Feeling the Pain: Substance Misuse & Generalised Anxiety Disorder

Research Paper Title

An Examination of Comorbid Generalized Anxiety Disorder and Chronic Pain on Substance Misuse in a Canadian Population-Based Survey.


Chronic pain and generalized anxiety disorder (GAD) are co-occurring, and both conditions are independently associated with substance misuse.

However, limited research has examined the impact of comorbid GAD and chronic pain on substance misuse.

The aim of this article was to examine the associations between comorbid GAD and chronic pain conditions compared to GAD only with non-medical opioid use, drug abuse/dependence, and alcohol abuse/dependence in a Canadian, population-based sample.


Data came from the 2012 Canadian Community Health Survey-Mental Health (N = 25,113). Multiple logistic regressions assessed the associations between comorbid GAD and chronic pain conditions (migraine, back pain, and arthritis) on substance misuse.


Comorbid GAD + back pain and GAD + migraine were associated with increased odds of non-medical opioid use compared to GAD only.

However, the relationship was no longer significant after controlling for additional chronic pain conditions.

No significant relationship was found between GAD + chronic pain conditions with drug or alcohol abuse/dependence.


Comorbid GAD + back pain and GAD + migraine have a unique association with non-medical opioid use in Canadians compared to GAD only, and chronic pain multi-morbidity may be driving this relationship.

Results emphasise the need for screening for substance misuse and prescription access in the context of GAD and comorbid chronic pain.


Bilevicius, E., Sommer, J.L., Keough, M.T. & El-Gabalawy, R. (2020) An Examination of Comorbid Generalized Anxiety Disorder and Chronic Pain on Substance Misuse in a Canadian Population-Based Survey. Canadian Journal of Psychiatry. doi: 10.1177/0706743719895340. [Epub ahead of print].

Meditation & Mindfulness

“Explain your work in one easy paragraph.

I am a Buddhist monk who teaches meditation and mindfulness. I’m interested in the application of Buddhist philosophy to the problems of modern life. Meditation is training for the mind, helping us become less controlled by stressful thoughts and emotions. Mindfulness brings the benefits of meditation into daily life. I am also interested in the interface between Buddhism and science, and I frequently collaborate with neuroscientists and medics.

How did you become a monk?

I had an extreme burnout 26 years ago due to high levels of stress, and I went to a Buddhist monastery to find answers. I loved it so much, I decided to remain a monk.

Did you have to overcome any particular challenges to get where you are today?

I used to have bouts of depression and anxiety, so my journey has involved quite a few rocky patches. I do, however, feel that these struggles have helped me to grow and discover valuable knowledge that I can share with others.” (Thubten, 2019, p.56).


Thubten, G. (2019) The Back Pages: The Q&A. New Scientist. 05 October 2019.

Eco-Anxiety, Like Climate Change, is on the Rise

If the prospect of climate change makes you stressed, anxious or depressed, you are not alone.

With reports of some children becoming terrified by climate change and the protest group Extinction Rebellion holding ‘grief-tending workshops’, there is an increasing awareness of so-called eco-anxiety.

A UK Council for Psychotherapy conference met in London on 19 October 2019 to discuss how best to manage such anxiety.

While there is little quantitative evidence about eco-anxiety yet, here are eight approaches that commentators suggest may help.

1. Live More in Alignment with your Values

  • The effect of individual actions can be very small, but changing how you live to be more compatible with your ideals can help with eco-anxiety.
  • You could eat less meat and dairy, drive less and stop buying and disposing of so many items, for example.

2. Give your Hone an Energy Health Check

  • Household energy use accounts for 14% cent of total UK greenhouse gas emissions.
  • Reducing your home’s energy use can help you take some ownership of your consumption.
  • Make sure you have good insulation and draught-proof windows and doors, and try putting on an extra layer of clothing rather than turning up your heating.

3. Cut Back on Flying

  • The Swedish concept of flygskam (“flight shame”) has recently gained wider attention, but a minority is responsible for the lion’s share of emissions from flights.
  • A 2014 analysis found that 15% of adults in the UK account for 70% of flights taken, so it is those who take three or more flights a year who will make the most difference by cutting back.
  • If taking fewer flights could put your job at risk, try switching from business class to standard, as this uses a plane’s capacity more efficiently.

