Directions for your Mental Health

Directions for your Mental Health A Guide to Alcohol, Tobacco and Other Drugs and Your Mental Health December 2014

Page 1 Directions for your mental health Directions is an organisation based on the principles of harm minimisation. Our role is to inform, educate, support and advocate for people with Alcohol, Tobacco and Other Drug (ATOD) issues and their families. This booklet has been designed specifically for clients experiencing mental health issues and also problems with their substance use, known as comorbidity. Directions acknowledges the assistance of funding from the Australian Government Department of Health and Ageing under the National Comorbidity Initiative in the development of this booklet.

Page 2 Directions for your mental health Table of Contents 4 About this booklet 5 What is comorbidity? 5 How are substance use and mental health connected? 6 Why are staff asking about my mental health? 8 Talking about mental health might seem scary... 8 What can I expect from Directions? 9 What might happen to my physical health if I slow down or stop using? 11 Substances and Mental Health 11 Substance use and Psychiatric Medications 12 Tobacco and Mental Health 13 Alcohol and Mental Health 14 Cannabis and Mental Health 15 Amphetamine Type Substances (ATS) and Mental Health

A Guide to Alcohol, Tobacco & Other Drugs & Your Metal Health Page 3 16 Benzodiazepines and Mental Health 17 Opiates and Mental Health 18 Ecstasy and Mental Health 19 Directory of Programs 20 Althea Wellness Centre 21 Arcadia House Detox, Transition and Day Programs 22 Counselling Program 23 Useful Mental Health Services in the ACT for ATOD clients 25 Resources

Page 4 Directions for your mental health About this booklet This booklet was developed through broad collaboration with staff and clients and we gratefully acknowledge the contribution of clients who participated in a forum to discuss their journey with comorbid mental health and substance use issues, and their experiences of seeking help for their issues. Their input and perspective about treatment has helped us in the production this booklet. The terms used in this booklet were chosen by the forum participants. This booklet uses the term mental health issues to refer to any formally diagnosed mental illness (e.g. schizophrenia and depression) or any symptoms, emotional or physical, that suggest a person is not experiencing good mental health (e.g. trouble sleeping, paranoia and hopelessness). Clients acknowledged the value of the continuity of care that they received through many Directions services, and the importance of working collaboratively with the mental health services. This booklet is not intended to replace specialist advice. Comorbidity is complex and an effective treatment program should include consultation with a doctor as well as regular support from a team of professionals.

A Guide to Alcohol, Tobacco & Other Drugs & Your Metal Health Page 5 What is comorbidity? Comorbidity in this context is when someone has problems with their substance use and their mental health. Mental health issues can be caused by substance use. Alternatively, some people use substances to try and cope with mental health issues. How are substance use and mental health connected? People who misuse alcohol or other drugs experience very high rates of mental health problems compared to the rest of the community (current estimates are approx 80%). People with mental health issues are more likely than the general population to misuse alcohol and other drugs (current estimates are approximately 60%). The most common mental health issues for people with comorbidity are depression and anxiety. Substance use affects people in very different ways. Some people feel depressed, anxious, paranoid, fearful, aggressive or even suicidal when affected by alcohol or other drugs.

Page 6 Directions for your mental health There is a definite link between alcohol, other drug misuse and mental health issues. Sometimes people get caught up in trying to work out if one causes the other. What is important however, is that we address both mental health and substance in a coordinated way. We know that addressing with your mental health issues and slowing down or stopping your substance use will enable you to improve your life and cope better with any problems you have. You may also experience a disappearance of all your mental health symptoms, however it is important to discuss this with your AOD practitioner and mental health clinician before making changes to your treatment. Why are Directions staff asking about my mental health? Our experience is that clients with comorbidity are more likely to suffer homelessness, family breakdown, lack of social supports, legal and financial issues. The reality is that they are also at higher risk of harm to themselves and others.

