Tag Archives: Addiction

A – #AtoZChallenge on Mental Health

Welcome to the #AtoZChallenge on mental health. I discussed many topics related to mental health already last October for #Write31Days. As I menitoned in my theme reveal post for the #AtoZChallenge, I’m going to give short descriptions of several words for each letter (sometimes though I have only one). For today, my letter A post, I have quite a lot of words. Here goes.

Acute unit


Also called “admission unit” in the Netherlands, here is where people go if they’re in crisis. The acute unit is for short-term treatment only: up to three months. Even so, some people stay there much longer. Like, I spent sixteen months on an acute ward because the rehabilitation unit didn’t want me.

Addiction

Though addictions are typically treated in separate units or even by separate agencies than mental illnesses, many people with a mental health diagnosis also have an addiction.

Admission

The process of getting admitted to a psychiatric unit. If people are admitted to an acute unit, this is usually through the crisis service or psychiatric liaison in the emergency department. On treatment units, such as for eating disorders or personality disorders, people usually get admitted through their outpatient treatment team. An admission interview typically consists of a brief assessment of one’s symptoms and some standard questions (eg. does the patient know where they are and what date it is). Details of the patient’s initial treatment may also be discussed.

Aggression

Aggression is quite common among mentally ill people, especially those in inpatient care. This may not be a politically correct statement but it’s true. Most times, this consists of verbal aggression, but nurses and patients sometimes get attacked physically too.

Alcohol

Alcoholism is not as common among mentally ill people in inpatient treatment – they often take their addictions out on other drugs. However, still you get the occasional alcoholic on an inpatient mental health unit. Most instituttions don’t serve alcohol in the cafeteria, though near my institution is the railroad store where they do sell alcohol.

Attention-Seeking

Us mentals are supposed to crave attention more than do people without mental illness, hence the common belief that a mental illness is “attention-seeking” behavior. Well, let me tell you: mentally ill people often keep their symptoms hidden for a long time and most don’t crave attention more than do mentally healthy people.

Attitude

A similar myth about mental illness is that it’s an attitude problem. It’s not. I wrote a post on mental illness and attitude last October. The idea that mental illness is an attitude problem is very damanging to people with mental illness, who often have a lot of shame as is. There is a group of people wiht an attitude problem here and they’re the people who think they can judge another person’s attitude like this.

Willpower

I am a member of a few general recovery groups on Facebook. Most of the members are addicts or alcoholics. I am not. I consider myself addicted to food in some ways, but it isn’t like I can just stop eating, like an addict can quit their substance of abuse. I’m not saying that’s easy either. That’s my point of this post.

Most recovery groups are based on some twelve-step model. As such, we see a lot of references to a higher power or God in the posts. One that I came across recently was that we have to redefine willpower. Willpower is the will to turn over the reigns of our life to God.

I like this statement. It doesn’t mean we don’t have to attempt abstinence (or in the case of an eating disorder, balance). We do still need to refrain from engaging in addictive behaviors. The difference is, God is guiding us on our journeys. If we turn over the reigns of our life to God, we are realizing that we need to follow His lead, not the road of addiction.

I am a person who often turns over the reigns of her life to other people. I allow others to make decisions for me and in some ways, I’d like them to make the decision that I can’t have binge food, too. Staff won’t do this, as I’m an adult and responsible for my own recovery. My husband sometimes gets me a small bag of candy when I’d intended on eating a far larger quantity. This may lessen the physical effects of a binge, but it still means I engage in compulsive eating.

The first step of Overeaters Anonymous is to say we’re powerless over food. (The same statement is used in Alcoholics Anonymous and Narcotics Anonymous, with “alcohol” or “drugs” instead of “food”.) Therefore, we need to find a power greater than ourselves to help us recover from our addiction. Note that this higher power doesn’t necessarily have to be God: for atheists and agnostics, it can be the OA group they participate in. This signifies that, while no-one is taking responsibility for another’s choices, it is the guidance of our higher power, be it God or the group, that leads us into recovery. Even as believers, we believe that we have free will, but we can still turn the reigns of our life over to God. If we do this, we learn to rely on Him for paving the way for us into recovery. It isn’t that we are no longer ourselves in recovery or not, but we rely on God for facilitating our process of recovery.

