substance
use
psychosis +
CONTENTS:
WHO IS THIS BOOKLET FOR AND WHAT DOES IT DO? 1
WHAT IS PSYCHOSIS? 1
WHAT IS SUBSTANCE-INDUCED PSYCHOSIS? 2
WHAT ARE PSYCHOTIC DISORDERS? 3
HOW COMMON IS PSYCHOSIS? 4
WHAT CAUSES PSYCHOSIS? 4
PSYCHOSIS AND SUBSTANCE USE 4
WHEN SHOULD I SEEK HELP? 6
HOW ARE PSYCHOTIC SYMPTOMS TREATED? 6
TIPS FOR STAYING WELL 7
TECHNIQUES FOR STAYING WELL 9
WHERE TO GET HELP 15
ABOUT THIS BOOKLET:
This booklet is part of a series on mental health and substance use funded
by the Australian Government Department of Health and Ageing.
Substance use in this booklet refers to the use of alcohol, tobacco and
other drugs.
Other booklets in this series include:
• TraumaandSubstanceUse
• MoodandSubstanceUse
• AnxietyandSubstanceUse
• PersonalityandSubstanceUse
Available at www.ndarc.med.unsw.edu.au
>> 1
WHO IS THIS BOOKLET FOR AND WHAT DOES IT DO?
• Thisbooklethasbeenwrittenforpeoplewhousealcohol,tobaccoorotherdrugs
whoareexperiencingsymptomsofpsychosis.
• Itaimsto:
—Helpexplainwhysomepeoplefeelthewaytheydo.
—Givesuggestionsaboutthingspeoplecandotohelpmanagethesymptoms
ofpsychosisandsubstanceuse.
WHAT IS PSYCHOSIS?
• Psychosisisacollectionofsymptomsthatoccurtogetheroveraperiodoftime.The
mostprominentsymptomsofpsychosisaredelusionsandhallucinationswherea
personlosestouchwithreality,andhastroubletellingthedifferencebetweenwhatis
realandwhatisnot.Psychosiscanaffectthewayapersonthinks,feelsandbehaves
(seeTable1).
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2  •  PSYCHOSIS  + SUBSTANCE USE
WHAT IS SUBSTANCE-INDUCED PSYCHOSIS?
• Substance-inducedpsychosisisaformofpsychosisbroughtonbyalcoholorother
druguse.Itcanalsooccurwhenapersoniswithdrawingfromalcoholorotherdrugs.
• Themostcommonsymptomsincludevisualhallucinations,disorientationand
memoryproblems.
• Symptomsusuallyappearquicklyandresolvewithindaystoweeks.However,the
personmayhaveanotherpsychoticepisodeinthefutureiftheyusethatdrugagain.
• Whilesubstance-inducedpsychosisistypicallybrief,alcoholorotherdrugusecan
triggertheonsetoflonger-lastingpsychoticdisordersinindividualswhoarepredisposed
todevelopingthem.
Table 1. Symptoms of psychosis
Psychosiscanaffectthewayyoufeelemotionallyandphysically,thewayyouthink,
andthewayyoubehave.Thistableshowssomecommonsymptomsofpsychosis.
Have you experienced any of these symptoms? Tick (4) the box next to the
symptoms that you have experienced.
Thoughts
Jumbledordisorganisedthoughts
Delusions—falsebeliefsthatusuallyinvolveamisinterpretationofperceptions
orexperiences(e.g.,thinkingthatsomeoneisouttogetyou,thatyouhavespecial
powers,orthatpassagesfromthenewspaperhavespecialmeaningforyou)
Hallucinations—seeing,hearing,smelling,sensingortastingthingsthat
otherscannot
Feelings
Confusion
Fear
Agitation
Lackofinterestinactivities
Behaviours
Difcultycarryingonorkeepingtrackofconversations
Havingtroublerememberingthings
Difcultymaintaininghygieneandotherdailyactivities
Inappropriatebehaviour(e.g.,silliness,laughinginappropriately)
Becomingangryorupsetfornoparticularreason
Becomingveryinactiveorlethargic
Becomingcompletelyunawareofthesurroundingenvironment
WHAT ARE PSYCHOTIC DISORDERS?
