Self-Care and Health

Health Basics

Health means soundness of body and mind, and the sense of well-being that goes with it. The better your health, the more you are able to do and the better you’re able to do it. Caring for your health improves your life and gives you more control over it. You will do better both at work and at home if you are rested and well fed than if you are tired and hungry, for instance.

If you have been in a high-demand group:

• • You may have been indoctrinated to put the group’s agenda ahead of your own needs. Even though you no longer believe that, it may still feel “selfish” or “worldly” to tend to your health. Far from being selfish or worldly, caring for your health can make you more energetic and productive; it also may relieve or reduce the burdens on others, or enable you to help others more.

  • You may have been taught that health problems like headaches and indigestion result from your lack of piety, understanding, or dedication to the cause. If you become purer, more guiltless, enlightened, or what have you, the symptoms will disappear. In fact,

  • Constant striving to reach an impossible goal can cause a huge amount of stress, which in turn can cause headaches, sleeplessness, and other health problems. But this is because there is something wrong with the goal, not you.

  • Whatever the cause, any pain, sleeping problem, or other symptom that hinders your functioning or lasts longer than a day or two needs medical attention.

  • You may have been told that your health problems are punishments for evil or sinful thoughts or deeds, such as asking questions, doubting, or disregarding group leadership or doctrine. There is no evidence to support this view. And there are plenty of healthy evildoers around to contradict it.

  • Some health problems actually may be caused by group practices like frequent fasting, limited sleep, or prolonged meditation.

  • Even though you may view some problems, such as alcohol or drug addiction, as “your own fault,” that is no reason to keep you from caring for your health now.

All of us, including those who suffer from chronic illness or impairments, are more comfortable and function better if we make the most of what we have. A good place to start is to tend to key elements that we ourselves can control: nutrition, exercise, sleep, and safe sexual practices.

Nutrition

Nutrition is shorthand for “eating that nourishes.” Our bodies extract the substances needed for growth and tissue replacement from the food we eat. Health improves when we eat foods that provide enough, but not too much, of such substances.

• • Salt, for instance, is necessary.

  • Lack of salt may cause illness ranging from heat exhaustion to swelling of the brain (actual, not figurative).

  • But too much salt over time can increase the risk of high blood pressure and heart disease.

  • Sudden ingestion of large amounts of salt can kill us.

While we’re on the topic, the current guideline for salt is “less than a teaspoon of salt a day.”

So, how do we know what—and how much—is good for us to eat? Opinions on this issue change from time to time. You can find a detailed discussion at Dietary Guidelines, a government publication. Below is a summary of current thinking.

How much to eat is measured in calories. A calorie is a measure of the energy we extract from the food we eat. (Technically, a calorie is the amount of heat needed to raise the temperature of one gram of water by one degree centigrade at one atmosphere of pressure.) In general, dietary experts advise that adults need 2,000 to 2,500 calories a day.

This amount varies depending on one’s size and activity levels:

• • Athletes who spend hours every day in motion will need more calories than people who sit at computers all day.

  • Pregnant women need more calories than women who are not pregnant.

  • To gain weight, one must eat more than the calories needed to maintain weight.

  • To lose weight, one must eat fewer calories than the number needed to maintain weight.

What to eat is expressed in terms of nutritional value—that is, the substances found in a given food. These substances are called nutrients. We need some nutrients regularly in large amounts, but others only occasionally or in very small amounts. There are seven major kinds of nutrients: proteins, carbohydrates, fats, vitamins, minerals, fiber, and water.

• • Proteins form the basis of much of our body structure, including muscles, skin, and hair. We need proteins to replace and repair this structure.

  • Our bodies do not store proteins, so we need to eat proteins often—if possible, at every meal.

  • Major sources of proteins are meat, eggs, dairy products, tofu and other soy products, grains, and legumes such as peas and beans.

  • Carbohydrates are a key source of energy.

  • Carbohydrates come from rice and grain-based products like noodles and bread, and starchy vegetables like potatoes.

  • Carbohydrates have different types of sugar in them.

  • Simple carbohydrates, such as fruits and milk, work quickly, causing blood-sugar levels to spike. (This kind of spike may contribute to vascular and heart disease over time.)

  • Complex carbohydrates, such as legumes, starchy vegetables, and cereals, take longer to digest and absorb.

  • Highly refined carbohydrates, like those in sweets, lack vitamins and other important nutrients and are significantly less healthy.

  • Fats supply energy, help our bodies absorb key vitamins, and provide nutrients called fatty acids that our bodies cannot form from other sources.

  • Not all fats offer these nutrients in the right balance and quantity, so it’s important to focus on the ones that do: fish, nuts, soy, pumpkin and sunflower seeds, and vegetable oils.

  • Fats that are solid at room temperature (called saturated fats), including animal fat in meat and dairy products and manufactured products like margarine, are linked to conditions that increase the risk of heart disease. Experts recommend limiting how much you eat of these.

  • Vitamins are complex organic substances found in plants and animals that are recognized as essential for health, mostly in small quantities.

  • Lack of vitamins can result in diseases such as scurvy or rickets, impaired immune systems, and other serious illnesses.

