Cognitive Distortions

Cognitive distortions are thought patters we develop over time that are inaccurate and that can contribute negatively to our mental health. The study of cognitive distortions was the foundation of Aaron Beck, who is considered to be one of the founding fathers of the cognitive behavior therapy (CBT) movement.

Beck started investigating our thinking patters after he became dissatisfied with the use of psychoanalysis for attempting to treat depression. His focus was on discovering a common set of thoughts that we tend to have that are either inaccurate or exaggerated. Over time, such thoughts impact our emotions and lead to psychological problems. Once a set of core maladaptive thoughts was identified, Beck and others in this field began creating various techniques to dismantle these thoughts, and replace them with more realistic thoughts.

CBT is used frequently in treating anxiety and depression. When you think about each of these conditions, our thinking mind is at the heart of the condition. We tend to be anxious about facing some future event, like speaking in public, or taking on a new activity. In our minds, we forms such thoughts as “I am always nervous in such situations”, or “I am not good enough to do this activity.” Similarly, depression is often rooted in some thought about the past. We think “I wasn’t loved as a child”, or “I am not good at anything”.

There are many cognitive distortions. Here is a list of some of the core ones, though not an exhaustive list:

  • Black-and-White Thinking. This refers to taking a position of extremes on the matter and not allowing for an in-between scenario. Thoughts like this always include “always” or “never”. For example, “I always do poorly in social situations”. Is that really true? Chances are, even if you are very introverted, there are certain social circles in which you do just fine – perhaps, around family and close friends. By taking a black-and-white approach, you close yourself off from the reality that you do have some situations in which you are perhaps in the middle of the two extremes of “good” and “bad”.
  • Using “Should” Thoughts. This type of thought can be diverted at ourselves or others. We may think that “I should have done this or that in the past”, or “he should be treating me this way or that”. When directed at others, it should be noted that we can’t really control others. By creating a “should” thought, we often set ourselves up for disappointment. When directed to ourselves, we create an unfair situation because we are often referring to something that has already happened and, therefore, we have no more control over. If it’s about the future, we may create an unrealistic expectations that can further perpetuate our frustration.
  • Catastrophizing Thoughts. This is related to black-and-white thinking whereby we can only see a worst-case-scenario about some upcoming event. I may be unemployed and may entertain a thought of “I will never get a job again”. That’s quite an extreme scenario. No matter the situation, it is very unlikely that the absolute worst-case scenario will come true. Maybe you won’t get a job right away. Or maybe you won’t get an amazing job. But to think that you will never get a job again is very unrealistic. Such catastrophizing thoughts can relate to many areas of our lives, such as relationships, career, and health.
  • Magnifying Thoughts. This takes place when we blow things out of proportion. You carry out a task not to your full potential and you have the thought that it was the worst performance of your life. This is related to catastrophizing and is tied to thoughts where you overamplify a certain situation.
  • Minimizing Thoughts. This is the same as magnifying thoughts but on the opposite direction. You get recognition from your supervisor at work and yet you minimize the event but thinking “well, I didn’t get that much recognition”. This type of thought undermines the potential positives in an event.
  • Thoughts of Discounting the Positive. This is related to minimizing thoughts and has to do with focusing unevenly on the negatives versus the positives.
  • Personalization Thoughts. We are susceptible to attributing various events to something we may have done. You are in a work meeting and the supervisor leaves the meeting unhappy. You have a thought that it must have been something you said or did. And yet, you don’t really know for a fact what may have contributed to the person’s dissatisfaction.
  • Mind reading and Fortune Telling Thoughts. This occurs when we jump to conclusions in our minds about what someone is thinking or about their motives. This often happens without direct evidence or external confirmation. Such a thought may spring up because we are trying to sustain a certain belief we have about a person or situation.
  • Filtering Thoughts. This type of thought is related to discounting the positives and having minimizing or maximizing thoughts. A filtering thought is more generally a type of thought that filters out some information when making an assessment.

There are many others, including blaming, always being right, and various false thoughts about how the world is and what level of control we have over it. At the heart of each of these is a thought that is not grounded in reality, or at least is not backed by external evidence. Regardless of the type of distorted thought, there are some steps we can take to help loosen their grip on us.

Techniques for working with distorted thinking

In a future article, we will look at various techniques that can help identify, and address such distorted thinking.

Question: Can you relate with some of these distortions?