• Thereareseveraldifferenttypesofpsychoticdisorders(seeTable2).Psychoticdisorders
arecharacterisedbasedonthetypeofsymptomsexperiencedandhowlongtheperson
hashadthem.Somepeopleexperienceshortepisodesofpsychosisthatlastafewdaysor
weeks.Others,suchasthosewithschizophrenia,experiencelongerepisodesofpsychosis.
• Psychoticsymptomsmayalsobepresentinpeoplewithmajordepressivedisorderor
bipolardisorder.Forfurtherinformationontheseconditionspleaseseethebooklet
Mood and Substance Useinthisseries.Psychoticsymptomsmayalsoarisefroma
medicalcondition(e.g.,headinjury,braintumour).
Table 2. Types of psychotic disorders
Brief psychotic disorder
Apersonwithbriefpsychoticdisorderexperiencespsychoticsymptomsforlessthan
onemonth.Symptomsareusuallytriggeredbyanextremelystressfulevent(e.g.,death
ofalovedone).
Schizophreniform disorder
Thisiswhenapersonhassymptomssimilartoschizophrenia,thatlastmorethanone
month,butlessthansixmonths.
Schizophrenia
Adiagnosisofschizophreniaisgivenwhenapersonhashadsymptomsofpsychosis
foratleastsixmonths.Themajorsymptomsofschizophreniaincludedelusions,
hallucinationsandjumbledthoughts.Apersonwithschizophreniamightalsohave
thinkingdifculties(e.g.,troubleconcentratingandrememberingthingsmuchmore
thanusual);theymightexperiencelossofmotivationtoperformeverydayactivities;
theycouldhaveasignicantreductionintheirabilitytoexperienceandexpress
emotions;andtheymightwithdrawfromsocialsettingsandpersonalrelationships.
Schizoaffective disorder
Apersonwithschizoaffectivedisorderexperiencesthesymptomsofschizophrenia
aswellasthesymptomsofamooddisorder,suchasdepressionormania.Formore
informationonmooddisorders,seethebookletMood and Substance Use.
Delusional disorder
Apersonwithdelusionaldisorderhasstrongbeliefsaboutthingsthatcouldoccurin
reallifebutwhicharenottrue.Forexample,theymightthinkthatpeoplearefollowing
them,orarelisteningintotheirphonecalls.Thesebeliefsneedtobepresentforat
leastonemonth.
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4  •  PSYCHOSIS  + SUBSTANCE USE
HOW COMMON IS PSYCHOSIS?
• Psychosisisnotuncommon—aboutthreeinonehundredAustralianswillexperience
apsychoticepisodeatsomepointduringtheirlife.Peoplewithpsychosisaremuch
morelikelytohaveanalcohol,tobaccoorotherdrugproblemthanpeoplewhodonot
experiencepsychosis.
WHAT CAUSES PSYCHOSIS?
• Thecausesofpsychosisarenotfullyunderstood.However,itislikelythatacombination
offactorsleadtothedevelopmentofpsychosisorpsychoticdisorders,including:
—Afamilyhistoryofpsychosisorpsychoticdisorders
—Chemicalimbalancesinthebrain
—Lifeexperiences(e.g.,stress,traumaticevents,illness)
—Alcoholorotherdruguse
PSYCHOSIS AND SUBSTANCE USE
• Asmentionedinthesectionofthisbookletonsubstance-inducedpsychosis,alcohol
orotherdruguse(orwithdrawal)cantriggerapsychoticepisode.
• Peoplewhohaveexperiencedasubstance-inducedpsychoticepisodeareathighrisk
ofexperiencinganotherpsychoticepisodeinthefutureiftheyusethatdrugagain.
• Peoplewhohaveexperiencedpsychosistendtobeparticularlysensitivetotheeffects
ofdrugsandcanexperiencenegativeeffectsevenatverylowlevelsofuse.
• Sometimespeoplewithpsychoticdisordersuse
alcoholorotherdrugstohelpthemcopewith
theirsymptomsofpsychosis.Thisisoftencalled
‘selfmedication’.Whilethismayprovidesome
short-termrelieffromsymptoms,alcoholand
otherdrugusecanmakeaperson’sexisting
symptomsworse.Inaddition,somepeoplend
thattheydevelopalcoholorotherdrugproblems
becausetheyusegreateramountsmore
frequentlytocopewiththeirpsychosis.
