Learn about their diagnosis. Every mental illness is different so every person needs a different approach. It can be very affirming when your loved ones take the time to learn about your diagnosis and the way in which it effects you. Having a better understanding of your loved one will help you make sense of […]
When we hear someone is psychotic, we automatically think of psychopaths and cold-blooded criminals. We automatically think “Oh wow, they’re really crazy!” And we automatically think of plenty of other myths and misconceptions that only further the stigma surrounding psychosis.
In other words, the reality is that we get psychosis very wrong.
For starters, psychosis consists of hallucinations and/or delusions. “You can have one or both at the same time,” said Devon MacDermott, Ph.D, a psychologist who previously worked in psychiatric hospitals and outpatient centers, treating individuals experiencing psychosis in various forms.
“Hallucinations are sensory perceptions in the absence of external triggers,” MacDermott said. That is, “the trigger comes from inside [the person’s] own mind,” and involves one of their five senses. The most common is hearing voices, she said. People also can “see or feel things that aren’t there.”
“Delusions are persistent beliefs without sufficient evidence to back up those beliefs—and often with substantial evidence to refute the belief,” said MacDermott, who’s now in private practice where she specializes in trauma and OCD.
Psychologist Jessica Arenella, Ph.D, describes psychosis as a disruption in meaning-making: “The person may be finding meaning in otherwise random or inconsequential things (e.g., license plate numbers, TV ads), while minimizing or failing to grasp the importance of basic needs (e.g., showing up for work, changing one’s clothes).”
The signs of a psychotic episode differ depending on the person, because the symptoms are “an extension of each person’s unique thinking patterns,” MacDermott said.
Generally, people’s speech can be tough to follow or not make sense (because the person’s thoughts are disorganized); they might mutter or talk to themselves; say extraordinary, often unlikely things (e.g., “An actor is in love with me”), she said.
During a psychotic episode, it’s common for individuals to act in ways that are strange or out of character for them, MacDermott said. “This can range from something small like wearing more layers of clothes than is appropriate for the temperature all the way to sudden bursts of emotion that seem to come out of nowhere.”
What Psychotic Episodes Feel Like
“[During a psychotic episode], I zone out. I’m gone. I leave reality,” said Michelle Hammer, who has schizophrenia. She’s the co-host of Psych Central’s A Bipolar, a Schizophrenic, and a Podcast and founder of Schizophrenic.NYC, a clothing line with the mission of reducing stigma by starting conversations about mental health. “I can be thinking of anything. A past conversation. A made-up conversation. A weird dreamlike situation. I lose reality of where I actually physically am.”
“I mainly just feel ‘off,’ Things just aren’t right,” said Rachel Star Withers, who has schizophrenia and is an entertainer, speaker and video producer. She creates videos documenting her schizophrenia and ways to manage it, and aims to let others like her know they are not alone and can still live an amazing life.
“The biggest tell for me is that I start talking to myself and thinking in third person,” Withers said. She’ll tell herself things like:”OK Rachel, just walk; be normal.”
A patient once described psychosis in this way to MacDermott: “Imagine that you summon a picture in your mind like, say, a baseball. Imagine a baseball. Now imagine what it would be like to have the knowledge that you put that image in your mind taken away. Now, all you are left with is a thought having no idea how it got there. That’s what it’s like to be psychotic.”
MacDermott’s patients also have told her that they struggle with interpreting situations and see special meaning in everyday things. “That same patient once saw a family member put a knife down while they were cooking and had the thought that the family member was trying to send the patient a message that they were going to be killed because a knife represents death.”
In this piece on The Mighty individuals shared what it’s like to experience psychosis. One person wrote, “For me, it felt like I was watching a movie that was my life. I knew bad things were happening and I couldn’t stop it.” Another person described having an “out of body experience,” along with “excruciating sensations amplified by 1,000 at the tip of every sensor in my body.”
Someone else explained it in this way: “Every sense is heightened and colors are especially bright. The world is on a giant flat screen TV. Everything seems more crystal clear than you ever knew, but then it all becomes confused and muddled. You make your own realities, constantly decoding messages that seem extremely important, but are ultimately meaningless. They further the storyline in your head that seems so real.”
