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Subjective Well-Being

Subjective Well-being: Examinations from a Health Psychology Grad Student

Greetings! As a graduate student of psychology, please allow this blogpost to have some nerdy citations along with an offering of insight for health and wellness supported on this website. I am thrilled you found this today, and I look forward to feedback. Please feel free to reach out to me with questions, concerns, jokes, or any other shareable input for the topic of subjective well-being.

To start, how are you today?

You are probably sitting in a comfortable and safe place. If you are reading this blog on a computer or personal device, you have achieved some form of wealth. And insomuch as you can read and are interested in this topic, you have also met some of the education beyond elementary levels. Without knowing you personally, as a writer and student of psychology, I can presume that you are doing okay or even feeling good. Still, maybe you also have un-named emotions that don’t surface right away. Perhaps you are not well, and this is a search for a way to feel better. Answering this simple question of “how are you” is not always so simple. It includes influences from the many facets of our life histories, our personalities, our local environment, our relationships with family and friends, our employment, the weather, politics, how we woke up today, and so on and so on. Dissecting the variables can get complicated quickly. The question may be simple, but the information we use to answer this question is not. Could this be the reason why so many of us often say that we are “fine” even when we are not? Avoiding the deeper emotions in casual interactions is good, right?

The world of psychology is a fascinating field of discovery, theory, and research dedicated to understanding and improving the lives of people. The development of reasoning in an attempt to explain and create positive life experiences can be seen far back into history, starting with the philosophers of ancient Greek and Roman civilizations. Existing as a human beyond survival has brought introspection to our behaviors and our mental states, mainly because the experiences of being human are different for each of us.

Psychology, as described by the American Psychological Association (APA), is the scientific exploration of the human mind and behavior. Psychology uses a scientific method that links deep philosophic questions of human existence with medical applications in an attempt to explain, and sometimes heal, processes that originate within the mind. The history of psychology as a scientific field is not long, with the first psychological researchers recognized in the late 1800s, and the foundational theories that built modern psychology following shortly after that in the early and mid-1900s. By the end of WWII, the executive function of psychology alongside medical professionals was established, and the work to explain, intervene, and treat mental illness began (Compton & Hoffman, 2013). Since that time, psychology has undergone many specializations including, industrial psychology, health psychology, and positive psychology (just to name a few).

This blog is not meant to provide a detailed history of psychology or mental disorders, though. This is just to set the scene for how the topic of subjective well-being is understood through the eyes of positive psychology in the decades since its birth. The majority of people do not suffer from mental disorders or illnesses at clinical intervention levels, and the answer to the question at the beginning does not spur endless processions of explanations of personal emotional states for most people. Though many people do express a variety of emotional states of being throughout their lifetimes, from the lows of trauma or stress to the highs of holiday travel or marriage, the following writing will focus on the ways positive psychology as science understands the state of well-being.

Positive Psychology is the newest viewpoint that takes on a different approach to understanding the human mind rather than the historical method of psychology I mentioned before that was built to address mental dis-ease by introducing psychiatric interventions. The science of psychology was created to decipher the wrong in us, and the reverse is now being explored by utilizing the scientific method, to understand what is right in us and discover how to enrich the positive effects of being human.

So back to the original question I asked in the beginning, how are you? When asked such a question, the knee-jerk reaction is to say “fine” or “good.” Am I right? We all say we are fine or good when we needed to share that one thing on our list that is producing anxiety, or the feelings from last night’s fight with our spouse that still hurt.

But a person may say, “I don’t recognize any of those things when I think of my emotions.” Indeed, one may not take all that information into account every time the question is asked or be comfortable sharing it. Still, the function of the brain and mind is to use those influences of our past, present continually, and future to keep us upright, adequately energized, and motivated. When there is disharmony in any of the facets of our life, one could then “feel” unhappy, sad, lazy, or upset. Our experience is subjective to personal interpretation, and the ways we define our emotions and feelings are individual as well. Subjective well-being is, therefore, an extension of our own feelings cumulated with our life experiences created within ourselves.

If we take the cognitive theory approach and relate it to subjective well-being, it is not the events that create a person’s well-being, but the way the person interprets those events that create well-being (Compton & Hoffman, 2013). So, we can change our minds to reflect a more positive or negative view of an event, and the event that is being experienced is just an outside process. When understood in this way, subjective well-being is defined as a mental state with opportunities to change according to the mindset of the individual. Michael Frisch’s Quality of Life Therapy states that the sense of well-being can be evaluated and altered through “objective life circumstances…our attitude…our standards…how important we believe an area is to our life…or focus attention on other areas that already give us a sense of satisfaction” (Compton & Hoffman, p 47).