  • Too much of some vitamins also can cause health problems.

  • Minerals are the many chemical elements, such as calcium, salt, phosphorus, and potassium, that we need for healthy functioning.

  • Minerals occur naturally in many of the foods we eat, especially fruits and vegetables.

  • Calcium, an essential for maintaining bones, is abundant in dairy products.

  • Fiber is a subset of carbohydrates that, oddly enough, assists our digestive system by being partly indigestible.

  • Fiber provides bulk for the intestines and helps move waste along the digestive tract.

  • Fruits and whole grains are good sources of fiber.

  • Water keeps the whole system working. A large portion of our non-fat body mass is water, which carries oxygen and other nutrients through our arteries and cleans wastes like carbon dioxide through our veins.

  • Water cools us through perspiration when we are hot and carries the food and chemical waste we expel through urine and feces.

  • Lack of water will kill us in a few days. We ingest some water through food, but most through liquids that we drink.

  • Surprisingly, there is no scientific agreement on how much water we need daily.

You can find detailed information about diet and nutrition on the Internet. A good place to start is the U. S. Department of Agriculture (USDA) section on Food and Nutrition.

A lot of diet and nutrition advice is impractical and unrealistic. For instance,

• • Recommended quantities may be listed

  • in ounces (Who has little scales handy to weigh bits of food?)

  • or by the cup (A cup of chopped carrots will have more carrots than a cup of carrot chunks, so which is it?).

  • Nutritionists often recommend foods that are complicated and time consuming to prepare, or hard to find.

  • They also seem to want us to eliminate tasty things like potato chips or ice cream from our diet—not a very realistic plan for most of us.

Rather than worry about these kinds of directions, focus on the following aspects:

• • A simple guideline to healthy eating. At every meal, include a food high in protein, some carbohydrates, and at least one fruit or vegetable.

  • Note that the more processed a food is, the lower its nutritional value is likely to be. White rice, for instance, has fewer nutrients than brown rice.

  • Sweets, such as cookies and ice cream, don’t have much nutritional value.

  • Read the nutrition information on packages of prepared foods, such as fish sticks. You might get a surprise, like finding there isn’t much fish in a fish stick!

  • Frozen or canned vegetables and fruit (as long as they’re not packed in syrup) are as nutritious as most fresh vegetables, and more nutritious than tired, old, “fresh” vegetables and fruit.

  • Watch out for trick labels like “fruit drink,” which means the contents have some fruit juice in them, but also have extra sugar and water; or “Cheese food,” which means it isn’t exactly cheese.

If you are concerned about quantities, think in terms of portions, each about the size of a deck of playing cards.

• • Enjoy what you eat. Drink when you’re thirsty. Don’t eat food you dislike. The essential nutrients come in a wide variety of foods. You can try different possibilities until you know what you like best, what’s OK but not tops, and what you don’t like.

If there were restrictions on various foods in the group you were in, such as not eating meat, you may be uncomfortable even with the smell of that food. There’s no need to force yourself to eat a food that makes you uncomfortable. You can get adequate nourishment from other foods.

Food Resources

If you cannot afford to buy enough food, you may be eligible for food stamps from the Supplemental Nutrition Assistance Program (SNAP), a government program that pays for part of your food costs.

• • The Pre-Screening Tool can be used to determine if you may be eligible to receive SNAP benefits,

  • or to Supplemental Nutrition Assistance Program to learn where to sign up.

If you need immediate help, ask about emergency food stamps, a program that provides food assistance swiftly, but on a temporary basis. Each state has its own rules about eligibility for this service. To learn about your state’s rules, google “emergency food stamps” plus the name of your state.

• • The government also supports free or low-cost lunches at school for children from low-income homes through the National School Lunch Program.

Most big cities have soup kitchens where people can sign up for free meals. Google “soup kitchen” plus the name of your city to help find those near you.

Exercise

Exercise is using your body.

• • The purpose of exercise is to maintain or improve “fitness,” the ability to

  • perform daily tasks vigorously,

  • enjoy leisure, and

  • meet emergencies adequately.

  • Among all the urgent demands on your time, attention, and wallet, exercise as a program may fall by the wayside, but exercise need not be part of a program.

  • Most of us get some exercise in the course of daily activities—walking to the bus stop, cleaning, or keeping up with small children, for instance.

  • Days off work also offer opportunities for pleasant, free, or inexpensive activities like hiking, frisbee, bowling, swimming, and other sports.

The brief overview that follows may help you understand more about exercise and fitness.

Fitness improves the functioning of our hearts, lungs, and muscles; improves mood; and assists emotional stability. The amount and type of physical exercise each person needs depends on one’s age, occupation, and overall state of health. The four basic components of fitness are:

• • Cardiovascular strength, which enhances the functioning of the heart, lungs, arteries, and veins. Activities such as walking, running, or swimming develop cardiovascular strength.

  • Muscular strength, the ability to exert force for brief periods of time. Lifting weights is the most common way to develop this strength.

  • Muscular endurance, the ability to continue applying force or maintain repeated exertions of force. Exercises such as push-ups develop muscular endurance.