We all have some of these thoughts. Do you find yourself repeating some of the above on a regular basis and across a broad area of your life?

References

Here are the books we find to be most influential and great resources in the field of CBT and working with cognitive distortions:

  • Robert L. Leahy, Contemporary Cognitive Therapy
  • Aaron T. Beck, A. John Rush, Brian Shaw, Gary Emery. Cognitive Therapy of Depression
  • Aaron T. Beck, Arthur Freeman, Denise D. Davis, and associates. Cognitive Therapy of Personality Disorders
  • Keith S. Dobson. Handbook of Cognitive Behavioral Therapies.

Author: Dr. Seda Gragossian

Dr. Seda Gragossian is the Clinical Director at the Talk Therapy Psychology Center. She has worked in the mental health field in clinical leadership roles in private practice,  at multiple outpatient facilities, as well as at large psychiatric hospital settings.

Download our free eBook to learn everything there is to know about Intensive Outpatient Programs!

Are you or someone you know suffering from depression, anxiety, or addiction? Don’t be nervous or shy about asking for help. We believe that everyone needs a little help now and then. We make no judgments and we meet you where you are at.

Natural ways to improve mental health

By now, many people have heard that our body produces various chemicals that significantly influence our mental state. While this is a very complicated subject, there are four specific chemicals that are of predominant importance. These are serotonin, oxytocin, dopamine, and endorphin. There a many products in the drug industry based on the manipulation of one of these chemicals. For instance, one of the first popular drugs in mental health, Prozac, is based on creating an environment where there is ample supply of serotonin in the body. Zoloft attempts to do the same.

When looking at the research, it is interesting to find that there are non-prescription approaches that can impact the supply and function of these chemicals in the body. While it’s hard to find quality research that compares natural approaches to ones created in the laboratory, it certainly does not hurt to be aware of what role these chemicals play and how you can influence them.

Please note that we make no statement about the effectiveness of drugs provided by the pharmaceutical industry. This is not the purpose of this article.

Let’s look at these four compounds a bit:

Serotonin

Serotonin is a neurotransmitter and is directly linked to your mood. Both good and bad moods have serotonin in their underpinnings. Neurotransmitters are used to govern emotions, and other cognitive functions, including memory. It is believed that they are tied to the human’s perceived availability of resources. Resources could be food or something more complex like social dominance. In other words, serotonin is directly tied to survival.

What’s particularly interesting about serotonin is that, while it is created in a couple of areas in the body, it is estimated that about 90% of serotonin is generated in our gastrointestinal (GI) track and is directly involved in our intestinal processes.

Serotonin is made from the essential amino acid tryptophan. This amino acid enters our body through our diet and is found in various meats, nuts, and cheese. A tryptophan deficiency, therefore, can result in a bad mood and feelings of anxiety.

How to naturally increase serotonin

  • Cheese
  • Eggs
  • Turkey
  • Salmon
  • Nuts
  • Pineapple

Oxytocin

Oxytocin is a neuropeptide hormone that is created in a gland in the brain. Oxytocin plays a role in the feeling of social bonding and is also released naturally during childbirth. One of the reasons this is tied to mental health is because this social bonding sensation is tied to the feelings of trust and belonging – both of which are very important in our mental state. Oxytocin, in fact, is often referred to as either the “bonding chemical” or the “love hormone”. It is also a natural antidepressant.

The feelings of trust and belonging influence the secretion of oxytocin. One interesting study found that oxytocin levels role both in humans and in pats, after a petting session. Other research has shown that increase in oxytocin reduces fear and also increase the feelings of empathy between people.

How to naturally increase oxytocin

  • Loving touch
  • Participating in close relationships
  • Hug (just 20 seconds a day releases enough oxytocin)
  • Cuddle while watching TV
  • Pet an animal
  • Spend time with someone you trust
  • Start building trust by meeting the expectations of others.
  • Engage in sexual activities with your loved one
  • Get a massage

More recently, research is being done on the effect of oxytocin to the metabolic functions. It appears that oxytocin plays some role in weight loss, though researchers are not yet in agreement on what is taking place.

Endorphin

Endorphin is another neuropeptide hormone created in the brain. It is a type of morphine that is created in response to pain and is considered nature’s pain relief. It is believed to be a part of the survival instinct of humans and is created to allow us to go on under pain, particularly in life-threatening situations. Endorphins also bring about a feeling of well-being and even euphoria.

