Content warning: this article contains frank discussions of drug use, addiction, mental illness, and suicidal thoughts.
It’s 3am and Emma*, 31, is carefully racking up another two lines of cocaine – one for each nostril – on a pocket mirror.
She’s not at a club or partying with friends, but in the bathroom of her houseshare, careful not to make a sound as she snorts up the powder. Her housemates are asleep. She has work in the morning. This isn’t a rare occurrence – instead it’s a near-nightly cycle that started out with an attempt to snuff out the intrusive thoughts associated with OCD and quickly spiraled into addiction.
Emma is one of many people who have used, or continue to use, illegal drugs as an ill-fated form of self-medication for mental illness.
This is a behaviour staff in rehabilitation centres have seen time and time again. There’s a name for this combination of longterm mental illness coupling up with addiction: dual diagnosis.
According to the National Survey on Drug Use and Health (NSDUH), 45% of people who struggle with addiction also have a mental illness, with substance abuse most often co-occurring with depression, OCD, anxiety disorders, PTSD, and psychosis.
The same report found that half of those with diagnosed mental illness will also abuse drugs or alcohol.
Dual diagnosis is a bit of a snake-eating-its-tail scenario, as it can be difficult to see where addiction is causing mental illness symptoms and where mental illness can lead to addiction.
The Dual Diagnosis Good Practice Guide from the Department of Health describes four possible relationships:
- A primary psychiatric illness precipitates or leads to substance misuse
- Use of substances makes the mental health problem worse or alters its course
- Intoxication and/or substance dependence leads to psychological symptoms
- Substance misuse and/or withdrawal leads to psychiatric symptoms or illnesses
Illegal mind-altering drugs can be tempting to those whose mental illness manifests as intrusive thoughts or low mood, with immediate highs serving as a way to ‘block out’ the fears, worries, and self-hatred their brain throws their way.
‘It’s estimated that around a quarter of people who suffer with OCD, try to self-medicate their symptoms with substance abuse,’ Nuno Albuquerque, Group Treatment Lead for addiction treatment firm UKAT, tells Metro.co.uk.
‘They use substances as a coping mechanism, in order to cope with and block out the overwhelming feelings of anxiety and fear. But addiction can quickly manifest, and addiction itself is a compulsive condition, and so dual-diagnosis occurs.
‘A person suffering with depression may seek to take substances to self-medicate with the perception and belief that the drugs will make them feel better, but this in itself is a vicious cycle, as substance abuse can cause and exacerbate depressive emotions.’
Like Emma, Ron*, used cocaine to try to block out overwhelming anxious and depressed thoughts.
After doing coke for the first time in his teens, Ron spent a decade getting drunk or high each night in an attempt to outrun the reality of mental illness. Now 33, he’s able to look back on his addiction and understand how it emerged from a desire to self-medicate.
‘When I hit my mid-twenties I started a couple of ultimately unsuccessful businesses and met a girl whose appetite for cocaine matched and even outweighed mine,’ Ron says.
‘With the combination of work stress, a toxic relationship, and a partner who enabled me and who I in turn enabled was where I feel I started to actively use cocaine and alcohol to self medicate, to find oblivion.
‘This went on for three years. Drinking nightly. Taking cocaine four or five times a week. Starting at 7pm and staying up til 5am.
‘Looking back on this period it really was a dark time. My family tried to stage an intervention. I denied it all and when they left my flat I ordered 3 grams.’
At the height of his addiction, Ron was drinking seven litres of spirits and taking 15 to 20 grams of cocaine a week.
What started out as a way to bond with friends soon took up every part of Ron’s life, with the business owner using drugs and alcohol to try to ‘remove any kind of mental state to speak of’.
Emma’s story is similar.
‘I did drugs for the first time in my teens with friends, but it wasn’t until my late twenties that I started regularly picking up coke on my own,’ she tells us. ‘I’ve had OCD my whole life and have been off and on medication, but when I was 26 I went through a bad breakup and my mental state took a nosedive – the medication just wasn’t working anymore.
‘In all honesty, I was suicidal and didn’t care if I lived or died. I thought there was nothing to lose by just getting in a couple of grams of coke – either it would make me feel good or I’d die, and either option sounded fine to me.’
Emma doesn’t describe herself as an addict, instead saying that she chooses to use drugs whenever she hits a low point – but acknowledges the damaging impact regularly taking cocaine is having on her life.
