When I slowed down posts two years ago, I was making a major career transition. Since we last spoke, I completed a fellowship in addiction psychiatry and joined the faculty at the University of Utah Spencer Fox Eccles School of Medicine. I love my new job, and it’s allowed writing to move back into my top 5 priorities.

I’m working on a lot of exciting posts surrounding the topics of sex, drugs and suicide. I’ve decided to stop updating this website for now, and will instead will be posting exclusively at SexDrugsAndSuicide.com.

Please consider subscribing to Sex, Drugs, and Suicide. I can’t wait to show you more.

-Jeff

What beat it out? Improving my spirituality, my relationships with family and friends, my work performance, a book I’m writing, an app I’m building, and my personal finance goals.

Frankly, it’s too much. So I decided to start trimming from the bottom of the list. I won’t stop creating blog posts, but I won’t be posting weekly. I haven’t decided on any frequency yet. I’m hoping that the quality will improve since I’ll be able to focus on longer, less-frequent posts. At the same time, I’m nervous that my writing may decline because I’m putting in fewer reps. 

Ultimately, I believe that slowing down is a great way to prioritize the other important things I’m working on. I can’t wait to show them to you! I hope you consider doing the same thing in your life.

Our actions may not be fully aligned with our long-term goals. But in the moment, there is a reason for what we do. We may want to feel better or avoid immediate pain. We may do something we’ve always done without really thinking. We may act because we feel lonely or frustrated or angry.

You aren’t broken because you made the wrong choice. You’re human. Step back and think, “what does that behavior do for me?” Because whether it’s sugar, YouTube, or heroin, there’s some reason we keep going back. Until we recognize why we do something, it’s hard to have lasting change in our lives. 

“I’m an addict” doesn’t explain anything. It’s a label, and usually not a helpful one. What about  “I like _, because _” (even if you hate other things about it). Be honest with yourself. Sit with that thought. It might be painful. It might make you realize that things aren’t so bad. 

It’ll take compassionate practice to change. But when we realize why we do something, change becomes much more realistic. 

Here’s a common example I hear almost every day: “I can’t do that because of anxiety.” It might be true; it might not be. How could you possibly know unless you try? But more importantly, the thought isn’t very useful if the thing you “can’t do” is something you really want. It provides a convenient excuse that you can turn to when you feel overwhelmed. Fighting against it, however, can often make the thought stronger. So rather than trying to contradict the thought or reframe it as something more helpful, it might be worthwhile just to recognize that the thought is there, and that you get to choose what you do with it. This thought doesn’t represent you. It doesn’t predict the future. And you can’t know if it’s true unless you commit yourself to action.

When I sat down to write this post, I was struck with the thought “this is too hard to do today.” I felt an immense weight behind posting something meaningful. I thought of writing a brief, low effort post. And that would have been fine. My current goal is to publish a single post every week; to build a habit first, and hope that skill develops with practice. Thankfully, the practice I’ve been doing with cognitive defusion–techniques used to “unstick” myself from my thoughts–kicked in. I noticed that what I had experienced was just a thought, and I started writing something anyways. It was painful and difficult at first. I still didn’t want to do it. And yet after a few minutes, I started to feel some relief. It felt right, and I’m glad I did it. It doesn’t always work that way, but I’m hopeful that I’ll get better with practice.

“I can’t do that because…” is almost never helpful. And, well, it’s just a thought. Recognize the noise your mind presents to you, but don’t believe it. Focus on what matters most. And then take a small step away from the darkness. You might find yourself enjoying the journey. 

There’s a movement to classify all mental health problems as brain disorders. And to some degree, these advocates aren’t wrong. All of human life is experienced by the brain. We can’t usually identify individual anatomical changes that distinguish one mental disorder from another, but there’s little pushback against the idea that the brain is at the center of our experience.

Brain-based explanations of mental health may also reduce some forms of stigma. And at the same time, we all have a natural tendency to be skeptical of recovery from brain-related deficits.

For example, we know that opioid use disorder (the clinical term for people who continue to misuse substances like heroin, morphine, or oxycodone despite negative consequences) can be convincingly modeled as a chronic, relapsing brain disorder. And at the same time, there are concrete behavioral changes that people can make to recover from opioid use disorder. 

My patients with opioid use disorder absolutely benefit from medications that stabilize the brain-based opioid system, just like someone with diabetes benefits from medications that stabilize blood sugar. At the same time, we can be so much more empowering by exploring behavior and providing coaching on ways to better manage the problem. For opioids, that might include education, changing contacts, identifying cravings, managing triggers, approaching trauma, and so much more. For diabetes, these interventions often fit the same mold. But to say “this is an insulin resistance problem” or “this is a brain-based opioid system problem” without saying “and I want to help you find ways to overcome this” sets people up for suboptimal outcomes. 

Like anything else in life, there are things we can change, and things we cannot. We can reduce stigma by normalizing the things we cannot change. And at the same time, we can empower each other emphasizing the depth, breadth, and reality of effortful improvement. Because at the end of the day, there is always some way we can improve our lives by changing our behavior.