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Dual Diagnosis: Anxiety and Substance Use Disorder

Dual Diagnosis: Anxiety and Substance Use Disorder

Anxiety, stress, and fear are common emotions people experience through the course of everyday life.  Anxiety disorders, on the other hand, go beyond our daily worries and fears. Stress and pressure is subjective to each person – anxiety disorders can induce heavy stress and pressure, and these feelings can become more intense over time. Issues that crop up for anxiety disorder sufferers range from anodyne to hair-raising. For example, some people are terrified of meeting new people and having to interact with strangers, while others suffer panic attacks when memories of past traumas surface. The most common types of anxiety disorders are diagnosed as:

  • Panic Disorder (PD)
  • Generalised Anxiety Disorder (GAD)
  • Social Anxiety Disorder (Social Phobia)
  • Agoraphobia (Perception of certain environments as unsafe, with no easy escape)
  • Obsessive Compulsive Disorder (OCD)
  • Post Traumatic Stress Disorder (PTSD)

Not only are there psychological symptoms, people dealing with anxiety disorders may also experience a litany of physical symptoms such as insomnia; inability to concentrate or relax; heart palpitations; gastroenterological issues; and sexual frustration, among others. When all these problems start impinging on one’s behaviour, mood and thoughts, life can start to feel like a slog through quicksand. A once “normal life” now appears out of reach, and getting there again can feel like a Sisyphean task.

What makes people suffering from an anxiety disorder seek out substances?

It’s important to understand a little more about addiction before dealing with this question. Addiction is indubitably a very uncomfortable disorder, and that’s characterising it mildly. For a “preference” to devolve into full blown addiction, a person must keep making the same conscious decisions every day, day after day, that facilitate  indulgence in his or her vice – in spite of a mounting cornucopia of problems. Maintaining an addiction certainly is tiresome. People suffering from addiction make these choices because their addiction serves them a purpose. Concomitant discomfort is tolerated in light of perceived benefits garnered from substance abuse.

A parsimonious way to think about addiction is to assume that it is a simple cost-benefit analysis. For someone struggling with an anxiety disorder, the allure of a “quick-fix” in the form of a suitable drug or drink is hard to ignore. What may begin as a misguided attempt to ameliorate paralysing fear can eventually develop into a fully-fledged addiction. With this in mind, it is now a lot clearer why substance use disorder (SUD) is a co-occurring psychiatric disorder that is one of the most prevalent among people with an anxiety disorder. The most recent and largest comorbidity study to date (with over 43,000 participants), the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), found that 17.7% of respondents with an addiction problem also had an anxiety disorder.

Ironically, the problem with the “solution” of substance abuse is that the ”solution” hurts more than helps. It can often exacerbate the anxiety disorder – which becomes ensnared in the convoluted mess that is addiction. Thus comes the slippery slope of anxiety, substance use, and elevated tolerance.

Chronic dependence is the likely consequence of this chain of events. For example, a person who suffers from social phobia might employ stimulants or anxiolytics to engender artificial confidence during a social situation. This can feel liberating, exhilarating, even, for someone who has spent a lifetime on the sidelines. The folly in this endeavour lies in the eventual normalising of this ‘chemically induced courage’ – if you turn it into a precondition to interacting with other human beings, you will only succeed in erecting progressively more imposing barriers in a completely self-defeating, tautological situation.

Are there psychotherapies out there that treat anxiety and addiction together?

Diagnosing a mental disorder in a person who also suffers from an addiction is challenging.

It may be hard to determine which came first, the addiction or the anxiety/depression. A clinical history, which is triangulated with loved ones, teachers and others may assist to know which came first. In any case, both the addiction and the disorders have to be treated at the same time. Otherwise, if untreated, the anxiety and depression may lead to the resumption of drug or alcohol use.  Cognitive behavioural therapies (CBT), meditation and mindfulness therapies, experiential therapies and medication can assist to address both compulsive behaviour and anxiety and depressive disorders.

A trained and experienced mental health professional can help you navigate your addiction recovery journey to ensure that you get the best possible outcome within the guidelines of your values and needs. While this article is about substance addiction, you will find that our team of psychiatrists, psychologists and therapists have the expertise and experience to work with a variety of addictions, and mental health issues such as anxiety disorders.

NeuroStar TMS Therapy® for Depression

NeuroStar TMS Therapy® for Depression

TMS1

How Does NeuroStar TMS Therapy® Work?

Transcranial magnetic stimulation (TMS) uses a targeted pulsed magnetic field, similar to what is used in an MRI (magnetic resonance imaging) machine. While the patient is awake and alert, NeuroStar TMS Therapy stimulates areas of the brain that are underactive in depression.2

NeuroStar TMS Therapy is an in-office treatment that takes 37 minutes, is performed while the patient sits in a chair, and is administered five days a week, for up to four to six weeks.

Simple steps for NeuroStar TMS Therapy:

  • Step One: The patient reclines comfortably in the treatment chair, awake and alert
  • Step Two: A small curved device containing the magnetic coil rests lightly on the patient’s head
  • Step Three: The device delivers focused magnetic stimulation directly to the target areas of the brain
  • Step Four: The patient can immediately resume normal activities

During treatment, the patient hears a clicking sound and feels a tapping sensation on the head. The most common side effect is generally mild-to-moderate pain or discomfort at or near the treatment area during the session. When this occurs it is temporary, and typically occurs only during the first week of treatment.