Arenella’s clients have described their psychotic episodes as “disorienting, overwhelming, frightening and isolating. They often describe heightened sensitivity, believing that there are no boundaries, that everything is related and transparent, and there is no privacy.”
Some might believe that they’re part of, or at the center of, a critical life-altering mission or plan, Arenella said. Which might lead to intense activity or the complete opposite: a feeling of paralysis.
Myths about Psychotic Episodes
One of the biggest and most harmful myths about psychosis is that people are dangerous and violent. Both MacDermott and Arenella emphasized that individuals in the throes of psychosis are much more likely to be victimized than to victimize.
Similarly, psychosis is not the same as psychopathy, MacDermott said. “Psychopaths are people who don’t feel empathy, are thrill seeking, and often are parasitic, aggressive, or manipulative to others. Psychosis is completely different and unrelated.”
Another misconception is that psychosis is always indicative of schizophrenia. Sometimes, psychotic episodes occur on their own, or as part of a different mental illness, such as depression, Arenella said. Most people only experience one or a handful of psychotic episodes in their lifetime, she said. (“Only approximately one third of people who experience psychotic episodes go on to have persistent psychotic states.”)
And if someone’s psychotic episodes are part of schizophrenia, it’s important to understand that people can and do recover from this illness, Arenella said.
Arenella, a founding board member of Hearing Voices NYC, also noted that eliminating voice hearing isn’t an essential part of treatment. “How a person interprets and interacts with their voices is more important for recovery than hearing them or not hearing them.” (This TED talk from Eleanor Longden, who has schizophrenia, provides more insight.)
Moreover, even many mental health professionals believe the widespread myth that medication successfully treats psychosis, said Arenella, the president of the United States chapter of the International Society for Psychological and Social Approaches to Psychosis. While medication can decrease the intensity of symptoms, many people still hear voices and have difficulty in social relating, she said. Many also experience bothersome or serious side effects.
“Medication works for some people, some of the time, but it is not a cure all.” Psychosocial treatments, such as cognitive behavioral therapy for psychosis (CBT-p), have been shown to be effective in treating psychosis.
What Causes Psychotic Episodes
MacDermott noted that there’s a lot we still don’t know about psychosis, and that includes its causes. Genetics likely plays a role. “People with an immediate family member with schizophrenia are much more likely to have schizophrenia themselves than someone who doesn’t have an immediate family member with the disorder,” she said.
Adverse childhood events and trauma can contribute to psychosis, as well, even though the episode can occur years later, Arenella said. She also identified other common factors: loss, social rejection, insomnia, illegal and prescribed drugs and hormonal changes.
“A lot of antipsychotic medication reduces the amount of certain neurotransmitters, like dopamine, in the brain,” MacDermott said. This suggests that too much dopamine (and other neurotransmitters) might be involved in psychosis. But, as MacDermott noted, “People and brains are so complicated that we can’t know for sure exactly what triggers psychosis in each person.”
A big reason psychosis scares and confuses us is because it seems so out of the realm of “normal.” But in actuality, “psychosis is part of the normal range of human experience,” Arenella said. “While it is unusual, it is not fundamentally different from other human experience.”
That is, she said, “people who hear voices actually hear them and they sound just as real as all of the other voices of people. Imagine if someone were talking to you all day long while you’re trying to have a conversation with someone else; you might be distracted, confused, irritable, and want to avoid conversations. This is a normal response, albeit to an unusual stimuli.”
Also, many people hear voices, and aren’t having a psychotic episode. Arenella noted that after a loved one dies, some people report hearing the person talking to them. “Musicians and poets often hear tunes and verses in their heads and may not feel as if they created them, but more like they received them somehow.” Many people also talk about hearing the voice of God or Jesus during pivotal moments in their lives.
We tend to be taught, both implicitly and explicitly, that psychosis is unlike any other mental health issue—such as anxiety or depression, and “is not amenable to regular therapeutic techniques,” Arenella said. “This fosters a profound othering and harmful stigma toward people who experience psychosis.”
And such teachings simply couldn’t be further from the truth.
This week marks the one-year anniversary of the horrific Parkland school shooting. That tragedy sparked an intense national debate over how best to protect our children from school shootings.
