Gut – by Dr. Giulia Enders
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On account of being an organ (or rather, a system of organs) whose functions are almost entirely autonomic, most of us don’t think about our gut much. We usually know there’s acid in the stomach, and we usually know there are “good and bad” gut bacteria. But what of the rest of what goes on?
For anyone who has a hazy half-remembered knowledge from school, this will serve as not only a reminder, but a distinct upgrade in knowledge.
Dr. Giuliua Enders talks us through not just the processes of what goes on, but, as a medical doctor, also many instances of what can go wrong, for example:
- Why do some people’s bodies mistake nuts for a deadly threat (and consequently, accidentally elevate them to the status of actually becoming a deadly threat)?
- Why are some people lactose-intolerant, and why do food intolerances often pop up later with age?
- Why do constipation and diarrhoea happen?
- Why is it that stress can cause stomach ulcers?
The style of writing is light and easy-reading, and the illustrations are clear too. This is a very accessible book that doesn’t assume prior knowledge, and also doesn’t skimp on the scientific explanations—there’s no dumbing down here.
Bottom line: knowing what goes on in our gut as akin to knowing what goes on under the hood of a car. A lot of the time we don’t need to know, but knowing can make a big difference from time to time, and that’s when you’ll wish you’d learned!
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DBT Made Simple – by Sheri van Dijk
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This book offers very clear explanations of DBT. In fact, a more fitting title might have been “DBT made clear”, because it does it without oversimplification.
This is a way in which van Dijk’s work stands out from that of many writers on the subject! Many authors oversimplify, to the point that a reader may wonder “is that all it is?” when, in reality, there’s rather more to it.
This work is, therefore, refreshingly comprehensive, without sacrificing clarity.
Van Dijk also takes us through the four pillars of DBT:
- Mindfulness
- Distress tolerance
- Emotional regulation
- Interpersonal effectiveness
Each of these can help an individual alone; together, they produce a composite effect with a synergy that makes each more effective. Hence, pillars.
On the topic of “an individual”, you may be wondering “is this book for therapists or the general public?” and the answer is yes, yes it is.
That is to say: it’s written with the assumption that the reader wants to learn DBT in order to practice it as a therapist… and/but is written in such a fashion that it’s very easy to apply the skills to oneself, too. As it’s an introductory guide—a comprehensive one, but without assuming prior knowledge—it’s a perfect resource for anyone to get a good grounding in the subject.
Bottom line: if you’ve been hearing about DBT (possibly from us!) and wondering where you might start, this book is an excellent place to begin.
Click here to check out DBT Made Simple, and start making many parts of life easier!
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Protein Immune Support Salad
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How to get enough protein from a salad, without adding meat? Cashews and chickpeas have you more than covered! Along with the leafy greens and an impressive array of minor ingredients full of healthy phytochemicals, this one’s good for your muscles, bones, skin, immune health, and more.
You will need
- 1½ cups raw cashews (if allergic, omit; the chickpeas and coconut will still carry the dish for protein and healthy fats)
- 2 cans (2x 14oz) chickpeas, drained
- 1½ lbs baby spinach leaves
- 2 large onions, finely chopped
- 3 oz goji berries
- ½ bulb garlic, finely chopped
- 2 tbsp dessicated coconut
- 1 tbsp dried cumin
- 1 tbsp nutritional yeast
- 2 tsp chili flakes
- 1 tsp black pepper, coarse ground
- ½ tsp MSG, or 1 tsp low-sodium salt
- Extra virgin olive oil, for cooking
Method
(we suggest you read everything at least once before doing anything)
1) Heat a little oil in a pan; add the onions and cook for about 3 minutes.
2) Add the garlic and cook for a further 2 minutes.
3) Add the spinach, and cook until it wilts.
4) Add the remaining ingredients except the coconut, and cook for another three minutes.
5) Heat another pan (dry); add the coconut and toast for 1–2 minutes, until lightly golden. Add it to the main pan.
6) Serve hot as a main, or an attention-grabbing side:
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Cashew Nuts vs Coconut – Which is Healthier?
