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When they are a danger to themselves or to others, can you have them committed? Will the state do what you cannot, and force someone in need of treatment to get help?

It seems obvious sometimes, obvious to everyone but the addict that they are placing their life in danger through their abuse, neglecting their basic needs for food and shelter and badly in need of help.

Sometimes, despite our most determined efforts, we just can’t get them to see reason and can’t get them to concede to a need for treatment. Surely when things get as bad as this we can have them temporarily committed for their own safety and wellbeing?

Unfortunately, the State is very unwilling to intervene except in real emergencies, unwilling for a couple of basic reasons.

Why the State Won't Often Intervene...

Civil Rights

Firstly and historically, it used to be quite easy to have a relative committed  for mental health or substance abuse needs, and in retrospect, civil rights advocates argue that it was far too easy to have someone committed against their will and consent, and for an indefinite length of time as well.

In response to many real abuses of individual rights on cases of questionable merit, the state in the second half of the last century moved progressively away from easy familial commitment of people in need of mental health or substance abuse treatment. The state would intervene only when there was a clear and imminent danger to self or others, and the standard of proof required to meet these criteria was quite high.

In retrospect, and in the guise of civil liberty, the state moved too far away from involuntary commitments and a great many people in real need of temporary psychiatric or substance abuse care were not compelled to get it, and a great many tragedies ensued as a direct result.

The state in recent years has moved back slightly towards making it easier for people in real danger to be treated without their consent, but the requirements for involuntary commitment remain very high, and most addicts, even those who are most certainly harming themselves as a consequence of their abuse, will not meet the stringent guidelines for involuntary commitment.

The regulations vary by state, but in general, to be involuntarily committed a person needs to present with an imminent (and provable based on recent actions) danger to themselves or others, or through their neglect of basic necessities (that cannot or are not being met by family) be placing themselves in immediate and direct harms way.

It can be very tough to prove that an addict or alcoholic is placing themselves imminent danger, chronic and long term danger is easy, but imminent danger is tough, and as a result few people with substance abuse problems will meet the minimum standards for involuntary commitment.

Limited Resources

The second fundamental problem state agencies face when dealing with requests for involuntary treatment is a real lack of resources to treat all people in society in need of mental health and substance abuse care, within their budgetary and personnel constraints. Essentially, unless these agencies are given greater funding they cannot meet the treatment needs of all those people who would benefit from involuntary care.

The regulations do vary by state though, and to get more information about the requirements for involuntary temporary commitment in your area you should visit or call the state court mental health department to learn more. It is worth looking into, and in some cases you may find that the state will do what you cannot, and compel needed treatment on an otherwise unwilling participant.

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Psychosis: it affects 3%, but if you spot and treat it in the pre-illness phase you can stop the symptoms before they even get started. Learn the warning signs of the prodromal phase.

If you act quickly enough, you can sometimes stop psychosis before it even really grabs a toehold.

First episodes of psychotic mental illnesses, like bipolar disorder, major depression and schizophrenia often occur during adolescence or early adulthood.¹

When people initiate psychosis treatment before full onset, in the pre-illness or prodromal phase, the prognosis is much better. In some cases, early intervention can stop the progression of psychosis before it gets to the acute or full symptomatic phase.

Unfortunately, loved ones often misinterpret the early warning signs of psychosis as typical emotional and behavioral changes of adolescence and early adulthood and so miss a valuable opportunity to really help.

Read on to learn how to identify psychosis in the prodromal stage and to learn why early intervention is so important.

What Is Psychosis?

• Psychosis is a disruption in brain function that results in a loss of contact with reality.

• Psychosis can occur as a syndrome within mental illnesses such as schizophrenia, schizoaffective disorder, delusional disorder, brief psychotic disorder, bipolar disorder and major depression. Drugs and certain physical illnesses can also cause psychosis.

• The primary symptoms of psychosis are delusions, hallucinations and disorganized thoughts, speech or behaviors²

The Importance of Early Intervention and Treatment for Psychotic Mental Illness

• At some point in life, about three people in a hundred are going to experience a disorienting and scary first episode of psychosis.
• Unfortunately, few people initiate treatment soon enough – at the point where treatment can do the most preventative good.

Psychosis always requires professional treatment so there is no point in waiting to see if things get better on their own. Without treatment symptoms will likely worsen, and the earlier you initiate treatment the better the ultimate prognosis – in fact, in some cases, early intervention not only reduces the severity of a psychotic episode it stops symptoms entirely so that full psychosis never occurs. ³

Early psychosis intervention can help a person avoid or minimize many of the consequences of untreated psychosis, such as:

• An increased risk of depression and anxiety – psychotic symptoms can cause a great deal of worry, a loss of social support systems, increased drug and alcohol abuse, a loss of functioning and other behaviors that up a person’s risk for secondary mental illnesses
• A loss of self confidence and self esteem
• An increased risk to develop a substance abuse problem (from self-medication with drugs or alcohol)
• An increased risk of self harm and suicide
• Decreased ability to function on the job or at school
• Disrupted social relationships ⁴
  

How to Spot Psychosis in the Prodromal Stage

Most people will go through a prodromal stage prior to a first onset of psychosis. This prodromal stage can vary in length but typically lasts for several months. During the prodromal stage, a person will start to experience subtle and gradually worsening symptoms.

If you initiate treatment in the prodromal stage you can stop things before they reach the acute psychosis phase. Without intervention, a person in the prodromal phase will eventually progress to acute psychosis and experience symptoms that are severe enough to disrupt the ability to function on a day to day basis.

The trick is in distinguishing the signs of early psychosis from the normal developmental changes of late adolescence and early adulthood.

