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Concurrent Disorders Centre for Addiction
and Mental Health

Moving beyond stigma: Information for families of people with co-occurring mental health and substance use problems

Your teenaged daughter has been diagnosed with both an anxiety disorder and an alcohol problem. You are reeling from the news, and wonder how this could happen in your family.

Your husband seems depressed and is taking sleeping pills every night. You fear a serious problem may be developing, but it all seems too much to face.

Since your mother died, your father has been grieving and seems less and less able to cope. He has begun to drink heavily. You find it embarrassing to speak to him about this issue, and worry about how your siblings and other family members will react.

Your loved one may have co-occurring mental health and substance use problems—also known as concurrent disorders.

About stigma

If you are concerned that a member of your family has co-occurring mental health and substance use problems, it can be easy to feel overwhelmed.

You may feel helpless, sad, stressed, frightened or even angry. Among the most difficult feelings are guilt and shame. For example, you may ask yourself: “What did I do wrong? What if other people find out? What will people think? Whom can I trust?”

Feeling ashamed about problems is a sign that there is stigma attached to the situation. “Stigma” refers to negative attitudes (prejudice) and negative behaviour (discrimination) toward people with substance use and mental health problems.

Mental health problems or substance use problems on their own can result in stigma. Having both problems together can increase the stigma.

The effects of stigma

The effects of stigma may be even more painful and harmful for families than dealing with the fact that a loved one has substance use and mental health problems.

For example, stigma may lead you to hide your loved one’s problems from your extended family, friends and community. You may isolate yourself and cut off links to people who could provide important social support.

When a person receives prompt treatment for co-occurring mental health and substance use problems, there are much greater hopes for recovery. But stigma can discourage families from seeking care and support for both their loved one and themselves.

You are not alone

It’s easy to believe that you and your loved one are alone in your struggles. In fact, co-occurring mental health and substance use problems are common:

  • Among people diagnosed with a mental health problem, 30 per cent will have a substance use problem at some time in their lives.
  • Among those with an alcohol problem, 37 per cent will have a mental health problem at some time.
  • For people who have a problem with a substance other than alcohol, more than half (53 per cent) will have a mental health problem at some time.

Many other families are dealing with the stress and emotional pain of supporting a family member with co-occurring problems—so you are not alone.

Your feelings are a normal reaction

“My immediate thought is fear of exposure. You know, fear of people’s reactions . . . You’re very fearful of a change in people’s attitudes toward you or toward your family member who’s ill.”

If you have a family member with co-occurring substance use and mental health problems, your entire family is under stress. It is normal to feel a range of difficult emotions, including fear, confusion, anger and hopelessness.

It is also normal to feel ashamed and afraid of judgment. You may want to protect your loved one from prejudice and discrimination. You may also worry that others will see the whole family as flawed, and will perhaps blame you for causing your loved one’s problems. As a family member, you are coming to terms with “stigma by association.”

Moving beyond stigma

“How many people know that family support is an avenue to help them cope with things like stigma? I mean, people just don’t know. But it’s very important for family members to get help.”

As we learn more about co-occurring mental health and substance use problems and how best to address them, there is more understanding and compassion for people living with these challenges, and for their families. For example:

  • Treatment professionals are learning how to better help families understand and deal with their feelings, including concerns about stigma.
  • Family treatment groups are available to provide education, support and a safe environment for family members to share their feelings and learn new ways to cope.
  • Many people and organizations are working against stigma, by raising awareness about co-occurring substance use and mental health problems and the progress that has been made in treatment and recovery.

As a family member:

  • As well as the many challenges you may face yourself, you may need to advocate on behalf of your loved one.
  • You may have to educate others to help them understand co-occurring mental health and substance use problems.
  • Accept that sometimes you will have negative feelings.
  • Get help in caring for your emotional, physical and social needs.
  • Remember that treatment professionals, friends and family members can help you deal with your challenges, including stigma.
  • Remember that you and your family are not to blame for your loved one’s problems.

When families work together, the person with co-occurring problems is more likely to have a successful and lasting recovery, and the family’s well-being is often improved in the process.

“I think as family members we have an opportunity here to offer a lot of hope to other families going through the same thing. Mental illness and substance abuse doesn’t have to mean that the person’s life is over. So I think we need to give some hope to people.”

Connecting with substance use and mental health services in Ontario

  • ConnexOntario Health Services Information
  • Drug and Alcohol Registry of Treatment (DART)
    1 800 565-8603
    DART provides information on and referral to alcohol and other drug treatment services in Ontario.
  • Mental Health Services Information Ontario (MHSIO)
    1 866 531-2600
    MHSIO provides comprehensive information about mental health services and supports across Ontario.

Depending on where you live, DART or MHSIO may be able to refer you to an agency that offers family programs.

A resource for families

The Centre for Addiction and Mental Health (CAMH) has developed the Family Guide to Concurrent Disorders for families of people with co-occurring substance use and mental health problems. Based on CAMH’s work in running family support and education groups, this guide is designed for families to use on their own or with a treatment program. It includes insights from other families, information about treatment options, plans for self-care, advice on how to move beyond stigma and much more. To download the guide and other information on concurrent disorders, click the link above.

Other important resources for families

The quotations in this brochure are from family members interviewed during research conducted by Dr. Caroline O’Grady of CAMH.

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