NHS Alcohol, Drug & Emotion

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First Steps, Version 2, February 2013

- 1 - Alcohol, drugs and emotional well-being

A First Steps guide to managing

Alcohol, drugs andemotional well-being



First Steps - 2 - Alcohol, drugs and emotional well-being

What is in this booklet?

Page

Introduction 3

Drugs that may affect emotional well-being

1. Alcohol

2. Amphetamines (speed); Methamphetamine (Crystal Meth)

3. Anabolic Steroids

4. Benzodiazepines

5. Caffeine

6. Cannabis

7. Cocaine; Crack Cocaine

8. Ecstasy (MDMA/MDEA)

9. Heroin (Diamorphine)

10. Ketamine; Phencyclidine (PCP)

11. Khat

12. LSD ((Lysergic acid diethylamide)

13. Magic Mushrooms

14. Methadone

15. Buprenorphine (trade name Temgesic)

16. Mephedrone

17. Research Chemicals (Legal Highs)

18. Solvents

5

Self-help tips for emotional well-being 12

Challenging negative thinking 13

Support networks 15

Keeping a balance 15

The ‘stress jug’ analogy 16

Communication and assertiveness 16

Relaxation exercises 17

Goal setting 18

Distraction techniques 19

Useful contacts 20




Introduction

Of all the people diagnosed with a mental health condition, 29% stated they misuse alcoholor drugs.

Drinking or using other drugs to deal with difficult feelings or symptoms of mental illness issometimes called ‘self-medication’ by people in the mental health field. If this self-medicationbecomes a regular tool for coping, a person can become psychologically dependent. Alldrugs (medicinal as well as illegal) have the potential for unwanted, and often unexpected,effects. They are usually substance and individual specific.

Also, some recreational drugs have been scientifically proven to be physically addictive. These are:

Alcohol (Booze)

Tobacco (Chewing and Smoking)

Heroin (Brown, Skag, Smack, Gear, Horse, H)

Cocaine (Coke, Charlie, C, Snow, Toot, White) Methamphetamine (Crystal Meth, Ice, Tina)

If you rely on drugs to help you feel less anxious or depressed or to improve your mood, youmay be becoming psychologically dependent. If you rely on drugs to achieve certain physicaleffects or you can’t face the unpleasant physical effects of not taking the drugs, you may bebecoming physically addicted. In fact, most drug-related problems generally involve physicaland psychological symptoms and sometimes it is difficult to separate the two.

Other signs that you could be becoming dependent on drugs are:

if obtaining and taking drugs is more important than anything else in your life

if you use drugs to block out both physical and emotional pain

if you use drugs to distance yourself from problems such as loneliness, family orrelationship problems, low self-esteem, poverty or housing difficulties, unemploymentor lack of opportunities

Being physically and/or psychologically addicted (or dependent) means that you will cravemore of the drug, even though it may be doing you physical or psychological harm. Someonemay notice withdrawal symptoms after a period of regular use, which may encourage them to

continue using. This applies for illegal drugs such as cocaine and heroin, as well as legaldrugs such as alcohol.




Withdrawal from a drug can make you very unwell in the short term, so it is important thatyou inform your GP before deciding to stop use of any drug, so that you can access the righttype of support.

Also it is important to remember that there may be many more unwanted side effects fromtaking illegal drugs or alcohol.

The effects of a drug may vary according to the mental state of the person taking it. Astrong mood-altering substance may trigger, or bring out an underlying emotionaldifficulty

Drugs may interact with each other (including legal ones such as alcohol). Somemixtures may even prove life- threatening

With any illicit drug there is no quality control so there is a constant danger of variablestrength and they can be mixed with other substances to ‘bulk up’ the drug

Injecting drugs involves the risk of introducing infections directly into the blood-stream.Sharing of needles is particularly dangerous as it may lead to cross-infections (e.g.HIV and hepatitis)

Drugs taken during pregnancy may damage the foetus




Drugs that may affect emotional well-being

AlcoholAlcohol is the most toxic of the commonly used drugs, but moderate use is not usually aproblem.

Short-term effects: initially you feel relaxed and more sociable, but alcohol is essentially adepressant, and as this effect sets in you may be tempted to drink more in order to recreatethe pleasant effects. Large amounts tend to make people uninhibited and aggressive.

