substance use

psychosis +

Contents:Who is this booklet for and What does it do? 1

What is psychosis? 1

What is substance-induced psychosis? 2

What are psychotic disorders? 3

hoW common is psychosis? 4

What causes psychosis? 4

psychosis and substance use 4

When should i seek help? 6

hoW are psychotic symptoms treated? 6

tips for staying Well 7

techniques for staying Well 9

Where to get help 15

About this booklet:this booklet is part of a series on mental health and substance use funded by the australian government department of health and ageing.

substance use in this booklet refers to the use of alcohol, tobacco and other drugs.

Other booklets in this series include:• TraumaandSubstanceUse• MoodandSubstanceUse• AnxietyandSubstanceUse• PersonalityandSubstanceUse

Available at www.ndarc.med.unsw.edu.au

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Who is this booklet for And WhAt does it do?• Thisbooklethasbeenwrittenforpeoplewhousealcohol,tobaccoorotherdrugs

whoareexperiencingsymptomsofpsychosis.• Itaimsto:

—Helpexplainwhysomepeoplefeelthewaytheydo.—Givesuggestionsaboutthingspeoplecandotohelpmanagethesymptoms

ofpsychosisandsubstanceuse.

WhAt is psyChosis?• Psychosisisacollectionofsymptomsthatoccurtogetheroveraperiodoftime.The

mostprominentsymptomsofpsychosisaredelusionsandhallucinationswhereapersonlosestouchwithreality,andhastroubletellingthedifferencebetweenwhatisrealandwhatisnot.Psychosiscanaffectthewayapersonthinks,feelsandbehaves(seeTable1).

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2  •  PSYCHOSIS  + substAnCe use

WhAt is substAnCe-induCed psyChosis?• Substance-inducedpsychosisisaformofpsychosisbroughtonbyalcoholorother

druguse.Itcanalsooccurwhenapersoniswithdrawingfromalcoholorotherdrugs.• Themostcommonsymptomsincludevisualhallucinations,disorientationand

memoryproblems.• Symptomsusuallyappearquicklyandresolvewithindaystoweeks.However,the

personmayhaveanotherpsychoticepisodeinthefutureiftheyusethatdrugagain.• Whilesubstance-inducedpsychosisistypicallybrief,alcoholorotherdrugusecan

triggertheonsetoflonger-lastingpsychoticdisordersinindividualswhoarepredisposedtodevelopingthem.

table 1. Symptoms of psychosis

Psychosiscanaffectthewayyoufeelemotionallyandphysically,thewayyouthink,andthewayyoubehave.Thistableshowssomecommonsymptomsofpsychosis.Have you experienced any of these symptoms? Tick (4) the box next to the symptoms that you have experienced.

thoughts

Jumbledordisorganisedthoughts Delusions—falsebeliefsthatusuallyinvolveamisinterpretationofperceptions

orexperiences(e.g.,thinkingthatsomeoneisouttogetyou,thatyouhavespecialpowers,orthatpassagesfromthenewspaperhavespecialmeaningforyou)

Hallucinations—seeing,hearing,smelling,sensingortastingthingsthatotherscannot

feelings

Confusion Fear Agitation Lackofinterestinactivities

behaviours

Difficultycarryingonorkeepingtrackofconversations Havingtroublerememberingthings Difficultymaintaininghygieneandotherdailyactivities Inappropriatebehaviour(e.g.,silliness,laughinginappropriately) Becomingangryorupsetfornoparticularreason Becomingveryinactiveorlethargic Becomingcompletelyunawareofthesurroundingenvironment

WhAt Are psyChotiC disorders?• Thereareseveraldifferenttypesofpsychoticdisorders(seeTable2).Psychoticdisorders

arecharacterisedbasedonthetypeofsymptomsexperiencedandhowlongthepersonhashadthem.Somepeopleexperienceshortepisodesofpsychosisthatlastafewdaysorweeks.Others,suchasthosewithschizophrenia,experiencelongerepisodesofpsychosis.

