Frequently asked Qs

• Key words

  On this page, ‘drugs’ means recreational drugs, or street drugs. This includes prescription drugs used in a way that was not intended by the prescriber of them.

  You might live with a mental illness and use drugs or drink a lot. Doctors call this ‘dual diagnosis.’

• What are the key facts?
  • There are many reasons why you might use drugs and alcohol. 
  • Some people use them to try and deal with their symptoms of their mental illness. This is called 'self-medication'.  
  • Drugs and alcohol can make the symptoms of your mental illness worse. 
  • Some drugs may make it more likely for you to get a mental illness, and they may make it harder to treat.  
  • Mental health, and drug and alcohol services should work together to give you the support you need.
  • If you have any problems getting help, there are things you can do.
• How can drugs and alcohol affect my mental health?

  People use drugs and drink alcohol for lots of different reasons. Whatever your reason, using drugs or drinking a lot of alcohol regularly may have a long-term negative effect on you. 

  The possible long-term effects include the following.

  • Needing to take more to get the same effect.
  • High blood pressure and strokes.
  • Problems with your liver and pancreas.
  • Development of certain cancers e.g. liver cancer, bowel cancer and mouth cancer.
  • Difficulty obtaining or maintaining an erection.
  • Problems with orgasms.
  • Difficulties becoming pregnant. 
  • Feeling like you must use the drug or alcohol. This is known as being dependent.
  • Withdrawal symptoms including feeling sick, cold, sweaty or shaky when you don’t take them.
  • Having sudden mood changes.
  • Having a negative outlook on life.
  • Loss of motivation.
  • Depression.
  • Anxiety.
  • Problems with relationships.
  • Being secretive.
  • Having episodes of drug-induced psychosis.

  If you use alcohol or drugs for a long time, it can cause serious issues for your mental wellbeing. Drugs can make you more unwell and more likely to try and harm yourself or take your own life.  

  There is also some evidence that using some drugs may cause mental illness for the first time. For example, research has shown that cannabis can increase your chances of developing psychosis or a psychotic disorder. 

  For more information, see our webpage on Cannabis and mental health. 

  What is psychosis?

  Psychosis is a medical term. If you have psychosis, you will process the world around you differently to other people. This can include how you experience, believe or view things.

  You might see or hear things that others do not. Or believe things other people do not. 

  It can be a symptom of mental illness and can also be a short-term effect of some drugs.  

  For more information, see our webpage on Psychosis.

• Which substances can affect my mental health?

  In this section we have listed some of the different types of substances that could have an impact on your mental health. There could be others that might affect you too.

  Taking any substances can be dangerous. They can also have bad interactions with any medications or other substances you might use.

  For more information on different substances, you can visit the Talk to Frank website

  Cannabis

  Also known as: bud, bhang, dope, draw, ganja, grass, hash, herb, marijuana, pot, skunk, weed

  Cannabis is one of the most used drugs in England. 

  According to one study, 1 in 13 people aged 16-59 had used it in the last year.  Young people aged 16-24 are more likely to use cannabis.  The same study shows that just under 1 in 5 young people had used cannabis between 2018 and 2019.  

  Some people take cannabis because it makes them feel relaxed or happy, but it can also make you feel anxious or feel paranoid.  Some people may experience things that are not real. This is a sign of drug-induced psychosis.  

  Some studies have shown that the risk of psychosis may be higher if you: 

  • use cannabis for a long time, 
  • use it frequently, and 
  • use ‘high strength’ cannabis, like skunk.

  If you have been using cannabis and you feel that it is affecting your health, make an appointment to see your GP as soon as you can. Your doctor should not judge you and should not tell other people you use drugs. 

  Alcohol 

  What is the government’s advice on safe alcohol use? 
  The government recommends that:  

  • Adults. It is safest to not drink more than 14 units a week. If you drink 14 units a week, spread this evenly over 3 days or more.
  • If you are pregnant. Do not drink alcohol at all.
  • Young people. An alcohol-free childhood is the healthiest and safest option.