Long-term effects: if you become addicted to alcohol, you may use it as an escape, or as ameans of coping with difficulties. If you drink a lot over a long period, you may find it difficultto form new memories, so that you cannot remember recent events; you may not be able tothink clearly; and may you have difficulty with problem solving and concentrating. You canrecover from these problems if you stop drinking.

Dependency and withdrawal: alcohol withdrawal causes sweating, anxiety, trembling anddelirium (which may include confusion, disorientation and hallucinations). Note: If you are

addicted, it is very dangerous to stop drinking suddenly.

Alcohol in excess can lead to serious physical and mental health conditions. Mental healthproblems not only result from drinking too much alcohol. They can also cause people to drinktoo much.

Put very simply, a major reason for drinking alcohol is to change our mood - or change ourmental state. Alcohol can temporarily alleviate feelings of anxiety and depression; it can alsohelp to temporarily relieve the symptoms of more serious mental health problems.

Alcohol problems are more common among people with more severe mental health

problems. This does not necessarily mean that alcohol causes severe mental illness. ‘Self medicating’ to deal with difficult feelings or symptoms of mental illness is often why peoplewith mental health or emotional problems drink. But it can make existing mental health oremotional problems worse.

Evidence shows that people who consume high amounts of alcohol are vulnerable to higherlevels of mental ill health and it can be a contributory factor in some mental illnesses, such asdepression.

When we have alcohol in our blood, our mood changes, and our behaviour then alsochanges. This change depends on how much we drink and how quickly we drink it.

Alcohol depresses the central nervous system, and this can make us less inhibited in ourbehaviour. It can also help ‘numb’ our emotions, so we can avoid difficult issues in our lives.

Alcohol can also reveal or magnify our underlying feelings. This is one of the reasons thatmany people become angry or aggressive when drinking. If our underlying feelings are of anxiety, anger or unhappiness, then alcohol can magnify them.

One of the main problems associated with using alcohol to deal with anxiety and depressionis that people may feel much worse when the effects have worn off. This can lead somepeople to drink more, to ward off these difficult feelings, and a dangerous cycle of dependence can develop.




Current recommended ‘sensible drinking’ limits are three to four units a day for men and twoto three units a day for women.

1 pint beer (5% vol) = 3 units 1 pint lager (3% vol) = 2 units 1 small glass wine (12% vol) = 2 units 1 measure spirit (40% vol) = 1 unit

Amphetamines (Speed); Methylamphetamine (Crystal meth)Short-term effects: Amphetamines increase attention and alertness and reduce tiredness.

They make you feel energetic and confident.

Long-term effects: as the drug is eliminated from your body, you may feel drowsy, anxious,depressed, and irritable. Amphetamines may also cause a psychotic reaction, with paranoia,especially if you already have a diagnosis of mental health problems.

Withdrawal: symptoms include tiredness and depression. The effects of crystal meth aresimilar to crack cocaine (see below) but longer lasting. The acute effects include agitation,paranoia, confusion and violence.

Anabolic steroidsAnabolic steroids are taken to increase muscle bulk and enhance sporting performance.

The possible adverse effects on mental health are aggression, dramatic mood swings,confusion, sleeping problems, depression and paranoia; these subside after stopping thesteroids.

Dependence: if you have become psychologically dependent on them, you may becomelethargic and depressed, even after you stop taking them.

BenzodiazepinesBenzodiazepines work by helping to calm the brain down. They are prescribed for anxietyand as sleeping pills. Regular street drug users may take them illegally if they can’t get theirusual drug; when they want to add to the effects of other similar drugs, such as alcohol oropiates; or to treat the effects of stimulants, including ecstasy or amphetamines, or to helpwith stopping smoking.

Short-term effects: they relieve tension and anxiety and make you feel calm and relaxed,while allowing you to still think clearly. Sometimes they may have the opposite effect andmake you feel agitated, hostile and aggressive.

Dependency and withdrawal: they should only be prescribed for short-term use, because it isvery easy to become dependent on them, and withdrawal may be very difficult. Withdrawalsymptoms include sleeping problems, anxiety, shaking, irritability, nausea, vomiting, andheightened senses.