Some have pushed for more restrictions on the constitutional rights of law-abiding citizens. Among them are the American Federation of Teachers and the National Education Association. These groups released a new set of proposals on Monday that they say “can prevent mass shooting incidents and help end gun violence in American schools.”
Unfortunately, these proposals miss the mark by neglecting to focus on the real problems, including, among other things, the role of mental illness in certain types of firearm-related violence.
How does serious mental illness factor in? And what steps can government take to mitigate the role of untreated mental illness in producing violent threats?
These questions merit deliberate, thoughtful examination, not reflexive calls for broad gun control.
For that reason, The Heritage Foundation recently published a legal memorandum, “Mental Illness, Firearms, and Violence,” as part of a series of papers by John Malcolm and myself exploring some of these deeper issues.
The paper makes clear that, while most mentally ill individuals are not and never will become violent, certain types of serious mental illness—especially when untreated—are associated with a higher prevalence of certain types of firearm-related violence.
In particular, individuals with serious mental illness are at a greater risk of committing suicide and are responsible for a disproportionate number of mass public killings.
Mass Public Shootings
There’s no evidence that all mentally ill people constitute a “high risk” population with respect to interpersonal violence, including firearm-related violence against others.
In fact, most studies indicate that mental illness is responsible for only a small fraction (about 3 percent to 5 percent) of all violent crimes committed in the United States every year, and most of those episodes of violence are committed by individuals who are not currently receiving mental health treatment.
There is, however, a strong connection between acts of mass public violence—including mass public shootings—and untreated serious mental illness.
While acts of mass public violence are extraordinary and rare occurrences, they are often high-profile events that deeply affect the national view of violent crime trends. Mass public shootings in particular stoke national conversations on gun violence and gun control, for understandable reasons.
The majority of all mass public killers (some studies estimate as many as two-thirds) likely suffered from a serious mental illness prior to their attacks, and often displayed clear signs of delusional thinking, paranoia, or irrational feelings of oppression associated with conditions such as schizophrenia and bipolar-related psychosis.
This includes many individuals who committed atrocious attacks on students, including the Parkland shooter, the Virginia Tech shooter, and the Sandy Hook shooter—all of whom had long histories of untreated mental health problems.
Unfortunately, hardly any of these individuals were receiving psychiatric treatment at the time of their attacks.
Even without access to firearms, individuals with untreated serious mental illness can and do find ways to commit mass public killings.
Activist groups and politicians who point to mass public shootings as a reason for broad restrictions on firearm access by the general public largely miss the underlying reality: The real problem is not the prevalence of firearms among the general public, but the prevalence of untreated serious mental illness that causes some individuals to become violent in catastrophic ways, regardless of lawful access to firearms.
The most significant link between mental illness and firearm-related violence is suicide, which accounts for almost two-thirds of all annual firearm-related deaths in the United States.
Of course, not every suicide is necessarily related to an underlying mental illness, but there is little doubt that the presence of a mental illness substantially increases a person’s risk for committing suicide.
The most common method of suicide in the U.S. is through the use of a firearm, an unsurprising reality given that the U.S. has the highest per-capita number of privately owned firearms in the world.
Despite the nation’s exceptionally high rate of suicide by firearm, however, it does not have a particularly high overall suicide rate, compared with other countries.
Our national suicide rate stands at roughly the world average and is comparable to the rate experienced by many European countries with significantly lower rates of private firearm ownership.
At the same time, a number of countries with severely restrictive gun control laws have much higher rates of suicide than the United States, including Belgium, Finland, France, Japan, and South Korea.
The connection between general measures of firearm access and general suicide rates is limited, at best. The U.S. suicide rate has remained relatively stable over the past 50 years, even though the number of guns per capita has doubled.
Moreover, the percentage of suicides committed with firearms has actually decreased since 1999, even though the number of privately owned firearms has increased by more than 100 million.
As this data suggests, broad restrictions on firearm access are unlikely to have a meaningful effect on general suicide rates, and there are other socioeconomic factors beyond firearm availability that better account for differences in suicide rates.
These factors largely include measures of “social cohesion,” such as divorce rates, unemployment, poverty, past trauma, and family structure, and it’s increasingly clear that more socially integrated communities also tend to have lower suicide rates.