  You can find more about What is an alcohol unit? from Drinkaware here

  Are there links between alcohol use and mental and physical health?
  There are links between alcohol use and mental and physical health and wellbeing. How much you drink, and in what environment, can shape how it affects your life. 

  You might drink moderately. Maybe with a meal, over a chat with friends or to celebrate. But you might drink a lot regularly, and that can make your mental and physical health worse. 

  If you experience mental health issues, you might drink to deal with symptoms or difficult feelings. This can be known as self-medicating. 

  This can lead some people who live with mental illness to develop issues with alcohol.  

  Also, if you drink a lot, it might lead you to develop mental and physical health issues. 

  How can alcohol affect my mental and physical health?
  If you regularly drink a lot, it can lead to the following mental health effects, amongst other things:

  • low mood or depression, 
  • feelings of anxiety, even though it might lessen them to begin with, 
  • suicidal thoughts,  and
  • psychosis, if you suddenly stop drinking. 

  There can be long term physical health effects of regularly drink a lot too. They might include high blood pressure, heart disease, stroke, cancer, liver, pancreas, or brain damage. , 

  You can watch this useful 1 min 10 seconds video on Alcohol and mental health from Drinkaware

  You can read more information from the following links:

  • Drinkaware. Alcohol and mental health.
  • Drinkaware. How alcohol affects your body.
  • Mental Health Foundation. Alcohol and mental health.
  • Royal College of Psychiatrists. Alcohol mental health and the brain.

  For more information see our webpages on the following:

  • Anxiety
  • Depression
  • Psychosis
  • Suicidal thoughts – How to cope 

  Can alcohol affect clozapine?
  If you take the medication clozapine, drinking alcohol can be very risky. In some cases, life threatening. ,   

  We will soon be publishing new information on our website called Clozapine and alcohol – the risks at www.rethink.org 

  It is very important you:

  • discuss alcohol use with your doctor, and
  • carefully read your medication patient information leaflet to see what it says about alcohol use. The box your medication comes in should include a patient information leaflet

  Can alcohol affect other mental health medications?
  Some medications for mental health conditions can be affected by alcohol.  

  You may need to limit your alcohol intake or avoid it altogether. You can find this out by checking the patient information leaflet that comes with your medication. 

  What is sudden unexplained death through alcohol misuse (SUDAM)?
  Sudden unexplained death through alcohol misuse is known as SUDAM. 

  A person’s death might be put down to SUDAM if: 

  • they have a history of drinking a lot of alcohol regularly, or they have alcoholic liver disease,
  • the death is sudden, and
  • the post-mortem examination does not find another cause of death.

  There might not be a dangerous level of alcohol in the body at the time of death.  

  A post-mortem examination is a medical procedure that looks at a dead body to find out the cause of death.

  People who live with severe mental illness are more likely to have issues with alcohol.  And to die because of SUDAM. 

  There are about 1,000 deaths put down to SUDAM in England and Wales in a year.  

  New psychoactive substances (NPS) 

  Also known as: PlantFood, NPS, Mdat, Eric 3, dimethocaine and bath salts.

  These are drugs that produce effects that are like cocaine, cannabis and ecstasy.
   
  Some of the drugs classed as NPS used to be known as ‘legal highs.’ This is a common term that people use. It is used because some NPS were legal before 2016. However, the name is now wrong, because since 2016 they have been made illegal. 

  The short-term effects of an NPS depend on what you take. 

  Some new psychoactive drugs can cause confusion and a feeling of panic. You can also hallucinate. This is when you see, smell, hear or feel things that other people do not. Hallucinations can affect the way you behave. Your behaviour can become erratic and can put your own safety at serious risk. 

  These drugs can also affect your judgement, which could put you at risk. 

  Some NPS can be very dangerous. They can kill you or hurt you very badly. There is a higher risk of this if taken with alcohol or other psychoactive drugs.  