CaffeineCoffee, tea and chocolate all contain caffeine. It is also added to some soft drinks and energydrinks as well an ingredient in some painkillers and cold remedies. The average cup of coffeecontains around 40mg of caffeine per cup, a can of cola around 23mg, and some energydrinks have four times that amount. P lain chocolate has 40mg caffeine per 100g – nearlythree times as much as milk chocolate

Sensitivity to caffeine varies from person to person, but too much can make you anxious,restless, irritable, jittery and sleepless. It can also give you headaches, stomach pain,nausea, muscle twitching or palpitations.

Cutting out caffeine in one go can be difficult because you may experience withdrawalsymptoms, including severe headaches as well as nausea, anxiety, fatigue and depression.One way to avoid this is to gradually decrease the amount of caffeine you consume, either bydrinking fewer cups of coffee each day or by gradually switching to decaffeinated coffee. It’simportant not to switch to other substances that also have high levels of caffeine, such ascola or chocolate.

Cannabis Largely seen as a harmless drug, it can have serious impacts on your emotional health andwell-being. It has effects which mimic stimulants, depressants and hallucinogens, although isclassed as a depressant. Many people take cannabis as a way of relaxing and getting high.

The effects will depend largely on your expectations and mood, the amount taken and yoursituation.

Short-term effects: a pleasurable state of relaxation, talkativeness, bouts of hilarity andfeeling excited by the things you see, hear and feel. People often feel hungry.

Low doses have more of a depressant effect, while high doses can distort your perceptions,and make you forgetful. If you are anxious, depressed or have not used cannabis before, andyou take a high dose, you may become very distressed and confused.

In some people, cannabis may trigger psychotic experiences (hallucinations and other

experiences which others don’t share). The reasons that some people get these while othersdo not are genetic, and also associated with the strength of the cannabis used. Thepsychotic experiences may include experiences such as hallucinations, fantasies,depersonalisation and derealisation (feeling out of touch with yourself or your surroundings),feeling a loss of control, fear of dying, irrational panic and paranoid ideas. These can stoponce the effects of cannabis have worn off, but in some cases cannabis can trigger a long-lasting illness that may be diagnosed as schizophrenia. As there is no way of knowingwhether you carry the gene that can put you at risk or not, it is safer to not use.

Long-term effects: Psychotic illness in some people. Some people may develop depressionas a result of using cannabis as teenagers. In addition, cannabis has been shown to impairbrain function.




It is suggested that the unwanted psychological effects of cannabis can be:

short-lived effects such as anxiety, panic, depression and psychosis, which usuallyoccur after excessive consumption of the drug

effects on pre-existing mental illness – it can make them worse

cannabis as a risk factor for mental illness

dependency and withdrawal

feeling lethargic

finding it difficult to communicate with others

having a general lack of ambition

Although the majority of adolescents are not harmed by using cannabis, a small minority are.Research in young people suggests that using cannabis as a teenager increases thelikelihood of experiencing symptoms of schizophrenia in adulthood, and the younger you arewhen you use it, the more you are at risk of developing schizophrenia. Cannabis use alonedoes not cause psychosis, but it is one of the things that may contribute to its development;

therefore, using cannabis increases the risk, and some cases of psychosis could beprevented by discouraging cannabis use among young people.

It was also found that those who used more cannabis were more likely to develop depressionand anxiety, and this was more marked in girls. Young women who used cannabis daily werefive times more likely to have depression and anxiety than non-users, and using cannabisweekly doubled the rates of anxiety and depression. There was no evidence that girls whowere already depressed before using cannabis were more likely than others to use it.Other studies, using self-reported questionnaires with groups of users, have reported panicattacks and anxiety in a significant number of users, and depression, tiredness and lowmotivation.

Cocaine; Crack cocaine Cocaine comes in two forms: cocaine powder which is snorted, and crack cocaine which issmoked. Both forms can be injected.

Short-term effects: initially you feel wide-awake, energetic and confident. These effects areshort-lived, which means that people tend to take them repeatedly, over a number of hours.Regular users may experience depression, anxiety, panic attacks, and paranoia. High dosesmay cause hallucinations and delusions, depression and suicidal thoughts.