• Psychoticsymptomsmayalsobepresentinpeoplewithmajordepressivedisorderorbipolardisorder.ForfurtherinformationontheseconditionspleaseseethebookletMood and Substance Useinthisseries.Psychoticsymptomsmayalsoarisefromamedicalcondition(e.g.,headinjury,braintumour).

table 2. Types of psychotic disorders

brief psychotic disorder

Apersonwithbriefpsychoticdisorderexperiencespsychoticsymptomsforlessthanonemonth.Symptomsareusuallytriggeredbyanextremelystressfulevent(e.g.,deathofalovedone).

schizophreniform disorder

Thisiswhenapersonhassymptomssimilartoschizophrenia,thatlastmorethanonemonth,butlessthansixmonths.

schizophrenia

Adiagnosisofschizophreniaisgivenwhenapersonhashadsymptomsofpsychosisforatleastsixmonths.Themajorsymptomsofschizophreniaincludedelusions,hallucinationsandjumbledthoughts.Apersonwithschizophreniamightalsohavethinkingdifficulties(e.g.,troubleconcentratingandrememberingthingsmuchmorethanusual);theymightexperiencelossofmotivationtoperformeverydayactivities;theycouldhaveasignificantreductionintheirabilitytoexperienceandexpressemotions;andtheymightwithdrawfromsocialsettingsandpersonalrelationships.

schizoaffective disorder

Apersonwithschizoaffectivedisorderexperiencesthesymptomsofschizophreniaaswellasthesymptomsofamooddisorder,suchasdepressionormania.Formoreinformationonmooddisorders,seethebookletMood and Substance Use.

delusional disorder

Apersonwithdelusionaldisorderhasstrongbeliefsaboutthingsthatcouldoccurinreallifebutwhicharenottrue.Forexample,theymightthinkthatpeoplearefollowingthem,orarelisteningintotheirphonecalls.Thesebeliefsneedtobepresentforatleastonemonth.

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4  •  PSYCHOSIS  + substAnCe use

hoW Common is psyChosis? • Psychosisisnotuncommon—aboutthreeinonehundredAustralianswillexperience

apsychoticepisodeatsomepointduringtheirlife.Peoplewithpsychosisaremuchmorelikelytohaveanalcohol,tobaccoorotherdrugproblemthanpeoplewhodonotexperiencepsychosis.

WhAt CAuses psyChosis?• Thecausesofpsychosisarenotfullyunderstood.However,itislikelythatacombination

offactorsleadtothedevelopmentofpsychosisorpsychoticdisorders,including:—Afamilyhistoryofpsychosisorpsychoticdisorders—Chemicalimbalancesinthebrain—Lifeexperiences(e.g.,stress,traumaticevents,illness)—Alcoholorotherdruguse

psyChosis And substAnCe use• Asmentionedinthesectionofthisbookletonsubstance-inducedpsychosis,alcohol

orotherdruguse(orwithdrawal)cantriggerapsychoticepisode.• Peoplewhohaveexperiencedasubstance-inducedpsychoticepisodeareathighrisk

ofexperiencinganotherpsychoticepisodeinthefutureiftheyusethatdrugagain.• Peoplewhohaveexperiencedpsychosistendtobeparticularlysensitivetotheeffects

ofdrugsandcanexperiencenegativeeffectsevenatverylowlevelsofuse.• Sometimespeoplewithpsychoticdisordersuse

alcoholorotherdrugstohelpthemcopewiththeirsymptomsofpsychosis.Thisisoftencalled‘selfmedication’.Whilethismayprovidesomeshort-termrelieffromsymptoms,alcoholandotherdrugusecanmakeaperson’sexistingsymptomsworse.Inaddition,somepeoplefindthattheydevelopalcoholorotherdrugproblemsbecausetheyusegreateramountsmorefrequentlytocopewiththeirpsychosis.

• Thiscanleadtoacyclewherepsychosissymptomsandalcoholorotherdrugusefeedoffeachother(seeFigure1).

