Substance use & mental illness

Information is power

Understanding what causes you to take drugs, as well as the effect they will have on your mind and body, can help you decide what to do about your drug use.

Why do people use drugs?

Some people find drug-taking hard to understand. It shouldn’t be. After all, most of us drink alcohol at times and one in four of us still smoke tobacco. We do it because it makes us feel better, in the short term at any rate.

Apart from drinking or smoking, people affected by mental illness, especially, may also use street drugs. Some common reasons are given below, look at these and think about which ones cause you to take drugs:

• Being part of a group – people take drugs with others as part of a group, this can provide a sense of belonging.
• Relieves boredom – when you feel bored it can be easy to fall into the trap of using drugs as this provides something to do.
• Relieves symptoms – people with a mental illness take drugs when they begin to feel they are having an episode of illness in order to cope with symptoms such as hearing voices, or feeling people are out to get them.
• To escape from reality – drugs can sometimes provide an escape from reality. Many people take drugs to try and forget or ease feelings that can be hard to deal with, like feeling lonely.
• To relax – feeling stressed or anxious happens to everyone at times, but they can be particularly common and difficult to handle in people with a mental illness.

What problems are associated with using drugs?

We all know that taking drugs can make a big difference to the way we feel and act in the period after they’ve been taken. What many people don’t understand is the effect of drugs on our minds and bodies in the long run.

The way drugs can make you feel and act in the long term varies depending on the amount of drugs taken, what type you take and whether they are mixed with any others.

Any use of tobacco is harmful, of course, as we all know (remember that smoking cannabis also usually means inhaling tobacco smoke). Alcohol can be harmful when taken in excess too (more than a couple of drinks a day, five days a week).

There are some common effects of many drugs though, including tobacco and alcohol as well as street drugs.

Some of the physical health problems include:

• eating unhealthily which can lead to obesity, anaemia, diabetes and other health problems
• having trouble breathing easily
• having trouble remembering things
• having problems getting sexually aroused
• getting sick (like colds and flu)
• having problems sleeping (feeling tired, early waking)
• constipation
• skin problems
• increased blood pressure
• heart problems
• liver damage
• irregular periods.

Lifestyle problems:

• having problems with people close to you.
• not having enough money.
• having problems with the law.
• finding it hard to stay in the same job.
• finding it hard to stay in the same house.

Mental health problems:

• feeling disoriented.
• feeling less motivated.
• having more mood changes.
• feeling angry and on edge.
• being likely to have a relapse.
• finding it more difficult to take prescribed medication regularly.
• feeling that this medication is not working so well, and experiencing the return of symptoms such as feeling paranoid or hearing or seeing things that aren’t really there.

What are the signs that you might have a drug problem?

Knowing whether your drug use is becoming a problem is hard for anyone. It can be even more difficult if you have a mental illness because it is harder to know whether what you are feeling is a result of your mental illness or drug taking.

Here are some ways of helping you work out whether your drug use may be becoming a problem.

Look at these and think about which ones are true of you:

• I often feel that I must have the drug.
• A lot of what I do during the day revolves around drug taking.
• I would rather spend money on drugs than pretty much anything else.
• I need drugs to get through a tough situation.
• These days I need to use more of the drug to get the same effect.
• Even though I’ve been in trouble because I take drugs, I still use them.
• I feel guilty about how much I use drugs.
• People make comments about how much I drink, smoke or use street drugs.

If some of these statements are true of you, talk to someone about getting support – see the next section, ‘Getting help’.

What signs of a drug problem could family and friends notice?

Family and friends can play an important role in supporting someone they care about to deal with their drug problems.

Unfortunately, friends and family don’t always find out about drug use until the problem gets out of hand. This can happen for a number of reasons. Drug problems can remain hidden because the person concerned may not yet see it as a problem, or they know they have a problem but feel bad about it or are scared of what people’s reactions might be.

Here are some possible signs of street drug use that family and friends may notice.

