.org.za

Picky Eater – Or Eating Disordered?
The Dividing Line:
This can be tricky to establish, given the range of ‘normal’ eating patterns and obsession with health and slimness. Not even body weight is necessarily an indication, says Graham Alexander, clinical psychologist and director of the specialised Eating Disorders Unit at Crescent Clinic in Cape Town. While someone with anorexia nervosa will be at least 15% underweight (through restrictive dieting and/or bingeing and purging or excessive exercise), a bulimic will be normal weight or overweight, ‘or at least less than 15% underweight’ (through bingeing and purging), and an orthorexic (someone overly preoccupied with fat avoidance and exercise) will have a combination of mild symptoms that can go undetected. (Orthorexia is not yet a psychiatrically accepted diagnosis.) But as a rule of thumb, you are crossing the line to an eating disorder when you move from regular exercise and cutting back on portion sizes and high-fat or processed foods to cutting out whole food groups, skipping meals, bingeing or purging, or exercising fanatically.

The Dangers:
If you restrict your diet for any period you risk micronutrient deficiencies, which can develop into anaemia, high or low blood pressure, hardening of the arteries, osteoporosis, abnormal thyroid function, infertility and even cancer, says Alexander. ‘Anorexia also has the highest mortality rate of any psychiatric disorder. Suicide is one of the main causes of death for long-term sufferers.’

The Warning Signs:
You constantly think about food, cooking or weight, and obsess about kilojoules and fat content. You start picking at food, skipping meals, feeling guilty about eating certain things, cutting out food groups, developing rituals around food, avoiding eating in public and obsessing about exercise. You already have a problem if you experience moodiness, irritability, depression, self-disgust (after bingeing or purging), dry hair and skin, loss of scalp hair, brittle nails, puffiness (from water retention) or digestive problems.

What To Do:
Get some more realistic appraisal of your weight from a trusted friend or impartial colleague. Read up on the basics of good health and find a balanced, sustainable eating plan. It’s best to book a session with a dietitian, who can personalise one to your tastes and lifestyle. If you have a perfectionist or obsessive-compulsive personality you may need counselling – don’t let embarrassment or denial hold you back. ‘Behind every eating disorder lies an emotional wounding bringing anger, guilt, shame, fear and emptiness, which are evading though the guise of control and order,’ says Alexander. Counselling can help you identify it and work past it.

It Worked For Me:
‘I just wanted to lose a bit of my bum fat,’ says Thandi*, 23, a Durban fashion assistant. ‘I joined a gym and went every day, cut out fats and all junk food and red meat, and I dropped a jeans size. People said I look great, and I felt wonderful. But then I got a bit carried away and started feeling tired. One day I fainted at work. When my manager heard I was living mostly on green salads and egg whites, she booked me an appointment with a dietitian. Now I’m on a moderate plan, gymming three times a week, and I’m still in shape – but I’ve got energy too.’

For Help:
Call the Association for Dietetics in South Africa on 011 789 6621 or visit www.adsa.org.za; and Crescent Clinic on 021 762 7666 or e-mail graalex@iafrica.com

Stressed – Or Mentally Ill
The Dividing Line:
Most of us feel angry, stressed and depressed at times, and in today’s uncertain, pressured climate these can be normal reactions. But if you have uncharacteristic or prolonged mood changes, and struggle to cope with daily activities, you may be crossing the line to mental illness. ‘For instance, a degree of stress is normal and even motivating,’ says Durban psychologist Tim Harkness. ‘But when your stress is not balanced by support, recovery and recognition, and comes from having too many demands and responsibilities, and too few resources, it can bring burnout – a collapse from nervous exhaustion.’ Ironically, stronger people may be more at risk. ‘One of the more insidious dangers of a demanding lifestyle is that the energy you expend is not being replaced,’ says Harkness. ‘Strong-willed people may have a tendency to push themselves harder for longer, meaning they get deeper into energy debt so that the burnout – when it happens – is a bigger one.’

The Dangers:
Untreated mental problems can cost you relationships, your job and ultimately your freedom, if you burn out or withdraw with social anxiety and panic attacks, or grow violent or self-destructive. Stress also releases adrenaline and cortisol, and constantly raised levels can cause heart attacks and cancers. Anxiety and depression can bring impaired immunity, headaches, digestive problems and sexual ones (such as lowered libido).

The Warning Signs:
You start to feel confused or ‘different’, battle to control intense fear or anger, lose interest in what you once enjoyed, believe others treat you completely differently or avoid you, feel compelled to perform certain rituals (avoiding pavement cracks, constantly washing your hands), or develop other behaviours or phobias. Don’t wait until you have a full-blown problem – hearing voices or seeing visions that usually supportive people dismiss as delusions or hallucinations, experiencing changes in eating and sleeping patterns, having suicidal or violent thoughts, withdrawing from society or hurting yourself.

What To Do:
If you’re stressed and heading for burnout, says Harkness, practise being assertive (get coaching if necessary), putting limits on people’s demands and building positive relations with others. ‘Simply smiling and greeting people can help significantly.’ Delegate where possible, take short breaks during the day and make time to relax and recharge with friends or a hobby. ‘The biggest danger is not the negative elements in your life but an absence of positive elements. Put back the energy you expend or you will burn out.’

It Worked For Me:
‘I was too busy to see I was heading for burnout,’ says Zubeida*, 34, who works in a bank in Gauteng. ‘I’d always enjoyed my job, but then there were staff cuts and pressure to improve results. I no longer had enough time to spend with clients, and I felt unsatisfied, tired and resentful. One day I nearly snapped over a small incident, and a colleague suggested a session with a coach. I learnt that if you don’t prioritise your own health, you are of no use to anyone. I’d stopped jogging because I didn’t have time, but I started again, and just that helped me cope better. I also started investing more in my home life, re-prioristing friends, and getting support and satisfaction there. I feel more balanced and alive than in ages!’

For Help:
Call the Psychological Society of South Africa on 011 486 3322 or visit www.psyssa.com (for a registered therapist or psychologicalist); Coaches and Mentors of South Africa on 021 790 2000 (for a coach) and the South African Depression & Anxiety Group on 011 262 6396 or visit www.sadag.co.za

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