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Families who have mentally ill relatives whose problems are compounded by substance abuse face problems of enormous proportions.

Research studies are beginning to help us understand the scope of the problem. As many as 50 percent of the mentally ill also have a substance abuse problem. The drug most commonly used is alcohol, followed by marijuana and cocaine. Prescription drugs may also be abused. In some cases over the counter sinus, cold, shaving lotion, medicinal alcohol or other medications may be substituted.

People with mental illnesses may abuse drugs without their families knowing it. The severity of the disease is underestimated.

There may be several reasons for this:

It may be difficult to separate drug or alcohol behavior from the behavior caused by a mental illness
There may be some degree of denial of the drug or alcohol problem.
Caregivers might prefer not to acknowledge such a frightening problem.
Caregivers might prefer not to address it, fearing the retribution.

Substance abuse complicates nearly every aspect of health care for the person with a mental illness. These individuals are difficult to engage in treatment. Diagnosis is difficult, as it takes time to unravel the symptoms of substance abuse from the symptoms of the mental illness.

Violence is more prevalent among the population with a dual diagnosis. Both domestic violence and suicide attempts are more common. Many of the mentally ill individuals who wind up in jail or prison are substance abusers as well.

This population may have difficulty living around people, whether at home, in community residences, or in rehabilitation programs. They tend to lose their support system quickly, and suffer frequent relapses and hospitalizations.

Social factors may also play a part in continued drug use. People with mental illnesses suffer from what has been called "downward drift". This means that as a consequence of their illness, they may find themselves living in neighborhoods or with people where drug use prevails.

Having great difficulty developing social relationships, they find themselves more easily accepted by groups whose social activity is based on drug use. Some may believe that an identity based on drug addiction is more acceptable than one based on mental illness.

Family Management and Coping

It is difficult enough to cope with problems presented by a relative's mental illness, but when substance abuse is also a problem, the family's stress can be multiplied. These families need all the help they can get to help them cope with the additional burdens that they face.

Recognizing the Problem

Many families do not recognize that their mentally ill member also has a substance abuse problem. This is not surprising, since many of the behaviors that lead to the suspicion of a drug problem already exist. Therefore, such behaviors as defiance frequent arguments, or being "spaced out" may be less reliable clues in this group.

Observation of the following may put families on the alert:

Suddenly having money problems
Appearance of new friends
Valuables disappearing from the house
Drug paraphernalia in the house
Long periods of time in the bathroom
Dilated or pinpointed eyes
Needle marks on arms or body
Changes in behavior.
Sleep pattern disturbances

Confronting the Problem

Confronting the problem may or may not involve confronting the individual. It is usually best not to immediately and directly accuse the individual of using drugs, as denial is a likely response.

Unless one has irrefutable evidence, the person is entitled to be presumed innocent. Drug induced behaviors may take any number of forms: apathy, lack of motivation, irritability, neglect of personal hygiene, belligerence, frequent arguments, and so forth.

Since the problem of drug use is a very serious and complicated matter, it should be addressed in a careful but deliberate manner. It is best not to try to approach the individual under the influence of drugs or alcohol, nor when family members are feeling most emotionally upset about the situation. Avoid making dire threats such as calling the police, threatening with hospitalization, or exclusion from the home, unless you are really serious about following through.

Develop a Plan of Action

Since it is likely to be difficult at best, select a time when things are relatively calm to decide what to do. Involve as many members of the family as possible, and develop an approach that all can agree upon.

The following guidelines may help in developing a plan:

Be sure that all members agree on what the problem is.
Generate a number of possible solutions to the problem, with the goal of acting on the one(s) that all agree is/are the best one(s).
Relay your concerns to your relative's psychiatrist or therapist. You may need their help or suggestions.
Confront him or her with your observations and request very specific changes in behavior.
Plan ways to reduce access to money that might be going for drugs.
Do everything possible to reduce his/her interest in, social groups that use drugs.
Confront the person with clear evidence that he/she is using drugs, and suggest treatment.
Develop very specific steps in carrying out your plans. Decide what role each member will have in implementing the plan. Be prepared to give the evidence.

Support and Self-Care for the Family

Coming to terms with chemical dependency of a mentally ill relative does not come easily. Feeling angry and rejecting does not help, and delays rational thinking about how to approach the problem. Parents and siblings may be hurt because the addicted person blames others for his/her problems, and destroys trust by lying and stealing. Members of the family may feel guilty because they think their relative's substance abuse problem is in some way their fault.

It is important, first of all, to realize that substance abuse is a disease. The person who is truly addicted is no more able to take control of this problem without help, than he/she is able to take control of his mental illness.

Finally, it is important to say that families cannot stop their relative's substance abuse. They can, however, avoid covering it up or doing things that make it easy for the person to continue the denial. Families can learn what they can do about the problem, but they must be realistic that much of the recovery is out of their hands.