Look at these and think about which ones are true of you or someone you care about:

• Suddenly having money problems or spending more than usual.
• Finding drug paraphernalia in the house.
• Very long periods of time spent in the bathroom.
• Dilated or pinpointed eye pupils.
• Needle marks.
• Selling own or others’ belongings.

If some of these statements are true of you or someone you care about, talk to someone about getting support – see the next section, ‘Getting help’.

Do drugs cause mental illness?

Use of street drugs, as well as tobacco and alcohol, is common in people affected by mental illness. There are a lot of different views on the relationship between the two.

In the past, drugs were thought bring on symptoms associated with mental illness, like psychosis and depression, but only in people who were otherwise likely to become mentally ill at some stage.

These days more and more research suggests that drugs can not only bring on symptoms of mental illness but may actually contribute to causing them in some people.

Or does mental illness cause a drug problem?

While drugs can trigger symptoms and even contribute to causing a mental illness, your illness can also make it more likely for you to develop a drug problem.

Studies have found that people who have a mental illness may be more likely to get into the cycle of using drugs because it helps them deal with some of the symptoms of their illness. Many of the major symptoms of mental illnesses – such as feeling anxious, depressed and disoriented – are temporarily relieved by using some types of drugs.

Unfortunately, using drugs and alcohol can make symptoms worse in the long term, so it becomes tempting to take more drugs just to keep getting the short term benefits however, eventually even these short-term benefits wear off.

Drug use among people with mental illnesses is also thought to relate to the difficult time some people have accepting that they have a mental illness. Having a mental illness can make a lot of things hard like getting on with people, getting a job and having a stable place to live in. It can be tempting to turn to drugs as an escape from reality.

In summary

While there are a few different views on the relationship between drug problems and mental illness, what we do know is that the combination is a risky and potentially dangerous one, which is better avoided.

Find the support you need

There are lots of different ways you can go about changing your drug use.

There are a number of ways to change drug use.

Self-help

Sharing experiences and providing support for each other is a good way of finding out what has helped others. This is where self-help treatments can be useful.

The main type of self-help treatments are mental illness support groups run through community support agencies and Narcotics Anonymous or Alcoholics Anonymous.

Ask your case manager, local council or Drug and Alcohol Treatment Service for the details of an appropriate group to join.

Controlled use

This type of approach can help you use drugs in a safer way. For example, using less often or only at times when other people are there to keep an eye on you can help you to use drugs more safely, see ‘How can drugs be used in a safer way?’ for details.

GPs, case managers and community support workers can help in working out ways you can use more safely.

Withdrawal programs

This method of treatment is useful for people who want to stop using drugs that their body may crave just after they stop taking them. It ‘s usually done as part of a detoxification program which also offers ongoing counselling, accommodation and day programs.

There are two main types of detoxification programs:

• residential rehabilitation programs – is a live-in program where treatment is provided on the spot.
• home based withdrawal programs – mean you still live in your own home but come into a centre (or are visited by a drug and alcohol worker) for regular treatment and support.

Contact the mental health branch in your state or territory to find out what services they offer in your local area.

Medication

Certain medication can help ease the cravings that can make it hard to stop using some drugs. Your GP or psychiatrist can help you to decide on whether this is the right method for you.

How can I use drugs more safely?

If you don’t feel able to stop using drugs straight away, there are ways of using them in a safer way.

Be careful who you get the drugs from

While you never know exactly what you are getting, some suppliers are less likely than others to sell ‘clean’ drugs.

Be careful where you take drugs

The effect that some drugs have (particularly Ecstasy, LSD and cannabis) can depend on what environment you use the drug in.

Taking drugs in places that are unfamiliar, such as being around people you are not comfortable with, can cause a bad reaction in many people, such as feeling panicky or having delusions and hallucinations. This can be especially difficult for people whose mental illness is associated with a chemical imbalance in the brain.

Stay in the company of friends

Make sure there is someone not too far away who can get help if you need it.