  • Flexibility, the ability to move joints through their full range of motion, such as being able to touch your toes.

Depending on your age and general physical condition, issues like balance, weight gain, or weight loss also may affect your fitness. If you have any kind of chronic problem, it’s a good idea to consult a doctor before you start an exercise program.

Physical activity is not necessarily the same as physical fitness. People who work in jobs that demand high levels of physical activity, like delivering parcels or waiting on tables, are not necessarily physically fit. Excellent muscular strength and endurance don’t include cardiovascular strength, for instance. The repetitious motions of an assembly line may leave you exhausted, but add little to your physical strength or cardiovascular conditioning.

Fitness guidelines are few and vague because individual needs are so varied. The most important guideline is your own reaction.

• • Pain is a signal to stop, as is exhaustion.

  • Perspiring and panting are positive indications that you are getting cardiovascular conditioning.

  • When you exercise unusually long or hard, be prepared to be unusually tired the next day.

  • Build fitness by working consistently and gradually. A brisk walk can start at 5, 10, or 15 minutes a day and increase over time to an hour.

Because you may hurt yourself if you overdo or do it wrong, it’s important to have good information when you make a fitness plan.

• • Free or inexpensive fitness programs are rare. The many “free” programs offered on the Internet all have addresses ending in .com; they are mainly selling equipment.

  • Joining a health club or gym will give you access to good equipment and some help in using the equipment properly.

  • Most gyms charge a monthly membership fee and ask for a one-year or longer contract. But the cost may be the same as or less than buying a lot of equipment for home use.

  • Fortunately, one can start a program at any age and from any condition, whenever doing so becomes a practical possibility.

As with any subject, a raft of information about fitness is available on the Internet and in bookstores and libraries.

• • Because this is a subject that attracts quacks, cranks, and profiteers, be careful to check the credentials of any site or book you consult.

  • Health.gov, a federal Web site, is a good place to start.

  • Body Mass Index, or BMI measures body fat based on height and weight.  It is a good indicator to determine healthy weight. 

Sleep

Sleep is a critical, often under-appreciated, bodily function. During sleep,

• • our heart rate and breathing slow,

  • blood pressure falls, and

  • we are not conscious of things around us.

Yet during sleep, our body produces essential hormones, and parts of our brain function more actively than when we are awake, often processing in their own manner events of the day or issues that are preoccupying us.

Sleep is connected with a system called circadian rhythms, which link us to the daily cycle of light and darkness.

• • Circadian rhythms regulate

  • metabolic processes such as body temperature and heart rate,

  • levels of hormones such as cortisol and insulin, and

  • neurotransmitters such as dopamine and serotonin.

  • The timing of these rhythms differs from person to person.

  • Some people are more alert and active in the morning.

  • Others are slow starters, feeling more alert and active in the afternoon and evening.

  • The disruption of our circadian rhythms due to sudden change in daylight and dark hours causes “jet lag.”

Problems caused by lack of sleep include

• • slowed reaction time

  • decreased immune function

  • stomach and digestive problems

  • mood swings

  • decreased alertness and concentration

  • impaired memory and judgment

These symptoms may develop if one sleeps less than 3 hours in any one night, or less than 5 hours on two or more nights.

Although most adults need 7 to 8 hours of sleep per night, some people who have left high-demand groups or cults have reported that they sleep 10 to 12 hours per night. They may somehow be making up for sleep deprivation while they were in the group, processing their experiences, or just experiencing exhaustion from the ongoing challenges of their new lives.

Not being able to get to sleep, or to get enough sleep, is a common problem. Insomnia, as it is called, comes in a variety of forms. Some people have trouble getting to sleep. Others sleep a couple of hours, wake up, and can’t get back to sleep. Some people have nightmares that wake them, leaving them anxious and uncomfortable.

Insomnia has many causes, from drinking too much coffee or alcohol to serious illnesses, including depression. You can find helpful information at Sleep Disorders Center, a University of Maryland site that suggests a number of ways to help you to sleep better. There are also over-the-counter medications available without a prescription. Use caution if you try any of these: They may have lingering effects over the next day, and they aren’t recommended for long-term use. If insomnia continues after you have tried these ideas, consider seeing a doctor.

Sex and Health

Physically mature human beings have a hard-wired, biological drive for sexual activity.

• • Sexual desire is normal and healthy, and it can be extremely powerful.

  • Controlling our sexual activity in healthy, fulfilling ways is part of taking command of our lives.

The section on boundaries and relationships discusses social aspects of sex and dating. This section provides information about important health issues that arise in everyone’s sex life. In presenting this information, there is no intent either to advocate or oppose any beliefs, practices, or ideology, but simply to present basic health considerations.

Sexually Transmitted Diseases (STDs)

Sexually transmitted diseases (STDs), illnesses that are passed from one partner to another during sexual contact, are widespread in the United States today. Some estimates say that at least half of all Americans have or have had an STD. The Center for Disease Control (CDC), a government agency, estimates that there are 19 million new infections each year. Of these, almost half are among young people from 15 to 24 years of age.