Many have heard the so-called “runner’s high”, which is supposed to be the equivalent of endorphin generated in response to strenuous exercise. In recent research, it is not so clear that endorphin is what causes this feeling of well-being. Rather, there seems to be some more complex function happening during exercise that also reduces stress and releases serotonin.

How to naturally increase endorphin

  • Some aromas can increase the production of endorphin, including the smell of ginger, vanilla, and lavender.
  • A good laugh from your belly (e.g., watching a good comedy)
  • Rigorous exercise, especially to the point where you are feeling challenged.
  • Walking 30 minutes per day

Dopamine

Dopamine is a neurotransmitter that is synthesized in the kidney and brain. It is tied to the motivational component of the human reward-motivation system. The anticipation of any type of reward releases dopamine in the body. While it was believed that dopamine is tied to pleasure, the latest research suggests that it is more precisely tied to the pleasure received from achieving a certain reward. In a survival situation, dopamine helps with the motivation of the organism to achieve certain rewards, such as hunting for food, or fighting for securing a mate.

Dopamine, similar to serotonin, is derived from amino acids. Dopamine, in particular, is derived from L-Tyrosin. Tyrosin is found in protein-rich food sources and is also tied to improved memory and general cognitive functions.

Low levels of dopamine in the body are linked with procrastination, self-doubt, and lack of enthusiasm.

How to naturally increase dopamine

  • Protein-rich foods, such as eggs, chicken, avocados.
  • Tyrosin supplements.
  • Set goals and work towards achieving them.
  • Create small and frequent rewards tied to activities you undertake.
  • Acts of kindness.
  • Volunteer work and acts of giving.
  • Vitamins B6, A, and C
  • Magnesium

Conclusion

As stated in the beginning of this article, the chemistry of our bodies is quite complex and the impact of these chemicals on mental health is a very broad subject. In fact, we are still learning through new research about the effects of various chemicals in the body, as well as their interactions.

There are many prescription drugs in the market that look to optimize various functions in the body. What we are highlighting above is that many of these same functions can be optimized in natural ways through various foods and actions. Broadly speaking, our mental health is closely tied to what we eat, our gastrointestinal processes, as well as what we do. Various actions, such as exercise, hugging someone, and volunteering our time, are also closely tied to improved mental health.

When it comes to general mental wellbeing, our recommendation is to stack the odds in your favor with maximizing all these areas of your life.

Author: Dr. Seda Gragossian

Dr. Seda Gragossian is the Clinical Director at the Talk Therapy Psychology Center. She has worked in the mental health field in clinical leadership roles in private practice,  at multiple outpatient facilities, as well as at large psychiatric hospital settings.

Download our free eBook to learn everything there is to know about Intensive Outpatient Programs!

Are you or someone you know suffering from depression, anxiety, or addiction? Don’t be nervous or shy about asking for help. We believe that everyone needs a little help now and then. We make no judgments and we meet you where you are at.

The Benefit of Groups in Outpatient Rehab

One of the most important aspects of an intensive outpatient rehab program, such as an IOP, is the power of groups. Much research has been performed both in psychology and sociology elaborating on the effects groups have on individuals. In fact, it is believed that participating in a group is a fundamental human need.

Here are some important aspects of group psychology that positively contribute to the success of an outpatient rehab program:

Ambiguity’s Role in Social Influence

Group social influence happens when people don’t know what the best thing is to do or say in a certain situation. In such a case, people look to the behavior of others in the group, including the group facilitator, as an important source of information, and use it to make choices.

This seems like an obvious scenario and one that we can all relate to. We often find ourselves in situations where we don’t know something, such as attending a new course in college or starting a new job. In such cases, we quickly learn from others in the group and often assimilate their behaviors and pay particular attention to their suggestions. According to research, this is especially the case when the situation is ambiguous – e.g., a situation involving fear, confusion, or crisis.

This is an important element in group therapy, especially for people who are attending an outpatient rehab program perhaps for the first time. Not knowing what the sessions are about, how to behave, what to say, and how to participate, allows the participant to be influenced by the therapist and longer-term group attendees. Furthermore, when working through addiction, one frequently experiences fear and confusion.

The therapist is typically the perceived expert in therapy and, therefore, commends a lot of influence on the group. The information conveyed by the therapist during times of ambiguity can be very influential.

