your guide to...
Mental health and alcohol and other drug problems
Your guide to...
Mental health and alcohol and other drug problems
Introduction This pamphlet provides a brief introduction to co-existing mental health and alcohol and other drugs (AOD) problems. It is suitable for the general public. For more detailed information, see your doctor, other health professional or local drug treatment service. A list of contact details are provided on the back cover of this pamphlet.
Many people who have problems with alcohol and other drugs may also have mental health issues such as anxiety, depression or psychosis. Problematic drug use may include dependence on, or misuse of, legal drugs such as alcohol and prescription medicines, or illegal drugs such as cannabis or methamphetamines.
WHAT IS DUAL DIAGNOSIS? Dual diagnosis refers to a person diagnosed as having an alcohol or drug problem in addition to a psychiatric diagnosis, for example, someone misusing cannabis who also has depression or schizophrenia. It is also known by a range of other terms, including “comorbidity”, “comorbid disorders” and “co-occurring disorders”. A PERSON WITH A MENTAL ILLNESS MAY USE ALCOHOL OR OTHER DRUGS TO HELP COPE WITH THE SYMPTOMS OF THEIR ILLNESS AND THIS CAN DEVELOP INTO PROBLEMATIC DRUG USE.
WHAT COMES FIRST: PROBLEMATIC DRUG USE OR MENTAL ILLNESS? It can be difficult to tell which occurs first as there are many reasons why a person may experience both problematic drug use and a mental illness. It may be that the mental illness contributed to the problematic drug use, or that the problematic drug use is related to the mental illness. It may also be that other issues increase the risk that a person may develop a mental illness or experience problematic drug use. For example: ÎÎ
A person with a mental illness may use alcohol or other drugs to help cope with the symptoms of their illness and this can develop into problematic drug use.
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Just like everyone else, a person with a mental illness may use alcohol or other drugs for a range of reasons, including curiosity, boredom, a desire for excitement, for social reasons or to cope with problems.
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For some people, drug use may “trigger” a mental illness. Problematic drug use may affect many aspects of a person’s life including their family, work or education. These kinds of issues may increase the risk that a person may develop mental health issues such as depression.
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There are a number of risk factors—physiological, genetic, social or environmental—that can increase the chance of a person developing a mental illness and/or problematic substance use. These risk factors include things like family problems and economic hardship.
WHAT ARE THE EFFECTS OF A DUAL DIAGNOSIS? Both mental health problems and problematic alcohol and other drug use have a significant impact on people’s lives and the lives of those around them. These problems may affect their health, relationships, education and employment. For example, family and friends may become frustrated if the person with the dual diagnosis does not recognise that their drug use or mental illness, or both, is causing problems. Legal and health problems can also add to the strain on personal, financial and work relationships. People with a dual diagnosis may also be faced with issues such as: ÎÎ
difficulties with diagnosis
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difficulties with completing treatment
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increased risk of relapse
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interactions between drugs (both prescribed and illegal) and mental health problems
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the stigma associated with dual diagnosis.
The impact of a dual diagnosis is different for everyone. It depends on a range of factors including the: ÎÎ
type of mental illness and its severity
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types of drugs used and the frequency of use
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person’s individual situation, including age, health, and current living circumstances
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treatment and support received.
Difficulties with diagnosis Identifying a dual diagnosis can be difficult because the person making the diagnosis needs to establish whether the issues the client is experiencing are due mainly to the drugs or the mental illness, or result from a combination of both. For example, the effects of drug use and the symptoms of drug withdrawal can sometimes imitate, or hide, a mental health problem.
TREATMENT ISSUES People with a dual diagnosis can be especially difficult to engage in treatment. They may deny or rationalise their drug use and mental health issues. They may also find it difficult to comply with and complete their treatment program because of the added complications associated with both mental health issues and problematic drug use. Not completing a treatment program can increase the length and severity of their illness. In order to recover fully, an individual with a dual diagnosis needs treatment for both problems. Focusing on one problem does not mean the other will “go away”.
INCREASED RISK OF RELAPSE People with a dual diagnosis have an increased risk of relapse for either condition. The relapse of one condition will also increase the risk of relapse in the other condition.
CHRONIC CONDITIONS CAN BE WORSENED Alcohol and other drug dependence and mental illnesses such as psychosis and mood disorders (e.g. anxiety and depression) are long-term conditions that can interact and impact on each other. With a dual diagnosis, one problem can increase the risk of the other, or an existing disorder can become more problematic with the other present. For example,
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psychotic symptoms such as hallucinations and paranoia can be intensified and may increase in frequency if alcohol or other drugs are used. Alcohol and other drug use can also increase the symptoms of anxiety and depression and the frequency and intensity of mood swings.
