Tonichttps://tonic.vice.com/en_usRSS feed for https://tonic.vice.comenFri, 14 Dec 2018 18:40:56 +0000<![CDATA[We Looked Into Whether CBD Would Show Up in a Drug Test]]>https://tonic.vice.com/en_us/article/xwjmpj/cbd-drug-testFri, 14 Dec 2018 18:40:56 +0000These days, cannabidiol, or CBD, which is the non-inebriating compound in marijuana, is being used for pain, anxiety, and as a sleep aid. Also, the FDA recently approved its use for seizures associated with Lennox-Gastaut Syndrome and Dravet Syndrome, which are severe forms of epilepsy. CBD oil and extract is everywhere—you can find it in a host of forms, including sublingual drops, vape oil, and even colorful gummies, available online and in stores all over the country. Despite the golden wellness glow around these products, can they get you in trouble by popping up in a drug test?

Will CBD show up in a drug test?

It's unlikely that CBD will show up in a drug test. If you have to take one for employment, chances are they will be screening for cannabis. But that actually means they're looking for the presence of THC or THC metabolites—not CBD. Technically, CBD is a chemical, and if you ingest it, your body will metabolize it, so it can be detected. But the average drug test is not designed to pick up CBD, or any other compounds found in cannabis other than THC, says Brenda Gannon, a toxicologist and postdoctoral fellow at the University of Texas, San Antonio. She says that “because CBD is chemically distinct from THC, it is unlikely that pure CBD would be detected in these types of drug tests. However, hemp-based CBD products often contain trace amounts of THC." (This is because some researchers believe that a tiny bit of THC enhances the effects of CBD.)

If there’s a little THC in my CBD oil, will I fail my drug test?

Different types of drug tests have different detection thresholds. A hair test, for example, is designed to catch chronic substance use. So if your CBD oil only has trace amounts of THC in it (.3 percent is the standard amount if there's any in it at all), and you're not chugging it by the bottle, it still probably won't show up in a hair test. It's worth noting that because CBD isn't regulated, you don't ever really know what's in a product that contains it.

If you're taking a urine or oral fluid test, the detection thresholds are even lower. Gannon says that "depending on a number of parameters—including amount consumed, how often one uses CBD products, and body composition—it is possible that these trace amounts of THC could accumulate and then be detected in a drug test." "It’s possible, but it's highly unlikely," concurs Jamie Carroon, a postdoctoral fellow at the National University of Natural Medicine and the founder of the Center for Medical Cannabis Education.

Is there a drug test that could detect CBD?

Since it's not standard to test for CBD, it would take a very specific test to detect it—your employer would have to commission it (and pay for it). Gannon says this would involve “notifying the testing company that the employer would like to test for an additional analyte” and “paying the testing company an additional charge to cover expenses associated with CBD—such as having to purchase additional standards for detection and [slightly] modifying their existing standard operating procedures to include CBD.” And that's really unlikely, since CBD doesn’t get you high—and therefore won’t impair your ability to perform your job functions—and most companies don’t like to spend extra money for no reason.


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At Quest Diagnostics, one of the biggest drug testing companies in the United States, they don’t offer testing for CBD and it’s not part of any employer drug testing program, says Barry Sample, director of science and technology for employer solutions at the company. Even people who are being drug tested for the DEA are not tested for CBD; in fact, federal employees can only be drug tested for certain predetermined compounds, and CBD isn’t one of them.

If your test comes up positive for THC but the only cannabis product you've used is a CBD tincture, you might be able to explain that to your employer. It's going to be up to her or him whether or not to believe you, and what she wants to do about it. According to Sample, there really isn’t a way to tell whether THC that shows up in your test came from a CBD product or a joint. “No workforce drug test commonly used will be able to tell how much was used, a pattern of use, or whether or not someone was impaired.”

Is it legal, in general, to use CBD?

Unfortunately, CBD itself has an unusually complicated regulatory status. It's classified as a Schedule I substance—meaning, legally speaking, it has no medical use and a "high potential for abuse.” This is, currently, a huge area of debate for medical professions and advocates since since CBD has been shown, in clinical trials, to help with an array of issues, and experts are looking at it as a potential treatment for addiction. These are preliminary findings though, and a lot more research is needed.

Hemp—the form of cannabis with virtually no THC present (it’s bred out)—is legal under the 2014 Farm Bill, which allows universities and state departments of agriculture to grow it. So the DEA isn't really going after hemp-derived CBD, which is why you can find its oil in vape stores, in skin products, and in stores that don't require a medical marijuana license.

"According to the federal government," Carroon says, "what makes it hemp is if you send a flower to a lab and it came back and it had less than .3 percent THC in it by dry weight." If the THC levels are higher than that cutoff, it's what we consider cannabis (a.k.a. marijuana), which is still illegal in the United States, according to federal law. So if you want to be able to go to your employer and say your test popped positive because of a legal product (or at least a sort of legal product), make sure you're using one with that .3 percent THC or no THC at all in it.

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<![CDATA[Just Hearing the Results of a DNA Test Can Make Your Body Act Differently ]]>https://tonic.vice.com/en_us/article/d3bezq/just-hearing-the-results-of-a-dna-test-can-make-your-body-act-differentlyFri, 14 Dec 2018 18:40:51 +0000 Each week, we read what's going on the world of science and bring the wildest findings straight to you. Here's the latest:

Just being told DNA test results can change your body, even if they’re not true

It’s easier than ever to get personalized DNA information—perhaps you’ll even give or receive a 23andMe-like kit this holiday season. These tests might inform you about small variations in your DNA that are associated with either positive or negative health effects, but what if simply receiving these genetic results was enough to change your health?

In a new study published in Nature Human Behavior, the findings suggest that genetic information can affect us in this way. Study participants’ bodies changed in ways that mirrored whatever genetic information they were told about, regardless of their real genetic risk profiles.

“Receiving genetic information doesn’t just make you more informed,” says Alia Crum, assistant professor of psychology at Stanford University, and senior author of the new study, in a release. “What this study shows is that it can also have a physiological impact on your body in a way that actually changes your overall risk profile.”

The researchers took DNA samples from people who were told that the study was about the relationship between DNA and diet. Then, some of the subjects did an exercise test and some ate a meal, while also being tested for a gene associated with obesity and for a gene associated with exercise capacity.

Next, participants were told what their genetic risks were—but only some of the people were told accurate information. “Some of those with genes that protect them from obesity or gave them higher exercise capacity were told they had a higher risk version of the gene, and vice versa,” the press release explains.

When they repeated the meal and exercise tests, the subjects who were told they had a gene that made them predisposed to feeling full, actually did feel more full, whether or not they truly had that gene. (Those participants felt more full compared to their own ratings of their fullness a week before, before they “knew” of their genetic results.)

Amazingly, these responses went beyond a perception of fullness; they had an immediate physical response too: A fullness protein called glucagon-like peptide 1 was released into the blood at a level 2.5 times greater than before they were told about their genetic risk.