Keep it legal

When using drugs you may be more likely to act out of control and do illegal things (such as driving fast). This puts you at even more risk. With a bit of preparation, there are steps you can take to make it less likely you will run into problems. For example, if you know you are going to take drugs make sure that you are not driving home.

Get informed

If you have any questions on how to use more safely contact your local drug and alcohol helpline, see ‘Who should I contact?’ for more information.

Keep it clean

Drug paraphernalia can carry germs that can make you sick. Keeping your gear clean can reduce the risk of spreading infection. For example, clean your bong after every session and make sure that you don’t share needles.

Don’t mix drugs

Combining drugs can make the effects of either or both drugs more powerful or than they may have been if taken separately. You may also want to ask your doctor about the effects of mixing street drugs with your medication.

Drink lots of water

Much of the harm caused by taking drugs is a result of dehydration. Making sure you have had at least 10 glasses of water in the previous 24 hours makes it less likely that you will experience any extra difficulties that come up because of dehydration.

Go easy

Using less concentrated versions of drugs (for example, light beer instead of spirits, leaf instead of heads) can reduce the risk of the having too much in one sitting.

Pace yourself

Spreading out your drug use over time can allow your body to process the drug out of your system. For example – use less drugs at one time (take fewer puffs, sips or hits, glasses or cones) or by having at least three drug free days per week to allow your body to recover. This will also save you money.

Set limits

Decide how much you want to use each day and stick to it.

Eat properly

When you take drugs it can be easy to skip meals or opt for food that are the easiest to get. Making sure that you have foods on hand that are nutritious and easy to prepare can make you more likely to eat properly, see ‘Healthy living’ for more ideas.

What can I expect to happen if I stop taking drugs suddenly?

People who have been using drugs may experience some withdrawal symptoms when they stop. These symptoms can differ depending on what drug you use, however the main symptoms of withdrawal are:

• irritability.
• restlessness.
• anxiety.
• depression.
• confusion.
• cravings.
• sleep problems.
• diarrhoea.
• shaking.
• sweating.
• feeling less hungry.

Having withdrawal symptoms may seem difficult, but they can be signs that your body is recovering and re-adapting to being drug-free. They tend to be short-term, only lasting about 7-10 days.

The withdrawal process can be trickier for people with a mental illness however, because of greater sensitivity to changing chemicals in the brain. This is why you should only withdraw from drugs in consultation with a doctor.

What kind of mental health services are available?

Managing your mental illness well can also help you get a handle of your drug use. That is why it is important that you start to look at what mental health support and treatment you are entitled to.

Dual diagnosis services

In most parts of the country there are now services especially for people who have a mental illness and a drug problem at the same time.

These dual diagnosis services work with you and your case manager to make sure that both your mental health and drug problems are being treated.

You can find out about your local dual diagnosis service by asking your local community mental health service or the mental health branch in your State or Territory.

General Practitioners (GPs)

GPs should be able to tell you about the local mental health and drug and alcohol services.

It is a good idea to use the same GP regularly if possible. This way you get to know and trust your doctor so that you can talk about any difficulties you are having.

If you don’t have a regular GP, try to find one who is right for you. Ask family and friends, a local pharmacist or at a community health centre if they can recommend someone.

Psychiatrists

Psychiatrists are trained to help you with any concerns you might have about your mental health, especially when you are dealing with the extra challenges that drug use can bring.

Psychiatrists can work in the public system (at community mental health services) where there is no charge, or in private practice where there may be a charge, mostly claimable under Medicare. If you do not have a psychiatrist, a GP can give you a referral.

Community mental health services

If you are in the public system and want to get long-term care you should ask about getting a case manager at your local community mental health service.

Case managers are like a ‘one stop shop’ for mental health services, and work with GPs and psychiatrists to providing information on various issues relating to mental illness (including education and support around drug use) to you and your family as well as referring you to relevant community agencies.

To find out about the closest community mental health service, contact your local council.