• Thiscanleadtoacyclewherepsychosis
symptomsandalcoholorotherdrugusefeed
offeachother(seeFigure1).
Figure 1:Cycleofpsychosissymptoms,cravings,and
alcohol,tobaccoorotherdruguse
Alcohol, tobacco
or other drug use
Psychosis
symptoms,
low mood
or anxiety
Craving
What happens to your symptoms of
psychosis when you reduce or stop
drinking, smoking or using? Do you
notice any changes?
What happens to your alcohol, tobacco or other drug use when you
are experiencing symptoms of psychosis?
Aside from using alcohol, tobacco or other drugs, what are some
other things you can do to distract yourself from your symptoms of
psychosis (e.g., going for a walk, listening to music, reading a book,
watching TV and so on)? Are there situations where your psychotic
symptoms don’t seem so bad?
>> 5
Alcohol, tobacco
or other drug use
Psychosis
symptoms,
low mood
or anxiety
Craving
WHEN SHOULD I SEEK HELP?
• Earlyinterventionisveryimportantinthetreatmentofpsychosis.Thesooneraperson
getstreatment,thelesslikelytheyaretodevelopalong-termpsychoticdisorder.
• Ifyoubelievepsychosismaybeaproblemforyou,orifyouansweryestoanyofthe
followingquestions,youshouldseekprofessionalassistance(seepages15–16):
Haveyouexperiencedhallucinationsordelusions?
Areyoursymptomsverydistressing?
Dotheyinterferewithyourhome,work,study,relationshipsorsociallife?
Doyouusealcohol,tobaccoorotherdrugstocope?
Haveyouthoughtaboutharmingyourselforothers?
HOW ARE PSYCHOTIC SYMPTOMS TREATED?
• Effectivetreatmentsareavailable.Bothpsychologicaltherapyandmedicationcanhelp
peopleaffectedbypsychosis.
Psychological therapy
• Psychologicaltreatmentsusuallyinvolvehands-onsupportandguidancewhichisaimed
atteachingyouabouttheearlywarningsignsofpsychosis.Treatmentsarealsoaimed
atstressmanagementandanxiety,relaxationtraining,employmentprograms,socialand
livingskillstrainingandfamilyeducation,aswellasdrugandalcoholprograms.These
treatmentswillalsoencourageyoutokeephealthyandgetplentyofexercise.
• Ifyou’reinterestedinseeingapsychologist,yourGPcanhelpyoubypreparingamental
healthplan,andreferringyoutoanappropriatepsychologist.
Medication
• Medicationmaybehelpfulalongsidepsychologicaltherapy.Therearemanydifferent
typesofmedication,whichincludeanti-psychoticandanti-depressantmedications.
• Medicationscanbehelpfulinmanagingyourpsychoticsymptoms;however,somepeople
experienceunpleasantanddistressingsideeffects.Inmostinstancesthereisachoiceof
medicationavailable,butitmaytaketimetoestablishwhichmedicationisbestsuitedto
yourneeds.Tellyourdoctoraboutanysideeffectsthataredistressingyou.
Interactions with alcohol, tobacco or other drugs
• Itisveryimportantthatyoufollowyourdoctor’sinstructionswhentakinganymedication
thathasbeenprescribedtoyou.
• Beforebeingprescribedmedicationitisimportanttotellyourdoctoraboutyouralcoholor
otherdrugusesothattheymaygiveyouthebestpossiblecare.Alcohol,tobaccoandother
drugscaninteractwithsomeprescriptionmedicationsandthisinteractionmayalterthe
6  •  PSYCHOSIS  + SUBSTANCE USE
effectivenessofthemedication.Mixingprescribedmedicationswithalcoholorotherdrugs
canalsohavedangerousconsequencesincludingoverdoseandpossiblydeath.
• Ifyouusealcohol,tobaccoorotherdrugsandareonmedication,letyourdoctorknowif
youareplanningtostopusingalcohol,tobaccoorotherdrugs.Whenyoustopdrinking,
smokingorusing,thebloodconcentrationsofothermedicationscanalsobeaffectedso
thedoctormayneedtoadjustthedoseofyourmedication.