I am nowhere near recovering, as regular readers of this blog know. My last binge was last Friday, and I was tempted to give in again today. I didn’t, which is a small win, and my thoughts on willpower contributed to that. I realized that God doesn’t want me to binge, and He gives me the means to resist the urge. Today, I was led to write this post instead of binge. It may sound like I don’t practise what I preach, as someone who’s still pretty deep in her eating disorder, but it personally helps me to preach recovery.

Dual Diagnosis: Addiction and Mental Illness #Write31Days

31 Days of Mental Health

Welcome to day 19 in the #Write31Days series on mental health. I am terribly late to write my post today and not really motivated for it. You see, I came down with a terrible cold and an earache. Life must go on though. Today, I’ll discuss a topic that does not affect me personally, but does affect many people I know in the psychiatric institution: dual diagnosis.

Dual diagnosis describes the co-existence between an addiction and a mental illness. The relationship between substance abuse and mental illness is complex. There may be many reasons why addicts get mental illness and why people with mental illness become addicted. For instance:


  • People with mental illness may use alcohol or drugs as a form of self-medication. This means that, when they experience undiagnosed or undertreated symptoms of mental illness, they turn to drugs or alcohol for a “quick fix”. They think they feel less anxiety or depression, for example, when high on durgs. Unfortunately, while this may temporarly seem true, substance abuse makes these conditions worse.

  • Symptoms of mental illness can be worsened by substance abuse. For example, a person who is depressed might experience suicidality when intoxicated with alcohol, or a person with an anxiety dsorder may experience worse anxiety when withdrawing from opiates (eg. heroin).

  • Substance use can cause symptoms of a mental illness to appear in otherwise healthy people. The most common example is maijuana leading to psychosis. This is often called a drug-induced psychosis. Unfortunately, drug-induced psychoses may set in motion a rollercoaster that leads to longer-lasting problems, ie. schizophrenia.

According to the Amercan Medical Association, 35% of people who abuse alcohol and 53% of those who abuse drugs have at least one co-occurring mental illnesss, and 29% of people diagnosed with a mental illness are substance abusers. Males and young adults are more likely to experience dual diagnosis than do females and older adults.

The treatment of co-occurring mental illness and addiction is harder than that of either condition alone. It may be hard to diagnose the individual with co-existing substance abuse and mental illness because of the interactions between the two. For instance, if a person abuses amphetamines, it may be hard to recognize they do so as a means of self-medication for undiagnosed ADHD.

Violence and suicidality are more common in the dually diagnosed than in those with a mental illness alone. People with mental illness who end up in jail for criminal behavior (not just drug-related crimes) are also more likely to have a co-existing addiction.

Because many psychiatric hospitals and drug rehab centers treat only those with either a mental illness or an addction, people with a dual diagnosis have a harder time accessing treatment for any of their problems. Fortunately for them, there are now dual diagnosis units in many psychiatric hospitals at least in the Netherlands. I say “for them”, because the larger population of dually-diagnosed people in psychiatric hospitals does cause at least some people with just a mental illness (ie. me) to feel unsafe.

Food

Food. I am addicted to it. Unfortunately, unlike other addictive substances, such as alcohol, cigarettes or drugs, food is something every living being needs. It isn’t like, when you become a part of Overeaters Anonymous or the like, you can abandon food like those in Alcoholics Anonymous or Narcotics Anonymous abandon their substance of abuse. I still fail to understand the twelve steps when applied to food.

Of course, I could abandon candy, chips, and other snacks. I bought a bag of candies twice this week and, each time, ate all of it within half an hour. In this sense, I’m not doing as well as I said on my blog that I was doing on Tuesday.

I tend to fall into the trap of believing that, since we need food, it doesn’t matter if I eat a bag of candies in half an hour. We don’t need those. Candies are addictive. Refined sugar wouldn’t have been approved by the FDA or similar organizations had it been first introduced today.