4. Do not Feel Ashamed

  • In relation to flygskam, billions of people fly.
  • Your individual actions are not actually capable of solving climate change.
  • While altering how you live and travel may help you by letting your life be more aligned with your values, you
  • should not feel ashamed for not being able to fully comply with these.
  • The systems in which we are all enmeshed essentially force us to harm the planet, and yet we (can) put all that shame on our own shoulders.

5. Focus on Changing Systems, Not Yourself

  • Accepting that we cannot get where we want to be through individual action can have therapeutic benefits.
  • A complete narcissistic focus on the self is not healthy.
  • Instead, you can have a much more meaningful impact by working with others to lobby governments.
  • For example by:
    • Letting your MP, local councillors, and and mayor know that you think action on climate change is important; and
    • Writing to your bank or pension provider to ask if you can opt out of funds that invest in fossil fuels.

6. Find Like-Minded People

  • Find a community of like-minded individuals so you can express and share your feelings of eco-anxiety.
  • Saying that you can not solve climate change alone and joining a group of some kind will help you to make friends.
  • Socialisation is an important aspect in mental health.

7. Protect and Nurture Local Green Spaces

  • Getting involved in community environment projects may help your mental health, as well as being good for the planet.
  • Green spaces absorb carbon dioxide, cool down urban areas in hot weather, reduce flood risk, and provide habitats for wildlife.
  • Additionally, a recent study found that spending 2 hours a week outdoors in nature is linked to better health and well-being.
  • Make an excuse to find some time outside every day.

8. Bring Others with You

  • Consider the importance of talking about your experiences – the challenges as well as the positives – and bringing other people along with you.
  • Talking about the practical things people can do in their day-to-day lives can give them some sense of control back, which can really improve people’s well-being.

Benzodiazepine & Prescribing Behaviour

Research Paper Title

An Intervention to Decrease Benzodiazepine Prescribing by Providers in an Urban Clinic.


The objective of this quality improvement project was to decrease the amount of benzodiazepines (BZDs) prescribed by providers at a Midwestern university outpatient clinic.


Clinic providers participated in a brief, live educational intervention combining academic detailing (i.e., the provision of current evidence about BZD) and pharmaceutical detailing (i.e., a sales technique borrowed from pharmaceutical companies).

A 1% decrease in BZD prescribing was set as the measure of success.

Using data from the electronic medical record, the monthly average of BZD prescriptions written within calendar year 2017 (before project launch) was compared to the number written 30 days after the intervention.


Following the intervention, an 80% reduction in BZD prescribing was calculated.


Combined academic and pharmaceutical detailing could be an effective way to change prescribing behaviour in this provider population.

Further investigation is needed to ascertain whether the change in prescribing behaviour can be sustained, and that no harm is being done to patients who are currently dependent on BZD medications.


Platt, L., Savage, T.A. & Rajagopal, N. (2020) An Intervention to Decrease Benzodiazepine Prescribing by Providers in an Urban Clinic. Journal of Psychosocial Nursing and Mental Health Services. 58(1), pp.39-45. doi: 10.3928/02793695-20191218-08.

Talking about Benzodiazepine Use with Patients

Research Paper Title

Let’s Talk About Benzodiazepine Use: Inpatient Psychiatric Nurses Initiating the Conversation.


Inpatient psychiatric nurses regularly dispense pro re nata (PRN) medication to individuals during their psychiatric hospitalisation.

International studies indicate that 66% to 90% of patients receive PRN medications during hospitalisation, a large percentage of which are benzodiazepines (BZDs).

Although clear opportunities exist for nursing intervention to reduce BZD use, there is little recent US literature on inpatient psychiatric nurses’ proactive approach to the issue.

The current article examines the factors that support BZD use during inpatient hospitalisation, including nurses’ attitudes around BZD use, the perceived effectiveness of the medication to address difficult situations, and the barriers to using alternative nonpharmacological methods.

Suggestions are presented for how nurses might begin dialogues with patients around BZD use and alternative strategies to manage distress.