Here’s what to look for:

1. Feeling Off or Wrong in Some Way

In the prodromal phase people often start feeling as if something there is something wrong with the way their brain is working. They may:

• Start having trouble doing school work or on the job
• Start feeling unusually sensitive to sounds, smells, light and touch (not like being touched by others)
• Start feeling like they have special powers or abilities

2. Feeling Muddled or Confused

• Having trouble paying attention or thinking clearly
• Forgetting things or getting lost easily
• Having trouble reading longer sentences
• Having trouble understanding what others are saying
• Getting mixed up when speaking or writing

3. Social Withdrawal and a Reduction in Self Care

• Suddenly caring less about your appearance/personal hygiene
• Withdrawing from friends and family (spending a lot of time on your own in your room, for example)

4. Behavioral Changes

• Sleeping or eating a lot less or more than normal
• Feeling very tired all the time
• Not interested in activities or hobbies you used to find enjoyable

5. Fear and Anxiety

• General fear and anxiety without apparent cause
• Feelings of suspicion and paranoia – worrying that others are thinking badly about you or want to harm you in some way
• Feeling fearful around people - maintaining vigilance

6. Hallucinations

• Feeling like someone else is planting ideas in your head
• Seeing or hearing things that aren’t real
• Feeling like your brain is ‘tricking’ you in some way

7. Emotional Changes

• Feeling depressed
• Experiencing extreme mood swings⁵

After You Notice the Warning Signs… Then What?

Whether for yourself or for a loved one, once you spot warning signs of a problem the next step is to make an appointment for a mental health assessment from a doctor or mental health professional experienced in early psychosis identification.

Treatment for early psychosis typically consists of medication and counseling, and since the earlier you start the better the outcome, it’s important to take action as quickly as you can.

Image Copyright: Mr. Pessimist

Create wellness sheets and have a reminder of what you need to do every day, and once in a while, to keep yourself feeling good and to prevent worsening psychiatric or emotional symptoms.

You know that certain behaviors keep you feeling good and that certain activities and habits lead you to places you'd rather avoid.

But you're only human(!) and when life gets busy or stressful, when symptoms flare up or even when you just start feeling really great for a while it's all too easy to forget those habits and behaviors that maintain wellness.

You already know what works - the trick is making sure you incorporate these positive habits into your daily life - that's what's hard, and that's where wellness sheets can make a big difference.

These activity plans were developed by other people with psychiatric or emotional symptoms and they are proven to help you maintain better mental health.

They don't cost you anything but a few minutes of your time and they put you in control of the maintenance of your own well-being.

Writing Out Wellness Sheets

Wellness sheets remind you, on a daily basis, of what you must do every day and what you might want/need to do some days, to maintain wellness and to prevent the onset of unwanted emotional or psychiatric symptoms.

There are 4 steps to developing your wellness sheets:

1. Brainstorm activities that you know or think make you feel good
2. Write out descriptive words that describe how you act and feel when you are feeling good
3. Make a list of a few simple activities that must be done on a daily basis to maintain good mental health
4. Make a list of activities that might need doing on a daily basis to maintain good mental health.

Brainstorm Activities That Help Maintain Wellness and Prevent Worsening Emotional or Psychiatric Symptoms

To get the ball rolling, take 10 or 15 minutes to fill a paper with activities that you know, or think, help you feel good. Don't be too selective at this stage as you're just providing yourself with inspiration for the steps to come. Some examples might be:

• Walking the dog
• Making sure to eat breakfast
• Taking some time to call a friend each day
• Limiting the time you spend watching TV
• Getting your hair done
• Tidying up your home environment
• Getting your homework finished up early

Write Out Words That Describe How You Act and Feel When You're Feeling Good

As part of a daily practice of incorporating wellness activities into your daily lifestyle you need to get into a habit of monitoring your emotional states so you know when you need to pay extra attention to making some time for yourself.

You can help yourself in this practice by writing out a list of  words that describe how you act/feel when you're at you're best and by comparing your mood and behaviors daily against your optimal self.

Some examples of words that you might use to describe yourself when you're at your best are:

• Cheerful
• Energetic
• Motivated
• Talkative
• Interested in the lives of people around me
• Relaxed
• Mindful

Make it individualized and true - there aren't any right or wrong answers here, and then compare how you're feeling each day against how you feel when you're at your best. When there's great divergence, you know you need to take some extra time to focus on wellness activities.

Make a List of Things You Must Do Each Day to Maintain Wellness

The experts say that when you find yourself feeling worse you can often trace the start of a downward spiral back to not taking adequate care of your emotional or physical health - to forgetting to do something that must be done to maintain good health on a daily basis.

To help avoid this, make a very short list of essential activities - things you must do each day to keep yourself feeling good (don't make your list too long or complicated or you'll never be able to complete all list items each day...this is just the daily essentials here.)

For example, every day I must:

• Talk to a friend or a family member each day on the phone or in person
• Get out of bed before 9 am
• Eat 3 meals
• Take a shower soon after waking
• Leave the house for some outside time for at least 30 minutes per day
• Take medication
• Do at least 20 minutes of meditation or relaxation exercises
• Spend at least 20 minutes doing something fun

Reminders -  Make a List of Things You Might Need to Do Each Day to Maintain Wellness

Some wellness promoting activities are done only occasionally, like visiting your doctor or therapist, and others, like doing laundry, need doing regularly, but not daily.

Getting behind on chores and obligations leads to increased stress and aggravation and forgetting important occasional activities can reduce quality of life.

For your daily reminder sheet make a list of chores, activities and obligations that you need to keep on top of to maintain wellness.

For Example:

Today, Do I Need To?

• Make or attend a doctor or dentist’s appointment?
• Do laundry or clean my living space?
• Complete a work or school task?
• Go to a support group meeting?
• Spend time with a loved one?
• Buy food for the house?
• Go to an exercise or yoga class?

Daily Attention Makes a Big Difference

Remember to consult your daily wellness activities and reminders lists every day and remember also to edit your lists whenever appropriate, adding activities that help and erasing activities that no longer provide you with much of a boost.

By thinking hard about what you need to do each day to stay happy and healthy and by structuring these activities into a daily routine you can do a lot, by yourself, to maintain wellness and to prevent worsening emotional or psychiatric symptoms.¹

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Drug rehab is a great step forward, yet it's only the beginning of the recovery journey - and the months and years after rehab present some pretty significant challenges to the dual diagnosis addict in recovery. Family can help, but they have to be tough.

Family can do a lot, and after rehab (or other drug treatment) family support can make all the difference. Enabling never helps, and family needs to learn effective supportive strategies, strategies that ensure ownership over the recovery process remains firmly on the shoulders of the dual diagnosis addict. You can help, but you can’t do it for her!