A few weeks ago, as I was panicking about some kind of poinsonous thing my husband was talking about, he said I ironically do not fear one of the worst poisons that we consume daily: refined sugar. I have to agree.

This afternoon, I knew that really I shouldn’t go to the store when I asked a nurse for a walk. And when I went to the store anyway, my first intention was to buy tomato soup only. Not terribly healthy, but there really isn’t anything healthy in this store. Fruit and veggies aren’t sold in my institution town’s only store, so well. I ended up buying a bag of my favorite candies too and genuinely promised myself I’d eat them mindfully and actually enjoy them. Not so.

Food. I really need to say the first step of the twelve steps of OA, which is that I’m powerless over it. I realize I truly am, but sometimes, I’m stuck in the trap of believing that you can’t be powerless over somethign that, well, everybody needs.

This post was inspired by one of Mari L. McCarthy’s journaling prompts in her free eBook Mari’s 143 Juicy Journaling Prompts. The prompt was to choose a four-letter word starting with “F”, and to journal about it.

Post Comment Love

Brilliant blog posts on HonestMum.com

What Recovery Means to Me

Recovery from an eating disorder, self-injury, another addiction or mental health condition can mean quite different things depending on whom you ask. When I joined a recovery group in my old institution in 2010, it was made clear that recovery is different from cure. You could be recovered while still having symptoms of your mental illness and, I assume, someone could be symptom-free but not recovered too. Recovery, in this situation, means living the life you want given the circumstances you’re in and taking responsibility for yourself.

In the eating disorder, self-harm and addiction communities, recovery is much more tied to cure. You cannot, it is assuemd, be recovered while still engaging in disordered eating behaviors or self-harm or, in the case of Alcoholics Anonymous, even drinking a sip of alcohol. I understand this. After all, how can you be fully taking responsibility for your life, living a full life when your life is ruled by food or alcohol or drugs or self-harm? I do see the point. When you’re powerless over an addiction – admitting this is the first step in twelve-step programs -, it takes abandoning the addiction in order to regain power over your life. I am not fully sure this applies to eating though.

The first definition of recovery – the one of taking control of your life, whether you’re still symptomatic or not -, was also devised by people with severe mental illness. You know, treatment-resistant, thought-to-be-lifelong conditions such as schizophrenia and bipolar disorder. People in the eating disorder and self-harm communities tend to assume that their conditons are curable, so their definition of recovery requires being symptom-free. Even so, people like Arnhild Lauveng prove that becoming completely symptom-free is possible with thought-to-be-lifelong conditions like in her case schizophrenia too.

I tend to side with the first definition of recovery with regards to most of my symptoms. I don’t even consider some of my symptoms to be entirely negative. Even when I do, it isn’t a priority for me to get rid of them. Rather, it’s my priority to live a fulfilling life in spite of my symptoms.

Having a fulfilling life, for clarity’s sake, does not mean not getting support or help. In the recovery group I was part of, my planning to go to a workhome – one of the more intensive forms of support within the autism community -, was seen as recovery, because I took steps towards taking control of my life. (I originally typed “restrictive” instead of “intensive”, but realized that there is a huge difference and this place was not that restricive at all.) Indeed, living your life with lots of support, but you being the one directing your support, is very much what recovery is about.

However, with regards to my eating disorder and self-injury, I would very much like to become symptom-free. That doesn’t mean that to have stopped bingeing or purging or self-harming for a set amount of time means I’m recovered. Recovery also means having overcome the emotional struggles that underly my food issues and self-harm. In this sense, since my eating disorder is probably and my self-harm is certainly part of my borderline personality disorder, I do hope to become symptom-free from BPD too.

Even so, for me living my life is a much higher priority than becoming symptom-free. I want to go find a place to live, whether it’s with my husband or in supported housing, and I want to take up some course again. Probably not a college-level course, but maybe a writing course or something. I also want to exercise a few times a week, which is good for keeping me healthy even should I not entirely overcome the overeating.

You can’t stop eating entirely, so I can’t decide that recovery means no more indulging into the addictive substance or behavior. In this sense, I realize I’m not fit for twelve-stp programs, even of the compulsive overeater type, because they do require you to be completely clean from overeating in order to consider yourself having entered the first phase of recovery. Becoming binge-free would be great, and I do strive for it, but it’s less of a priority than having a fulfilling life.

