Author: Carolyn Weisman, LCSW, CADC, Associate Director of Adolescent PHP, Northbrook
The combination of the winter season with shorter and colder days and the pressure of the holidays can highly impact mental health symptoms and increase substance use.
Co-occurring Disorders: Co-existing Mental Illness(es) and Substance Use Disorder(s)
According to The National Alliance on Mental Health, “About a third of all people experiencing mental illnesses and about half of the people living with severe mental illnesses also experience substance abuse. These statistics are mirrored in the substance abuse community, where about a third of all alcohol abusers and more than half of all drug abusers report experiencing a mental illness.”
Connections Between Substance Use and Mental Health
When people face uncomfortable emotions, thoughts, physical reactions, or increased mental health symptoms, we often turn to familiar behaviors that help eliminate or manage them. For many people, substances like drugs or alcohol could be that familiar behavior, leading to substance dependence.
For others, engaging in persistent and long-term alcohol or drug use can cause unpleasant side effects and lead to mental health disorders. With co-occurring disorders, there is also an opportunity for disorders to exist without causing each other; this could be due to trauma, environmental factors, or genetics.
What Causes Holidays to be Especially Triggering?
During the holidays, there is less routine, more stress, and more alcohol. Knowing your limits and triggers during the holiday is important to manage them effectively. If we know why we are feeling an increase in symptoms or emotions, we have a choice to respond differently to them; if we can name it, we can tame it.
Think about the why. Why are the holidays, family, or this time of year stressful and/or exciting? Are you excited to see those you haven’t seen yet? Are you dreading getting a long list of questions from your relatives? Are you grieving special people who won’t be here this year? During the holidays, there is a broad range of emotions that we all experience. Our bodies respond to anxiety and excitement similarly, leading us to make impulsive decisions we may want or need to avoid, like substance use, isolation, or engaging in arguments.
Pressure, nostalgia, and complicated relationships can also add to the holiday stress. There are many pressures during the holiday season; pressure to be happy, expectations to engage with everyone, financial stressors, and sometimes even pressure to indulge. Pressure can lead to decisions without weighing the pros and cons of short- and long-term outcomes.
Nostalgia is a complex emotion largely experienced by joy and warmth, increasing the connection to the past and family. Memories are different for everyone based on their emotional response to the moment. Thinking of the past or being constantly reminded of past experiences that others may not see as triggering can cause emotions and thoughts to become overwhelming and, at times, unmanageable.
Seeing family and friends over the holidays may cause a range of emotions. Being in environments from the past and being around family often increases our chances of regressing into old behaviors and communication patterns. Being aware of who will be at gatherings, who has a history of asking invasive questions, who has expectations of you to use substances with them, or who also is struggling with substance use and/or mental health can give you space to create a plan on how to manage emotions and thoughts that arise.
Lapse vs. Relapse
Managing mental health symptoms and urges to use substances can be a bumpy road with the pressures, memories, and interpersonal experiences the holidays bring. Engaging in familiar behavior, like substance use, typically serves a purpose like stress management, relief, or instant self-esteem. However, lapses and relapse can start long before someone engages in the behavior of using. Falling back into old thought patterns, behavior patterns, or keeping individuals in your life who also use them can be red flags you are starting to lapse. A lapse is a short-term engagement in the behavior you want to change. Relapse is continuing to engage in the behavior you are wanting to change and slipping back into an old behavior pattern. There are many events during the holidays, and it is important to validate your emotions and note that this is a learning opportunity, not a failure, if there is a lapse or relapse. Lapse and relapse prevention planning focuses on your past victories, strengths, and who can help support you while you engage in new healthy behaviors.
Talk to Trusted Friends and Family
Having loved ones who are on the same page and have similar expectations and limits around substances can increase our ability to feel safe during a gathering. Increasing predictability can decrease anxiety and assist in managing substance use urges.
If you are hosting, check in with loved ones for whom you are aware the holidays are difficult. Have a range of food and beverages to accommodate all your guests.
If you are a guest and feel comfortable doing so, reach out to the host to let them know your concerns and/or goals. Share coping strategies and discuss options to take breaks (outside, basement, spare room, bathroom). Historically, if the host has limited options for safe food/beverages, bring items that can keep you safe.
