| Mental Illness and Substance Use Disorders
(MISUD)
What is a mental illness and substance
use disorder?
What is the relationship between misusing
substances and mental health?
How common is mental illness and substance
use disorder?
What kind of difficulties can result
from a MISUD?
How do I know if I or a family member/friend
has a MISUD?
What kind of treatments are available?
Where can I find treatments and support in
the ACT?
How do I talk to someone who I think has a
MISUD?
What is a mental illness
and substance use disorder?
ïMental illness and substance use disorderÍ describes when
someone has a mental illness (like depression, anxiety or
psychosis) and uses drugs or alcohol in a way that triggers
or intensifies the mental illness.
What is the
relationship between misusing substances and mental health?
The relationship varies from individual to individual, with
a range of factors making some people more vulnerable to a
mental illness and substance abuse disorder. These factors
can be genetic, environmental, psychological or behavioural.
Experts agree there are four general types of relationships
between mental illness and substance abuse. These are:
- a primary mental illness triggers or leads to substance
misuse
- use of substances makes the mental illness worse
or changes it
- dependence on drugs or alcohol leads to psychological
symptoms
- misusing substances, or withdrawing from them, leads
to psychiatric problems or illnesses.
(Source: www.rethink.org)
Some people with mental illnesses use drugs or alcohol to
ïself-medicateÍ. They find that using substances takes away
troubling symptoms, at least in the short term. In the long-term,
however, substance use worsens the symptoms, adds new symptoms
and is likely to prolong the illness.
There is a lot of research underway now to see if drug use
can spark mental illness in otherwise healthy people. Some
people seem to have a pre-disposition to psychotic breakdown,
which can be triggered by substance use. This is particularly
the case with alcohol, cannabis and amphetamines.
Opinion is growing that persistent, heavy use of cannabis
can cause psychosis even when the person does not have
an underlying vulnerability - especially when people start
using it at a young age while their nervous system is still
developing.
It is even clearer from research that amphetamines can cause
psychosis.
Both amphetamines and cannabis have a clear association with
depression.
How common is mental illness
and substance use disorder?
The number of people with co-existing mental illness and
substance use disorders is growing. Some reasons for this
are that more substances are available at a cheaper cost,
so people – often younger people - are using more drugs.
At the same time, many drugs are in stronger forms than before,
so their effects are more intense and unpredictable.
More people are being diagnosed with mental illness and substance
abuse disorders because of greater awareness of the disorder.
Between 30 and 80 per cent of people with a mental illness
have a coexisting substance abuse disorder. Seventy per cent
of young people admitted to hospital with psychosis in NSW
each year have a substance abuse disorder.
What kind of
difficulties can result from a mental illness and substance
use disorder?
Because so many factors are involved in a mental illness
and substance use disorder, each
person with this sort of disorder experiences different things.
He or she may have long periods of stability between mental
health problems or misusing substances. Or they he or she
may tend to use drugs only during an acute episode, such as
in mania.
Dual Recovery Online http://draonline.org/ describes a general,
shared pattern among people with mental illness and substance
abuse disorders. The pattern looks like this:
- Symptoms Begin
- Symptoms Interfere
- Problems and Consequences Occur
- Self Defeating Behaviors Begin
- Self Esteem is Affected
- Crisis
*Continue
* Change and recover
ïSymptomsÍ in this case may be either psychological or drug-related,
or both. (Click on any of these words for further information
on mental disorders and conditions: clinical depression,
anxiety disorders, schizophrenia, eating disorders, and
bipolar disorders.)
People with mental illness and substance use disorders are
more likely to:
- have signs of their illness earlier in their lives
- have more severe symptoms
- have more disruption in their lives
- have more frequent and longer periods of hospitalization
- need more psychiatric medication than they would otherwise
need if they werenÍt taking drugs.
Problems associated with mental illness and substance use
disorders are not just physical and psychological. There are
many potential social, emotional and financial problems such
as:
- Family problems or problems in intimate relationships.
- Employment or school problems.
- High risk behavior while driving.
- Multiple admission for chemical dependency services due
to relapse.