Running in Lavender

Brilliant blog posts on HonestMum.com

Mental Illness and Causing Emotional Harm

On day four of the recovery challenge, we’re supposed to honestly say whether we have emotionally harmed anyone (besides ourselves) with our addiction/disorder. This is a hard one for me, because with respect to my eating disorder, my answer would be “No”. That doesn’t mean I’ve not harmed people emotionally because of my mental health problems.

Generally speaking, it is not cool to admit you’ve harmed others because of your mental illness. Then again, a lot of family members of the mentally ill do consider being victimized to abuse by the mentally ill person a regular consequence of mental illness. Why is it that people with mental illness don’t want to admit that they can do harm with their disorder? Probably it’s because we don’t want to be seen as bad people, and actually many of us have experienced abuse ourselves. It seems pretty much impossible to find someone who will admit they’ve been abused and yet they are harming others themselves. There is a forum on iSurvive for abuse survivors who abuse others, but that’s about it. I understand it is hard for victims to admit they cause harm to others themselves, but you have to be completely honest about your own actions in order to heal.

I have caused emotional harm to others because of my mental health conditions in several ways. The first is engaging in the addictive behavior in front of others. I have never binged in front of my husband or parents, but I have self-harmed in front of them.

Then there is the emotional unavailability because of the addiction/disorder. I remember one day my mother wanted to talk to me and I ignored her and started eating candy. I also believe that I may not be as available to my husband as I could be. I don’t know whether this is due to my eating disorder – as I said, I don’t binge in front of him, but food is on my mind often. It also could be my general self-centeredness which may or may not be due to any of my mental health conditions.

Then there is the anger issue. This is not caused by my eating disorder or self-harm, but more often the other way around. Both my borderline personality disorder and my autism though have caused me to act out towards others. This is the worst way in which I’ve harmed people emotionally. Except during my teens according to my mother, I haven’t been physically violent, but I have been verbally aggressive often. I can’t be sure that the urge to overeat has never contributed to this behavior. IN fact, usually at least compulsive or rigid behavior has. I mean, if I’ve gotten it in my head that we’re going to do X, the idea of doing Y often sets me off. It is possible that X more often than would be considered normal involves food.

The thing is, mental health problems make people emotionally hurt others. They also are common in people who have been the victims of emotional or other forms of abuse. This is why the cycle of abuse usually doesn’t end with one victim. And it has to end. If you’re suffering with an addiction/disorder, admit that it causes harm to others too. That doesn’t make your own traumatic experiences not valid.

Benzodiazepine Use: Benefits and Risks

A few days ago, I was sent an E-mail requesting I post an infographic on my blog about the dangers of benzodiazepines. The infographic was created by a dual diagnosis recovery center for people with a mental illness and co-occurring addiction. Because it is very much focused on the U.S. situation, I cannot repost the infographic here without further comment. I don’t do that anyway. Instead, I’m also sharing my knowledge of and experience with benzodiazepines, their benefits and risks.

The Hidden Dangers of Benzos
All rights reserved. Attribution: first posted on DualDiagnosis.Org

Benzodiazepines are a class of tranquilizing medications, among which are diazepam (Valium) and lorazepam (Ativan). While they can legally be prescribed for a range of conditions – insomnia, anxiety, panic attacks, seizures, etc. -, the Dutch insurance system limits coverage for benzodiazepines to four conditions:


  • Maintenance treatment of epilepsy or as-needed treatment of an epileptic seizure.

  • Treatment of anxiety disorders, when treatment with at least two antidepressants has failed.

  • Treatment of multiple psychiatric conditions that require use of high doses of benzodiazepines.

  • Palliative sedation during end-of-life care.


Physicians who prescribe benzodiazepines for these conditions, need to add the code B2 to the prescription.

