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Mental illness, and other drugs – the story of no. 3 Jason – the psychonaut

OUT of YOUR HEAD guides for people who use drugs and have experienced mental illness

Mental illness is a reaction to life The journey between our birth and death is the story of our life. On this journey we will meet with desperation, delight, love and loneliness. Sometimes our minds respond to the events and the experiences in our lives in ways that can become extremely disturbing for us and those around us. Doctors call this reaction to life ‘mental illness’.

Drugs have an effect on mental illness We use drink and drugs to give us pleasure, to stop us feeling pain or because we have nothing better to do. If drugs are part of our life they will have an effect on our mental illness. What this effect will be depends on the person, the drug and how the drug is used.

These stories are based on talking to people in psychiatric treatment.

This story is about Jason and the role that alcohol and a range of other drugs play in his life and his illness.

2 Out of Your Head guides for people who use drugs and have experienced mental illness David Martha Jason God

3 Brain chemistry

Your brain is the most complex object in the known Alcohol, along with most illegal drugs, causes the universe – it contains 100 billion special cells called release of a neurotransmitter calleddopamine , neurons. Neurons communicate with each other by which feels pleasurable. We know that drugs used releasing a sort of ‘chemical e-mail’. to treat psychosis and schizophrenia type illnesses work by reducing the amount of in your There are more than 80 types of these chemicals brain. – called neurotransmitters and they have an important (though not yet fully understood) role in Alcohol also affects your body’s production ofGABA mental illness. and glutamate. GABA relaxes and sedates you making you feel euphoric at first before glutamate, a , kicks in to compensate.

4 Alcohol & other drugs

If you are a heavy drinker, stopping suddenly will or ecstasy can damage your ability to produce stop GABA immediately but glutamate will lag serotonin. A type of depression that is long lasting behind. This extra glutamate can cause DTs, fits and and difficult to treat can result. lasting nerve damage. Glutamate is involved in the way we interpret reality and is also affected by the Long term use of alcohol damages brain cells which drug . can lead to problems with concentration, memory, judgement and controlling your emotions. Stimulant drugs boost noradrenaline. Ecstasy boosts both noradrenaline and serotonin Using a variety of drugs at the same time is (at (sometimes called 5HT) which is also boosted by best) going to have unpredictable results on such a LSD. Use of drugs like speed, sensitive and complex object as your brain.

5 I was getting very confused . . . at least I think it was me.

Me Mam says I’m going off me head again – but she always says that when she’s been on the piss. 6 Dazed and confused

Jason is very confused – he can’t find his them or is better than experiencing the front door. symptoms of their illness ‘neat’. Added to this, some of the effects from drugs Schizophrenia type illness (sometimes can be almost identical to the symptoms called ‘psychosis’) often starts with of mental illness – which is one of the confused and muddled thinking and reasons they are often confused. speech. However, Jason has not slept for three days as he’s been out with his Like his friends, Jason is all muddled up mates, drinking and using by lack of sleep, the effects of the speed sulphate (speed). and alcohol and the thought of the deep depression when he eventually comes As soon as his money arrives Jason and down and sobers up. Unlike his friends, his mates go on a ‘benefits bender’. Jason has been treated for depression Everybody Jason knows drinks heavily and for schizophrenia, and is therefore and uses drugs, but only Jason has a more vulnerable to the unwanted effects serious mental illness. He’s not sure why of drink and drugs. this is and neither are the experts. Going on a three day bender may be Some drugs can trigger a latent (hidden) risky for people like Jason who have mental illness, while some drugs may experienced mental illness. However, even cause mental illness. Nearly all most of us have taken risks with drink or drugs can make an existing illness worse. drugs at times, because that’s just the People use drugs during periods of way some of us are made. To Jason, his mental illness because they say it helps benders are the highlight of his life.

Things you can do: O Be aware of the risks. If you have a history of mental illness or history of mental illness in your family, you may be more vulnerable to the negative effects of drink and drugs. O Learn to recognise the early symptoms of your illness. The longer you leave an illness untreated the worse it gets and the harder it is to remedy. If you are worried, get help or advice from a health worker. 7 WhenIt were I found them me creepy front door,crawlies It were them bastard creepy I toreunder me mekecks skin off that so I coulddidn’t like. crawlies under me skin again. have a good scratch.

It’s thirsty work is scratching bugs – I need more drink!