If we use a psychoanalytic approach related to subjective well-being, a person holds inherent motivations to achieve well-being based on the unconscious. Through social connection and personal development, optimal mental health can be achieved (Compton & Hoffman, 2013). In this view, it is like we all have an inner compass pointing us in the direction of positive social and personal achievements. Still, we must act on those motivations in the proper modalities to achieve our best health. Subjective well-being in this approach is experienced as an effect of actions rather than the goal of the actions.

If we put behavioral theories with subjective well-being, people are either encouraged or discouraged to complete social or personal actions by rewards or punishments, and based on these beliefs; people can repeat specific steps to increase well-being or neglect certain actions to decrease well-being (Compton & Hoffman, 2013). This is a view that reflects the process of learning and the ability to use actions and functions of social or personal beliefs to create subjective well-being.

If we look at the humanistic approach to subjective well-being, the potential for well-being is available through the advancement of the person through self-actualization (Compton & Hoffman, 2013). Self-actualization is open to the interpretation of the person. In this way, subjective well-being can be an experience that is gainful for each individual based on their personal views. In this approach, most positive psychology has bloomed. The Modes of Fulfillment theory by Richard Coan highlights five basic modes: efficiency, creativity, inner harmony, relatedness, and self-transcendence as ways to find personal fulfillment in life (Compton & Hoffman, 2013).

The traditional psychological theories described here are useful to access the points for positive psychology researchers use for methods and definitions of the term well-being. The relationship with well-being (along with the quest for well-being) is different for each person, and that is why it is subjective. The experience of well-being can be expressed in a variety of ways through the different psychological approaches, but it could be one thing or many things that make us feel good, bad, sad, or any other way. Positive psychology has taken the scientific method and applied its measurement to trials for the experience of subjective well-being. When researchers can identify the values associated with well-being, there can be proof of having it or not having it. If a person is low in well-being, the goal is to support interventions to cultivate more well-being. If a person is high in well-being, the goal is to identify the actions, mental states, or any other identifiers that produce an ongoing state of well-being.

Martin E.P. Seligman, credited with the introduction of the field of positive psychology in 1998, proposed the PERMA approach within the Well-Being Theory to create measurable and teachable traits for producing subjective well-being (Compton & Hoffman, 2013). PERMA is an acronym that means Positive emotion; Engagement; Relationships; Meaning; and Accomplishment (Compton & Hoffman, 2013). Each of these items is relatable to subjective well-being by inducing authentic happiness in the three domains that Seligman describes for the pleasant life, the good life of engagement, and the meaningful life (Compton & Hoffman, 2013).

Positive emotion (P) is the ability to increase well-being through physical or sophisticated pleasures that produce feelings like joy, and engagement (E) with activities increases the flow and the ability to be in the moment, which also increases well-being (Compton & Hoffman, 2013)—having positive relationships (R) and meaningful life (M) service the well-being of an individual by providing something outside of the self that is necessary to set the social life of an individual (Compton & Hoffman, 2013). Lastly, accomplishment (A) is the development of self-discipline to create goals and challenges which evolve into competence and mastery (Compton & Hoffman, 2013).

The internet and social media are becoming an everyday focal point of people worldwide. In recent studies, the use of social media has increased stress and lead to difficulties dealing with emotions (Rasmussen, Punyanunt-Cartera, LaFreniere, Norman, & Kimball, 2020). As people and technology evolve, there will be a discussion of the role of social media and internet use to well-being. By this point, it should be evident that our well-being is influenced by more than our inner feelings. Definition of feelings, emotions, mood, and the words to give them meaning are learned expressions of our internal state of being, but that is not the whole picture of a person’s state.

What we share on social media is influencing our well-being, and young adult users of these internet platforms are showing signs of depression and less life satisfaction (Rasmussen et al., 2020). The use of social media to fulfill any of the facets of well-being through the theories that have been discussed is limited. In the land of Facebook, positive messages posted by an individual are seeking approval, while negative messages are seeking recognition (Luo & Hancock, 2020). While disclosures that are positive produce well-being for the user when the post is approved, a false declaration from a person who has a negative self-image will further their disconnection and depression (Luo & Hancock, 2020). This does not mean I wish to convey a sad desire to eliminate social media websites. Still, it does say that I want there to be more experiences outside the internet for people to base their social and personal well-being.