I have used benzodiazepines on several occasions. First, in 2006, I was prescribed a benzodiazepine sleeping pill. It was at the time still covered, but no longer would under the current insurance regulations. However, from 2007 on, I’ve used several benzodiazepines for PRN use for irritability. Whether this falls under the multiple psychiatric conditions rule, I do not know, since I am in an institution so medications are covered anyway.

In 2010, I was on Ativan daily for three months. I was on a moderate dose of 3mg/day. After these three months, I told my psychiatrist I felt I no longer needed the Ativan. He changed the prescription to as-needed and I quit taking the benzodiazepine cold turkey. That truly wasn’t a wise choice. A few days from quitting, I was trembling and shaking. At first, I thought it was the antidepressant I’d started taking three weeks prior, but I eventually realized I was probably experiencing Ativan withdrawal. I spoke to my psychiatrist, who put me on a taper schedule that took several months. Ultimately, I spent almost as long trying to taper the Ativan as I’d been on it.

I honestly never found relief from benzodiazepines. Usually, I slept for a few hours then was irritable again. Then again, it seems that with irritability, the goal is to knock you out, not to really make you feel better. I also learned recently that benzodiazepines should really not be prescribed to people with borderline personality disorder, as the anti-anxiety effect causes borderline patients to be disinhibited and potentially become aggressive. I don’t think I ever experienced this myself.

I tend to develop tolerance to benzodiazepines really quickly. With the sleeping pill I took in 2006, I was given ten tablets that I used up over a six-week period. No daily use at all. Still, the last few pills didn’t really work at all. Please realize that, if you got used to one benzodiazepine, you’ll likely develop tolerance to the next pretty soon too. In November and December of 2007, I was on three different benzodiazepines, with about ten benzo-free days in early December. The first, I got used to within five days but kept taking for a month anyway. Then I had the ten days when I was off benzos – but on a stronger tranquilizer that is really an antipsychotic. Then I started taking nitrazepam (Mogadon), one of the more expensive benzos out there. It worked for about two weeks, but I did use the neuroleptic as adjuvant treatment. By the time I’d gotten used to the Mogadon, my doctor thought it would be time for something other than a benzo, but the psychiatrist disagreed and put me on diazepam. That didn’t work and I quit all tranquilizers at the end of December.

I have not been on any benzodiazepines for about a year now. I took Ativan as-needed until the summer of 2013, but it hardly worked so I now take promethazine (Phenergan), a low-potency neuroleptic. I do not want to be on benzos anytime soon again. Then again, I don’t suffer from epilepsy or a significant anxiety disorder and my irritability is kept relatively under control by a daily antipsychotic and PRN Phenergan.

When I ran the above infographic by some fellow bloggers to determine whether it was genuine, some people told me they did great on benzos. If you’ve suffered from severe anxiety for a time and antidepressants have not worked, I can totally see why you’d try benzodiazepines. If you have epilepsy, something has got to drag you out of a seizure. Therefore, even though I have personally not had luck with benzos, I don’t want to say that benzodiazepines are necessarily bad. I like the Dutch insurance policy, making sure that people won’t reach for benzos too soon but those who need them, can get them.

The Five Stages of Grief in the Recovery Process from Binge Eating

When browsing blogs on mental health on Mumsnet, I came across a blog on recoveyr form alcoholism. While there, I found a post on the five stages of grief in substance abuse. You are probably familiar with Elisabeth Küber-Ross’ five stages of grief in bereavement. These same stages apply to some extent to those recovering from an addiction:


  • Denial: people feel that they do not have a problem concerning alcohol or substances. Even if they do feel as if they might have a small problem, they believe that they have complete control over the situation and can stop drinking or doing drugs whenever they want.

  • Anger at the fact that the addict has an addiction or at the fact that they can no longer use alcohol or drugs.

  • Bargaining: the stage where people are trying to convince themselves or others that they will stop substance abuse in order to get out of trouble or to gain something.

  • Depression: sadness and hopelessness, which usually happen during the withdrawal process from alcohol or drugs.

  • Acceptance, not merely as in admitting you have a problem with alcohol or drugs. Acceptance involves actively resolving the addictioon.