Community support agencies

Community support agencies provide psychosocial rehabilitation programs, supported accommodation, and a range of recreational and creative activities.

These services can help you meet others, learn new skills and join in the life of your local community.

Availability of theses services varies widely around the country. Contact your local community mental health service for referral to services an agency in your area.

What can family friends and workers do to help support someone who is trying to change their drug use?

Research shows that people who have some kind of supportive relationship generally find it easier to tackle their drug problem. Having someone around to encourage you is important because there is someone to talk to if times get tough, and to help you learn new ways of dealing with old problems.

This support person could be a case manager or other support worker. It could be a neighbour, friend, someone in your family, or even a psychiatrist or GP. It can be anyone who knows you’re trying to change your drug and alcohol use and agrees to help keep a friendly eye on how you’re going.

The following things are important when thinking about who to ask to be your support person:

• Trust – remember your support person needs to be someone you trust, and who will take a real interest in how you are getting on.
• Being available – no one person can be available all the time, but think about how available a person is – in person, by phone or email – before you ask them whether they will be your support person.
• Familiarity – being a support person means being familiar with you and your life. This is likely to be someone you’ve known for some time and are comfortable talking to
• A positive attitude – a good support person sees the bright side of life. It can make all the difference to have someone with a positive approach to life helping you.

Changing habits

Getting into a routine and finding new ways to handle old problems can help you to change your drug use.

How can I start to change my drug use?

Sometimes changing your drug habits can be easier if you get into a routine that includes activities that aren’t related to using drugs. This can give you something to look forward to and achieve, however small. If you save any money by spending less on drugs, make sure you spend this on something else enjoyable – a reward to yourself.

Here are some tips for getting into a routine that suits you.

Take it easy at first

Getting back into a routine after much of your time has been taken up by drugs can be a challenge. That is why it’s a good idea to avoid over-doing it at first.

Try to be active and do things you enjoy, but not so much that you feel stressed. For example, start of with one or two activities a day until you see how long they take. If you find you have spare time and energy you might include other activities step by step.

Build on what you know

Recognise and build on some of the good habits you already have or the things you have done in the past to move beyond your drug problem.

For example, if you like reading and find that it distracts you from taking drugs, join your local library or ask about local book clubs. Apart from being interesting, it’s also a useful place to meet people with similar interests.

Find interests that suit you

The stress of trying to do something you don’t enjoy can make it harder to stay on track. The more you enjoy something, the easier it will be to stick to a good routine.

Spend some time thinking about what really interests you, or trying out something you always meant to do – enjoying what you do can give you the motivation to keep going and to develop your own sense of purpose and identity, away from drugs.

Vary your activities

Don’t allow new activities to get boring – boredom can make it all too tempting to get into the cycle of taking drugs again.

For example, do some things on you own (like yoga or listening to music) and others with people (like going for a walk or seeing a movie). Doing something to help others, such as volunteer work, can also be a useful way of distracting yourself.

Be flexible

It’s not always easy to settle into a routine, especially if you are not used to it. Treat your plan as a general guide that can change if you find it’s not working for you.

A weekly plan

Here is an example of a weekly plan:

Monday

• Take neighbour’s dog for a walk in park.
• Yoga class at neighbourhood house.

Tuesday

• Do washing.
• Appointment with psychiatrist.

Wednesday

• Cheap night at the movies.
• Go to Alcoholic’s Anonymous.

Thursday

• Clean house.
• Volunteer work at Lost Dog’s Home.

Friday

• Computer class at day program.
• Go out for coffee with worker from the clinic.

Saturday

• Free concert.
• Catch up with friends for a coffee.

Sunday

• Go to parents for lunch.
• Go for a walk.

Try making your own weekly plan.

How can I deal with triggers?

Stressful events make life difficult for anyone. They can be especially difficult to handle if you have a mental illness and can act as a trigger for taking drugs.

By recognising the situation that you find stressful, you can plan how to deal with them. This can help you get more control in your life.

