Polyvagal Theory and Trauma – Dr. Stephen Porges

Psychological factors influencing drug use in Sydney’s gay community often stem from unique social and emotional challenges. Research highlights that stigma, discrimination, self-stigma, and internalised homophobia can lead to feelings of isolation, shame, and mental distress, which may increase vulnerability to substance use.

Additionally, the normalisation of partying in certain social settings, such as bars and clubs, has historically been a way for subcultural populations of LGBTQ+ individuals to connect and find community. However, this environment can also contribute to higher rates of drug use. Emotional coping mechanisms, such as using substances to manage stress or trauma, are also significant factors.

The biopsychosocial model provides a comprehensive framework for understanding alcohol and other drug dependency in the LGBTIA+ community. Here’s a breakdown of the factors:

1. Biological Factors:
   • Genetic predisposition plays a role, with some individuals being more vulnerable to chemical dependency due to inherited traits.
   • Neurobiological changes caused by substance use can alter brain function, making it very challenging to reduce or stop using substances despite the negative consequences occurring in the individual’s life.
2. Psychological Factors:
   • Trauma, such as adverse childhood experiences, peer bullying, neglect, authoritarian child rearing, seemingly innocuous societal messages, and/or discrimination, can lead to emotional distress and substance use as a coping mechanism.
   • Internalised stigma, homophobia, or transphobia can exacerbate mental health issues like anxiety and depression, increasing the risk of substance use and potential physical and psychological dependency.
3. Social Factors:
   • Experiences of ostracism, violence, or lack of acceptance and belonging can lead to isolation and substance use.
   • Social norms in certain LGBTQ+ spaces, such as bars or clubs, may normalise or encourage substance use.

This model underscores the importance of addressing all these interconnected factors in prevention and treatment efforts.

The Flux Study, also known as “Following Lives Undergoing Change,” is a longitudinal research project focusing on the lives of gay and bisexual men in Australia. Conducted by the Kirby Institute at UNSW Sydney, it examines various aspects of health, behaviour, and social factors, including drug use, sexual health, and the adoption of HIV prevention strategies like PrEP.

Key findings from the study include:

• Recreational drug use is common among gay and bisexual men, with substances like marijuana, amyl nitrite (“poppers”), and party drugs being frequently used. However, dependency rates are relatively low.
• Drug use is often linked to enhancing pleasurable experiences, including sexual enjoyment.
• The study has provided insights into how men mitigate risks, such as using biomedical HIV prevention methods alongside drug use.

The Flux Study is a collaborative effort involving organisations like the National Drug and Alcohol Research Centre, ACON, and the Victorian AIDS Council. It aims to inform health interventions and support services tailored to the needs of this community.

The Flux Study has provided valuable insights into the health and behaviours of gay and bisexual men in Australia. Here are some key findings:

• Drug Use: While recreational drug use is common, most participants reported infrequent use. Harm reduction strategies, such as not sharing injecting equipment, were widely practiced.
• HIV Prevention: There was a significant increase in the uptake of HIV pre-exposure prophylaxis (PrEP), with usage rising from less than 1% in 2014 to about one-third of participants by 2017.
• COVID-19 Impact: During the pandemic, participants reduced sexual contacts and adapted strategies to minimize risks in sexual contexts. Many also paused PrEP usage due to reduced sexual activity.
• Mental Health: A notable proportion of participants reported mental health challenges, highlighting the need for targeted support services.

