Joanne Marcone, Pharm.D., LPC

Psychotherapist and Substance Abuse Counselor

Individual, Couples, Family Therapy

​​First Lady speaks up for Mental Health
By Bethany Bray                           March 6, 2015  

Counseling Today, a publication of the American Counseling Association (ACA)

 (Description: First Lady Michelle Obama speaks at the launch of the Campaign to Change Direction, March 4 in Washington, D.C.]​

Imagine if people reacted to a friend or neighbor’s diagnosis of bipolar disorder or depression no differently than if they just learned that person has breast cancer or heart disease. “Whether an illness affects your heart, your leg or your brain, it’s still an illness. It shouldn’t be treated differently,” said First Lady Michelle Obama at a mental health summit in Washington, D.C. this week. “There should be absolutely no stigma around mental health. None. Zero.” 

Normalizing mental illness in the United States will take a cultural shift, a shift that will hopefully begin as more and more people talk about it and share their stories. This was the message at Wednesday’s launch of the Campaign to Change Direction, a joint project between numerous mental health, business, nonprofit and government agencies that aims to break down the stigma surrounding mental health.  First Lady Michelle Obama was the event’s keynote speaker. 

The campaign asks people to pledge to learn and spread awareness of the five signs of emotional suffering that may indicate a person needs help: withdrawal, agitation, hopelessness,  decline in personal care and change in personality (see sidebar, below).

We want these five signs of suffering to be as well-known as the warning signs for a stroke or heart attack, said Todd Mahr, a regional partner of the campaign in LaCrosse, Wisconsin, a physician and director of pediatric allergy and immunology at Gundersen Health Systems. “We’re undertaking a marathon, not a sprint,” said Mahr. “With this launch, I have hope.” 

The campaign’s ultimate goal is to change the landscape in America so that mental health has the same importance and value as physical health. Campaign partners, from Aetna to Easter Seals and Volunteers of America, have pledged to host programs and distribute materials over the next five years to further the campaign’s mission of “changing the national conversation about mental health.”

 “It is really time to flip the script on mental health in this country. Getting help is not a sign of weakness. It’s a sign of strength.,” said Obama. “Those who suffer from mental illness should be able to get the help they need. End of story.”

According to data from the National Institute of Mental Health (NIMH), an estimated 42.5 million Americans – about one in every five adults – experience a diagnosable mental disorder in a given year.

“We want to create a new normal, where asking for help (for mental illness) is not a sign of weakness,” said Angelo McClain, CEO of the National Association for Social Workers. “We want people to be able to raise their hands and say ‘I need help’.”

At Wednesday’s event, the first lady urged people to listen, connect and offer compassion to those with mental illness so they can get the help they need. “Reach out and have those tough conversations with a friend,” she said.

Obama’s keynote speech concluded a morning of discussion and talks on mental health issues. Video of the event was streamed live on the Internet and is posted at

“We will save lives in the year ahead,” Obama concluded. “Let’s roll up our sleeves and keep getting stuff done.” 

The Campaign to Change Direction’s five signs that may mean someone is in emotional pain and needs help:
Personality change: Sudden or gradual changes in the way that someone typically behaves. He or she may behave have in ways that don’t seem to fit the person’s values, or the person may just seem different.
More frequent problems controlling temper, irritability or an inability to calm down. Symptoms may also include insomnia or explosive displays of anger in response to minor problems.
 Pulling away from family and friends, not taking part in activities the person used to enjoy. In more severe cases he or she may start missing school or work. These symptoms should not to be confused with the behavior of someone who is more introverted, but a marked change in someone’s typical sociability.
Poor self-care:
A deterioration of personal hygiene, which may include things like not bathing or wearing unclean clothes. Lack of self-care can also include abuse of alcohol or illicit substances or engaging in other risky behaviors.
An inability to hope or look forward to anything. Symptoms may also include feelings of worthlessness or guilt. May also include statements such as “The world would be better off without me,” which may be a sign of suicidality. 

HEROIN          Girlfriend            Sports

  Family             Food          ALCOHOL

Video Games  OXYCONTIN     Church         God     COCAINE         Sleep       Sex   BEER     College    Marriage 


D​​​​​​​​rug & Alcohol Addiction is a Brain Disease

Nobody starts out intending to develop an addiction, but many people

get caught in it's snare. Why some and not others? It is a combination

of inherited genes and environmental factors. Environmental factors

include family beliefs & attitudes and exposure to a peer group that 

encourages drug use. Once a person starts using a drug, genetic or

inherited factors can influence the rate at which an addiction develops.

Scientific consensus recognizes addiction as a chronic disease that changes

both brain structure and function. Just as high blood pressure damages the

heart and diabetes is due to impairment of the pancreas, addiction hijacks

the brain. This happens as the brain goes through a series of changes

beginning with the feeling of pleasure and ending with compulsive use.

