Overview

• 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.
• When someone with a mental illness also uses drugs, doctors call this ‘dual diagnosis’ or ‘co-occurring diagnosis’.
• 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, you could make a complaint.
• In this section, ‘drugs’ means recreational drugs, alcohol, or prescription drugs. 

About

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 alcohol 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 well-being. 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.

You can find more information about ‘Cannabis and mental health’ by clicking here.

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. Some people describe it as a "break from reality". There are different terms use to describe psychosis. Such as “psychotic symptoms”, “psychotic episode” or “psychotic experience.”

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

You can find more information about 'Psychosis' by clicking here.

Drugs and effects

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. Please be aware that this list is not a list of all substances.

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 website of ‘Talk to Frank’. They are a specialist charity that provides information on drugs. You can find their website here: www.talktofrank.com/

Cannabis

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

Cannabis is one of the most commonly 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 aren't 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

(Also known as: bevvies, booze)

Some people with a mental illness have problems using alcohol. Alcohol is legal, which means it is easier to get. It can make the feelings of some mental health issues feel worse.

The long-term effects of alcohol also depend on how much you drink, and how regularly you drink it. If you drink too much on a regular basis then you could cause yourself serious physical and mental harm.

Drinking can make you do something you would not normally do. This can include self-harm and suicide. Very high levels of alcohol can cause psychosis.

New Psychoactive Substances (NPS)

(Also known as: PlantFood, NPS, Mdat, Eric 3, Dimethocaine and Bath salts).

These are drugs that contain one or more chemical substance. They produce effects that are similar to 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 have hallucinations. This is when you see, smell, hear or feel things that other people don’t. 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 tranquilisers. They are used to treat anxiety. They are also used as a muscle relaxant. Sometimes a doctor will tell you to take benzodiazepines to help you with anxiety. But people also buy them illegally because of their relaxing effects. They can be addictive, and so doctors only give them for a short time.

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.

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, some people become addicted. This can have a big effect on their day-to-day life.

You can find more information on ‘Benzodiazepines’ by clicking here.

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.

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 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. However, 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 aren't 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 haven’t experienced before.

Getting help

How can I get help?

If you have a mental illness and use drugs, the NHS may call this 'dual diagnosis' or ‘co-occurring diagnosis’. Your local NHS trust may have a policy that says how they will help people with dual diagnosis. Check on their website to see if you can find out more about what to expect locally.

If you are not already getting help with your mental health from your local mental health team, a good first step is to make an appointment to see your GP. Your GP may offer you medication and therapy to treat your mental illness. They may refer you to a drug and alcohol service to help you with your drug use.

If your needs are too complicated for your GP to deal with alone, you might need more specialist support. A GP can refer you to your local mental health service or community mental health team (CMHT).

They should offer this support and work with drug and alcohol services to give you all the help you need. The Department of Health and Social Care says that people with dual diagnosis are a key group of people who should get help from mental health services. You should not be stopped from getting help if you have drug or alcohol problems and severe mental illness.

Care Programme Approach (CPA)

The National Institute for Health and Care Excellence (NICE) produces guidance for the NHS and other organisations responsible for people’s health and care. They say that people who have a severe mental illness and drug or alcohol problem should get help under the Care Programme Approach (CPA). The CPA is a framework that the NHS uses to plan someone’s long-term care.

Under the CPA you will have a care co-ordinator to plan your care. They will help to write a care plan. This should account for all the different needs you might have such as:

• social care,
• housing, and
• physical health.

NICE also say that you should be able to give your views on the care plan to make sure that it meets your needs. And the care plan should be shared with your carers or family if you agree.

You can read the NICE guidance online here:
www.nice.org.uk/guidance/ng58

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. If there isn't one in your area, you could try contacting your local community mental health team (CMHT) for help. However, you will need to be referred to the CMHT by your GP.

As well as NHS services, you could try contacting local charities. Many charities have support services or support groups for people struggling with substance misuse. You can find some national charities listed in the Useful Contacts section below.

You can find more information about:

• NHS Mental Health Teams (MHTs) by clicking here.
• Worried about your mental health? by clicking here.
• Care Programme Approach by clicking here.

Problems

What can I do if I have problems trying to get help?

Some people with dual diagnosis have told us that it has been difficult to get the help they need. For example, you may have been told that mental health services cannot help you because of your drink or drugs problem.

But the Department of Health and Social Care is very clear that mental health services should try to help you if you have dual diagnosis.

The National Institute for Health and Care Excellence (NICE) also say that you should not be turned away from mental health services because you have a drug or alcohol problem.

If your mental health team have said they can’t help you then you can ask them what their reasons are. You can ask for a copy of their policy for eligibility criteria. You may then be able to use this to show you are eligible for their support.

If you are not happy with the services you get, talk to the person in charge of your care. This might be your GP or your 'care coordinator'. They might be able to change things for you. An 'advocate' may be able to help you to get your point of view across. You might need to make a complaint to the NHS if you do not get the help you need.

You can find more information about:

• Advocacy by clicking here.
• Complaints by clicking here.

Carer's, friends and relatives

What if I am a carer, friend or relative?

Supporting someone struggling with dual diagnosis can be difficult. It might help to speak to the person you are helping, to see what support they want. For example, some people might just want someone to talk with. Other people might want more practical help, such as with booking appointments or helping them speak to professionals.

We Are With You and Adfam are two charities that offer support and advice to relatives, friends and carers of those struggling with substance misuse. 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 the mental health team if you have ideas about what services should be available or how things could work better.

You can find more information about:

• Supporting someone with a mental illness by clicking here.
• Carers’ assessments and support planning by clicking here.
• Confidentiality – for carers, friends and relatives by clicking here.

Useful contacts

Drinkline
This is the national alcohol helpline. They provide information and selfhelp 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.

Telephone: 0300 123 1110. Open weekdays 9am – 8pm, weekends 11am – 4pm.
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

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.

Telephone: 0300 123 6600. Open 24 hours a day, every day
Text: 82111
Email: Online form here: www.talktofrank.com/contact
Webchat: www.talktofrank.com/contact-frank Open 2pm-6pm every day.
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: www.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.

Telephone (for over 50’s): 0808 801 0750
Online Chat: www.wearewithyou.org.uk/help-and-advice/about-our-online-chat/ Monday to Friday 9am-9pm and Saturday and Sunday 10am-4pm
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.

Telephone: 0800 0086 811 Open 10am-10pm, 365 days a year
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 10am – midnight
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.

Telephone: 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.

Telephone: 0800 612 0225 Open 10am – 10pm every day.
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.

Telephone: 0117 966 3629 10am-4pm
Address: PostScript360, 1st Floor, East Wing, The Kingswood Estate, Britannia Road, Kingswood, Bristol, BS15 8DP
Email: info@postscript360.org.uk
Website: www.postscript360.org.uk/

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

Telephone: 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
Email:
Website: www.turning-point.co.uk