Figure 1:Cycleofpsychosissymptoms,cravings,andalcohol,tobaccoorotherdruguse

Alcohol, tobacco or other drug use

Psychosis symptoms, low mood or anxiety

Craving

What happens to your symptoms of psychosis when you reduce or stop drinking, smoking or using? do you notice any changes?

What happens to your alcohol, tobacco or other drug use when you are experiencing symptoms of psychosis?

Aside from using alcohol, tobacco or other drugs, what are some other things you can do to distract yourself from your symptoms of psychosis (e.g., going for a walk, listening to music, reading a book, watching tV and so on)? Are there situations where your psychotic symptoms don’t seem so bad?

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Alcohol, tobacco or other drug use

Psychosis symptoms, low mood or anxiety

Craving

When should i seek help?• Earlyinterventionisveryimportantinthetreatmentofpsychosis.Thesooneraperson

getstreatment,thelesslikelytheyaretodevelopalong-termpsychoticdisorder.• Ifyoubelievepsychosismaybeaproblemforyou,orifyouansweryestoanyofthe

followingquestions,youshouldseekprofessionalassistance(seepages15–16): Haveyouexperiencedhallucinationsordelusions? Areyoursymptomsverydistressing? Dotheyinterferewithyourhome,work,study,relationshipsorsociallife? Doyouusealcohol,tobaccoorotherdrugstocope? Haveyouthoughtaboutharmingyourselforothers?

hoW Are psyChotiC symptoms treAted?• Effectivetreatmentsareavailable.Bothpsychologicaltherapyandmedicationcanhelp

peopleaffectedbypsychosis.

psychological therapy• Psychologicaltreatmentsusuallyinvolvehands-onsupportandguidancewhichisaimed

atteachingyouabouttheearlywarningsignsofpsychosis.Treatmentsarealsoaimedatstressmanagementandanxiety,relaxationtraining,employmentprograms,socialandlivingskillstrainingandfamilyeducation,aswellasdrugandalcoholprograms.Thesetreatmentswillalsoencourageyoutokeephealthyandgetplentyofexercise.

• Ifyou’reinterestedinseeingapsychologist,yourGPcanhelpyoubypreparingamentalhealthplan,andreferringyoutoanappropriatepsychologist.

medication• Medicationmaybehelpfulalongsidepsychologicaltherapy.Therearemanydifferent

typesofmedication,whichincludeanti-psychoticandanti-depressantmedications.• Medicationscanbehelpfulinmanagingyourpsychoticsymptoms;however,somepeople

experienceunpleasantanddistressingsideeffects.Inmostinstancesthereisachoiceofmedicationavailable,butitmaytaketimetoestablishwhichmedicationisbestsuitedtoyourneeds.Tellyourdoctoraboutanysideeffectsthataredistressingyou.

interactions with alcohol, tobacco or other drugs

• Itisveryimportantthatyoufollowyourdoctor’sinstructionswhentakinganymedicationthathasbeenprescribedtoyou.

• Beforebeingprescribedmedicationitisimportanttotellyourdoctoraboutyouralcoholorotherdrugusesothattheymaygiveyouthebestpossiblecare.Alcohol,tobaccoandotherdrugscaninteractwithsomeprescriptionmedicationsandthisinteractionmayalterthe

6  •  PSYCHOSIS  + substAnCe use

effectivenessofthemedication.Mixingprescribedmedicationswithalcoholorotherdrugscanalsohavedangerousconsequencesincludingoverdoseandpossiblydeath.

• Ifyouusealcohol,tobaccoorotherdrugsandareonmedication,letyourdoctorknowifyouareplanningtostopusingalcohol,tobaccoorotherdrugs.Whenyoustopdrinking,smokingorusing,thebloodconcentrationsofothermedicationscanalsobeaffectedsothedoctormayneedtoadjustthedoseofyourmedication.

tips for stAying WellThereareanumberofthingsyoucandotolookafteryourself:• Recognise early warning signs. Earlywarningsignsofpsychosisincludenotsleeping

well,feelingmoreanxious,stressedorfearfulthanusual,hearingorseeingthings,andfeeling‘strange’.Ifyouexperiencethesesymptoms,itisimportantthatyouseekprofessionalhelptoreducetheriskofdevelopinglong-termpsychosis.