TIPS FOR STAYING WELL
Thereareanumberofthingsyoucandotolookafteryourself:
• Recognise early warning signs. Earlywarningsignsofpsychosisincludenotsleeping
well,feelingmoreanxious,stressedorfearfulthanusual,hearingorseeingthings,
andfeeling‘strange’.Ifyouexperiencethesesymptoms,itisimportantthatyouseek
professionalhelptoreducetheriskofdevelopinglong-termpsychosis.
• Take care of yourself.Makesureyoueathealthilyandgetregularexercise.Exercise
canhelpbygivingyouanoutletforthestressthathasbuiltupinyourbody.
• Plan to do something you enjoy each day.Thisdoesn’thavetobesomethingbigor
expensiveaslongasitisenjoyableandprovidessomethingtolookforwardtothatwill
takeyourmindoffyourworries.
What are some things that you like to
do that are pleasant orenjoyable?
• Make time for rest and relaxation.Stressandanxietycanmakeanyproblemsseem
worse.Trytoreducestressandanxietybygivingyourselftimetorestandrelax.Youcanuse
techniquessuchascontrolled breathing, progressive muscle relaxation,ormindfulness(these
techniquesaredescribedonpages9–12),oranyotheractivityyoundrelaxing(e.g.,reading,
listeningtomusic,goingforawalk).Thesetechniquescanalsohelpyoumanageyour
cravingsorurgestousealcohol,tobaccoorotherdrugs.
>> 7
8  •  PSYCHOSIS  + SUBSTANCE USE
• Avoid or limit your use of alcohol, tobacco or other drugs.Alcohol,tobaccoand
otherdrugscanintensifyyourpsychoticsymptoms.Itisrecommendedthatnomore
thantwostandarddrinksshouldbeconsumedeachday(forfurtherinformationrefer
totheAustralianDrinkingGuidelines).Avoidhighdosesofsubstances,andriskydrug
takingbehaviour,suchasinjectingdruguse.Takeregularbreaksfromdrinkingorusing,
andavoidusingmultipledifferenttypesofdrugs.Ifyouhavebeendrinking,smokingor
usingregularlyitcanbedifculttocutdown.Theactivitieslistedonpages9–14ofthis
bookletmayhelpyoucopewithyourcravingsandurgestouse.
• Take medication as prescribed.Avoidmixingprescribedmedicationwithalcohol,
tobaccoorotherdrugs,asthiscouldhavedangerousconsequences,suchasmaking
prescribedmedicationineffective,orincreasingtheeffectsofalcoholorotherdrugs.
• Seek support.Everybodyneedssupport.Talktofamilymembersorfriendsthatyoutrust
aboutyourfeelings,orwritethemdowninadiary.Theserviceslistedattheendofthis
bookletmayalsobeuseful.
• Plan to do something each day that brings a sense of achievement.Ofteneveryday
taskslikewashing,cleaning,payingbillsorreturningphonecalls,tendtopileupwhena
personisgoingthroughahardtime.Thiscanbecomeoverwhelmingasthepilegetsbigger
andbigger.Byjustchoosingoneoftheseactivitiestodoeachday,youcanpreventthings
pilingup,whichcanhelpyoufeelabitmoreincontrolofyourlife.Theow-oneffectcan
bearealsenseofachievement(orrelief)thatthisactivityhasbeencompleted.
• Monitor your emotions.Trykeepingtrackofyouremotionsandpsychosissymptoms
inadiary.Writedownhowyouhavefeltatdifferenttimesoftheday.Whenwereyour
symptomshighest?Whenwereyoursymptomslowest?Whatwereyoudoingandwhat
wereyouthinkingatthosetimes?Whendidyouhavecravingstousealcohol,tobacco
orothersubstances?Howmuchsleepdidyouhaveeachnight?Keepingadiaryofyour
symptomsandemotionscanhelpyoulearnthepatternsbetweenthewayyoufeel,the
thingsyoudoandthewayyouthink.
What strategies do you nd help manage your psychotic symptoms?
