Concurrent Substance Use and Mental Health Disorders: An Information Guide
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What happenswhen someone you love has concurrent disorders?
When someone has any chronic problem, it affects his or her entire family. Family members must cope with extra stressors.
Many family members struggle to accept that their relative has both substance use and mental health problems. Some families
may accept the mental health diagnosis, but not the substance use problem. They may think the substance use is a sign of “bad”
behaviour. Other families may accept the substance use, but find it hard to accept that their relative has a mental health
problem. Some families struggle to understand that concurrent disorders are a relapsing condition, and not an illness with
Family members may feel:
- a sense of loss.
They need to recognize that the expectations they had for their family member may change.
However, families can play a strong role in recovery. With support and understanding from families, people with concurrent
disorders are more likely to have a successful and lasting recovery.
Family members need to learn how to:
- communicate effectively
- help when needed
- know when to let go
- take care of themselves.
As the relative undergoes treatment, family members may also feel hope and optimism. They may begin to appreciate how hard
it is for their relative and admire the person’s courage. When the person with concurrent disorders has success in treatment,
family members may also feel a sense of personal reward.
Getting treatmentfor your family member
It may be hard to get your relative or partner to accept help. The person may be so discouraged about the situation that he
or she may not be able to see how treatment might help. People with concurrent disorders are more likely than other people
to have other health care issues. But they may not have a diagnosis of concurrent disorders. So, even though you may suspect
the nature of the problem, your relative might refuse to accept that he or she needs treatment for concurrent disorders.
It is best to be supportive when trying to get your relative to accept help. It is not helpful to be confrontational. One
way to be supportive about getting help is to find where your relative is least resistant to the idea of changing. For example,
the person may mention that drinking has a terrible effect on his or her mood. You could then start talking about drinking.
You could use this discussion to start the person thinking about getting help.
When your family member is ready to seek treatment, take an active role in helping. An active role could involve, for example:
- finding treatment centres
- setting up an appointment
- coming to the appointment.
With the consent of your family member, you may also be able to give the therapist information that offers insight into the
When someone has a serious condition, family members naturally feel worried and stressed. They spend time comforting or helping
their loved one. At the same time, they are also dealing with the usual challenges of family life. As a result:
- They may find that caring for their family member has replaced their own routines and activities.
- They may be unsure of how others may respond to the person with concurrent disorders, so they avoid having friends visit their
- Over time, they may lose touch with their own network of friends.
Recognize signs of stress
You need to recognize signs of stress in yourself. Often, people take a long time to realize how emotionally and physically
drained they have become. This stress can lead to:
- sleeping badly
- feeling exhausted all the time
- feeling irritable all the time.
Recognize you own feelings
Your own feelings are important. If you accept your own feelings, you can better help the person who has the concurrent disorders.
You may feel:
- sad that the person has both a substance use and a mental health problem
- angry that this has happened to your relative and seriously affects you as well
- afraid of what the future holds
- worried about how you will cope
- guilty—that somehow you caused the problem
- a deep sense of loss when your relative behaves in ways that you do not recognize
- stressed by the extra tasks you have to take on.
Take care of yourself
You need to look after your own physical and mental health. To do this, you need to:
- Find your own limits.
- Make time for yourself. Keep up your interests outside the family and apart from your relative.
- Try to create a support system of friends and relatives you can rely on.
- Think about people you might want to confide in. Substance use and mental health problems are hard for some people to understand.
Be careful—confide only in people who will support you.
- Consider seeking support for yourself, even if your relative is not in treatment. Understanding your relative’s problems and
the impact they have on you will help you cope better. Perhaps join a self-help organization or family support program. Local
community mental health clinics, substance use treatment agencies or hospitals may offer such programs.
- Acknowledge and accept that sometimes you will have negative feelings about the situation. These feelings are normal try not
to feel guilty about them.
Being readyfor a relapse or crisis
Families often avoid talking to their relative about relapses or crises. They fear that talking about a crisis will bring
one on, or will upset their relative. Also, everyone hopes that the last crisis was something that only happened once, and
will not happen again.
However, the best way to handle a crisis, or possibly avoid one, is to know what to do before it happens. While you focus
on wellness, you should also plan for a crisis or relapse. This can help both the ill person and the family to feel more secure.
When your relative or partner is well, plan what to do if problems come back. Consider the following:
- Could you both visit the doctor to discuss your relative’s condition and how to deal with a possible crisis?
- Will your relative give you advance permission to contact his or her doctor?
- Do you have your relative’s consent to take him or her to hospital in a crisis? If so, which hospital has your relative chosen?
- If your relative becomes ill and cannot decide on treatment, does he or she agree that you can decide?
You may want to write down the terms that you and relative have agreed on. This can help to ensure that the terms are followed.
You can also build a good relationship with a therapist and have a pre-arranged emergency plan to avoid a crisis.
Tips for helpingyour family member
1. Learn as much as you can about the causes, signs and symptoms and treatment of the problems your family member has. This will help you to understand and support your family member in recovery. Acknowledge and accept your own feelings. Having
conflicting emotions is normal. Knowing this can help you control these emotions, so you can support your relative through
2. Encourage your family member to follow the treatment plan. Encourage the person to attend treatment sessions regularly. If the medication doesn’t seem to help, or the side-effects
are uncomfortable, encourage the person to:
- speak to the doctor, nurse, therapist or other member of the treatment team
- speak to a pharmacist, or
- get a second opinion.
Go with your relative to an appointment, to share your observations. Support your relative’s efforts to avoid things that
may trigger substance use.
3. Learn the warning signs of self-harm or suicide. Warning signs include:
- feeling increasing despair
- winding up affairs
- talking about “When I am gone . . . .”
If the person makes any threats, take them very seriously - get help immediately. Call 911 if necessary. Help your family
member to see that self-harm or suicidal thinking is a symptom of the illness. Always stress how much you value the person’s
4. When your family member is well, plan how to try to avoid crises. With your family member, work out how to respond to a relapse or crisis. Prepare for how you will deal with:
- a substance use relapse
- an episode of mental health problems
- other potential problems.
5. Remember your own needs. Try to:
- take care of yourself
- keep up your own support network
- avoid isolating yourself
- consider entering therapy for yourself
- acknowledge the family stresses of coping with concurrent disorders
- share the responsibility with others, if possible
- don’t allow the problems to take over family life.
6. Recognize that recovery is slow and gradual. Know that your family member needs to recover at his or her own pace. You can support recovery from an episode or relapse
in these ways:
- Try not to expect too much, but avoid being overprotective.
- Try to do things with your relative rather than for him or her. That way, your relative will slowly regain self-confidence.
7. See concurrent disorders as an illness, not a character flaw. Treat your relative normally once he or she has recovered. At the same time, watch for possible signs of relapse. If you
see early symptoms, suggest a talk with the care provider.
In Concurrent Substance Use and Mental Health Disorders: An Information Guide
- What Are Concurrent Disorders?
- What Are the Symptoms of Concurrent Disorders?
- What Causes Concurrent Disorders?
- How Are Concurrent Disorders Treated?
- Recovery and Relapse Prevention
- How Concurrent Disorders Affect Families
- Explaining Concurrent Disorders to Children
References and On-line resources