Category Archives: Psychological

Thoughts of the escape of drinking/Impostor Syndrome

<– This is what drinking was for me.  An escape hatch from myself and the world.  And I still miss this at times of stress and crisis.  Even now this last week I’ve recalled memories where I’ve thought and felt that drinking made the unbearable bearable.  I KNOW that this is a salvation fantasy but it still persists.

So I’ve been struggling a bit recently to feel happiness in life generally prompting mid life musings of the ‘Is this it?’ variety.  Not in a ‘f*ck it, a drink is the answer’ way but in a ‘I wish I could escape these thoughts/feelings’ type way.  The ever present hangover free clear head lamented as a burden, not a gift.  I yearn for an escape or miracle and feel overwhelmed with impostor syndrome.  I must be a fraud right?  Approaching 4 years sober and yet still wishing for an off switch to my brain – the release of being comfortably numb.  And then as often happens I order the perfect book from the library to aid my discomfort.

I’ve been reading ‘Making Miracles in 40 days – turning what you have into what you want‘ by Melody Beattie.  She is a recovery warrior and has written numerous books including seminal works on co-dependency and these were the words that stopped me reading and found me here writing a blog post to share her words:

Either we refuse to talk about the loss or we can’t stop telling the story.  Guilt and obsession are the sixth and seventh stages of loss.

Once I made my choice, I began to consciously grow despite the numbness, rage, and sadness I felt.

When deep change begins – whether it’s a miracle or loss – expect to feel uncomfortable for a while.

I feel all of these things right now.  Not about not drinking – although I can’t stop telling the story here still – but about living life not numbed by booze but numb, rageful and sad because of the reflections on my past life, how they have left me feeling in the present and how it then impacts on my future tripping thinking (which is not the first time either!).  It feels like the deep change with recovery is two-fold: the stopping drinking part and then the emotional learning part.  Getting sober is both a miracle and a loss so you feel very uncomfortable in the beginning and then get waves of uncomfortable as you continue to change emotionally.  This is where I am.

She goes on to talk about happiness after loss:

Your happiness will look and feel more like peace.  But now it will be real, and it will be yours.  It won’t depend on others or what they do or don’t do.  That long, dark tunnel of transformation – when we really become empowered to make miracles – only happens once. 

Happiness means being at peace with ourselves, wherever we are, whoever we’re with, whatever we feel, whatever we’re going through, and whatever we have or lack.  Happiness means working for the sake of doing the work, not for a particular outcome.  Happiness means we’re with someone, because we enjoy the person’s company, not because we want to get that person to ask us to get married.   To feel this kind of happiness, we need to release old unfelt emotions, and feel whatever we feel.  We’re not desperately seeking someone to love us.  We want everyone to be themselves – to be who they really are.

She goes on:

Most of the time we aren’t learning what we think we are.  Being open and empty are the requirements for learning something new.  Later, when we master the lesson, we’ll see what we learned.

By being present for each moment, we learn to live in the Mystery.  We stop trying to figure things out (another form of control) and relax into not knowing.  We trust that our answers will come in their own time.

Time to learn to let go of my impostor syndrome and work on that salvation fantasy of a realistic miracle, non-drinking escape hatch or just peace within myself.

 

Friday Sober Inspiration: Heads Together + Mad World podcast

So this caught my eye over the Easter week-end and struck a cord in so many ways.  The London Marathon is this week-end – Sunday 23rd April and this is the Virgin Money London Marathon chosen charity which is also supported by Prince William & Catherine and Prince Harry.

Here’s what their website says:

ABOUT HEADS TOGETHER

Through our work with young people, emergency response, homeless charities, and with veterans, we have seen time and time again that unresolved mental health problems lie at the heart of some of our greatest social challenges.

Too often, people feel afraid to admit that they are struggling with their mental health. This fear of prejudice and judgement stops people from getting help and can destroy families and end lives. Heads Together wants to help people feel much more comfortable with their everyday mental well-being and have the practical tools to support their friends and family.

The Heads Together campaign will build on the great work being done by our partner charities so that prejudice and fear no longer stand in the way of people getting the help they need.