- What Matters Most For Your Heart?
- Beyond Supplements: The Real Immune-Boosters!
- Goji Berries: Which Benefits Do They Really Have?
- Our Top 5 Spices: How Much Is Enough For Benefits?
Take care!
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Should We Skip Shampoo?
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small 😎
❝What’s the science on “no poo”? Is it really better for hair? There are so many mixed reports out there.❞
First, for any unfamiliar: this is not about constipation; rather, it is about skipping shampoo, and either:
- Using an alternative cleaning agent, such as vinegar and/or sodium bicarbonate
- Using nothing at all, just conditioner when wet and brushing when dry
Let’s examine why the trend became a thing: the thinking went “shampoo does not exist in nature, and most of our body is more or less self-cleaning; shampoos remove oils from hair, and the body has to produce more sebum to compensate, resulting in a rapid cycle of dry and greasy hair”.
Now let’s fact-check each of those:
- shampoo does not exist in nature: true (except in the sense that everything that exists can be argued to exist in nature, since nature encompasses everything—but the point is that shampoo is a purely artificial human invention)
- most of our body is more or less self-cleaning: true, but our hair is not, for the same reason our nails are not: they’re not really a living part of the overall organism that is our body, so much as a keratinous protrusion of neatly stacked and hardened dead cells from our body. Dead things are not self-cleaning.
- shampoos remove oils from hair: true; that is what they were invented for and they do it well
- the body has to produce more sebum to compensate, resulting in a rapid cycle of dry and greasy hair: false; or at least, there is no evidence for this.
Our hair’s natural oils are great at protecting it, and also great at getting dirt stuck in it. For the former reason we want the oil there; for the latter reason, we don’t.
So the trick becomes: how to remove the oil (and thus the dirt stuck in it) and then put clean oil back (but not too much, because we don’t want it greasy, just, shiny and not dry)?
The popular answer is: shampoo to clean the hair, conditioner to put an appropriate amount of oil* back.
*these days, mostly not actually oil, but rather silicon-based substitutes, that do the same job of protecting hair and keeping it shiny and not brittle, without attracting so much dirt. Remember also that silicon is inert and very body safe; its molecules are simply too large to be absorbed, which is why it gets used in hair products, some skin products, and lube.
See also: Water-based Lubricant vs Silicon-based Lubricant – Which is Healthier?
If you go “no poo”, then what will happen is either you dry your hair out much worse by using vinegar or (even worse) bicarbonate of soda, or you just have oil (and any dirt stuck in it) in your hair for the life of the hair. As in, each individual strand of hair has a lifespan, and when it falls out, the dirt will go with it. But until that day, it’s staying with you, oil and dirt and all.
If you use a conditioner after using those “more natural” harsh cleaners* that aren’t shampoo, then you’ll undo a lot of the damage done, and you’ll probably be fine.
*in fact, if you’re going to skip shampoo, then instead of vinegar or bicarbonate of soda, dish soap from your kitchen may actually do less damage, because at least it’s pH-balanced. However, please don’t use that either.
If you’re going to err one way or the other with regard to pH though, erring on the side of slightly acidic is much better than slightly alkaline.
More on pH: Journal of Trichology | The Shampoo pH can Affect the Hair: Myth or Reality?
If you use nothing, then brushing a lot will mitigate some of the accumulation of dirt, but honestly, it’s never going to be clean until you clean it.
Our recommendation
When your hair seems dirty, and not before, wash it with a simple shampoo (most have far too many unnecessary ingredients; it just needs a simple detergent, and the rest is basically for marketing; to make it foam completely unnecessarily but people like foam, to make it thicker so it feels more substantial, to make it smell nice, to make it a color that gives us confidence it has ingredients in it, etc).
Then, after rinsing, enjoy a nice conditioner. Again there are usually a lot of unnecessary ingredients, but an argument can be made this time for some being more relevant as unlike with the shampoo, many ingredients are going to remain on your hair after rinsing.
