How to get help for a friend or loved one

Do you suspect your friend or loved one may have a concurrent disorder?

It can be very distressing to realize that someone close to you has a concurrent disorder. You may have suspected that this is the case for some time, or there may be some event or series of occurrences that leads you conclude that they may well be struggling with both mental health and substance use issues. You may feel shocked, confused, bewildered, and very likely overwhelmed and helpless. There is no right or wrong way to feel.

You may find it hard to take the first step to obtain help. There can be many reasons for this. You may be unsure what the problem is. One of the most challenging aspects of concurrent disorders is trying to sort out what is causing certain behaviours or symptoms to manifest - for example, is it depression that is causing them to have a low mood and retreat from social encounters, or can what you are witnessing be better explained by the fact that they are abusing alcohol, a depressant, that is forcing them to stay away from family and friends out of shame, guilt or just a shift in priorities?

Add to this the fact that your loved one may not even be willing to admit and/or discuss that they might have a serious problem that needs professional intervention; many mental illnesses and most substance use problems are disorders of denial, and simply pointing out or trying to convince the person that they have a problem rarely results in any real changes on their part. Indeed, they may not even know that they are unwell, as both disorders also tend to be characterized by a lack of insight into the problem.

It can be extremely difficult and frustrating to cope with a person who has both a mental health and substance use disorder. However, there are professionals out there who are trained and experienced at helping people who present with both issues together, so it is important to try to stay encouraged and hopeful, and to do your best to get them the help they need.

The person you care about may need help to find out exactly what is happening and what type of treatment is required. Help is also needed for families, partners and friends so you can understand what is going on, and to find out how to be involved in the assessment, treatment and recovery process in order to support your loved one through all aspects of their care.

Often the first step when dealing with someone you suspect may have a concurrent disorder is to make an appointment with a local mental health or substance use agency. Many of these services have specialized professionals such as psychiatrists, mental health nurses and counselors who are trained to work with clients with concurrent disorders. Calling or dropping by either type of agency is at least a first step in the process, and once there they can refer you and your loved one to a more appropriate service if need be. This website will have a list of agencies that you can contact.

back to top

When should I consider getting help?

A referral to a mental health or substance use agency, or a specialized concurrent disorders program is a good idea if some of these signs are present:

• Cycles of increased energy, restlessness, and inability to sleep (often seen in bi-polar and anxiety disorders and stimulant use)
• Abnormally slow movements, speech or reaction time, confusion and disorientation (often seen in psychosis and mood disorders, as well as in opiates and benzodiazepine use)
• Sudden weight loss or weight gain (often seen in depression and various substance use)
• Cycles of excessive sleep (often seen in depression and various substance use)
• Responding to voices or delusional thinking (see in psychotic or mood disorders and crack/ amphetamine use)
• Appearing fidgety, poor eye contact, generally anxious (seen in anxiety disorders and crack/cocaine use)
• Changes to mood (seen with mood disorders and various substance use)
• Progressive severe dental problems (manifestation of poor self care see with psychotic disorders, and especially common with methamphetamine use)

back to top

How do I get treatment and support for a friend or loved one?

It may be hard to get your friend, relative or partner to accept help. The person may be so discouraged about the situation that he or she may not be able to see how treatment might help. People with concurrent disorders are more likely than other people to have other health care issues. But they may not have a diagnosis of concurrent disorders. So, even though you may suspect the nature of the problem, your relative might refuse to accept that he or she needs treatment for concurrent disorders.

It is best to be supportive when trying to get your relative to accept help. It is not helpful to be confrontational. One way to be supportive about getting help is to find where your relative is least resistant to the idea of changing. For example, the person may mention that drinking has a terrible effect on his or her mood. You could then start talking about drinking. You could use this discussion to start the person thinking about getting help.

When your family member is ready to seek treatment, take an active role in helping. An active role could involve, for example:

• Finding treatment and support services
• Setting up an appointment
• Coming to the appointment.

With the consent of your family member, you may also be able to give the therapist information that offers insight into the person's situation.

back to top

How do I make a referral?

