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Fentanyl, a commonly used, legal opioid anesthetic, is fifty to a hundred times more powerful than morphine--which explains why it is so often present in the blood of people who die of accidental drug overdoses. They never knew what hit them. Ingesting high doses of a drug, another way of increasing its potency in the body, can produce toxic psychotic states. We see this with cocaine, hashish, belladonna, and even alcohol. Potency matters, whatever the agent. Higher potency can enhance the desired response as well as amplify unintended consequences, which range from bothersome constipation to the cessation of breathing. How much time are you wasting each morning? How much time are you wasting at night? How much time are you wasting by spending unproductive and counterproductive time with friends, on your phone, and in front of the TV? If you add up all of the time you're wasting each day and multiply it by 365, you can make big improvements in your life in one short year. It certainly lends new meaning to the famous words of U.S. President Franklin D. Roosevelt, who said - in his first inaugural address to the nation in 1933: "The only thing we have to fear is fear itself." What to keep in mind - a "cheat sheet" for moments of severe anxiety or panic: When you are feeling overwhelmed by anxiety or panic - or are feeling isolated and convinced that others do not understand the reality or appreciate the severity of your symptoms - here are some simple facts to keep in mind: Anxiety and panic are not dangerous. Panic attacks do not physically harm your body, even though they can be very distressing and frightening when they are occurring. As uncomfortable as these experiences may be, they will not hurt you or cause you to hurt yourself. Anxiety and panic will not make you do anything you do not want to do. Because panic is often associated with a sense of "losing control" over one's emotions, many people with anxiety fear that they will lose control as well over their actions and behavior - causing them to hurt themselves, for instance, or do the very things of which they are most afraid of. People who are afraid of heights, for example, often report - while being on a high precipice, for instance - that they are afraid their panic will induce them to throw themselves off the ledge. Similarly, people who are afraid of flying often fear that their panic will get so intense that it will force them to do something that would damage the aircraft, thus bringing on the very midflight accident they were afraid of in the first place. In reality, as we will discuss more fully in Chapter 6, even when we are in the midst of a panic episode, we have more control over our emotions than we may think.

More important to note here, emotions cannot force you to act a certain way, and fear specifically is especially unlikely to force you to do the things you are afraid of. While excessive fear is a distressing thing, we have fear emotions as a species for a reason. Fear is a valuable emotion, one that serves an important evolutionary function of alerting us to danger. Your feelings of fear or panic can never force you to do things you are afraid of - that is the opposite of the role fear plays in our minds. It will not lead us into the things we consider dangerous. It's become almost a cliche that big cities can wear down your happiness and that moving out to a quieter place more deeply connected with nature can improve your mood. But there is evidence to support this. The General Social Survey (GSS), conducted by the National Opinion Research Center at the University of Chicago since 1972, gathers Americans' demographic and behavioral information as well as their attitudes on a range of topics, such as stress, social mobility, and spending habits. Drawing on data from the GSS from 1972 to 2008, public policy researchers at the University of Texas at Dallas found that people in major cities do indeed express lower levels of subjective well-being than those in small towns or rural areas. The data shows that people living in small towns and rural areas generally report being happier, even when controlling for other variables--likely driven, according to the researchers, by the lower density and greater homogeneity in these more low-key areas. Harvard economics professor Edward Glaeser begs to differ. In his book Triumph of the City, he makes the case that cities are "our species' greatest invention." He counters the reports of how urban centers can wear on citizens' happiness with data that demonstrates the opposite: 30 percent of those living in countries where more than half the population is urban say they are very happy, compared to 25 percent who say the same in countries where more than half the population is rural. On the other end, just 17 percent of citizens in majority urban countries say they are not very or not at all happy, compared with 22 percent of those in majority rural countries. He points out that "[a]cross countries, reported life satisfaction rises with the share of the population that lives in cities, even when controlling for the countries' income and education." Researchers have been gauging the "goodness of life" in US cities at least as far back as the 1930s. But the first comprehensive approach, based on statistical evidence, to measuring the quality of life on a citywide and regional level seems to have been by David Smith, in his book The Geography of Social Well-Being. The book, published in 1974, looked at statistical data for poverty, health care delivery, environmental quality, and other factors believed to have an effect on well-being. However, at least one critic at the time commented that the variables he chose to determine these happy places (e.g., welfare payments, diets, incomes) were "somewhat arbitrary, largely a function of what is publicly available. Venereal disease is given as much weight as poverty." But early efforts to determine the happiest cities evolved, with researchers looking at the type of amenities in a given city, as well as using more sophisticated measurement of variables to work out more objective quality-of-life scores for cities, states, and countries. We all have stories for why we're not where we want to be and doing the things we know we should be doing. We all have a thing, a person, or a circumstance to point at and say, "That thing, that person, or that situation held me back and is keeping me from moving forward." We can all use the "bad childhood", "bad luck", and "life has been unfair" stories and excuses, but at the end of the day, we're using them to dodge full accountability and responsibility and we know it.