Between washes, if you have long hair, consider putting some hair-friendly oil (such as argan oil or coconut oil) on the tips daily, to avoid split ends.
And if you have tight curly hair, then this advice goes double for you, because it takes a lot longer for natural oils to get from your scalp to the ends of your hair. For those of us with straight hair, it pretty much zips straight on down there within a day or two; not so if you have beautiful 4C curls to take care of!
For more on taking care of hair gently, check out:
Gentler Hair Care Options, According To Science
Take care!
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Is stress turning my hair grey?
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
When we start to go grey depends a lot on genetics.
Your first grey hairs usually appear anywhere between your twenties and fifties. For men, grey hairs normally start at the temples and sideburns. Women tend to start greying on the hairline, especially at the front.
The most rapid greying usually happens between ages 50 and 60. But does anything we do speed up the process? And is there anything we can do to slow it down?
You’ve probably heard that plucking, dyeing and stress can make your hair go grey – and that redheads don’t. Here’s what the science says.
Oksana Klymenko/Shutterstock What gives hair its colour?
Each strand of hair is produced by a hair follicle, a tunnel-like opening in your skin. Follicles contain two different kinds of stem cells:
- keratinocytes, which produce keratin, the protein that makes and regenerates hair strands
- melanocytes, which produce melanin, the pigment that colours your hair and skin.
There are two main types of melanin that determine hair colour. Eumelanin is a black-brown pigment and pheomelanin is a red-yellow pigment.
The amount of the different pigments determines hair colour. Black and brown hair has mostly eumelanin, red hair has the most pheomelanin, and blonde hair has just a small amount of both.
So what makes our hair turn grey?
As we age, it’s normal for cells to become less active. In the hair follicle, this means stem cells produce less melanin – turning our hair grey – and less keratin, causing hair thinning and loss.
As less melanin is produced, there is less pigment to give the hair its colour. Grey hair has very little melanin, while white hair has none left.
Unpigmented hair looks grey, white or silver because light reflects off the keratin, which is pale yellow.
Grey hair is thicker, coarser and stiffer than hair with pigment. This is because the shape of the hair follicle becomes irregular as the stem cells change with age.
Interestingly, grey hair also grows faster than pigmented hair, but it uses more energy in the process.
Can stress turn our hair grey?
Yes, stress can cause your hair to turn grey. This happens when oxidative stress damages hair follicles and stem cells and stops them producing melanin.
Oxidative stress is an imbalance of too many damaging free radical chemicals and not enough protective antioxidant chemicals in the body. It can be caused by psychological or emotional stress as well as autoimmune diseases.
Environmental factors such as exposure to UV and pollution, as well as smoking and some drugs, can also play a role.
Melanocytes are more susceptible to damage than keratinocytes because of the complex steps in melanin production. This explains why ageing and stress usually cause hair greying before hair loss.
Scientists have been able to link less pigmented sections of a hair strand to stressful events in a person’s life. In younger people, whose stems cells still produced melanin, colour returned to the hair after the stressful event passed.
4 popular ideas about grey hair – and what science says
1. Does plucking a grey hair make more grow back in its place?
No. When you pluck a hair, you might notice a small bulb at the end that was attached to your scalp. This is the root. It grows from the hair follicle.
Plucking a hair pulls the root out of the follicle. But the follicle itself is the opening in your skin and can’t be plucked out. Each hair follicle can only grow a single hair.
It’s possible frequent plucking could make your hair grey earlier, if the cells that produce melanin are damaged or exhausted from too much regrowth.
2. Can my hair can turn grey overnight?
Legend says Marie Antoinette’s hair went completely white the night before the French queen faced the guillotine – but this is a myth.
It is not possible for hair to turn grey overnight, as in the legend about Marie Antoinette. Yann Caradec/Wikimedia, CC BY-NC-SA Melanin in hair strands is chemically stable, meaning it can’t transform instantly.
Acute psychological stress does rapidly deplete melanocyte stem cells in mice. But the effect doesn’t show up immediately. Instead, grey hair becomes visible as the strand grows – at a rate of about 1 cm per month.