Call one of the programs listed on this website. Pick one that serves the area in which the person lives. You will likely speak with an intake worker who will ask you some questions, assess the situation and talk to you about what's next. This information helps to determine whether the individual may fit into the program and what other services may be needed.

Sometimes the person you are worried about may be unwilling to seek help. The intake worker will suggest strategies for you to try. They can also give ideas for other service options (e.g., programs that have the capacity to visit the person in his/her home) that may work to engage the person to seek help.

back to top

We've been told our friend or loved one has a concurrent disorder - now what?

When someone has any chronic problem, it affects his or her entire family. Family members must cope with extra stressors.

Many family members struggle to accept that their relative has both substance use and mental health problems. Some families may accept the mental health diagnosis, but not the substance use problem. They may think the substance use is a sign of "bad" behaviour. Other families may accept the substance use, but find it hard to accept that their relative has a mental health problem. Some families struggle to understand that concurrent disorders are relapsing conditions, and not simply illnesses with a cure.

Family members may feel guilt, shame, grief, depression, anxiety, and/or a sense of loss. They need to recognize that the expectations they had for their family member may change. However, families can play a strong role in recovery. With support and understanding from families, people with concurrent disorders are more likely to have a successful and lasting recovery.

back to top

What role can family and friends play?

Friends and family members can be supportive. By reading the information on this website, you already are being supportive. Family members, partners and friends are very important in the process of recovery. When a person is addressing their mental health and substance use issues, you can provide love, stability, understanding and reassurance. Listed below are other things you can do.

Check on the person's safety

Always take talk of suicide or self-harm seriously. It is important to stay calm. You can:

• Be there to listen to the person's concerns
• Show them that you love and care for them
• See about reducing any stressors that may be adding to their depression
• Notify your mental health professional if the ideas persist
• Try to stay positive

Try to get your friend or loved one's agreement to accept help

Give hope. Assure the person that help is available and that things can get better. Point out that seeking help is a sign of strength rather than a sign of weakness or failure.

Most times, the person will feel relieved that there is help available. Sometimes, however, getting the person to seek help involves overcoming such things as:

• The person's inability to see that something is wrong
• Their fear of appearing strange or abnormal
• Dealing with the stigma associated with mental illness and substance use/abuse
• Simply not being ready &/or willing to change their behaviour/coping mechanisms

Prepare the person for what they might expect. Tell them what you know about what help is available. Reassure them that your decision to seek help is based on your best judgment. Tell them in clear and calm terms what you have noticed that makes you concerned. Reassure them that you will support them throughout. Be patient and persistent. Mental illness and Substance Abuse are manageable. Recovery is possible.

In an emergency situation

In an emergency or life-threatening situation, you must ensure that the individual gets professional help immediately. This may be done by going with the individual to the appropriate service. You can use emergency resources such as your local hospital emergency department, or mobile crisis program, or 24 hour crisis centres.

back to top

How to cope as a family member or friend?

It is important to be yourself and to understand that the lifestyle and outward manifestation of a concurrent disorder is stressful for everyone. You may have a range of feelings - shock, fear, sadness, anger, frustration or despair.

You also spend time comforting or helping your loved one. At the same time, you are also dealing with the usual challenges of family life. As a result:

• You may find that caring for your family member has replaced your own routines and activities
• You may be unsure of how others may respond to the person with concurrent disorders, so you avoid having friends visit your home
• Over time, you may lose touch with your own network of friends.

Mental illness and substance use disorders are not usually short term - they are often chronic, relapsing conditions and as such can continue for months or several years. Be prepared for setbacks, as recovery may not come quickly.

Remember that families, partners and friends also need a period of recovery and time to understand and accept what has happened. Don't keep things a secret. Talking with others, whether they are family members, friends or professionals, can be very helpful.

Recognize signs of stress

You need to recognize signs of stress in yourself. Often, people take a long time to realize how emotionally and physically drained they have become. This stress can lead to:

• Sleeping badly
• Feeling exhausted all the time
• Feeling irritable all the time.