Norms and social influence

Humans have a strong need to be accepted. We tend to change our behavior to match that of others, not necessarily because they are right but because we want to remain members of a particular group. The effect of being rejected by a group is very strong, and, therefore, we do our best to avoid the pain of rejection.

Social conformance to group norms is said to be stronger depending on the strength, purpose and size of the group. We tend to conform more when we are in a group we care about, the group has a common purpose, and a particular size.

Group size and conformance to social norms

A study by Asch identified that conformity increases as the number of people in the group increases. But that’s the case up to a point. Once the group reaches four or five other people, conformity does not increase much further.

When looking at our IOP groups, we particularly like to keep them between 3 and 7 participants, though we have also worked outside those quantities. Once a group gets to 10 or more people, however, many of the benefits of participation are reduced. People don’t get as much attention or as many chances to participate. As a result, they tend to lose interest or just don’t feel a strong sense of belonging.

The perceived importance of the group

Another study suggested that the strength of the group, as defined by how important the group is to us, makes a difference. Group normative pressures seem to be stronger when they come from people we appreciate or a group we strongly identify with. This is often seen when people participate in competitive sports teams, where there is a strong interest in being a part of that team, participation is perceived to be of high value.

Obviously, this is very important in therapy and also one of the reasons we especially like clients who are self-motivated to get better and are excited to be part of the group. It’s not only themselves they are improving but the quality of the whole group.

This is also the reason why it’s very important to have a therapist who has experience, empathy, and even charisma. These elements come together to further enhance the group’s success. When participants look up to the therapist, or the outpatient center has a certain level of positive history and reputation, those attributes contribute to the participant’s chances at getting value.

Critically thinking about groups

As an exercise, we would like you to take a few minutes and think about some of the groups you belong to. This isn’t just about your therapy group. This could also be your school group, social group, work group, competitive teams, or your family group.

What kinds of benefits do you get by being a member of these groups?

Think about how your attendance in those groups is helping or hurting you.

Do any of the groups you belong to frequently deal with ambiguity?

Think through some scenarios and look to see if you often come across points of ambiguity. For instance, do you socialize with a group that takes on risky actions? Perhaps you belong to a group that likes to take things to the edge a bit as a form of entertainment. Does ambiguity arise in the form of fear and uncertainty in you? If so, pay attention to those particular moments and see if there are moments when you are being particularly influenced by others.

Who are the influencers in the group?

In each of the groups you participate in, are there key individuals that seem to dominate the conversations? Does one person’s opinion seem to have a stronger resonance with the group than the others?

Are you being positively or negatively influenced?

Now that you have identified the influencers in the group, can you tell if their behaviors, actions, and directions impact you in a positive or negative way? Do you have influencers that take energy away from the group or ones that contribute energy to the group? They are both easy to spot once you start paying attention.

What actions, stances, or behaviors are you taking because of social norms in those groups?

As you thought through some examples from the above questions, were you able to identify how your actions and behaviors may change as a result of the influence of the group or the leading voices? Do you “play along” with a direction that doesn’t resonate with you, just by being a member of that group?

Note that it’s also interesting to do these exercises and focus on groups where you are the leading voice. Respond to the same questions above from that perspective. Do you lead differently during times of ambiguity? How are others brought along to your cause as a result of your influence? Are you contributing to the group or perhaps taking energy away from the group?

The above is not meant to be an exercise in beating yourself up. It’s an exercise in becoming aware of the groups we all participate in and critically thinking through what is going on in those groups.

If you have any questions about the above, or would like to understand your options for treatment, please don’t hesitate to reach out to us.

References

Aronson, E., Wilson, T., Akert, R. Social Psychology. Firth Edition.

Author: Dr. Seda Gragossian

Dr. Seda Gragossian is the Clinical Director at the Talk Therapy Psychology Center. She has worked in the mental health field in clinical leadership roles in private practice,  at multiple outpatient facilities, as well as at large psychiatric hospital settings.

Download our free eBook to learn everything there is to know about Intensive Outpatient Programs!

Are you or someone you know suffering from depression, anxiety, or addiction? Don’t be nervous or shy about asking for help. We believe that everyone needs a little help now and then. We make no judgments and we meet you where you are at.