The quality of our lives is represented in how we feel. How are you? Throughout this blog, I have presented a view of psychology that attempts to harness positivity towards life itself. Cultivating a good sense of well-being can come from many places, but most of all, it needs to come from within our ability to recognize we have a good life. Expression of our lives through how we engage with our family, friends, and neighbors will equate happiness and build healthy communities (Nima, Cloninger, Persson, Sikström, & Garcia, 2020).

The better we are, the better the world will be. The better our experience of the world, the better we feel. The better we feel, the better we are to others. Share and spread the love and well-being. Thank you for reading!

References

Compton, W.C., & Hoffman, E. (2013). Positive Psychology: The Science of Happiness and

Flourishing. Independence, KY: Cengage

Luo, M., & Hancock, J.T. (2020). Self-disclosure and social media: motivations, mechanisms and

psychological well-being. Current Opinion in Psychology, 31(1), 110-115.

doi.org/10.1016/j.copsyc.2019.08.019

Nima, A.A., Cloninger, K.M., Persson, B.N., Sikström, S. & Garcia, D. (2020). Validation of

subjective well-being measures using item response theory. Frontiers in Psychology,

10, 1-33. doi: 10.3389/fpsyg.2019.03036

Rasmussen, E.E., Punyanunt-Cartera, N., LaFreniere, J.R., Norman, M.S., & Kimball, T.G. (2020).

The serially mediated relationship between emerging adults’ social media use and

mental well-being. Computers in Human Behavior, 120, 206-213.

doi.org/10.1016/j.chb.2019.08.019

Seligman, M.E.P., Railton, P., Baumeister, R.F., & Sripada, C. (2013). Navigating into the future

or driven by the past. Perspectives on Psychological Science 8(2), 119-141. DOI:

10.1177/1745691612474317

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Envisioning My Future

Before engaging in the exercise for this week, I researched the Positive Psychology website (Houston, 2020) to get an understanding of the various techniques utilized in this specialized approach of interventions. Together with a specialist, individual or group sessions offer ways for clients to be guided into internal states to recognize and promote core values, strengths, and states of positive emotions. The importance of gaining insights from these practices is to indulge clients (or ourselves) in a safe space of complete possibility for a positive future or to accentuate the positive traits that exist amongst adverse environments.

From Barbara Frederickson’s research to broaden and build positive emotions, the effect of increasing positive emotions in one’s life “resulted in cognitive flexibility and openness to experience and help[ed] create a sense of meaning” (Compton & Hoffman, 2013). These exercises offer a way to activate the client with positive emotions, rather than the relentless stream of negative emotions which are typically observed (Houston, 2020). When we engage positive emotions or character strengths in our day to day lives, we expand our well-being and start to experience the “good life” that Positive Psychology embodies.

A study by Pryor, Rush, and Buschor evaluated interventions associated with character strengths that highly correlate with life satisfaction between two experimental and one control group (2013). The character strengths most correlated with life satisfaction are zest, humor, curiosity, hope, and gratitude, to which one experimental group completed various interventions to improve these strengths (Pryor, Rush, & Buschor, 2013). The interventions for curiosity training included four different activities new to the person, while gratitude interventions included writing a letter of gratitude (Pryor, Rush, & Buschor, 2013). The interventions for zest offered physical activities and challenging additions to daily routines (Pryor, Rush, & Buschor, 2013). The action for developing hope as a character strength exercised the idea of one door closes, and one door opens, while developing humor as a character strength utilized an intervention from a humor training program (Pryor, Rush, & Buschor, 2013).

Pryor, Rush, and Buschor (2013) also provided interventions to strengthen the lower correlated character strengths related to life satisfaction. Those strengths were “appreciation of beauty and excellence,” creativity, kindness, love of learning, and open-mindedness (Pryor, Rush, & Buschor, 2013). Before interventions, the participants surveyed their life satisfaction for a pre and post-test analysis. Curiously, the experiences of interventions to lower correlated strengths also improved life satisfaction. Still, the intervention group with the highly correlated strengths showed more improvement in their rating of life satisfaction in the post-test (Pryor, Rush, & Buschor, 2013). The experiment, therefore, is positively supporting the engagement of character strengths to help and offer satisfaction with life, no matter which strength is enhanced.