Being the 2017 Virgin Money London Marathon Charity of the Year is the perfect springboard for the Heads Together campaign. We cannot wait to see hundreds of runners hitting the streets of London this April to end the stigma and change the conversation on mental health once and for all.

Bryony Gordon and The Telegraph have supported them by launching a podcast series discussing mental health with high profile UK figures – the first interview being with Prince Harry himself.  Their website features other well known personalities such as Rio Ferdinand and Lady Gaga.

This is The Telegraph’s brief:

Bryony Gordon’s Mad World is a new ten episode podcast brought to you by The Telegraph. Each week, Bryony will talk to a different guest about how their mental health has been affected by events in their own lives and find out why feeling weird is the most normal thing in the world.

You can listen to Bryony’s podcast interviews and the first one with Prince Harry is well worth your time:

Bryony Gordon’s Mad World

And the impact of this was immediate:

Schoolchildren will get access to NHS mental health workers in wake of Prince Harry’s ‘brave’ intervention

Alcohol dependency is a mental health issue and Prince Harry mentions it specifically in his interview so this is an important new charity both for those suffering because of the devastation of alcohol on them directly and the impact on those around them including children.  The destigmatization and normalisation of the conversation around mental health, and particularly the bolstering of mental health support for children and adolescents, is long overdue and I’m so pleased the Royal Family have got behind the cause and changed the direction of effect!

Friday Sober Inspiration: The Four Essential Processes of Grieving

So I’ve spoken about grief and grieving before in this post and this was a great podcast about the subject too.

As I’ve continued to read Pete Walker The Tao of Fully Feeling he has described his four essential processes of grieving .  So I’m going to add to my knowledge from Kubler-Ross and include it here as a reference for you too.

He argues that “grieving is the key process for reconnecting with our repressed emotional intelligence.  Grieving reconnects us with our full complement of feelings.  Criticism of emotional expression is especially damaging when it is expressed towards expressions of emotional pain as it forces our all-important capacity for healthy grief into developmental arrest.”

Pete Walker maintains that grieving is not just crying but for it to be fully effective it must include the processes of “angering”, verbal ventilation, and feeling.  He says the active resolution comes from crying, “angering” and talking about it whereas the passive resolution comes from simply focusing on and feeling what is stored somatically in our bodies.

I’ll cover a short summary of each here but again go read the book if you want to understand fully (although here is a link to a pdf on grief and complex PTSD written by Pete).

  • Crying is the healing release of pain through tears.  Unashamed crying creates deep, bodily-based feelings of peace and relaxation as tears are the body’s most powerful way of releasing emotional tension.  He believes that crying heals ‘catastrophising‘ and ‘drasticizing’ which are forms of toxic shame that taint our thought processes with unfounded perceptions of dread and doom.  What Brene Brown calls ‘foreboding joy‘.  Crying also allows for positive nostalgia or ‘euphoric recall’.
  • Angering is the process of actively expressing anger in a a safe and healthy way and is as essential to effective grieving as crying.  He believes we can break the ‘repression-accumulation-explosion-guilt-repression’ cycle by befriending our anger and refusing to guiltily squash it when it arises.  He says we can use a range of approaches to releasing anger to allow joy such as: thinking to writing to speaking to shouting to shadowboxing to pounding on pillows to finally breaking expendable objects.  He maintains when we finally end our repression of our anger we often feel exuberant relief and that it also builds confidence and self-assertiveness.
  • Verbal ventilation is when language is charged with feeling and is the release of pain through talking or writing about it.  This is where I have found this blog and therapy the most valuable in moving through my own grief.  It is also therapeutic he says to record jokes, anecdotes, and incidents that make you laugh as these can serve as heartening reminders of the joys of life.  Swearing is a powerful form of  verbal ventilating particularly if you chose words judiciously and sparingly.  He also talks about fully emoting which is when we cry, rage and verbally ventilate all at the same time!
  • Feeling is the process of grieving that focuses on pain with the intention of relaxing any resistance to it, so that it may pass through and out of the body.  I often think of funeral wakes when I think of this as this is where I would use alcohol to not feel the pain and sadness that the loss had triggered.  Some of my most spectacular relapses when I was moderating were after funerals where I would hold it together at the event and then drown myself in alcohol on getting home.  Feeling involves the direction of attention to the internal experiences in the body below the realm of thinking.  Feeling experiences are often accompanied by physical sensations in the heart area or “guts”.  No wonder I struggled with Irritable Bowel Syndrome (IBS) for so much of my adult life.  Feeling is a kinesthetic rather than a cognitive experience.  It’s why I’ve avoided yoga for so long – as I know that this is where I finally need to release the somatic feeling states that I’ve been resisting facing in recovery.  After all this therapy I know they are there and I’ve been scared to confront them …..