25 Practical Tips for Staying on the Road to Recovery from Addiction

Here are some practical tips for helping you stay on the road to recovery:

  • Maintain a healthy diet. There is a strong correlation between diet and mental health.
  • Sleep hygiene. Lack of sleep is tied to mental instability across many research studies.
  • Exercise regularly. Exercise is proven to release good chemicals into the system.
  • Set healthy boundaries.
  • Say goodbye to your “using” buddies.
  • Remove and block the phone numbers for your suppliers.
  • Send a clear message to those around you that you are no longer using. This announces your intentions and helps keep you accountable.
  • Remove yourself completely from unhealthy situations and settings.
  • Practice self-compassion and make amends with yourself.
  • Meditate regularly.
  • Don’t make the process harder than it already is; get all the help you need.
  • Work with a professional, either in individual settings or by attending an outpatient addiction treatment facility.
  • Attend self-help groups.
  • If you slip, don’t beat yourself up. Get back on track.
  • Take responsibility for your choices and feel empowered that change is possible.
  • Pick up healthy hobbies that make you feel good.
  • Structure your day in advance. Too much free time can be problematic.
  • Give back to the community.
  • Let go of the past and engage in the present.
  • Practice gratitude.
  • Practice positive affirmations such as “I choose to live a healthy life”, “I love myself”, “I deserve to be happy”, etc.
  • Smile, even if you don’t feel like it.
  • Mend your relationship with friends and family.
  • Change your job if it involves substances (e.g., for a person who abuses alcohol, being a bartender is not the best choice.)
  • Set small goals and reward yourself frequently with healthy forms of recognition.

Recovery takes work and the above will help you stack up the odds of success in your favor.

All the best.

Dr. Seda Gragossian

858 205-2490

www.TalkTherapyCenter.com

 

Download our free eBook to learn everything there is to know about Intensive Outpatient Programs!

Do you really worry about outpatient rehab costs?

We encourage our clients to shop around for not only the best therapist but also the best prices. This is especially true when your insurance does not cover an adequate portion of outpatient rehab costs. However, we are often surprised by people who do not pursue treatment altogether because they believe it is “too expensive”. Similarly, we are surprised when patients cut their treatment short because of financial considerations.  Don’t get us wrong, we understand that getting treatment for substance abuse, whether it is through individual sessions or through intensive outpatient programs (IOP), can be expensive. But money should not be the sole consideration when foregoing treatment altogether or when stopping the therapy before enough positive changes have been made. The reason we say this is because we believe that returning to the addiction can be even more expensive, not only in intangible ways, but also in very real tangible costs.

Here are some tangible and intangible costs of continuing to use:

1. Risk of dying

First there is the possibility of dying. We are not sure this should be categorized as a tangible or an intangible cost but we certain believe it is an important one. It has been reported that excessive alcohol use kills about 88,000 people in the United States.

2. Cost to society

Substance abuse results in behaviors that cost the whole society quite a bit. Research indicates that the primary costs come from losses of productivity in the workplace, healthcare expenses from treating the substance abuse symptoms and outcomes, law enforcement and criminal justice costs, and motor vehicle related costs. In fact, it is estimated that alcohol use costs the US a staggering $200 Billion per year.

3. Cost of missing work

The most significant problems that companies experienced due to addiction are absences from the workplace, reduced productivity, missed deadlines, and increases healthcare costs.

4. Direct cost of spending on purchasing alcohol

We use alcohol as an example because it is easily researched, though you can substitute illegal substances in here as well. For instance, the costs of drinking a bottle of wine, or a case of beer, per night, comes out to approximately $3,00 per year.

5. Cost of car accidents and DUIs

Almost one third (29%) of all traffic-related deaths in the US are due to alcohol-impairment. In 2015, 10,265 people died in alcohol-impaired driving crashes.

There are obviously many more incidents that did not result in deaths. Every year, 708,000 persons are injured in alcohol related crashes; 74, 000 of those people suffer serious injuries.

One study suggests that there were as many as 111 million self-reported episodes of alcohol-impaired driving in the US in 2015. That year, nearly 1.1 million drivers were arrested for driving under the influence of alcohol or narcotics. This number has gone up to as much as 1.5 million arrests, per another study.

In the case where the driver is stopped for a DUI charge, the fines are significant. It is estimated that the total cost of a DUI that goes to trail is between $8k and $10k. That’s once you add legal fees, rehabilitation fees, increases to your car insurance, and other associated costs from the whole ordeal.

Keep in mind that the increase to your car insurance is not a one-time fee. It takes years of good behavior to get your premium back down again. On average, your car insurance will increase by $3,000 to $6,000 per year.