To increase well-being or life satisfaction, we must increase our ability to flourish, and Martin E.P. Seligman’s Well-being Theory offers five dimensions that he describes in the acronym PERMA (Compton & Hoffman, 2013). [P]Positive emotions to enjoy the pleasures of life, [E]engagement to identify and cultivate signature strengths for everyday activities, (positive) [R]relationships to which all must acknowledge the togetherness of modern living, [M]meaningful life to offer signature strengths towards something more than individual needs, and (positive) [A]accomplishments to achieve and challenge one’s self for mastery and competence (Compton & Hoffman, 2013). The character strengths and their cultivation are, therefore, a huge chunk of positive psychology, as all character strengths can vary per individual. In the variance, each individual can thrive and flourish in any way that piques their efforts so long as they are actively striving towards and achieving PERMA.

A program to develop character strengths serves to broaden personal understanding of self, but also provides useful tools for resiliency to handle future missteps or problems. As a student of psychology, I understand that a personal journey towards understanding the self can be tricky and hard to do on your own, without a guide, so most of us don’t go further into that inner world. Where positive psychology offers a place for individuals to grow through their character strengths, virtues, and positive emotions are by practices and exercises like the one I completed this week, or through the interventions proposed at the beginning of this paper.

The assignment to sit down with oneself can be a challenge for some, but I am seasoned by the years of yoga and meditation I continue to practice. Before engaging with the writing, I listened to a guided meditation for personal development and growth (link in References), and used my character strengths of gratitude and love of learning to envision a lifestyle I will truly honor for myself and my family. The guided meditation helped to slow my mind and close the gap between my thoughts and my feelings. Through the time in meditation, I was able to surrender my body to the sensations in the room completely, and my mind was ready to take the guidance to go within and “see” the life I envision in my future.

Following the guided meditation, the timer is set for fifteen minutes, and a blank piece of paper started to become filled with goals, ideas of where I will be, how I will act, how I will feel, and what that means for work and travel and family. The ideas poured out of me, and I could have continued to write past the timer. Instead, I used the bottom of the paper to draw the image of myself with the envisioned lifestyle. Following the exercise, rereading the words I quickly wrote caused me to smile and reflect that I genuinely do desire these things in my life, and then an urgency to get to the next step to achieve these things started to press through my mind. Usually, I wouldn’t say that I am emotional, yet I can FEEL something inside that has changed from this exercise. Something pulling me to start actions to get here, and something is saying to me that I can do it.

I have completed tasks like this before, but as I age, I find that I am more engaged with my future through immediate actions. I understand through my experiences that I am in control of myself, the steps I take, and the path I choose. This exercise puts pictures and a narrative as the goal for which my actions should direct. Coincidently, I am also part of a dynamic group that also had an assignment this week to draw a picture of my future achieved self. I had already practiced a little at this exercise.

I find that carrying on without goals or direction is limiting and creates disharmony in my daily actions. Life does not come with an instruction manual, but we can start anytime or anywhere on the path towards a brighter future. The future that is envisioned is achievable. In my opinion, positive psychology will help create the vision for a brighter future through doable exercises and strengthening our connection with character strengths and positive emotions.

References

Compton, W.C., & Hoffman, E. (2013). Positive Psychology: The Science of Happiness and

Flourishing. Independence, KY: Cengage

Fletcher, D. & Sarkar, M. (2016). Mental fortitude training: An evidence-based approach to

developing psychological resilience for sustained success. Journal of Sport Psychology in Action, 7(3), 135-157. DOI 10.1080/21520704.2016.1255496

Houston, E. (2020). 19 Positive Psychology Exercises To Do With Clients or Students. Retrieved

from https://positivepsychology.com/positive-psychology-exercises/#best-possible-self

Proyer, R.T., Ruch, W., & Buschor, C. (2013). Testing strengths-based interventions: A

preliminary study on the effectiveness of a program targeting curiosity, gratitude, hope, humor, and zest for enhancing life satisfaction. J Happiness Study, 14, 275–292. DOI 10.1007/s10902-012-9331-9

“Guided Meditation for Personal Development and Growth” Retrieved from

Substance Use Disorder

Let’s talk about drugs! I love my daily coffee or tea, and maybe you do as well. Sometimes when I skip the caffeinated part of it, I feel a little grumpy, snap at my co-workers regretting it later, and wonder why I am so sleepy by 4 p.m. So, am I addicted to caffeine? I like to have a glass of wine with dinner during the weeknights sometimes. When I have an evening with friends, I can overdo the drinks without realizing, and then spend the next day nursing a hangover. Does that mean I have a socially dependent relationship with alcohol?