Long-term effects: Cocaine can make existing mental health problems worse. Long-term usecauses irreversible brain damage, in particular to the areas of the brain which control

judgment and planning. This is one of the reasons why cocaine addiction is hard to treat, asthe part of the brain needed to make rational decisions is no longer able to function properly.Dependency and withdrawal: Cocaine is very addictive. The brain adapts to it, so thatincreasing doses are needed to create the same effect. Dependency may cause loss of energy, psychosis, depression, and akathisia (a feeling of intense restlessness alsoassociated with antipsychotic medication).

Cocaine is often mixed with other substances. If you combine cocaine with alcohol, theyproduce a very poisonous substance which has been associated with a 25-fold increase in

sudden death.






Dependence and withdrawal: you are more likely to become dependent on PCP thanketamine, and more likely to have withdrawal symptoms, including depression and sleeping alot.

Khat Khat is a green, leafy plant that has been chewed in East Africa for thousands of years. It issimilar to alcohol in that it produces relaxation and aids socialisation, and people may go tokhat houses (mafreshi) in a very similar way to going to the pub. And, as with alcohol,problems come with over-use, leading to financial problems, an inability to work, loss of self-respect, relationship problems and so on.

Short-term effects: it can make you feel elated and energetic; you can’t sleep and may notfeel like eating.

If you take a lot, you may hear voices and become paranoid. Afterwards you may be tired,depressed, anxious and irritable.

LSD (Lysergic acid diethylamide) LSD is a synthetic drug that was first made in the 1940s. It causes random and sometimesfrightening effects which may be delayed.

Short-term effects: these include feelings of detachment from your surroundings, an alteredsense of space and time, and hallucinations. You may have feelings of insight, mysticismand spirituality.

You may feel you can fly and put yourself in serious danger. Some people have accidentallykilled themselves under the influence of LSD and related drugs. People may have ‘good’ or

‘bad’ ‘trips’, at different times. A bad trip can give you acute anxiety and panic. Afterwardsyou may get flash-backs of bad trips, when you feel they are happening to you all over again.

The user’s own intentions, and other people’s suggestions, can influence the experience, sofriendly reassurance can help someone on a bad trip. If you already have a diagnosis of schizophrenia, LSD is very likely to make your symptoms worse. It may also cause you torecall unpleasant memories.

Long-term effects: there is no evidence of long-term damage, though some people, whowere prescribed LSD in the 1960s and ‘70s to help recover repressed thoughts and feelingsduring psychoanalysis, reported that their mental health had been damaged by it and theyhad never recovered. This may be associated with the whole treatment method and the way

it was applied at that time, and not simply the use of LSD.

Magic mushrooms The effects of magic mushrooms are similar to LSD (see above).

Hallucinations may be quite pleasant and non-threatening but may also be very frightening.

Methadone has similar effects to heroin, but they are milder and longer lasting, so it stopsyou going through withdrawal, and also doesn’t give you the initial high. Changes of mood,

hallucinations, restlessness and decreased libido are side effects listed in the informationleaflet for this drug.




Buprenorphine (trade name Temgesic) is less sedating than methadone, and so may bepreferable if you are in employment, or if you drive. Depression, loss of libido, hallucinationsand other psychotic symptoms, and feelings of detachment are listed among the side effectsof this drug.

Mephedrone (do not confuse with methadone – see above)Short-term effects: increases levels of dopamine, serotonin and noradrenaline in the brain,causing over-stimulation. Its main adverse effect is agitation, with hallucinations (hearing andseeing things and also strange touch sensations) and paranoid delusions. It may also causeyou to grind your teeth.

In some people it may cause depression and suicidal feelings. All of these are more likely if you already have mental health problems, and you may still get the hallucinations anddelusions even if you are taking antipsychotic medication

Research chemicals (legal highs)

Legal highs can be bought over the internet and in shops, and are often marketed ascommon household products (such as plant feed, or room odoriser). There is a myth thatbecause these are legal to produce and buy, that they are safe to use. However this is notthe case. Research chemicals are often among the most dangerous to use because therehas been no research done on the chemicals to monitor their short and long term effects. If while taking these chemicals, something unfortunate does happen to you, doctors would notalways know how to treat you, which can lead to short and long term damage to yourphysical and mental health, and in some cases even death.