• • A number of different STDs of varying seriousness exist,  from rashes to life-threatening conditions. They include HIV-AIDS, chlamydia, gonorrhea, human papillovirus (HPV), syphilis, and hepatitis.

  • STDs are caused by bacteria, parasites, or viruses. Those caused by bacteria or parasites can be treated with antibiotics. Those caused by viruses cannot be cured, but medications may keep them under control.

  • Some of these diseases have few or brief symptoms at onset, but they continue to infect and weaken the body after symptoms have disappeared. If left untreated, some STDS may result in permanent damage, such as sterility, or even death.

  • Some STDs cause different symptoms in women than in men. Several are more serious for women than for men.

  • Some common symptoms of STDs are

  • Pain in the genital area or while urinating

  • Unexplained discharge from the genitals

  • Sores, blisters, or warts in the genital area

  • Scaly rash on the palms of the hands and soles of the feet

  • Unusual infections, fatigue, night sweats, and weight loss

You can find more information and details about specific STDS from the National Prevention Information Network and Planned Parenthood.

Medline Plus, a branch of the National Institutes of Health (NIH), offers an interactive tutorial on sexually transmitted diseases, which allows you to ask questions. You can work through it by reading the screens or using a spoken version.

Protecting yourself

You can protect yourself from STDs in these ways:

• • Take steps to prevent infection. Latex condoms, correctly used, greatly reduce, but do not completely eliminate the risk of catching or transmitting an STD. In general, the risk of contacting an STD is higher if you have had many sex partners, or if you have sex with someone who has had many partners.

  • Know your partner. Couples in an exclusive, settled relationship, with no other sexual partners, who have both been medically examined (and treated, if necessary) can do without the protection of condoms.

  • Get treatment immediately if you develop any troublesome symptoms. Both partners need to be treated if either one has an STD. It is also responsible behavior to notify other sexual partners who might have been infected.

Birth Control

Birth control refers to the ability to prevent unwanted pregnancies. Birth control options range from abstinence (not having sexual intercourse) to the “morning-after pill,” more formally known as “emergency contraception.”

• • Birth control is the responsibility of both partners in a heterosexual relationship.

  • There is a wide variety of techniques. Birth control procedures may be temporary, long-term, or permanent. They may involve either the male or female partner, or both. They also vary in effectiveness, cost, and ease of use.

  • Your circumstances and personal situation may affect which method you choose. It’s a good idea to explore your options and think carefully about which is best for you and your partner.

  • It’s important that you and your partner have a clear understanding and, unless you are planning to have children, a solid plan to prevent pregnancy.

Reliable Web sites with detailed information about birth control options are:

• The Mayo Clinic

• Planned Parenthood.

Emergency contraception

If by accident a woman has unprotected intercourse, she can protect herself by using a "morning after" pill or an intrauterine device (IUD), which prevent pregnancy up to five days after intercourse.

Abortion

Abortion is a way to end an unplanned pregnancy. Some religions forbid or deplore abortion, but millions of American women have had abortions.

• • Abortion is a common, legal, and—under proper medical care—safe method to end a pregnancy; it does not usually affect one’s ability to bear children in the future.

  • Abortion may have serious emotional and psychological aspects. Experts generally recommend counseling while you are thinking about coping with an unplanned pregnancy.

  • Most abortions are performed early in a pregnancy.

The following Web sites have helpful information about abortion:

• FamilyDoctor.org

• Planned Parenthood

Emotional and Mental Health Issues

Emotions powerfully affect our lives. After leaving a cult or high-demand group, you may experience many strong emotions, sometimes to the point that they interfere with your ability to work, learn, sleep, eat, or otherwise function well. People who leave cults may face problems:

• arising from ill-treatment while they are in the group

• stemming from before their involvement in the group

• dealing with grief following losses

• learning about and adjusting to mainstream society

For example:

• Your family may have cast you out for leaving—or for joining—the group.

• You may have extreme waves of emotion, when you feel like hurting yourself or someone else, or when you are afraid of everyone.

• You may have experiences of

  • seeing or hearing something that isn’t there, or

  • suddenly not being sure where, or even who, you are.

• The strangeness of your new life, both daily living and long-term thinking about your life, may cause an unusual amount of anxiety.

These problems are mental health issues.

• Just as physical health refers to soundness of body, mental health refers to soundness of mind.

• Just as physical health means both overall good feeling and absence of illness, mental health means both overall good feeling and absence of illness.

• Mental illness is not a personal deficiency.

• Having a mental illness does not mean you are “crazy,” any more than having a physical illness is due to your failure to please or obey someone.

• This section discusses a few of the many emotional extremes that may disturb you.

Anger

Like pain, anger is a common, natural emotion that signals something is wrong. People may get angry if they feel hurt, threatened, or cheated, or if they cannot overcome obstacles to their needs or goals. Anger may be slight and passing, deep and long-lasting, or anywhere in between.

People are sometimes taught that anger is bad and they shouldn’t feel angry. In fact, the problem with anger is not the emotion itself—it’s what to do about it. Two of the most common ways to deal with anger are“

• Exploding”—yelling, screaming, throwing things, or actually attacking someone.