- Multiple admissions for psychiatric care.
- Increased emergency room admissions.
- Increased need for health care services.
- Legal problems and possible prison terms.
- Homelessness.
Because so many factors are involved, expert help is needed
from three directions - mental health workers, as well as
drug specialists and social workers. This is to deal with
the mental health, substance use and social situation of the
person.
How do I know if I or a family
member/friend has a mental illness and substance abuse disorder?
If any of the above descriptions sounds like you or someone
you know, then it is a good idea to seek assessment from a
professional. The earlier you seek help, the better.
People with a mental illness and substance use disorder might
recognise one part of the disorder but not the other. For
tips on talking to someone you think might have difficulties,
click here. (How do I talk to someone who I think has
a mental illness and substance use disorder?)
What kind of treatments
are available?
In the past, mental illness services have tended to be quite
separate from drug and alcohol services. This often made it
hard for people with mental illness and drug/alcohol problems
to find appropriate care.
Services are now working more closely to deal with a personÍs
mental illness and substance use problems at the same time.
The person may access help from both services in various forms.
If they are currently being treated for a mental illness,
this should include information and support to deal with the
drug or alcohol problem. If they are currently part of a drug
education or ïdetoxÍ program, staff can also link them to
treatment for the mental illness
The person may recognise one part of the illness but not
the other. Services try to work with the personÍs own view,
at the same time providing information and education improve
their understanding of the dual nature of the disorder.
It is important to get help as soon as possible with mental
illness and substance use problems. Drug and alcohol services
generally only provide treatment that the person is ready
to accept. Treatment should include education and self management
strategies. These will help the person deal with his or her
increased vulnerability due to the interaction of the mental
illness and the substance use.
If the person is at risk to him- or herself or others, mental
health services have more power to intervene and provide treatment
in illness.
Where can I find treatments
and support in the ACT?
The best starting point for referral and help is to call
the Mental Health CATT (Crisis Assessment and Treatment Team),
phone 1 800 629 354 free call. CATT can then put you in touch
with appropriate services. You may also call the ACT
Alcohol & Drug Program if you wish to start work on your
substance use problem by calling (02) 6207 9977. If they canÍt
help you directly, they can refer you to another service.
Dual Diagnosis Anonymous meets on Monday evenings 8-10, at
the Junction Health Service, Corner of Moore and Rudd Street,
Civic. All people are welcome, regardless of age, sex, sexual
identity and/or preference; religion/lack of religious belief,
current or past drug or alcohol usage, psychiatric diagnosis
or emotional state.
How do I talk to someone who
I think has a mental illness and substance use disorder?
ItÍs important to remember that you should talk to them the
same way you talk to anyone else. Even if you are nervous,
try to remain calm and talk in a normal voice.
If you are trying to encourage the person to get help, the
first thing is to get their understanding about what is going
on. You can ask them what help they would like, or offer to
contact someone for them to talk to. If the person wants help,
he or she may want to speak to family, a friend or GP in the
first instance, rather than specialist services.
You might want to check in with the person that what you
think is happening is the case. A simple question could be:
ñHave you taken anything that might have affected you?î.
Try not to get in to an argument about what may or may not
have happened. Keep focused on the things youÍve noticed about
the person that concern you, and ask if they are also concerned.
Remind them there are avenues to help if they want to take
them, and that you can contact someone if they want.
People with mental illness arenÍt necessarily violent –
in fact, very few are. But if someone is intoxicated, they
are often less inhibited (meaning they canÍt control their
feelings as much) and they are more likely to act on a violent
impulse.
If you think the person might harm themselves, notify a family
member or call the Crisis Team on 1800 629 354, even if the
person doesnÍt agree. The Crisis Team will discuss the situation
with you and make a decision about whether to attend.
If someone is in need of medical assistance and has taken
an illegal substance, never delay calling for help, for any
reason. If it is an emergency, call 000. If you or a friend
are aged between 12yrs and 18yrs and have taken pills or hurt
yourself, CAHMS Crisis Line for Young
People (02) 6205 1971.
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