  Amphetamine and methamphetamine

  Also known as: crystal meth, ice, meth, glass, whizz, speed, billy, base, yaba, tina and christine

  In the short-term, these drugs can make you feel wide awake and alert. This can make it difficult for you to relax or get to sleep. They might cause you to have a drug-induced psychosis. 

  In the long-term, amphetamines might make you anxious and depressed. They can also be addictive. 
   
  When you stop taking the drug, you may feel depressed, and you might find it hard to sleep.

  Benzodiazepines  

  Also known as: benzos, blues, downers, roofies, vallies, Diazepam, Rohypnol, Valium, Xanax

  Benzodiazepines are a type of tranquiliser. They are used by doctors to treat anxiety, and sometimes muscle spasms too.  They can be addictive, and so doctors should only prescribe them for a short time.

  But people also take them illegally because of their relaxing effects. 

  In the short-term, these drugs can make you feel calmer. Depending on the type you take, they could make you feel confused or overly sleepy. 

  They can also increase suicidal thoughts and depression. 

  Taking benzodiazepines with other drugs or alcohol can be dangerous. It can affect your breathing. It can also increase the risk of overdose and death.  

  In the long-term, you could become addicted. This can have a big effect on your day-to-day life. 

  If you are dependent on benzodiazepines you can experience unpleasant withdrawal symptoms if you stop taking them. Like nausea, irritability, insomnia, and hallucinations. 

  For more information, see our webpage on Benzodiazepines. 

  Cocaine 

  Also known as: blow, crack, coke, charlie, chang, freebase, sniff, snow

  In the short-term, cocaine can make you feel awake, talkative and confident. After this wears off, you can feel tired and depressed after taking it and may experience mood swings. 

  In the long-term, cocaine use can affect how you feel. It can affect your relationships with friends and family. Cocaine is also addictive and over time you are more likely to have ongoing problems with depression, paranoia or anxiety.

  Cocaine can cause fits, heart attacks and strokes. If you mix it with some other drugs, you are more likely to overdose or die.

  Ecstasy 

  Also known as: E, MDMA, MD, molly, pills, XTC

  In the short-term, ecstasy may make you feel energetic, very happy, chatty and confident. It can also sometimes make you feel anxious, confused or it can trigger drug-induced psychosis. 

  In the long-term, ecstasy use can lead to memory problems. You may also develop depression and anxiety.

  Heroin 

  Also known as: brown, gear, H, smack, skag

  In the short-term, heroin can make you feel relaxed and happy. It takes away pain and can make you feel sleepy. But there is a higher risk that you could take too much or overdose with heroin than some other drugs.

  Heroin can be taken in lots of different ways, including by injection. But there is a high risk of getting an infection if you inject heroin, particularly if you share needles with someone else.

  Heroin is very addictive. It can have serious long-term effects. You may feel that heroin becomes more important than other things in your life. This might make it harder to keep a job and affect your relationships.

  LSD 

  Also known as: acid, blotter, trips, micro-dot

  In the short-term, LSD may make you experience things that are not real. Sometimes the experience will be enjoyable, and sometimes it will be frightening. This is known as a bad trip.

  If you have a history of mental health problems taking LSD can make it worse. If you panic during a trip on LSD, it can be scary. LSD may also trigger mental health problems which you have not experienced before.

• How can I get help?

  You might not be getting and help with your mental health or drugs or alcohol issues.   A good first step is to see your GP. 

  Your GP can:

  • offer you help for your mental health, and
  • refer you to a drug and alcohol service, if appropriate. 

  Your GP might recommend referring you to a specialist NHS mental health team if appropriate.

  For more information see our webpages on the following:

  • GPs and your mental health
  • NHS mental health teams

  For more information on drug and alcohol support, see:

  •    NHS. Drug addiction getting help.
  •    NHS. Alcohol support.

  You can also contact the drug and alcohol charities and organisations in the Useful contacts section at the bottom of this page.