The Pleasure Center of the Brain

The "pl;ease center" in the brain is actually composed of a small group of cells located in an area called the nucleus accumbens. The release of the neurotransmitter dopamine in this area of the brain cause a feeling of intense pleasure. ​ All drugs of abuse, from nicotine to heroin, cause a powerful surge of dopamine in the nucleus accumbens. The brain registers all pleasures

in the same way - whether they originate with a drug, a large raise at work, a sexual encounter,

a satisfying meal, or a series of compliments. Although the main pathway of addiction is similar

for all substances and behaviors, no one knows why people develop addictions to different things.

Behavioral Addictions

Addiction to drugs is not the only problem. People struggle with all types of "attachments" to "things" rather than people. When did people get so busy and stressed that it was easier to cope by shopping or eating, or driving fast cars or visiting pornography sites on the internet? What they are really doing is "distracting" their attention away from an issue they don't have time to deal with; or the issue is too painful to deal with; or they are at their breaking point (a crossroad) and cannot handle more stress. And distraction can work really well. Something about the behavior is rewarding. Gradually, a person's energy becomes so focused on the behavior that it becomes an addiction.The behavior takes priority over family, friends, love, school, life . . . Examples of behavioral addictions include addictions to food (binge eating – or avoiding food as in anorexia); compulsive shopping;  sex &/or pornography;  exercise; gambling; internet; gaming; cosmetic surgery; and addiction to risky behavior such as sky diving or rock climbing. I knew a young man who was "addicted" to risky behavior. He liked to do things like hopping onto a passing freight train to "catch" a ride; sky diving, race care driving; and he often flew to Las Vegas for a weekend of card playing and gambling. He never wore a helmet when he rode his mountain bike to and from work. His life ended abruptly when the tire of his mountain bike hit a rock and he was throw headfirst onto a concrete sidewalk. He was a very intelligent man. He was a physician, a father, a husband. He was loved by everyone. Yes, people die from behavioral addictions too.




                                                                                                                                by Joanne Marcone, 8-15-2015

Physical RecoveryAbstinence from the addictive behavior is a must.  An alcoholic can not get sober until he/she stops drinking; a drug addict must stop using; and/or a person with an eating disorder must follow a meal plan.  Those with depression must get out of bed, take a shower, and change maladaptive thought processes.  Engaging in sick behaviors will not get you well no matter how many self help books you read. You can not think your way into sober living – you must live your way into sober thinking.

Treatment Team:  IT TAKES A VILLAGE – Involve trained professionals as much as possible.  Get a therapist – family therapist – dietician (if applicable) – psychiatrist - and listen to their advice.  They are trained professionals with valuable knowledge about recovery from your illness.

Support Meetings:  There all types of support meetings.  Twelve step meetings are available (and free) for all types of addictions and disorders.  Attend in person if possible or seek on-line meetings if unable to travel.  Other support meetings include process groups, DBT groups, trauma groups, domestic abuse groups, etc.  Check out social services, churches, treatment centers to find groups that meet your needs.

Self Care:  Never get too hungry – angry – lonely –tired (HALT).  This will impede recovery from any disorder.

Journal:  You can only hold a little bit of information in conscious memory. That is why when you are trying to sort something out you tend to think the same thing over and over. You are unable to go beneath that thought until you free up some space in memory for new information to be retrieved. Writing it down on paper is the best way to do this. Once the thought is on paper, a new one will come up. It is amazing what goes on beneath the surface. If you have trouble starting, just ask you therapist for ideas.

Telephone:  Isolation is part of ALL mental disorders.  Call someone at least once per day.

Sponsor:  Sponsors are people in recovery willing to guide you through the recovery process.  Generally, sponsors are found in 12-step programs and will assist you with working the 12-step program.

GET INVOLVED:  Speak at meetings.  Let others get to know you.  Join a group and help others.  Get to meetings early and greet newcomers or help set up.  Talk to people after meetings.  Make friends and learn to connect spiritually with other women or men. You never have to be alone again. If fact, your recovery journey cannot be made alone.Humans are social creatures. We are made to be with others. So, let others help you when you are in need. Help someone else when you can.

                   These principles are simple but not easy. They are always worth the effort! 

This young mother is addicted to cosmetic surgery. She is lying to her husband; willing to hurt herself to have her nose fixed, exercises compulsively to become excessively thin, & is devastated because of a blemish. She could be suffering from Body Dysmorphic Disorder. That is a psychological disorder in which the person spends hours each day trying to conceal flaws that are not there. Another possibility is some type of Eating Disorder.


Dopamine works here

​​This young man's thoughts are turning more toward drugs & away from family,

friends, God, & life goals. A mental obsession for drug use is a hallmark symptom of 

addiction. Without help soon, he will lose his ability to "choose" to use. He will

continue to use drugs despite consequences to himself, his career, & his family. 


 by Joanne Marcone  3-16-15

     "I need a new outfit" 

"I will tell my husband my purse was stolen and use the money for botox - he'll never know"

   "I will break my nose so I can get it fixed better" . . . ."I need to exercise more so I can get this fat off" . . . "EeekI have a pimple . . ."