Support, Not Enabling

There is a fine but certain line between family support and enabling behaviors, and when a loved one suffers a dual diagnosis (mental heath challenges with addiction) determining where support ends and enabling begins can seem an impossible task!

Dual diagnosis patients, especially those newly in recovery, do face significant life and sobriety challenges and family social support can be of fundamental importance. Family support behaviors that go beyond assistance and allow the recovering addict to regress in the process of recovery are enabling behaviors, and do nothing to help alleviate the pains of a dual diagnosis addiction.

Structure

In addition to continuing aftercare therapy, what dual diagnosis addicts in recovery need most - are structure and proactive support.

Many addicts (while using) live very unstructured, ruminating and unproductive lives; lives not fit for much beyond lengthy periods of daily intoxication. One of the most significant things family can do for the dual diagnosis addict in recovery is simply to promote a minimum structuring of daily life.

The addict in recovery will no longer be permitted to live free from responsibilities and enjoy financial and other support. They will be required to actively participate in the world as they are able, and they will benefit from this enforcement of structure. We all need things to do and places to be, and none of us excels blowing in the wind. Structure helps, and it helps the dual diagnosis addict enormously.

Contingent Support

No more free lunch!

Tough love can be pretty tough! It's not often what feels right, and it can be awfully tough to follow the brain when the heart screams help.

But for most families, the initial periods of sobriety and recovery follows a lengthy period of active use, and most families will have first-hand experience on the manipulations of the using addict. Addicts by nature manipulate to protect their lifestyle and their drug or alcohol use, and newly in recovery dual diagnosis addicts will very likely continue to try the same manipulations that have long worked well for them.

Family can exert an enormous positive influence simply through discussing contingent support in a calm and reasoned manner with the in recovery addict, and then ensuring that they abide by any pre agreed upon arrangements. 

Family may decide that a dual diagnosis addict in recovery may receive familial financial support as long as they are attending aftercare treatment. This type of arrangement can work well for all involved, and family can influence continued growth through positive and constructive support. But the addict in recovery must live up to their end of the bargain…no excuses – no more manipulations.

The support of an educated and caring family does wonders for a dual diagnosis addict or alcoholic in new recovery, but just as the addict learns of a new way in rehab, the family must also take on new roles if they truly wish to promote lasting change.

Tough love and support are rarely easy, never intuitive, but they are needed - and they can really help.

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Treat the disease, not the symptoms. Dual diagnosis addicts use manipulation as a way to continue to drink or drug, and family can only influence change through tackling the real root of the problem, and by being tough...tough love

Addicts are master manipulators, and dual diagnosis addicts are no different. Manipulation is part and parcel with denial, and is a defense mechanism essential to continuing to use or to drink. All addicts use manipulation to protect their use, they’ll do almost anything to protect their use!

Although dual diagnosis addicts do use manipulation as a strategy to continuing intoxication, the co presence of another disorder makes it much tougher for family to deflect this manipulation, and thus much tougher for family to act in constructive and supportive ways.

Family can exert a great influence towards getting a dual diagnosis patient both off drugs or alcohol, and towards better mental health as well, but they can only exert this positive influence if they retain a clear view of the situation…and this is very tough to do!

Why Tough Love Is the Best Love

No one enjoys seeing a loved one in pain, and our first and very natural impulse is always to do whatever we can reasonably do for them…whatever they ask of us. Problematically, what the dual diagnosis addict will ask of us is often completely at odds with an end to pain, and actually far more likely to create more pain through continuing and increasing drug and alcohol use.

Family will often coddle a dual diagnosis addict, accepting explanations for poor behaviors and life choices that they would never accept from another family member. Family will often do more than simply accept poor behaviors; they will tacitly support these behaviors through continuing financial or other support.

A dual diagnosis addict may offer a million explanations as to why they cannot go to treatment, why they cannot work, why they cannot handle their responsibilities, and the truth is they are very likely struggling to fulfill these tasks. However, when family indulges and accepts poor behaviors, and cleans up any and all messes made by the dual diagnosis addict, they create a situation very unlikely to induce positive change.

Addicts not faced to live their true reality are not addicts very likely to ever get better.

Dual diagnosis addicts coddled and supported by the family and not compelled to take steps to better their addiction and psychiatric issues tend to get increasingly isolated in the home. They do not work, they do not participate in outside activities, and they develop erratic sleeping patterns. They tend to develop lifestyles well fit to getting drunk or high, and not much else. Family that supports such a lifestyle does little to help the dual diagnosis addict get better.

To influence positive change, family must create a situation in which the dual diagnosis must face the consequences of their poor behaviors. Where family support is contingent on the fulfillment of certain agreed upon requirements (attending treatment, for example) and where the manipulations of the addict are minimized.

Treat the Disease, Not the Symptoms

Families, acting out of the best of intentions, too often spend enormous resources and energy fighting the symptoms of the disease, yet never tackling the disease itself.

Families try getting them into new living arrangements, try taking them on vacation, try buying them a car so that they can get around better…none of these things solve the root cause of all other difficulties.

You cannot expect lasting change through a symptoms management approach to the problem. The problem is from within, and altering external factors cannot change what emanates from within a sick person. Things cannot get better until the addiction is tackled as a primary cause of all other difficulties. (Addiction must be tackled however in a manner cognizant of the challenges facing a dual diagnosis patient.)

Tough Love is Tough

Family does not indulge a dual diagnosis addict out of any motivation other than concern and a misguided direction of natural compassion. It feels normal and right to try and “rescue” someone obviously hurting. Family can exert a great influence towards change, but only through tough love, love that is not easy and doesn’t always feel good. You have to be firm, tackle the real cause of the problem, and stop all behaviors that allow the addict to continue to use or drink without facing up to the consequences of these actions.

Psychiatric challenges do cause a predisposition to addiction. It’s not fair, but it’s reality, and you have to move forward with the hand you’ve been dealt. Dual diagnosis patients can and do get better, but they need to face their reality, and they need to become active participants in their recovery.

Tough love isn’t easy, but it works, and it makes things better.

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People with co-occurring disorders need treatment which integrates substance abuse and mental health therapies at the same time. Read on to learn more about 8 elements of effective co-occurring disorder treatment programs.