8 Stimulant drugs and those pesky little bugs

Confused scrambled thoughts, paranoia, sweating. When the sweat evaporates, it delusions, strange beliefs and hallucinations removes the protective oil that coats your are common symptoms of schizophrenia skin. The combination of these things type illnesses (often called ‘psychoses’). creates a sensation on the nerve endings, The main symptoms are the same no matter which feels like bugs under the skin. if they are triggered by life events or drugs. Stimulant drugs also result in repetitive When drugs alone are the cause, the behaviour (called stereotypy) – such as symptoms go away quickly. dancing to electronic beats on ecstasy or Stimulant drugs (like amphetamine, crawling around obsessively looking for cocaine and ecstasy) can not only trigger bits of crack (known as ‘white eye’). The these symptoms in people with a hidden or sensation of bugs under the skin leads to existing illness, but they are among a small compulsive picking, scratching and even number of drugs that are thought to cause attempts to dig them out with sharp objects. the illness in anyone who uses them heavily They can become tactile hallucinations, (often called ‘a drug induced psychosis’). where the physical feeling leads to a belief (delusion) that something is under the skin However, here, Jason’s bizarre behaviour is or in the body. This false belief feels real a result of his mind reacting to the effects and frightening. of amphetamine on his body. One of the stranger effects of heavy stimulant drug The reason Jason drinks so much when use is known as ‘speed bugs’ ( formication speeding also has a simple explanation. or parasitosis). Stimulant drug use causes He likes drinking. Speed dehydrates him a rise in body temperature, dehydration, making him thirsty and speed keeps him increased blood flow to the skin and awake, so he’s able to booze for far longer.

Things you can do:

O Be aware of the risks of using stimulant drugs. Stimulant drugs can cause mental illness, can lead to relapse of an existing illness and makes your illness harder to treat. The more you use the greater the risk you run. O If you are ‘speeding’ try drinking something other than alcohol. Coffee and cola also cause dehydration because they contain – so try plain water, fruit juices or milky drinks instead. 9 Me nerves were starting and I was I drank and drank until I couldn’t remember if feeling dead sad. It’s better being there was anything I was trying to forget . . . drunk than feeling like that, init?

I drank all I could and then I drank some more. I drank until I passed out and pissed me pants. 10 Drowning your sorrows

Alcohol affects your sense of right your head swirls around and you can’t and wrong as much as it affects your remember what it was you were worried ability to put one foot in front of the about . . . until you sober up and find your other without falling over. This makes troubles are still there. accidents, violence and all sorts of Alcohol can lead to depression, just as trouble much more likely to happen suffering from depression can lead to when you’ve been drinking. alcoholism (or problem drinking as it is There are risks involved in using alcohol now called). Drowning your sorrows will for anybody, but some of those risks only put off your problems making it less are higher for people who have mental likely you will deal with them later. health problems. Drinking leads to If you are experiencing depression, more relapses, depression and suicidal , phobias or post traumatic stress feelings. Drinking increases paranoid disorder, your chances of becoming a thoughts leading to suspicious fear and problem drinker doubles. If you have sometimes violence. Drinkers are more it is five times more likely to need psychiatric treatment in likely. About a third of people with hospital, more likely to be taken there schizophrenia become problem drinkers. against their will and will take longer to recover from their illness. Jason has found he needs more and more alcohol to cope with his anxiety and Like Jason, most of us have tried to shyness. His heavy drinking is starting drown our sorrows in booze. Alcohol can to become a habit. dampen down your worries and fears or it can magnify and distort them until Things you can do:

O Be aware of the risks of using alcohol. Heavy drinking can lead to depression and relapse. If you have experienced mental illness, you run an increased risk of becoming dependant on drink. O If your drinking is becoming a problem, ask for help and advice. Ask the person who gave you this leaflet about the help available for drinking problems. 11 When I woke up, the wallpaper MFI had started watching the street from their was closing in on me. I felt . . . space ship again, waiting for me to go to the vulnerable. shops so they could use the mind ray on me.

There was only one thing for it . . . a couple of lines of ketamine and an umbrella!

12 , withdrawals and comedowns

The speed wore off and the drink that they might get caught. On the other knocked him out, so Jason has finally hand, believing spaceships are trying got some sleep. If you start to rely on to probe your mind is a fairly sure sign alcohol to help you sleep it can interfere Jason is becoming ill again. with your deep sleep (REM sleep), which means you’ll become tired and irritable. The ‘high’ of stimulant use is followed In people vulnerable to depression or by feelings of depression and tiredness hallucinations (like hearing voices) during the comedown which can last for this can lead to relapse. Alcohol is also days. Stimulant drugs can trigger manic a ‘diuretic’ so it disturbs your sleep episodes in people with bipolar disorder, because you keep waking up to pee. whilst the comedown can result in very severe depression in people with bipolar When you wake up after drinking and disorder, schizophrenia or depression speeding there is often a confusing alone. Regular use of stimulants can and disorienting period before the also cause a form of depression that can , sweating and shakes of the last for a long time and is very difficult from the alcohol kicks in. to treat. Jason is still confused but, what with The comedown with stimulant drugs can the hangover and the comedown, he’s be harsh, so it is tempting to use other starting to feel anxious and paranoid drugs like alcohol, cannabis or benzos to again. Paranoia is common in drug users, help ease the crash. Jason has chosen to as quite apart from the effects of the use ketamine – which is not perhaps the drugs there is the very reasonable fear wisest of choices . . .

