Substance Abuse and Mental Health

When you have both a substance abuse problem and a mental health issue such as depression, bipolar disorder, or anxiety, it is called a co-occurring disorder or dual diagnosis. Dealing with substance abuse, alcoholism, or drug addiction is never easy, and it’s even more difficult when you’re also struggling with mental health problems, but there are treatments that can help. With proper treatment, support, and self-help strategies, you can overcome a dual diagnosis and reclaim your life.

Understanding the link between substance abuse and mental health

In a dual diagnosis, both the mental health issue and the drug or alcohol addiction have their own unique symptoms that may get in the way of your ability to function, handle life’s difficulties, and relate to others. To make the situation more complicated, the co-occurring disorders also affect each other and interact. When a mental health problem goes untreated, the substance abuse problem usually gets worse as well. And when alcohol or drug abuse increases, mental health problems usually increase too.

What comes first: Substance abuse or the mental health problem?

Addiction is common in people with mental health problems. But although substance abuse and mental health disorders like depression and anxiety are closely linked, one does not directly cause the other.

• Alcohol or drugs are often used to self-medicate the symptoms of depression or anxiety. Unfortunately, substance abuse causes side effects and in the long run worsens the very symptoms they initially numbed or relieved.
• Alcohol and drug abuse can increase underlying risk for mental disorders. Mental disorders are caused by a complex interplay of genetics, the environment, and other outside factors. If you are at risk for a mental disorder, drug or alcohol abuse may push you over the edge.
• Alcohol and drug abuse can make symptoms of a mental health problem worse. Substance abuse may sharply increase symptoms of mental illness or trigger new symptoms. Alcohol and drug abuse also interact with medications such as antidepressants, anti-anxiety pills, and mood stabilizers, making them less effective.

Addiction is common in people with mental health problems

According to reports published in the Journal of the American Medical Association:

• Roughly 50 percent of individuals with severe mental disorders are affected by substance abuse.
• 37 percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness.
• Of all people diagnosed as mentally ill, 29 percent abuse either alcohol or drugs.

Source: National Alliance on Mental Illness

Recognizing co-occurring disorders or dual diagnosis

It can be difficult to diagnose a substance abuse problem and a co-occurring mental health disorder such as depression, anxiety, or bipolar disorder. It takes time to tease out what might be a mental disorder and what might be a drug or alcohol problem.
Complicating the issue is denial. Denial is common in substance abuse. It’s hard to admit how dependent you are on alcohol or drugs or how much they affect your life. Denial frequently occurs in mental disorders as well. The symptoms of depression or anxiety can be frightening, so you may ignore them and hope they go away. Or you may be ashamed or afraid of being viewed as weak if you admit the problem.

Admitting you have a dual diagnosis or co-occurring disorders

Just remember: substance abuse problems and mental health issues don’t get better when they’re ignored. In fact, they are likely to get much worse. You don’t have to feel this way. Admitting you have a problem is the first step towards conquering your demons and enjoying life again.

• Consider family history. If people in your family have grappled with either a mental disorder such as depression or alcohol abuse or drug addiction, you have a higher risk of developing these problems yourself.
• Consider your sensitivity to alcohol or drugs. Are you highly sensitive to the effects of alcohol or drugs? Have you noticed a relationship between your substance use and your mental health? For example, do you get depressed when you drink?
• Look at symptoms when you’re sober. While some depression or anxiety is normal after you’ve stopped drinking or doing drugs, if the symptoms persist after you’ve achieved sobriety, you may be dealing with a mental health problem.
• Review your treatment history. Have you been treated before for either your addiction or your mental health problem? Did the substance abuse treatment fail because of complications from your mental health issue or vice versa?

Signs and symptoms of substance abuse

If you’re wondering whether you have a substance abuse problem, the following questions may help. The more “yes” answers, the more likely your drinking or drug use is a problem.

• Have you ever felt you should cut down on your drinking or drug use?
• Have you tried to cut back, but couldn’t?
• Do you ever lie about how much or how often you drink or use drugs?
• Have your friends or family members expressed concern about your alcohol or drug use?
• Do you ever felt bad, guilty, or ashamed about your drinking or drug use?
• On more than one occasion, have you done or said something while drunk or high that you later regretted?
• Have you ever blacked out from drinking or drug use?
• Has your alcohol or drug use caused problems in your relationships?
• Has you alcohol or drug use gotten you into trouble at work or with the law?