Not all hair is in the growing phase at any one time, meaning it can’t all go grey at the same time.
3. Will dyeing make my hair go grey faster?
This depends on the dye.
Temporary and semi-permanent dyes should not cause early greying because they just coat the hair strand without changing its structure. But permanent products cause a chemical reaction with the hair, using an oxidising agent such as hydrogen peroxide.
Accumulation of hydrogen peroxide and other hair dye chemicals in the hair follicle can damage melanocytes and keratinocytes, which can cause greying and hair loss.
4. Is it true redheads don’t go grey?
People with red hair also lose melanin as they age, but differently to those with black or brown hair.
This is because the red-yellow and black-brown pigments are chemically different.
Producing the brown-black pigment eumelanin is more complex and takes more energy, making it more susceptible to damage.
Producing the red-yellow pigment (pheomelanin) causes less oxidative stress, and is more simple. This means it is easier for stem cells to continue to produce pheomelanin, even as they reduce their activity with ageing.
With ageing, red hair tends to fade into strawberry blonde and silvery-white. Grey colour is due to less eumelanin activity, so is more common in those with black and brown hair.
Your genetics determine when you’ll start going grey. But you may be able to avoid premature greying by staying healthy, reducing stress and avoiding smoking, too much alcohol and UV exposure.
Eating a healthy diet may also help because vitamin B12, copper, iron, calcium and zinc all influence melanin production and hair pigmentation.
Theresa Larkin, Associate Professor of Medical Sciences, University of Wollongong
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Body Scrubs: Benefits, Risks, and Guidance
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝I was wondering whether I should be using a body scrub in the shower, rather than just soap. What should guide me in the choice of a body scrub, and are there any risks to be aware of?❞
Body scrubs are great for giving skin a healthy glow, but are best used sparingly—over-exfoliation leads to the opposite effect (unhappy skin, premature skin aging, etc).
As for contents:
- microplastics are now banned in most places, but you might want to check any products (and their containers!) are BPA-free, pthalate free, etc.
- fragrances in body scrubs are usually a bad idea, and many essential oils have been shown to be endocrine-disruptors, which you do not want:
About the microplastics, harmful artificial chemicals in general, and what constitutes “etc”:
About the fragrances’ (including “natural” essential oils’) endocrine-disrupting shenanigans:
Endocrine-disrupting chemicals: an Endocrine Society scientific statement
So, what might you want to use instead?
If you’re feeling adventurous, you might like to try treating yourself to a pineapple-based mask instead (a muslin cloth soaked in pineapple juice will work just fine; please don’t waterboard yourself though), as the bromelain enzymes (found very generously in pineapple juice) break down dead cells without the need for scrubbing.
Another option is a homemade salt- or sugar-scrub. Put your salt or sugar into a jar, add enough warm water to cover it, leave it for about a day, adding more water if it seems in danger of drying out, until it recrystallizes with a high water content keeping it malleable to the touch; congratulations, you now have a very simple scrub. This should still not be used more than, say, once per week, though.
Last but not least, you might consider investing in a konjac sponge; they gently remove dead skin without damaging living skin. Here’s an example product on Amazon, for your convenience
For more on gentle-yet-effective skincare, you might like to read:
Clean: The New Science of Skin and the Beauty of Doing Less
Enjoy!
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Doctors Are as Vulnerable to Addiction as Anyone. California Grapples With a Response
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BEVERLY HILLS, Calif. — Ariella Morrow, an internal medicine doctor, gradually slid from healthy self-esteem and professional success into the depths of depression.
Beginning in 2015, she suffered a string of personal troubles, including a shattering family trauma, marital strife, and a major professional setback. At first, sheer grit and determination kept her going, but eventually she was unable to keep her troubles at bay and took refuge in heavy drinking. By late 2020, Morrow could barely get out of bed and didn’t shower or brush her teeth for weeks on end. She was up to two bottles of wine a day, alternating it with Scotch whisky.
