Biopsychosocial factors influencing drug use in the LGBTQIA+ Community

Unhelpful Cognitions

Mental Filter: This thinking style involves a “filtering in” and “filtering out” process – a sort of “tunnel vision”, focusing on only one part of a situation and ignoring the rest. Usually this means looking at the negative parts of a situation and forgetting the positive parts, and the whole picture is coloured by what may be a single negative detail.

Jumping to Conclusions: We jump to conclusions when we assume that we know what someone else is thinking (mind reading) and when we make predictions about what is going to happen in the future (predictive thinking).

Mind reading: Is a habitual thinking pattern characterized by expecting others to know what you’re thinking without having to tell them or expecting to know what others are thinking without them telling you. This is very common, and most people can identify. Oftentimes, when we are telling someone a story about an interaction, we’ve had with someone else, we will make mind reading assumptions without actually having fact or evidence e.g., “They haven’t phoned me in two weeks so they must be angry with me for cancelling on them last week.”

Personalisation: This involves blaming yourself for everything that goes wrong or could go wrong, even when you may only be partly responsible or not responsible at all. You might be taking 100% responsibility for the occurrence of external events. It can also involve blaming someone else for something for which they have no responsibility. This can often occur when setting a boundary with someone and you take responsibility for their guilt or anger.

Catastrophising: Catastrophising occurs when we “blow things out of proportion” and we view the situation as terrible, awful, dreadful, and horrible, even though the reality is that the problem itself may be quite small.

Black & White Thinking: Also known as splitting, dichotomous thinking, and all-or-nothing thinking, involves seeing only one side or the other (the positives or the negatives, for example). You are either wrong or right, good or bad and so on. There are no in-betweens or shades of grey.

Should-ing and Must-ing: Sometimes by saying “I should…” or “I must…” you can put unreasonable demands or pressure on yourself and others. Although these statements are not always unhelpful (e.g., “I should not get drunk and drive home”), they can sometimes create unrealistic expectations.

Should-ing and must-ing can be a psychological distortion because it can “deny reality” e.g., I shouldn’t have had so much to drink last night. This is helpful in the sense that it communicates to us that we have exceeded our boundaries, however, saying “shouldn’t” about a past situation can be futile because it cannot be changed.

Overgeneralisation: When we overgeneralise, we take one instance in the past or present, and impose it on all current or future situations. If we say, “You always…” or “Everyone…”, or “I never…” then we are probably overgeneralising.

Labelling: We label ourselves and others when we make global statements based on behaviour in specific situations. We might use this label even though there are many more examples that are not consistent with that label. Labelling is a cognitive distortion whereby we take one characteristic of a person/group/situation and apply it to the whole person/group/situation. Example: “Because I failed a test, I am a failure” or “Because she is frequently late to work, she is irresponsible”.

Emotional Reasoning: This thinking style involves basing your view of situations or yourself on the way you are feeling. For example, the only evidence that something bad is going to happen is that you feel like something bad is going to happen. Emotions and feelings are real however they are not necessarily indicative of objective truth or fact.

Magnification and Minimisation: In this thinking style, you magnify the positive attributes of other people and minimise your own positive attributes. Also known as the binocular effect on thinking. Often it means that you enlarge (magnify) the positive attributes of other people and shrink (minimise) your own attributes, just like looking at the world through either end of the same pair of binoculars.

(CCI, 2008)

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

Albert Ellis, in his Rational Emotive Behaviour Therapy (REBT), identified a number of dysfunctional beliefs that people often hold. Ellis intentionally adopts extreme views to emphasize how people often exaggerate their perspectives irrationally. He referred to this tendency as “awfulizing,” where we negatively overgeneralise situations. This behaviour can stem from a strong desire for certainty, causing us to perceive things in extreme terms rather than viewing them as part of a nuanced spectrum. Consequently, this leads to the formation of self-stereotypes.

A self-stereotype refers to the process of applying generalised beliefs or stereotypes about a group to oneself, especially when one identifies as part of that group. For instance, if someone belongs to a specific cultural or social group (gay men) and internalises the commonly held stereotypes about that group (partying and casual sex), they may unconsciously start viewing and behaving in ways that align with those generalisations.