“Interestingly, these effects were greater than the effects due to people’s actual genetic risk,” first author and graduate student Bradley Turnwald tells me. “This means that the risk level that we randomly chose to tell people was more influential for their feelings of fullness and their gut peptide response than people’s actual genetic risk in this case.”

The people who were told that they were genetically at risk for poor exercise capacity showed reduced lung capacity and couldn’t run as long as they could before they were told about their “risk.” They also had a decreased ability to exchange CO2 buildup for oxygen.

The results show how powerfully a person’s mindset can affect their body, and how mindsets can be changed with new information, like genetic “results.” We know this already from placebo and nocebo studies, Turnwald tells me, but the effect may be more pronounced with genetic information. People tend to think of genes as permanent and unchanging compared to many other markers of health, like cholesterol or blood pressure.

It’s important for clinicians and scientists to recognize how genetic results can affect a person who is receiving them, and for us to remember that genes are certainly not everything. “Information should be given in a way that maximizes the potential benefits on physiology for those who learn that they are protected, and minimizes potentially negative effect of the mindset that one is at risk,” Turnwald says.

Gratitude meditation might make stress harder to handle for new meditators

Meditation and mindfulness are often promoted as a treatment for all kinds of mental and health problems, but it doesn’t always work for everyone. This might be because there are many forms of meditation, and different styles can lead to different benefits. Yet it’s still most often recommend as one monolithic practice.

In a new study in PLOS One, researchers examined different types of mindfulness-based interventions to see what kinds of distinct outcomes they had in people with no previous experience with meditation. “Understanding more about the specific impact of different practices may help us design better interventions and potentially predict who will respond positively or negatively to a given practice type, especially upon introduction,” says first author Matt Hirshberg, a postdoctoral research associate at the Center for Healthy Minds at University of Wisconsin Madison.

They looked at mindfulness-based interventions like breath awareness, loving-kindness, gratitude practices, and attention control. These were chosen because they are all commonly used, but thought to have different benefits. Hirshberg was surprised to find that the gratitude practice enhanced the negativity response to a stressor compared to the other kinds of meditation.

The stressor was called a “the cold pressor test”— people were asked to keep their hand up to the elbow in an ice bath for three minutes “while being observed at a close distance by an unexpressive experimenter wearing a white laboratory coat recording time,” the paper says. It induces both psychological and physical stress.

People in the gratitude meditation group reported that stress was more aversive and had larger increases in negative emotion related to stress. They don’t yet know why a gratitude practice would increase reactivity to stress, Hirshberg says, but one theory is that because gratitude involves remembering a time when you felt grateful, it could increase your inward focus on yourself and your perspective.

“Once stressed, because awareness of self has been centered, the stressful experience may become more entwined with this awareness of self, making the experience even more stressful,” Hirshberg tells me. “We might think of this as akin to the difference between ‘I am so stressed out! When is this going to end!’ versus ‘This is unpleasant.’”

The different types of meditation need to be studied more fully to appreciate all of these subtle differences. But Hirshberg thinks that if you are new to meditation, perhaps you shouldn’t do a gratitude practice if you know you’re going to be facing some stress soon after.

“For example, you may not want to induce a state of gratitude immediately before a high stakes test or a job interview,” he says. “In those cases, you may be better off resting attention on the breath or generating feelings of goodwill towards others, as these techniques may help mitigate the stressful experience rather than heighten it.”

There’s a potential new drug for cannabis use disorder

Cannabis use disorder (CUD) affects around 13 million people worldwide, but many people don’t know it exists. The Diagnostic and Statistical Manual, or DSM5, list several criteria for CUD, including: wanting to cut down or stop using but not being able to, having cravings and urges for weed, not managing to get things done at school, work, or home; continuing to use even when it’s causing problems in your relationships, developing a tolerance to weed and needing to use more to feel high, and getting withdrawal symptoms when you do stop, which are only relieved by using more.

In the US, around a third of all current cannabis users meet these diagnostic criteria, and more than 250,000 people were admitted for treatment of cannabis abuse treatment in 2016.

“That is not a trivial number,” says Deepak Cyril D’Souza, a professor of psychiatry at Yale University School of Medicine. “[The number of treatment admissions] was second only to heroin. However, there are no FDA-approved treatments for CUD, and there are no other existing medications that clinicians have found to be consistently effective or safe in treating CUD.”

In a study published in The Lancet Psychiatry, a phase 2 randomized trial of 70 men showed that a new experimental drug could help reduce withdrawal symptoms and help people with CUD stop using.

The drug is a fatty acid amide hydrolase, or FAAH inhibitor called “PF-04457845.” Basically, the drug blocks the enzyme that breaks down the brain’s own cannabis-like chemical called anandamide. When it blocks this enzyme, it increases anandamide. The people who were given the drug, and not the placebo, had fewer withdrawal symptoms, used cannabis less, had less THC in their urine, better self-reported sleep, and better sleep architecture as measured by brain wave monitoring.

“With the growing legalization of cannabis worldwide, it is only reasonable to assume that the rates of cannabis use disorder will go up,” says D’Souza, the first author of the paper. “The latest survey of high school students by the Substance Abuse Mental Health Treatment Services Administration (2018) showed that cannabis use was highest in those states that legalized cannabis.”

How can we both recognize the potential beneficial and therapeutic effects of cannabis while recognizing the growing risks? D’Souza says that there needs to be more rigorous randomized, double-blind, placebo-controlled with adequate sample sizes to test the effects of cannabis and all its compounds.

“But we need to do those kinds of studies before we can make any conclusions,” he says. “So the bottom line is that like all other potential medicines we need to weigh the risks and benefits of the potential medicine based on scientific evidence, and not public opinion.”

Your weekly health and science reading list

'Before, I was quite a shy person': life after brain damage. By Sirin Kale in The Observer.
The stories of people whose memories, personalities, and experiences change after a brain injury– but not necessarily in a bad way.

Why are so many people getting a meat allergy? By Maryn McKenna in Mosaic.
It’s called ‘alpha-gal allergy,’ it's caused by a tick bite, and it’s turning people into reluctant vegetarians

23andMe Informed Me My Husband and I Are Related. By Liane Kupferberg Carter in The Cut.
“I discovered that my husband Marc and I are related through more than mere marriage. We’re third cousins.”

Is Listening to a Book the Same Thing as Reading It? By Daniel T. Willingham in The New York Times.
I listened to my first audiobook recently, and had a tough time paying attention. Am I just a book snob, or is there a big difference between reading and listening? Willingham explains.

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<![CDATA[An Influential Think Tank Suggested That Harm Reduction Doesn't Work]]>https://tonic.vice.com/en_us/article/gy7ke9/brookings-institution-suggested-that-harm-reduction-doesnt-workThu, 13 Dec 2018 23:40:39 +0000Last week, two prestigious think tanks released recommendations related to the opioid crisis. One came down in favor of piloting a highly controversial harm reduction treatment—prescribing heroin for opioid addiction—based on a careful review of the data. The other reached the opposite conclusion on harm reduction, claiming that syringe exchange programs and distributing naloxone to reverse overdose actually make matters worse—while ignoring decades of public health data to the contrary.

