Demi Lovato and the fragility of mental health and substance misuse.

I was saddened to read of Demi Lovato’s suspected drug overdose this week. Whether or not her relapse was related to her bipolar diagnosis is impossible to know. We do know that mental ill health and substance misuse are a bad combination. The statistics are frightening: in the UK, 75% of individuals in drug services and 85% in alcohol services have a co-existing mental health condition. More on this here.

 

A significant issue in considering mental ill health and substance misuse is the chicken and egg nature of the problem. Did the substance misuse start first or was the mental ill health the cause of the substance misuse? Long waits to access specialist mental health services mean that self medication with substances can provide an outlet from troublesome symptoms. The chaotic lives of some substance misusers make engagement and ongoing treatment problematic. If you’re homeless, how do you receive appointment letters? If you aren’t earning, how do you afford the bus fare to get to appointments? When the day is structured around relieving immediate discomfort, are you going to regulate your sleeping and eating patterns and remember your meds? The answer is a resounding no.

 

I don’t do illicit substances (if my boss is reading this I’m sure she’ll be relieved) but I do drink. When I’m having an episode I tend to drink more. I’m sure that the motivations of each individual to misuse substances are different but here are my personal reasons behind using alcohol to cope with bipolar:

 

When I’m hypomanic, I love a party. I’m outgoing, chatty and definitely up for doing shots of tequila (yuck) at 3am. Hypomania gives me a super human tolerance to alcohol. It’s easy to get caught up in the fun especially if you’re with the wrong crowd as Lovato was reported to be.  What’s fun and exciting at first ends up in a slow car crash when you inevitably fall off the hypomanic cliff.

 

When I’m depressed (and I’ve been depressed waaaay more than hypomanic), sleep tends to go out the window. I sleep 4-5 hours a night, waking at 2am and then wanting to drift off around 5:30am when I need to get up. I’m anxious and sad. Drinking helps me to relax,  sleep and socialise when I’d rather hide in my room with the lights off. I don’t binge drink when I’m low but get into the habit of having one drink several nights a week, more on weekends. I completely get how 1 or 2 can turn into 2, 3 or 4.

 

Alcohol doesn’t help, not really. It’s a depressant, it stops your medication from working (in some cases its downright dangerous to mix your meds with alcohol). If you’re using other substances to self medicate then you’re adding to the adverse effect.

 

Situations like Lovato’s illustrate the need for a watertight crisis plan. This needs to be done when you are well. Who is looking out for you? What will they do if you hit a crisis? What do you want to happen when you’re unwell? Mine has various sections- a note of my early triggers (not sleeping, not eating), giving authorisation for my husband to discuss my care with my doctors if I’m acutely unwell, what I would be happy to undertake treatment-wise (would I agree to hospital admission- yes, would I ever have ECT, no). The plan needs to be shared and agreed by everyone involved. Not only does the plan help those around you in a crisis, it gives you a sense of security. I know if the sh*t hits the fan I’ve got a strong team who will step in even if it might not be what I want at the time. That support is worth its’ weight in gold.

 

Get well soon Demi Lovato, we’re all human, we all relapse, it’s what we do in the aftermath that counts. She needs support, she needs a crisis plan and above all she needs no judgement.

 

If you are struggling with substance misuse, it’s important to see your health professional. You can also find more information here.

Christmas a.k.a how to relapse in 24 hours

What are your plans for Boxing Day? Roll out of bed to eat leftover Quality Street whilst watching a boxed set? Hitting the sales for some bargains that maybe you don’t really need?

I’ve decided to blog today because I need to talk about how one day of excess can trigger a serious mental health relapse. Every year I think “It’s just one day, I’ve got this, I don’t need to stick to the rules.”

So instead of sticking to a routine, eating well, moderating my alcohol intake and doing some exercise, the day tends to unfold like this:

Get up at ungodly hour with excited child and slight headache after having too many gin and tonics the night before.

Skip breakfast, crack open a bottle of something bubbly around lunch time.  Extra points for drinking in ridiculously hot kitchen prepping lunch so dehydrate quicker.

Eat huge Christmas dinner, washed down with more fizz and some wine too. Screw sleep pattern by having  ridiculously long nap in the middle of the bloody day.

Get up in the early evening, not hungry but squeeze in some Quality Street/leftover roast potatoes/cheese and biscuits. Put a film on, crack open some gin, get tipsy and chattier than usual and reward self with another few drinks, go to bed at ridiculously small hours of the morning, sleep badly because you have heartburn and slept too long during the day.

Bonus points for: making a mental list of ways you’ve messed up previous Christmases/missing relatives who are no longer with is/looking at social media and berating self because everyone else seems to have their shit together.

