Depressed On Drugs

Person sitting on train track with cloud of smoke in the dark

Using Drugs To Cope With Depression

Not everyone will admit that they use drugs to cope with depression, but it’s quite common. Whether it’s your bottle of liquor, line of cocaine or blunt of marijuana, substance use comes in quite handy in times of depression. But there’s a catch; they actually make your depression worse in the long run because they don’t fix the problem to begin with. Substances only mask the problem, allowing you to believe that you can now live your life without experiencing the symptoms of depression.

Another danger with using substances to cope with depression is the increased risk of impulsive acts. Substances give you more power, freedom and ability to perform acts which you otherwise would not have if you were sober. In relation to depression, the most severe act is a suicide attempt. Because substances impair your judgment as well, you can end up doing something very dangerous towards yourself or others.

Many patients will deny having problems with substances and you can tell so by observing how they become defensive about the topic when you inquire more about their alleged use of a substance. If you pay attention to their body language as well as to the tone of their voice, you will realize that they experience your questions as intrusive, judgmental and even accusatory.

But you’re not doing any of that (hopefully)! What you’re in fact doing is called motivational interviewing; a technique utilized with substance abuse patients that attempts to understand where they are coming from and whether they are ready to make a change, the change being to eventually quit the substance. But patients who are depressed may have a more difficult time with motivational interviewing because many will hide their substance abuse in the first place.

Depressed patients typically have a low self-esteem during their depressive episodes, so the last thing that they want to do is to reveal their problems with substances; some might, but many won’t. Depression and substance abuse is a deadly combination because the substances give more power to the user to commit suicide. In addition, substances and psychiatric medications are never a good mix, sometimes even inducing serotonin syndrome if a combination of cocaine and SSRIs are used.

If you encounter a depressed person and you suspect substance abuse, then you’re likely right. But don’t pressure them to reveal their use; this will almost always backfire. Inquire and show your concern, but allow them to slowly reveal it to you when they are ready. Rather, you want to focus more on their depression because often times, it’s their depression that made them start abusing substances in the first place.

Are you Ready? (This is Defeating Stigma Mindfully)

Malingering At Its Finest

Gangster man with three silver rings smoking cigar

Malingering And Substance Abuse

Psychiatric patients who malinger do not necessarily have any psychiatric issues to begin with. Often times, they have a history of antisocial behavior such as criminality, spending time in the prison system, homelessness and getting involved with heavy substance use. They may have a history of psychiatric-like features, but even then, they’re often secondary to substance abuse or malingering for the sake of secondary gain.

What is secondary gain? This is when a malingerer wants to obtain something of personal interest, such as spending time in the hospital in order to avoid upcoming court dates. Malingerers are street smart; they know what to say and how to act in the emergency room in order to earn themselves a night or two in the hospital.

The problem with malingerers is that if they tell a psychiatrist in the emergency room that if they do no get admitted, they will cut their throat, jump off the bridge or OD on substances, it puts the psychiatrist in a corner; this corner often leads to the psychiatrist admitting the patient for the sake of the patient’s life.

Even though you may suspect someone to be a malingerer does not mean that the person won’t actually try to kill themselves. For instance, if as a psychiatrist you decide not to admit the malingerer to the hospital and they go and jump in front of a train, there can be potential liability if their family pursues a legal investigation.

That’s because anyone that actually shows up to an emergency room and talks about depression and suicidal ideations is already in a state of mind that is not considered normal. Unfortunately, you have people who abuse the system such as those who are homeless and want a bed to sleep and food to eat when it’s 10 degrees outside.

It’s very difficult as a psychiatrist to accept or deny malingerers into a hospital. Accepting them is difficult because you suspect that they are playing you for a fool, but you also don’t want to take a chance with legal liabilities and them actually harming themselves. Denying them is also difficult because you are now taking a chance that they won’t actually kill themselves.

Believe it or not, even after a malingerer obtains a hospital admission, they may decide to cut their hospitalization short due to getting annoyed over something such as “cold food.” So even though they have a place to sleep, food, psychiatric medications and round the clock care and comfort, they may ask for a discharge the very next day for reasons not even worth further mentioning.

Unfortunately, malingerers are part of the healthcare system and they have to be dealt with. But even for them I feel bad because at the end of the day we are all human beings!