There are several support services available for addressing mental health challenges, particularly for the LGBTIA+ community in Australia. Here are some key options:

1. QLife: A free, anonymous peer support and referral service for LGBTQ+ individuals. It operates via phone and webchat from 3 PM to midnight, 7 days a week. Phone: 1800 184 527. Their website provides a webchat service: QLife – Support and Referrals
2. Beyond Blue: Offers 24/7 mental health support, including phone and online counselling. They also provide resources tailored to the LGBTQ+ community. Phone: 1300 22 4636. Click the following link to Beyond Blue’s Wellbeing Action Tool: beyond-blue-wellbeing-action-tool_dec_2024_updated.pdf
3. Lifeline: A leading crisis support service available 24/7 for anyone in distress. They offer phone, text, and online counselling. Phone: 13 11 14
4. Head to Health: Connects individuals to mental health resources, including helplines, apps, and digital programs. Medicare Mental Health is a free service that connects you with the mental health support that is right for you. Phone: 1800 595 212 or visit their website: Home | Medicare Mental Health
5. WayAhead Directory: An online database to find local mental health services and resources. Phone: 1300 794 991
6. NSW Mental Health Line: A 24/7 telephone service providing advice and recommendations for appropriate care. Phone: 1800 011 511

These services are designed to provide immediate support and guide individuals toward long-term mental health care.

1. Alcohol (ethanol) enters the body through the oral cavity (i.e., the mouth). The inner surface of the oral cavity is mucosal tissue to keep the cavity lubricated and it is capable of absorbing alcohol into the bloodstream. This absorption is considered “insignificant”.

2. Alcohol flows down the oesophagus to the stomach where 10-20% of ethanol will be absorbed into the bloodstream. Alcohol enters the bloodstream via the mucosal tissue of the stomach wall, and travels straight to the liver. Alcohol can take 5-10 minutes to reach the brain because of the ethanol absorbed via the stomach. If you drink alcohol on an empty stomach, the pyloric sphincter [gateway between the stomach and the small intestine] is going to be more open, and the alcohol is going to immediately enter the small intestine after reaching the stomach. If food is also present in the stomach, the sphincter will open and close at a rate that allows food to enter the small intestine gradually, therefore if alcohol is also in the stomach, it will gradually enter the small intestine.

3. Alcohol flows through the pyloric sphincter into the small intestines where most alcohol absorption occurs. Human intestines are attached the to the posterior abdominal wall by a fold of membrane called the mesentery. Alcohol is absorbed into the mesentery via veins and then travels to the liver.

4. One function of the liver is that it detoxifies toxic elements into non-toxic elements before passing it to the heart and then the rest of the body. The liver sustains considerable “abuse” from a variety of toxic elements and chemicals, and therefore it needs to be capable of full regeneration. NOTE: Many diseases and exposures can harm it beyond the point of repair. These include cancer, hepatitis, certain medication overdoses, and fatty liver disease.

In the liver, ethanol is met with an enzyme called alcohol dehydrogenase and converts ethanol into acetaldehyde [ass-eh-tal-de-hide]. This chemical is more toxic than ethanol, so the liver uses another enzyme to convert acetaldehyde into acetate, which is non-toxic to the human body. NOTE: the amount of alcohol consumed + the timeframe it is consumed [and a variety of other factors] will influence the ability of the liver to effectively convert acetaldehyde all the way into acetate. The liver can’t handle the entire workload effectively therefore ethanol (before being metabolised) will go straight from the liver to the bloodstream and make its way directly to the heart.

NOTE: Genetics will play a role! Certain people do not produce the liver enzymes in enough quantity to properly breakdown ethanol.

5. Blood leaves the liver through the hepatic veins. The hepatic veins carry blood to the inferior vena cava—the largest vein in the body—to the right side of the heart. The heart will beat and send the incoming blood to the lungs to oxygenate and expel carbon dioxide as we breath out. This is how ethanol can be on your breath. Inside the lungs, at the very end of the bronchioles, are hollow air sacs called alveoli where there is a gas exchange. Ethanol evaporates through capillaries into the air sacs and exhaled out of the body. Breathalysers can detect the quantity of ethanol in a person’s system based on the quantity of ethanol in our breath.