• Take care of yourself.Makesureyoueathealthilyandgetregularexercise.Exercisecanhelpbygivingyouanoutletforthestressthathasbuiltupinyourbody.

• Plan to do something you enjoy each day.Thisdoesn’thavetobesomethingbigorexpensiveaslongasitisenjoyableandprovidessomethingtolookforwardtothatwilltakeyourmindoffyourworries.

What are some things that you like to do that are pleasant or enjoyable?

• Make time for rest and relaxation.Stressandanxietycanmakeanyproblemsseemworse.Trytoreducestressandanxietybygivingyourselftimetorestandrelax.Youcanusetechniquessuchascontrolled breathing, progressive muscle relaxation,ormindfulness(thesetechniquesaredescribedonpages9–12),oranyotheractivityyoufindrelaxing(e.g.,reading,listeningtomusic,goingforawalk).Thesetechniquescanalsohelpyoumanageyourcravingsorurgestousealcohol,tobaccoorotherdrugs.

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8  •  PSYCHOSIS  + substAnCe use

• Avoid or limit your use of alcohol, tobacco or other drugs.Alcohol,tobaccoandotherdrugscanintensifyyourpsychoticsymptoms.Itisrecommendedthatnomorethantwostandarddrinksshouldbeconsumedeachday(forfurtherinformationrefertotheAustralianDrinkingGuidelines).Avoidhighdosesofsubstances,andriskydrugtakingbehaviour,suchasinjectingdruguse.Takeregularbreaksfromdrinkingorusing,andavoidusingmultipledifferenttypesofdrugs.Ifyouhavebeendrinking,smokingorusingregularlyitcanbedifficulttocutdown.Theactivitieslistedonpages9–14ofthisbookletmayhelpyoucopewithyourcravingsandurgestouse.

• Take medication as prescribed.Avoidmixingprescribedmedicationwithalcohol,tobaccoorotherdrugs,asthiscouldhavedangerousconsequences,suchasmakingprescribedmedicationineffective,orincreasingtheeffectsofalcoholorotherdrugs.

• Seek support.Everybodyneedssupport.Talktofamilymembersorfriendsthatyoutrustaboutyourfeelings,orwritethemdowninadiary.Theserviceslistedattheendofthisbookletmayalsobeuseful.

• Plan to do something each day that brings a sense of achievement.Ofteneverydaytaskslikewashing,cleaning,payingbillsorreturningphonecalls,tendtopileupwhenapersonisgoingthroughahardtime.Thiscanbecomeoverwhelmingasthepilegetsbiggerandbigger.Byjustchoosingoneoftheseactivitiestodoeachday,youcanpreventthingspilingup,whichcanhelpyoufeelabitmoreincontrolofyourlife.Theflow-oneffectcanbearealsenseofachievement(orrelief)thatthisactivityhasbeencompleted.

• Monitor your emotions.Trykeepingtrackofyouremotionsandpsychosissymptomsinadiary.Writedownhowyouhavefeltatdifferenttimesoftheday.Whenwereyoursymptomshighest?Whenwereyoursymptomslowest?Whatwereyoudoingandwhatwereyouthinkingatthosetimes?Whendidyouhavecravingstousealcohol,tobaccoorothersubstances?Howmuchsleepdidyouhaveeachnight?Keepingadiaryofyoursymptomsandemotionscanhelpyoulearnthepatternsbetweenthewayyoufeel,thethingsyoudoandthewayyouthink.

What strategies do you find help manage your psychotic symptoms?

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teChniques for stAying Well Theactivitiesandtechniquesonthefollowingpagescanbeusedtohelpyoumanageyourpsychoticsymptomsandtocontrolcravingstousealcohol,tobaccoandotherdrugs.Youcanalsousethemeverydayaspartofageneralplantostaywell.Whilemanypeoplefindthetechniquesonthefollowingpagesuseful,theydon’tworkforeveryone.Donotusethemifyoufindthemdistressingorunpleasant—itisimportanttofindwhatworksbestforyou.