• “Stuffing”—trying to ignore the anger and telling yourself you don’t care, aren’t angry, or it will just go away if you ignore it.

Both of these approaches are likely to backfire:

• Exploding tends to drive away friends and colleagues, and make others reluctant to be around you. Exploding may result in destructive or even criminal acts.

• Stuffing leads to anger leaking out through stinging remarks or other negative behavior. In the end, stuffing may hurt or alienate others who sense your anger, but misunderstand its cause. Furthermore, the constant effort of holding in the anger may drive up your stress levels and cause headaches, sleeplessness, and other uncomfortable symptoms.

Therefore, it’s important to learn to 

• recognize and acknowledge when you are angry, and

• manage the anger so that you don’t unnecessarily hurt yourself or others.

Recognizing and managing anger is not a one-size-fits-all issue. We all have different triggers that set us off. Our bodies signal in different ways when we are getting angry. We may feel

• a tightening in the stomach

• a hot feeling in the head

• tenseness in the shoulders

• a headache

• other physical change

Once you recognize the onset of anger, the next step is to take charge of the rising anger and not do something you regret later.

• This does not mean “Forget about it.”

• Strong emotions cloud everyone’s thinking, so it’s important to get calm enough to think about what made you angry and what to do about it.

  • For some people, taking a few deep breaths will help.

  • Others will need to

    • leave the room, or

    • go for a walk, or maybe

    • wait a day or two.

Eventually, often after talking it over with someone else, you will be able to size up the situation and decide what, if anything, to do about it. Learning to manage anger may take a long time and a lot of personal attention.

Many specific suggestions are available for dealing with anger and any underlying stress that may accompany it. A good place for ideas and information about anger management is The Mayo Clinic.

You are likely to find commercial online sites that want to sell you their anger management programs. It’s advisable to check out these offerings thoroughly. If your anger problems are severe, you will probably get better value for your money by finding live, local programs sponsored by reputable local agencies.

You may also find religious or ideological sites that preach “patience” and “resignation.”  While patient acceptance of some ills is appropriate for some situations, it is not suitable for all. For example, while there is no need to be rude when someone overcharges you, you are only hurting yourself if you fail to dispute the overcharge.

Sadness and Depression

After you have left the group, you may find that you are sad, even though you are convinced you have made a change for the better. The sadness is entirely understandable. Among the many possible causes are

• Grief and loss. Leaving the group may mean losing friends, family members, spouses, or children. You may have lost housing or a job. If you joined as an adult, you have probably lost the idealism and trust that led you to think the group was the way to a better life.

• Loneliness. You may know few or no people outside the group. You may have no one to consult about your needs or questions.

• Abuse while in the group. You may have repeatedly been told that you fall short in important ways—that you are stupid, disloyal, spiritually deficient, and so on. You may have been physically or sexually assaulted. The section on Abuse and Neglect explains this in more detail.

• Hopelessness. Total dependency while in the group and lack of knowledge about mainstream living may add up to a sense of overwhelming inadequacy—that you will never be able to master the skills you need to succeed in mainstream society, or you will never be happy or comfortable in the outside world.

• Physical illness. Many “mental” symptoms, such as sleeplessness or fatigue, may have actual “physical” causes. A mental health professional may ask you to get a physical exam to rule out any physical cause.

Like anger, sadness is a common and natural emotion. There is no shame in feeling or acknowledging sadness. The most common cure for sadness is time and support from others. With time, people generally are able to process grief, and the mood lifts. If there are friends or loved ones who offer sympathy and support, the process may go faster.

But extreme, prolonged sadness might be a sign of

• Depression. When sad feelings continue for a long time or impair daily functioning—if you

  • can’t sleep or eat, or

  • are too sad or too tired to go to work, or

  • have trouble concentrating, or

  • find yourself extremely irritable,

think about getting professional help because you may be suffering from depression.

Depression is one of the most common mental illnesses, and there are a variety of ways to treat it. For detailed information about depression, see the Web site of the National Institute of Mental Health (NIMH). If you think you might be depressed, you can try a confidential depression screening test, a service of Mental Health of America. Treatment for depression might include medications and therapy, therapy alone, or medication alone. A psychiatrist or qualified mental health professional can make the diagnosis and help you design a treatment plan.

See counseling and therapy for information about the different kinds of mental health professionals.

Treatment for depression is important because prolonged, severe depression may lead to thoughts of hurting or killing yourself—suicide.

Suicide

The pain of depression may be so severe that you think that no one can help and there will never be an end to it. This sense of hopelessness is extremely dangerous, as it may lead you to feel like killing yourself, an angry and destructive action closely akin to murder. The word suicide literally means “self-killing.”

But it is possible to get help, both immediate and ongoing. If you are thinking of hurting yourself or know someone who is thinking that way, immediate help is available at 

• Suicide Awareness Voices of Education ; or

• Befrienders Worldwide

Or you can

• call 911,

• go to a hospital emergency room, or

• call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY(4889) to talk to a trained counselor.

If you are feeling suicidal, do not stay by yourself. If you are concerned that someone else may be suicidal, make sure they are not left alone.