It is important to note that these research chemicals also carry along all the other risks of taking Street Drugs – they can be mixed with impurities as they are not regulated, they can

reduce inhibitions and therefore make you more likely to take up risky behaviours, they cancause feelings of anxiety, depression, insomnia, loss of short term memory, and paranoia,there is a serious risk of overdose as strengths can vary, and in very serious cases, they canlead to seizures, coma and even death.

Solvents Solvents, glues, gases and aerosols are used mainly by asmall percentage of young people, usually only for a shortperiod.

Short-term effects: The effects are similar to getting drunk,including feeling dizzy, unreal, euphorically happy, and lessinhibited. The effects can also include ‘pseudo-hallucinations’, which you know are not real.

Repeated ‘sniffing’ can cause a hangover effect, making you pale, very tired, forgetful andlosing concentration.

Dependence: Tolerance and dependence may develop over a long period of time, but onlyfor a minority of young people.




Self-help tips for well-being

People often misuse drugs or alcohol to try and improve their emotional well-being. However,although drugs and alcohol may appear to help in the short-term, they actually can make youfeel much worse in the long term. There are other methods that can be used to improveemotional well-being that work just as well in both the short and long-term. These methodscan often be quite difficult to use at the beginning, but just as achieving physical fitness takestime, practice and commitment, so too does achieving mental fitness. There are 3 basicprinciples in obtaining emotional wellbeing: the first is to maximise the things that make youfeel good, and minimise the things that make you feel bad; second is valuing yourself; andthird is to recognise that you can change.

Maximise the things that make you feel good, and minimise (as far as practical) thethings that make you feel bad.

Some feel good factors include:

Making time for relaxation

Being able to express your feelings Having achievable goals to aim for

Making time for the things you enjoy

Maintaining a healthy diet

Starting a sport or exercise you enjoy

Work you find rewarding

A comfortable balance between work and leisure

Time to yourself, to do the things that interest you

Time for friends and family

Some things to minimise: Unnecessary stress, at home or at work

Misusing drugs or alcohol as coping mechanisms – it may help you to feel better in theshort term, but you will feel worse off in the long term. Use other coping mechanismswhich are better for your health, and will help you to sort out any issues, such astalking to a friend or family member.

Misusing drugs or alcohol to try and ignore/block out situations – you will only have todeal with the situation once your high wears off.

Feelings of rage or frustration

Expecting too much of yourself and negative thoughts and feelings

What things could you increase or need to decrease?




Valuing yourself

Valuing yourself will help you to recognise the things in your life that you value and deserveand help you to build your life on a secure foundation. Everyone deserves to have a lifewhere you feel happy and secure. If you value yourself enough, you will know when to takeaction and make changes in your life and when to let go of problems that you cannot changeor are not yours.

Recognising that you can change

Change is part of life. We are all products of our environment and experience, but are neverfated to live or feel the same way forever. There are three conditions for long-lasting change:

a. Understand the present: Don't hide from reality, but see the present clearly.

b. Do not be burdened by the past: The past cannot be changed. Do not allow it to weighyou down. Choosing to let go of the past does not mean that you accept or agree with

what has happened; just that you recognise that thinking about it is not helpful to you.

c. Accept the uncertainty of the future: Much of the future is not under our control. It is in ourbest interest to accept uncertainty and learn how to face the future with confidence.

Challenging negative thinking

Events themselves do not cause us to feel upset or depressed. It is our beliefs about theseevents that determine our emotional reaction. We have a tendency to think “If I think thesethoughts, they must be true”.

However, when we feel low in mood we are more likely to focus on negative things from thepast. We become really good at ignoring any of the positive, and then wonder why we aredepressed.

Unhelpful thoughts pop into our minds so quickly that it is often difficult to spot them. Think of it this way, we don’t get to choose whether or not a bird lands on our heads. We do get tochoose, though, whether or not it makes a nest.

This is true of our thoughts as well. J ust because we think a thought, does not mean that wehave to believe it or continue to think about it!