Controlled breathing exerciseHaveyounoticedsometimesthatyou’rebreathingtoofast?Stresscanaffectyourheartrateandbreathingpatterns.

Arelaxedbreathingrateisusually10to12breathsperminute.

Practisethisexercisethreetofourtimesadaywhenyou’refeelingstressedoranxioussothatyoucanusethisasashort-termcopingstrategy.

1 Timethenumberofbreathsyoutakeinoneminute.Breathingin,thenoutiscountedasonebreath.

2 Breathein,holdyourbreathandcounttofive.Thenbreatheoutandsaytheword‘relax’toyourselfinacalm,soothingmanner.

3 Startbreathinginthroughyournoseandoutslowlythroughyourmouth,inasix-secondcycle.Breatheinforthreesecondsandoutforthreeseconds.Thiswillproduceabreathingrateof10breathsperminute.Inthebeginning,itcanbehelpfultotimeyourbreathingusingthesecondhandofawatchorclock.

4 Counttoyourself.

5 Continuebreathinginasix-secondcycleforatleastfiveminutesoruntilthesymptomsofoverbreathinghavesettled.

6 Afterpractisingthisexercise,timethenumberofbreathsyoutakeinoneminute.Practisethecontrolledbreathingexerciseeachdaybeforebreakfast,lunch,dinnerandbedtime.Usethetechniquewheneveryoufeelanxious.Gradually,you’llbefamiliarenoughwiththeexercisetostoptimingyourself.

Source:beyondblueFactSheet6–ReducingStress2010

10  •  PSYCHOSIS  + substAnCe use

mindfulnessMindfulnessisatechniquethathelpsyoufocusonyourinternalorexternalenvironment,withoutbeingdistractedorconcernedbywhatsurroundsyou.Mindfulnesscanbeappliedtoanytaskthatyoudo,suchasdoingthewashingup,orbrushingyourteethforexample.Thisparticularactivityistoshowyouhowtousemindfulnessskillstopayparticularattentiontoaroutineactivity(walking).Thistechniquemightseemdifficulttostartwith,butifyoupractise,itwillbecomeeasier.

1 First,findaplacewhereyoucanwalkupanddownwithoutworryingaboutwhomightseeyou.Itdoesn’tmatterwhereyouare,aslongasyoucantakeabout10steps.

2 Standinarelaxedposturewithyourfeetpointingstraightaheadandyourarmshanginglooselybyyoursides.Lookstraightahead.

3 Youwillpractisewalkinglikeitisthefirsttimeyouhaveeverwalked.Startwalkingandwhileyouarewalking,practisepayingattentiontoallthephysicalandothersensationsthatoccur—sensationsthatyouprobablywouldnotnormallybeawareof.Startbybringingyourfocustothebottomsofyourfeet,noticingwhatitfeelslikewhereyourfeetcontacttheground.Feeltheweightofyourbodytransmittedthroughyourlegsandfeettotheground.Youmayliketoflexyourkneesslightlyacoupleoftimestofeelthedifferentsensationsinyourfeetandlegs.

4 Next,transferyourweightontotherightfoot,noticingthechangeinphysicalsensationsandyourlegsandfeetasyourleftleg‘empties’ofweightandpressureandyourrightlegtakesoverassupportforyourbody.

5 Withtheleftleg‘empty’,allowyourleftheeltoriseslowlyfromthefloor,noticingthechangeinsensationsinyourcalfmusclesasthishappens.Allowtheentireleftfoottoliftgentlyofftheflooruntilonlyyourtoesarestillincontactwiththeground.Slowlyliftyourleftfootcompletelyoffthefloorandmoveyourleftlegforward,noticingthephysicalsensationsinyourfeet,legsandbodychangeasyourlegmovesthroughtheair.

6 Placeyourleftheelonthegroundinfrontofyouandallowtherestofyourleftfoottomakecontactwiththefloor.Asthishappens,noticethechangesinphysicalsensationsthatoccurasyoutransfertheweightofyourbodyontoyourleftfootfromyourrightfoot.Allowyourrightfootto‘empty’ofweight.