Signs and symptoms of common co-occurring disorders

The mental health problems that most commonly co-occur with substance abuse are depression, anxiety disorders, and bipolar disorder.

Common signs and symptoms of depression

• Feelings of helplessness and hopelessness
• Loss of interest in daily activities
• Inability to experience pleasure
• Appetite or weight changes
• Sleep changes
• Loss of energy
• Strong feelings of worthlessness or guilt
• Concentration problems
• Anger, physical pain, and reckless behavior (especially in men)

Common signs and symptoms of mania in bipolar disorder

• Feelings of euphoria or extreme irritability
• Unrealistic, grandiose beliefs
• Decreased need for sleep
• Increased energy
• Rapid speech and racing thoughts
• Impaired judgment and impulsivity
• Hyperactivity
• Anger or rage

Common signs and symptoms of anxiety

• Excessive tension and worry
• Feeling restless or jumpy
• Irritability or feeling “on edge”
• Racing heart or shortness of breath
• Nausea, trembling, or dizziness
• Muscle tension, headaches
• Trouble concentrating
• Insomnia

Treatment for substance abuse and mental health problems

The best treatment for co-occurring disorders is an integrated approach, where both the substance abuse problem and the mental disorder are treated simultaneously.

Recovery depends on treating both the addiction and the mental health problem

Whether your mental health or substance abuse problem came first, recovery depends on treating both disorders.

• There is hope. Recovering from co-occurring disorders takes time, commitment, and courage. It may take months or even years but people with substance abuse and mental health problems can and do get better.
• Combined treatment is best. Your best chance of recovery is through integrated treatment for both the substance abuse problem and the mental health problem. This means getting combined mental health and addiction treatment from the same treatment provider or team.
• Relapses are part of the recovery process. Don’t get too discouraged if you relapse. Slips and setbacks happen, but, with hard work, most people can recover from their relapses and move on with recovery.
• Peer support can help. You may benefit from joining a self-help support group like Alcoholics Anonymous or Narcotics Anonymous. They give you a chance to lean on others who know what you’re going through and learn from their experiences.

How to find the right program for co-occurring disorders

As with a substance abuse program, make sure that the program is appropriately licensed and accredited, the treatment methods are backed by research, and there is an aftercare program to prevent relapse. Additionally, you should make sure that the program has experience with your particular mental health issue. Some programs, for example, may have experience treating depression or anxiety, but not schizophrenia or bipolar disorder.
There are a variety of approaches that treatment programs may take, but there are some basics of effective treatment that you should look for:

• Treatment addresses both the substance abuse problem and your mental health problem.
• You share in the decision-making process and are actively involved in setting goals and developing strategies for change.
• Treatment includes basic education about your disorder and related problems.
• You are taught healthy coping skills and strategies to minimize substance abuse, cope with upset, and strengthen your relationships.

Treatment for dual diagnosis or co-occurring disorders

• Helping you think about the role that alcohol and other drugs play in your life. This should be done confidentially, without any negative consequences. People feel free to discuss these issues when the discussion is confidential, nonjudgmental, and not tied to legal consequences.
• Offering you a chance to learn more about alcohol and drugs, to learn about how they interact with mental illnesses and with medications, and to discuss your own use of alcohol and drugs.
• Helping you become involved with supported employment and other services that may help your process of recovery.
• Helping you identify and develop your own recovery goals. If you decide that your use of alcohol or drugs may be a problem, a counselor trained in integrated dual diagnosis treatment can help you identify and develop your own recovery goals. This process includes learning about steps toward recovery from both illnesses.
• Providing special counseling specifically designed for people with dual diagnosis. This can be done individually, with a group of peers, with your family, or with a combination of these.

Source: SAMHSA

Treatment programs for veterans with co-occurring disorders

Veterans deal with additional challenges when it comes to co-occurring disorders. The pressures of deployment or combat can exacerbate underlying mental disorders, and substance abuse is a common way of coping with unpleasant feelings or memories. Often, these problems take a while to show up after a vet returns home, and may be initially mistaken for readjustment. Untreated co-occurring disorders can lead to major problems at home and work and in your daily life, so it’s important to seek help.
Veterans often benefit from treatment and support from specialized programs that address the unique stresses veterans face.