6. Not all the ethanol will expel from the body via the breath. The rest will flow back to the heart, with newly oxygenated blood, and then get pumped all the way up to the brain and around the body. NOTE: Ethanol is water soluble. It will be distributed to every cell in the body except bone and fatty tissue [some will enter fat cells but not easily]. Ethanol will interact with every other cell i.e., every organ, gland, nerve, muscle etc.

7. Ethanol will affect and compromise protein synthesis inside muscle tissue. Therefore, if you have been training at the gym, running, swimming etc., your muscles will not effectively be able to repair.

8. Once ethanol has reached the brain, it will cross the blood-brain barrier and begin to affect chemical messengers [neurotransmitters] in the grey matter of the brain. It affects serotonin, dopamine, gamma-amino-butyric-acid (aka GABA), glutamate, endorphins etc. The person will experience pleasure, euphoria, lowered inhibitions [related to dopamine], lowered cognitive ability (e.g., decision making/problem solving, emotion regulation) and lowered coordination and reflexes.

The more ethanol ingested, the more dopamine is secreted and communicated between neurons (i.e., nerve cells). One of dopamine’s functions is to make you feel pleasure or ‘rewarded’ for doing things that are good for humans, hence, from an evolutionary perspective, we are likely to do them again to help us thrive in our environment and social world. Dopamine is secreted when we:

• eat healthy foods (but also recently developed processed foods that are high in sugar and salt)
• exercise
• achieve goals
• be productive (e.g., finish a task like cleaning, cooking, work-related tasks)
• master new skills (e.g., learning an instrument or a new talent), and
• have positive and stimulating social interactions

Ethanol influences so much dopamine secretion and communication that the brain becomes unable to make responsible decisions cognitively. The simultaneous experience of euphoria and lowered cognitive ability means we are more likely to be “happy” about making irresponsible decisions.

Increased dopamine is how drinking alcohol “blocks” unpleasant emotions like fear, stress, anxiety, and insecurity. When we don’t feel these unpleasant, yet necessary, emotions we will behave in ways that are dangerous, abnormal, potentially embarrassing, and generally problematic.

Another significant brain region affected by ethanol is the hypothalamus and the pituitary glad [together known as the hypothalamic-pituitary axis]. These structures control the entire hormonal system. The hypothalamus monitors the body, and it will send instructions to the pituitary gland based on information it receives from the hypothalamus. The hypothalamus is aware that ethanol is flooding the brain and it starts adjusting the secretion of hormones via the pituitary gland.

One of the instructions it gives the pituitary gland is to start modulating the adrenal glands to secrete cortisol (i.e., stress hormone) and epinephrine and norepinephrine (i.e., adrenaline).

Now, our cognitive capacity is diminished, inhibitions are lowered, and we will experience a rush of stress hormones and adrenaline coursing through the body. Cortisol and adrenaline will provide a boost of energy. It will increase the heart rate, blood pressure, body sweat, sugar levels in the bloodstream, and enhances the brain’s ability to use glucose. Glucose is a “fuel” source for brain functioning, including the generation of neurotransmitters. Behaviourally, we can see this in children when we say they are “hyperactive” because they’ve ingested too much sugar.

The pituitary gland will also slow the secretion of anti-diuretic hormone (aka. vasopressin). A diuretic is something that makes us urinate. If the anti-diuretic hormone (also called vasopressin) slows down, then we won’t be “holding on” to water as effectively, hence we begin to urinate more. People call this “breaking the seal”.

9. South of the body, blood is pumped into the kidneys via the renal artery which spreads through the renal cortex. The blood is then filtered into urine and expelled from the body. The lowered anti-diuretic hormone will dilate (become wider/bigger or more open) blood vessels in the kidneys which means more blood gets passed through and filtered, but it also means we lose a lot more body water which leads to dehydration. Vasopressin is essential in the control of osmotic balance, blood pressure regulations, and kidney function, therefore, when vasopressin is lowered, we are losing essential water and minerals/electrolytes. Electrolytes are involved in urination because the kidneys need them to make the process of filtering blood more efficient.