Anxiety

Anxiety is a kind of dread or fear. Anxiety keys up our systems to function at a high level of alertness.

• A certain amount of anxiety about, for instance, whether or not we will get the job we want, is normal and appropriate.

• But ongoing anxiety that never lets us relax, or irrational anxiety for unknown reasons, can be very troubling.

• People who have left high-demand groups may have sustained very high levels of anxiety for a long time, as the demands of the leaders left them in constant dread of chastisement or punishment. After leaving, they may believe that they will be punished, or even die, because they left.

• There are many types and gradations of anxiety disorders, up to and including post-traumatic stress disorder (PTSD) following an incident that threatens your life. All are treatable to some extent.

• If you are constantly on high alert, have frequent nightmares or flashbacks of a terrifying experience, or find yourself afraid of everyone and everything, see a mental health professional for help.

Stress

Stress arises from ongoing tension, new situations, and worry.

• Change of any sort—even happy change—is stressful. Change is more stressful for some people than for others. And some people are stressed by things that others enjoy.

• Stress may be short-term, as for taking a test, or long-term, such as that related to dealing with divorce or chronic illness.

• In some situations, like taking a test, a moderate amount of stress makes you more alert and is actually helpful.

• But, depending on the source, quantity, duration, and intensity of stressors, and your own personality and experiences, stress can cause sleeplessness, headaches, high blood pressure, indigestion, and other ailments, such as post-traumatic stress disorder.

• You can find information about stress and some good ideas for reducing stress from Medline Plus (Numerous commercial Web sites promote their own businesses. It’s best to take these with a grain of skepticism and try some simple, effective, and free options first.)

  • Exercise is an effective stress reducer.

  • Try this simple breathing exercise: Breathe in deeply through your nose, hold for a few seconds, and then breathe out slowly through your mouth. Take a few regular breaths, and then repeat.

• You may need therapy or medication to help you manage the stress. If you want to get professional help, read Finding and Evaluating Health Care Providers.

Dissociation or Spacing Out

Also called “floating,” dissociation is a confusion about where you are and what you are doing. 

• Daydreaming is a harmless kind of dissociation, but

• People who have left cults also may struggle with dissociation that is scary or harmful, or that occurs without notice, out of their control.

• Dissociation may be a sign of serious mental illness, or

• It may be a momentary slip of consciousness that you can remedy fairly quickly.

• Take Back Your Life, by Janja Lalich and Madeline Tobias, is an excellent book that can help you understand and cope with dissociation.

Lifestyle Issues

If you come from an environment where practically everything in the outside world is “evil,” “corrupt,” or otherwise wrong, it may be hard to distinguish what is really harmful from what is just different. So here is information about activities that often tempt people who have left cults, and that really are harmful: smoking, alcohol abuse, and drug or other substance abuse.

These activities may be attractive for many reasons:

• There are immediate positive effects: relaxation, relief from stress or pain, confidence, energy. The damage usually comes later.

• People smoke, drink, or drug to go along with friends or relatives who do so.

• They relieve feelings of shyness or awkwardness.

• They express contempt for or rebellion against those who deplore such activities.

It’s also important to know that

• Once begun, smoking and substance abuse may hard to stop, although

• Not everyone who experiments with these things becomes addicted. Some people even contend that occasional use of marijuana under controlled conditions (such as not driving while intoxicated, etc.) is harmless.

• The key is to control usage and be able to stop. What started as “recreational” use can subtly escalate until the user is no longer in control and life becomes a continuous search for the next round.

Several factors increase the risk of abuse or addiction, among them:

• Age. The earlier a person begins to use, the more likely she is to become addicted. Teens and young adults, particularly, may be attracted by something new and risky, but there is a risk of changes in brains that are still developing—which may continue up to the age of 25.

• Biological factors, including mental illness such as depression or post-traumatic stress disorder, or chronic pain.

• Exposure to stressful situations such as physical or sexual abuse, or unstable family relationships.

• Method of administration. Inhaling or injecting a drug brings an immediate “high” (as opposed to drinking) and a faster return to “low”—a strong inducement to repeat the experience quickly.

• Social pressure, such as use of drugs by family members and friends, and their assurances that “Everybody does it.”

• Times of transition, including moving to a new place, divorce, deaths of loved ones.

Knowing more about how substance abuse and addictions can cause damage may make it easier to manage, reduce, or resist use of these substances.

Smoking

Smoking and other forms of tobacco use, although once seen as harmless, are now known to be a serious health hazard, responsible for many of the most common chronic illnesses and health problems in the United States today.

Smoking can cause

• cancer of all sorts, not just lung cancer

• ulcers

• kidney and liver damage

• heart attacks and strokes

• hearing and vision loss

• tooth decay

• and a host of other ailments

Even being in a room where other people are smoking can contribute to serious illness. (For more information, see the Centers for Disease Control [CDC] Web site.)

So why do people do it?

The attraction of smoking, once you get past that first horrific puff, is strong. Cigarettes are legal, widely available, and affordable in small quantities.  They make you feel more relaxed and comfortable, and may be a satisfying gesture of defiance to the culture you have left. The damage may be invisible for several years, so there is little or no immediate and observable harm to counter the immediate benefit.