Access to firearms may, however, exacerbate the danger for people who are already at a heightened risk for committing suicide. For example, when individuals have a serious mental illness, access to firearms appears to increase their risk of committing suicide.
But it’s also more complicated: While individuals with serious mental illness may have an increased risk of committing suicide when they have ready access to firearms, they may also be less likely than the general population to commit suicide with firearms.
Why? Because they often have greater barriers to legal firearm access, including disqualifying mental health histories under state or federal law, and concerned friends or family members who may limit their unsupervised access to firearms.
Several studies suggest, then, that reducing unsupervised access to all commonly employed means of suicide (including firearms, but also sharp objects, medications, and rope material) for at-risk persons reduces their individual risk of suicide.
In short, broad limitations on firearm access for individuals who are not necessarily at heightened risk for committing suicide are unlikely to meaningfully affect overall suicide rates and should be viewed with a heavy dose of skepticism, but policies designed to limit firearm access for individuals with serious mental illness may be an important step in the right direction for reducing state and national suicide rates.
It is clear that mental illness—especially untreated serious mental illness—plays a significant role in certain types of firearm-related violence that cannot be ignored.
This is not to suggest that individuals with mental illness should be treated as community pariahs or that they are even the cause of most firearm-related violence in the United States. But any holistic approach to reducing suicide and violent crime rates in our communities must account for the role played by serious mental illness.
The reduction of suicide rates requires a comprehensive approach that addresses all of the various factors related to suicide risk, including mental illness, socioeconomic variations, and access to a support system.
Similarly, policies to reduce the rate of mass public shootings in the United States must account for the significant role played by untreated serious mental illness in such killings.
The broad-scale disarmament of the general population is an inappropriate and unnecessary substitute for dealing with the underlying problems.
Psych Central Article Here
By John M. Grohol, Psy.D.
You can extract more than 70 different components from a marijuana plant, technically known as cannabis sativa. Two of the most common constituents are delta-9-tetrahydrocannabinol (known colloquially as THC) and cannabidiol (CBD).
Because CBD is not as regulated as THC (though it may be technically illegal under federal laws), nor does it provide any accompanying “high” as THC does, it has become increasingly marketed as a cure-all for virtually any ailment. You can now find CBD oil products online to treat everything from back pain and sleep problems, to anxiety and mental health concerns.
How effective is CBD oil in the treatment of mental disorder symptoms?
Unlike it’s sister THC, CBD doesn’t have any of the associated negative side effects of tolerance or withdrawal (Loflin et al., 2017). CBD is derived from the cannabis plant, and shouldn’t be confused with synthetic cannabinoid receptor agonists like K2 or spice.
Because of its relatively benign nature and more lax legal status, CBD has been more widely studied by researchers in both animals and humans. As researchers Campos et al. (2016) noted, “The investigation of the possible positive impact of CBD in neuropsychiatric disorders began in the 1970s. After a slow progress, this subject has been showing an exponential growth in the last decade.”
Research has shown that CBD oil may be effective as a treatment for a variety of conditions and health concerns. Scientific studies demonstrate the effectiveness of CBD to help relieve some of the symptoms associated with: glaucoma, epilepsy, pain, inflammation, multiple sclerosis (MS), Parkinson’s disease, Huntington’s disease, and Alzheimer’s. It appears to help some people with gut diseases, such as gastric ulcers, Crohn’s disease, and irritable bowel syndrome as well (Maurya & Velmurugan, 2018).
You can find low-end and high-end CBD oil products. The most popular CBD oil product on Amazon.com retails for around $25 and contains only 250 mg of CBD extract.
In a pilot randomized placebo-controlled study of adults with attention deficit hyperactivity disorder (ADHD), a positive effect was only found on the measurements of hyperactivity and impulsivity, but not on the measurement of attention and cognitive performance (Poleg et al., 2019). The treatment used was a 1:1 ratio of THC:CBD, one of the common CBD treatments being studied along with CBD oil on its own. This finding suggests more research is needed before using CBD oil for help with ADHD symptoms.
There are a number of studies that have found that CBD reduces self-reported anxiety and sympathetic arousal in non-clinical populations (those without a mental disorder). Research also suggests it may reduce anxiety that was artificially induced in an experiment with patients with social phobia, according to Loflin et al. (2017).