How did the Brookings Institution get such radically different results from the Rand Corporation? The answer lies in a clash between economics and medical and public health research, which has infuriated addiction experts to the point of demanding a retraction from Brookings. With overdose deaths at an all-time high and thousands of lives at stake, getting these recommendations right matters. Politicians, policy makers, and their staff often rely on summaries of these reports to make decisions, rarely digging into the details themselves.

(As of this writing, Brookings has merely amended the article to acknowledge that the previously unmentioned public health research exists, but this has not satisfied its critics).

Brookings’ article, titled “Research roundup: What does the evidence say about how to fight the opioid epidemic?” immediately angered experts, who took to Twitter to complain that its conclusions did not match those of the researchers and physicians who actually study and treat people with addiction. It has taken decades for harm reduction to move from being a fringe idea into an essential part of drug policy, most of which were spent using empirical evidence to fight against the idea that anything other than making the consequences of drug use worse would increase it.

The Brookings authors—Jennifer Doleac, associate professor of economics at Texas A&M University, Anita Mukherjee, assistant professor of risk and insurance at the University of Wisconsin, and Molly Schnell, a postdoc at the Stanford Institute for Economic Policy Research—are all economists. And their roundup was almost comically focused on the economic literature.


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Based on two studies—one a working paper and the other not yet published or available for review—they indict harm reduction via needle exchange and naloxone, which literally has a literature that includes thousands of studies. On needle exchange, they claim:

New work by Packham and Wells (2018) suggests that syringe exchange programs—a staple of harm-reduction efforts—reduce HIV rates as intended but unintentionally increase opioid-related mortality by making it easier, cheaper, and safer to use heroin.

In the original version of their post, the authors didn’t mention that virtually all public health authorities—from the US to China and Iran—support needle exchange based on reviews by the World Health Organization, the Centers for Disease Control and Prevention, the Institute of Medicine (now the National Academies of Science, Engineering and Medicine), a Cochrane review, and many others.

The support comes from data cited in those reviews showing that needle exchange reduces injection drug use and makes people more likely to seek addiction treatment—both of which lead to fewer overdoses, not more.

In the updated version, they added a paragraph noting the discrepancy while still failing to cite the data and the weight of the consensus that needle exchange doesn’t do harm.

Regarding naloxone, they cite their own working paper (which was the subject of previous controversy due to its methodology and its own failure to grapple with the public health data), writing:

The results of the Doleac and Mukherjee study suggest that broadening access to naloxone can unintentionally increase opioid abuse by reducing the cost of overdose. That is, while naloxone saves lives in the moment—which is clearly a priority for policymakers and public health officials—it may increase rates of drug abuse and possibly even mortality.

Once again, actual research on the ground contradicts these claims and remains unmentioned. For example, a study on naloxone programs by Alexander Walley and colleagues found that in Massachusetts, areas with low levels of naloxone availability and training reduced overdose death by 27 percent and those with high levels cut it by nearly half, compared to places that did not implement naloxone programs.

“What’s interesting is that they appear not to read anything that’s not published by an economist,” says Richard Frank, professor of health economics at Harvard Medical School. He notes that the Doleac naloxone study measured availability of the medication indirectly, by assuming that laws passed to increase access actually do that in a timely fashion and by looking at the number of searches for naloxone on Google and the number of drug arrests.

But when Frank and his colleagues used a more direct measure—comparing the results of expanding Medicaid and legal changes on actual naloxone sales—they found that, as the public health data suggests, more naloxone leads to fewer overdose deaths, not more. (His study is also not yet published in a peer-reviewed journal, but some of the data was published on the website of Health Affairs, in an article raising concern about Doleac’s naloxone research.)

Doleac would not respond to specific questions I sent about the Brookings article and her naloxone work, but released a statement to several journalists who inquired, saying:

“I find it utterly disheartening that a discipline as important as public health is filled with so many people who collectively have so little understanding of rigorous research methods. Advocates should acknowledge that many of their strongly-held priors are not evidence-based. Anecdotes and personal experience are valuable but are not a substitute for rigorous causal inference methods.”

Doleac’s contention appears to be that the only data that counts is economic research that uses mathematical techniques to tease out whether harm reduction tactics cause or reduce harm—or randomized controlled trials. This rejects nearly all of public health—tens of thousands of studies that compare communities or individuals before and after an intervention, using controls to manage pre-existing differences and other observational methods.

And the reason why randomized controlled trials haven’t been conducted on needle exchange and naloxone is the same one as why parachutes have never been tested against simply jumping out of planes at altitude. It would be unethical for the control group to be randomized to a potentially deadly study condition like not getting clean needles or access to a drug proven to reduce overdose.

“The dispute is primarily disciplinary—although it is taking on metaphysical proportions given the inability or unwillingness of Doleac and colleagues to acknowledge the validity of other methodologies or to reflect constructively on the weakness of their own methods,” says Ricky Bluthenthal, professor of preventive medicine at the University of Southern California. “Ignoring findings from other methodological approaches is uncommon in public health. We are multidisciplinary by necessity and training.”

Or, to paraphrase Donald Rumsfeld, you have to use the data you have, not the data you might want or wish you had.

When advising on policies that affect the lives of vulnerable people, understanding the science across disciplines and the political environment is essential. And that’s where The Rand Corporation’s research on heroin prescribing, also released last week, stands out.

Heroin by prescription is, to put it mildly, a tough sell for the public and policy makers. For people raised on DARE and the war on drugs, it seems like “enabling” and just giving up on helping.

But in fact, most of damage and destruction associated with heroin addiction is linked to its illegality—and the research on heroin shows clearly that when you remove the danger and drama of chasing down the drug and dodging the cops, people’s lives tend to become much more calm, productive, and caring.

Without having to raise money for drugs (often through crime) and without having to spend hours waiting for dealers and then working to hide their drug use, people on heroin prescriptions have time to think. The research shows that this means they’re more likely to get a job, repair family relationships, and, yes, get into traditional treatment and recovery than if they’re simply left to risk their lives on the street.

To explain this to policymakers, Rand published four reports laying out the research on heroin and another harm-reduction approach, safe injection facilities (SIFs), which are rooms where people can consume drugs under medical supervision. Rand found that the data supporting heroin prescribing was far stronger and that, while safe injection sites are promising, it would be hard to create enough facilities to make a significant difference.

No fewer than ten randomized controlled trials have been conducted on prescription heroin. (Curiously, this approach wasn’t even mentioned in the Brookings piece). And as far back as 2011, a Cochrane Review, considered the gold standard for medical evidence, was published favoring heroin prescribing. That review, which covered trials including more than 2,000 patients in several countries, concluded that:

The available evidence suggests an added value of heroin prescribed alongside flexible doses of methadone for long-term, treatment refractory, opioid users, to reach a decrease in the use of illicit substances, involvement in criminal activity and incarceration, a possible reduction in mortality; and an increase in retention in treatment.