He finishes by saying that a balanced approach to grieving includes an openness to feeling emotions as well as emoting feelings.  He says “if we do not accept and value both processes, we will not become fully feeling human beings”.

Here’s to moving on to the next and final stage of learning to fully feel – connecting totally the mind and body experience where feeling becomes a spiritual experience.  He says “perhaps the greatest freedom attainable is that which is born out of a consistent willingness to stay lovingly and acceptingly present to whatever unfolds inside oneself.”

I saw this film again recently and this clip felt so apt:

Sober Inspiration: The four key dynamics of the emotional nature

So continuing on from last week’s post about the Tao of Fully Feeling I’m going to continue inspiring you with Pete Walker’s insights and knowledge on emotions.  He talks about the four key dynamics of the emotional nature which was all completely new to me but yet made perfect sense!

These are: wholism, polarity, ambivalence, and flow.  I’ll do a brief synopsis of his interpretation but I really recommend you go read the whole book.

  1. Wholism: This refers to the fact that the emotional nature cannot be broken down into individual, separate feelings existing independently from one another.  How the psyche cannot be filled with pleasant emotions only while the negative ones are left behind.  As he so beautifully puts it: “Individuals who only identify with ‘positive’ feelings often become bland, deadened and dissociated in a feeling-less desert, a true no-man’s land.  In the psychic desert of disavowed emotion, the smouldering heat of repressed anger evaporates our feelings of love and affection, leaving us emotionally dehydrated.  Rejecting emotions because they are sometimes unpleasant is like cutting off body parts because they are not pretty
  2. Polarity: This is about emotional polars – opposite but complementary halves.  There are graded bands of emotional intensity that stretch between each pair of emotional opposites.  Our emotional experience shifts from one pole to another along a continuum of feeling, and there are many different degrees of feeling on each particular emotional continuum.  We are all subject to both gradual and sudden oscillations between the emotional extremes of the various feeling continua.  As he says: “When we refuse to feel the full intensity of our emotions, we become depressed and stuck in the ‘safe’ and dreary midland plains of the emotional continua.  Apathy is a common result of throwing out the baby of emotional vitality with the bath water of unaccepted feelings“.  He argues that understanding polarity helps us deal with normal loneliness as a certain amount of loneliness is absolutely intrinsic to the human condition.
  3.  Ambivalence: These ‘mixed feelings’ occurs when we entertain opposing emotional experiences simultaneously and he feels this is possibly the most misunderstood and vilified of all the complex emotional experiences.  Ambivalence is also the state of rapidly vacillating between contradictory feelings.  Ambivalence is a normal and healthy response but because it is culturally incomprehensible most  of us repress the unpreferred half of the ambivalence, and only experience it as anxiety.  He argues that intolerance of ambivalence destroys relationships through a process known as splitting.  Ambivalence and splitting are opposite responses to emotional polarity.  A less extreme form of splitting is ambivalating – a relatively rapid wavering back and forth between opposing emotional experiences.  When we welcome our normal ambivalence we achieve a deeper self-understanding and make better decisions about complex life issues.
  4. Flow: The ever-shifting, unpredictable rise and fall of emotions.  An appreciation of flow, the fluid quality of the emotional nature, allows us to respond to our feelings in healthy ways.  He states: “Avoidance of unwanted emotions also commonly leaves us trapped in chronic, low grade manifestations of them.  Many long-enduring moods are caused by repressed emotions that slowly and biliously leak into consciousness.  When underlying emotions are offered no effective expression and release, the moods they create contaminate and dominate awareness for inordinately long periods of time.  Moodiness is a very slow and inefficient way of processing feelings.

