Let’s talk about breastfeeding. First of all, I think that it’s wonderful that the “breast is best” campaign has led to more support for women to breastfeed their babies. Over the last several years, there are more and more supportive organizations to help mothers with breastfeeding, including La Leche League, Milkworks, and lactation consultants that can help guide mothers to successful breastfeeding; “mother’s rooms” for nursing mothers appear all over the place, more public support for women to breastfeed and more information about the benefits of breastfeeding. This is all wonderful. Breastfeeding offers so many cognitive health benefits and supports bonding, for both baby and mother.

However, as a mental health therapist that specializes in perinatal mental health, I have seen the dark side of this motto. It seems that for many, breastfeeding has become what “good” mothers do. Well, there are many reasons why a woman may choose or not be able to breastfeed. There may be trauma issues, medical issues, or even employment barriers to breastfeeding. Women may struggle with supply issues and a baby going to the NICU especially can create barriers to successful breastfeeding. The “breast is best” motto has led to a view that formula is bad and that a mother feeding her baby with formula is “less than” in some way. This perspective may lead to a lot of self-criticism for mothers who do not or cannot breastfeed their babies. I have seen many women struggle tirelessly attempting to breastfeed and ultimately develop negative views of themselves if unable to succeed. This struggle can be a contributing factor to postpartum depression.

Often, mothers love their babies so much before they’re even born and put so much pressure on themselves to be perfect and meet their babies’ every single need. The desire to meet your babies’ needs is instinctive and how they survive. There is plenty of information out there that is helpful, but there is also plenty that adds to the pressure. There is also plenty of judgment from some about a mother not breastfeeding.

Over the years, I have seen mothers who feel their bodies have failed them. Mothers who question if they should’ve been a mom. Mothers feeling like they’ve already failed at motherhood. Many have identified this as a contributing factor and/or a major focus of their postpartum depression and/or anxiety. Many of these mothers have expressed pressure from others for their decisions regarding how they feed their baby.

I am supportive of breastfeeding, pumping and bottle feeding, and formula. I’m not a doctor and I don’t know all the evidence on pros vs. cons. However, I do feel confident in saying that these are the most important: your baby needs to be fed sufficiently and how that is happening is secondary; mom needs to take care of herself and choose what option is best for her.

The Fed is Best Foundation is a wonderful resource that promotes safe infant feeding, both in the form of breastfeeding and bottle feeding or a combination of both, while providing education and information on infant feeding, including risks of insufficient breast milk intake. In addition, they “strive to eliminate infant feeding shaming while prioritizing perinatal mental health.”

One final message: Mom, you are enough. If you love your baby and do what you can to take care of your baby and meet their needs, you are being a good mom. I know all your loved ones can tell you this, but sometimes it’s still hard to believe it. If you feel like you could benefit from additional support in the form of therapy, please feel free to contact me. I’d love to help you look in the mirror and be proud of the mother you are.

In June, I attended the Midwest Conference for Problem Gambling and Substance Abuse. As with every year, this conference was filled with many wonderful presentations. Two that stood out the most to me were both presented by Cam Adair, Founder of Game Quitters. I found these as being very useful and relevant to my practice as they were about issues I have frequently encountered in my practice over the years. During his presentations, I learned some very helpful information about video gaming, video game addiction, and the crossover between gambling and video gaming.

First, I must begin by pointing out why video gaming and gaming disorder is an area that needs some attention. Gaming has been exploding and continues to grow. 10% of students report gaming at least 5 hours per day. Colleges are adding Esports teams and offering scholarships for E-Sport competitors. Esports are may be included in the 2020 Olympics. Some gamers can make a living by streaming online on YouTube or Twitch. There are two billion gamers worldwide and 1-3% of gamers are addicted. As of June 18^, 2018, the World Health Organization officially recognized “Gaming Disorder.” Gaming Disorder is a mental health problem, depression and anxiety being co-factors, but gaming itself is part of the problem.

