Category: Dual Diagnosis

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Antidepressants Misuse and Addiction

Some people, especially those in recovery, may worry about developing an addiction to antidepressants. Thankfully, antidepressant addiction doesn’t occur often, but it is a possibility at non-therapeutic doses. This is due to how they can affect and change the brain, leading to a dependence then compulsory use. 

Anyone worried about their antidepressant use can bring their concerns to their doctor, who can start a tapering plan or even switch to a different type of antidepressant. Behavioral strategies, like therapy, can help people transition off antidepressants while still managing their symptoms.

What Are Antidepressants?

Antidepressants primarily treat depression1 and other mood disorders, plus conditions like obsessive compulsive disorder (OCD). They work by balancing disruptions in neurotransmitters and boost the reception of serotonin, which can make people feel happier. 

Most antidepressants work on serotonin and another neurotransmitter called norepinephrine1. When your brain can receive and process more of these neurotransmitters, symptoms of depression can fade. Depression can go fully into remission due to neuroplasticity1, where your brain changes and adapts to sustain these positive changes. 

Common Types of Antidepressants

Antidepressants can have a variety of formulas and interact with different parts and systems within the brain. Your doctor and/or psychiatrist will aim to find the best match for you. A genetic test can help you pinpoint good matches. Sometimes, people cycle through a few antidepressants to find the one that works best.

Interestingly, many antidepressants have off-label uses for conditions besides mood disorders. For example, trazodone can help people fall asleep1. Some other antidepressants help patients with chronic pain.

SSRIs

Selective serotonin reuptake inhibitors (SSRIs) are often the first line of defense against depression2 due to their low side effects and general effectiveness. Most people respond positively to them, and doctors can smoothly pivot to another if one doesn’t seem to have much effect.

Prozac, Zoloft, Lexapro, Paxil, and Celexa are all common SSRI antidepressants. Potential side effects of SSRIs1 include:

  • Weight gain.
  • Dizziness.
  • Nausea, especially for the first couple weeks after starting the medication. In most cases, it goes away.
  • Sexual dysfunction.
  • Headaches.

SNRIs

Serotonin/norepinephrine reuptake inhibitors (SNRIs) work similarly to SSRIs1, but also block the reuptake of norepinephrine, not just serotonin. Doing this helps various synapses in your brain access more of these neurotransmitters, making you feel better. Norepinephrine triggers the central nervous system’s fight-or-flight response, leading to anxiety and panic disorders if these triggers don’t come when needed. SNRIs can reduce symptoms of both depression and anxiety.

SNRI brand names include Cymbalta, Pristiq, Effexor, and Fetzima. They can cause most of the same side effects as SSRIs, like:

  • Nausea that typically goes away after a week or so.
  • Headaches.
  • Excessive sweating.
  • High blood pressure.

MAOIs

Monoamine oxidase inhibitors (MAOIs) are a less-commonly prescribed antidepressant3, often used when an SSRI or SNRI doesn’t work. They’re more likely to have side effects, drug-food interactions, and drug interactions, which is why they’re prescribed with caution.

Common MAOIs include Marplan, Nardinm and Emsam. They can have side effects like:

  • Serotonin syndrome (too much serotonin).
  • Dizziness.
  • Vomiting.
  • Constipation.
  • High blood pressure and potential death if foods with tyramine are consumed (cheese, alcohol, leftovers, certain fruits, and more).

TCAs

Tricyclic antidepressants (TCAs) also inhibit the reuptake of serotonin and norepinephrine4, which can boost mood and attention. Some versions of TCAs are also used off-label to treat obsessive compulsive disorder (OCD), insomnia, migraines, and chronic pain.

Common TCAs include Elavil, Silenor, and Asendin. Their side effects1 include:

  • Dry mouth.
  • Difficulty peeing.
  • Constipation.
  • Seizures.

How Are Antidepressants Misused?

An increase in feel-good neurotransmitters like serotonin can cause a reinforcing effect, though rare in antidepressants since this boost in mood is often subtle and feels natural. Misuse often happens outside prescribed doses5; for example, someone may take double or triple their prescribed dose (sometimes even 10x more) to achieve a ‘high’ similar to other drugs. This sensation only happens with high doses of certain antidepressants5, like bupropion.

Someone taking antidepressants for the sensation of being high may dissolve several pills in water and inject it using a syringe, take multiple pills orally, or crush them into a powder and snort it. To maintain their high dosing, they might request refills sooner than needed, take out prescriptions through multiple doctors, or request higher and higher doses without a demonstrated need.

Sadly, some people misuse antidepressants with the intent of taking their lives. In 2011 nearly every emergency room visit for a drug-induced suicide attempt came from prescribed medications; 20% of those overdoses involved antidepressants5, the highest percentage after prescribed opioids.

Can You Become Addicted to Antidepressants?

It’s very unlikely. One study answers this question6 with, “antidepressants do not have a clinically significant liability to cause addiction.” This is because most antidepressants don’t cause pleasurable or rewarding effects6, as addictive drugs like cocaine or alcohol do. And compulsive use of antidepressants, as seen in substance use disorders, is “exceptionally rare.”6

Antidepressants can cause withdrawal symptoms7, which raises an argument for their addictive potential since people may need to keep taking the substance to avoid withdrawals, similar to opioids and other addictive substances. Tapering plans can prevent uncomfortable withdrawals.

Factors Contributing to Antidepressant Misuse

Those who misuse antidepressants often have a history of substance use disorders5 or other comorbid conditions. And, as expected, people who misuse antidepressants typically have a mental health condition like depression. Since symptoms of depression can include suicidality8, these patients can be more likely to misuse their prescribed antidepressants in an overdose. 