Check-in With Yourself
During the pressure of the holiday hustle and bustle, we can forget to check in with ourselves or others. Take a moment to observe inward and whether you notice any of the following symptoms within yourself or others:
- Frequent arguments, irritability, sudden mood changes, and unexplained actions
- Increase in energy, racing thoughts, and impulsivity
- Changes in eating and sleeping patterns
- Sudden weight gain or loss
- Loss of interest in usual activities or hobbies
- Avoidance or isolation from friends or family
- Increased engagement in risk-taking behavior or time spent on social media
- The urge or feeling like you need a substance to function
Depressed mood, frequent panic, or thoughts/talk about depression or death
Teenagers and adults with co-occurring disorders can simultaneously endorse multiple symptoms like those listed above. For example, many behaviors of a teenager using substances can mimic depression or anxiety, causing concern and confusion for parents. Trusting your gut and routinely checking in with your teenager before, during, and after gatherings can help detect use or if your teen is struggling.
Skills to Try During the Holiday Season
Boundaries are limits we set for ourselves based on our needs and values. They take effort to set and maintain and can change based on the situation, environment, and who you are with. To set boundaries, name your limits, tune into your feelings as they are cues to your well-being, consider the past and present, seek support from a mentor, therapist, or trusted family member or friend, and start small as setting boundaries takes practice.
Developing plans to manage expected and unexpected difficulties during the holiday can assist us in remaining present. Engaging in routines and having skills to use at the moment, like breathing, taking a break, or spending time with a supportive person, can assist us in responding versus reacting to emotions if we feel overwhelmed.
This skill focuses on our basic needs and creates a space for self-awareness. It allows individuals to connect their mental health to their physical well-being in learning that improved self-care can result in improved mental health. The goal is to remind us to care for our most basic needs first to stabilize mental health by Sleeping, Eating, Exercising, Doctors (taking medicine, taking care if you are ill), and Self-care/Sobriety.
This skill also asks us to stop and check in with ourselves in the present moment to ensure our basic needs are met. This acronym assists in checking in if you are Hungry, Angry, Lonely, or Tired and provides a space to allow yourself to support these needs at the moment.
Acceptance is about acknowledging reality and not what we interpret or want it to be; what is in our control and what is not. Acceptance also does not mean approval. The willingness to know that others may not accept your change is instrumental in moving forward within your own goals.
This assists us in pushing the “pause” button when we are having urges or struggling with impulsivity; it helps us slow down. PAUSE focuses on being Proactive and preparing for urges, so we are equipped to manage them. Having Awareness of triggers can help individuals feel prepared to manage their urges. It is important to Understand what you are experiencing in your thoughts, emotions, behaviors, and physical reactions to better respond. Use Supports and Engage in skills to effectively manage urges.
These techniques assist in bringing us back to the present moment if we are overwhelmed. There are many grounding techniques, such as:
- 4 x 4 Breathing: Breathe in for 4 counts, hold for 4 counts (optional), breathe out for 4 counts, hold for 4 counts (optional)
- Take 5/10: Take a break for 5-10 minutes. It is important that you tell the person you are with that you are taking a break and when you plan to return. During your break, you should distract yourself with something unrelated.
- 5 Senses: Do things that engage the 5 senses. Have an essential oil or something with your favorite scent. Eat a mint or piece of chocolate. Feel a favorite fabric or texture etc.
- Pet your Pet: The physical sensation can be very soothing, and the bond with a pet is often very helpful when feeling low.
- Soothe or Shock Your Senses: Depending on how you feel, holding ice cubes, drinking a cold glass of water, splashing cold water on your face, or drinking hot chocolate can assist your body in regulating its temperature when you are feeling overwhelmed.
Next Steps for More Support
For co-occurring disorders, integrated treatment, such as Partial Hospitalization (PHP) and Intensive Outpatient (IOP) programs, is proven more effective long term. Integrated care assesses each diagnosis and treats them concurrently yet independently. Cognitive behavioral models and motivational interventions are most beneficial, focusing on dialectical behavior therapy, seeking safety, family therapy, and medication management. These treatment approaches take a “wrap-around” approach to addressing the individual’s complex needs.
Within Compass Health Center’s PHP programs, treatment addresses mental health symptoms manifesting through substance use and abuse through short-term stabilization. Individuals that report substance use or abuse will receive support from a Certified Alcohol and other Drug Counselor (CADC). At the same time, they reduce and/or eliminate alcohol or drug use through evidence-based therapies, customized treatment, urine drug screens, and combined intervention techniques.
Learn more about Compass Health Center’s PHP/IOP programming here.
Please see the resources below for higher levels of care, substance dependence programs, self-help groups, and more information on co-occurring disorders.
- Substance Abuse and Mental Health Services Administration (SAMHSA) treatment finder: https://www.samhsa.gov/find-treatment
- National Alliance on Mental Illness (NAMI) support groups: https://namiillinois.org/meetings-support/
- National Alliance on Mental Illness (NAMI) on Co-Occurring Disorders: https://www.nami.org/About-Mental-Illness/Common-with-Mental-Illness/Substance-Use-Disorders