‘Obviously there’s the comedown, which is horrific, and when I’m far away from payday and I can’t afford to pick up I just have to sit with feeling unbelievably low,’ she explains.
‘There’s a lot of shame that piles on top of the OCD and anxiety. No one knows that I’m doing so much coke – I’ll split a bag with a friend when we’re out but no one knows I’m doing it at home and at work too.
‘I know I should go to therapy and go back on medication, but those things haven’t worked for me.’
Frustration with long waiting times for therapy, the difficulty accessing treatment, and medication that can sometimes bring more side effects than benefits, pushes those prone to addiction to rely on the highs they’ve felt previously, knowing that even though a comedown is imminent, at least they can escape their mental illness for a few hours.
Mandy*, 23, has had anxiety and depression for as long as she can remember. She started taking antidepressants on the advice of her GP, but found the medication wasn’t working for her – so created a cocktail of self-medication by smoking weed daily and regularly taking ketamine and cocaine with her friends.
‘I was living for pure escapism,’ says Mandy. ‘I took ketamine with cocaine (counter intuitive, but addiction doesn’t make sense) every day for two years.
‘I’d take it with my flatmate at the time, and we’d buy 3 grams of ket and 1 gram of coke a day. Sometimes more if we ran out. It was split pretty much 50/50 but we weren’t strangers to doing an extra line if the other left the room. I was more into the ket, she was more into the coke.
‘Ketamine felt like unlocking the part of my brain that held in unlimited creation. I was always creating something. Pretty much none of it was good, but it was happening. And the more I created, learned, found interest in – the further away my depression seemed.
‘I also did find it calming for my anxiety, but that’s because I was always in my flat. Realistically it made my anxiety much worse, but I absolutely wasn’t ready to accept that.’
Drugs such as cocaine and ketamine have a sneaky way of appearing to fix symptoms of mental illness, even when they’re in fact making your mental state so much worse.
The high of cocaine can make you feel productive, energised, and on top of the world – a stark contrast to depression, which can make getting out of bed feel impossible – while ketamine can dull a stream of anxious thoughts by tranquilising your mind entirely.
But we know that immediately after using drugs, the comedown can be pure torment, especially for someone with existing mental illness.
‘Drug use alters the chemical makeup of the brain,’ Nuno explains. ‘It releases feel-good neurotransmitters called serotonin. But what goes up, must come down, and once the effects of the drugs have worn off, a person may experience a comedown, where these chemicals fall to levels that make the user feel extremely anxious, paranoid, depressed and fatigued; feelings which a user with mental health illness may have been using drugs to get some relief from in the first place, but who will now experience them ten times worse.’
It’s easy to see how dangerous patterns of use can then occur. There’s the high, and the momentary escape from the pain of mental illness, followed by extreme, crashing lows and a return to an even darker reality – simply doing more drugs to recapture that high feels like an easy fix.
Lily*, 41, used speed and cocaine to deal with the crippling fear and shyness that generalised anxiety disorder made a part of her daily life, finding that when she was high, she was suddenly able to have conversations with people without feeling immense self-doubt. She also thought drugs helped her avoid the panic attacks that kept popping up unannounced – but these reemerged with every comedown.
‘Comedowns were simply horrific,’ she says. ‘I imagine they are for most people, but when you’re prone to panic attacks and health anxiety they are horrendous. And I could have a comedown before I even got home.
‘I’ll never forget “coming to” at a party in some stranger’s garden one Sunday morning and just bursting into tears. I cried on and off that day until teatime and the world felt black.
‘From a panic point of view, I remember calling my mum so many times to come and get me for ‘doing something stupid’ again and thinking I was having a heart attack – which was one of my health anxiety obsessions – so the post night-out palpitations terrified me.’
Over time, the effects of coexisting mental illness and addiction go beyond the usual cycle of highs, comedowns, and dependence. While drugs might have started out as a way to cope with existing mental illness, their use can prompt the worsening of symptoms and the development of new ones.
‘Chronic drug use causes long term changes to the brain, resulting in mental illness disorders,’ Nuno says. ‘People addicted to drugs are twice as likely to develop mood and anxiety disorders and vice versa. This means that in the main, the two go hand in hand, yet they do not compliment each other. In fact, quite the opposite. Mental health disorders from drug addiction include paranoia, psychosis, depression, anxiety and aggression.’