So you or someone you love has a mental illness and drinks or uses drugs to excess. You would be right in thinking that a co-occurring disorder complicates treatment, but you might be surprised at just how commonly addiction and mental illness co-exist and you’ll be pleasantly surprised to learn how well addiction treatment can work – even for those with co-occurring disorders.

People with co-occurring disorders will benefit greatly from addiction treatment, as long as treatment integrates substance abuse and mental health therapies at the same time.

1. Untreated addiction will always lead to drug or alcohol abuse which will inevitably derail mental illness remission.
2. Untreated mental illness will invariably lead to symptoms which make substance use relapse very likely
   

So when searching for co-occurring disorder addiction treatment, finding an integrated treatment program is essential. But what does an effective integrated addiction treatment program look like and how does it differ from conventional treatment?

According to the experts at The National Alliance for Mental Illness (NAMI), here are some elements of effective integrated treatment programs.

Elements of Effective Integrated Addiction Treatment Programs for People with Co-occurring Disorders

Effective Programs Work to Build Trust between Client and Caregiver

Effective treatment occurs in stages and the building of trust between the client and treatment staff is of utmost importance. Once clients trust caregivers they are more likely to become actively involved in their own recovery program.

Outreach Programs Improve Retention and Overall Success

Integrated treatment tends to take longer and it needs to be more comprehensive – and one aspect of this comprehensiveness is taking treatment beyond a main central facility and extending services into a client’s home environment – to see what is really going on and to provide the services that are necessary ay any given time.

Home visits and other outreach services also serve to strengthen the therapeutic bond between caregiver and client. Programs which use outreach interventions to engage with clients have much better retention rates than programs which are confined to a central location. Outreach might involve home visits to the client’s residence and/or other out-of-building meetings.

Effective Programs Often Incorporate Motivational Interviewing

Clients can often enter into treatment lacking confidence in their ability to change and may be battling some ambivalence about treatment and abstinence. Motivational interviewing is an evidence based intervention that helps people overcome ambivalence to change, take more ownership over treatment decisions and become more actively involved and committed to meaningful change.

Effective Treatment Programs Offer Counseling

Whether individual, group or family based, all effective treatment programs for those with co-occurring disorders offer at least some counseling. Counseling teaches coping, behavioral and cognitive skills and is an essential element of dual diagnosis treatment.

Effective Programs Help Clients Build Positive Social Relationships

Negative peer relationships (drug using friends or drinking buddies, for example) can damage recovery efforts while positive and supportive social relationships reduce the odds of relapse. Effective programs help clients identify and end dangerous social relationships and help clients develop the skills needed to build new or strengthen existing healthy relationships.

Effective Treatment Is Extended and Open Ended

Dual diagnosis treatment can take months or even years. Protracted treatment allows for a natural rate of progress and protects greatly against early relapse. Every person is different and every person’s treatment schedule will differ. Although 28 days of treatment to a ‘cure’ may sound attractive it is not likely realistic or desirable.

Effective Treatment Is Comprehensive

When mental illness intertwines with substance abuse, treatment cannot focus solely on internal changes – it must help the client make changes and progress in all areas of life. To do this, effective treatment programs provide intervention and support in areas such as social relationships, living arrangements, employment skills, handling leisure time and dealing with stress and anger.

Effective Treatment is Culturally Aware

Caregivers must be able to understand, relate to and communicate effectively with the client for any chance at real success. It is important that people receive integrated treatment within a program that is culturally sensitive. Cultural sensitivity is of paramount importance to many people from certain groups, such as women with small children, teens, homeless people, African Americans or Hispanics and others. ¹

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Don’t try chasing away those winter blahs with a few drinks to lift your spirits, you may be suffering from undiagnosed Seasonal Affective Disorder and by using alcohol as self medication you are greatly upping your risk of a substance abuse problem.

Are you a seasonal drinker or drug user? Does the change from the light and heat of summer to the dark and cold of winter cause you to increase your drinking or drug using each year, possibly as a way to fight against those winter blues?

If yes, then you may be a seasonal substance abuser who uses drugs or alcohol as a way to self medicate your symptoms of Seasonal Affective Disorder (SAD).

Having SAD increases your risk of developing a substance abuse disorder and researchers say that some alcoholics tend to drink with some seasonality, likely as way to cope with feelings of depression related to SAD*.

Unfortunately, a large percentage of those with the disorder remain undiagnosed and untreated.

What Is SAD?

Seasonal Affective Disorder is a form of depression that occurs on a seasonal basis, most often beginning each year as the days shorten into winter, worsening over the winter season and lasting until the longer and warmer days of early spring (a less common form of SAD begins in spring and lasts through to the shorter days of autumn.)

Symptoms of SAD include:

• Feelings of depression
  
• Anxiety
  
• A loss of energy and feelings of heaviness in the body and limbs
  
• Feelings of hopelessness or despair
  
• Sleeping too much
  
• Withdrawing from social life to ‘hibernate’ at home
• Experiencing food cravings, especially for carbohydrate rich foods
  
• Experiencing weight gain
  
• Difficulty in maintaining concentration*
• Increased alcohol and drug use
  

Why Are People with SAD at Increased Risk of Alcoholism and Substance Abuse?

It is estimated that about 5% of Americans and 7% of those in the UK have SAD.* Many people with SAD do not receive an accurate diagnosis of their condition and as such go completely untreated. People with untreated or ineffectively treated SAD are at increased risk of self medicating their symptoms of depression with alcohol and other drugs.

Regular self medication with alcohol and illicit drugs greatly increases a person’s risk of developing a substance abuse disorder.

Who Is Most at Risk of SAD?

People most at risk of SAD include:

• People living in northern latitudes (or very southern latitudes below the equator)  who experience greatly reduced sunlight during the winter months
  
• People with a family history of SAD
  
• Women
  
• People who spent much of their early life in areas near the equator and then immigrated to live in colder areas of the world seem to be at an increased risk of SAD
• Younger adults are more likely than older adults to experience a first incidence of SAD, and most people experience an age of onset before the age of 31*

Treatment

Do not self medicate your winter feelings with alcohol or drugs. You won’t achieve any lasting symptoms betterment and you are putting yourself at risk of alcoholism/drug addiction, which are potentially life threatening conditions.