Cigarettes and other tobacco products contain nicotine, an addictive substance that makes you feel good, but quickly accustoms your body to its presence, so that you feel a frequent need to get more. If you try to stop, your body will crave tobacco and you may experience “withdrawal” symptoms, like headaches, anxiety, depression, irritability, and difficulty concentrating. Researchers think that it’s harder to stop smoking than to stop drinking or drugging, especially since it takes so long to notice the damage.

How to quit smoking

Stopping smoking can be very hard. Some people try several times before they succeed. It may help if you get support and some medication to reduce symptoms. Programs to help you stop smoking are called smoking-cessation programs.

• According to the U.S. CDC, the most popular and effective programs are a combination of individual counseling and the use of medications, gum or patches that you can buy without a prescription.

• Some health insurance plans cover the cost of counseling, although most do not. However, since the CDC found that as few as four face-to-face or telephone counseling sessions were needed, the cost need not be prohibitive.

• It’s also possible to succeed without counseling. Some useful information and free programs are available:

  • American Lung Association

  • HelpGuide.org, a nongovernment site with more general advice.

• Companies that sell smoking-cessation products may have useful information about their products, but you can assume that their programs are biased in favor of the product they are selling, and they may not be comprehensive.

Alcohol

Alcohol use need not be excessive and, unlike nicotine, alcohol isn’t necessarily addictive. Most people can drink alcoholic beverages without overdoing it, and some researchers contend that a glass of red wine a day is good for one’s health. But too much alcohol is harmful and is called alcohol abuse, or, in extreme cases, alcohol dependence.

Alcohol abuse means excessive use of alcoholic drinks, leading to irresponsible behavior, such as

• hurting others,

• frequently getting drunk,

• hurting yourself, or

• messing up at work or home. 

Drinking too much has immediate negative effects:

• Your thinking fuzzes.

• You lose track of where you are and why.

• Your reaction time slows.

• Your mood may change drastically.

• The next day you may be groggy and suffer from a headache.

It’s not unusual to have one or two episodes like this while you are learning your limits. But if it happens regularly, you are hurting yourself.

What’s wrong with alcohol? There are both immediate and long-term problems.  Among the immediate problems are the following:

• Alcohol removes barriers to behavior that you wouldn’t do when sober. People who have drunk too much may get into fights, act rudely, or have sex with strangers. Much as you may regret this behavior the next day, it can’t be undone, and the consequences may go on for a long time afterwards.

• Alcohol impairs your judgment and slows your reaction time. This is why it’s not a good idea to drive after drinking, or for that matter, make any kind of business or other important decision before the alcohol clears out of your system.

• Alcohol is a depressant. It changes your brain chemistry, so that although at first you feel relaxed and relieved of worry, later on you feel sadder than you otherwise would. 

• Alcohol interferes with sleep. At first you may feel sleepy, but after a few hours, the alcohol will make you wakeful.

• Binge drinking, taking large amounts of alcoholic beverages in a short time, may be poisonous enough to kill you within hours.

• Drinking in any quantity may counteract or intensify the effects of medications you may be taking.

Long-term alcohol abuse will cause serious or fatal illness, damaging the liver and kidneys and affecting parts of the brain, such as memory and organizing functions. Because drinking becomes the top priority of an alcoholic’s life, alcohol dependence can destroy marriages and careers and even lead to prison sentences. For detailed information about alcohol abuse, start at the Web site of the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

How much alcohol is usually OK? According to the Centers for Disease Control, one drink a day for women, two drinks a day for men.

• Note that this standard isn’t a question of weight—even if a woman weighs the same as a man, it’s one drink for her, two for the man.

• The usual measurements for “one drink” are 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of hard liquor. (Of course, we all carry little ounce-measurers around with us! And check our drinks before we quaff! But the numbers do give you an idea.)

Most people can and do control their drinking. But some gradually slip into a pattern of drinking too much too often. When the need for alcohol becomes a driving factor in one’s life, it’s time to stop.

Some people who realize they are abusing alcohol can stop on their own. Others need help. The biggest ongoing source of help in the United States is Alcoholics Anonymous (AA), a free network of support groups.

There are also residential and day-treatment programs of varying quality and cost.

Drug and Substance Abuse

Drugs and other chemicals subject to abuse are those that change the workings of the brain. Like alcohol, they intoxicate. Temporarily one feels better—in different ways, depending on which drug one uses—but over time harm or even death may result. Some drugs are so powerful that even a single use can cause permanent damage.

Like alcohol, each use of drugs affects judgment, learning and memory, and behavior control. In the longer term, the brain becomes dependent on the drug and the user’s life becomes an overwhelming need to find the next dose. Nothing else matters. This is called addiction. Current medical theory considers drug or alcohol addiction a disease.

Cigarettes and alcohol are legal, widely used, and have long been socially acceptable. Drugs discussed here are substances that are illegal or abusive if used as intoxicants:

• prescription medications, such as narcotics, legal only when professionally prescribed, in the dosage prescribed, and for the person named;

• readily available substances not primarily considered to be drugs, such as glue; and

• illegal substances such as cocaine, marijuana, and heroin.