In other words, providing heroin as an addition to methadone cuts crime, reduces drug use, and helps people turn their lives around. Over the years, I’ve interviewed a number of participants in heroin treatment and the first thing most of them said to me was that it saved their lives.

The research does caution that heroin treatment must be more carefully supervised than current medications like buprenorphine and methadone because it is riskier. As Beau Kilmer, co-director of Rand’s drug policy research center, put it in a press release, “Given the increasing number of deaths associated with fentanyl and successful use of heroin-assisted treatment abroad, the US should pilot and study this approach in some cities,” adding, “This is not a silver bullet or first-line treatment. But there is evidence that it helps stabilize the lives of some people who use heroin.”

But Rand went even further than just reviewing the literature (and reviewing the reviews of the literature). It also conducted interviews with 150 community members who might be affected by heroin prescribing, including people who take opioids, treatment providers, and law enforcement. Not surprisingly, many expressed fear that heroin prescribing would “enable” continued drug use without helping—and the researchers concluded that educating communities about the research showing that it does not prolong addiction would be important.

If think tanks are to do their job and inform policy makers of the relevant data, they can’t simply ignore cross-disciplinary research, even if they disclose that they have done so. Drug policy can be a matter of life and death—so extreme care must be taken. Or as Frank put it, “I think a lot of humility is called for and I think that’s what’s missing here.”

Update 12/14/18: A spokesperson for the Brookings Institution provided the following response:

"Brookings supports the academic freedom of our resident and nonresident scholars, including their right to publish controversial research that adheres to our quality and independence standards. However, Brookings as an institution does not take positions on issues, nor do we endorse Doleac’s response to the criticism and feedback she received. Public health experts, researchers, and advocates have made important and critical contributions to our society, and their efforts have saved countless lives by informing America’s response to the opioid crisis."

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<![CDATA[When I Couldn’t Find a Therapist I Liked, I Tried Brain Stimulation]]>https://tonic.vice.com/en_us/article/vbaqpy/when-i-couldnt-find-a-therapist-i-liked-i-tried-brain-stimulationThu, 13 Dec 2018 19:12:02 +0000Ah, therapy, the elusive grande dame of mental healthcare. It has been shown to help for a wide range of mental health issues, but for so many people it's inaccessible.

First of all, it's expensive. Often, insurance doesn't cover it. Other times, insurance does cover it and it's still too expensive. Or maybe you just can't find a good therapist. Or you did, but you feel weird about telling your boss and family you need to carve out time to see them.

Here at Tonic, we wanted to know: How are people making it work despite all these challenges? How are they paying for therapy, and how do their lives change when they do actually make it to the couch? Welcome to Therapy Diaries, where we explore all this and more.

To submit your experience to the therapy diaries, answer a few questions here.

Bryson, 28 San Francisco

Are you in therapy now?

No, but I've been to therapy for PTSD, depression, anxiety, and maybe some other neurodiversity (still figuring that out). Over the past few years I've been in and out of therapy due to changing health insurance. After my first therapist, I've been finding it difficult to find a therapist who is in my network, professional, and sympathetic to my issues.

When I lived in New York, I just didn't connect with one therapist. I told her about a traumatic experience and I remember her staring at me blankly saying something along the lines of "Are you a risk taker?" and "Why would you put yourself in that situation?" I left the session feeling unvalidated and guilty.

When I was unemployed, I was too much of a wreck to navigate affordable mental health options while looking for another job. I did, however, do a lot of yoga, meditating, and frequently visited the Zen Mountain Monastery in Downtown Brooklyn. I can't say it helped with my clinical depression, but it got me through a very difficult time.

Once in San Francisco with a new job and new healthcare I immediately began searching for a new psychiatrist and therapist. The psychiatrist was easy, finding a therapist has been tricky. One therapist waited until the end of our first session, after I told her my whole life story, to tell me that (in spite of listing my insurance as covered on Psychology Today) she wasn't in network. It was really disappointing.

Another just seemed like she didn't care. I was trying virtual sessions through a network of therapists in the hopes that once an in-person therapist became available, I could do that. The first session was a little awkward but I was determined to make it work. The second session was pretty bad. After spending about a third of the session trying to find me another therapist in the network (there were none), I had to retell her very basic things, like what brought me to therapy and my goals for therapy. She didn't look at her notes, interrupted me when I told her about a recent anxiety-inducing event, and recommend a pretty strong anti-anxiety medication, and that I enroll in a meditation class at SF State. The session really ruined my day. Again, I left therapy feeling unvalidated and discouraged.

Then I started TMS [transcranial magnetic stimulation] with my psychiatrist. I originally wanted to find a talk therapist first, but it didn't seem like that was going to happen anytime soon.

How often do you go, and how much does each session cost?

For TMS, daily, for 15-20 minutes long sessions for a month. I also saw my psychiatrist weekly to make sure everything was going well. When I was in therapy, it was about once a week, if I didn't suddenly cancel.

Does your insurance help pay for this?

For TMS, yes. I had to get approval for the treatment first though. It's FDA approved and covered by my insurance but still new and pretty expensive. I had to be treating depression with medication for more than two years and have tried at least 5 medications (yup). I pay a $30 copay for each session and each psychiatric check in. Out of pocket, the entire treatment was around $1,100. I believe the full cost of the treatment without insurance is somewhere between $15,000 and $25,000.

When I was seeing a therapist, it was about $25 per session.

Has the cost ever deterred you from seeing the right therapist/ a therapist at all?

Yes. If I could afford to see a therapist out of network, I would. I am making more money now than when I was in New York, but between TMS therapy and talk therapy, I wouldn't have money to live. I'm currently tapering off TMS so I'll be back to hunting for a talk therapist soon.

Have you had to turn alternate ways, other than therapy, for dealing with mental health?

I wouldn't say that TMS is an alternative, it was always my intention to do a combination of TMS, medication, and talk therapy. TMS has helped tremendously with my anxiety and depression. When I take those anxiety and depression tests, I'm not depressed or anxious anymore. I've had many discussions with my psychiatrist about the benefits of a combining medication, TMS, and talk therapy for developing healthy coping skills and understanding what makes me feel so cognitively different from most folks. I told him about my struggles to find a therapist and he told me that a lot of his patients experience the same thing.

Also, the anxiety-reducing effects of TMS has allowed me to meet other "weirdos," which has also helped.

What would you be spending that money on if insurance actually covered therapy?

I have a very long Christmas List/Chart of Desires. At the very top is furniture for my apartment. Correction: if I had the money, I’d go to a dentist.

When you're able to do it consistently, how does being in therapy make you feel?

I have difficulty with long term goals, like remembering them. Being in therapy made me feel like I was emotionally, socially, psychologically developing. The best was when my therapist would tell me something about myself that is shatteringly true but something I could never never recognize on my own because I'm me, you know?

This interview has been edited and condensed for clarity.

For more advice on how to deal with anxiety and other mental health stuff sign up for our weekly newsletter, Coping.