When we experience depression, we tend to think in any or all of the following ways. Howmany apply to you?

Al l or nothing th inking. Thinking inabsolutes, black and white, or goodand bad with no middle ground and a

tendency to judge people or eventsusing general labels, e.g. “He’s anidiot”, “I’m a failure”

Catastrophizing. Overestimating thechances of disaster, e.g. whatever cango wrong will go wrong or a set backbeing part of a never-ending pattern of defeat

Jumping to conclusions. Making

negative interpretations even thoughthere are no definite facts. Also makingnegative predictions about the future

Negative focus. Ignoring ormisinterpreting positive aspects of asituation. Focussing on your own

weaknesses and forgetting yourstrengths

Living by fixed rules. Fixed rules andunrealistic expectations, regularly usingwords such as “should”, “ought”, “must”and “can’t”, leading to unnecessary guiltand disappointment. The more rigidthese statements are, the moredisappointed, angry and depressed youare likely to feel

Personalising. Taking responsibilityand blame for everything that goeswrong

When trying to come up with a helpful thought, here are some tips to help you…

What is the evidence to support the unhelpful thought?What tells you that this thought is correct?

What is the evidence that does not support the unhelpful thought? This is the hard part, because it is often overlooked, but ask yourself thesequestions: How would someone else view the situation? How would I have viewedthe situation in the past? What might I say to a friend who was in a similar situation?

What is the effect of thinking the way I do? Does it help me or make me feelworse?

Now, is there an alternative, more helpful thought that could also be true to that

situation…




Support networks

Social supports (friends, families etc) can be an important way of increasing our mood. Whena person feels low in their mood it is not uncommon for them to reduce their contact with theirfriends/family which can lead to social isolation and the associated negative effects on well-being.

Increasing our social support is not simply a case of increasing our contact with more peopleas not all social contacts are positive. For example, only meeting up with somebody who isvery low and has a number of difficulties of their own may have an adverse affect on yourmood. It is possible to feel lonely even when surrounded by others.

Increasing our positive social contact could be through a number of ways including:

Pushing ourselves to meet up with friends, family or colleagues

Contacting friends via the telephone, internet or email

Doing activities which provide us with the opportunity to meet and choose new friends

Sharing our experiences with the people around us

Keeping a balance

It is important to keep a balance between things that you have to get done like work,household tasks, paying bills etc. and the things that you enjoy and that help you to feelrelaxed. Keeping up your own interests and hobbies is a big part of managing youremotional well-being and allows you to give more to your family and friends.

Think about where you can take a break and spend some time on activities that are just foryou. This is important for your emotional and physical well-being as it allows you to spendtime doing things that you find rewarding, fun and engaging. By doing these activities, youwill find enjoyment in things that don’t involve using alcohol or other substances.




The ‘stress jug’ analogy

As humans, we only have a certain capacity for managingstress. Imagine that all of your stress was in a jug. The fulleryour jug is, the greater the symptoms of stress will be. Oncethe jug is full, your ability to manage any situation that arises isgreatly compromised, which is why you may feel less able tocope with matters that would normally have no effect on you.

Some of your jug is already filled with the anxieties of life thatwe cannot avoid, (i.e. money, illness, family, not havingenough time for yourself, etc). Therefore, if you have a largesource of stress in one area of your life that is filling your jug,your capacity to manage stress in the other areas will be

compromised. You may feel that you manage your stressful job very well, for example, butfeel that you are unable to cope with any stresses at home or vice versa.

If you partially empty your jug on a daily basis, you can avoid it ‘over-flowing’ which will helpyou to reduce your symptoms and to feel more in control. It may be that you are unable tochange the main contributor to your stress, but if you can do something about your othersources of stress, you will feel better able to cope.

You can empty a little out of your jug on a daily basis by using self-help techniques to:

Look at your stressors to see if there is anything you can do to reduce the level of stressthey produce or if you could manage them in a different way

Identify if the stressful situation is really your responsibility. If not, could it be delegated tosomeone else or could your energy be better used elsewhere?