So although I thoroughly enjoyed spending time with my family, eating gorgeous food and sampling some of the amazing gins I was gifted, today I need to be a little more responsible and manage myself better. That means eating regularly, not drinking today, going for a gentle walk and remembering that one day doesn’t have to start a downward trajectory.

Can someone remind me of this post on December 24th next year?!

5-things to do when you’re struggling with your mental health

Having hit rock bottom (with a splat) several times in my life, I’ve built up an awareness of what does and doesn’t help my symptoms.  Now, before I share this list, I’m want to say: this stuff isn’t rocket science but in the middle of a mental health crisis getting out of bed is hard, let alone anything else. It’s also easy to dismiss small changes and activities that stuff that psychs/nurses/relatives tell us will help.

During one particularly bad call to my crisis team I remember being told to slow down and start breathing deeply. I wanted to scream down the phone:”Breathe?! WTF do you mean breathe?! Of course I’m bl**dy well breathing, I’d be dead if I wasn’t. I’m calling you because I feel like I want to die and the best advice you can give me is breathe?!”

As it was, I did the breathing exercise like I was told and after a couple of attempts felt much better. I still remember the name of the nurse who took my call, her nagging me to breathe made a world of difference. I’m not going to say if you get your breathing right your mental health problems will vanish, we all know it’s not like that.

So without further rambling, I give to you my list of 5 things to do when you’re struggling with your mental health:

1. Write it down: I’ve journaled for about 15 years now, my journal provides a safe space for me to vent but it also helps me track my mood and look for patterns in my behaviour. It also means I get to splurge on stationary (particularly stuff that’s shiny….I love shiny!). If you’re struggling to open up to loved ones or professionals about your feelings, show them your journal instead.

 

2. Exercise (at the right time and with the right type of activity): I do not enjoy sweating. I don’t like lycra. You won’t find me in the gym. BUT I love how I feel when those happy chemicals are floating around after an hour of dancing. There’s plenty of research about the benefits of exercise to help regulate our sleep patterns, reduce our stress and increase our energy levels. The key is finding what works for you, I don’t run anywhere but I love yoga and cycling. On the days that feels like too much, a 20 minute walk is enough to give me a boost. A word of caution- time your exercise well, during a particularly highly strung phase, my evening exercise class gave me such a buzz I was awake until well after 1am. The Royal College of Psychiatrists have a nice leaflet about exercise and its’ impact on mental health here.

 

3. Avoid excess alcohol: Yep you feel more relaxed after that first drink. Maybe you’re drinking a few drinks to get you off to sleep each night. But remember: alcohol is a depressant. It wipes out that happy chemical serotonin (which is also the chemical many antidepressants work on). So not only are you making yourself more depressed, you’re also making it more likely that your antidepressants won’t have the full effect. Drinking to excess also puts you at risk of making poor judgements calls by decreasing your inhibitions.

 

4. Use technology to help, not hinder your recovery.  I love the internet. I love being able to research, read the news and access support groups at the same time as stalking people I know on social media. I also like to go on pinterest and make boards about tattoos I will never have the guts to get and recipes I will never actually make. Social media can bring out the worst in us: never ending comparisons about people we haven’t seen since school (Wow, she looks so happy, her family are gorgeous, I’m so jealous of that car etc) or reading too much into situations (two of my friends went for coffee?! Why wasn’t I invited?! I’ve obviously upset them and they don’t want to be friends with me.)  Lets not forget the sleep destroying effects of blue light emitted from phones and tablets. At its’ worst tech leaves us overstimulated and anxious. Can’t take a break? Force yourself to let a loved one change your passwords for a week- the temptation is gone. Or make a firm decision to put the tech down an hour before bed so that blue light doesn’t impact on your sleep.

 

5. Do something to occupy your mind. Distraction is a useful tool and yet one that we struggle to use. When I’m low, an hour can feel like a week and I don’t always see the value of doing something to take my mind off things, I’d rather sit in my pyjamas and stare into space. Do something to take your mind off things: read a book, do some colouring in (I’ve got a swear word colouring book that I love, intricately colouring the worse Asshole with pencils always amuses me), walk, knit, paint your nails, do some puzzles, download a free mindfulness app and try one of the exercises. Even if you set a timer and do it for 10 minutes, just DO it. You’ll feel proud that you have and often when the timer goes off you’ll carry on with your activity. I love to read but when I’m a bit manic I can’t focus on the words so instead I like to bake cakes. When I’m down I watch Youtube videos of baby animals, also a good way of keeping little people amused if you have them.

 

What small things do you do to help look after yourself when you’re struggling with your mental health? What baby animals would you watch on YouTube (panda’s are my fave). Let me know by commenting or e-mail. Pictures of sparkly stationary are always welcome too!