Mr. Adair’s presentations spoke about the perspective of a video gamer. Gaming fulfills needs: it can be a temporary escape, it’s a social connection, gamers see constant measurable growth in a game, it is a safe place to fail, and it can give them purpose. Games are intentionally designed to keep you hooked using state of the art behavioral psychology. Games are fully immersive and provide dopamine overload. Compared to this, the rest of the world can seem very boring. Overexposure to gaming causes structural changes to your brain and numbs the pleasure response. Games can erode one’s willpower. Gamers can become desensitized to the rest of the world when compared to a video game, where you are immersed in constant action and stimulation. Video games are something where one has much more control than they ever will in the real world. For many gamers, this is their social life and as opposed to in real life, when you don’t like someone, or they are bullying you, you can block them or take other measures to reduce exposure to them. On the other hand, many gamers are on the defensive to those outside of this community because society has shamed gamers for being “lazy,” “wasting their potential,” and being told that their online friends are not their “real friends.” This has created an “us vs. them” mentality. This stigma and shame has created barriers to seeking help. Like everyone, a gamer struggling with a gaming disorder needs to feel understood and not judged.

Gaming can be a healthy recreational activity. However, it can cross over to be a problem. Here are some tips that Mr. Adair provided when battling a gaming addiction. He recommended a 90-day detox to reset the brain, break attachments to gaming, create a contrast, and build new habits. He suggested to fill the void that stopping gaming has left with three types of activities. 1) something that is mentally engaging (such as learning a new skill), 2) resting (at home), and 3) new social activity (make new friends outside of gaming). He suggested adding structure with a daily agenda. Create a system of accountability and support. Family and friends would be great for this. Another option is www.gamequitters.com. Remove gaming devices from the bedroom. Block access to games, apps, and other problematic websites. For parents: stay firm and consistent in setting boundaries. Require exercise and homework to be complete before being allowed to game. When you are still gaming, mix it up by playing less than two hours at a time and not playing every day. Find an alternative to YouTube or gaming after school before doing homework. When trying to cut back from gaming or stopping gaming altogether, expect as with any addiction, that there will be compulsions to play, cravings, and withdrawal, especially in the form of boredom. Stopping gaming will mean losing friends, conversation topics, loss of the “gamer” identity, nostalgia to play, and struggles with time management.

Where gaming is crossing the line into gambling is in the form of something called “loot boxes.” These loot boxes are something that players can purchase and they can contain anything from simple customization options for a player’s avatar or character to game-changing equipment such as weapons and armor. They don’t know what’s in these loot boxes, but they’re spending money with the chance of winning something of value. This is the definition of gambling. These are found in many free-to-play games, yet individuals are spending large quantities of money at times to obtain these loot boxes. Fortnite, a popular game has made over $1 billion in less than a year. So, not only can video games become addictive, causing negative affects on one’s life, but it can also cause significant financial loss, much like gambling.

The Nebraska Gamblers Assistance Program (GAP) pays for confidential counseling with certified problem gambling providers to Nebraskans and their families who suffer a gambling addiction.

A list of all GAP-certified counselors in Nebraska is located at

problemgambling.nebraska.gov

GAP 24/7 Helpline – Call 1-800-522-4700 

This presentation is sponsored by and paid for by the Nebraska Gamblers Assistance Program

Gambling can be a fun activity for many people. However, 2-3% of U.S. citizens are reported to have a problem with gambling. Here are some ways to minimize your risk of gambling becoming a problem for you:

Always gamble with a predetermined amount of money that you can afford to lose

Set limits on time you have available to gamble, both duration and frequency

Gamble for fun, not to win money

Gamble only with money set aside for your entertainment budget

Balance recreational gambling with other healthy hobbies and activities

Know the risks before you bet

Keep gambling a social activity

Bet only what you can afford to lose

Know when to quit, don’t chase your losses

Realize that knowing more won’t guarantee a win

Never borrow money to gamble with

Understand that everyone loses over time

Play for fun, not just for money

Never gamble when stressed, depressed, or in recovery

Don’t play to escape

Avoid mixing gambling with alcohol or other substances

Know what’s legal to play in your area and avoid gambling illegally

Know where to get help if you need it

The Nebraska Gamblers Assistance Program (GAP) pays for confidential counseling with certified problem gambling providers to Nebraskans and their families who suffer a gambling addiction.

A list of all GAP-certified counselors in Nebraska is located at problemgambling.nebraska.gov

GAP 24/7 Helpline – Call 1-800-522-4700

This presentation is sponsored by and paid for by the Nebraska Gamblers Assistance Program