Are you Ready? (This is Defeating Stigma Mindfully)

Living In A Suicide Forest

Two persons hugging trees in a dark forest

Suicide Squad To The Rescue

When some people suffer from chronic, passive suicidal ideations, their lenses have become so dirty from the forest that they have been living in, that they can no longer properly see what lies ahead. They venture deeper into the forest with not many options, but only to blindly traverse the path of unknown destination. Living in a suicide forest is like jumping in a zoo exhibit of hungry lions slowly approaching you for their next meal.

No one in their right mind requests to visit a suicide forest. These forests grow all around us; you don’t have to go searching far. The problem with these forests is that once you enter them, it becomes very difficult to come back out alive. As soon as you cross the imaginary perimeter surrounding a suicide forest, you are drawn in like a black hole.

What usually drives one into a suicide forest? Typically, it’s major depressive disorder or substance abuse that draw people near the imaginary line. These mental illnesses are so powerful that if you lose your grip on them, it’s almost inevitable that you won’t end up staring at death trees all around you.

How does it feel to traverse a suicide forest? No one can really tell you, unless they have been there and have come back out alive. But once in these forests, people tend to see no way out of their depression; no matter how positive they try to be, they just can’t see the light anymore. Suicide forests receive little light from the sun; they remain dark most of the day.

Even when light from the sun makes it through, people tend to remain in their rut and seem to struggle with experiencing happiness. Eventually, only one destination manifests in their minds: committing suicide. They realize that they have no chance of getting out of the suicide forest by themselves, so they prefer to just end everything right there and then.

But that’s where we come in; the suicide squad! Everyone in the world can join this free squad. It just requires patience, will and the determination to help those in need who have been stuck in suicide forests for days, months, years or even decades. Saving depressed people does not require us to actually enter suicide forests.

The nice feature about suicide forests is that when we talk from their imaginary line making up their borders, our words resonate throughout the entire forest, making it easy for the victims to hear us. In other words, they can be miles away and still hear us clearly. But this does not mean that it’s an easy task to get them out of there. But at least we can try.

This is the suicide squad. Are you ready to join and help over 200 million people worldwide who are suffering from depression and stuck in suicide forests?

Are you Ready? (This is Defeating Stigma Mindfully)

Homelessness Epidemic In America

Homeless man in subway station holding card with seeking human kindness text

How To Solve Homelessness

There is no doubt that America has a homelessness problem, especially on the west coast. There are many reports of homeless people attacking innocent pedestrians, breaking and entering, contaminating streets with human feces and spreading disease. But what is causing all of this and can it be controlled and prevented?

Chronic substance abuse is spreading like a wildfire. We have an opioid and methamphetamine epidemic plaguing our country, K2 polluting the minds of our youth and poor and e-cigarettes ruining our respiratory health. Add to these problems the ongoing rise in alcohol consumption, the legalization of marijuana and the continued prevalence of cigarette smoking and you have yourself a nicely painted picture of why homelessness is flooding our streets.

Secondly, there is ongoing financial instability caused by unemployment or underemployment. This factor is definitely influenced by others because if someone is struggling to maintain a job, they can always find some other type of work to support themselves. But some regions of the United States are still struggling with unemployment; on top of that, add substance abuse and mental illness and you have yourself another reason for the rise in homelessness.

Mental illness is another contributing factor. Many people remain under-treated or not treated at all. They either have no access to mental health resources, their families do not believe in mental illness or they remain noncompliant with medications because of stigma. With mental illness affecting judgment and decision-making, it is no wonder why people become homeless.

Do not rule out domestic abuse! Most of the time, it is due to men physically or psychologically abusing their spouses. In these cases, women become conditioned to remain in their relationships out of fear of upsetting their man. They also have a fear of leaving, losing their relationships and starting all over; they become dependent. But in some situations, when they do leave and have no family or social support, their newfound home becomes the streets.

So what is the solution? First of all, we need to address substance abuse and mental illness at a more aggressive rate. We need more governmental support and action. Rather than wasting time and energy fighting wars overseas or improving military technology, let’s use those resources to advance psychiatric research, improve rehabs and treatment centers, offer more social support, come up with advancements in medications and end mental health stigma.

Let us shed more light on the importance of helping each other mentally, physically and even spiritually. We remain a divided society because we are divided within ourselves. We are engulfed in technology, social media and work; we are becoming robotic, isolated and less relatable. We need to connect with each other, provide empathy and support for one another and come together in times of need; not just when there is a mass shooting or natural disaster.

The DSM Ready Movement is providing the foundation. Are you willing to build upon it and spread this opportunity to the rest of humanity?

Are you Ready? (This is Defeating Stigma Mindfully)