A Guide to Alcohol, Tobacco & Other Drugs & Your Metal Health Page 7 When you attend your first appointment at Directions, a staff member will conduct a routine mental health screening assessment. This will enable us to work with you to achieve the best possible outcomes from our service, no matter why you have come to Directions. Our programs and services are geared toward assisting you with all aspects of your life, particularly supporting and promoting good mental health. If you have comorbidity, you are likely to be feeling extremely stressed. Even if you think your symptoms are only minor (e.g. feeling a bit down or anxious), treatment can really help improve your situation, so getting help for both your substance abuse and mental health issues is very important. You are not alone; we are here to help and able to help.

Page 8 Directions for your mental health Talking about mental health might seem scary However, treatment is about us supporting you to achieve good outcomes in your life. Good outcomes include: Reduced substance abuse Reduced high risk behaviour Reduced legal problems Improved physical health Improved lifestyle Improved emotional and psychological wellbeing (mental health) Increased control over your life What can I expect from Directions? We don t believe in bouncing clients back and forth between services. Directions has a No Wrong Door Policy, which means assisting anyone who approaches us for assistance. We know that many of our clients have a mental health issue. We have the skills, knowledge, resources and commitment to deal with mental health issues as part of our one stop shop service. We offer a wide range of programs to support clients including counselling, treatment options, medical care, detoxification and family support.

A Guide to Alcohol, Tobacco & Other Drugs & Your Metal Health Page 9 Sometimes you may need specialised care which Directions does not have the capacity to provide. If you are experiencing severe symptoms, we will refer you to a specialist mental health service. We will work together with any other service involved in your treatment in order to get you the best possible outcomes. What might happen to my mental health if I slow down or stop using? Everyone is different and people will experience a range of symptoms if they use less or stop using entirely. However, many people find their mental health issues decrease as they slow down their substance use. Medications are one option for coping with mental health issues when slowing down or stopping substance use. Your doctor may prescribe medications (such as anti-depressants or anti-psychotics) to improve symptoms, mood or sleep. A treatment plan should be a combination of supportive relationships, exercise, hobbies, medication and counselling. What might happen to my physical health if I slow down or stop using? Withdrawal can be dangerous. If you are considering slowing down or stopping use of any substance it is vital you seek advice and support from a medical professional.

Page 10 Directions for your mental health It is important to emphasise that Directions will support you with your mental health. The approach we take is holistic: that is, we will assist you with your relationships, health, housing, legal and financial situations. Mental health support will be part of a broader plan we develop with you to achieve balance and wellbeing in all aspects of your life. It is likely that many of your relationships and social activities are connected to substance abuse. Although it can be scary and lonely to move away from familiar people and habits, there are plenty of reasons to be hopeful for the future. Breaking old ties can actually open the door to new and positive ways of living.

A Guide to Alcohol, Tobacco & Other Drugs & Your Metal Health Page 11 Substances and mental health This section of the booklet covers drugs that are commonly associated with mental health issues. We strongly recommend that if you are using any substances that cause you concern please speak to your Directions worker or health professional. Mental health symptoms can occur during intoxication and throughout withdrawal. These symptoms sometimes last for days or longer and mental health treatment is necessary if symptoms persist. Poly drug use is strongly linked to mental health problems. Substance Use and Psychiatric Medications Alcohol and other drugs can interact with medications prescribed for mental health issues. They may reduce the effectiveness of psychiatric medications, or increase side effects such as drowsiness. They may also result in serious effects like seizures.

Page 12 Directions for your mental health Tobacco and Mental Health People with mental health issues are more likely to smoke. About 17% of Australians smoke, however that number jumps to around 32% for people with mental health issues. More than 70% of people with psychotic disorders smoke. People who feel stressed or anxious often smoke to calm down, however smoking can actually increase stress levels. When you smoke a cigarette, you can feel a short term lift in mood. After a while the effect of the tobacco wears off and you may become agitated and cranky if you don t have another cigarette. This creates the cycle of addiction: you feel better but only when the drug is in your system. So unless you have an endless supply of cigarettes, or you can smoke wherever and whenever you want, you will experience periods of stress when you are unable to smoke. Your physical health will suffer if you smoke: you are more likely to catch colds and flues because your immune system will be weakened; you will be at greater risk of heart and lung disease and your risk of cancer is increased. The short term effects of giving up smoking usually last about two weeks and may include feelings of stress, anger and anxiety. In the long term, people who have smoked to help manage their mental health symptoms have reported feeling less stressed once they ve ceased smoking. We can assist you with strategies to give up smoking, including Nicotine Replacement Therapy (NRT).