Group support for substance abuse and co-occurring disorders

As with other addictions, groups are very helpful, not only in maintaining sobriety, but also as a safe place to get support and discuss challenges. Sometimes treatment programs for co-occurring disorders provide groups that continue to meet on an aftercare basis. Your doctor or treatment provider may also be able to refer you to a group for people with co-occurring disorders.
While it’s often best to join a group that addresses both substance abuse and your mental health disorder, twelve-step groups for substance abuse can also be helpful—plus they’re more common, so you’re likely to find one in your area. These free programs, facilitated by peers, use group support and a set of guided principles—the twelve steps — to obtain and maintain sobriety.
Just make sure your group is accepting of the idea of co-occurring disorders and psychiatric medication. Some people in these groups, although well meaning, may mistake taking psychiatric medication as another form of addiction. You want a place to feel safe, not pressured.

Self-help for substance abuse and co-occurring disorders

Getting sober is only the beginning. Your continued recovery depends on continuing mental health treatment, learning healthier coping strategies, and making better decisions when dealing with life’s challenges.

Recovery tip 1: Recognize and manage overwhelming stress and emotions

• Learn how to manage stress. Stress is inevitable, so it’s important to have healthy coping skills so you can deal with stress without turning to alcohol or drugs. Stress management skills go a long way towards preventing relapse and keeping your symptoms at bay.
• Know your triggers and have an action plan. If you’re coping with a mental disorder as well, it’s especially important to know signs that your illness is flaring up. Common causes include stressful events, big life changes, or unhealthy sleeping or eating. At these times, having a plan in place is essential to preventing drug relapse. Who will you talk to? What do you need to do?

Recovery tip 2: Stay connected

• Get therapy or stay involved in a support group. Your chances of staying sober improve if you are participating in a social support group like Alcoholics Anonymous or Narcotics Anonymous or if you are getting therapy.
• Follow doctor’s orders. Once you are sober and you feel better, you might think you no longer need medication or treatment. But arbitrarily stopping medication or treatment is a common reason for relapse in people with co-occurring disorders. Always talk with your doctor before making any changes to your medication or treatment routine.

Recovery tip 3: Make healthy lifestyle changes

• Practice relaxation techniques. When practiced regularly, relaxation techniques such as mindfulness meditation, progressive muscle relaxation, and deep breathing can reduce symptoms of stress, anxiety, and depression, and increase feelings of relaxation and emotional well-being.
• Adopt healthy eating habits. Start the day right with breakfast, and continue with frequent small meals throughout the day. Going too long without eating leads to low blood sugar, which can make you feel more stressed or anxious.
• Exercise regularly. Exercise is a natural way to bust stress, relieve anxiety, and improve your mood and outlook. To achieve the maximum benefit, aim for at least 30 minutes of aerobic exercise on most days.
• Get enough sleep. A lack of sleep can exacerbate stress, anxiety, and depression, so try to get 7 to 9 hours of quality sleep a night.

Helping a loved one with a substance abuse and mental health problem

Helping a loved one with both a substance abuse and a mental health problem can be a roller coaster. Resistance to treatment is common and the road to recovery can be long.
The best way to help someone is to accept what you can and cannot do. You cannot force someone to remain sober, nor can you make someone take their medication or keep appointments. What you can do is make positive choices for yourself, encourage your loved one to get help, and offer your support while making sure you don’t lose yourself in the process.

• Seek support. Dealing with a loved one's dual diagnosis of mental illness and substance abuse can be painful and isolating. Make sure you're getting the emotional support you need to cope. Talk to someone you trust about what you're going through. It can also help to get your own therapy or join a support group.
• Set boundaries. Be realistic about the amount of care you're able to provide without feeling overwhelmed and resentful. Set limits on disruptive behaviors, and stick to them. Letting the co-occurring disorders take over your life isn't healthy for you or your loved one.
• Educate yourself. Learn all you can about your loved one’s mental health problem, as well as substance abuse treatment and recovery. The more you understand what your loved one is going through, the better able you’ll be to support recovery.
• Be patient. Recovering from a dual diagnosis doesn’t happen overnight. Recovery is an ongoing process that can take months or years, and relapse is common. Ongoing support for both you and your loved one is crucial as you work toward recovery.