Do these scenarios relate to your life? Do you feel there may be a connection with chemicals that is unhealthy? Do you see someone around you that may struggle with a relationship with a chemical substance? In this first blog post of health and wellbeing insights, the focus is on the subject of substance use disorders, or SUDs as I will now refer to them. I will look at the relationship with chemicals and our bodies, risk factors for use with adolescents, the clinical diagnosis of SUDs, and the cost of drug use on society.

Drugs, illegal or from a doctor or the store, are substances that interact with our bodies in such a way that they can produce physical, psychological, cognitive, and sometimes emotional connections. Substances of all kinds can create chemical rewards in our brains, and through our individual biochemistry and the way it gets into our bodies, certain substances can produce increased pleasure at a quick pace (Doweiko, 2015). When our brains get the stimulus right and understand what increases satisfaction while decreasing discomfort, brain-behavior creates ways for us to keep doing the same actions with substances (Doweiko, 2015). Think about the coffee in the morning, and the alcohol with friends at night. Both will induce similar behaviors the next time a similar situation presents itself. The opposite is also true when something creates more discomfort and reduces pleasure. The act does not get repeated because the brain learns to avoid anything that does not create the pleasure it likes (Doweiko, 2015).

So why do we start using drugs anyway? I remember the first taste of coffee I had as a child, and it was horrible! Now, I can smell it brewing as I walk down the sidewalk from a coffee shop, and I have to talk myself out of going inside to buy a cup. Several theories exist about the initiation of substance use. As I mentioned the chemical pathways in our brains from substance use, it’s important to acknowledge other factors that are present in our environment that could predict or prevent our future substance use.

The researchers Miller and Cook developed an assessment of factors related to substance use of adolescents (2017). In their research, they developed a continuum from low to moderate to high for substance use connected with cultural influences and biological factors (Miller & Cook, 2017). The low continuum of risk factors from cultural influences includes ethnicity and socioeconomic status, with biological factors such as gender (Miller & Cook, 2017). As the continuum moves to moderate other influences such as age, indigenous culture, and nationality play a more significant role (Miller & Cook, 2017). The highest risk factors on the continuum are sexual orientation and race (Miller & Cook, 2017). These factors are both predicters and preventors with a collage of everyone’s mix of upbringing to help understand who will be at a higher risk of substance use now and later in their lives.

The family I was in drank coffee, could afford to purchase coffee. So I now drink coffee, despite the aversion to it as a younger person. However, in my household, my parents did not drink alcohol (and still don’t). The predictor of my alcohol use came from factors outside my home environment; perhaps my age of starting to try alcohol, the culture of friends I surrounded myself with, and my race played a more significant role in my mild consumption of alcohol.

There is another continuum of use to consider as well because individuals are exposed to substances that do not mean all will engage. Some individuals will remain abstinent from any substances for their entire life, and others will engage with substances on a rare use. The continuum of use shows that through five levels, zero (abstinent) to one (rare or social use) to two (heavy social use or early problem use) to three (late problem use or early addiction) to four (late-stage addiction), individuals can move between levels or remain stagnant with substance use (Doweiko, 2015). Based on a person’s active use of a substance, their history of use, a pattern from a lifetime of use, and current actions, an individual will fall somewhere on the sloping continuum of use. During my younger years, I would have been a level three or four users of alcohol and marijuana, because that is what the culture around me was doing. Still, now I wouldn’t be nearly that high on the continuum of use for either of those substances.

The application of the continuum of use for recreational substances has some validity in that is helps classify the substance use patterns on a fundamental level; however, as a person who has admitted to substance use, I wouldn’t classify myself as a level two user of coffee or a level one user of alcohol all the time. There are so many other factors that need to be included besides the level of use of a substance before there is a determination of problems or addiction. When looking at the DSM-5 (Diagnostic Statistical Manual of Mental Disorders, Fifth Edition) section titled, “Substance-Related and Addictive Disorders,” it includes the description for the diagnosis of SUDs and the ten categories of drugs with specific criterium for such a determination. In the DSM-5, SUDs are a diagnosis given to an individual that present physiological, behavioral, or cognitive symptoms of continued use of a substance, even though the use of the substance itself presents problems (DSM-5, n.d.).