A review of the literature published in 2017 (Loflin et al.) could find no study that examined CBD as a treatment for depression specifically. A mouse study the researchers examined found that mice treated with CBD acted in a way similar to the way they acted after receiving an antidepressant medication. Therefore, there is virtually little to no research support for the use of CBD oil as a treatment for depression.
Loflin et al. (2017) only found a single CBD study conducted on sleep quality:
Specifically, 40, 80, and 160 mg CBD capsules were administered to 15 individuals with insomnia. Results suggested that 160 mg CBD was associated with an overall improvement in self-reported sleep quality.
There are two human trials currently underway that are examining the impact of both THC and CBD on post-traumatic stress disorder (PTSD) symptoms. One is entitled Study of Four Different Potencies of Smoked Marijuana in 76 Veterans With PTSD and the second is entitled Evaluating Safety and Efficacy of Cannabis in Participants With Chronic Posttraumatic Stress Disorder. The first study is expected to be completed this month, while the second should be completed by year’s end. It can take up to a year (or more) after a study has been completed before its results are published in a journal.
Bipolar Disorder & Mania
Sadly, this has not yet been studied. What has been studied is cannabis use on the effect of bipolar disorder symptoms. More than 70 percent of people with bipolar disorder have reported trying cannabis, and around 30 percent use it regularly. However, such regular use is associated with earlier onset of bipolar disorder, poorer outcomes, and fluctuations in a person’s cycling patterns and severity of manic or hypomanic episodes (Bally et al., 2014).
More research is needed to see whether supplementing CBD oil might help alleviate some of the negative impact of cannabis use. And additional research is needed to examine whether CBD oil on its own might provide some benefits to people with bipolar disorder.
Compared to the general population, individuals with schizophrenia are twice as likely to use cannabis. This tends to result in a worsening in psychotic symptoms in most people. It can also increase relapse and result in poorer treatment outcomes (Osborne et al., 2017). CBD has been shown to help alleviate the worse symptoms produced by THC in some research.
In a review of CBD research to date on its impact on schizophrenia, Osborne and associates (2017) found:
In conclusion, the studies presented in the current review demonstrate that CBD has the potential to limit delta-9-THC-induced cognitive impairment and improve cognitive function in various pathological conditions.
Human studies suggest that CBD may have a protective role in delta-9-THC-induced cognitive impairments; however, there is limited human evidence for CBD treatment effects in pathological states (e.g. schizophrenia).
In short, they found that CBD may help alleviate the negative impact of a person with schizophrenia from taking cannabis, both in the psychotic and cognitive symptoms associated with schizophrenia. They did not find, however, any positive use of CBD alone in the treatment of schizophrenia symptoms.
Improved Thinking and Memory
There is little to no scientific evidence that CBD oil has any beneficial impact on cognitive function or memory in healthy people:
“Importantly, studies generally show no impact of CBD on cognitive function in a ‘healthy’ model, that is, outside drug-induced or pathological states (Osborne et al., 2017).”
If you’re taking CBD oil to help you study or for some other cognitive reason, chances are you’re experiencing a placebo effect.
As you can see, CBD research is still in its early stages for many mental health concerns. There is limited support for the use of CBD oil for some mental disorders. Some disorders, including autism and anorexia, have had little research done to see whether CBD might help with the associated symptoms.
One of the interesting findings from research to date is that the dosing found to have some possible beneficial effects in research tends to be much higher than what is found in products typically sold to consumers today. For instance, most over-the-counter CBD oils and supplements are in bottles that contain a total of 250 to 1000 mg.
But the science suggests that an effective daily treatment dose might be anywhere from 30 to 160 mg, depending on the symptoms a person is seeking to alleviate.
This suggests that the way most people are using CBD oil today is not likely to be clinically effective. Instead, at doses of just 2 to 10 mg per day, people are likely mostly benefiting from a placebo effect of these oils and supplements.
Before starting or trying any type of supplement — including CBD oil or other CBD products — please first consult your prescribing physician or psychiatrist. CBD may interact with psychiatric medications in a way that is unintended and could cause negative side effects or health problems.