He write so much more detail about each element that I can’t even begin to encapsulate here and closes the chapter with “A wonderful grace of self-renewal comes from immersion in the invigorating waters of fully and flexibly feeling.”

I couldn’t agree more! 🙂

Sober Inspiration: The Tao of Fully Feeling

So I’m reading a new book that I heard talked about recently by Pete Walker called The Tao of Fully Feeling.  I’m only a few pages in but text is already jumping out at me and screaming to be shared!

Here’s the opening:

Feelings and emotions are energetic states that do not magically dissipate when they are ignored.  When we do not attend to our feelings, they accumulate inside us and create a mounting anxiety that we commonly dismiss as stress.

So, like so many of us, I believed that all those years of pouring wine down my neck to manage ‘stress’ was helpful.  In reality I was busy self-medicating away my feelings and emotions.

I felt that emotions were something to be corralled, minimised, denied even.  In my household growing up we ‘didn’t do’ emotions as we were often reminded.  I now understand that we weren’t allowed to do negative emotions.  I learned very early on to keep my head down, my mouth shut and a smile on my face.  Look happy even if you were dying inside.  No wonder I ended up emotionally constipated and believing that drinking allowed me to express my emotions fully because it was only in that dis-inhibited state that I actually heard them as they roared from their cage inside.  “A drunk mind speaks a sober heart” right?  A saying often attributed to French Enlightenment philosopher Jean-Jaques Rousseau which we know not to be true.

Pete goes on:

We can learn to be emotional in benign ways.  We can have our emotions without holding onto them.  We can soften and relax into our feelings without exiling or enshrining them.  We can let our feelings pass through us when they have fully served their function.  When we learn to experience our feelings directly, we eventually discover that surrendering to them is by far the most efficient – and, in the long run, least painful – way of responding to them.  We realise first-hand that life does not have to be pain-free to be fully enjoyed.  Life is inordinately more painful than necessary when we hate, shame, and abandon ourselves for not feeling ‘good.’

As we become more emotionally whole, our health and vitality naturally improve.  When we disburden ourselves of old unresolved trauma, energy wasted holding the past at bay becomes available for celebrating daily life.  As we learn to befriend our emotions, we suffer less and less from self-damaging flights from feelings.  We gracefully accept the reality that our emotional nature, like the weather, often changes unpredictably with a variety of pleasant and unpleasant conditions.  We realize that a positive feeling cannot be induced to persist any more than the sun can be forced to continuously shine.

And this reflects my experience over the last 3 1/2 years.  Emotions are no longer something to be scared of but welcomed and embraced, whether happy, sad or mad.  My emotional repertoire has grown incredibly as I have allowed my caged and numbed heart to feel what my head was taught to deny for so long.

Welcome to emotional recovery that forms the biggest part of recovery from addiction.  I think I’m going to really enjoy this book 🙂

 

Radical ketamine therapy could treat alcohol addiction

This was featured in The Guardian in January whereby a one-off dose of the drug, ketamine could help alcohol addicts reduce their intake by ‘erasing’ drink-related memories, say psychologists testing treatment.

Ketamine is used as an anaesthetic agent and also in terminal care in my professional experience and as a recreational drug in my personal experience.

Here’s what the researchers say:

Scientists believe that a radical treatment involving the tranquilliser ketamine could help overcome alcohol addiction by “erasing” drink-related memories.

Psychologists based at University College London are testing whether a one-off dose of the drug could help hazardous drinkers who are trying to reduce their alcohol intake. Alcohol addiction is notoriously difficult to treat, and there are few effective therapies available.

Using a recreational drug to treat addiction may sound counterintuitive, but the researchers say there is a growing body of research suggesting that ketamine can be used to disrupt harmful patterns of behaviour.

Ravi Das, one of the lead researchers, said: “There is evidence that it could be useful as a treatment for alcoholism.”

Crucially, ketamine can disrupt the formation of memories, and scientists believe that this property could be harnessed to over-write the memories that drive addiction and harmful patterns of behaviour.

“Memories that you form can be hijacked by drugs in some people,” said Das. “If you were an alcoholic you might have a strong memory of being in a certain place and wanting to drink. Those memories get continuously triggered by things in the environment that you can’t avoid.”