It is recommended that the specialty initiate a research agenda for reducing BZD use during inpatient psychiatric treatment and champion the issue as a focus for systematic improvement efforts.


Delaney, K.R. (2020) Let’s Talk About Benzodiazepine Use: Inpatient Psychiatric Nurses Initiating the Conversation.

Owning & Managing a Business Can be Hazardous to your Mental Health

1.0 Introduction

Owning and Managing a Business Can be Hazardous to your Mental Health.

This article provides an overview of business ownership in the context of mental health.

If you are one of the millions of small and medium business owners around the globe, you probably have a good idea of how tough (and sometimes lonely) it can be at the top of the business – and how owning and managing your own business can be hazardous to your mental health.

It is well-known that our mental health can deteriorate, for a variety of reasons, and, if left unchecked, can lead to mental health problems.

Although depression and anxiety are likely to be the most common issues an owner faces, it is important to remember that mental health symptoms and conditions come in many forms.

2.0 Why Be a Business Owner?

Many of us are drawn to small business because working for others provides its own stresses, for example, the feeling of lost control as others make decisions we may feel unable to influence.

Being a business owner offers a level of freedom and control that we may be unable to achieve as an employee.

3.0 Factors Affecting Mental Health in Owners

Although the symptoms of mental health conditions can be similar between people, the triggers can be very different.

There are a number of factors that could lead to a deterioration in a business owner’s mental health, including:

  • Excessive stress;
  • A toxic work environment;
  • Poor leadership;
  • Uncertainty;
  • Long hours;
  • A lack of sleep; and
  • So on.

These can lead to burnout which, in turn, can lead to mental health conditions such as anxiety and depression.

Increased competition in your particular market or industry means added pressure to perform and stand out from the crowd, as well as potentially making it more difficult to be financially successful. Business costs may also be rising, possibly faster than your ability to increase sales and revenue – meaning the bottom line is impacted, aka less profit.

Using a contemporaneous example, the business uncertainty surrounding Brexit, especially for export-orientated businesses, can have a profound impact on business planning and sales generation.

4.0 A Blur between Personal, Family & Work

Small business ownership, especially, can be tough because there are few support structures for owners.

As an owner, you are responsible for everything and the lines between personal and family pressures and work are blurred or even non-existent.

Finally, the financial pressures are very real, as it is the owner’s money at stake not a large company’s money.

5.0 I’m In Control!

Business owners may be reluctant to seek, ask or talk about any mental health issues they may be facing due to the need to be perceived as having everything under control.

This means that business owners can, effectively, end up in rather stressful jobs.

With this in mind, most employees will be unaware of the stress attached to owning a business and how challenging cashflow, for example, can be. When margins are tight, paying wages can be extremely stressful. There are real life examples where owners have paid staff wages through their credit cards or overdrafts to ensure their employees get paid – mainly due to a feeling of guilt and not wanting to let them down. It can be stressful knowing that your employee’s family relies on the wage you are paying their loved one.

There is also the stress on marriages, especially if a couple is in business together.

6.0 The Value of Mentors

Other business owners understand what you, as a business owner, are going through. They understand the impact that long hours, for example, can have on the owner’s well-being and their families.

A business mentor can assist by helping the owner find ways of being more effective with their time, among other things.

7.0 Addressing Mental Health Issues

It is imperative that you do not do nothing.

There are a number of things owners can do, at both at an individual and organisational level:

  • Know the risks to mental health and well-being in your business.
    • What are the triggers?
  • Talk about mental health and well-being.
    • This helps to normalise it.
  • Leaders in your business need to be on board.
    • They must send the message to all staff that the business takes mental health seriously.
    • Role model what good mental health looks like and what we do when someone needs our help.
  • Get some education around mental health.
    • The reason that myths and fear exist is because of lack of awareness and knowledge.
    • There are workshops, coaches and even online courses now which help plug this knowledge gap.
  • Have the conversation with your people.
    • Not saying anything to someone who is struggling is not the way to go.
    • Simply asking “Are you OK?” is a really good start and shows the person that you have noticed and do care.
  • Sleep, nutrition, relationships and exercise all correlate with mental health, so check in on your people to see how they are going with these areas.
    • For example, if someone tells you that they have not been sleeping for two months, that is going to take its toll and something needs to be done.
  • Know who to go to.
    • Have an accessible list of contacts that you can call on for a range of different mental health and well-being matters.