RISK OF OVERDOSE AND INTERACTIONS Interactions between prescribed medications and alcohol or illicit drugs can be dangerous. Some drugs and medications can interact and reduce the effectiveness of medications or produce unexpected side effects. A person with a mental health problem who is taking prescribed medication and consuming alcohol or other drugs may find it difficult to judge how much to take. The risk of overdose is therefore greatly increased. It is important that the person who is prescribing a medication be informed of any intended (or actual) alcohol or other drug use so that they can adjust dosages of medications to reduce the risk of unwanted effects.
Other consequences of dual diagnosis Research has found that people with a dual diagnosis experience higher rates of: ÎÎ
homelessness and social isolation
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infections and physical health problems
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suicidal behaviour
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violence, antisocial behaviour and time in jail.
DEALING WITH STIGMA People who have a mental health issue often have to deal with being stigmatised and the same can be said of people with problematic alcohol and other drug use. People who live with a dual diagnosis can be doubly stigmatised, and this can have an impact on their ability to deal effectively with their conditions. Peer support groups for either condition and support groups that deal specifically with dual diagnosis can offer valuable assistance in dealing with stigmatisation. Health practitioners may also be able to provide advice or other assistance.
HOW IS A DUAL DIAGNOSIS IDENTIFIED? Identifying a dual diagnosis can be difficult and involves a comprehensive assessment process to identify all areas that are problematic for the person. This assessment should be carried out by a health professional and should include a discussion about issues related to both mental health and alcohol and other drug use. Sometimes it can be difficult to diagnose both problems because many of the symptoms of mental illness are similar to those associated with problematic alcohol or other drug use.
HOW IS A DUAL DIAGNOSIS TREATED? A range of treatments is available to assist someone with a dual diagnosis. Research suggests that, in order to recover fully, an individual with a dual diagnosis needs treatment for both problems at the same time. Both mental health and drug treatment services are able to provide treatment for both disorders. For cases that are more complex, there are specialist dual diagnosis services that provide an integrated program for each condition, helping people recover from both conditions in one setting and at the same time. A doctor or other health professional may prescribe a separate treatment for each condition. This may involve seeing more than one doctor or service. For example, methadone may be prescribed as a substitute for heroin, while the mental illness may be
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treated with psychiatric medication or counselling. In some cases, one treatment team may administer both treatments but, where several health professionals are treating a client, it is important that all involved parties communicate their treatment plans.
WHERE TO GET HELP Help is available through local self-help services and support groups. Contact details for some of these services are listed at the back of this pamphlet. Many counselling, information and support services can be accessed anonymously through telephone services, but in order to receive the best assistance with mental health issues and problematic drug use it is best to consult a professional face-to-face. A good starting point is your family doctor or local community health centre. They may not be able to manage the condition on their own but they will have access to a range of other professionals and services. The best treatment for dual diagnosis is likely to be through mental health and drug treatment services. These services exist both as specialist services and as part of a larger service such as a hospital or community health centre. The ideal outcome for the person will be achieved if the services work in partnership and involve the client in the decisionmaking process. Many services employ, or have access to, a dual diagnosis specialist who is trained to assess and treat both conditions at once.
DO YOU HAVE A DUAL DIAGNOSIS? If you have a dual diagnosis, it is important that you learn to deal with the symptoms. Dealing with what may be difficult or challenging symptoms can help you develop coping strategies and relapse prevention skills. This can enable you to increase the quality of your life and of those around you. Assistance and support from friends and family can help you take the first steps and provide valuable support through your treatment.
Are you supporting someone who has a dual diagnosis? A dual diagnosis does not just affect the person with the diagnosis, but can also impact on the people around them. If a family member or friend has a dual diagnosis there are several things you can do to support them and to support yourself: ÎÎ
Be clear about the role you will be playing in someone’s treatment program. Think about what you are willing to do and what you won’t do. For example, can they call you at work if they need to chat?
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Make sure you are well informed. The information and support services (listed on the back of this pamphlet) can provide information about alcohol and other drugs, what to expect during withdrawal, and how to support someone with a mental health issue.
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It’s important that you have support available and someone to talk to when things become difficult. The support services listed at the back of this pamphlet can provide counselling, additional information and referral to services. Specialist family services and support groups also exist and usually operate on a peer support model where family members and friends of people who use drugs, provide support and information and share their own experiences.
