The Stigma of Co-Occurring Disorders


Originally published on Psych Central

There is a great deal of stigma attached with both mental illnesses and addictions. That is one reason I talk about my experiences. So, others won’t feel alone, and, to put a face to these conditions. It is scary to get a diagnosis of a life-long mental health condition that all you have heard are extreme negatives. People can lose hope. And, people fear what they don’t know.

I also have shame, or self-stigma. I have worked on accepting the schizoaffective diagnosis and at this point am okay. There was a time when I felt, less than, because of the severe symptoms. Now, I know I could not control what happened in the past, and just work on staying stable.

Social anxiety is something I contend with daily, and I cannot seem to prepare enough. I don’t know if I can ever accept how limiting it is for me. There are some things, like volunteering at my children’s school events, that are just too busy for me. I cannot enjoy shopping or parties, I just want an exit. I have worked very hard on this and work with people now and even do public speaking, but it is difficult.

The alcohol addiction label is new to me. In the program I am doing, SMART Recovery, they don’t give labels. But, I need to call it something. The drinking is not new, just the acknowledgement.

There are choices of programs for changing addictive behaviors. Some people work more than one at a time. This was just one that seems to fit my philosophy. It uses cognitive behavioral therapy (CBT) principles and I already learned some of those for my anxiety.

I haven’t had serious consequences from drinking. No DUIs or jail time, No relationship problems. But, I drink more than I would like  and it is hard for me to abstain completely.

I decided I would like to write about the alcohol component along with the mental illness. So many of us have co-occurring disorders. I was excited, and then, I paused. What will people I know think when they see ‘alcoholic’?

I couldn’t decide which was the worst of 2 stigmas. It doesn’t matter.

Info on SMART Recovery

Info on Alcoholics Anonymous (AA)

Meeting of the Minds, 2015

Two weeks ago, I attended Meeting of the Minds. This is a conference that is held every year in Orange County, CA, for mental health professionals, first responders, patients (whom the conference calls “consumers,” but that term always sounds odd to me) and family members. These are the sessions I attended:

Accessing Mental Health Services in Orange County: This is the third year in a row that I have attended a session that had something to do with available county services. Why, when I could pick a different topic each year? Mainly because I wanted to see what might be changing in the wake of the Affordable Care Act. Two years ago, the session I attended was all about what we could expect from the Affordable Care Act, and, above all, how to get the word out to people who would be eligible for subsidies and get them to sign up. Last year, it was all about what was new with the Affordable Care Act, which mainly boiled down to people on Medicaid (called Medical in California) being able to get mental health services before they are in dire crisis (plus, since California isn’t one of the states that rejected the Medicaid expansion, more people can get Medical). This year was different; the changes from the Affordable Care Act have already happened, and the focus was not so much on what has changed as on what the services are, going forward. There were two sections to the session, one on Caloptima (the provider for everyone on Medical in Orange County – this varies from county to county), and one on the OC Links information and referral line.

As of March 31, 2015, Caloptima in Orange County had 730k members, up from less than 500k before the Affordable Care Act. There’s also a behavioral treatment program for autism spectrum disorder that’s new as of September, 2014. Otherwise, the mental health services available are, as they were last year, individual and group therapy, psychological testing, outpatient monitoring of drug therapy, psychiatric consultation, and Screening, Brief Intervention, and Referral to Treatment (SBIRT), a program where primary care physicians screen their patients for alcohol abuse.

OC Links is a phone number to call for all kinds of referrals related to mental health (855-OC-LINKS). It differs from 211 in being specifically focused on mental health.

OC CAT and PERT: This session covered two things. CAT is for Centralized Assessment Team, a team that you can call to come to wherever you are and do an assessment as to whether someone is a danger to self or others, and might need to be committed on a 5150. They can get anywhere in the county usually within 30 minutes (in an immediately life threatening situation they advise calling 911 instead). What you get are mental health professionals who work closely with the police; cops will come with them, but it will be mental health professionals who do the evaluation. PERT is related in that it also involves mental health professionals riding with police and helping them learn to better handle people in their area who have mental illness. A trained clinician rides with a patrol 1 to 5 days a week, and the city involved develops a team of police officers with additional training related to working with people who are mentally ill. We heard from police officers in Newport Beach and in Anaheim, and the mental health professionals who rode with them.

Keynote speech at lunch: This was about the treatment of PTSD in veterans. The speaker clearly knew his topic well, and had some of the most compelling information of any keynote speech I’ve heard at the several Meeting of the Minds conferences I attended. That was the good part. The bad part was that, in the part of the room where I was sitting, he was not very audible at all. It took constant concentration to hear what he was saying, and this situation got worse as people around me gave up on hearing the talk and began talking about other things. Maybe the mic needed adjusting? What I did get out of the talk was that perhaps 16% of veterans have PTSD, and as many as 30% of those wounded, and that while only a very small percentage recover on their own, around two thirds can get better with proper treatment. The treatment was multi-faceted, and I wish I could have heard all of it, but I gathered that it included yoga, meditation, cognitive behavioral therapy for insomnia, and prolonged exposure with breathing.