We also do not really understand the long-term effects and impact of CBD oil use on a daily basis over the course of years, as such longitudinal research simply hasn’t yet been done. There have been some reported negative side effects experienced in the use of cannabis, but it’s hard to generalize such research findings to CBD alone.
In short, CBD shows promise in helping to alleviate some symptoms of some mental disorders. Much of the human-based research is still in its infancy, however, but early signs are promising.
For further information
Reason Magazine: Is CBD a Miracle Cure or a Marketing Scam? (Both.)
Thanks to Elsevier’s ScienceDirect service in providing access to the primary research necessary to write this article.
Bally, N., Zullino, D, Aubry, JM. (2014). Cannabis use and first manic episode. Journal of Affective Disorders, 165, 103-108.
Campos, AC., Fogaça, M.V., Sonego, A.B., & Guimarães, F.S. (2016). Cannabidiol, neuroprotection and neuropsychiatric disorders. Pharmacological Research, 112, 119-127.
Loflin, MJE, Babson, K.A., & Bonn-Miller, M.O. (2017). Cannabinoids as therapeutic for PTSD
Current Opinion in Psychology, 14, 78-83.
Maurya, N. & Velmurugan, B.K. (2018). Therapeutic applications of cannabinoids. Chemico-Biological Interactions, 293, 77-88.
Osborne, A.L., Solowij, N., & Weston-Green, K. (2017). A systematic review of the effect of cannabidiol on cognitive function: Relevance to schizophrenia. Neuroscience & Biobehavioral Reviews, 72, 310-324.
Poleg, S., Golubchik, P., Offen, D., & Weizman, A. (2019). Cannabidiol as a suggested candidate for treatment of autism spectrum disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 89, 90-96.
When we think of addiction, our thoughts tend to turn to drug and alcohol addiction but addiction can relate to numerous different things; drugs, alcohol, food, exercise, pornography, gaming, social media, tattoos, self-harm, gambling, shopping – anything that we feel as though we’re not in control of, and has an impact on our mood and behaviours. Addiction can be incredibly difficult to cope with, particularly when the things we’re addicted to are often readily available. Depression and addiction can go hand in hand. Addiction can help us to cope with depression, but equally, depression can be caused or worsened by the things we’re addicted to.
Depression: Coping With Addiction
In terms of addiction, triggers are any emotional or environmental factors that cause us to feel as though we need to use our addiction. It could be related to people, places, things, times of the year, or something else. Working out what our triggers are can take time, but once we know what they are, we can avoid them or learn ways to manage them.
High-risk situations are similar to triggers, but rather than being a specific ‘thing’, such as ‘seeing a person walking a dog’, they’re specific situations. This could be something like Christmas, seeing family, or getting a piece of negative feedback at work. Sometimes these situations can be difficult to spot until we’re in them, so it can be helpful to make a note when a situation causes us to feel like we need our addiction.
Once we identify these situations, we can make a plan for how to cope with them without turning to our addiction.
For example, if one of our high-risk situations is ‘seeing my auntie’, we might choose to see them less often, only see them in the company of other friends/family, and invite a friend to stay over for the night whenever we do see them, so that we’re not having to cope alone. We could also note down any alternative coping mechanisms we could use, so that we don’t have to think about them ‘in the moment’, and can just refer to our notes. It’s often helpful to write down a couple of different ideas because sometimes our first or second ideas aren’t possible or don’t work.
Depression: Coping With Addiction
CLICK TO TWEET
WORKING OUR HOW OUR ADDICTION HELPS US
If our addiction didn’t help us on some level, we wouldn’t keep using it. Something that can be really key when coping with addiction is working out how it helps us and then finding a healthy coping mechanism to replace it. It can sometimes be helpful to use the acronym ‘Hungry Angry Lonely Tired (HALT)‘ when thinking about the need that we’re filling, as these are common emotions associated with addiction.
ALTERNATIVE COPING MECHANISMS
Having a list of coping mechanisms that we can use when we want to turn to our addiction is helpful. We’re all different, and we all turn to our addictions for different reasons, so we will find that different coping mechanisms work for different people. As an alternative to our addiction, we could try things like watching TV, reading, walking, talking to a friend, drawing, writing, painting, listening to music, listening to podcasts, doing some breathing exercises, ripping up sheets of paper, drawing on ourselves, running, cleaning, self-soothing, doing some puzzles, singing, hugging a pet, dancing, playing with play-doh or contacting a helpline. Sometimes we’ll have to try a coping mechanism a few times before we can get it to work for us – practice makes perfect!