We're using stories and excuses as tools to avoid having to be absolutely truthful. The past can't hold us back at this current moment and when we decide to be lazy and complacent, we pull that story out of our pocket and use it to justify our poor decisions and behavior. Once I decided to quit acting like a child and got rid of my stories and excuses for why I wasn't where I wanted to be, I had no choice but to move forward and make things happen. I had to accept full responsibility for my situations and quit using stories and excuses as crutches. The World Happiness Report, from the United Nations' Sustainable Development Solutions Network, bases its ranking on a simple number: the average answer of how the citizens of each country evaluate the quality of their lives, on a scale from zero to ten. Specifically, respondents are asked this question, based on the research of Hadley Cantril: "Imagine a ladder, with steps numbered from 0 at the bottom to 10 at the top. The top of the ladder represents the best possible life for you and the bottom of the ladder represents the worst possible life for you. On which step of the ladder would you say you personally feel you stand at this time?" There are many types of negative thoughts. You may find you relate to some more than others. You see things in extreme terms such as good or bad, right or wrong, success or failure. You probably set impossible tasks and then feel bad when you do not achieve them. You may even not start tasks because you feel you cannot complete them to the desired standard. You planned how to deal with a social event and although you have done really well you misunderstand what someone says to you and feel stupid - you say to yourself Well that's it - I've blown it'. <a href=''>You</a> may be struggling with a diet and find that you have eaten two biscuits. <a href=''>You</a> then say to yourself,I might as well finish them all now that I've broken my diet, I'm so useless'. If you decide that all or nothing thinking relates to you, in your notebook list two situations where you can identify this type of thinking, together with the thoughts that were going through your head at the time. This is rather like believing you are telepathic and can read minds. You predict a negative outcome and then encourage it to happen by telling yourself it will. In effect, you set up what could be called a self-fulfilling prophecy'. <a href=''>Your</a> stories and excuses are only holding you back. <br /><br /><a href=''>Alprazolam,</a> or Xanax, was introduced in the United States in 1969. <a href=''>A</a> benzodiazepine, a class of drugs that includes Librium, Valium, and Klonopin, Xanax quickly became among the five bestselling drugs in the United States and has done well since then. <a href=''>It</a> has sometimes been called vitamin X. <a href=''>I</a> recall prescribing Xanax for patients with significant anxiety and for people with severe depression until they experienced some symptomatic relief from treatment with antidepressants and therapy; with some other patients I used Xanax to help them with their fear of flying. <a href='<=6&dest='>But</a> I assiduously avoided giving it to people with substance-abuse problems because, as a "benzo," it could be habit-forming. <a href=''>The</a> half-life of a drug is defined as the time required for the body's blood levels of the substance to decrease by half. <a href=''>For</a> Xanax, reportedly it is about eleven hours on average, in a range that goes from six to twenty-seven hours, reflecting how different individuals metabolize the drug. <a href=''>Clinically,</a> many patients seem to feel its waning effects toward the lower end of the time range. <a href=''>Many</a> patients I treated would report Xanax "wearing off" in just a few hours and then their feeling even more anxious. <a href=''>They</a> wanted to know if they could take more sooner. <a href=''>They</a> were experiencing withdrawal from the drug, not likely the breakthrough of their underlying psychiatric disorder. <a href=''>Patients</a> found it exceedingly hard to stop using Xanax, even after a few weeks; the dose kept having to be halved, with even the lowest-dose pills broken into tiny particles, before patients could finally quit. <a href=''>This</a> problem with Xanax, which many but not all experience, is now well-known and has led many doctors to prefer benzos with far longer half-lives (such as Klonopin, or clonazepam as a generic). <a href=''>Behavioral</a> views of addiction importantly stress both its negative and positive aspects. <a href=''>Negative</a> reinforcement is seen when drug levels decrease in the body, which can be terminated by taking the drug. <a href=''>Positive</a> reinforcement refers to effects on the brain's reward system, including releasing dopamine and other neurotransmitters. <a href=''>Anyone,</a> but especially someone with an addiction, will seek the reward (e.g., euphoria) or to avoid the pain (reductions in blood levels and withdrawal). <a href=''>What</a> stories about your childhood are you using to justify why you're a victim and why you're not getting your act together? <a href=''>What</a> stories and excuses about your current situation are you using? <a href=''>What</a> stories and excuses do you regularly use for not getting your act together? <br /><br /><a href=''>Quit</a> telling them. <a href=''>Quit</a> using them. <a href=''>Quit</a> repeating them. <a href=''>Let</a> them die. <a href=''>No</a> matter who you are, how fortunate you are, and how successful you are, shitty things are going to happen to you and you're just going to have to suck it up and roll with it. <a href=''>You</a> can't use them as a wall to hide behind. <a href=''>When</a> something bad happens, say, "Well that sucks but I'm not going to use it as an excuse. <a href=''>I'm</a> not going to let it hold me back." You have to make a comment about a project at work and find yourself thinking about everything that could go wrong. <a href=''>As</a> you do this you feel more and more anxious and then discover that all the things you have told yourself will happen come true! <a href=''>You</a> are out on a date for the first time and the person you are with seems a little withdrawn. <a href=''>You</a> thinkHe's disappointed with me, as he thinks I am not very interesting.' In fact, however, he has had some bad news and does not realize it has upset him as much as it has. Because you believe it is you, the situation deteriorates between you. Imagine a drug with a half-life of about fifteen minutes, which is the half-life of crack cocaine, with the high maybe lasting ten minutes. The euphoria is sky-high, but the crash is intense, precipitous, and deep. The answer? Take more. Keep taking it. Methamphetamine tablets have a half-life of about ten hours (range six to fifteen hours). When smoked as crystal meth, its "bioavailability," or capacity to be taken up by nerve and other cells, is far greater, yet this drug sticks around with a half-life similar to that of the tablets. This allows for meth "runs," in which users stay high for days on end, finally crashing into a physical and emotional abyss.