>> 9
TECHNIQUES FOR STAYING WELL
Theactivitiesandtechniquesonthefollowingpagescanbeusedtohelpyoumanageyour
psychoticsymptomsandtocontrolcravingstousealcohol,tobaccoandotherdrugs.Youcan
alsousethemeverydayaspartofageneralplantostaywell.Whilemanypeoplendthe
techniquesonthefollowingpagesuseful,theydon’tworkforeveryone.Donotusethemif
youndthemdistressingorunpleasant—itisimportanttondwhatworksbestforyou.
Controlled Breathing Exercise
Haveyounoticedsometimesthatyou’rebreathingtoofast?Stresscanaffectyourheartrate
andbreathingpatterns.
Arelaxedbreathingrateisusually10to12breathsperminute.
Practisethisexercisethreetofourtimesadaywhenyou’refeelingstressedoranxiousso
thatyoucanusethisasashort-termcopingstrategy.
1
Timethenumberofbreathsyoutakeinoneminute.Breathingin,thenoutis
countedasonebreath.
2
Breathein,holdyourbreathandcounttove.Thenbreatheoutandsaythe
word‘relax’toyourselfinacalm,soothingmanner.
3
Startbreathinginthroughyournoseandoutslowlythroughyourmouth,ina
six-secondcycle.Breatheinforthreesecondsandoutforthreeseconds.This
willproduceabreathingrateof10breathsperminute.Inthebeginning,itcan
behelpfultotimeyourbreathingusingthesecondhandofawatchorclock.
4
Counttoyourself.
5
Continuebreathinginasix-secondcycleforatleastveminutesoruntilthe
symptomsofoverbreathinghavesettled.
6
Afterpractisingthisexercise,timethenumberofbreathsyoutakeinoneminute.
Practisethecontrolledbreathingexerciseeachdaybeforebreakfast,lunch,dinner
andbedtime.Usethetechniquewheneveryoufeelanxious.Gradually,you’llbe
familiarenoughwiththeexercisetostoptimingyourself.
Source:beyondblueFactSheet6–ReducingStress2010
10  •  PSYCHOSIS  + SUBSTANCE USE
Mindfulness
Mindfulnessisatechniquethathelpsyoufocusonyourinternalorexternalenvironment,
withoutbeingdistractedorconcernedbywhatsurroundsyou.Mindfulnesscanbeappliedto
anytaskthatyoudo,suchasdoingthewashingup,orbrushingyourteethforexample.This
particularactivityistoshowyouhowtousemindfulnessskillstopayparticularattention
toaroutineactivity(walking).Thistechniquemightseemdifculttostartwith,butifyou
practise,itwillbecomeeasier.
1
First,ndaplacewhereyoucanwalkupanddownwithoutworryingaboutwho
mightseeyou.Itdoesn’tmatterwhereyouare,aslongasyoucantakeabout
10steps.
2
Standinarelaxedposturewithyourfeetpointingstraightaheadandyourarms
hanginglooselybyyoursides.Lookstraightahead.
3
Youwillpractisewalkinglikeitisthersttimeyouhaveeverwalked.Start
walkingandwhileyouarewalking,practisepayingattentiontoallthephysical
andothersensationsthatoccur—sensationsthatyouprobablywouldnot
normallybeawareof.Startbybringingyourfocustothebottomsofyourfeet,
noticingwhatitfeelslikewhereyourfeetcontacttheground.Feeltheweightof
yourbodytransmittedthroughyourlegsandfeettotheground.Youmayliketo
exyourkneesslightlyacoupleoftimestofeelthedifferentsensationsinyour
feetandlegs.
4
Next,transferyourweightontotherightfoot,noticingthechangeinphysical
sensationsandyourlegsandfeetasyourleftleg‘empties’ofweightandpressure
andyourrightlegtakesoverassupportforyourbody.
5
Withtheleftleg‘empty’,allowyourleftheeltoriseslowlyfromtheoor,noticing
thechangeinsensationsinyourcalfmusclesasthishappens.Allowtheentire
leftfoottoliftgentlyofftheooruntilonlyyourtoesarestillincontactwiththe
ground.Slowlyliftyourleftfootcompletelyofftheoorandmoveyourleftleg
forward,noticingthephysicalsensationsinyourfeet,legsandbodychangeas
yourlegmovesthroughtheair.