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<![CDATA[Kotex Tampons Are Being Recalled After Reports of Them Unravelling Inside People's Vaginas]]>https://tonic.vice.com/en_us/article/wj3b79/kotex-tampon-recall-unravelThu, 13 Dec 2018 17:06:58 +0000It's not just romaine lettuce you have to worry about: On Tuesday, Kotex maker Kimberly-Clark announced that it was voluntarily recalling some of its tampons after hearing from customers that the product was unravelling inside their vaginas and sometimes leaving pieces of tampon behind, which had to be removed by a doctor. Errant tampon shreds could cause health problems.

The recall affects specific lot numbers of U by Kotex Sleek Tampons, in regular absorbency only, sold in the US and Canada in packages of various sizes. No other U by Kotex products are being recalled, and other absorbencies of the Sleek Tampons are not affected. The tampons were distributed between October 17, 2016, and October 23, 2018, and Kotex has told retailers to remove the recalled lot numbers from their shelves and post notices in stores.

To see if your Kotex Sleek Tampons are affected, you can type the lot number on the bottom of the box into the search bar on the Kotex recall page or check it against the list of lot numbers on the websites of Kimberly-Clark or the FDA. You can also call Kimberly-Clark's Consumer Service team at 1-888-255-3499.

The company says "a quality-related defect" is potentially impacting the performance of the tampons. The specific problems reported are:

Kimberly-Clark has received reports from consumers of the U by Kotex® Sleek® Tampons, Regular Absorbency, unraveling and/or coming apart upon removal, and in some cases causing users to seek medical attention to remove tampon pieces left in the body. There also have been a small number of reports of infections, vaginal irritation, localized vaginal injury, and other symptoms.

The company says anyone with these tampons should stop using them immediately and that people who experience the following problems after using the products should seek immediate medical attention: vaginal irritation; bladder infections; yeast infections; vaginal pain, bleeding, or discomfort; and hot flashes, abdominal pain, nausea, or vomiting.

The last four symptoms are similar to those of toxic shock syndrome (TSS), according to the Mayo Clinic and the National Institutes of Health. Using tampons is associated with a small risk of developing TSS, which is why those folded instructions inside the box say to change tampons at least every eight hours (for people who have a certain bacteria in their vaginal flora, leaving a tampon in long enough could result in that bacteria producing a dangerous toxin).

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<![CDATA[How to Get Some of the Benefits of a Vegan Diet Without Actually Going Vegan]]>https://tonic.vice.com/en_us/article/8xpeap/benefits-vegan-diet-less-meatThu, 13 Dec 2018 13:00:00 +0000From the omnivore’s perspective, going vegan seems like an insurmountable task. A lot of sacrifice, a lot of discipline, a lot of explaining your choices to friends and family, and a lot of scrabbling around to get the macronutrients, minerals, and vitamins that ordinarily, you’d automatically get from animal products.

But a growing body of research suggests that making the change to a plant-based diet is worth the trouble given the health benefits it’s likely to impart. I’m talking lower cholesterol, a lower risk of cardiovascular disease, a higher resting metabolic rate, improved management of type 2 diabetes, the reduction of osteoarthritis and rheumatoid arthritis symptoms and a slew of other outcomes besides.

Still, it seems like a lot of work, right?

Well the good news is that you don’t have to commit yourself to a vegan diet, or even a vegetarian one, to realize some of these proven benefits. Just apply these following four principles to give your health and wellbeing a boost.

Increase your fiber intake

A diet that’s abundant with vegetables, grains, legumes, fruit, nuts, and seeds is going to pack a lot of fiber, something that most Americans don’t consume nearly enough of. “Fiber regulates your entire system,” says Niket Sonpal, New York-based gastroenterologist and professor of clinical medicine at Touro College. Sonpal explains that fiber clears out our intestines and helps keep us to feel fuller for longer periods of time, curbing our impulse to binge and snack.

“Fiber also helps regulate your blood sugar,” he says. “Adding more vegetables like broccoli; snacking on almonds and fruits like pears, blackberries, and oranges; and eating more lentils and beans will add fiber which will help with digestion and excretion which is always a good thing.” Research published in the Journal of Nutrition showed that increasing intake of dietary fiber significantly reduces the risk of gaining weight and body fat—independent of physical activity and dietary fat intake.

And then there are the awesome poops. So do like the vegans do, and add more weight-shedding fiber to your diet. Susan Tucker, a nutritional counselor and founder of Green Beat Life (a nutrition-counseling practice in New York City) suggests that you fill half of your dinner plate with vegetables, a quarter with a starch, and the remaining quarter with protein. “For any meal or snack, always up the fiber content,” she says. “You may find yourself with fewer cravings and skipping the snacks.”

Avoid cholesterol-rich foods

Vegans don’t eat animal fats, processed meats, cheeses, and non vegetable-based oils. This means that they steer clear of cholesterol-rich foods. While the scientific consensus on the ills of dietary cholesterol has softened over the years, the 2015–2020 Dietary Guidelines for Americans still strongly recommends eating as little dietary cholesterol as possible. It makes mention of studies and trials that have produced strong evidence that healthy eating patterns that are low in dietary cholesterol can reduce the risk of heart disease in adults.


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Roughly 30 percent of our calories should come from fats, says New York City-based registered dietician Keri Glassman. The good fats she prescribes are all vegan: Monounsaturated fats (such as olive oil, peanut oil, flaxseed oil, nuts and avocado) and polyunsaturated fats and essential fatty acids (including safflower, sunflower and sesame oils, seeds, nuts, flax and hemp). Instead of eating a fried egg on toast, Tucker says, have a slice of toasted sprouted-grain bread with mashed avocado and a dash of lime. Rather than snacking on an ounce of cheese, try an ounce of nuts.

Pump up the volume

Most plant foods, especially vegetables, provide more volume than animal foods, says Matt Ruscigno, a vegan of 19 years, is a registered dietician, expert in the field of vegetarian nutrition, and the co-author of The No Meat Athlete. In other words, you can eat more food for fewer calories.

“I work with a lot of athletes who are new to veganism. Many are confused by this and end up not eating enough,” he says. The best way to get the benefits of vegan diets is to eat way more vegetables. For vegans, Ruscigno recommends not five servings per day, but five per meal.

“When you begin to incorporate more vegetables into your diet, you begin to realize you can eat more food while consuming fewer calories,” Sonpal says, confirming Ruscino’s theory. “This is a great way of losing weight but keeping your body full of the nutrients it needs to thrive.” Sonpal says that something as simple as subbing in zucchini, eggplant, bell peppers, sliced cucumber, olives, cauliflower for rice and potatoes meal sides can really make a huge difference in how you feel.

Cast a wide nutritional net

Meat, fish, eggs, and dairy have been a part of most humans’ diets for a long, long time. There’s a good reason: All of these food groups are packed with the protein, vitamins, and minerals our bodies need. Vegans have to cast a wider net for essential nutrients. As a consequence, they tend to eat more colors of the rainbow and try new ingredients to make nutrient-dense meals. Tucker’s challenge for those of us not ready to say goodbye to cheese, bacon and ice cream? Be as adventurous as a vegan. “Get a wide variety of colors from plant sources into your diet, via fruits, vegetables and legumes, or replace that weekly burger with a quinoa-black-bean burger,” she says.