Have time to relax. This may be by completing a relaxation routine, playing a sport orsocialising, etc

Communication and assertiveness

Being assertive is a way of communicating your thoughts and feelings without hurting others.It is an alternative to being aggressive where you get what you want but hurt others. It is alsoan alternative to being passive where you don’t hurt others but you also do not get what youwant.

We are unassertive because we have learned to be this way from childhood. Some childrenare encouraged to express their feelings and some are not. They good news is that as youhave learned to be this way, you can learn to be a different way.

Being assertive means we can ask for what we want from others; we can say ‘no’ to others’requests; we can express our emotions; and we can express personal opinions withoutfeeling self-conscious.

Being aware of your communication style with others is important as it will affect yourrelationship with them and also the way they communicate with you. Being firm, clear and

assertive is likely to get better results when it comes to trying to express your opinion. Bylearning to communicate effectively and assertively in your everyday life, it is likely to bemuch easier to maintain this at times when you may be feeling stressed or low.




Relaxation exercises

Breathing control

Taking a deep breath at times of difficulty gives you time to recompose yourself andgather your thoughts, whilst reducing your physical symptoms

Irregular or erratic breathing is one of the first responses to severe stress.Unfortunately, this may make you feel more panicky, as you feel the need to gasp for

air, which in turn makes you more anxious. However, your breathing is easy to control

Your stomach muscles should rise and fall as you breathe- As you inhale your stomach moves out slightly- As you exhale your stomach moves in slightly

It will help to count as you breathe. Concentrate on the number three.Breathe in for three counts and out for four counts. Maintain a steady,comfortable rhythm and try to avoid holding your breath in between each count

Muscle relaxationSit comfortably and take a few deep breaths. Now focus on your body, tensing and relaxingeach of the muscle groups in the following order:

Feet – point your toes away from your body, hold, then relax

Calves – bend your foot at the ankle towards you, hold, then relax

Thighs – push your knees together, hold, then relax

Bottom – clench your buttocks together underneath you, hold, then relax

Stomach – pull in your stomach muscles, hold, then relax

Hands – clench your fists, hold, then relax

Hands (again) stretch the fingers wide apart, hold, then relax

Ar ms – bend your arms at the elbow, bringing your hands up towards the shoulders,hold, then relax

Shoulders – hunch your shoulders up towards your ears hold, then relax

Neck – pull your chin forwards on to your chest hold, then relax

Neck (again) stretch your chin up, pushing your neck back, hold, then relax

Jaw – clench teeth together, hold, then relax Lips – press tightly together, hold, then relax

Eyes – screw up eyes tightly, hold, then relax

Forehead – frown hard, wrinkle forehead, hold then relax

In each case, as you relax the muscles feel the tension draining away. Notice the differencebetween tension and relaxation.




Goal setting

Most people find that working towards realistic goals is motivating and satisfying, but it isimportant to start off by setting the right goals. This really will have a positive impact on thesuccess of building confidence and self-esteem.

Remember, change is not always easy, and there may be slips or lapses along the way. This is normal, and so don’t be put off or be hard on yourself if you find that you don’t alwaysstick to the plan!

S Specific By being clear about your target goal you will be able to take pride inachieving it

M Measurable J ust wanting to “build up my social life” is not measurable; taking part in adance class twice a week is.

A Achievable Recognise your limits, if you set goals too high you are more likely to quitand feel that you failed. Challenging yourself is great but don’t expect theimpossible!

R Relevant The goal has to make sense to you and be something you feel isworthwhile and that applies to your views and lifestyle

T Timely Think when the best time is for you to fit in your goals and try not to tackletoo many goals at once

Goal setting is an on-going process

E Evaluate Regularly look again at what has gone well or less well and why thismight be the case

R Redo Set new goals or adapt the ones you have. Give yourself a reward forwhat you achieve, even if you did not complete the goal, but gave it agood shot!




Distraction techniques

Taking a few minutes out of the stressful situation will allow you time to think clearly andrationally. Removing yourself from a situation is not always possible or practical. At this time,distraction techniques may be useful. Try using one of the following:

1. Mental exercises, such as counting backwards from a hundred, reciting a poem frommemory, practicing your times tables. Anything that makes you focus yourconcentration away from the stressful thoughts will help.