7 Repeatthisprocesswiththerightfoot.Firstliftyourrightheelofftheground,thentherestofyourfoot,andmoveitslowlyforward,noticingthechangesinphysicalsensationsthatoccurthroughoutthismotion.

8 Keeprepeatingthisprocessasyouslowlymovefromoneendofyourwalktotheother,beingawareoftheparticularsensationsinthebottomsofyourfeetandheelsastheymakecontactwiththefloor,andthemusclesinyourlegsastheyswingforward.

9 Continuethisprocessupanddownthelengthofyourwalkforabout10minutes,beingawareasbestyoucan.

10 Yourmindwillwanderawayfromthisactivityduringyour10minutesofpractice.Thisisnormal—it’swhatmindsdo.Whenyounoticethishashappened,gentlyguidethefocusofyourattentionbacktothesensationsinyourfeetandlegs,payingparticularattentiontothecontactyourfeethavewiththefloor.Thiswillhelpyoustayinthepresentmoment,concentratingonwhatishappeningnow,ratherthanworryingaboutthepastorthefuture.

11 Tobeginwith,walkmoreslowlythanusual,togiveyouabetteropportunitytopractisethisexercise.Onceyoufeelcomfortablewiththeexercise,youmayliketoexperimentwithdifferentspeedsofwalking.Ifyouarefeelingagitated,youmayliketostartoffwalkingfast,withawarenessthatthisiswhatyouaredoing,andthenslowdownnaturallyasyoubegintosettle.

12 Trytoworkthisactivityintoyourdailyroutine—practisewhenyouarewalkingtothebus,ortotheshops,oraroundthehouse.

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12  •  PSYCHOSIS  + substAnCe use

progressive muscle relaxationProgressivemusclerelaxationinvolvestensingandrelaxingdifferentmusclegroupsoneaftertheother.Ithelpstoreducephysicalandmentaltension.Afullsessionofrelaxationtakesabout15to20minutes.

1 Sitinacomfortablechairinaquietroom.

2 Putyourfeetflatonthefloorandrestyourhandsinyourlap.

3 Closeyoureyes.

4 Dothecontrolledbreathingexerciseforthreeminutes.

5 Afterthreeminutesofcontrolledbreathing,startthemusclerelaxationexercisebelow.

6 Tenseeachofyourmusclegroupsfor10seconds,thenrelaxfor10seconds,inthefollowingorder:» Hands:clenchyourhandsintofists,thenrelax» Lower arms:bendyourhandsupatthewrists,thenrelax» Upper arms:bendyourarmsupattheelbow,thenrelax» Shoulders: liftyourshouldersup,thenrelax» Neck:stretchyourneckgentlytotheleft,thenforward,thentotheright,

thenbackwardsinaslowrollingmotion,thenrelax» Forehead and scalp: raiseyoureyebrows,thenrelax» Eyes:closeyoureyestightly,thenrelax» Jaw: clenchyourteeth,thenrelax» Chest:breatheindeeply,thenbreatheoutandrelax» Stomach:pullyourtummyin,thenrelax» Upper back:pullyourshouldersforward,thenrelax» Lower back:whilesitting,rollyourbackintoasmootharc,thenrelax» Buttocks:tightenyourbuttocks,thenrelax» Thighs:pushyourfeetfirmlyintothefloor,thenrelax» Calves:liftyourtoesofftheground,thenrelaxand» Feet:gentlycurlyourtoesdown,thenrelax

7 Continuecontrolledbreathingforfivemoreminutes,enjoyingthefeelingofrelaxation.

Source:beyondblueFactSheet6–ReducingStress2010

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Coping with CravingsTheeasiestwaytocopewithcravingsorurgestousealcohol,tobaccoorotherdrugsistotry to avoidtheminthefirstplace.Thiscanbedonebyreducingyourexposuretocravingtriggers(e.g.,gettingridofdrugsandfits/pipesinthehouse,notgoingtopartiesorbars,reducingcontactwithfriendswhouse,andsoon).Sometimescravingscan’tbeavoided,andyouneedtofindwaystocopewiththem.