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8xpeapGrant StoddardRajul PunjabinutritionFOODdietVeganPlant BasedvegetarianbodycholestérolFiberEat Thischolesteroil
<![CDATA[Why Some Young Vets Are Becoming Personal Trainers]]>https://tonic.vice.com/en_us/article/vba3p3/veterans-ptsd-addiction-fitops-programWed, 12 Dec 2018 22:22:30 +0000It’s dusk in the woods. We’re sitting on benches around a fire, plumes of smoke gradually reaching everyone—22 ripped military vets in all, and me. Coughs erupt sporatically. Randy Lloyd, a 34-year-old Army-vet-turned-bodybuilder, is up tonight. He’s holding the talking stick, which is a giant mallet affectionately referred to as the “hammer of tears.” He pauses after every few sentences to regain his composure.

Lloyd's story is a tough one to tell, and he’s clearly reliving the trauma as he recounts the details. There are vivid descriptions of bloody combat in Iraq, followed by stories of an opioid dependence that nearly killed him after he came home. "I remember waking up in a grocery store parking lot—being shaken by a paramedic after overdosing," he says. It happened after an outing where he and his friends were doing heroin and coke. He'd been dead for a few minutes, he tells us.

So he tried rehab again—as in, really tried. His mother supported him again, through his second round in recovery, which was more successful. But Lloyd had lost so much by then, including his girlfriend and her children, his tight family unit that began to unravel as his drug use progressed. He tears up when he repeats the words he said to the kids the night the couple separated: "I have to go away for a little while and get better." He tells me later how lucky he is to still have them in his life at all.

There are visible moments of commiseration from each of the men and women sitting around me. A lot of them are living with addiction, or have in the past. One particularly young vet whose name I don’t know has tears rolling down his face. He doesn’t bother to wipe them away. His breaths are deep and controlled. I can tell that he wants to cry harder.

Bonfire group therapy is not mentioned when veterans apply to the FitOps Foundation training camp. The non-profit’s three-week "live on camp" program has been running for two years now, at different locations throughout the year based on the geographical demand from veterans (this time, it's at a serene, bucolic camp two hours outside New York, in East Stroudsburg, PA). It’s a fitness-certification program comprised of academic instruction, fitness regimens, and personal and professional development that culminates in a “graduation” and assistance with job placement. The camp is largely funded by Matt Hesse’s company Performix, a suite of premium, performance driven-supplements, as well as Performix House, an upscale training center in Manhattan. An Army vet himself, Hesse’s aim is to empower veterans, many of whom are now struggling with depression, addiction, and PTSD during their transition back to civilian life, by providing career opportunities and a sense of community. The whole “give a man a fish” deal and then some.

Transition stress hits when a vet leaves the military to return to civilian life. In a lot of instances, it can be a very startling rebirth of sorts. You no longer have a specific, prescribed schedule, daily structure, or even life purpose. How smoothly this transition goes is integral to health outcomes, explains Irina Wen, clinical psychologist and director of the Military Family Clinic and NYU Langone Health. And by now, the disheartening mental health statistics for the veteran community are pretty well-known. Experts tell us that 20 veterans die by suicide every day.

These outcomes affect a lot more people than the 1 percent of Americans who have served. “There’s a ripple effect to the families they’re a part of,” Wen tells me. “The effect of war does not stop at the veterans. They have spouses. They have children who, as a result, are also often affected in some way."

Lloyd finishes his story and it’s now quiet, save for the crackle of a now-struggling fire and people’s sniffles. The stillness is broken as people get up to dap, hug, and thank him for sharing some truly dark shit. One of these people is a lithe redhead named Andi Ward. When I first arrived at the camp to report this story, a few people told me, in hushed voices, to see if she was down to talk. “She’s got a story,” they all said cryptically.

Ward is 32, though any civilian passing her in the cereal aisle might guess she was a decade younger. But at the camp that morning, when I make eye contact from across a bench, I can tell that her 20s are dead and the ashes have long been scattered.

Ward sits with one leg curled into her, comfortable and contemplative. I ask questions carefully, but it's soon clear that she's willing to spill the difficult details of the last 15 years. Ward’s desire to go into law enforcement—despite her teenage years having been dotted with infractions for drinking—attracted her to military life. Her first experiences didn’t go as planned. “I was raped in A-school by I don’t know how many people. Some people. So that was pretty rough on me,” she tells me, almost as an aside. (A-school is a colloquial term for post boot-camp training.) “So I started drinking even more. Everyone in the military drinks a lot to deal with all the stress. But being a female, I stood out."

There was another point in Ward’s military career, she tells me, when she got into a physical altercation with a group of male marines. Her tone is detached, kind of like she’s already spent time working through all of it. I wonder how much of her effort in various recovery programs was spent forgiving, letting go of the reality that there is a rotten part of the system she devoted so much of herself to.

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Sherri Thomas

During the second part of class, Gabe Snow, a seasoned trainer from Performix House, is in from the city to help the group review material they’ll need to know in order to pass the National Exercise Trainers Association (NEDA) exam they’ll sit for the following week. Snow talks about the pitfalls of fat-shaming in a training—the least meathead-ish lecture you’d ever expect from such a class. Two hours later, they head to the gym for physical practice. Tomorrow, a doctor will be in to lecture on anatomy.

After Ward left the military, she re-enrolled in college and started taking stimulants, among other drugs, savoring the energy they gave her. “I did a little bit of everything for about five years. I ended up being a huge meth addict for five years. I did crack, I did MDMA. I did the stimulants mostly so I could drink without blacking out,” she tells me. “Then I started getting work dancing. I started working in the adult entertainment industry. I got really wrapped up into that world.” She quit the drugs, the escort life, and some of the toxic people that came along with that about two years ago, she says, and was able to take school more seriously.

Ward tells me her story not in chronological order, but in the order of what seems most important to her. She’s gentle with the words she uses to describe her life experiences—like someone who recently became aware of what her worth might be. She found a partner this year—her first real relationship, she says. “I didn’t want someone who wanted to be with me when I was a meth addict. So I always knew that I had to fix myself before I was going to find somebody who I’d want to be attracted to me.”

FitOps is indeed a certification program, but Ward tells me that for some of the attendees, the cert is the side dish. It’s cast-iron baked mac-and-cheese with the seasoned breadcrumbs on top, satiating and substantial, but still a side dish. Being around people who’ve been through at least some of what she has is even bigger for her. “For the first time in my life, I’m happy,” she says. “I’ve never been happy unless I was drinking. Now I’m happy just being myself. You can do anything with that.”

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vba3p3Rajul PunjabiKate Lowensteinaddictionmental healthMILITARYHEROIN ADDICTIONcommunityrehabveteransFitnessbodymindLiving With ItPhys Ed
<![CDATA[Being Sore After a Workout Doesn't Mean Your Muscles Are Growing]]>https://tonic.vice.com/en_us/article/9k4gvy/being-sore-after-a-workout-doesnt-mean-your-muscles-are-growingWed, 12 Dec 2018 17:00:00 +0000See if this sounds familiar: You went to the gym yesterday. Today, your muscles feel sore. You might think that means your workout was an effective one, and that growth is sure to follow. On the flip side, workouts that don’t leave you stiff and sore produce little in the way of results. If you’ve stopped feeling sore, you might think it's a sign that you need to switch things up if you want to get your muscles growing again.