Here are some examples of common triggers and some ways you can deal with them:

Trigger – feeling stressed

• relaxing activities like listening to quiet music.
• talking to a friend.
• do breathing exercises.
• do Tai-Chi.
• do yoga.

Trigger – feeling bored

• get into a routine, see ‘How can I start to change my drug use?’
• try a new hobby.
• pick up a class at the local Neighbourhood House.
• look into TAFE or CAE classes.
• give someone a call.
• go for a walk.

Trigger – anniversary of an unhappy time

• have something planned for the anniversary time.
• keep to your routine.
• make sure you let your support person know that you might need a little extra help to get through this time.

Trigger – being around people who are taking drugs

• tell these people what you are trying to do and ask them not to offer you drugs.
• mentally prepare yourself for how you are going to say ‘no’.
• you may want to ask friends if they could hold off from taking drugs in your company.
• only see them at times where they are not drinking or taking drugs, until you are well into the swing of things.

Take another step in the right direction by writing down the things that trigger you to take drugs and how you might deal with this in a different way than you have in the past.

Your action plan

Changing any behaviour is a challenge for most people. With support and advice you can learn to move on from difficult times and be better able to deal with drugs in the future.

How can I make sure I don’t start using drugs again?

We all feel better on some days than others. On the bad days it is easy to go back to using drugs in the same way as before. Fortunately, there are ways of stopping this cycle before it gets too bad. Recognising early warning signs can reduce the risk of becoming unwell.

Below is a list of common early warning signs. Look at these and see if there are any you recognise:

• Having a lot of arguments with people.
• Sleeping too much, not enough or having disturbed sleep.
• Not wanting to see anyone.
• Saying irrational things.
• Feeling disoriented.
• Hearing voices.

Now that you know what are common early warning signs you might want to think about what signs you showed last time you went through a difficult time.

Looking back on this, what were some of the things that made you realise this? Have a go at writing these down.

It is important to have an action plan so that you can get the help you require at the first sign of problems. For example, you may want to have a list of important numbers next to the telephone that is in order of importance. These could be contacts such as support people or health professionals you can call quickly and ask for help and support. See ‘Who do I call for help’, for further information.

How can I deal with negative thoughts?

A big part of changing drug use is about changing the way you look at things. With the help of your support person spend some time finding new ways to look at old challenges.

Below are some examples of negative thoughts that people often have about drugs and how they can be turned into positive ones.

Before

‘It’s the only thing that makes me feel good’.

After

‘I used to like doing lots of things that made me feel good. Now I’ll finally have the money or energy to do them’.

Before

‘It’s not like I can get better if I stop using drugs– I have a mental illness’.

After

‘There are lots of ways I can manage my illness’.

Before

‘I’ve tried changing my drug use before and couldn’t – why should this time be any different?’

After

‘Each time I try, I get closer to changing’.

Before

‘I have spent so long taking one drug or another that I don’t think I can change now’.

After

‘There have been other times I have changed things for the better, so why not now?’

Before

‘Changing my drug use is really hard’.

After

‘Changing my drug use altogether is hard, but I am still managing to make some small changes’.

Before

‘Nothing I try seems to try seems to change the way I use drugs’.

After

‘I am going through a difficult stage, I think I’ll give my support person a call.’

Before

‘I need it’.

After

‘I crave it sometimes, but if I keep on track this time, one day I won’t anymore.’

How do I deal with cravings?

Going off a drug or even using less, can lead to cravings. Cravings can be difficult to fight, but there are some ways of controlling them so that they don’t get the better of you, these include:

• Take control – try and think about something else, or do something that will take your mind off the symptoms. Doing what you had set out to do with your day before you had the craving is a good idea
• Take 20 – if you have the urge to take drugs try put it off, even for 20 minutes. Use this time to think about what using the drug will mean to you. Often your need to use will pass
• Take heart – remind yourself that cravings are to be expected and that nothing will happen to you if you don’t act on them
• Take flight – do something that will help you relax – like listening to music, going for a walk, having a warm bath or something light to eat.