Cravingsaretime-limited,thatis,theyusuallylastonlyafewminutesandatmostafewhours.Ratherthanincreasingsteadilyuntiltheybecomeunbearable,theyusuallypeakafterafewminutesandthendiedown,likeawave.Everywave/cravingstartssmall,andbuildsuptoitshighestpoint,beforebreakingandflowingaway.

Cravingswilloccurlessoftenandfeellessstrongasyoulearnhowtocopewiththem.Eachtimeapersondoessomethingotherthanuseinresponsetoacraving,thecravingwilllosesomeofitspower.Thepeakofthecravingwavewillbecomesmaller,andthewaveswillbefurtherapart.

Below are some things for you to try out, to cope with the symptoms of cravings. Put a tick (4) in the box next to those things you think you could do.

Eat regularly,evenwhenyoudon’tfeellikeit.

Drink plenty of water—especiallywhenyougetacraving.

Insteadofdrinking,smokingorusing,drink water or chew gum.

Use‘Delaying’and‘Distraction’whenyourcravingissetoff.Whenyouexperienceacraving,putoffthedecisiontodrinkorusefor15minutes.Goanddosomethingelselikegoforawalk,read,listentomusic,ordothedishesetc.Thiswillhelpyoutobreakthehabitofimmediatelyreachingforalcohol,tobaccoorotherdrugswhenacravinghits.Youwillfindthatonceyouareinterestedinsomethingelse,thecravingwillgoaway.

What are some things you could do to distract yourself?

14  •  PSYCHOSIS  + substAnCe use

Usetherelaxationanddeep breathingtechniquesdescribedearliertocopewithacravingonceitissetoff.Ifacravingdevelopsinresponsetostressfulsituations,relaxationtechniquesanddeepbreathingexercisesarereallyuseful.

Ride out the craving by ‘urge surfing’.Formapictureinyourmindofawaveatthebeach.Thisisacravingwave,andrememberthatthecravingwavewillbuilduptoitshighestpoint,andthenfallawayasitrollsintoshore.Picturethecravingwavebuildingup,gettingreadytobreak,seeitbreak,seethefoamform,andseethewavefadeawayasitrollsintoshore.Now,pictureyourselfridingthewave,surfingthecravingwaveintoshore.Youdon’tfalloff,youdon’tgetdumpedandchurnedaround,justpictureyourselfcalmlysurfingthecravingwaveintoshore.

Talk to someone,perhapsafriendorfamilymember,aboutcravingwhenitoccurs.

Use positive self-talk.Tellyourselfthatcravingsonlylastabout10minutes.Tellyourself‘thisfeelingwillpass’.Youwillfindthattheurgesandcravingsthemselveswillbeeasiertodealwith.Saytoyourself,‘yes,thisfeelsprettybad,butIknowitwillbeoversoon’.

Challenge and change your thoughts.Whenexperiencingacraving,manypeoplehaveatendencytorememberonlythepositiveeffectsofusingdrugsandoftenforgetthenegativeconsequencesofusing.Remindyourselfofthebenefitsofnotusingandthenegativeconsequencesofusing.Thisway,youcanremindyourselfthatyoureallydon’tfeelbetterifyouhave‘justonedrink’andthatyoustandtolosealotbydrinking,smokingorusing.Are there other things you do that help you cope with cravings?

Coping with Cravings continued

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Where to get helpThebestplacetostartistosee a doctor.Theycanprovideyouwithfurtherinformationandareferraltoanappropriatehealthprofessional.Theorganisationsbelowmayalsobeuseful.

