Mental Health First Aid: Substance use disorder an illness for millions of Americans

A Hays Post series focusing on mental health issues.

By CRISTINA JANNEY
Hays Post

An occasional glass of wine with dinner is not a symptom of mental illness, but for more than 21 million Americans — 8 percent of the U.S. population older than 12 — substance use disorder is a debilitating disease.

Alcohol use disorder is the most common of the substance use disorders, with 17 million American affected, students in a recent Mental Health First Aid class offered by High Plains Mental Health learned.

Substance use disorders are characterized by a dependence on the substance.

“For instance, you no longer just want to have a glass of wine with dinner, you need a glass of wine with dinner,” Kaley Conner, trainer, said. “It can become something that people depend on like a coping mechanism or a way to relax for people with extreme social anxiety. It may become an unhealthy coping mechanism for how to socialize, how to make friends, to cope in society in some of those stressful situations.”

It can also mean substance use, which is use of alcohol or drugs, leads to problems at work, home, school, in their physical or mental health, or to legal problems.

Substance use disorders start at a median age of 20. They are common among people who suffer from other mental illnesses. People who have mood or anxiety disorders are twice as likely to have substance use disorders, and men are twice as likely as women to have substance use disorders.

Warning signs of alcohol use disorder can include an increased tolerance, difficulty controlling use, symptoms of withdrawal, preoccupation with alcohol, impairment of major functions in life — ability to live, love and learn — inability to stop drinking even though they have expressed a desire to decrease or stop drinking.

Mental Health First Aid uses a four-question screen to determine if someone is at risk for alcohol use disorder

Rapid Alcohol Problems Screen

During the past year, have you had a feeling of guilt or remorse after drinking?
During the past year, has a friend or family member told you about things you said or did while you were drinking that you could not remember?
During the past year, have you failed to do what was normally expected from you because of drinking?
Do you sometimes take a drink in the morning when you first get up?

Yes to any of these questions indicates that a person’s drinking is harmful to their health and well-being. The person should receive a full evaluation from a qualified professional, according to the Mental Health First Aid curriculum.

Risk factors

Availability
Social factors
Genetic predisposition
Sensitivity
Learning
Other mental health problems

“I think it is important we change our frame of understanding around substance use disorders. For a long time, it has been thought of as a moral failure and maybe we have not had as much patience with people who have substance use disorders,” Conner said, “but realistically it is a physical addiction. It’s an illness.”

How to help

The course offers the acronym ALGEE to help first aiders remember the steps in aiding in a mental health crisis.

Access risk of suicide or harm.
Listen non-judgmentally
Give reassurance and information
Encourage appropriate professional help
Encourage self-help and other support strategies

Alcohol and drugs can lower inhibition. About 26 percent of people who complete suicide have a substance use disorder.

In addition to suicide and self-injury, a person with substance use disorder can have medical emergencies, including alcohol poisoning, overdose or severe withdrawal that will need medical attention.

Continual vomiting; vomiting while unconscious; person falls into unconscious state; signs of head injury; irregular, shallow breathing; irregular, weak pulse; and cold clammy pale or bluish skin are all signs of alcohol poisoning. Call 911. If a person is unconscious, roll them on their side until medical help arrives to avoid the person choking on vomit.

Confusion, visual hallucinations, agitation, fever, seizures and blackout are signs of severe alcohol withdrawal. Seek medical attention.

Some people when they drink may become aggressive. Don’t put yourself or others in harm’s way.

Remain as calm as possible and try to de-escalate the situation by talking calmly, not arguing, not threatening, refrain from using negative words, don’t restrict the person’s movement, consider taking a break to allow the person to calm down, according to the MHFA curriculum.

The only thing that can really help a person sober up is time. Black coffee, water and other cures are a myth, Amy Byrd, MHFA trainer, said.

Talk when you are both sober and when you are in a calm frame of mind, Amy Bird, MHFA trainer, said.

“It is very different dealing with a friend or family member who you love and you really care about, not that you don’t care about your co-workers or someone you don’t know as well. This can be a really emotional topic,” Bird said. “There may be kids involved or someone else you love. There can be a lot of anger and a lot of emotion. The time to talk about your concerns is not when you are really upset or angry because then you are going to be talking out of emotion.”

A person who has a substance problem might not have good insight into their problem. They might not recall everything that happened when they were intoxicated. Pointing all of those things out, though, might not be helpful.

“My perception of what is going on and their perception of what is going on may be two very different things,” Bird said.

She suggested refraining from assigning labels, such as alcoholic or drug addict.

As when dealing with other mental illnesses, try to focus on “I” statements and avoid “you” statements that may seem to assign blame —”I am concerned about your drinking?” instead of “You are drinking too much.”

“I am not saying you are a bad person. I am concerned about what you are doing, but I am not saying you are bad,” Bird said.

When you try to give reassurance, the G in ALGEE, consider the following:

Changing a substance use habit is not easy.
Willpower is not always enough.
Advice alone might not help a person change their behavior.
If abstinence from drinking is not the person’s goal, reducing the quantity consumed is a worthwhile objective.
A person may attempt to change or stop their behavior more than once before they are successful

Don’t join the person in drinking or substance use. Don’t try to control the person through nagging or threatening. Don’t make excuses for the person to cover up their substance use or behavior. Don’t take on the person’s responsibilities. Try not to feel guilty. You are not responsible for someone else’s substance use.

“Sometimes addressing underlying depression or anxiety [may help],” Bird said. “Asking people, ‘What does drinking do for you?’ Not just assuming you are drinking because you want to be drinking.”

Major life changes may be required in recovery.

“In AA, they talk about when you get sober you have to change your playmates, your playthings and your playgrounds,” Bird said.

Treatment does not necessarily mean inpatient rehab. You may start with your primary care physician, a drug and alcohol specialist, mental health professional, certified peer specialist or a support group, such as Narcotics Anonymous or Alcoholics Anonymous, which have support groups worldwide. There is an app for Apple and Android devices to find AA meetings.

High Plains Mental Health has a 24-hour crisis line that can be reached at 1-800-432-0333. Valley Hope is an addiction treatment facility, which has a site in Norton. They can be reached at 1-800-544-5101.

However, there remains a treatment gap. In 2014, an estimated 22.5 million Americans 12 and older needed treatment for a problem with drugs and alcohol, but just 4.1 million people received help. Money, stigma, lack of insurance, waiting lists and proximity to treatment can all be barriers to receiving treatment, Bird said.

Although you can’t make someone seek treatment, you can be there during treatment. Statistics indicate sufferers of substance use disorder are more likely to be successful in treatment if they have supportive friends and family. Groups for those who have loved ones struggling with substance use include Al-Anon and Alateen.

Other resources

Illustration courtesy Canstockphoto.com