The most common treatment for SAD is to sit in front of a specially designed high intensity light box for 15 to 30 minutes per day. These special light boxes emit UV light in quantities that approximate strong sunlight and many people find that after using this light therapy for only 3 to 5 days, SAD symptoms disappear or are reduced substantially.

Some people will not experience relief through light therapy alone and will need to substitute or complement light therapy with antidepressants and/or psychotherapy.

Most people will respond well to light therapy and since this therapy is so easily implemented into daily life and because the costs of treatment are so low (a light therapy box may retail for $100 - $200) there is really no reason to suffer with SAD and an increased risk of alcoholism and substance abuse – If you think you may be affected by the changing light levels of winter and if you think that you use drugs and alcohol as a way to compensate for these feelings, talk to your doctor today, before an easily treatable condition becomes something much more severe.

The odds of addiction go way up for people with ADD/ADHD, and untreated ADD is one of the leading causes of substance abuse in America today. Stimulant type medications work in the treatment of ADD/ADHD symptoms, but these medications may not be advised for people with addictions, due to their potential for abuse.

ADD and Addiction Facts

1. 7% of children between the ages of 3 and 17 have ADHD¹
2. 40% of children and teens with ADHD have a co-occurring disorder of Oppositional Defiance Disorder, 21.6% have minor depression (dysthymia) and 15.2% have an anxiety disorder²
3. Studies of adults with ADHD have found co-occurring alcohol abuse disorders at rates ranging from 17% to 45% and drug abuse or dependence at rates ranging from 9% to 30%³
4. Studies have shown that people with ADHD are more likely to develop a substance abuse problem at a younger age, more likely to require lifetime substance abuse treatment and more likely to develop protracted substance abuse problems throughout life.⁴
5. Medication treatment reduces the risks of substance abuse by 85% amongst teen patients with ADHD⁵

Symptoms of ADD/ADHD

A large number of ADD/ADHD sufferers never get properly diagnosed, and some get misdiagnosed with bi-polar disorder. The risks of addiction for untreated ADD/ADHD increase dramatically, and although there has been controversy surrounding the medicating of young children, and a concern that by "drugging" these kids with potent psycho stimulants we would predispose them to addiction, the reverse has in fact been found true. People medicated appropriately are far less likely to develop substance abuse problems.

Anyone who believes they may have ADD/ADHD should get a professional diagnosis, and treatment.

Some ADD/ADHD symptoms include:

• Impulsivity
• Forgetfulness
• A lack of focus
• Impatience
• Thrill seeking
• Day dreaming
• Restlessness
• Unusual sleep patterns

ADD/ADHD patients are often very creative and due to unusual thought processing are sometimes more able to grasp big picture concepts quickly. Many very successful people achieve even with a diagnosis of ADD/ADHD, but in general, the disorder makes academic and work performance more difficult, and less likely.

Why Are ADD/ADHD Patients More Vulnerable to Addiction?

While ADD/ADHD addiction, like addiction in general, remains only partially understood, there are certain known characteristics of the ADD/ADHD patient that make the development of an addiction more likely.

ADD/ADHD is very highly correlated with poor academic and professional performance. Unfortunately, for many ADD/ADHD sufferers, enduring constant underperformance throughout the developmental years of childhood and adolescence hurts self esteem - and low self esteem is well correlated to high levels of substance abuse.

Some ADD/ADHD patients also have trouble forming meaningful relationships, both friendships and love relationships. They tend to get more isolated, lack strong social support, and feel lonelier. They are also more likely to suffer depression. Isolation and depression are very highly correlated with an increased risk for substance abuse.

There is a theory that ADD/ADHD patient may suffer an altered dopamine response. Dopamine, the reward (feel good) neuro chemical, may be released in lesser amounts in those with ADD/ADHD, causing them a lessened inability to feel normal pleasure. They may need to seek out normal pleasure levels through intoxication or thrill seeking behaviors.

Although drugs such as alcohol, cocaine or meth can produce temporary symptoms betterment, these substance over time will worsen ADD/ADHD severity.

Treatment for ADD/ADHD and Addiction

As for any dual diagnosis, for addiction treatment to work, treatment must integrate therapies for addiction management with ADD/ADHD symptoms management. Treating either condition in isolation won't work. Untreated ADD/ADHD will quickly prompt relapse and abuse, and untreated addiction will worsen ADD/ADHD symptoms. Treatment must occur in concert.

ADD/ADHD addicts and alcoholics do not require any unusual treatments for their substance abuse behaviors, and provided their ADD/ADHD symptoms are managed, conventional addictions treatments prove quite effective.

Treatments for ADD/ADHD symptoms include medication, exercise and diet modification, psychotherapy and a lengthy participation in peer based recovery groups.

Medication

The most widely used treatment for ADD/ADHD symptoms control are stimulant type medications, such as Ritalin or Adderall. These medications will work for approximately 80% of patients, both children and adults. These medications, although not intoxicating when used as directed, do carry some risk for abuse, and so should be used with care for the treatment of an ADD/ADHD addict in recovery.

Alternative medications, such as the antidepressants Wellbutrin, Eflexor or SSRI's can be used without risk of abuse.

Although the use of potent psycho stimulants in the treatment of ADD/ADHD symptoms has been, and continues to be controversial, they remain widely prescribed because nothing else works as well.

It is vital that ADD/ADHD symptoms moderate for any chance of a recovery from addiction, and medications that may help need to be considered.

Exercise and Diet

Behavioral choices on diet and activity levels can have a significant impact on the severity of ADD/ADHD symptoms expression. A healthy diet, low in carbohydrates promotes balanced blood sugar and an evenness of mood and energy.

Vigorous exercise also helps to stabilize mood and attention, and certain balance type exercises (such as yoga or martial arts) have been shown to exert an impact on hypothalamic functioning, increasing an ability to focus.

Anyone in recovery benefits from a healthy diet with exercise and meditative movements, and these behavioral choices seem especially important for the ADD/ADHD addict in recovery.

Therapy

Therapy benefits the ADD/ADHD patient for several reasons. Many enter into substance abuse in part from lowered self esteem, a lack of confidence, and an inability to form lasting friendships. Medication can help to alleviate symptoms of the disorder, but unless the underlying psychological distress gets dealt with, lasting recovery is unlikely.