  For your mental health, you can also self-refer yourself to your local NHS talking therapy service. Or you can get private talking therapy if you can afford it.

  For more information, see our webpage on Talking therapies. 

  Should the NHS and drug and alcohol services work together?

  You might be referred to NHS specialist mental health services.

  NHS specialist mental health services should not refuse to support you with your mental health because you: 

  • take drugs, or
  • regularly drink alcohol.

  The services should assessed both of your drug or alcohol needs and mental health needs.  They should then work with the following to get you the help you need: 

  • drug and alcohol services, and
  • organisations like social services, local authorities and housing and employment services.

  It says the above in paragraphs 1.2.1 and 1.3.1 of NICE Guidelines Coexisting severe mental illness and substance misuse: Community health and social care services.  You can find the guidelines here

  NICE stands for National Institute for Health and Care Excellence. The NHS follow their guidance.

  There may be a team in your area which helps people with dual diagnosis. It is sometimes called the dual diagnosis team. However, not all areas of the country have them, and it may have a different name.

• What can I do if I have problems getting help?

  You might live with dual diagnosis. This is when you live with a mental illness and use drugs or drink a lot.  

  As we said above, the NHS and drug and alcohol services should work together to meet your needs.

  Some people with dual diagnosis have told us that it is difficult to get the help they need. Like, they been told that NHS mental health services cannot help them because of their drink or drugs issues. 

  You can say that paragraphs 1.2.1 and 1.3.1 of NICE Guidelines on Coexisting severe mental illness and substance misuse say that you should be supported.  You can find the guidelines here

  You can: 

  • talk the person in charge of care and treatment, 
  • get an advocate to help you, 
  • contact Patient Advice and Liaison Service (PALS), or
  • make a complaint. 

  You can find more information about: 

  • Advocacy for mental health – Making your voice heard
  • Complaining about the NHS or social services
• What if I am a carer, friend or relative?

  Supporting someone who lives with dual diagnosis can be difficult. It might help to speak to the person you are helping, to see what support they want. 

  We Are With You and Adfam are two charities that offer support and advice to loved ones of those who live with drug or alcohol issues. You can find their contact details in the Useful contacts section below. 

  You might also feel that you need support for yourself. The National Institute for Health and Care Excellence (NICE) says that carers who support someone with a dual diagnosis should be offered a carer’s assessment under the Care Act 2014.  You may be able to get practical support to help you with your caring responsibilities.   

  NICE also says that if you are caring for someone with a dual diagnosis you can:

  • be involved in their care planning, and 
  • work with services to help those services improve. 

  But this can only happen if the person who you care for wants you to be involved. Speak to their mental health team if you have ideas about what services should be available or how things could work better.

  For more information see our webpages on the following:

  • Supporting someone with a mental illness
  • Getting help for someone in a mental health crisis
  • Confidentiality, information and your loved one - For loved ones of people living with mental illness 
  • Suicidal thoughts - How to support someone
  • Responding to unusual behaviour linked to mental illness
  • Carer’s assessments – Under the Care Act 2014
  • Worried about someone’s mental health
  • Stress – How to cope
• Useful contacts

  Drinkline 
  This is the national alcohol helpline. They provide information and self-help materials for callers worried about their own drinking, and to support the family and friends of people who are drinking. They are confidential, you do not have to give your name and they can provide advice on where to get help.

  Phone: 0300 123 1110
  Webchat (Drinkchat): www.drinkaware.co.uk/advice/support-services/chat-with-an-advisor
  Website: www.drinkaware.co.uk/alcohol-support-services/ 

  Adfam 
  This is a national charity for families and friends of drug users. It offers confidential support and information. 

  Address: 2nd Floor, 120 Cromer Street, London, WC1H 8BS 
  Email: admin@adfam.org.uk            
  Website: www.adfam.org.uk

  Drugfam
  This is a national charity that supports everyone affected by alcohol, drugs, substances, and gambling, including loved ones and people bereaved by addiction.