A Guide to Alcohol, Tobacco & Other Drugs & Your Metal Health Page 13 Alcohol and Mental Health People with mental health issues may use alcohol to numb bad or uncomfortable feelings. Unfortunately, this effect only lasts for a short amount of time and is likely to make the symptoms worse. This sets up a destructive cycle of drinking more but never feeling better. Drinking excessively may also lead to depression. Drinking alcohol interrupts your sleep patterns so that you may wake up in the early hours of the morning and not be able to get back to sleep; or have poor quality of sleep and wake up feeling tired. Poor sleep and chronic tiredness are linked to poor mental health. Not only does alcohol abuse commonly lead to a deterioration of mental health, you can quickly develop a dependence on alcohol which can lead to many other problems such as relationship breakdown; legal hassles; unemployment; homelessness and financial stress. Heavy drinking with mental health issues puts you at greater risk of self harm and suicide. Your physical health can be compromised if you drink to excess. Severe symptoms include: chronic liver disease, cancer, impotence and/or sexual dysfunction, lower fertility, stomach problems, mood swings, blackouts, and permanent brain damage.

Page 14 Directions for your mental health Cannabis and Mental Health Cannabis is the most commonly used illicit substance in Australia. There is a misconception that cannabis has few or no ill effects. Current research shows that cannabis has many negative effects on a person s physical and mental health. Common and unpleasant effects of using cannabis are anxiety and paranoia. People who feel anxious often say that using cannabis helps them feel better in the short term. In order to reduce anxiety, they may begin to use more cannabis to maintain a stable mood. As their tolerance to cannabis increases, they will need to increase their consumption to achieve the same effect. There are known links between cannabis and psychosis for people with schizophrenia. Although cannabis doesn t cause psychosis, you are likely to have psychotic episodes more often if you have schizophrenia and smoke cannabis. If you smoke cannabis you may see or hear things that aren t there (hallucinations). For some people, using cannabis triggers a psychotic episode. These symptoms are extremely frightening and can recur if you use cannabis in the future. Remember: It is a myth that you cannot get addicted to cannabis.

A Guide to Alcohol, Tobacco & Other Drugs & Your Metal Health Page 15 Amphetamine Type Substances (ATS) and Mental Health ATS are stimulants, commonly used forms are speed, ice and cocaine. Some people may use ATS to increase their energy and self confidence, to feel happier and cope with emotional problems. People who use ATS can experience mental health symptoms such as feeling depressed, sad, irritable, panic, memory loss or anger. These symptoms can occur during or after intoxication and they usually disappear in a few days but can sometimes last for weeks or longer. People may also find that their eating and sleeping patterns are affected. A frightening consequence of ATS use is psychosis. Any amount of ATS can trigger a psychotic experience (e.g. hearing, seeing or even smelling things that aren t there, feeling paranoid or having scattered thoughts). ATS psychosis usually disappears after a few days, once the drugs have left the system. If you have experienced psychotic symptoms after using ATS, symptoms are more likely to return with future use.

Page 16 Directions for your mental health Benzodiazepines and Mental Health Benzodiazepines (benzos), such as Valium and Xanax are prescription medications used for sleep problems, substance withdrawal and to relieve anxiety. Benzos are highly addictive and you can become dependent on them after using them for as little as four weeks. The symptoms associated with benzo withdrawal can be severe and prolonged. Common withdrawal symptoms can include sleep problems, mood swings, anxiety, and seizures. It is dangerous to abruptly stop benzo use. It is recommended that withdrawal from benzos is managed by a doctor and other support workers over a long period of time. If you are taking benzos, you should be aware that they dull your emotions, coordination and thinking, which places you at greater risk of having an accident. You are also less able to feel things that you would normally feel such as being excited, sad or happy. People find that taking benzos can lead to difficulties in relationships.