THE BEST TREATMENT FOR DUAL DIAGNOSIS IS LIKELY TO BE THROUGH MENTAL HEALTH AND DRUG TREATMENT SERVICES.
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COMMON TERMS Assessment Specific methods, instruments and tests used in screening, identification and diagnosis of mental illness or problematic alcohol and other drug use in individuals. Dependence When a substance is central to a person’s life and they have trouble cutting down their use and/or experience symptoms of withdrawal when trying to cut down, they are said to be dependent on that substance. Dependence on a substance can be physical, psychological, or both. Drug Any substance—solid, liquid or gas—that brings about physical and/or psychological changes in the body. Dual diagnosis Refers to a person diagnosed as having an alcohol or drug problem in addition to another diagnosis, usually psychiatric; for example, having alcoholism in combination with a mood disorder or schizophrenia. Dual diagnosis is also known as comorbidity or cooccurring disorders. Lapse The use of alcohol or other drugs once or twice during withdrawal or treatment, or during a period of attempting to change the person’s drug use. A lapse may result in a relapse (see page 11) to previous drugusing behaviour, or may be considered a mistake and an opportunity to gain insight into the problems that may contribute to the drug misuse. Mental illness A cognitive, emotional, social or behavioural disorder that affects the way a person thinks, feels and behaves. Overdose When the amount of the drug taken exceeds the body’s ability to cope, resulting in stupor, coma, respiratory depression, or death.
Pharmacotherapy 11 The use of medications in response to drug dependence. Used to ease withdrawal discomfort, as maintenance substitution (for example, methadone) or to reduce craving (for example, nicotine replacement therapy). Psychosis Any significant mental disorder, characterised by a loss of contact with reality. Relapse A recurrence of harmful drug use or mental illness after a period of improvement. Relapse is common among people who are drug-dependent when they are attempting to stop their drug use. Self-help group Voluntary group dedicated to assisting recovery from mental illness and substance use dependence. Treatment Assisting people to address problems relating to their mental illness and/or drug use. Treatment can be conducted as part of an in-patient or residential program, on an out-patient basis or through a home-based withdrawal program. Withdrawal Withdrawal describes a set of symptoms that can occur when a person who uses drugs cuts down or stops the use of a particular drug. Withdrawal symptoms can range from mild to severe, and are different depending upon what drug it is the person is withdrawing from.
Further assistance For information, counselling, advice or other assistance, contact the alcohol and drug informtion service in your state and territory. Australia-wide Family Drug Support: 1300 368 186 The Mental Health Carers ARAFMI Australia www.arafmiaustralia.asn.au SANE Australia: 1800 187 263 Counselling Online: www.counsellingonline.org.au ACT Alcohol and drugs: (02) 6207 9977 Mental Health Carers ARAFMI NSW: (02) 9332 0700 or 1800 655 198 NSW Alcohol and drugs: (02) 9361 8000 (Sydney) 1800 422 599 (NSW) Mental Health Carers ARAFMI NSW: (02) 9332 0700 or 1800 655 198 NT Alcohol and drugs: 1800 131 350 Mental Health Carers NT: (08) 8948 1051 Qld Alcohol and drugs: 1800 177 833 Mental Health Carers ARAFMI QLD: (07) 3254 1881 or 1800 351 881 SA Alcohol and drugs: 1300 131 340 Carers SA: 1800 242 636 Tas Alcohol and drugs: 1800 811 994 ARAFMI Tasmania: (03) 6228 7448 (7pm–10pm 7 days per week) Vic Alcohol and drugs: 1300 85 85 84 (information) 1800 888 236 (counselling) Family Drug Help: 1300 660 068 ARAFEMI: (03) 9810 9300 or 1300 550 265 WA Alcohol and drugs: (08) 9442 5000 (Perth) 1800 198 024 (WA) Mental Health Carers ARAFMI (WA) Inc: (08) 9427 7100 or 1800 811 747 Produced by the Australian Drug Foundation © 2012 Celebrating more than 50 years of service to the community, the Australian Drug Foundation is Australia’s leading body committed to preventing alcohol and other drug problems in communities around the nation. www.adf.org.au For more copies of this brochure, contact Australian Drug Foundation: Post: PO Box 818 North Melbourne VIC 3051 E-mail: druginfo@adf.org.au Web: www.shop.adf.org.au Information provided in this brochure is offered for general purposes, and should not be considered a substitute for specific, professional advice.