For instance, seeing a glass of beer, hearing the clinking of glasses or even arriving home from work may trigger memories of the rewarding sensation of taking a drink – and might prompt a person to follow this urge.

“The main problem is the really high relapse rate after treatment,” said Das. “People can successfully quit using over the short term while they’re being monitored in the hospital … but when they return home they’re exposed to those environmental triggers again.”

There is increasing evidence, however, that memories are less stable than once assumed and may be open to manipulation.

Each time our brain accesses a memory, the neural connections that encode it are temporarily destabilised, meaning that our recollection can be slightly altered before it goes back into storage. This is one reason why, in everyday life, people can recall wildly different versions of the same events.

In the clinic, scientists believe this short period of instability, represents a window of opportunity. Ketamine blocks a brain receptor called NMDA, which is required for the formation of memories. So the logic is that giving someone the drug just as a memory has been destabilised could help weaken the memory, or even erase it.

A similar approach with a different drug was shown to eradicate people’s phobia of spiders. And research in rats that were made to be addicted to cocaine showed that the memories underpinning their addiction could be completely wiped out using a similar strategy (although this involved injecting a chemical into the brain).

In the UCL trial, the scientists will intentionally trigger alcohol-related memories by placing a glass of beer in front of the participants, who are all heavy drinkers. They will then disrupt the memory, by surprising the participant (the team is not disclosing the exact details as this could bias the results).

Participants will then be given either a ketamine infusion, with a concentration equivalent to a high recreational dose, or a placebo. The team will follow up the people for a year and monitor whether their drinking has changed and by how much.

In total the scientists are aiming to include 90 people in the trial and more than 50 have already taken part. It involves people who drink harmful quantities of alcohol, but excludes anyone who meets the clinical criteria for alcoholism. The participants were drinking at least 40 units for men (equivalent to four bottles of strong wine) and 28 units for women, and drinking on at least four days.

Nikki, 31, who works as a consultant in London said she decided to take part in the study when she had some time off between jobs and realised she was drinking more than she wanted to. “It’s just in the culture, that’s what all my friends are like. Everyone drinks to excess,” she said.

She described the experience of being given the ketamine as “overwhelming and intense”, but not unpleasant. “My body felt like it was melting away,” she said. “It was quite psychedelic, I felt untethered from my body.”

In the week after the session, she said, she felt in an “incredibly positive mood” and that since taking part she has been more conscious about deciding whether to have a drink, although said this could also be linked to starting a new job and taking up meditation. “In the past, there were occasions where I would be drinking and I’d be on autopilot ‘Let’s get another drink’,” she said.

If the trial yields promising results, the team hope that the approach could form the basis for therapy sessions targeted at alcoholics and people who are drinking unhealthily. However, they acknowledge that there may be resistance to the use of a recreational drug to treat people with addiction.

“There’s just the general social attitude that everything that’s illegal is terrible. There will obviously be that kind of narrow-sighted pushback,” said Das. “But if it’s safe and effective enough it should be recommended.”

Andrew Misell, a spokesman for Alcohol Concern, said: “The researchers have quite rightly highlighted what a lot of people in recovery from alcohol problems know from experience, namely that cues or triggers like the smell of beer can cause a relapse even after long periods of abstinence. Any work looking at how people can overcome these pitfalls is going to be useful.”

However, he added, no drug-based therapy is risk-free “and that certainly includes ketamine”.

Professor Michael Saladin, of the Medical University of South Carolina, is looking at similar approaches to help people quit smoking. “There is a vast animal research literature that suggests memories can be manipulated following reactivation,” he said. “I am convinced that there is sufficient evidence to believe that memory reconsolidation can be harnessed for clinical purposes.”

The Evening Standard also picked up on the research:

Researchers at University College London are trialling the use of ketamine, a powerful anaesthetic used in the NHS and on animals, to block or dismantle the “alcohol reward” memories that cause cravings and addictions. It is hoped the drug, known as ‘Special K’ on the party scene, will help drinkers “reboot” their brain and get their habit under control.

Well I’m all for research and trying new things if it will potentially help.  Although I’d be slightly concerned about cross-addiction because if it is a very pleasant experience people may wish and seek to repeat it and ketamine is available as a street drug.