A Guide to Alcohol, Tobacco & Other Drugs & Your Metal Health Page 17 Opiates and Mental Health Heroin is an illicit opiate that has a similar effect to legal prescription medications such as methadone, MS Contin, Oxycontin, codeine, pethedine and morphine. All opiates are highly addictive and people quickly build up a tolerance, leading to a rapid increase in the dose required to get the desired effect. Physical withdrawal symptoms can be severe. Most people who are addicted to opiates also have issues with depression, anxiety and trauma. It is important to be aware that heroin and other opiates can interfere with how psychiatric medications work. There are some types of antidepressants that should not be taken by people who use opiates, as the combination increases the risk of overdose. Illicit opiates (such as heroin) are expensive and not always readily available. The stress of accessing opiates, because of the cost or availability issues, means that there is little time for you to look after other parts of your life such as health, nutrition, work and relationships. You can rapidly find yourself unemployed, homeless, malnourished, unwell, alone or in serious legal trouble and need assistance as a result of your addiction. These situations are very distressing and can lead to significant mental health issues.

Page 18 Directions for your mental health Ecstasy and Mental Health Most people use ecstasy with the intention of bringing on feelings of euphoria, energy and happiness that can last for hours at a time. Many people experience negative symptoms that can last for up to three days after using ecstasy. These after effects can include disturbed sleep and appetite, low mood or depression. If you use large or frequent doses of ecstasy, you are likely to suffer severe symptoms that last for longer periods of time. You may experience mental health symptoms such as anxiety, panic attacks and paranoia. If you are a heavy user you may develop ongoing problems with your ability to concentrate, experience memory problems or flashbacks.

A Guide to Alcohol, Tobacco & Other Drugs & Your Metal Health Page 19 Directory of Programs Our commitment to our clients Directions will make every reasonable effort to assist you within our programs and services, or link you with the most appropriate help for your circumstances. We will provide follow up care and use the most up-to-date methods to assist you in treatment. We will treat you with respect and dignity at all times.

Page 20 Directions for your mental health Althea Wellness Centre Phone: 6132 4880 The Althea Wellness Centre offers a holistic approach to health care based on harm minimisation principles and specialises in medical issues relating to alcohol, tobacco and other drugs. Althea wellness centre is one of the many services provided by Directions, and offers primary and secondary health care as part of its ongoing commitment for better health outcomes for clients and their families. Access Criteria Clients with a current drug and/or alcohol issue that do not have a GP. Family of those clients who wish to have some advice about their family member. Clients who do have a GP but who want some advice about their current treatment but will continue with current GP. Appointments The Althea Wellness Centre team includes a Director of Primary Care, general practitioners, psychologist, practice nurse and visiting health professionals. Appointments can be made Monday to Wednesday 9am to 5pm. A practice nurse will assess each new client prior to the appointment with the GP. The clinic operates on an appointment system, it is important, therefore, that people inform us if a longer appointment time is necessary and notify us as soon as possible if they are unable to attend.

A Guide to Alcohol, Tobacco & Other Drugs & Your Metal Health Page 21 Arcadia House Detox, Transition and Day Programs Phone: 6129 5900 The purpose of the Arcadia House program is to not only provide clients with the physical and personal resources to successfully withdraw from alcohol and other drugs but to also assist in the development of positive life skills that can assist in maintaining a happy and healthy life that is substance free. It is a condition of admission to Arcadia House that people cease using substances and participate in all aspects of the program. Clients are assigned a case manager who will work with them to develop a treatment plan during their stay and support for their discharge including relapse prevention strategies. This will help clients to identify and plan their desired goals, work through their individual issues and look at ongoing health care and other options to assist in their recovery. Access Criteria An assessment is required to gain admission to Arcadia House. The phone assessment will take approximately one hour. We will ask you a variety of questions to assess your suitability for the programs or the best course of action that will assist you in your journey towards recovery. We accept people from the age of 18 years with alcohol and other drugs issues, as well as those with comorbid substance use and mental health issues. People under the age of 18 years are encouraged to contact the Ted Noffs Foundation.