Sitting in her well-appointed home on a recent autumn afternoon, adorned in a bright lavender dress, matching lipstick, and a large pearl necklace, Morrow traced the arc of her surrender to alcohol: “I’m not going to drink before 5 p.m. I’m not going to drink before 2. I’m not going to drink while the kids are home. And then, it was 10 o’clock, 9 o’clock, wake up and drink.”
As addiction and overdose deaths command headlines across the nation, the Medical Board of California, which licenses MDs, is developing a new program to treat and monitor doctors with alcohol and drug problems. But a fault line has appeared over whether those who join the new program without being ordered to by the board should be subject to public disclosure.
Patient advocates note that the medical board’s primary mission is “to protect healthcare consumers and prevent harm,” which they say trumps physician privacy.
The names of those required by the board to undergo treatment and monitoring under a disciplinary order are already made public. But addiction medicine professionals say that if the state wants troubled doctors to come forward without a board order, confidentiality is crucial.
Public disclosure would be “a powerful disincentive for anybody to get help” and would impede early intervention, which is key to avoiding impairment on the job that could harm patients, said Scott Hambleton, president of the Federation of State Physician Health Programs, whose core members help arrange care and monitoring of doctors for substance use disorders and mental health conditions as an alternative to discipline.
But consumer advocates argue that patients have a right to know if their doctor has an addiction. “Doctors are supposed to talk to their patients about all the risks and benefits of any treatment or procedure, yet the risk of an addicted doctor is expected to remain a secret?” Marian Hollingsworth, a volunteer advocate with the Patient Safety Action Network, told the medical board at a Nov. 14 hearing on the new program.
Doctors are as vulnerable to addiction as anyone else. People who work to help rehabilitate physicians say the rate of substance use disorders among them is at least as high as the rate for the general public, which the federal Substance Abuse and Mental Health Services Administration put at 17.3% in a Nov. 13 report.
Alcohol is a very common drug of choice among doctors, but their ready access to pain meds is also a particular risk.
“If you have an opioid use disorder and are working in an operating room with medications like fentanyl staring you down, it’s a challenge and can be a trigger,” said Chwen-Yuen Angie Chen, an addiction medicine doctor who chairs the Well-Being of Physicians and Physicians-in-Training Committee at Stanford Health Care. “It’s like someone with an alcohol use disorder working at a bar.”
From Pioneer to Lagger
California was once at the forefront of physician treatment and monitoring. In 1981, the medical board launched a program for the evaluation, treatment, and monitoring of physicians with mental illness or substance use problems. Participants were often required to take random drug tests, attend multiple group meetings a week, submit to work-site surveillance by colleagues, and stay in the program for at least five years. Doctors who voluntarily entered the program generally enjoyed confidentiality, but those ordered into it by the board as part of a disciplinary action were on the public record.
The program was terminated in 2008 after several audits found serious flaws. One such audit, conducted by Julianne D’Angelo Fellmeth, a consumer interest lawyer who was chosen as an outside monitor for the board, found that doctors in the program were often able to evade the random drug tests, attendance at mandatory group therapy sessions was not accurately tracked, and participants were not properly monitored at work sites.
Today, MDs who want help with addiction can seek private treatment on their own or in many cases are referred by hospitals and other health care employers to third parties that organize treatment and surveillance. The medical board can order a doctor on probation to get treatment.
In contrast, the California licensing boards of eight other health-related professions, including osteopathic physicians, registered nurses, dentists, and pharmacists, have treatment and monitoring programs administered under one master contract by a publicly traded company called Maximus Inc. California paid Maximus about $1.6 million last fiscal year to administer those programs.
When and if the final medical board regulations are adopted, the next step would be for the board to open bidding to find a program administrator.
Fall From Grace
Morrow’s troubles started long after the original California program had been shut down.
The daughter of a prominent cosmetic surgeon, Morrow grew up in Palm Springs in circumstances she describes as “beyond privileged.” Her father, David Morrow, later became her most trusted mentor.