6
Placeyourleftheelonthegroundinfrontofyouandallowtherestofyourleft
foottomakecontactwiththeoor.Asthishappens,noticethechangesinphysical
sensationsthatoccurasyoutransfertheweightofyourbodyontoyourleftfoot
fromyourrightfoot.Allowyourrightfootto‘empty’ofweight.
7
Repeatthisprocesswiththerightfoot.Firstliftyourrightheelofftheground,then
therestofyourfoot,andmoveitslowlyforward,noticingthechangesinphysical
sensationsthatoccurthroughoutthismotion.
8
Keeprepeatingthisprocessasyouslowlymovefromoneendofyourwalktothe
other,beingawareoftheparticularsensationsinthebottomsofyourfeetand
heelsastheymakecontactwiththeoor,andthemusclesinyourlegsasthey
swingforward.
9
Continuethisprocessupanddownthelengthofyourwalkforabout10minutes,
beingawareasbestyoucan.
10
Yourmindwillwanderawayfromthisactivityduringyour10minutesofpractice.
Thisisnormal—it’swhatmindsdo.Whenyounoticethishashappened,gently
guidethefocusofyourattentionbacktothesensationsinyourfeetandlegs,
payingparticularattentiontothecontactyourfeethavewiththeoor.Thiswill
helpyoustayinthepresentmoment,concentratingonwhatishappeningnow,
ratherthanworryingaboutthepastorthefuture.
11
Tobeginwith,walkmoreslowlythanusual,togiveyouabetteropportunityto
practisethisexercise.Onceyoufeelcomfortablewiththeexercise,youmayliketo
experimentwithdifferentspeedsofwalking.Ifyouarefeelingagitated,youmay
liketostartoffwalkingfast,withawarenessthatthisiswhatyouaredoing,and
thenslowdownnaturallyasyoubegintosettle.
12
Trytoworkthisactivityintoyourdailyroutine—practisewhenyouarewalkingto
thebus,ortotheshops,oraroundthehouse.
>> 11
12  •  PSYCHOSIS  + SUBSTANCE USE
Progressive Muscle Relaxation
Progressivemusclerelaxationinvolvestensingandrelaxingdifferentmusclegroupsone
aftertheother.Ithelpstoreducephysicalandmentaltension.Afullsessionofrelaxation
takesabout15to20minutes.
1
Sitinacomfortablechairinaquietroom.
2
Putyourfeetatontheoorandrestyourhandsinyourlap.
3
Closeyoureyes.
4
Dothecontrolledbreathingexerciseforthreeminutes.
5
Afterthreeminutesofcontrolledbreathing,startthemusclerelaxation
exercisebelow.
6
Tenseeachofyourmusclegroupsfor10seconds,thenrelaxfor10seconds,
inthefollowingorder:
» Hands:clenchyourhandsintosts,thenrelax
» Lower arms:bendyourhandsupatthewrists,thenrelax
» Upper arms:bendyourarmsupattheelbow,thenrelax
» Shoulders: liftyourshouldersup,thenrelax
» Neck:stretchyourneckgentlytotheleft,thenforward,thentotheright,
thenbackwardsinaslowrollingmotion,thenrelax
» Forehead and scalp: raiseyoureyebrows,thenrelax
» Eyes:closeyoureyestightly,thenrelax
» Jaw: clenchyourteeth,thenrelax
» Chest:breatheindeeply,thenbreatheoutandrelax
» Stomach:pullyourtummyin,thenrelax
» Upper back:pullyourshouldersforward,thenrelax
» Lower back:whilesitting,rollyourbackintoasmootharc,thenrelax
» Buttocks:tightenyourbuttocks,thenrelax
» Thighs:pushyourfeetrmlyintotheoor,thenrelax
» Calves:liftyourtoesofftheground,thenrelaxand
» Feet:gentlycurlyourtoesdown,thenrelax
7
Continuecontrolledbreathingforvemoreminutes,enjoyingthefeeling
ofrelaxation.