Source: https://www.blogger.com/blogger.g?blogID=4592506238738253894#editor/target=post;postID=2798203633748840306

Anxiety Attacks & Anxiety Disorders

Signs, Symptoms, and Finding Treatment that Works for You

It’s normal to feel anxious when facing a challenging situation, such as a job interview, a tough exam, or a blind date. But if your worries and fears seem overwhelming and interfere with your daily life, you may be suffering from an anxiety disorder. There are many different types of anxiety disorders—and many effective treatments and self-help strategies. Once you understand your anxiety disorder, there are steps you can take to reduce your symptoms and regain control of your life.

In This Article:

• Understanding anxiety disorders
• Anxiety signs and symptoms
• Anxiety attacks
• Types of anxiety disorders
• Self-help for anxiety
• Professional help for anxiety
• Anxiety treatment options

Understanding anxiety disorders

Anxiety is the body’s natural response to danger, an automatic alarm that goes off when you feel threatened, under pressure, or are facing a stressful situation.
In moderation, anxiety isn’t always a bad thing. In fact, anxiety can help you stay alert and focused, spur you to action, and motivate you to solve problems. But when anxiety is constant or overwhelming, when it interferes with your relationships and activities, it stops being functional—that’s when you’ve crossed the line from normal, productive anxiety into the territory of anxiety disorders.

Do your symptoms indicate an anxiety disorder?

If you identify with several of the following signs and symptoms, and they just won’t go away, you may be suffering from an anxiety disorder.

• Are you constantly tense, worried, or on edge?
• Does your anxiety interfere with your work, school, or family responsibilities?
• Are you plagued by fears that you know are irrational, but can’t shake?
• Do you believe that something bad will happen if certain things aren’t done a certain way?
• Do you avoid everyday situations or activities because they cause you anxiety?
• Do you experience sudden, unexpected attacks of heart-pounding panic?
• Do you feel like danger and catastrophe are around every corner?

Signs and symptoms of anxiety disorders

Because anxiety disorders are a group of related conditions rather than a single disorder, they can look very different from person to person. One individual may suffer from intense anxiety attacks that strike without warning, while another gets panicky at the thought of mingling at a party. Someone else may struggle with a disabling fear of driving, or uncontrollable, intrusive thoughts. Yet another may live in a constant state of tension, worrying about anything and everything.
Despite their different forms, all anxiety disorders share one major symptom: persistent or severe fear or worry in situations where most people wouldn’t feel threatened.

Emotional symptoms of anxiety

In addition to the primary symptoms of irrational and excessive fear and worry, other common emotional symptoms of anxiety include:

Feelings of apprehension or dread Trouble concentrating Feeling tense and jumpy Anticipating the worst

Irritability Restlessness Watching for signs of danger Feeling like your mind’s gone blank

Physical symptoms of anxiety

Anxiety is more than just a feeling. As a product of the body’s fight-or-flight response, anxiety involves a wide range of physical symptoms. Because of the numerous physical symptoms, anxiety sufferers often mistake their disorder for a medical illness. They may visit many doctors and make numerous trips to the hospital before their anxiety disorder is discovered.
Common physical symptoms of anxiety include:

Pounding heart Sweating Stomach upset or dizziness Frequent urination or diarrhea Shortness of breath

Tremors and twitches Muscle tension Headaches Fatigue Insomnia

The link between anxiety symptoms and depression

Many people with anxiety disorders also suffer from depression at some point. Anxiety and depression are believed to stem from the same biological vulnerability, which may explain why they so often go hand-in-hand. Since depression makes anxiety worse (and vice versa), it’s important to seek treatment for both conditions.

