Help for Struggling Family Member

By Monica Nouvong and Mary Peterson –

My family member is struggling with substance use but I really think the center of the problem is anxiety and depression. What can I do to help?

What your family member is going through is not uncommon. When a person uses a substance and also has problems coping with life, it can be very difficult to manage. Sometimes experiences of depression or anxiety are actually signs of a mental illness. This is known as comorbidity or dual diagnosis. An individual may be feeling symptoms related to mental illness and start using substances to help alleviate what they are experiencing. Or because of an individual’s substance use, mental illness symptoms can become worse. The most common mental illness diagnoses associated with dual diagnosis include depression, anxiety, schizophrenia, and personality disorders. Often individuals having one disorder, may also meet criteria for the other. Skilled clinicians will take careful behavioral health histories and try to differentiate the best plan for addressing this. Some individuals will cut back on their substance use and feel better. For others, recovery entails significant life changes, learning new skills and possibly medication. Knowing some of the key symptoms of each individual diagnosis can help determine if your loved one will benefit from professional help.

Symptoms of substance abuse may include: sudden changes in behavior, isolation, risky behavior, loss of control over use of substances, lifestyle change to accommodate use of substances, craving a substance, experiencing withdrawal symptoms, and feeling that the substance is needed for getting by day to day.

For mental health, there are a number of warning signs that indicate a possible illness. Generally you should look out for: extreme mood changes, uncharacteristic confusion, issues with concentrating and problem-solving, isolation from friends and family, avoidance of activities they used to enjoy doing, and thoughts of suicide. When these experiences occur and you are confident that your family member has not used substances, a professional evaluation may be needed.

Dual diagnosis is treated most commonly through an integrated intervention which treats both the mental illness and substance abuse disorder at the same time. A person who struggles with both a mental illness and substance abuse disorder should consider seeking treatment that addresses both simultaneously.

The road to long term sobriety has many steps. An individual may have to go through detoxification if they are experiencing signs of physical withdrawal from the substance. Detoxification is sometimes an inpatient, monitored process where a medical staff assists an individual while weaning off the substance they are using. Some individuals may not need medical detoxification, but will benefit from removing themselves temporarily from their environment to start initial sobriety.

After detoxification, an individual might consider going to inpatient rehabilitation. These programs include medical monitoring and can assist in evaluating an individual’s mental health. Rehabilitation includes peer support, medication and health services management, and therapy. After inpatient rehabilitation some individuals with very complicated living circumstances or difficulties in managing daily life, may consider living in supportive housing. Supportive housing is a residential treatment program that assists individuals in recovery who are newly sober or trying to avoid relapse but lack adequate social supports and resources.

After rehabilitation, most individuals will engage in some kind of outpatient counseling and some elect to use self-help. The greatest predictor of success in recovery, is changing the people, places and things that promoted substance use in one’s life. For individuals with dual disorders, an integrated outpatient program may offer the best combination of services, including medication management. This approach makes it possible to address both disorders in a comprehensive way and set meaningful goals for sustained recovery.

Outpatient treatment for dual diagnosis is available in Cortland. Individuals should discuss these options when they present at local clinics and ask how services can be coordinated for their needs.

Monica Nouvong is an intern at Cortland Prevention Services, a division of Family Counseling Services.  Mary Peterson is the Director of Clinical Services at Family Counseling Services.