2. Physical activity. Give yourself a practical task to do, such as washing up the coffeecups, doing some photocopying or cleaning your desk. Be sure to focus your attentionon the task.

3. Focusing on your environment. Choose an object in your immediate environmentand concentrate your thoughts on it for a while. Describe the object to yourself; thinkabout its texture, shape, size and colour. Think about the purpose of the object andwhat makes it unique.

4. Visualisation. A quick way of getting away from a situation without physically leaving

Imagine yourself walking to a door

Open the door and walk down 3 steps, taking a deep breath for each step

You walk into an environment that you have come to associate with relaxation andcalmness. This could be a familiar place, a happy memory, or somewhere in yourdream

What can you see?

What can you hear?

What can you smell?

What can you touch?

Spend a few minutes in this place, enjoying the feeling of relaxation

When you feel ready, start to make your way back up the steps, taking a breath foreach of the 3 steps. Make your way back through the door and back into thepresent situation




Useful contacts

If you have any questions about your, or others, drug use, would like to find out moreinformation, or would like to know where you can access more support or where to get helpfor stopping your own or others drug and alcohol use, please contact one of the beloworganisations.

First Steps Surrey0808 801 0325 - Monday and Wednesday 10 to 4.30pm and Thursday 11 to 5.30pm. Thehelpline will be open on a Tuesday following a Bank Holiday.www.firststeps-surrey.nhs.uk [email protected]

Provides advice and information on a wide range of emotional and mental health issues.Provides information on where to get more support if required, and holds a large directory of local services.

Surrey Drug and Alcohol Care 0808 802 5000 (24 hours a day, 7 days a week)

A confidential helpline for all those living and working in Surrey who wants to find out moreinformation about theirs or others drugs and alcohol use and abuse, who are concernedabout others or their own drug or alcohol use, want to access treatment for reducing orabstaining their own use, or who require emotional and practical support. This helpline canprovide referrals into drug and alcohol services if required.

FRANKwww.talktofrank.com 0800 77 66 00SMS 82111

Provides confidential drugs advice and information to those worried about theirs or othersdrug or alcohol use. Provides signposting to local services which can offer more long termsupport.

SADAS – Southern Addictions Adv isory Service (has various services countywide)www.sadas.org.uk 01483 590 150

Provides urgent advice in alcohol, drug or related situations. Also provides drug and alcoholservices within the community for those looking to abstain their use or cut down their use.Also provide information on housing and tenancy issues. This service also have acounselling service and run group therapy workshops.



SHOT – Surrey Harm Reduct ion Outreach Team (covers the South East and NorthWest of Surrey)01483 773242

Provides:

needle exchange (including Performance & Imaging Enhancing Drugs)

advice, support and information

brief interventions for drug & alcohol users, including triage,

assessment and other care planned interventions including 1:1 sessions and groups

care planned structured interventions including structured

psychosocial interventions and other structured drug treatment

acts as a treatment referral point for J obcentre Plus referrals

signposting to other services

sexual health supplies and advice

training programmes on safer drug use

services for those affected by other people's substance misuse, i.e. parents andcarers

Catch 22 – 24/7 Surrey01372 832 888 or 0800 622 6662 (emergency referral and crisis line for young people andfamilies)www.catch-22.org.uk/Services/Detail/247-Surrey [email protected]

24/7 in Surrey is a county-wide specialist treatment service, offering a range of support foryoung people, aged 11 to 21, who have problems with drugs or alcohol.

They have a multi-professional staff team of specialist support workers, social-work qualifiedworkers, qualified education, training and employment-support workers, parent and familyworkers, mental-health nurses and A&E link workers. They offer:

a 24/7 emergency referral & crisis line for young people: 0800 622 6662 a confidential online referral form (anyone can refer, including the young people

themselves) a prompt response before motivation falters and problems get worse a harm-reduction approach which informs young people about the effects of drug and

alcohol misuse and the risks involved

individually tailored help, based on an assessment of each young person’s needs specialist support for mental health problems access to our education, training and employment specialists to open up new

opportunities help for the family so they’re better able to support the young person access to prescribing and needle exchange services access to alternative therapies, such as acupuncture social work qualified staff access to mentors and aftercare

Documents

NHS Alcohol, Drug & Emotion