Anxiety attacks and their symptoms

Anxiety attacks, also known as panic attacks, are episodes of intense panic or fear. Anxiety attacks usually occur suddenly and without warning. Sometimes there’s an obvious trigger— getting stuck in an elevator, for example, or thinking about the big speech you have to give—but in other cases, the attacks come out of the blue.
Anxiety attacks usually peak within ten minutes, and they rarely last more than thirty minutes. But during that short time, the terror can be so severe that you feel as if you’re about to die or totally lose control. The physical symptoms of anxiety attacks are themselves so frightening that many people believe they’re having a heart attack. After an anxiety attack is over, you may be worried about having another one, particularly in a public place where help isn’t available or you can’t easily escape.

Symptoms of anxiety attacks include:

Surge of overwhelming panic Feeling of losing control or going crazy Heart palpitations or chest pain Feeling like you’re going to pass out Trouble breathing or choking sensation

Hyperventilation Hot flashes or chills Trembling or shaking Nausea or stomach cramps Feeling detached or unreal

Types of anxiety disorders

There are six major types of anxiety disorders, each with their own distinct symptom profile: generalized anxiety disorder, obsessive-compulsive disorder, panic disorder (anxiety attacks), phobia, post-traumatic stress disorder, and social anxiety disorder. Helpguide.org offers an entire article on each type of anxiety disorder.

Generalized anxiety disorder

If constant worries and fears distract you from your day-to-day activities or you’re troubled by a persistent feeling that something bad is going to happen, you may be suffering from generalized anxiety disorder (GAD). People with GAD are chronic worrywarts who feel anxious nearly all of the time, though they may not even know why. Anxiety related to GAD often shows up as physical symptoms like insomnia, stomach upset, restlessness, and fatigue. Learn more.

Anxiety attacks (Panic disorder)

Panic disorder is characterized by repeated, unexpected panic attacks, as well as fear of experiencing another episode. Panic disorder may also be accompanied by agoraphobia, which is a fear of being in places where escape or help would be difficult in the event of a panic attack. If you have agoraphobia, you are likely to avoid public places such as shopping malls or confined spaces such as an airplane. Learn more.

Obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is characterized by unwanted thoughts or behaviors that seem impossible to stop or control. If you have OCD, you may be troubled by obsessions, such as a recurring worry that you forgot to turn off the oven or that you might hurt someone. You may also suffer from uncontrollable compulsions, such as washing your hands over and over. Learn more.

Phobia

A phobia is an unrealistic or exaggerated fear of a specific object, activity, or situation that in reality presents little to no danger. Common phobias include fear of animals such as snakes and spiders, fear of flying, and fear of heights. In the case of a severe phobia, you might go to extreme lengths to avoid the thing you fear. Unfortunately, avoidance only strengthens the phobia. Learn more.

Social anxiety disorder

If you have a debilitating fear of being seen negatively by others and humiliated in public, you may have social anxiety disorder, also known as social phobia. Social anxiety disorder can be thought of as extreme shyness. In severe cases, social situations are avoided altogether. Performance anxiety (better known as stage fright) is the most common type of social phobia. Learn more.

Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is an extreme anxiety disorder that can occur in the aftermath of a traumatic or life-threatening event. PTSD can be thought of as a panic attack that rarely, if ever, lets up. Symptoms of PTSD include flashbacks or nightmares about what happened, hypervigilance, startling easily, withdrawing from others, and avoiding situations that remind you of the event. Learn more.

Self-help for anxiety, anxiety attacks, and anxiety disorders

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Not everyone who worries a lot has an anxiety disorder. You may be anxious because of an overly demanding schedule, lack of exercise or sleep, pressure at home or work, or even from too much coffee.
The bottom line is that if your lifestyle is unhealthy and stressful, you’re more likely to feel anxious—whether or not you have an anxiety disorder. So if you feel like you worry too much, take some time to evaluate how well you’re caring for yourself.

• Do you make time each day for relaxation and fun?
• Are you getting the emotional support you need?
• Are you taking care of your body?
• Are you overloaded with responsibilities?
• Do you ask for help when you need it?

If your stress levels are through the roof, think about how you can bring your life back into balance. There may be responsibilities you can give up, turn down, or delegate to others. If you’re feeling isolated or unsupported, find someone you trust to confide in. Just talking about your worries can make them seem less frightening.