There are times when we don’t see the point in fighting our addiction. It feels too hard. We’re too tired. There’s no point because we can’t do it so why even bother trying?!
At times like these, we have no interest in reaching out for support, or in using healthy coping mechanisms.
These times are very ‘high risk’, in terms of falling back into our addiction. Having reminders of why we don’t want to go there can help us to keep going. This could be in the form of photos on our phone, on the wall, or in our purse or wallet. We might have lists of ‘reasons to keep going’, or ‘things we want to do once we’re up to it’. There might have been a time when we had a particularly amazing day, and we might have a momento from that day that we can hold. A specific smell or taste could take us back to happier times that we’re hoping to replicate at some point in the future. Keeping little reminders in our house, bag, or coat pocket, can help us to keep going at times when we want to return to our addiction.
There are times when things go really well, and we feel like we’re beating our addiction. At other times, things don’t go so well, and it can feel as though our addiction is beating us.
It’s important to remember that a lapse is not the same as a relapse. Recovery is not a straight line. Whether things go right, or wrong, it’s important to reflect and learn from them.
If we’ve managed a difficult situation without turning to our addiction, then that’s wonderful progress! How did we do it? What coping mechanisms did we use? Is there anything that could be helpful to note down so that we know to try it again in the future?
If we’ve struggled through a difficult situation and turned to out addiction, then we haven’t failed, we’ve just had a wobble. Recovery is a learning curve, and we can learn as much (if not more) from our mistakes as from our successes. What went wrong this time? Was there a trigger that we weren’t expecting, or a high-risk situation that we didn’t know would be high-risk? Did anything go right? Can we think of anything we could do differently in future? Sometimes we have to try a coping mechanism a few times before we can get it to work. At other times, we might have tried a coping mechanism that didn’t work for us at all, so it’s not one that we want to try again.
This reflection can be really important because it can help us to keep moving forward. Some of us might find it helpful to journal this sort of thing.
Depression: Coping With Addiction
HONESTY IS IMPORTANT
One of the most important things when it comes to addiction is honesty. Honesty to others, and honesty to ourselves. Lying to ourselves and others is likely to cause a lot of problems, so even when it’s really difficult, it’s important to try and tell the truth.
We don’t have to cope with addiction alone. Addiction can be incredibly strong, so we need to try and build up a strong support system to fight it with. Our support system doesn’t need to be massive, but it can be helpful to have a couple of friends or family members or organisations we can turn to when we’re struggling. Sometimes, it can be dangerous to stop an addiction ‘cold turkey’, so it’s often a good idea to reach out for some professional support on top of the support we get from our loved ones. We might also find that some medication, therapy or counselling from professionals is something that we need.
There are times when we struggle to let people help us. We might feel as though we don’t deserve it or we’re being a burden – but we do deserve support, and in the same way that if one of our friends were struggling, we’d want to support them, our friends will probably want to support us. There are times when it can be hard to reach out for support because we don’t have any hope, but there’s nothing wrong with letting other people hold our hope for a little while until we’re able to hope again.
On top of support from our friends, family, and professionals, we might find that support groups with others who have experienced similar addictions to us can be comforting and can help us to cope. Sometimes being around others who’ve experienced similar things to us can help us to feel less alone, and can give us some hope of things improving. There are different support groups for different addictions including alcoholics anonymous, narcotics anonymous, national self-harm network, sex addicts anonymous, overeaters anonymous, Beat support groups, on-line gamers anonymous, and gamblers anonymous.
Please help us to help others and share this post, you never know who might need it.