What happens if I slip up?

Slipping up is when you go back to old patterns of drug use for a little while. While slip-ups happen from time to time with support, a plan and good advice you can learn to move on from this slip-up and be better able to control your drug use.

Here are some tips for getting back on track after you have slipped up.

Understand triggers

Looking at what made you feel like you needed to return to your old patterns of problematic drug use after you have slipped up can also be a good way of helping to avoid these patterns in the future.

For example, you may have been sticking to your goal of no more than three drinks per night for the last couple of weeks, but you go to a family gathering where there is a large supply of alcohol and end up drinking more.

This may help you to understand that being in a social situation, around family or in a place with a large supply of alcohol is likely to trigger the kind of binge drinking you are trying to avoid.

Reflect on small achievements

When you slip up it’s easy to feel bad about what’s happened and punish yourself. Instead of this, take time to look at how far you have come.

For example, you may have felt like binge drinking but instead you only allowed yourself four beers and you forced yourself to take a bus home instead of driving.

Practice makes perfect

Most people go back to old habits from time to time, especially when they are trying to stop using drugs altogether. Change can take practice. Slip-ups can be seen as test runs for the real thing. So when you get back to changing them again you will be that much closer to making that change.

Re-examine goals

When slip-ups happen it can be a good time to look at whether your goals are right for you. For example, you may have aimed to stop drinking altogether, until the cravings got too much. A better goal would be to lower your drug use slowly.

Don’t blame yourself

Feeling guilty about a slip-up is common and understandable, especially if it has got you into trouble. However, it’s in everyone’s best interest to dismiss any feelings of blame, and focus on the present and the future.

How do I support a family member or friend who has a drug problem but won’t get help?

Watching someone you care about make choices that you don’t agree with can be very difficult.

Someone who has a drug problem may find it difficult to talk about what they are experiencing. They might feel very sensitive, that they are going to be criticised, especially if they are taking illegal drugs or feel unable to change their drug taking habits. This may mean they refuse to get help, or they may deny that there is a problem.

While you can’t get someone to stop taking drugs or even use them safely, there are some things that you can do to help yourself cope better with the situation. Here are some ways that you can do this.

Help at hand

Reassure them that there is help available and that a lot can be done to help them with their drug problem. Suggest you or another trusted person helps to find out about options, by making some calls or going along as support to appointments.

Encourage honesty

Encourage the person to talk about their problem in a relaxed way. People sometimes react to a relative or friend who is having problems with drugs by pretending it’s not happening, by never discussing it. This often means that the problem remains hidden and untreated.

Encouraging a friend or relative with a drug problem to talk openly and honestly about it is an important first step in helping them realise that you care for their safety, above all else. It also can provide a good opportunity to encourage them to seek help and support.

Timing is everything

Trying to get someone to talk is much easier if you pick the right time. Choose a time when they are more likely to be relaxed and open up and when they’re not affected by drugs.

Get information and support

Contact a support group. Often people who are unwell are unwilling to get help for their problem and this leaves family and friends in a difficult situation.

Organisations working with family and friends of people who have a mental illness can be useful at these times, providing information about strategies to getting help. They may also be able to provide support after a drug-related incident.

Ask about support groups at the local community mental health service or contact the SANE Help Centre on 1800 688 382.

Take time out

Dealing with a relative or friend who has a mental illness and is abusing substances can be difficult. Remember to give yourself a bit of time to treat yourself. Going for a walk, getting a massage, going to a bed-and-breakfast for the weekend or spending the whole day immersed in a book can help you recharge your batteries and give you the boost you need to get through the hard times.

Alcohol and drug information service

NSW
1800 422 599

VIC
Directline
1800 136 385

SA
1300 131 340

TAS
1800 811 994

NT
Amity House
1800 629 683

ACT
(02) 6205 4545

QLD
1800 177 833