While most people think that sore muscles after a workout are a sign that you’ve stimulated growth, and that more soreness equals faster results, it's not necessarily true. In fact, there’s very little evidence to show that muscle soreness is a reliable indicator of muscle damage, or that being sore means faster muscle growth, or that a lack of soreness means that your workout wasn’t effective. More about that in a moment, however.

First, let's discuss what causes delayed-onset muscle soreness—or DOMS, for short. To be blunt, scientists aren’t sure exactly why people get sore after a workout. But their best guess is that a tough workout, or even just a single exercise that you haven’t done before, typically leads to a bout of inflammation, which is the way your body handles an injury.

As part of the repair and recovery process, your body ramps up the production of cells that make certain nerve endings in your body more sensitive. When you move, these nerves send signals to the brain, which then creates the perception of soreness. These nerve fibers are located mainly in the connective tissue found between muscle fibers, as well as the junction between the muscle and tendon. In other words, the source of post-exercise muscle soreness appears to be the connective tissue that helps to bind muscle fibers together, rather than the actual muscle fibers themselves.

What’s more, an increase in muscle soreness doesn’t necessarily reflect an increase in muscle damage. Conversely, a decrease in soreness is not always indicative of less muscle damage, either. Muscle soreness can show up without any apparent damage to the muscle or signs of inflammation.
In one study, for instance, a team of Danish scientists got a group of young men to exercise one leg on an isokinetic dynamometer—essentially, a souped-up leg extension machine. The other leg had a couple of electrodes slapped on it, which delivered an electrical impulse to the muscle, causing it to contract.

Muscle soreness was assessed in both legs 24 hours later, and again after four and eight days. The researchers also extracted a slice of muscle tissue from each leg, and looked at it under an electron microscope in order to see how much damage was done. The result? Muscle soreness hit a peak 24 hours after exercise, and was still significantly higher four days after the workout. There was no significant difference in soreness between the two protocols. That is, subjects were just as sore in the days following electrically stimulated contractions as they were after voluntary exercise. The amount of muscle damage, however, was considerably higher from the extension machine.

Other studies report much the same thing, with only moderate levels of soreness associated with a high degree of damage. In short, you can’t rely on muscle soreness to gauge the extent to which a particular workout has damaged your muscles. So, can you still train if your muscles are sore?


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According to conventional wisdom, training a muscle that still feels sore will only delay the recovery process and put the brakes on muscle growth. But that doesn’t seem to be the case, either. That is, training a muscle when it still feels sore doesn’t appear to create any further damage or slow the recovery process.

In one study, scientists recruited a group of student athletes and split them into two groups. Both groups completed 30 negative reps of dumbbell curls, which is a highly effective way to create both muscle damage and soreness. The first group rested, but the second group came back to the lab three days later—when their muscles still felt sore—to do the whole thing again. Both groups were tested every day for nine days after the first workout.

You’d think that the second bout of training would interfere with recovery from the first, or at least make muscle damage worse. But this wasn’t the case. The researchers found no significant difference between the groups in terms of muscle soreness or markers of muscle damage. Some people also experience a far greater degree of soreness than others, even when they do the same workout. In fact, there seems to be a population of “high responders” to resistance exercise. Research shows

that these people lose more strength after a workout, take longer to recover, as well as experience a greater degree of muscle soreness.

There are also differences in the ability of various exercises to create soreness. Certain movements, particularly those involving high levels of muscle activation at long rather than short muscle lengths, are more likely to leave you feeling sore.

Let’s take the bench press as an example. At the bottom of the movement, with the bar just above your chest, the pecs are lengthened while simultaneously experiencing high levels of tension.

It’s a different story with an exercise like the dumbbell lateral raise. At the bottom of the movement, with the dumbbells in front of you, there isn’t much tension on the delts. Muscle activation increases as you raise both arms out to the side and the delts shorten. This “length-dependent component” is one of the reasons why the bench press (high levels of muscle activation at a long muscle length) leaves your chest feeling sore the next day, while the lateral raise (high levels of muscle activation at a short muscle length) doesn’t do the same thing for your delts.

When researchers have put high- and low-soreness training programs to the test, they've found that both deliver similar gains in muscle mass. In one trial, Brazilian scientists compared training a muscle once a week with a full-body workout performed five times a week, Monday through Friday. Subjects in the group that hit each muscle group once a week reported a much higher level of post-exercise muscle soreness. There was no significant difference in strength or size gains, however, between the two groups. In other words, both the “low soreness” and “high soreness” training programs increased muscle mass and strength to a similar degree.

Muscle soreness is nothing more than a sign that you did something your body wasn’t used to, or performed an exercise that just so happens to trigger more soreness than others. Some people will experience DOMS to a greater extent than others, while some exercises will stimulate more soreness than others. While being sore and stiff might feel oddly satisfying, however, it’s not a reliable sign that growth has been stimulated. Likewise, the fact you’re not sore doesn’t mean your muscles aren’t growing.

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Christian Finn is a UK-based personal trainer and exercise scientist. He blogs frequently about fitness and weight loss at muscleevo.com.

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9k4gvyChristian FinnMike DarlingmuscletrainingstrengthFitnessexercisebodyWeight LossPhys Edsoreness
<![CDATA[How I Made Consensual Non-Monogamy Work]]>https://tonic.vice.com/en_us/article/zmdgnj/6-things-to-know-about-making-an-open-relationship-workWed, 12 Dec 2018 15:00:00 +0000While I would never claim to be an expert on the subject, this year marks a decade since I decided to explore consensual non-monogamy. I’ve learned a lot since then, though I’m still trying to fine tune how I do things, particularly as I have a habit of dating people who are new to non-monogamy in theory and practice. Below are the six most important things lessons I’ve learned—and find myself relearning—along the way.

Learn the language

Like kitesurfing or ferret breeding, having a relationship in which you have sexual and/or romantic engagements with other people comes with its own peculiar jargon. While getting comfortable with the idea of being open, I came to grips with some of the terminology. One of the first things I learned was that there are plenty of modes of being “open,” which is a loose umbrella term for them all.

You can be “monogamish,” meaning that you and your partner have agreed that some degree of sexual activity outside of the relationship is okay. There’s “polyamory”—literally, many loves—which means that you and your partner can be romantically and not just physically involved with others. “Swinging” generally means couples consensually exchanging partners for sexual play. There are lots of other ways in which people agree to go about it too. My partner and I initially decided that being monogamish was for us, but a few years later we had secondary and tertiary partners. We were then polyamorists, but of course, that sounds a bit too ‘70s. So we went with “open,” though I feel that in the eleven years since we started down that road, “consensual non-monogamy” is the more up-to-date term.