Working with a therapist, patients can better understand their disorder, understand how their disorder and their self worth must be distinct entities, and learn effective life and coping skills.

Therapists can help patients to organize structured daily routines which minimize relapse (and ADD/ADHD symptoms provoking) boredom and frustration.

Peer Recovery

All addicts and alcoholics in recovery require a lasting participating in aftercare for the best chance of sobriety, and ADD/ADHD patients need this more than most.

Regular reinforcement of recovery lessons help those that have difficulty focusing on long-standing goals incorporate recovery techniques into everyday life. The meetings also provide additional daily structure – structure that can help a lot.

Additionally, many ADD/ADHD patients in recovery find aftercare peer groups such as AA or NA great places for social support, often making lasting friendships with like minded people. Many alcoholics in recovery suffer from ADD/ADHD, and there can be an understanding and fellowship in recovery groups that is hard to find in regular society. Sober support helps.

ADD/ADHD increases the likelihood of an addiction, it also complicates the treatment, but any treatment that works concurrently on issues of addiction and ADD/ADHD symptoms has a great chance of success.

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PTSD and substance abuse go hand in hand, and since each condition exacerbates the severity of the other, alcohol or drugs are never a good idea. Get help at a facility that combines effective treatments for PTSD and substance abuse, and turn the corner to a brighter tomorrow.

Not everyone who witnesses or is subjected to a terrifying situation or an imminent threat to life will develop PTSD, but many people do develop this syndrome of symptoms, and people with PTSD are far more likely to turn to the use and abuse of alcohol or illicit drugs as self medication to the negative symptoms of the disorder.

About 70% of Americans have been exposed to a violent trauma severe enough to cause PTSD, and about 11% of these people will develop PTSD. People are considered to have PTSD after symptoms of anxiety and insomnia continue for more than a month. Additional symptoms of PTSD include irrational terrors, fatigue, poor concentration and memory performance, emotional blunting, apathy, tachycardia and gastro intestinal distress. The risks to developing PTSD are increased with increasing trauma severity, and as well with a prior history of anxiety or other psychiatric conditions.

Concurrent alcohol or substance abuse with PTSD will almost invariably entrench and worsen the experienced symptoms of the disorder, and PTSD sufferers need treatment that confronts both their psychological problems as well as their dependency issues, simultaneously.

Clinical experts remain unsure about how exactly PTSD and substance abuse are linked together; and research has linked the two disorders in diverse ways. People may have a genetic vulnerability to the two conditions together, alcohol or drug use may alter the brain to increase the vulnerability to PTSD and people experiencing PTSD may use alcohol or drugs as self medication. Although researchers are not yet certain how the two disorders interact, that they are interrelated is known with certainty.

Some Facts About PTSD and Alcohol or Drug Abuse

Being diagnosed with PTSD greatly increases the likelihood of experiencing an alcohol abuse problem, and 25% - 75% of people exposed to violent trauma will also develop substance abuse problems.

Alcohol and substance abuse worsens the symptoms of PTSD. Substance abuse worsens sleep (greatly linked to PTSD symptoms) increases feelings of hyper vigilance and also makes the treatment for PTSD much more difficult.

Women are twice as likely as men to develop PTSD, and women seeking residential alcohol rehab are 500% more likely to be suffering PTSD symptoms than the general population.

60-80% of Vietnam vets receiving PTSD treatment have a concurrent substance abuse problem

Treatment for Concurrent PTSD and Substance Abuse

The treatment needed for concurrent PTSD and substance abuse will depend on the relative severity of both anxiety symptoms and substance abuse behaviors. As they are interrelated, the two problems cannot be treated separately; and treatment must begin with a comprehensive pre assessment period to gain an accurate understanding of the severity of symptoms.

The initial withdrawal and detox stage of substance abuse treatment can greatly increase anxiety and other PTSD symptoms, and patients undergoing detox need special monitoring and maintenance for safety and comfort during this period.

The substance abuse strategies for treatment do not differ substantially from strategies offered to single diagnosis patient, but corresponding and concurrent therapies should be offered to treat the unique symptoms of PTSD. Cognitive behavioral "exposure" therapy, in which patients learn to confront their fears and memories of trauma are often used to lessen symptom severity. Cognitive skills education also teaches PTSD addicts how to manage and assess symptoms of the disorder.

Medications such as SSRI anti depressants are often used to decrease symptoms severity and decrease the likelihood of alcohol or drug relapse.

Aftercare therapies need to be maintained at a relatively intensive level, as PTSD symptoms often seem worse through the initial months of abstinence and sobriety, and are a significant threat to recovery and relapse.

Dual Diagnosis Patients Need Early Intervention and Treatment

Similar to any dual diagnosis of a psychiatric condition and addiction, PTSD and addiction treatment needs to be more intensive, needs to provide comprehensive and interlinked care for symptoms of all co-occurring disorders, and treatment will likely take longer than for a single diagnosis patient.

Because the risks towards abuse and also the risks of abuse are higher with PTSD patients; people suffering both stress related anxiety disorders and substance abuse problems need early intervention and treatment.

Very rarely will either problem dissipate without treatment, so getting help is always the first step to getting better!

53% of people who abuse drugs will also experience a mental health problem at some point, and this is nearly 4 times the average for the non drug abusing community; and helps somewhat to understand the factors that may lead to addiction and substance abuse.

Concurrent mental health problems and addiction make the treatment of the addiction far more complex, and there can be a continuum along which either the metal health problem or addiction may be more harmful. It is important to realize that all mental health problems differ in their treatment requirements and symptomology, and a person with anxiety, will not likely act in the same way as someone with a borderline personality disorder or someone with depression. Accurate pre treatment assessment of the concurrent mental health problem and addiction is the best way to determine the most appropriate treatment needed, and as such a number of professionals may need to be involved in the diagnosis.

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With an increasing pop-culture awareness of mental health conditions there is a tendency for individuals or families to attempt a self diagnosis, and even to take treatment steps based in this self diagnosis. Don't do it!

You can't find depression on an X-Ray and there's no blood test for bi-polar.