It is important to seek support from someone who:

  • Has received appropriate training;
  • Is a registered practitioner; and
  • Has frequent supervision.

8.0 Pursing Good Mental Health

In the pursuit of good mental health, it is important to:

  • Understand our stressors;
  • Name our stressors;
  • Admit they exist; and
  • Aim to avoid them.

If our stressors cannot be avoided, we should attempt to better manage them.

Finally, when possible, it is important as a business owner to make time and take personal care of yourself.

Can Mushrooms be the New Cannabis?

In the attached article, from The Economist, investors are hoping that medical psychedelics will be the new cannabis.

It briefly looks at how Ketamine and psilocybin (which gives mushrooms their magic) are being researched for their potential effects on psychiatric conditions such as depression, anxiety, and addiction.


The Economist. (2019) Medical Psychedelics: Shroom to Grow. The Economist. 16 October 2019.

Mental Health in Japan: The Rise of Recluses

Did you know that the pressures from work and society are causing more people in Japan to shun the outside world.

In the attached article by The Economist we can read about “Mika Shibata’s youngest son”, aged 26, who has not emerged from his bedroom for a year! (The Economist, 2019, p.49).

In an article by Andrew McKirdy, for the JapanTimes.co.jp, he states that a Government survey suggested that 613,000 people, between the ages of 40 and 64, are believed to be hikikomori.

This is up from the estimated 541,000 people aged between 15 and 39 that a 2015 Cabinet Office survey found to be hikikomori.


McKirdy, A. (2019) The prison inside: Japan’s hikikomori lack relationships, not physical spaces. Available from World Wide Web: https://www.japantimes.co.jp/life/2019/06/01/lifestyle/prison-inside-japans-hikikomori-lack-relationships-not-physical-spaces/#.Xil8ymieSUk. [Accessed: 23 January, 2020].

The Economist. (2019) Mental Health in Japan: The Rise of Recluses. The Economist. 30 November 2019.

Patients Dependent on Benzodiazepines: Make Alliances

Research Paper Title

Making Alliances With Patients Dependent on Benzodiazepines: A Provider’s Experience.


Tens of millions of benzodiazepine (BZD) prescriptions are written annually for the outpatient management of anxiety disorders and insomnia.

Many prescribers do not follow published treatment guidelines for these disorders.

Psychiatric-mental health nurse practitioners (PMHNPs) regularly meet patients who have been treated with BZDs for years.

The dangers posed by outpatient BZD use are recognised, especially among older adults, and their use should be minimised or eliminated.

There are multiple manualised approaches to outpatient down-titration of BZDs, but little evidence about which methods really work.

To effect change, it is essential that PMHNPs establish a sound therapeutic alliance with these patients, especially by using their skills in therapeutic communication.

One major conflict that may occur early in the relationship is the patient’s expectation that the BZD medication regimen will continue indefinitely and their unwillingness to risk discontinuing the drug.

This conflict commonly raises non-adherence to a down-titration plan or patient termination of the relationship.

It is essential that PMHNPs take the time and patience to build strong therapeutic alliances with patients to design and implement a successful BZD discontinuation regimen.


Amberg, A. (2020) Making Alliances With Patients Dependent on Benzodiazepines: A Provider’s Experience. Journal of Pyschosocial Nursing and Mental Health Services. 58(1), pp.29-32. doi: 10.3928/02793695-20191218-06.

Suicide in Older Adults: A Critical Problem

Research Paper Title

Suicide in Older Adults.


Suicide in older adults is a critical problem that nurses and other health professionals need to address. Evidence-based interventions for prevention of late-life suicide are urgently needed, as well as increased availability of health care professionals with knowledge and skills to recognise suicide risks and intervene to provide effective care for this vulnerable population.


Sorrell, J.M. (2020) Suicide in Older Adults. Journal of Psychosocial Nursing and Mental Health Services. 58(1), pp.17-20. doi: 10.3928/02793695-20191218-04.