Talkingwithtrustedfamily members or friendscanalsobeveryhelpful.Yoursupportnetworkcanassistyouinmakingdecisions,helpyouaccessservices,andgiveyouvitalsupportthroughyourrecovery.national

FamilyDrugSupport: 1300 368 186Lifeline: 13 11 14Quitline: 13 78 48SANEHelpline: 1800 187 263ACt:

Alcohol&DrugInformationService: (02) 6207 9977CanberraAllianceforHarmMinimisationandAdvocacy: (02) 6279 1670nsW:

Alcohol&DrugInformationService: (02) 9361 8000or1800 442 599NSWUsersandAIDSAssociation: (02) 8354 7300or1800 644 413nt:

Alcohol&DrugInformationService: (08) 8922 8399or1800 131 350NorthernTerritoryAIDS&HepatitisCouncil: (08) 8953 3172qld:

Alcohol&DrugInformationService: (07) 3837 5989or1800 177 833QLDInjectorsHealthNetwork: (07) 3620 8111or 1800 172 076QueenslandIntravenousAIDSAssociation: (07) 3620 8111sA:

Alcohol&DrugInformationService: 1300 131 340SouthAustralianVoiceinIVEducation: (08) 8334 1699tAs:

Alcohol&DrugInformationService: (03) 6230 7901or1800 811 994TasmanianCouncilonAIDS,Hepatitis&RelatedDiseases: (03) 6234 1242

16  •  PSYCHOSIS  + substAnCe use

ViC:

Alcohol&DrugInformationService: (03) 9416 1818or1800 888 236HarmReductionVictoria: (03) 9329 1500VictorianDrugUsersGroup: (03) 9329 1500WA:

Alcohol&DrugInformationService: (08) 9442 5000or1800 198 024WesternAustraliaSubstanceUsersAssociation: (08) 9321 2877

Therearealsosomehelpful websiteswhichgiveinformationandguidance.Herearesome:

AustralianCentreforPosttraumaticMentalHealth: www.acpmh.unimelb.edu.auAustralianDrinkingGuidelines: www.alcohol.gov.auAustralianDrugInformationNetwork: www.adin.com.auBeyondblue: www.beyondblue.org.auBlackDogInstitute: www.blackdoginstitute.org.auClinicalResearchUnitforAnxietyandDepression: www.crufad.unsw.edu.auDruginformationandadvice: www.saveamate.org.auDruginformationandresearch: www.druginfo.adf.org.auDruginformation,services,informationandsharedstories: www.somazone.com.auDualDiagnosis:AustraliaandNewZealand: www.dualdiagnosis.org.auEarlyPsychosisPreventionandInterventionCentre: www.eppic.org.auFamilyDrugSupport: www.fds.org.auHeadspace: www.headspace.org.auHIV,sexualheathanddruginformationforlesbian,gay,bisexualandtransgendercommunities: www.acon.com.auMentalHealthNet: www.mentalhelp.netMentalIllnessFellowship: www.mifa.org.auQuitnow: www.quitnow.info.auReachOut!: www.reachout.com.auSANE: www.sane.orgSchizophreniaFellowship: www.sfnsw.org.auSchizophreniaResearchInstitute: www.happinessanditscauses.com.au

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©NationalDrugandAlcoholResearchCentre2011

ThisbookletwasproducedbytheNationalDrugandAlcoholResearchCentre.ItwaswrittenbyKatherineMills,ChristinaMarel,AmandaBaker,MareeTeesson,GlenysDore,FrancesKay-Lambkin,LeonieMannsandTonyTrimingham.Thankyoutoeveryonewhowasinvolvedindevelopingthisbooklet.

DesignedandtypesetbyPetaNugent

ISBN978-0-7334-3049-7

ThisbookletispartofaseriesonmentalhealthandsubstanceusefundedbytheAustralianGovernmentDepartmentofHealthandAgeing.

Thisbooklethasbeenwrittenforpeoplewhousealcohol,tobaccoorotherdrugswhoareexperiencingsymptomsofpsychosis.

Itaimsto:• Helpexplainwhysomepeoplefeelthewaytheydo.• Givesuggestionsaboutthingspeoplecandotohelpmanage

theirsymptomsofpsychosisandsubstanceuse.

Otherbookletsinthisseriesandfurtherinformationonmentalhealthandsubstanceuseareavailableatwww.ndarc.med.unsw.edu.au