Sober Inspiration: Dan Siegel Wheel of Awareness

drdansiegel_wheelofawarenessSo the further into recovery I’ve got the more mindful and conscious I have become and in fact my awareness continues to deepen all the time.  With that in mind I wanted to share with you Dan Siegel‘s work on the Wheel of Awareness.  The reason I’m posting this today is because yesterday he led a meeting in LA to mark the beginning of his ‘Wheel of Awareness Community’.

Here is an image of “The Wheel of Awareness.” The hub represents the experience of awareness itself — knowing — while the rim contains all the points of anything we can become aware of, that which is known to us. We can send a spoke out to the rim to focus our attention on one point or another on the rim. In this way, the wheel of awareness becomes a visual metaphor for the integration of consciousness as we differentiate rim-elements and hub-awareness from each other and link them with our focus of attention.

I attach below a presentation on the subject that Dan has shared on SlidePlayer:

Mindsight Presentation by Dr Dan Siegel

And now a Youtube guided meditation that he has created:

And then finally the pdf handout that was created by him to support our further understanding of the Wheel of Awareness:

wheelofawareness-guided-meditation

The total package free on the internet from him – how wonderful is that? 🙂

For me this is what it is all about now.  Deepening my  understanding and integration of my sixth, seventh and eighth senses – so my somatics and my ability to perceive my mind by reflecting on my experience.  As Dr Siegel says:

“When we carry out a mindfulness practice of focused awareness, we develop mindsight”

Here’s to that and me finally acting on all the universes hints that I need to start a yoga practice to compliment my running!

NICE guidance on dual diagnosis 2016

This is not the first time that Dual Diagnosis has been discussed on this blog (you can read them all here).  However we now have official guidance from the National Institute of Clinical Excellence (NICE) on the issue.

My lovely friend Libby Ranzetta did an excellent synopsis that garnered praise on Twitter from the NICE guidelines chair themselves no less! 🙂

Over to her summary detailed over at Alcohol Policy UK:

New NICE guidance on dual diagnosis was released in November 2016: Coexisting severe mental illness and substance misuse: community health and social care services.

The guidance and supporting tools and resources sets out how services for those dually diagnosed aged 14 and above should be improved to ‘provide a range of coordinated services that address people’s wider health and social care needs, as well as other issues such as employment and housing.’

NICE has also produced a guideline on coexisting severe mental illness (psychosis) and substance misuse: assessment and management in healthcare settings.

Context and definitions

NICE contextualises the guidance by stating that adults and young people with coexisting severe mental illness and substance misuse have some of the worst health, wellbeing and social outcomes (details here). It is not clear how many people in the UK experience dual diagnosis issues, partly because some people in this group do not use services or get relevant care or treatment (see previous post).

The Department of Health’s Refocusing the Care Programme Approach identifies people with dual diagnosis as one of the groups in need of an enhanced Care Programme Approach. That is because they are not being identified consistently and services are sometimes failing to provide the support they need. The policy highlights the need for a whole systems approach to their care, involving a range of services and organisations working together. This guideline, NICE claims, aims to address this need.

In announcing the guidance, Professor Alan Maryon-Davis, chair of the guideline committee, spoke frankly about the challenges coexisting substance misuse and mental health problems pose for patients and practitioners alike.

“People with dual diagnosis almost always have multiple needs – often with physical health and social issues as well as their dual mental health and substance problem. They are often unemployed or struggling to hold onto a job. They may be in debt, homeless or poorly housed. They could even be in an abusive relationship.

To add to their woes, they are also more likely to be stereotyped and stigmatised. They are often regarded as unreliable, feckless, difficult to engage, aggressive or abusive.

As a result, they tend to get shunted around the various services they need support from with no-one wanting to take responsibility for them. This can all too easily lead to a downward spiral and sooner or later a crisis – perhaps forcing them into A&E, or on the streets. They may even find themselves in the magistrate’s court.

This is why our NICE guideline is so desperately needed.”

For Guideline 58 the age cut-off for young people has been set at 14 to reflect the small numbers affected below this age and the fact that many early intervention services usually start at age 14. ‘Substance misuse’ refers to the use of legal or illicit drugs, including alcohol and medicine, in a way that causes mental or physical damage.