I do not have an alcohol or drug problem, but I do exhibit disordered eating. I wonder to what extent these stages of grief apply to the recovery process from eating disorders, in my case mostly binge eating. Denial is certainly common in individuals with all types of disordered eating. I for one was in the stage of denial up until quite recently. This is not merely not being aware of the problem, like I was in early adolescence. Rather, from my teens on, I did realize to some extent that my eating habits weren’t normal. I remember one day buying five candy bars at once and eating them all in one go. When my classmates pointed out that this was outrageous, I shifted from lack of awareness of my eating disorder into denial.

As I said, I stayed in denial for years. I continued buying sausage rolls for lunch every single day until the end of high school, then at blindness rehab ate candy and chips everyday. I gained rougly ten pounds in those four months at blindness rehab, thereby reaching the upper limit of a healthy BMI.

It took several more years before I moved into the stage of anger. By 2008, I was convinced I would die young, and my unhealthy eating habits were one reason for this. I hated myself and my body, yet didn’t stop eating unhealthy amounts of candy. If anything changed at all, I binged more.

I don’t know how I maintained a relatively healthy weight until 2012, but I did. I did start purging in 2011, which can be seen as either a response to anger or a form of bargaining. After all, bargaining can also be seen as trying to reduce the (effects of the) addiction while not completely trying to abandon it.

I reached overweight status in 2012, then obese a few months ago. I started going to a dietician in 2012, then quit going again, went back in the fall of 2013, quit again, and recently started going again. I am still at the stage of bargaining regarding my disordered eating. When told I just need to stop buying candy, I object. Instead, I want to lessen my candy consumption, keep it under control. Yet isn’t the whole point of an addiction not the substance, but the lack of control? I know that one difference between food and alcohol or drugs is that you can’t completely abandon food, and my dietician said that getting fruit or veggies within easy reach as a substitute for candy, is unlikely to work. After all, I’m going to keep the idea that food is an easy way out of emotional stress.

Overeating or Binge Eating Disorder: Is It “Food Addiction”?

I have had issues with disordered eating since early adolescence. I mostly engage in overeating or maybe even binge eating (a binge being a distinct period of severe overeating accompanied by a feeling of being out of control). When I still purged regularly several years ago, I took my eatig issue much more seriously than I do now, despite my overeating/bingeing having gotten worse over time and my weight recently having increased to a number that is within the obese range for my height.

Overeating is often seen as an addiction. I’ve never really seen my eating habits as such, and I wonder what the implications would be if “food addiction” were formally recognized. Curtis & Davis (2014) ask the same question in the conclusion to their qualitative study of “food addiction” in obese women with and without binge eating disorder (BED). In their study, all BED women met criteria for “food addiction” when DSM-5 criteria of substance use disorder were used with food being the substance. Obese women who didn’t suffer from BED also often displayed “food addiction” symptoms. They however attributed their inability to stop overeating more to liking the food or not wanting to stop than to feeling intrinsically unable to stop.

Interestingly, many women in the study weren’t sure whether they were food addicts when directly asked about it. I can relate to this. I at one point participated in an unofficial Overeaters Anonymous online group, and didn’t feel this suit me really. I do notice that I hold many of the same misconceptions about what an addiction is that the study authros found. For example, I tend to believe food cannotbe addictive because we need it, that substance abusers use their substance all the time, etc. The idea of food as an addictive substance does raise questions about what it is to be dependent on a substance. I know that the DSM-5 removed the distinction between substance abuse and substance dependence, and, in a way, this is good. Then again, you can get physically dependent on certain substances, and that makes an addiction to that substance (eg. alcohol) look more real than an addiction to a substance that you won’t develop physical dependence. Addiction to a substance you can’t get physically dpeendnet on, in turn, looks more real than behavioral addictions like “Internet Addiction”. These novel addictive disorder concepts do create fundamental debates about personal responsibility, which do have implications for treatment. After all, an impulse control disorder is treated differently from a substance dependence.

Reference

Curtis C & Davis C (2014), A Qualitative Study of Binge Eating and Obesity From an Addiction Perspective. Eating Disorders: The Journal of Treatment & Prevention, 22(1):19-32. DOI: 10.1080/10640266.2014.857515.