Attaining a correct diagnosis of the psychiatric illness compounding an addiction challenge is essential for any hope of a successful recovery. It's also very difficult – so complex in fact that mental health challenges are routinely incorrectly diagnosed by medical professionals (and incorrectly medicated as a result) and so complex that family alone should not attempt to make a diagnosis-even informally-without professional help.

A Dual Diagnosis Is Complex

Drug and alcohol use create certain neuro chemical imbalances that can manifest quite similarly to certain psychiatric disorders, drug and alcohol use can induce a psychiatric illness, and an existing psychiatric illness can induce alcohol or drug abuse as a form of self medication.

With the advent of the internet and an increasing pop culture awareness of mental illness, there can be a tendency for loved ones to attempt to diagnose certain behavioral traits, and even take certain treatment steps assuming a correct diagnosis, yet the complexity of making a correct diagnosis discludes laypeople from correctly determining the real extent of the situation. Even seasoned psychiatric health professionals struggle to accurately diagnose these difficulty measured challenges, and with limited diagnostics testing available, the diagnosis in many cases falls to the experience and observations of a multi disciplinary team working in concert.

Get a Professional Diagnosis

If you or a family member struggles with psychiatric challenges concurrently with addiction, make sure you get a professional diagnosis. Addiction and mental health issues are strongly interrelated, and a dual diagnosis is very common - and very under diagnosed. If you or a loved one is suffering from an addiction to drugs or alcohol, it can be beneficial to seek out some preliminary professional therapy prior to selecting a treatment location, to ensure that you get a preliminary diagnosis and to ensure that the treatment facility you select for your care is well equipped to handle your mental health needs.

An accurate diagnosis, although complex, greatly accelerates treatment, and guards greatly against relapse. Neither condition (addiction or mental health issues) can be treated in isolation for any likelihood of long term success and sobriety. Get help, get a diagnosis and start getting the treatment needed to start getting better.

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Concurrent substance abuse and psychiatric conditions are a common and problematic occurrence; and unfortunately, the treatment is tougher and takes a long time. But recovery is possible, and needs to happen. The stakes of a concurrent disorder are too great, and both conditions tend to exacerbate the severity of the other. With appropriate treatment, and therapy and medications compliance; sober living and psychiatric symptoms remission is probable...but the first step is always to stop the abuse.

Tragically, mental illness and addiction are too often found together, and the treatment of either is complicated and prolonged due to the effects of the other condition. Sometimes it's assumed that the behavioral and emotive or affective symptoms are merely a symptom of the drug abuse, and it's not until weeks into rehab, when the symptoms don't dissipate, that the coresponsding mental health condition is diagnosed. However it occurs, it's a tough one, but with co occurring mental health deficits and addiction, the stakes of abuse are even greater than normal, and it’s imperative than anyone suffering a concurrent addiction and mental illness get treatment right away.

The biggest problem with concurrent addiction and mental illness is that both problems tend to exacerbate the severity of the other. A mild depression, controllable with medications, can become severe under a regime of illicit drug self medication, and the depths of depression can compel ever greater drug abuse to ease the pain of the symptoms. Additionally, a lot of the medications used to treat mental conditions are rendered less effective or even ineffective when taken with alcohol or other drugs, and so even if the mental condition has been diagnosed, and is undergoing treatment, the concurrent abuse of alcohol or drugs reduces the effectiveness of otherwise very sound medical therapies.

The stakes are great, and addiction and mental illness just do not mix. If a loved one is suffering a concurrent problem, you need to get them the help they need, and you need to get it fast. But what type of treatment is appropriate for concurrent addiction and mental health occurrence?

The most appropriate treatment will depend on the relative severity of the dual presenting condition. If at the time of treatment the mental health deficit is more severe than the substance abuse, then a psychiatric facility that can stabilize the psychiatric condition may be required, and if the addiction is more severe, and is the primary cause of the severity of the mental health concern, then often a residential rehab program, and a period of enforced sobriety, is all that is required.

When considering the most appropriate facility, it’s wise to include all medical professionals and case workers currently involved in the care and diagnosis of the patient for their recommendations. You may need to yield to the advice of professionals more knowledgeable than yourself in the interest of arranging appropriate treatment. You will want to ensure that whatever facility the person is sent to, it is staffed with the necessary psychiatric professionals that will be needed for ongoing care and evaluations as the rehab progresses.

Rehab for concurrent disorder sufferers tends to take a little longer, but it can and does work. A period of time away from abuse, fully medicated, and learning the strategies needed to stay abuse free is often all that is needed to better the emotional and mental health of the patient, and break the cycle of self medication and ever greater abuse.

Patience and empathy are needed, and the patient needs the love and support of their family and friends. If a loved one is abusing, and is either diagnosed with a concurrent mental condition, or you suspect an undiagnosed condition, make every effort to get that person the help they need, and rescue them from the downward spiral that concurrent addiction always becomes.

Psychiatric medications and therapies are very effective, and with ongoing treatment and medications compliance, the odds of a full recovery are great.

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Hope is vital. Without hope, family gives up and the dual diagnosis addict lose necessary and beneficial support. Learn why treatment works, and why you have to keep hope alive!

Family watching a loved one succumb to addiction often feels powerless to exert change, and when a psychiatric condition complicates things, family often feels helpless to make things better.

While it's true that a dual diagnosis complicates treatment, treatment still works and works quite well, and there is always hope for a better tomorrow.

It's not going to be easy, recovery from addiction never is, but it's possible, and it's the only acceptable outcome.

Hope

Hope is an intangible. Hope is hard to measure, hard to quantify, and hard to put into practice; yet without a belief that change is possible, family cannot do much of value.

It's natural to get discouraged after your efforts are rebuffed and you cannot seem to influence positive change. The things that work are not always intuitive nor what feel good, but if family does get informed, and does start to act in a concerted manner to exert change, the odds are high that a dual diagnosis addict will also take some steps towards recovery. And this is fantastic, because once walking that path, the road to health is open and wide, and there is a great chance that addiction can be overcome.

Here are three reasons why treatment works for dual diagnosis patients…three reasons why families need to keep hope alive.

1. Enforced sobriety

Many dual diagnosis patients take drugs or alcohol as a way of self medicating the negative symptoms of their psychiatric condition. Intoxication can bring a temporary reprieve from these negative symptoms, but over time, using drugs or alcohol always exacerbates the severity of the mental health challenge.