‘Severe mental illness’ includes a clinical diagnosis of:

  • schizophrenia, schizotypal and delusional disorders, or
  • bipolar affective disorder, or
  • severe depressive episodes with or without psychotic episodes.

NICE Recommendations

The guideline is arranged as series of detailed recommendations on the following:

  • first contact with services
  • referral to secondary care mental health services
  • the care plan: multi-agency approach to address physical health, social care, housing and other support needs
  • partnership working between specialist services, health, social care and other support services and commissioners
  • improving service delivery
  • maintaining contact between services and people with coexisting severe mental illness and substance misuse who use them

Drug and Alcohol Findings Bank has provided a summary of the key recommendations here.

Professor Maryon-Davis summed up two main messages from the recommendations:

“First, there has to be much wider recognition that this group of people, despite their complexities, have as much right to dedicated care and support as anyone else. They should not be turned away or left to flounder. Every effort should be made to help them benefit from the services they so badly need. Crucial to this is a non-judgmental, empathetic approach and the building up of mutual respect and trust.

And secondly, good communication is key! Staff working in mental health, substance misuse, primary care, social care, housing, employment, benefits, criminal justice and the voluntary sector need to have strong leadership to ensure that they are all working together as best they can. We recommend that this can be best achieved by having a dedicated care coordinators.”

What happens next

Substance misuse practitioners could be forgiven for saying they have heard these messages before; messages which have not made much difference to the way mental health services respond to dual diagnosis. Last year the Recovery Partnership’s Review of Alcohol Treatment Services found a clear failure of services to meet the needs of people with dual diagnosis, summarising the policy context for such failure as follows:

“National guidance on the management of this [dual diagnosis] group was first published by the Department of Health in 2002. NICE published further guidance on psychosis with coexisting substance misuse in 2011.

However, the… situation has not improved and may be worsening because budgets have been cut in mental health services, and because mental health services are now commissioned by a separate body (Clinical Commissioning Groups) from alcohol services (Public Health). This represents a real blockage in the pathway of care for problem drinkers (and drug users), a blockage that cannot be easily resolved at the local level.”

Other questions may relate to possible missed opportunities to address low level mental health problems and substance misuse. For instance Improving Access to Psychological Therapies (IAPT) services – which exist for those mild to moderate mental health difficulties, such as depression, anxiety and phobias – are not mentioned within the guidance. IAPT though may be considered an ideal setting for brief intervention given the link between alcohol misuse and problems such as anxiety and depression, yet few IAPT services appear to routinely deliver IBA (although guidance was released for IAPT roles in 2012).

In 2014 an analysis suggested cognitive based therapy (CBT) and/or motivational interviewing (MI) for comorbid alcohol use disorder and major depressive disorder produced small but robust beneficial effects on both depression and alcohol consumption – regardless of whether delivered by mental health or subtance misuse roles.

Commissioners and service providers though will now be expected to use Guideline 58 to improve the quality of care given to people with dual diagnosis involving severe mental health problems. The Care Quality Commission (CQC) use NICE guidelines and quality standards as evidence for inspections, to inform the award of good and outstanding ratings. CQC’s inspection regime and associated powers may well provide the impetus needed for real change to happen this time.

Guest Post: Finding the Link Between Substance Abuse and Schizophrenia

pt_figure_dopamine-pathways-in-schizophrenia_53127-pngI was contacted on email by Justin in November who said; “I am a recovering addict and content writer interested in providing a guest post article.  In my path to recovery I’ve taken to writing content about addiction, recovery and substance abuse through my treatment program.”  Here’s what he wrote about substance abuse and schizophrenia:

New studies have found a link between substance abuse and schizophrenia.  While the relationship between mental health and substance abuse is an incredibly complex one, a group of Denmark researchers have determined that abuse of virtually every type of drug can contribute to mental deterioration and eventual, schizophrenia.

A common misconception about schizophrenia is that those afflicted have split personality disorder or multiple personalities.  However, this has been determined false, as most people suffering from schizophrenia are non violent and lead fairly normal lives, posing no immediate threat to others. Per the National Institute of Mental Health:

“Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality. Although schizophrenia is not as common as other mental disorders, the symptoms can be very disabling.”