		DUAL DIAGNOSIS - Substance Abuse and Mental Illness Families who have mentally ill relatives whose problems are compounded by substance abuse face problems of enormous proportions. Research studies are beginning to help us understand the scope of the problem. As many as 50 percent of the mentally ill also have a substance abuse problem. The drug most commonly used is alcohol, followed by marijuana and cocaine. Prescription drugs may also be abused. In some cases over the counter sinus, cold, shaving lotion, medicinal alcohol or other medications may be substituted. People with mental illnesses may abuse drugs without their families knowing it. The severity of the disease is underestimated. There may be several reasons for this: It may be difficult to separate drug or alcohol behavior from the behavior caused by a mental illness There may be some degree of denial of the drug or alcohol problem. Caregivers might prefer not to acknowledge such a frightening problem. Caregivers might prefer not to address it, fearing the retribution. Substance abuse complicates nearly every aspect of health care for the person with a mental illness. These individuals are difficult to engage in treatment. Diagnosis is difficult, as it takes time to unravel the symptoms of substance abuse from the symptoms of the mental illness. Violence is more prevalent among the population with a dual diagnosis. Both domestic violence and suicide attempts are more common. Many of the mentally ill individuals who wind up in jail or prison are substance abusers as well. This population may have difficulty living around people, whether at home, in community residences, or in rehabilitation programs. They tend to lose their support system quickly, and suffer frequent relapses and hospitalizations. Social factors may also play a part in continued drug use. People with mental illnesses suffer from what has been called "downward drift". This means that as a consequence of their illness, they may find themselves living in neighborhoods or with people where drug use prevails. Having great difficulty developing social relationships, they find themselves more easily accepted by groups whose social activity is based on drug use. Some may believe that an identity based on drug addiction is more acceptable than one based on mental illness. Family Management and Coping It is difficult enough to cope with problems presented by a relative's mental illness, but when substance abuse is also a problem, the family's stress can be multiplied. These families need all the help they can get to help them cope with the additional burdens that they face. Recognizing the Problem Many families do not recognize that their mentally ill member also has a substance abuse problem. This is not surprising, since many of the behaviors that lead to the suspicion of a drug problem already exist. Therefore, such behaviors as defiance frequent arguments, or being "spaced out" may be less reliable clues in this group. Observation of the following may put families on the alert: Suddenly having money problems Appearance of new friends Valuables disappearing from the house Drug paraphernalia in the house Long periods of time in the bathroom Dilated or pinpointed eyes Needle marks on arms or body Changes in behavior. Sleep pattern disturbances Confronting the Problem Confronting the problem may or may not involve confronting the individual. It is usually best not to immediately and directly accuse the individual of using drugs, as denial is a likely response. Unless one has irrefutable evidence, the person is entitled to be presumed innocent. Drug induced behaviors may take any number of forms: apathy, lack of motivation, irritability, neglect of personal hygiene, belligerence, frequent arguments, and so forth. Since the problem of drug use is a very serious and complicated matter, it should be addressed in a careful but deliberate manner. It is best not to try to approach the individual under the influence of drugs or alcohol, nor when family members are feeling most emotionally upset about the situation. Avoid making dire threats such as calling the police, threatening with hospitalization, or exclusion from the home, unless you are really serious about following through. Develop a Plan of Action Since it is likely to be difficult at best, select a time when things are relatively calm to decide what to do. Involve as many members of the family as possible, and develop an approach that all can agree upon. The following guidelines may help in developing a plan: Be sure that all members agree on what the problem is. Generate a number of possible solutions to the problem, with the goal of acting on the one(s) that all agree is/are the best one(s). Relay your concerns to your relative's psychiatrist or therapist. You may need their help or suggestions. Confront him or her with your observations and request very specific changes in behavior. Plan ways to reduce access to money that might be going for drugs. Do everything possible to reduce his/her interest in, social groups that use drugs. Confront the person with clear evidence that he/she is using drugs, and suggest treatment. Develop very specific steps in carrying out your plans. Decide what role each member will have in implementing the plan. Be prepared to give the evidence. Support and Self-Care for the Family Coming to terms with chemical dependency of a mentally ill relative does not come easily. Feeling angry and rejecting does not help, and delays rational thinking about how to approach the problem. Parents and siblings may be hurt because the addicted person blames others for his/her problems, and destroys trust by lying and stealing. Members of the family may feel guilty because they think their relative's substance abuse problem is in some way their fault. It is important, first of all, to realize that substance abuse is a disease. The person who is truly addicted is no more able to take control of this problem without help, than he/she is able to take control of his mental illness. Finally, it is important to say that families cannot stop their relative's substance abuse. They can, however, avoid covering it up or doing things that make it easy for the person to continue the denial. Families can learn what they can do about the problem, but they must be realistic that much of the recovery is out of their hands.	Alcohol Abuse Drug Abuse Dual Diagnosis -substance abuse & Mental Illness Anxiety Depression Eating Related Disorders Manic Depresion/Bi-Polar Mental & Emotional Issues in Elders Obsessive Compulsive Disorder Panic Disorder Phobia Post Traumatic Stress Disorder - PTSD Schizophrenia Chronic Illnesses & Medical Problems

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