Source:beyondblueFactSheet6–ReducingStress2010
>> 13
Coping with Cravings
Theeasiestwaytocopewithcravingsorurgestousealcohol,tobaccoorotherdrugsisto
try to avoidthemintherstplace.Thiscanbedonebyreducingyourexposuretocraving
triggers(e.g.,gettingridofdrugsandts/pipesinthehouse,notgoingtopartiesorbars,
reducingcontactwithfriendswhouse,andsoon).Sometimescravingscan’tbeavoided,
andyouneedtondwaystocopewiththem.
Cravingsaretime-limited,thatis,theyusuallylastonlyafewminutesandatmostafew
hours.Ratherthanincreasingsteadilyuntiltheybecomeunbearable,theyusuallypeakafter
afewminutesandthendiedown,likeawave.Everywave/cravingstartssmall,andbuilds
uptoitshighestpoint,beforebreakingandowingaway.
Cravingswilloccurlessoftenandfeellessstrongasyoulearnhowtocopewiththem.Eachtime
apersondoessomethingotherthanuseinresponsetoacraving,thecravingwilllosesomeofits
power.Thepeakofthecravingwavewillbecomesmaller,andthewaveswillbefurtherapart.
Below are some things for you to try out, to cope with the symptoms of cravings.
Put a tick (4) in the box next to those things you think you could do.
Eat regularly,evenwhenyoudon’tfeellikeit.
Drink plenty of water—especiallywhenyougetacraving.
Insteadofdrinking,smokingorusing,drink water or chew gum.
Use‘Delaying’and‘Distraction’whenyourcravingissetoff.Whenyou
experienceacraving,putoffthedecisiontodrinkorusefor15minutes.Goand
dosomethingelselikegoforawalk,read,listentomusic,ordothedishesetc.
Thiswillhelpyoutobreakthehabitofimmediatelyreachingforalcohol,tobacco
orotherdrugswhenacravinghits.Youwillndthatonceyouareinterestedin
somethingelse,thecravingwillgoaway.
What are some things you could do to distract yourself?
14  •  PSYCHOSIS  + SUBSTANCE USE
Usetherelaxationanddeep breathingtechniquesdescribedearliertocopewith
acravingonceitissetoff.Ifacravingdevelopsinresponsetostressfulsituations,
relaxationtechniquesanddeepbreathingexercisesarereallyuseful.
Ride out the craving by ‘urge surfing’.Formapictureinyourmindofawaveat
thebeach.Thisisacravingwave,andrememberthatthecravingwavewillbuild
uptoitshighestpoint,andthenfallawayasitrollsintoshore.Picturethecraving
wavebuildingup,gettingreadytobreak,seeitbreak,seethefoamform,andsee
thewavefadeawayasitrollsintoshore.Now,pictureyourselfridingthewave,
surngthecravingwaveintoshore.Youdon’tfalloff,youdon’tgetdumpedand
churnedaround,justpictureyourselfcalmlysurngthecravingwaveintoshore.
Talk to someone,perhapsafriendorfamilymember,aboutcravingwhen
itoccurs.
Use positive self-talk.Tellyourselfthatcravingsonlylastabout10minutes.Tell
yourself‘thisfeelingwillpass’.Youwillndthattheurgesandcravingsthemselves
willbeeasiertodealwith.Saytoyourself,‘yes,thisfeelsprettybad,butIknowit
willbeoversoon’.
Challenge and change your thoughts.Whenexperiencingacraving,many
peoplehaveatendencytorememberonlythepositiveeffectsofusingdrugsand
oftenforgetthenegativeconsequencesofusing.Remindyourselfofthebenets
ofnotusingandthenegativeconsequencesofusing.Thisway,youcanremind
yourselfthatyoureallydon’tfeelbetterifyouhave‘justonedrink’andthatyou
standtolosealotbydrinking,smokingorusing.
Are there other things you do that help you cope withcravings?
Coping with Cravings continued
>> 15
WHERE TO GET HELP
Thebestplacetostartistosee a doctor.Theycanprovideyouwithfurtherinformation
andareferraltoanappropriatehealthprofessional.Theorganisationsbelowmayalso
beuseful.
Talkingwithtrustedfamily members or friendscanalsobeveryhelpful.Yoursupport
networkcanassistyouinmakingdecisions,helpyouaccessservices,andgiveyouvital
supportthroughyourrecovery.