There are no effects on alertness or understanding; patients being treated with NeuroStar TMS Therapy can drive themselves to and from their treatment sessions. Above information is taken from: https://neurostar.com/neurostar-tms-depression-treatment/

Myth Busting Teen Mental Health – Self-Harm

Debunking myths about adolescent mental healthviolence-self-harm

Although society has made some headway in reducing the stigma and misinformation about general mental health issues, the public’s understanding of self-harm remains decades behind. Let’s debunk some common myths about adolescent self-harm.

Myth: ‘Self-harm means cutting right? Only emos and goths do that.’

Self-harm refers to a range of behaviours that are purposely inflicted to cause damage to the body. It can include cutting, but also refers to scratching, picking at wounds, burning, pinching, hitting, head banging, and minor overdosing. Self-harm can also be in the form of excessive risk-taking that is above and beyond typical adolescent risk-taking.

It is a misconception that only ’emos’ and ‘goths’ self-harm. Although self-harm can be part of adolescent subculture experimentation, it is more often a sign that a teenager is experiencing unmanageable distress. Self-harm becomes a way of coping with distress that provides temporary relief from emotional pain.

Myth: ‘Self-harm is all about attention-seeking. If a person was really depressed enough to cut themselves then they would probably just commit suicide.’

Self-harm is not about attention-seeking. It is often a secretive and private behaviour. For a teenager, self-harm is a way of coping with unmanageable distress, and can be a medium to communicate that distress to others. Self-harm should never be dismissed as attention-seeking.

A person who cuts themselves is not necessarily suicidal. Cutting behaviour can be suicidal, non-suicidal, or a mix of both. It is important to remember that suicide risk is not static. A teenager who displays non-suicidal self-harm can become suicidal at another point in time.

Any teen who self-harms should undergo a thorough and comprehensive suicide risk assessment by a registered mental health professional. Their suicide risk should be closely monitored and assessed at regular intervals.

Myth: ‘I can punish my teen so that they stop self-harming. That will solve the problem.’

Punishing a teen for self-harming does not solve the problem. Cutting is a symptom of a deeper issue – unmanageable distress. Stopping the cutting via punishment may actually worsen their distress, especially if the teen lacks healthy and effective coping strategies.

Here are some suggestions for what you can do instead of punishing your teen:

  • Be an active listener
  • Validating their feelings
  • Be emotionally and physically present for them
  • Engage in joint problem solving

Always seek advice from a registered child psychologist if you suspect that your teen may be self-harming.

Written by Leeran Gold, Psychologist in our Forensic Service.

At Promises Healthcare, we are committed to helping you through your journey to recovery. Discover a new life and find renewed hope. If you or someone you know needs mental health support, please contact our clinic for inquiries and consultations.

For after-hours crisis support contact your local mental health service or emergency services.

In Singapore: IMH 24-hour helpline +65 6389 2222, Ambulance 995.

Myth Busting Mental Health – Youth Suicide

Myth Busting Mental Health – Youth Suicide

youth-suicideLet’s take a look at some common mental health myths about youth suicide and set the record straight.

Attempted suicides are just a cry for attention.

A suicide attempt should never be dismissed as ‘just a cry for attention’. A young person is highlighting that their level of internal distress is unmanageable and unbearable. They need help, not judgement. A young person can feel even more isolated and misunderstood if those around them fail to take their actions seriously. Never ignore or minimise suicidal behaviours and seek professional help as soon as possible.

Teens who cut their wrists must be suicidal.

Cutting is a form of self-injury that can either be suicidal or non-suicidal. In both cases, the cutting is a sign that a young person is not managing their internal distress in a healthy way. Any young person who self-injures should undergo a full suicide risk assessment by a registered mental health professional.

If I ask a young person whether they are feeling suicidal, it might put the idea in their head.

This is a particularly dangerous myth as it discourages discussion of the issue at hand. Talking about suicidal feelings will not encourage a young person to commit suicide. When having the conversation try to stay calm and non-confrontational. Remain open and genuine, and remember the overall message – it is ok to talk about feelings, and there is help available. Show that you care and avoid judging the young person. If you are uncomfortable or unsure about having the conversation, get in touch with a mental health professional for some tips and guidance.

Written by Leeran Gold, Psychologist in our Forensic Service.

At Promises Healthcare, we are committed to helping you through your journey to recovery. Discover a new life, away from addiction and find renewed hope. If you or someone you know needs mental health support, please contact us today for inquiries and consultations.

For after-hours crisis support contact your local mental health service or emergency services.

In Singapore: IMH 24-hour helpline +65 6389 2222, Ambulance 995.

Caring For Every Aspect of Addiction Recovery

Caring For Every Aspect of Addiction Recovery

Many of us want to know how a person becomes an addict. Such compulsion is often described as a: “bio-psycho-social disease”. Some people inherit genetic vulnerabilities. They are predisposed to anxiety, depression, anger, stress and impulsivity.

Some may have suffered dreadful traumas. Neglected childhoods.  Were thrill seekers. They got in with the wrong crowd in school. Did badly in class. Have low frustration and distress tolerance. Some have jobs or friends that make drink and drugs the norm. Some struggle with boredom and routine. Delayed gratification is tough for them. Some are overwhelmed by intense feelings. Some have a combination of these things. And everyone is different.

But how does knowing the root cause help with recovery? It may not. The recovery solution is in the present and in the future – not in the past. What can you do, here and now, to make a difference?

At Promises Healthcare, we are committed to helping you through your journey to recovery. Discover a new life, away from addiction and find renewed hope. Please contact our clinic for inquiries and consultations.

 Written by: Andrew da Roza – Psychotherapist, Promise Healthcare Pte. Ltd.