Recognize you own feelings

Your own feelings are important. If you accept your own feelings, you can better help the person who has the concurrent disorders. You may feel:

• Sad that the person has both a substance use and a mental health problem
• Angry that this has happened to your relative and seriously affects you as well
• Afraid of what the future holds
• Worried about how you will cope
• Guilty-that somehow you caused the problem
• A deep sense of loss when your relative behaves in ways that you do not recognize
• Stressed by the extra tasks you have to take on.

Take care of yourself

You need to look after your own physical and mental health. To do this, you need to:

• Find your own limits.
• Make time for yourself. Keep up your interests outside the family and apart from your relative.
• Try to create a support system of friends and relatives you can rely on.
• Think about people you might want to confide in. Substance use and mental health problems are hard for some people to understand. Be careful-confide only in people who will support you.
• Consider seeking support for yourself, even if your relative is not in treatment. Understanding your relative's problems and the impact they have on you will help you cope better. Perhaps join a self-help organization or family support program. Local community mental health clinics, substance use treatment agencies or hospitals may offer such programs.
• Acknowledge and accept that sometimes you will have negative feelings about the situation. These feelings are normal try not to feel guilty about them.

Be ready for a relapse or crisis

Families often avoid talking to their relative about relapses or crises. They fear that talking about a crisis will bring one on, or will upset their relative. Also, everyone hopes that the last crisis was something that only happened once, and will not happen again.

However, the best way to handle a crisis, or possibly avoid one, is to know what to do before it happens. While you focus on wellness, you should also plan for a crisis or relapse. This can help both the ill person and the family to feel more secure.

When your relative or partner is well, plan in advance what to do if problems come back. Consider the following:

• Could you both visit the doctor to discuss your relative's condition and how to deal with a possible crisis?
• Will your relative give you advance permission to contact his or her doctor?
• Do you have your relative's consent to take him or her to hospital in a crisis? If so, which hospital has your relative chosen?
• If your relative becomes ill and cannot decide on treatment, does he or she agree that you can decide?

You may want to write down the terms that you and relative have agreed on. This can help to ensure that the terms are followed. You can also build a good relationship with a therapist and have a pre-arranged emergency plan to avoid a crisis.

back to top

Tips for helping your friend or loved one

1. Learn as much as you can about the causes, signs and symptoms and treatment of the problems your family member has.  This will help you to understand and support your family member in recovery. Acknowledge and accept your own feelings. Having conflicting emotions is normal. Knowing this can help you control these emotions, so you can support your relative through recovery.

2. Encourage your friend or loved one to follow their treatment and recovery plan. Encourage the person to attend treatment sessions regularly. If the medication doesn't seem to help, or the side-effects are uncomfortable, encourage the person to:

• Speak to the doctor, nurse, therapist or other member of the treatment team
• Speak to a pharmacist, or
• Get a second opinion.

Go with your friend or relative to an appointment, to share your observations. Support your friend or relative's efforts to avoid things that may trigger substance use.

3. Learn the warning signs of self-harm or suicide.  Warning signs include:

• Feeling increasing despair
• Winding up affairs
• Talking about "When I am gone . . . ."

If the person makes any threats, take them very seriously - get help immediately. Call 911 if necessary. Help your friend or family member to see that self-harm or suicidal thinking is a symptom of the illness. Always stress how much you value the person's life.

4. When your friend or family member is well, plan how to try to avoid crises. With your friend or family member, work out how to respond to a relapse or crisis. Prepare for how you will deal with:

• A substance use relapse
• An episode of mental health problems
• Other potential problems.

5. Remember your own needs. Try to:

• Take care of yourself
• Keep up your own support network
• Avoid isolating yourself
• Consider entering therapy for yourself
• Acknowledge the family stresses of coping with concurrent disorders
• Share the responsibility with others, if possible
• Don't allow the problems to take over your or your family's life.

6. Recognize that recovery is slow and gradual.  Know that your friend or family member needs to recover at his or her own pace. You can support recovery from an episode or relapse in these ways:

• Try not to expect too much, but avoid being overprotective
• Try to do things with your friend or relative rather than for him or her - that way, your relative will slowly regain self-confidence.

7. See concurrent disorders as an illness, not a character flaw. Treat your friend or relative normally once he or she has recovered. At the same time, watch for possible signs of relapse. If you see early symptoms, suggest a talk with the care provider.