There are ten categories included in the DSM-5 for SUDs, “alcohol; caffeine; cannabis; hallucinogens … ; inhalants; opioids; sedatives, hypnotics, and anxiolytics; stimulants (amphetamine-type substances, cocaine, and other stimulants); tobacco; and other (or unknown) substances” (DSM-5, n.d., p481). It’s not just illegal drug use that can turn into a SUD diagnosis. Legal substances, including caffeine, nicotine, alcohol, and in some states, marijuana, are also included because the use and the individual’s reaction to them can induce problems that inhibit normal functioning. While some people can produce the same level of societal functioning while drinking caffeine or smoking nicotine, there may be another individual that meets classifications for mild SUD for caffeine or nicotine. The DSM-5 is a useful tool for providing a rating of mild SUD with two to three symptoms, moderate SUD with four to five symptoms, and severe SUD with six or more symptoms (DSM-5, n.d.).

One statistic that stands out the most about our connections with substances is “at least half of the world has used at least one psychoactive substance at least one time in their life” (Doweiko, 2015, p3). That substance is most likely a legal one for adults over 21 in the United States, ALCOHOL. The prevalence of this substance and its use is almost like an acceptance of certain chemical substance addictions in our society in the United States, and it is staggering to me. It starts at a young age with adults around us consuming certain legal (or illegal) drugs, television, or movies showing the consumption of drugs in positive or rebellious ways. Then as we age, some peer groups start to pressure the use of drugs.

Could media play a more prominent role and produce more intensive reports of the effects of SUDs in our families and culture? I believe so, and I also think there should be more reports of the comorbidity that SUDs produce within our society. The DSM-5 shows how SUDs and other disorders are concurrent for individuals, including bipolar disorder, depression, anxiety, and sleep disorders (DSM-5, n.d.). The health of our society depends on knowledgeable, reliable reporting of chronic illness, and these disorders, along with SUDs, affect individuals and increase overall health risks.

According to the latest edition of Concepts of Chemical Dependency (Doweiko, 2015), the most prevalent mental health issue facing our society today is the use (or misuse) of substances. This means a typical person today in our community is likely to interact with another individual with a SUD or to have a SUD at some point in their lives. The continuing use of substances on the high end of the continuum is presenting a considerable cost to society and potentially more significant deficits to people’s health and livelihood. SUDs affect more than the health of people who suffer with them, and it is being shown through the strain on the healthcare system by having limited focus on preventative care due to more attention needed to attend to repeat SUD visits (Leslie, Ba, Agbese, Xing, & Liu, 2019).

In their study, Leslie, Ba, Agbese, Xing, & Liu found that over fifteen years, the use of opioids and the related hospital costs for treatment increased from $919 million in 1999 to $3 billion in 2013 (2019). Most upsetting is the non-opioid treatment for patients with opioid use disorder, costing triple the number of treatment costs (Leslie, Ba, Agbese, Xing, & Liu, 2019). Currently, four cents of every dollar in the state government budgets is to address the prevention of SUDs (Doweiko, 2015).

As you can see, the use of substances is a threat to the health of our bodies, our relationships, and our healthcare system. As we explore the health and wellbeing insights I provide on this blog, you are provided an insider look at the ways to excel in your health. Please feel free to leave a comment or ask questions.

References

Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). (n.d.).

Doweiko, H. (2015). Concepts of Chemical Dependency. CT, USA: Cengage Learning

Leslie, D., Ba, D.M., Agbese, E., Xing, X., & Liu, G. (2019). The economic burden of the opioid epidemic on states: The case of Medicaid. The American Journal of Managed Care, (25),13. S249-S243.

Miller, A., & Cook, J. M. (2017). The Adolescent Substance Use Risk Continuum: A Cultural, Strengths-Based Approach to Case Conceptualization. Professional Counselor, 7(1), 1–14. Retrieved from https://search-ebscohost-com.proxy1.ncu.edu/login.aspx?direct=true&db=eric&AN=EJ1159707&site=eds-live

Minkoff, K. (2019). Substance Use Disorders in Crisis Settings: Engagement, Assessment, and Intervention Approaches. Psychiatric Times, 36(1), 26–29. Retrieved from https://search-ebscohost-com.proxy1.ncu.edu/login.aspx?direct=true&db=ofs&AN=134145809&site=eds-live