The loss of water and electrolytes will contribute to a hangover. Electrolytes play a role in cellular water absorption so if we are losing more water than we are bringing in, and we are losing the electrolytes that support the absorption of water, we become dehydrated very quickly.

10. The Hangover

Symptoms: nausea, fatigue, diarrhoea, vomiting, paranoia, anxiety, anorexia (i.e., loss of appetite), increased thirst, muscle weakness, irritability, sweating, increased blood pressure, and headache.

The exact cause of a “hangover” is not yet known however variables affecting the hangover are:

• individual differences such as sex, size, body fat, genetics etc
• lack of sleep
• general health
• drinking behaviour e.g., frequency, duration, quantity
• food intake before and during
• water intake before and after
• your body’s ability to metabolise alcohol i.e., excessive amounts of acetaldehyde due to fewer enzymes to metabolise alcohol in the liver before entering the bloodstream
• general behaviour while drinking e.g., poly-substance use, dancing, sexual activity, risk-taking behaviours etc.

Strategies for Controlled Drinking

• Setting personal drinking limits and sticking to it
• Alternating alcoholic drinks with soft drinks i.e., one alcoholic drink then a water, soft drink, or juice
• Have a meal before drinking
• Switching to low alcohol drinks
• Having regular alcohol-free days/weeks/months
• Identifying high risk situations for heavy drinking and creating a management plan

Engaging in alternative activities to drinking

Well, hello and good morning, afternoon, and evening readers. I truly hope you’re swimming in the pleasantries of life rather than keeping your head above water in the unpleasant swamp. HOPE = Hold On Pain Ends. And there’s generally a learning or personal growth that comes after the storm of every painful experience, even if it’s simply greater empathy and compassion for others.

Today’s the day to learn or remember the fallacies of the human mind. I am not as smart as I look, haha. Have you heard of heuristics before? In cognitive psychology, a heuristic is a mental “shortcut” that allows people to solve problems and make judgments quickly and efficiently. They can be very helpful in many situations, but they can also lead to cognitive biases, errors in thinking, and even perhaps without the mental shortcut, our thinking is often filled to the brim with cognitive distortions, assumptions and fallacies (faults). Awareness raising is probably the first step to identify our own cognitive traps and also identify them in others. Cognitive errors are natural – we all have them. Below are some cognitive distortions/errors to be aware of when we reflect on our interactions with people, during personal reflection, and when making meaningful decisions or judgements.

• ALL-OR-NOTHING THINKING (aka. POLARISED THINKING, SPLITTING, and BLACK-AND-WHITE THINKING: is extreme thinking i.e., the error in a person’s thinking to bring together the dichotomy of both positive and negative qualities of the self and others into a cohesive, realistic whole. It is a common defense mechanism. Before you think “I must have really shitty thinking because I do this ALL the time”, give yourself a break. If you’re thinking in black and white, you probably internalised this from social media, television and movies, your family of origin and the broader society. Be mindful of using extreme, dichotomist terms, such as “failure”, “success”, “best”, “worst”, “freezing”, “boiling”, “everything”, and “nothing”. If you think “I’m a terrible person”, that is bullshit and inaccurate. You may have behaved terribly for a period of time towards yourself, to someone else, or towards some “thing”, but we cannot discount all the NON-terrible qualities about you. We must THINK in DIALECTICS i.e., the ability to view issues from multiple perspectives with reason and wisdom or in other words being able to have two contradictory viewpoints, where a greater truth emerges from their interplay. The truth is, if you think you’re a terrible person, there’s also virtuous person in there too.