But her charmed life began to fall apart in 2015, when her father and mother, Linda Morrow, were indicted on federal insurance fraud charges in a well-publicized case. In 2017, the couple fled to Israel in an attempt to escape criminal prosecution, but later they were both arrested and returned to the United States to face prison sentences.
The legal woes of Morrow’s parents, later compounded by marital problems related to the failure of her husband’s business, took a heavy toll on Morrow. She was in her early 30s when the trouble with her parents started, and she was working 16-hour days to build a private medical practice, with two small children at home. By the end of 2019, she was severely depressed and turning increasingly to alcohol. Then, the loss of her admitting privileges at a large Los Angeles hospital due to inadequate medical record-keeping shattered what remained of her self-confidence.
Morrow, reflecting on her experience, said the very strengths that propel doctors through medical school and keep them going in their careers can foster a sense of denial. “We are so strong that our strength is our greatest threat. Our power is our powerlessness,” she said. Morrow ignored all the flashing yellow lights and even the red light beyond which serious trouble lay: “I blew through all of it, and I fell off the cliff.”
By late 2020, no longer working, bedridden by depression, and drinking to excess, she realized she could no longer will her way through: “I finally said to my husband, ‘I need help.’ He said, ‘I know you do.’”
Ultimately, she packed herself off to a private residential treatment center in Texas. Now sober for 21 months, Morrow said the privacy of the addiction treatment she chose was invaluable because it shielded her from professional scrutiny.
“I didn’t have to feel naked and judged,” she said.
Morrow said her privacy concerns would make her reluctant to join a state program like the one being considered by the medical board.
Physician Privacy vs. Patient Protection
The proposed regulations would spare doctors in the program who were not under board discipline from public disclosure as long as they stayed sober and complied with all the requirements, generally including random drug tests, attendance at group sessions, and work-site monitoring. If the program put a restriction on a doctor’s medical license, it would be posted on the medical board’s website, but without mentioning the doctor’s participation in the program.
Yet even that might compromise a doctor’s career since “having a restricted license for unspecified reasons could have many enduring personal and professional implications, none positive,” said Tracy Zemansky, a clinical psychologist and president of the Southern California division of Pacific Assistance Group, which provides support and monitoring for physicians.
Zemansky and others say doctors, just like anyone else, are entitled to medical privacy under federal law, as long as they haven’t caused harm.
Many who work in addiction medicine also criticized the proposed new program for not including mental health problems, which often go hand in hand with addiction and are covered by physician health programs in other states.
“To forgo mental health treatment, I think, is a grave mistake,” Morrow said. For her, depression and alcoholism were inseparable, and the residential program she attended treated her for both.
Another point of contention is money. Under the current proposal, doctors would bear all the costs of the program.
The initial clinical evaluation, plus the regular random drug tests, group sessions, and monitoring at their work sites could cost participants over $27,000 a year on average, according to estimates posted by the medical board. And if they were required to go for 30-day inpatient treatment, that would add an additional $40,000 — plus nearly $36,000 in lost wages.
People who work in the field of addiction medicine believe that is an unfair burden. They note that most programs for physicians in other states have outside funding to reduce the cost to participants.
“The cost should not be fully borne by the doctors, because there are many other people that are benefiting from this, including the board, malpractice insurers, hospitals, the medical association,” said Greg Skipper, a semi-retired addiction medicine doctor who ran Alabama’s state physician health program for 12 years. In Alabama, he said, those institutions contribute to the program, significantly cutting the amount doctors have to pay.
The treatment program that Morrow attended in spring of 2021, at The Menninger Clinic in Houston, cost $80,000 for a six-week stay, which was covered by a concerned family member. “It saved my life,” she said.
Though Morrow had difficulty maintaining her sobriety in the first year after treatment, she has now been sober since April 2, 2022. These days, Morrow regularly attends therapy and Alcoholics Anonymous and has pivoted to become an addiction medicine doctor.
“I am a better doctor today because of my experience — no question,” Morrow said. “I am proud to be a doctor who’s an alcoholic in recovery.”
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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