Page 22 Directions for your mental health Treatment and Support (including counselling and case management services) Phone: 6132 4800 Treatment and support is available for people who are considering their substance use issues, and thinking about making changes in their lives. Many people with substance use issues are simultaneously dealing with mental health issues. As an important part of developing an effective care plan, you will be asked about your mental health. Our practitioners are skilled in assessing clients with common mental health issues such as depression, anxiety, trauma, self harm and suicide. Counselling and support services are also available to those who have recently completed or are waiting for a detox or rehabilitation program and are looking for interim support or strategies to prevent relapsing into past substance use habits. AOD practitioners can also advocate on behalf of clients with all types of health and legal professionals, services and government departments. All treatment and support services are provided free of charge is provided free of charge and are nonjudgmental and confidential. For more severe or complex mental health problems, crisis support is available is available as a drop-in service at the Directions Woden office and the Civic Needle and Syringe Program.

A Guide to Alcohol, Tobacco & Other Drugs & Your Metal Health Page 23 Useful Mental Health Services in the ACT for people who use alcohol and other drugs Crisis Assessment and Treatment Team (24/7) 6205 1065 or free call 1800 629 354 Eating Disorders Program 6205 1519 ACT Health Aboriginal Liaison Officer 6244 2316 The Canberra Hospital Adult Mental Health Unit 6244 3210 Calvary Ward 2N Mental Health Unit 6201 6022 Child and Adolescent Mental Health Service 6205 1469 Older Persons Mental Health Service 6205 1957 ACT Mental Health Consumer Network Inc 6230 5796 www.actmhcn.org.au Adult Step Up Step Down Program 6245 6400 www.mifellowship.org

Page 24 Directions for your mental health Mental Health Foundation ACT 6282 6658 www.mhf.org.au Headspace ACT 6201 5343 www.headspace.org.au/act Vista Vocational Services (formerly Mental Illness Fellowship of the ACT) 6205 1349 http://www.mifellowship.org Personal Helpers and Mentors Program 6242 7195 (Northside) www.mhf.org.au Personal Helpers and Mentors Program 6221 9523 (Southside) www.wcs.org.au The Rainbow 6242 6575 www.mhf.org.au/the-rainbow NewAccess 6287 0866 www.actml.com.au/programs/ mental-health/newaccess Lifeline 13 11 14 www.lifeline.org.au OZHELP Foundation 1300 694 357 https://ozhelp.org.au MI Fellowship Home-based services Residential Program Vocational Program 6246 7100 http://mifellowship.org/content/ services-in-the-act Personal Helpers and Mentors Program 6259 2022 (Belconnen and Gungahlin) http://rfact.org.au/contact/

A Guide to Alcohol, Tobacco & Other Drugs & Your Metal Health Page 25 Richmond Fellowship Life Your Life Recovery Program 6221 9289 www.rfact.org.au WIREDD 6248 8600 wired@toora.org.au Resources Tobacco http://www.cancercouncil.com.au/ Alcohol http://www.therightmix.gov.au/resources/ Cannabis http://ncpic.org.au/static/downloads/workforce/cannabisinfo/ resources/fast-facts-on-mental-health-and-cannabis.pdf Mental Health and Drug & Alcohol Fact Sheets http://www.health.nsw.gov.au/mhdao/factsheets/pages/ default.aspx http://www.dualdiagnosis.org.au/home/index.php? option=com_docman&task=cat_view&gid=15&itemid=27

A Guide to Alcohol, Tobacco & Other Drugs & Your Mental Health Level 6 Cosmopolitan Centre Woden Square Canberra Phone 6132 4800 Fax 6132 4801 reception@directionsact.com www.directionsact.com facebook.com/directionsaod twittercom/directionsaod