National
FamilyDrugSupport: 1300 368 186
Lifeline: 13 11 14
Quitline: 13 78 48
SANEHelpline: 1800 187 263
ACT:
Alcohol&DrugInformationService: (02) 6207 9977
CanberraAllianceforHarmMinimisationandAdvocacy: (02) 6279 1670
NSW:
Alcohol&DrugInformationService: (02) 9361 8000or1800 442 599
NSWUsersandAIDSAssociation: (02) 8354 7300or1800 644 413
NT:
Alcohol&DrugInformationService: (08) 8922 8399or1800 131 350
NorthernTerritoryAIDS&HepatitisCouncil: (08) 8953 3172
QLD:
Alcohol&DrugInformationService: (07) 3837 5989or1800 177 833
QLDInjectorsHealthNetwork: (07) 3620 8111or 1800 172 076
QueenslandIntravenousAIDSAssociation: (07) 3620 8111
SA:
Alcohol&DrugInformationService: 1300 131 340
SouthAustralianVoiceinIVEducation: (08) 8334 1699
TAS:
Alcohol&DrugInformationService: (03) 6230 7901or1800 811 994
TasmanianCouncilonAIDS,Hepatitis&RelatedDiseases: (03) 6234 1242
16  •  PSYCHOSIS  + SUBSTANCE USE
VIC:
Alcohol&DrugInformationService: (03) 9416 1818or1800 888 236
HarmReductionVictoria: (03) 9329 1500
VictorianDrugUsersGroup: (03) 9329 1500
WA:
Alcohol&DrugInformationService: (08) 9442 5000or1800 198 024
WesternAustraliaSubstanceUsersAssociation: (08) 9321 2877
Therearealsosomehelpful websiteswhichgiveinformationandguidance.Herearesome:
AustralianCentreforPosttraumaticMentalHealth: www.acpmh.unimelb.edu.au
AustralianDrinkingGuidelines: www.alcohol.gov.au
AustralianDrugInformationNetwork: www.adin.com.au
Beyondblue: www.beyondblue.org.au
BlackDogInstitute: www.blackdoginstitute.org.au
ClinicalResearchUnitforAnxietyandDepression: www.crufad.unsw.edu.au
Druginformationandadvice: www.saveamate.org.au
Druginformationandresearch: www.druginfo.adf.org.au
Druginformation,services,informationandsharedstories: www.somazone.com.au
DualDiagnosis:AustraliaandNewZealand: www.dualdiagnosis.org.au
EarlyPsychosisPreventionandInterventionCentre: www.eppic.org.au
FamilyDrugSupport: www.fds.org.au
Headspace: www.headspace.org.au
HIV,sexualheathanddruginformationforlesbian,gay,
bisexualandtransgendercommunities: www.acon.com.au
MentalHealthNet: www.mentalhelp.net
MentalIllnessFellowship: www.mifa.org.au
Quitnow: www.quitnow.info.au
ReachOut!: www.reachout.com.au
SANE: www.sane.org
SchizophreniaFellowship: www.sfnsw.org.au
SchizophreniaResearchInstitute: www.happinessanditscauses.com.au
>> C
©NationalDrugandAlcoholResearchCentre2011
ThisbookletwasproducedbytheNationalDrugandAlcoholResearch
Centre.ItwaswrittenbyKatherineMills,ChristinaMarel,AmandaBaker,
MareeTeesson,GlenysDore,FrancesKay-Lambkin,LeonieMannsand
TonyTrimingham.Thankyoutoeveryonewhowasinvolvedindeveloping
thisbooklet.
DesignedandtypesetbyPetaNugent
ISBN978-0-7334-3049-7
Thisbookletispartofaseriesonmentalhealthandsubstanceusefunded
bytheAustralianGovernmentDepartmentofHealthandAgeing.
Thisbooklethasbeenwrittenforpeoplewhousealcohol,tobaccoorother
drugswhoareexperiencingsymptomsofpsychosis.
Itaimsto:
• Helpexplainwhysomepeoplefeelthewaytheydo.
• Givesuggestionsaboutthingspeoplecandotohelpmanage
theirsymptomsofpsychosisandsubstanceuse.
Otherbookletsinthisseriesandfurtherinformationonmentalhealth
andsubstanceuseareavailableatwww.ndarc.med.unsw.edu.au