Things you can do:

O There is no cure for a hangover but – Drinking a glass of water before you go to sleep will help as it stops you feeling so dehydrated. O If you think you are dependant on alcohol – stopping suddenly can be dangerous. Ask the person who gave you this leaflet about where to get help or advice. 13 Bugger me, it was raining Bruce Forsythe’s.

Nice to see you To see you nice Nice to see you

Nice to see you

Nice to see you

Nice to see you I went to tell me Mam, ’cause she likes Brucie!

14 Hallucinations and psychedelic drugs

In the past, drugs that cause hallucinations you are experiencing is totally real. were called ‘psychotomimetics’ because Added to this a hallucination occurring they mimic a psychosis. They are now unexpectedly can be far more frightening usually called ‘hallucinogenic’ or than one you expect because you’ve taken ‘psychedelic’ drugs. a drug. LSD or mushroom trips for people without a serious mental illness last for up The effects of a ‘psychedelic’ depends on to 8 to 12 hours – whereas hallucinations the drugs type and strength, the mood, that are a result of an mental illness can personality and previous experience of the last for days, even weeks, months or user, where you are and who you are with years. when you take it. Experienced users often learn to control their ‘trips’ and avoid ‘bad In lower doses, ketamine feels like being trips’. If you use psychedelics it is a good extremely drunk. At higher doses ket- idea to have a friend there to calm and amine is a very powerful hallucinogenic reassure you if things become frightening. drug. The effects last for less than an hour Hallucinations can involve distortions in if snorted, but can go on for much longer all the senses, sight, sound, touch, taste if taken as a pill. Like stimulant drugs, and smell. Hallucinations caused purely regular use of ketamine can also cause by drugs in people without a mental all of the symptoms of a psychosis and is illness are usually recognised as not being one of the drugs that is thought to actually real and are therefore not as frightening. cause a mental illness that would not have On the other hand, hallucinations caused otherwise occurred. by mental illness are more often ‘true’ hallucinations – in that you believe what

Things you can do: O Psychedelic drugs are likely to lead to relapse or worsen your illness. O If you do use psychedelic drugs, find out all you can about the drug before you use it and don’t use alone.

15 Doctor says I shouldn’t drink or use drugs because it makes me ill. I told me Mam about the Brucie’s, but she called the doctor and they sent me here.

Yeah, Me too!

16 Drugs, medication & the crafty spliff

Jason was admitted to hospital because values and enjoys more than anything the symptoms of his schizophrenia else. Becoming ill is the part of his life got worse (called a relapse). A likely he hates more than anything else. The reason for this is that Jason had stopped two parts of his life clash badly with each taking his medication. other. Finding other things to do with his Most drugs, even cigarettes, can stop time and getting a group of friends who antipsychotic medication from working are not users is easier said than done. properly. However even if you are drinking and using drugs, it is still far Jason, David, Martha and God have all less likely you will relapse if you keep been known to have a crafty spliff when taking your medication. they are in hospital. They smoke because they enjoy it and because they are bored. Jason’s illness may have come back on Some of the doctors and nurses are its own, but his drinking and drug use sympathetic and understand why they do may have also played a big role. Drink this, but they will still try and stop them. and drugs may have caused his illness to worsen or it may have been that he They try and stop them not only because was using drink and drugs to cope with using drugs could make their illness last the symptoms of his illness. It might longer and be harder to treat, but because have been a bit of both – who knows? they have no choice. It is illegal for staff to Discussing it will help you find out. allow you to use drugs or drink in hospital, psychiatric units, hostels or anywhere Drinking and taking drugs with his else they work and they could face being friends is the part of Jason’s life that he sacked if they allow this to happen.

Things you can do: O Keep taking the medication. Many people dislike the side effects of medication, but these can be controlled. O Ask your mental health worker about help with making changes in your life.

17 Street drugs and your medication Reported adverse reactions that can take place. Antidepressants Anxiolytics & Mood Stabilisers Hypnotics

Added drowsiness. Increased heart rate Added drowsiness. Added drowsiness. Cannabis (palpitations) with Some antipsychotic tricyclics. Paradoxical Possible rise in less effective (higher Possible . agitation. blood lithium levels doses may be Serotonin antidepressant (toxic). needed). recommended. Nervous edginess.