  Helpline: 0300 888 3853
  Email: Online form here: www.drugfam.co.uk/contact/
  Website: www.drugfam.co.uk/ 

  Frank 
  Frank provides information and advice on drugs to anyone concerned about drugs and solvent misuse, including people misusing drugs, their families, friends and carers. 

  Phone: 0300 123 6600. 
  Text: 82111     
  Email: Online form here: www.talktofrank.com/contact 
  Webchat: www.talktofrank.com/contact-frank 
  Website: www.talktofrank.com 

  Alcohol Change UK
  Alcohol concern is the national organisation for alcohol misuse. It does not provide services, but they do produce information on alcohol.
   
  Address: 27 Swinton Street, London, WC1X 9NW
  Email: contact@alcoholchange.org.uk 
  Website: https://alcoholchange.org.uk/ 

  We Are With You 
  This is a drug and alcohol treatment agency. Their services deal primarily with drug and alcohol problems including support for families. 

  Phone (for over 50’s): 0808 801 0750
  Online Chat: www.wearewithyou.org.uk/help-and-advice/about-our-online-chat/ 
  Website: www.wearewithyou.org.uk/

  Al-Anon Family Groups 
  This is a service for families and friends of alcoholics. Al-Anon family groups provide understanding, strength and hope to anyone whose life is, or has been, affected by someone else's drinking.

  Phone: 0800 0086 811 
  Address: Al-Anon Family Groups, 57B Great Suffolk Street, London, SE1 0BB 
  Email: helpline@al-anonuk.org.uk
  Website: www.al-anonuk.org.uk 

  Narcotics Anonymous UK (NAUK)
  NA is a non-profit fellowship or society of men and women for whom drugs had become a major problem. They are recovering addicts who meet regularly to help each other stay clean. They have groups around the country.

  Helpline: 0300 999 1212 
  Website: www.ukna.org/ 

  Alcoholics Anonymous (AA)
  AA provides an opportunity for people to get together to solve their problem with alcohol and help others to recover. 

  Phone: 0800 9177 650
  Address: PO Box 1, 10 Toft Green, York, YO1 7NJ
  Email:  help@aamail.org 
  Website: www.alcoholics-anonymous.org.uk    

  Cocaine Anonymous (CA)
  CA is a fellowship of men and women who use the 12 step, self-help programme to stop cocaine and all other mind-altering substances. 

  Phone: 0800 612 0225
  Address: CAUK, PO Box 1337, Enfield, EN1 9AS  
  Email: helpline@cauk.org.uk         
  Website: www.cauk.org.uk 

  DrugWise
  DrugWise provides information and publications on a wide range of drug related topics. 

  Website: www.drugwise.org.uk/  

  PostScript 360
  A charity committed to supporting individuals to reduce the harms caused by prescribed drugs that are associated with dependence and withdrawal. They do this through a wrap-around service of one to one therapy, group therapy and a telephone support service.

  Phone: 0117 966 3629 
  Address: PostScript360, 1st Floor, East Wing, The Kingswood Estate,
  Britannia Road, Kingswood, Bristol, BS15 8DP
  Email: info@postscript360.org.uk
  Website: https://postscript360.org.uk/

  Release 
  They offer advice and information on drug problems. They have expertise in legal matters surrounding drugs.

  Phone: 020 7324 2989 
  Address: 61 Mansell Street, London, E1 8AN.
  Email: ask@release.org.uk 
  Website: www.release.org.uk

  Turning Point
  This is an organisation that works with people affected by drug and alcohol misuse, mental health problems and learning disabilities. 

  Address: Standon House, 21 Mansell Street, London, E1 8AA
  Website: www.turning-point.co.uk

  Dual Diagnosis 
  A space for people with co-occurring mental health and addiction issues to find online information, tools, support groups, and resources. 

  Phone: 01962 622 122 or 07545 990 335
  Email: hello@dualdiagnosis.org.uk 
  Website: www.dualdiagnosis.org.uk/

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