New Diagnostic Test and Treatments for Depression: This session discussed three things. The MDD Score is a simple blood test for biomarkers associated with depression. It includes neuroendocrine, metabolic, neurotropic, inflammatory, etc. biomarkers, for an overall score that says whether you’re likely depressed. The GeneSight Psychotropic Test looks at genes that may affect your body’s response to and metabolism of different psychotropic drugs, to help in selecting which drug to give you. And Transcranial Magnetic Stimulation is a treatment for depression, where you sit in a chair and get a magnetic pulse sent through your brain. It’s still not covered by Medicare in California (though it is in some states), but is covered by some insurance plans.

I have more notes on the talks, but that’s the gist of what they were about.



How Far Would You Go?

We are quick to judge someone who abuses drugs. But shouldn’t we evaluate what led them to use such methods in the first place?

The first time I smoked weed was because I felt depressed and wanted to feel anything else. I didn’t know I was in a depressive episode at that time.

I no longer use it, I actually rather despise the substance.

But it is not the only drug.

I want to feel guilty about abusing my psychiatrist’s trust but I am not the type to feel much remorse.

The powder can work better than the whole. Your nose may ache and the initial rush is so heavy you feel like your heart will explode out of your chest. But I found if you balance the drug with another… then you can excel.

In a way, it is typical cliche college student. They say a ridiculous amount of college students abuse stimulants but I’m not sure of how accurate that is. I have yet to meet any who do but then again- I don’t have many friends and I’m sure it is not something most will announce to the world.

It is not something I do that often, at least not anymore. It is something I do when I’m desperate. I felt so stressed out that I couldn’t function- I couldn’t focus, I couldn’t get started- and the seconds were ticking away.

The pressure to never fail. Not a single class. You want to go to grad school, don’t you? You want to be a success, you want this career because for some reason you have equated it to happiness.

You’d do an awful lot to get this, wouldn’t you?

There are some who would go further than I am. Sabotage their peers even. I am not so devious.

Shouldn’t I feel bad that I have to use these methods at times? I should but I don’t. Like I said earlier, I’m not the type to feel guilt. Would I feel more accomplished if I did it the “right” way? Eh. Maybe. But I’d probably see no real difference. Either way I got the work done- that’s what matters, right?

I’m driven to these methods by expectations. Expectations that were put on me by family and by myself. Ever since I was little it was like my whole life revolved around my future career. Was it my fault? I don’t know. My siblings are all older than me by quite a bit. When I was old enough to start having a good concept of the future, my siblings were all determining what they wanted to do in this world. It made me ask myself the same question. And for as long as I can remember I have had a career goal. I revolve my life around it. But I don’t want to. I want to be happy and have fun.

So I come to be between a rock and a hard place. I can either spread out the time spent studying by not going out drinking or I can get it done in one night by working excessively (and perhaps with a little help) and go drinking.

I’ve done this to myself. I feel trapped in a world where career is everything. But to get to career, I have to get through college. And let me be honest- I hate college. Or at least, I hate the pressure. The deadlines, the high marks, everything. I wish I could learn in an enjoyable way. But let’s face it, I hate my major. I love my minor. Both are useless unless I can get into grad school. I’ve given up on med school, which is what I have completely devoted my college classes towards and it is too late to go back. I am shifting my goal but it doesn’t exactly align with what I’ve done.

What a mess.

Stability… does that word even truly apply to me, ever? You would think so. But I don’t think so. I am always a little up or down. Always have some unhealthy addiction. Am always a little self destructive.

Tonight I used unethical means to get some school work done.

But will you judge me before you even consider what made me want to?

Don’t call me lazy. But if you want… you can call me desperate.


The Dangers of Online Mental Health Quizzes

Alright so this is a big topic for me. A fellow author posted a link to a ridiculous quiz on Facebook that I feel the need to (and was asked to) write about.

I am going to take this quiz, step by step, and report exactly what I think about it. And after I will tell you why these quizzes aren’t just silly or stupid, but dangerous (with my anecdote evidence- reliable I know).

Alright, so when you click on the quiz, it starts off by saying, “Are you prone to dramatic and unpredictable mood-swings? What about anxiety and frustration? What’s your level of uniqueness? Find that all out right here.” Right off the bat I am annoyed. This perpetuates the stereotype that bipolar is sudden changes in mood. Going from happy to sad and back in a second. Unless you have extremely rapid-cycling bipolar, this is very unlikely. Bipolar is experienced in episodes. Generally meaning they have to last at least a few days. Although I do have little spikes of bipolar feelings, they aren’t full episodes and are mostly just annoying.

And for anxiety and frustration, yeah those can happen. I have anxiety that is sometimes correlated with my bipolar. But bipolar itself doesn’t specify that you need to have anxiety. Additionally, “frustration?” Really? Who doesn’t experience that? And lastly- “What’s your level of uniqueness?” That makes me want to hit my face on my keyboard. Being bipolar is unique in a sense, because a small amount of the population experiences it. But in this context it is taken in a positive way. In the United States we have a culture where individualism and self-expression is very important. If you’re unique, then it’s usually considered a good thing. But as far as I’m concerned, bipolar is not a good thing.

And then, of course, it adds that this should be used as a diagnostic test. And I’ll explain later why that really doesn’t matter.
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