Another new word I learned was “compersion.” It’s often defined as the positive feeling you experience when a partner is enjoying another relationship. You may find, as I did, an unimagined capacity for compersion. You may, on the other hand, find the reality of your dearest one rimming a hot bartender a bit much when it comes right down to it.

Don’t rush

For an open relationship to have any chance of success, it’s imperative that you’re both fully on board with the venture when it’s time to actually start seeing other people. If you’re not and forge ahead anyway, things are almost certainly doomed to failure.

Of course, it’s not unusual for one person to be more enthused about the prospect of being open. Open relationships coach Effy Blue says that one partner being more gung-ho about being open than the other is one of the top three reasons couples seek her counsel.

“When one partner wants to be consensually non-monogamous and the other is not so sure, it makes sense to give the reluctant partner time to read and think about it,” says Terri Conley, associate professor of psychology at the University of Michigan. In other words, these new ideas need some processing. Conley, who does research on non-monogamy, says that if the reluctant partner remains unconvinced after a month or two of thinking and processing, then some tough decisions have to be made.

In 2007, my girlfriend—who later became my wife—was the one interested in the idea of being open while I was duly terrified at the prospect. I asked for a six-month freeze on the non-monogamy plan and she agreed. As luck would have it, that length of time was exactly what I needed in order to mentally and emotionally prepare myself for the prospect of her seeing other people. I was so wrapped up in mental prep that I didn’t even consider that I’d be able to see other people too but, as it turned out, I was the first person to take advantage of non-monogamy.

Pressing pause for an agreed upon length of time and letting the more apprehensive partner get become more comfortable is likely going to improve your chances of success should you decide to give it a go. So take your time, sit with your feelings, and use your words. If at the end of the agreed upon period, you’re still nauseated by the thought of sharing bae, own the fact that that non-monogamy may not be for you.

Set boundaries (with the understanding that they will probably change)

When embarking on being open, you have to imagine how you might feel in a number of different situations. “People in consensually non-monogamous relationships do not have scripts to follow,” Conley says. While there’s a general consensus of what’s okay and what’s not in monogamous relationships, open relationships are negotiated and re-negotiated all the time. “I think boundary setting should happen in monogamous relationships as well. People think that they know what other people mean by ‘monogamous,’ for example. But in reality, people's definitions of monogamy are idiosyncratic,” she says.

One of the boundary-related agreements that came out of my kitchen-table discussion with my partner was that we both practice impeccable condom use with other partners. This was a health decision, but our barrier-less sex imbued our relationship with a greater intimacy. We also agreed that we wouldn’t have sex with our friends, that we could only have casual one-time encounters rather than relationships. We also agreed upon the level of detail we preferred about each other’s solo adventures. She wanted the broad strokes, and I preferred a blow-by-blow.

All of the boundaries we set were reviewed, reworked, and in almost all cases, retired as we became more comfortable with non-monogamy. Whether you’re open or not, chances are that your relationship will evolve over time, so you should also review boundaries together if and when they begin to feel too constricting, too loose, or irrelevant. That said, to ensure everyone remembers what’s been agreed upon, you might even write down the boundaries in some form so that it’s easier to remain accountable to them while they’re still in place.

Don’t go at it alone

Blue says that a community of open people can provide a support network, insight, tips, camaraderie, and a space away for judgment and scrutiny. “Open relationships can feel isolating,” she says. “Especially if you’re not in a position to be open with your friends and family or if they don’t understand or support you.” Blue recommends that you connect with other open people, talk to them about their experiences, and find out about their journey.

Conley agrees, adding that more experienced consensually non-monogamous people can offer valuable advice. “Having mentors is really crucial with consensual non-monogamy because monogamous norms serve as roadmaps,” she says.

In our case, my partner and I were lucky to have open friends as inspiration. The pair had been in an open relationship for seven years, and at the time, were the only direct example of a functional, loving, sexy open relationship that we had. At the same time, we knew that the way they did it wouldn’t work for us—this helped us set our own expectations.

“If you don’t know anyone in an open relationship, Meetup.com is a great platform to search and connect with a community near you in person,” Blue says. “Facebook has many public and private groups that you can join, and there is a polyamory subreddit. If you are on the kinky side, fetlife—think: Facebook for kinksters—has great groups and event listings. Search for ‘open relationships,’ ‘polyamory’ and/or ‘non-monogamy’ to get you started.”

Resist the urge to compare yourself to the people your partner is seeing

Had I met my partner a year or two earlier, her proposal that we had an open relationship would have sent me packing. But by the time we got together, I’d turned 30 and was feeling more comfortable in my skin than I ever had. I felt secure in my career, at ease with my body, and was getting a handle on my own unique appeal. That meant that I was less compelled to compare myself to the men she saw who were invariably tall, handsome, smart, successful, impossibly well-endowed.

There are plenty of things I did to shore up my self-esteem during my open relationship and marriage including positive self-talk, focusing on the things I liked about myself and are unique to me, exercise, spending more time doing things I enjoyed, and yes, meeting new people.

Conley says that while it may be impossible to resist the urge to compare oneself to others, people who have successful open relationships understand that your partner has needs that you cannot meet and that you also have needs that your partner cannot meet. “It's probably easier if you're able to ask your partner what needs this person is meeting,” she says. “With an open mind, you might start to realize that you are not, in fact, the person to best meet those needs.”

Allow yourself to feel jealous.

One of the first things people want to know about open relationships is how people manage feelings of envy that can arise when someone other than you is gleefully schtupping your partner. According to Blue, there are two types of jealousy: “dispositional,” meaning that feeling some degree of jealousy is part and parcel of your personality, and “incidental,” meaning that certain activities or dynamics tend to arouse jealousy as they occur. “The former is a character trait,” she tells me. “If you are a [dispositionally] jealous person, you might want to rethink non-monogamy. It is the latter that we can manage.”

Dispositional jealousy had always been the thing that prevented me from entertaining the thought of being open in my 20s. But by the time I turned the big 3-0, found a partner I loved, and, as I mentioned before, worked on myself and cultivated compersion, that emotion began to fade. It also helped that the thought of my wife being sexual outside of our marriage turned me on.

“Jealousy is something that people who are open recognize as uncomfortable but not devastating,” Conley says. “So, feel it and understand that it will pass—people who choose to stay consensually non-monogamous find that it gets more manageable over time.”

My wife changed challenged me to be open and it completely changed my life. Then, seven years into our marriage, she decided that being monogamous was something she wanted to revisit and we subsequently separated. In the three years since then, I’ve dated several people, some quite seriously, all with the understanding that we always had the option to see other people. Employing some takeaways from my first foray into non-monogamy hasn’t meant that it’s always smooth sailing, but I have found that going through the list above has been helpful in keeping heartache to a minimum while enjoying a lifestyle that—if it’s a good fit—can change the way you experience yourself and the world around you.

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<![CDATA[The Tonic Guide to Healthcare]]>https://tonic.vice.com/en_us/article/wj37bq/the-tonic-guide-to-healthcareTue, 11 Dec 2018 19:59:05 +0000

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