• OVERGENERALISTION: The words “always”, “every” and “never” come into play here, and you have an unshakable “rule” or “conviction” about yourself, something, or someone, based on one or two incidences. Overgeneralising is “a cognitive distortion in which an individual views a single event as an invariable RULE, so that, for example, failure at accomplishing one task will predict an endless pattern of defeat in all tasks.” Coming into the present moment and being specific can be helpful if you are someone who overgeneralises. You may also want to ask yourself if what your saying is the really the truth. Is it really accurate or correct. There’s an assumption that because something has happened once or a few times that it’s like going to happen every time. Remember, the words “always”, “every”, and “never” frequently appear in this cognitive “trap”. I encourage you to look at the big picture and ask yourself if what you’re saying or thinking is accurate. Overgeneralisations tend to be vague and board statements e.g., “I always get every red light”. Perhaps this is part of our evolutionary negativity bias. We tend to notice the so-called “bad” and overlook the so-called “good”. If you find yourself using overgeneralisations that suggest a future prediction (e.g., “I’ll never get a partner) … use some humour – you may have big balls but neither one of them are crystal – VEEP. If there is some truth to unusually frequent and specific situations that are making your life unpleasant, validate them, talk to someone, and brainstorm some solutions. We humans have plenty of blind spots that others can see sometimes.

• MENTAL FILTER: is considered to be the opposite to OVERGENERALISATION the mental filter takes one small event and focuses on it exclusively, filtering out anything else that’s relevant. Filtering out the positive and focusing on the negative can have a detrimental impact on your mental well-being. Filtering out the so-called “negative” can also make one a bit hubris (excessive pride or self-confidence), arrogant, vain and conceited – and then you’re just a stone’s throw away from narcissism.

• PERSONALISATION AND BLAME: Personalization and blame is a cognitive distortion whereby you entirely blame yourself, or someone else, for a situation that in reality involved many factors that were out of your control. I think this is a symptom of our wounded ego, or simply just the ego. As human’s we are egocentric, like children, and we often think that circumstances in our environment are solely because of our influence. For example, your friend isn’t behaving like they usually do, so it must be because you have done something.

Again, personalisation is an egocentric error in cognition. “Of course it has to do with me”, we think. It makes sense that we personalise things. We are the star of our own show, our own narrative. If you personalise something, it means we’ve directly influenced it – we are the primary cause. This may elicit internal pain, shame or guilt, so what’s the pay-off? Personalisation is a cognitive error that offers us the illusion of control e.g., “If we caused it then we will learn how to not cause it again, and maybe even undo what we have caused”. If you think about it, personalising something is something children do. Remember, there are infinite variables in any situation to take full credit of the outcome. That being said, it is responsible and mature to reflect objectively on the influence of our behaviour and what we can learn about our shortcomings.

Blame deserves it’s own blog post but in short, it can be defined as a defence mechanism to protect the self from feeling some unwanted emotion or thinking something unacceptable in relation to the “self”. Blaming provides a way of devaluing others, an the pay-off or reinforcement the blamer receives is a sense of superiority. It protects our ego from feeling responsible for something, and protects us from feeling guilt or shame. Perfectionists are very good at blaming others, and themselves. Even if you genuinely think faulting someone or something is valid, remember that no one is perfect. Recognise that you are human and others are fallible humans. As they say in recovery, “there is a bit of bad in the best of us and a bit of good in the worst of us“. We may have internalised from society and culture that we couldn’t make mistakes (because we receive “punishment” for making mistakes) but we must move beyond that now. As adults, we need to get real. Validate your experience because it may be very disappointing when we don’t meet others or our own expectations. We must nurture and care for the wounded child. Lets attend and befriend to our shortcomings and accept we are not superhuman. Learn to expect you will make mistakes. Failure is kind of an illusion, isn’t it? Or maybe a social construct? “Failure” is really learning – replace ‘failure’ with the word ‘feedback’. Would a cat or dog blame them self for a “mistake”? In the minds of animals, there’s no such concept as failure or a mistake.

Here’s a link to website “simplypsychology” that discusses a theory called Attribution Theory, an idea about how people explain the causes of behaviour and events: Attribution Theory – Situational vs Dispositional | Simply Psychology