Self-help for anxiety attacks and anxiety disorders #1: Challenge negative thoughts

• Write down your worries. Keep a pad and pencil on you, or type on a laptop, smartphone, or tablet. When you experience anxiety, write down your worries. Writing down is harder work than simply thinking them, so your negative thoughts are likely to disappear sooner.
• Create an anxiety worry period. Choose one or two 10 minute “worry periods” each day, time you can devote to anxiety. During your worry period, focus only on negative, anxious thoughts without trying to correct them. The rest of the day, however, is to be designated free of anxiety. When anxious thoughts come into your head during the day, write them down and “postpone” them to your worry period.
• Accept uncertainty. Unfortunately, worrying about all the things that could go wrong doesn’t make life any more predictable—it only keeps you from enjoying the good things happening in the present. Learn to accept uncertainty and not require immediate solutions to life’s problems.

Self-help for anxiety attacks and anxiety disorders #2: Take care of yourself

• Practice relaxation techniques. When practiced regularly, relaxation techniques such as mindfulness meditation, progressive muscle relaxation, and deep breathing can reduce anxiety symptoms and increase feelings of relaxation and emotional well-being.
• Adopt healthy eating habits. Start the day right with breakfast, and continue with frequent small meals throughout the day. Going too long without eating leads to low blood sugar, which can make you feel more anxious.
• Reduce alcohol and nicotine. They lead to more anxiety, not less.
• Exercise regularly. Exercise is a natural stress buster and anxiety reliever. To achieve the maximum benefit, aim for at least 30 minutes of aerobic exercise on most days.
• Get enough sleep. A lack of sleep can exacerbate anxious thoughts and feelings, so try to get 7 to 9 hours of quality sleep a night.

When to seek professional help for anxiety disorders

While self-help coping strategies for anxiety can be very effective, if your worries, fears, or anxiety attacks have become so great that they’re causing extreme distress or disrupting your daily routine, it is important to seek professional help.
If you’re experiencing a lot of physical anxiety symptoms, consider getting a medical checkup. Your doctor can check to make sure that your anxiety isn’t caused by a medical condition, such as a thyroid problem, hypoglycemia, or asthma. Since certain drugs and supplements can cause anxiety, your doctor will also want to know about any prescriptions, over-the-counter medications, herbal remedies, and recreational drugs you’re taking.
If your physician rules out a medical cause, the next step is to consult with a therapist who has experience treating anxiety attacks and anxiety disorders. The therapist will work with you to determine the cause and type of your anxiety disorder and devise a course of treatment.

Treatment options for anxiety disorders

Anxiety disorders respond very well to treatment—and often in a relatively short amount of time. The specific treatment approach depends on the type of anxiety disorder and its severity. But in general, most anxiety disorders are treated with behavioral therapy, medication, or some combination of the two. Sometimes complementary or alternative treatments may also be helpful.

Behavioral therapy for anxiety disorders

Cognitive-behavioral therapy and exposure therapy are types of behavioral therapy, meaning they focus on behavior rather than on underlying psychological conflicts or issues from the past. Behavioral therapy for anxiety usually takes between 5 and 20 weekly sessions.

• Cognitive-behavior therapy focuses on thoughts—or cognitions—in addition to behaviors. In anxiety disorder treatment, cognitive-behavioral therapy helps you identify and challenge the negative thinking patterns and irrational beliefs that fuel your anxiety.
• Exposure therapy for anxiety disorder treatment encourages you to confront your fears in a safe, controlled environment. Through repeated exposures to the feared object or situation, either in your imagination or in reality, you gain a greater sense of control. As you face your fear without being harmed, your anxiety gradually diminishes.

Medication for anxiety disorders

Is anxiety medication right for you?

Anxiety medications can be habit forming and cause unwanted side effects, so be sure to research your options. It’s important to weigh the benefits and risks so you can make an informed decision about whether anxiety medication is the right treatment for you.

A variety of medications, including benzodiazepines and antidepressants, are used in the treatment of anxiety disorders. But medication is most effective when combined with behavioral therapy and anxiety self-help strategies. Medication may sometimes be used in the short-term to relieve severe anxiety symptoms so that other forms of therapy can be pursued.
Source: http://www.helpguide.org/mental/anxiety_types_symptoms_treatment.htm