There is real therapeutic power in a period of enforced sobriety. A few weeks away from drug or alcohol abuse can improve mental health symptoms substantially, even without any of the additional and beneficial therapies of drug treatment. Sobriety reduces the assault on the chemicals of the mind, and allows for a natural healing of psychiatric symptoms.

Sobriety without therapy is probably not going to be enough, but it does make a real difference, and it is a real start to recovery.

2. Medication

Whether or not the dual diagnosis addict has been diagnosed and medicated while still using, the corresponding use of drugs or alcohol greatly reduces the efficacy of these otherwise very effective psychiatric medications.

Addicts using don’t often take medications on schedule and most of these drugs do not work well when taken with other intoxicants.

Getting into treatment, getting sober and receiving appropriate medication can greatly reduce symptoms severity, and can get the dual diagnosis addict feeling better and thinking more clearly.

With a reduction in symptoms severity, the addict in recovery can participate more intensely in the recovery process, can take ownership over the process, and can experience in part what getting sober and getting healthy feels like.

Getting sober and getting medicated can get the addict in recovery feeling so much better that they once again want sobriety as a lifestyle, and have them once again hopeful for a life free from the pains of abuse, and the clouding of mental illness.

3. Inspiration from Others

Recovery at its best doesn’t happen alone.

Dual diagnosis addicts are often trapped within a web of hopelessness and irresponsibility, and without transitioning to a belief in recovery and an ownership over the process, sustained betterment is unlikely.

A dual diagnosis is tough, and it's unfortunate that anyone must endure the trial-but equally-there is no point in wishing away what life brings. Recovery is possible.

Recovering in a group with others also facing similar life challenges can inspire, and the authentic inspiration of witnessing other dual diagnosis addicts get better is not easily mimicked outside of the group recovery environment.

You can’t say it's impossible when you watch someone else that you know suffers as you do get better. You can’t say you can’t do it when others do.

A period in a residential rehab brings many things to the table, and sobriety and professional therapy (medication) help greatly, but unless that recovering addict can be made to believe in the possibility of a life without abuse, and believe that they must ultimately choose to participate in this recovery, all else is irrelevant. Group therapy in rehab brings the hope towards recovery, hope that is so desperately needed.

Recovery and Hope

No one says it's going to be easy and no says it's fair either – but recovery is possible. Keep hope alive, believe that it is possible (it is) and work towards getting the dual diagnosis addict into a program where they will get sober, get medicated; and hopefully, get inspired.

Family can do a lot, and they can take steps to get a loved one into appropriate treatment, but at the end of the day recovery happens from within, and without belief, determination and inspiration, recovery can’t hold.

Help them find the inspiration they need. Help them get into a group recovery environment.

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It's tough to make an appropriate decision about treatment when you can't understand the terminology used by drug treatment facilities!

While searching for a drug or alcohol treatment facility for a person with a dual diagnosis, you will often encounter the terms inpatient (hospitalization) and partial hospitalization (residential treatment). These terms used by drug and alcohol treatment facilities refer to a level of care and staffing, and have nothing to do with leaving the hospital, in either case.

Deciding on appropriate care for a dual diagnosis patient is tough enough, and confusing terminology certainly does not make the process any easier!

Hospitalization (inpatient)

Facilities that offer true hospitalization or true inpatient care will offer medical care around the clock; 24 hour a day nursing care, and 24 hour a day access to doctors when needed.

Medical detox will occur in a hospitalization setting, for safety, and in some cases psychiatric patients will need hospitalization for stabilization of symptoms before proceeding to lesser intensity partial hospitalization care.

Full hospitalization for dual diagnosis patients generally occurs for only a very brief period, a mater of days, and as soon as psychiatric symptoms have stabilized to the point where the patient can participate safely in a traditional drug treatment environment, they will be moved.

Partial Hospitalization (Residential Treatment)

The vast majority of drug and alcohol rehabs are partial hospitalization facilities. Patients reside within the facility 24 hours a day, but medical nursing services will not be offered around the clock. These services are offered in emergency situations.

Dual diagnosis patients need only a partial hospitalization environment, as long as their symptoms are stable, they are not a danger to themselves or to others, and they are lucid enough to participate effectively in the therapies of drug or alcohol treatment.

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All of us benefit from healthier lifestyle habits, but those feel-good benefits are exaggerated beautifully for those suffering a mental disorder. Get enough rest, eat well and get some exercise; it makes a big difference.

Little things that can make a big difference...

When family contemplates options for dual diagnosis addiction treatment, they often think of drug rehab, psychiatric hospitalization and strong psychotropic medications…and these all can have a place in a treatment regimen for more seriously afflicted patients. Family tends to overlook some of the less intrusive environmental factors than can exert a significant influence on mental health and stability, and overall quality of life.

Sleep, Eat, Exercise

Sleep right, eat right and get some exercise. Not exactly rocket science, but improve in these three areas and you’d be hard pressed not to feel better.

It’s a recipe for health and happiness for anyone, but for those facing a dual diagnosis, taking proper care of the physical earns enormous dividends within the mental realm. Good nutrition promotes glycemic stability beneficial to an evenness of mood and emotions, free from the highs and lows induced by sugar and junk. Getting all needed vitamins also protects from nutrient deficiencies that can have a significant influence on mood, thought and even mental health. Good nutrition makes a difference.

Insomnia promotes ruminant, maladaptive thinking, it induces more solitary lifestyles, and insomnia also leads to greater rates of substance abuse and addiction. Exercise tires the physical, increasing the propensity towards a good night's rest. Vigorous and sustained exercise causes a release of natural feel-good endorphins, and regular exercise can replenish the brain's levels of mood and sleep stabilizing serotonin.

Exercise, sleep, and good healthy meals; they affect far more than the physical alone.

Healthy habits do not cure serious psychiatric challenges, but they always help, they create a stability of mood, can restore certain neuro chemicals to optimal levels and can reduce the difficulties inherent in overcoming addiction or alcoholism. Whatever the severity of the condition, a bettering of environmental and lifestyle factors can induce a bettering of psychiatric symptoms manifestation. Little things can sometimes make a difference and small changes together can create a whole greater than the sum of the parts.