In addition to the health risks, the illegality or illegal use of these drugs exposes the user to other risks:

• Legal consequences, such as arrests, fines, or even jail time.

  • Although few individuals who simply use are actually jailed, charges that include possession of more than a small amount, or intent to distribute, may be added.

  • Even a misdemeanor conviction for a drug offense may have unforeseen consequences in a job hunt or other future endeavor.

• Contamination, adulteration, or other pollution of the drug.

  • Impurities creep in even to legal and regulated substances. Opportunities for cheating in illegal and unregulated substances are virtually unlimited. There is no way to know what is actually in the substance one buys or where it came from.

  • Even if the drug is what it is represented to be, a buyer could be tormented with a dose that is half what his system craves, or killed with a dose that is more than his system could tolerate.

• Infectious diseases. Injections of drugs such as heroin, cocaine, and methamphetamines with unsterilized needles are major causes of HIV-AIDS and a serious form of hepatitis.

Different drugs have different effects and consequences. Here are a few:

• Stimulants, like cocaine and amphetamines

  • make one exhilarated and energetic;

  • can cause weight loss, sleeplessness, irregular heartbeat, and heart failure.

• Narcotics, like Fentynal

  • The high potency of fentanyl greatly increases risk of overdose, especially if a person who uses drugs is unaware that a powder or pill contains it. They can underestimate the dose of opioids they are taking, resulting in overdose. Naloxone is a medicine that can be given to a person to reverse a fentanyl overdose.

• Depressants, like Nembutal and Phenobarbital

  • reduce anxiety and lower inhibitions;

  • cause impaired coordination, memory, and judgment;

  • can cause respiratory arrest and death.

• Opioids, like heroin, morphine and codeine,

  • relieve pain and relax a person;

  • can cause nausea, confusion, respiratory arrest, unconsciousness, or death.

• Hashish

  • make people feel happy and calm;

  • can cause

    • frequent respiratory infections;

    • impaired memory and learning;

    • anxiety and panic attacks.

• PCP and Valium

  • cause dissociation, taking one’s mind far away from troubles;

  • can cause memory loss and depression.

• Hallucinogens, like peyote and LSD,

  • induce altered states and perceptions;

  • can cause persisting flashbacks and other ongoing mental disorders.

• Inhalants, like oven-cleaners, gasoline, and spray paints,

  • are so toxic that even a single session of prolonged sniffing can cause death or destruction of parts of the brain within minutes.

This information, and much more, about specific, commonly abused drugs and their effects is available in a well-organized, concise table at The National Institute on Drug Abuse (NIDA).

Addiction

Not all drug or alcohol abusers become addicts. 

• One can get drunk or high once or twice and not want to do it again.

• The catch is to recognize the point of no return. Some people use intoxicants only on weekends and think that because they go to work regularly and only drink or drug over the weekend that they are in control. But what happens if they try to stay sober over a weekend? That’s the test.

• Addiction develops as the brain becomes dependent. Over time, the brain requires more and more of the drug to achieve the needed comfort level, and it inflicts greater and greater distress until the craving is satisfied.

• Obviously, the more limited one’s use of the substance, the less its effect on the brain and the easier it is to stop the use.

Getting help for Addictions

Treating an addiction is no simple matter. But addiction to alcohol or illegal drugs may prevent you from meeting basic needs, and it calls for immediate attention.

Drug and alcohol treatment should be tailored to the individual needs of each person. There are many options. Almost always, a combination of treatments is necessary. Treatments include:

• Medication to relieve withdrawal symptoms or reduce craving;

• Education about ways to avoid or manage situations that trigger the craving for drugs;

• Rehabilitation services—medical, psychological, social, vocational, and legal—to address the person’s needs as she emerges from addiction and re-integrates into society; and

• Support, both formal support from counselors and support groups, and informal support from friends and family.

Treatment programs may take the form of

• Hospitalization;

• Non-hospital residential programs, in which the patient is subject to close supervision and has 24-hour assistance at hand;

• Day treatment, during which the patient lives at home, but reports for treatment daily or a few days a week for a set time ranging from part to all day;

• Combined partial hospitalization/day treatment programs, or

• Personalized treatment, in which the patient works with a variety of professionals according to an individual plan.

Although many programs are private and quite expensive, some health insurance plans provide coverage that may make them affordable. Most local governments also offer treatment at low or no cost for those who are eligible. To find accredited drug and alcohol treatment plans in your area, go to the Substance Abuse and Mental Health Services Administration (SAMHSA).

In many parts of the country, the demand for treatment is greater than the available services. You may need to go on a waiting list.

Relapse, a return to using alcohol or drugs, during or after treatment for addiction, is not unusual. Studies find that more than 50 percent of addicts experience at least one relapse. Factors that affect relapse rates include the specific addiction, the intensity and effectiveness of treatments, and external factors such as the patient’s stress levels and level of support.

• Relapse is not failure. It is a temporary setback, and perhaps a signal that the relapser needs more, or different, support and treatment.

• Relapsers can use the experience to find clues about possible changes in treatment or about their own attitudes.

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