Added drowsiness & Added drowsiness, Added drowsiness. Rise in blood Lithium Alcohol lethargy. Increased seizures and Hypotension (low levels.Dehydration/ heart beat/hypotension hypotension with blood pressure), over hydration. fainting. Respiratory Disrupt bloodLithium (low blood pressure). Tricyclics. Serotonin arrest. levels. DANGEROUS. Respiratory depression. antidepressants DANGEROUS. Carbamazepine & DANGEROUS. recommended. alcohol bad for the liver.

Antipsychotic less Disturbed heart rhythm Anxiolytic/hypnotic Heart problems effective. Stimulant (Arrhythmias). less effective. Over (Arrhythmias). Stimulants Dehydration leading Cocaine/ less effective (may Serotonin sedation when used to toxicity. Diminished lead to a higher dose antidepressants may with cocaine. ‘high’ could lead to Amphetamine/ of both). cause stimulation/ poor meds compliance. Ecstasy etc. Carbamazepine and agitation. cocaine toxic mix.

Increased sedation. Added drowsiness. Added drowsiness. Carbamazepine less / Respiratory depression effective and reduced Hypotension (low Risk of respiratory (laboured or stopped blood opiate levels. O/D Methadone blood pressure). depression. risk if sudden cessation Respiratory depression breathing). May & other opiates Blood opiate may of Carbamazepine. (lower, stopped increase blood Sodium valproate rise – danger of O/D breathing). opiate levels. possible alternative. DANGEROUS

Some antipsychotic less Antidepressant side- None /little known/ None /little known/ Tobacco effective eg. effects may worsen, reported. reported. & , so higher some less effective. doses may be needed. Higher doses may be Dose adjustment maybe needed e.g. fluvoxamine necessary on smoking / duloxetine. Side effects cessation to avoid side may worsen when effects /over sedation. stopping smoking. 18 O/D = Overdose Examples of drugs used to treat psychiatric illness

Possible Antipsychotics Antidepressants Anxiolytics & anticholinergenic Drugs used to treat psychosis Drugs used to treat depression. and schizophrenia type illness. Hypnotics psychosis. Drugs used to treat anxiety and sleep problems. Antipsychotics (Typicals) Serotonin/Newer Antidepressants Anxiolytics & Hypnotics Trifluoperazine Citalopram Diazepam Haloperidol Fluvoxamine Temazepam None/little known/ Sulpiride Fluoxetine Pregabalin reported. Flupentixol Clonazepam Zuclopenthixol Venlafaxine Buspirone Sertraline Chloral Hydrate Fluphenazine Reboxetine Duloxetine Propranolol (Beta-blocker) Antipsychotics (Atypicals) Risperidone Agomelatine Agitation. Anticholinergics Olanzapine Drugs used to treat anti Over stimulation. Tricyclic/Older -psychotic side-effects. Clozapine Antidepressants Anticholinergics Amisulpride Aripiprazole Trihexyphenidyl None/little known/ Trazodone reported. Mood Stabilisers Drugs used to treat bipolar disorder, depression and other mood disorders. Mood Stabilisers Monoamine oxidase Lithium Agitation. inhibitors e.g phenelzine, *Carbamazepine Over stimulation tranylcypromine are rarely *Sodium Valproate possible. used due to dangerous Semisodium Valproate interactions. The combination *Lamotrigine of these and opiates/ stimulants is very bad. *Also used in epilepsy.

19 These guides are based upon the experiences of people in psychiatric treatment.

code A39 | version 1.3 The stories were told as part of a Ph.D. sponsored by Print date 04/2014 | Review date 04/2016 the Manchester Mental Health & Social Care Trust and The University of Salford. Research: Dr. Mark Holland: aims Consultant Nurse Dual Diagnosis. Manchester Mental To provide up to date information and health & Social Care Trust. Michael Linnell. advice on drugs and mental illness. Text: Michael Linnell, Mark Holland. audience Illustrations: Michael Linnell. People who use drugs and have experienced mental illness and the staff who work with them. Special Thanks to: All the clients and staff involved in this project, Dr. Russell Newcombe, Peter McDermott, content Dr. Tim Garvey (Consultant Psychiatrist, General Some swearing and graphic images of drug use. Psychiatry and Assertive Outreach, MMHSCT), Petra Brown (Chief Pharmacist MMHSCT), Dr. Deepak Gupta, funding Professor Duncan Mitchell, Sabrina Schulte. Self-financed. North West NHS Innovation Awards 2007 – First prize NHS National Technology Awards 2007 – Runner up Nursing Times, Chief Nursing Officer’s Award 2007 – Finalist

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