6. Cost of divorce

While divorce is common in the us, with a first-time divorce rate hovering around 40%, it is interesting to note that the rate is 50% when one spouse drinks heavily. That’s a 25% higher rate than the national average. With the average cost of a contested divorce ranging from $15K to $35K, this is a very real and substantial cost. Obviously, drinking is not the only reason people in this one study got a divorce, the increase in the statistic was significant.

7. Associated smoking expense

According to the NIH, between 80% and 95% of alcoholics smoke cigarettes. Based on CDC estimates, someone who smokes a pack a day spends roughly $2,300 per year.

8. Work absence

Absenteeism is estimated to be on average 6 times greater among alcoholics and alcohol abusers, than the general public. This not only impacts the employer, it also impacts the individual who is potentially hurting chances at a raise, or a promotion. Obviously, absenteeism can also get someone fired.

Additionally, in one study, workers with alcohol problems were nearly 3 times more likely to have injury-related absences, than the general public.

9. Other costs

There are obviously many other general costs that could be considered. For incidents that result in some injury, there are hospital and medical bills to cover. There are also unintentional injuries that may result from being under the influence.

Apart from medical bills, there are other unpaid bills that can add up, as people forego tending to their responsibilities as a result of their addiction.

The list goes on and on. So, now, with those costs in mind, let’s look at what treatment may cost you.

In general, there are a few paths that one can take when seeking treatment for substance abuse. There are inpatient programs, outpatient rehab programs, such as Intensive Outpatient Programs (IOP), partial hospitalization, and outpatient individual sessions.

Cost of Inpatient Care

Inpatient rehab will cost you anywhere between a few thousand dollars to upwards of $60,000 for a month of treatment. There is such wide range largely due to location, the amount of services provided, and the center’s reputation. A basic, low-cost 30-day residential rehab will be in the range of $2 to $7k. your standard residential inpatient treatment will go up from there all the way to $20,000 per month. Above that amount, you enter into the world of premium, luxury, and so-called executive residential inpatient rehab centers. Such options will offer a fast range of amenities on premises, several therapy alternatives, and the highest quality of accommodations.

Costs of Outpatient Care

Intensive outpatient program (IOP) participation will range between a few thousand and $10,000. Such programs can be very effective while also allowing you to continuing carrying on with your life’s responsibilities, including work, and family care.

It should be noted that both inpatient and outpatient rehab centers can take insurance. You should consult your insurance or talk to the treatment center you are considering to understand what your insurance covers.

Cost of Detox Centers

Sometimes, detox is first required before therapists can start working with you. Often, this is in response to a significantly compromised individual who requires some return to normalcy before pursuing treatment or returning to their daily lives. Detox treatment centers will typically charge by the day and the range can be anywhere between a few hundred dollars to $1,500 per day. Again, the location, reputation, and amenities of the facility play a big role in the big range in costs.

As always, we encourage people to consider their options. Sometimes, a few individual sessions is all you need to get back to balance. Other times, a more intensive treatment option may be warranty. However, we would like to encourage all those who are dealing with substance use issues to seek help. Even if you pursue a free, community-based solution, it is better than doing nothing. It will also get you moving into the right direction.

If you have any questions about the above, or would like to understand your options for treatment, please don’t hesitate to reach out to us.

All the best.

Dr. Seda Gragossian

858 205-2490

www.TalkTherapyCenter.com

Download our free eBook to learn everything there is to know about Intensive Outpatient Programs!

Resources

https://www.cdc.gov/features/costsofdrinking/index.html

https://www.cdc.gov/motorvehiclesafety/impaired_driving/impaired-drv_factsheet.html

http://www.faddintl.org/pr/p5.html

http://onedui.com/dui-costs/

http://www.medicaldaily.com/heavy-drinking-will-lead-divorce-unless-both-partners-are-equally-alcoholic-263648

https://www.addiction.com/3003/will-alcohol-abuse-lead-divorce/

http://info.legalzoom.com/average-cost-divorce-20103.html

https://www.ncadd.org/about-addiction/addiction-update/drugs-and-alcohol-in-the-workplace

https://www.opm.gov/policy-data-oversight/worklife/reference-materials/alcoholism-in-the-workplace-a-handbook-for-supervisors/

https://pubs.niaaa.nih.gov/publications/aa39.htm

https://www.cdc.gov/tobacco/data_statistics/fact_sheets/economics/econ_facts/index.htm