There is simply no way self-medication with the abuse of illicit drugs can be beneficial to mental health. Changing the amount you do, what drugs you take, how you take them, won’t magically erase the crushing comedowns or the longterm damage they cause.
Those who are self-medicating with drugs need to realise that while they might think they’re perfectly in control and simply doing what makes them feel good, they may be in a damaging and destructive cycle.
It’s vital that anyone trying to drown out mental health issues by pouring as much cocaine, ketamine, and booze into their system they can manage makes the decision to seek treatment, pursuing therapy or rehabilitation with a professional who understands the complexity of dual diagnosis, and who will ensure the individual doesn’t feel judged or in danger of criminal punishment for the use of illegal drugs.
Lily realised recreational drugs simply weren’t working for her, and was able to stop easily. She now uses prescribed medication and talking therapies to manage her anxiety.
It took Mandy ‘ages’ to realise she had a problem with drugs, only understanding that her addiction to ketamine was out of control when her physical health dropped.
‘I remember being a year in, still absolutely convinced I wasn’t addicted,’ she says. ‘I could stop anytime, it was just a hobby, right? Then my health started really declining. Ketamine f***s your gall bladder, stomach lining and urine bladder. And after a while, you feel it.
‘Not to mention the wreck my nose was in. I was pretty much in constant agony towards the end. That’s when I really took in how bad it had become.
‘I couldn’t go outside, I didn’t leave the flat for months, aside from short trips to the doctors to deal with my paranoia, and of course to the dealer’s car.’
One day she was able to stop cold turkey, an act Mandy describes as hard, but ‘the best thing’ she’s ever done.
‘I felt so weird and new, being sober,’ she explains. ‘I’m still finding things I did in those years and revisiting them with fresh eyes. It’s like being born again. The world looks totally different.’
Once Mandy was free from drugs, she was able to face her depression head on. She’s now in therapy, and while she hasn’t found an antidepressant that works for her, she’s immensely proud of herself for learning that she can be creative and content ‘without class Bs’.
There was one moment for Ron that made it clear his drug use and depression was a problem that was out of his control. Terrified that he would drive his car off the road, he asked his girlfriend not to go to work, as her presence felt like the only thing that would stop him from carrying out suicide.
‘After making Lisa come to work with me I instantly recognised I needed to change,’ says Ron. ‘Instantly. The following morning I went to the GP. He immediately diagnosed me with severe depression and prescribed 50mg sertaline. I’ve been taking that daily since August 2019 and it has changed my life.
‘It has totally changed. My mood has lifted. I finally understand what the word happiness means. I’m hopeful. I’m excited about the future. I want to live as long as possible to enjoy my partner and future kids we have. Our lives together. It’s changed everything.
‘Cocaine is a thing of the past. I’ll have a few drinks at the weekend but it’s controlled. If I have too much to drink the following morning I feel like I did (to a much lesser extent) pre sertaline. And that’s enough to fire a warning shot to get back on track.’
After a decade of depression, drinking, and cocaine, Ron feels free. He’s in a loving relationship with the girlfriend who he credits with changing his life, and lives with her and their two cats. He’s had hours of talking therapy and has learned to recognise his those triggers and patterns of self-destruction.
‘I take my tablets daily,’ he says. ‘I go to work every day. I make sure I get out in the world and breathe deeply and appreciate how wonderful things are.
‘It’s a tough road but there is help out there.
‘Therapy for me was good but honestly I needed and still do need medication. I guess I’m still medicating but this time it’s prescribed and doesn’t rob me of all the other good things in life. Alcohol blanked my brain and switched it off and the next day I was in hell. Sertraline has done the complete opposite.
‘I feel alive again.’
How to get help for addiction and mental health issues.
If you’re concerned about your use of drugs or alcohol, talk to your GP about treatment options or find a service near you with this online tool.
Addaction has a livechat option for anyone who needs to talk about addiction issues.
You can also call Adfam on 020 3817 9410 or DAN 24/7 on 0808 808 2234.
For more general emotional support you can call the Samaritans 24-hour helpline on 116 123, email [email protected], visit a Samaritans branch in person or go to the Samaritans website.
*Names have been changed.
Source: Read Full Article