While there is no consensus on the exact definition of disability (especially psychological disability), there is greater recognition these days that, like physical disease, psychological conditions can cause functional impairment and dysfunction—some more so than others. In a paper, published in the November issue of Social Psychiatry and Psychiatric Epidemiology, Edlund et al. conclude that among the 15 mental health conditions examined, mood disorders (e.g., depression) are associated with the greatest functional impairment and disability.1
The Mental Health Surveillance Study
Data for the present research came from the Mental Health Surveillance Study (MHSS). The MHSS is a sub-sample of 2008-2012 National Survey on Drug Use and Health (NSDUH), an annual survey of non-institutionalized US civilians 12 years or older. MHSS, however, includes only individuals aged 18 and over.
For the Mental Health Surveillance Study, researchers conducted phone interviews with participants, utilizing the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV-TR. Of the original NSDUH 2008-2012 sample of 220,000 adults, 5,653 completed the MHSS interview (48% men; 67% White, 14% Latino/Hispanic, and 12% Black).
Using these interviews, researchers attempted to determine if participants met the criteria for any of the following 15 psychiatric conditions:
Mood disorders (major depressive disorder, mania, and dysthymic disorder), anxiety disorders (post-traumatic stress disorder, panic disorder, agoraphobia, social phobia, specific phobia, obsessive-compulsive disorder, and generalized anxiety disorder), alcohol use disorder, illicit drug use disorder, intermittent explosive disorder, adjustment disorder, and psychotic symptoms.
Other conditions (e.g., eating disorders) were not examined because of their low prevalence in the sample.
Three measures of disability
Functional impairment was assessed using three measures (modified for this investigation):
Global Assessment of Functioning (GAF)
World Health Organization Disability Assessment Schedule 2.0 (WHODAS)
Scores for GAF range from 0 to 100 (higher means better functioning). GAF scores are based on both functional impairment and symptom severity (whichever happens to be worse).
Unlike GAF, which is determined by clinical judgment and thus has a subjective element, WHODAS and DOR are based strictly on objective criteria and the patient’s responses.
DOR measures the number of days in the past year when an individual could not function at all because of mental health issues.
WHODAS assesses cognitive abilities (e.g., memory, concentration), social relations, social participation, self-care, and ability to do one’s duties (whether related to work, home, or school). In this study, a 0-24 score range was used, with the higher score meaning worse functioning.
Mental illness and disability: Results
Descriptive statistics revealed the sample’s average…
GAF = 74.1 (median 75)
WHODAS = 3.5 (median 1)
DOR = 6.7 (median 0)
Researchers performed a series of regression analyses, and concluded that among 15 mental health conditions, mood disorders were associated with the greatest functional impairment; anxiety disorders, with intermediate functional impairment; and substance use disorders, with less functional impairment.
For instance, in the fully adjusted model, the greatest decrease in GAF scores was seen in psychotic symptoms (22), followed by depression (16), and mania (13). In WHODAS modeling, mania (9), depression (6), and social phobia (5) had the largest coefficients. And, in the final analysis, only depression, adjustment disorder, and panic disorder, had a significant association with DOR.
These results are comparable with those of a 2007 study, which also included a nationally representative sample, used DOR, and employed similar statistical methods. In that investigation, mood disorders resulted in higher days-out-of-role than most other disorders examined.2
Commentary on use of disability measures
Aside from suggesting that mood disorders are associated with the greatest disability among conditions examined, the present investigation highlights the importance of using multiple measures in determining disability.1
Employing a single measure paints a misleading picture. For instance, as mentioned above, the median value for days-out-of-role was zero. Indeed, 70% of participants with one mental disorder, and over half of those with two disorders, had zero days-out-of-role. Only 3/15 disorders were statistically linked with DOR scores (8/15 with WHODAS; all 15 with GAF).
Therefore, DOR was the least sensitive of the three measures used. If we were to rely only on days-out-of-role numbers, we would miss significant dysfunction and disability.
While GAF is likely the most sensitive of the three measures, it does not always assess functional status. As mentioned, GAF scores depend on functional impairment and symptom severity; when there is disagreement between the two values, GAF score is determined by the worse of the two. For instance, if symptoms are severe but functioning is okay, GAF scores will still be low.
Thus, it is important to use complementary measures of disability; doing so allows clinicians to achieve greater accuracy in determining a patient’s needs and in monitoring a patient’s progress. Use of complementary measures can also inform public policy and resource allocation. Physicians, politicians, and the public cannot make informed decisions about how to improve functional impairment if they fail to recognize disability in the first place.