Rather than split personality disorder, which is a separate diagnosis, those suffering from early onset schizophrenia can experience a decrease in mental processing, rational thinking and general mental well being.  Furthermore, in can take years for schizophrenia to fully develop and during this time, can manifest itself as more common mental health disorders like depression and anxiety.

So what environmental and societal factors can worsen these symptoms into full blown schizophrenia?

The new Denmark study has determined that substance abuse can not only trigger schizophrenia in people genetically at risk, but also increase the chances of developing schizophrenia by up to six times.

While the direct cause and effect relationship between substance abuse and schizophrenia is tremendously complex, the study found the following increases in risk:

  • Cannabis: 5.2 times
  • Alcohol: 3.4 times
  • Hallucinogenic drugs: 1.9 times
  • Sedatives: 1.7 times
  • Amphetamines: 1.24 times
  • Other substances: 2.8 times.

The study notes, while the effects are not often immediately noticed, symptoms of schizophrenia as it relates to drug abuse, often surface later in life: sometimes ten to fifteen years after the substance abuse diagnosis.

Mental health and substance abuse treatment centers often offer dual diagnosis programs for this exact reason, noting that symptoms of schizophrenia can be coupled with drug use.

A particularly worrisome finding of the study is the risk found with two of the most prevalent substances, marijuana and alcohol.  While marijuana is federally illegal, it is used medicinally and recreationally in many stages, including California.  A large factor in the correlation found between cannabis and schizophrenia is due to the fact that people can be exposed to it second hand.  That is to say, unlike most other substances (not smoked), marijuana can be introduced to people’s systems indirectly, simply by being in close proximity of someone that is using the drug.

Alcohol on the other hand, tops the list, as it’s the most socially acceptable and easily obtainable substance given it’s legal place in American media and culture.

While the newly discovered findings presented by the Denmark study do not provide us with a black and white relationship between schizophrenia and substance abuse, the evidence is undeniable: The prolonged abuse of illicit drugs and alcohol increases the risk of developing schizophrenic tendencies and symptoms later in life.

Article courtesy of the team at Muse Treatment

Thank you Justin!

Friday Sober Jukebox – Ghosts in the Machine

ghosts-in-the-machineSo this feels like a timeless sober jukebox tune for a timeless post.  I’m actually writing this at the end of October 2016 because I have been struggling with some recurring demons – my ghosts in the machine as it were.

Coming from the family experience that I do I struggle with fear and anxiety pretty regularly and it settles for long periods of time and then flairs up again.  Invariably I think that I have more power than I do and that everything is my fault, everything will fall apart and it will all be my fault.  I listened to a Yoga Church podcast last night called ‘Step Out of Your Past and Into Your Now’ that got me thinking about this again as I struggle to get on top of another bout of raging anxiety and fear.

shadow-dancerMeadow and Laura McKowen were talking about the words that define their past and for me those two words, fear and anxiety, express it pretty succinctly.  They discussed coming up with an image that portrayed this and pretty similarly to Laura the one I landed on was shadow dancer.  I spent my entire life dancing to the tune of others to dodge the shadows of fear and anxiety – either my own or those of others around me.  No wonder I ended up in the bottom of a bottle!

This image and these words must then be honoured and let go in a ritual of some kind of your making.  To me it felt like I had to sit with them and not dance myself away from them and my shadow side.  To be honest the trigger events have prompted a great deal of soul searching and somatic discomfort so I feel like this has been part of the process and hence why it is time to move on from being stuck in these feelings.

explorerHaving created the image and words that defined the past the task was then to create ones to replace these for the future.  My brain was pretty fried by this point (or I was simply disassociating under the stress of it!) but with the help of MrHOF we came up with calm and fearless as the words and the image was explorer.

This image seemed fitting in terms of my internal exploring of more positive feelings and our external plans for travel as a family too 😉

This is an ongoing process and I continue to have waves of emotional upheaval but like the waves of craving to drink they come less often and are less intense and I see them build to crescendo and break now so I’m making progress.  I recommend you give it a try what with the heralding of a new year not that long ago.

And now to one of my favourite albums 🙂