Signs of Antidepressant Addiction

If you’re worried a loved one struggles with an antidepressant addiction, you can watch for signs and start an open-minded conversation. If you’re worried about your antidepressant use, you can bring your concerns to your doctor and look for signs of addiction in your own life.

Some key signs of an antidepressant addiction include:

  • Taking more than their prescribed dose. For example, you may notice they take three pills when the prescription bottle only says to take one. 
  • An inability to stop taking the pills, even if negative health, work, or relationship consequences arise.
  • Spending excessive time and money to procure antidepressants. 

Treatment Options for Addiction

If you’re struggling with an antidepressant addiction or any drug or alcohol addiction, you have resources available for recovery. Treatment options broadly fall into 2 categories: inpatient and outpatient care.

Inpatient Care

Inpatient treatment includes treatment in a hospital (often for acute withdrawal needs or overdoses) or attending a residential rehab. At rehab, you’ll live with peers and receive treatment from clinical staff, who monitor your health and emotional needs around the clock. 

Each day often follows a structure, with time for therapy (group therapy, 1:1 sessions with your therapist, and family therapy), fun activities, peer meetings, and downtime. Rehabs last 28+ days, aiming to treat both mental and physical needs for comprehensive healing. You’ll also learn relapse prevention strategies and get connected with outpatient levels of care, if desired, to continue your healing journey.

Outpatient Care

In short, outpatient care is the treatment you attend without living at a treatment facility. You return home after treatment and have more flexibility to work, attend school, and meet family needs. Outpatient care could include

  1. Day treatment, where you undergo therapeutic treatment and practice practical recovery skills for 5-7 days a week. Sessions often last 5-7 hours daily, making day treatment the most intensive version of outpatient care.
  2. In intensive outpatient programs (IOPs), you attend treatment 3-4 days weekly for about 3 hours a day. These also offer therapy, peer support, and an encouraging and supportive recovery environment but with a less intensive schedule.
  3. General outpatient can include 1-2 weekly group therapy sessions, lasting an hour or so each. 
  4. Regular 1:1 therapy sessions with a therapist. You may see them once a week, once every two weeks, or at the cadence best fit to your recovery needs.

Help from Your Doctors

As medication prescribers, your primary care physician (PHP) and/or psychiatrist can also help you. They can ensure that, going forward, all antidepressant prescriptions are carefully considered and that you have a clear plan for how to take them without risking addiction.

For example, your doctor may only prescribe a week’s worth and set up regular appointments to check in and monitor your use. Or you can work out a plan with loved ones, like a spouse or parent, to keep your medications locked in a safe. This can also be a preventative measure for people struggling with suicidal thoughts or with a history of suicidal ideation and attempts.

At your appointment, you can ask questions like,

  • “What is the addictive potential of this medication?”
  • “Are there other medications with less addictive potential that I could try first?”
  • “What signs should I look out for that mean this medication isn’t a good fit?”
  • “What can I do if I start to feel like I’m relying on it too much?”

Find Treatment for Drug Misuse

Recovery exists for all types of addictions, including antidepressant addiction. Treatment can help you navigate the underlying causes of addiction and address emotional struggles with healthy coping strategies and new behaviors. 
You can use Recovery.com to find prescription drug treatment centers and see their insurance information, reviews, photos, and more.

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Sensory Processing and Mental Health: An Introduction: Dr. Sarah Anderson

Our senses shape how we experience the world—the sights we see, the sounds we hear, the textures we touch, the flavors we taste, and the scents we smell. While many people find everyday sensory experiences manageable or even enjoyable, others may find certain stimuli overwhelming or insufficient, creating challenges in their daily lives. By deepening our understanding of sensory processing and its link to mental health, we can foster greater well-being and support more effective paths to recovery.

What Is Sensory Processing?
Sensory processing refers to how your body and brain receive, recognize, and interpret sensory information (Brown et al., 2019). This process begins when your nervous system detects sensory stimuli through various receptors, leading to a behavioral response. For example, imagine hearing a loud alarm while working at your desk. You recognize the sound as a fire alarm, observe others moving toward safety, and are prompted to follow them. This highlights how sensory processing helps you respond adaptively to your environment.

There is variability in sensitivity to sensory stimuli based on individual thresholds (Brown et al., 2019). A high threshold indicates that a person needs a stronger stimulus to notice it, whereas a low threshold means even minimal stimuli can become overwhelming. For instance, while most people would quickly respond to a loud fire alarm, individuals who are hyper-responsive to auditory stimuli may find such sounds painful, causing long-lasting dysregulation. On the other hand, those who are hyposensitive may require a stronger stimulus for recognition.

While many people are familiar with the five traditional senses—sight, sound, touch, taste, and smell—three lesser-known senses are also critical for understanding sensory processing: proprioception (awareness of body position), vestibular (balance and movement), and interoception (awareness of internal body states) (Brown et al., 2019). In individuals with typical sensory processing, the brain effectively organizes and integrates sensory information, allowing appropriate responses to stimuli. For example, a person might walk along a crowded street, effectively filtering out distractions like billboards and other pedestrians, or engage in a conversation in a busy café without becoming overwhelmed by the surrounding noise and activity. Those with atypical sensory processing may struggle to take in stimuli and modulate their responses, leading to feelings of overwhelm or anxiety. 

A Model for Understanding Sensory Processing 

As a mental health occupational therapist, I use a specific framework to understand my clients’ sensory processing patterns—Dunn’s Sensory Processing Model. This model categorizes sensory processing into four quadrants (or patterns), each representing different ways individuals respond to sensory input (Brown et al., 2019):

Sensation Seeking

These individuals actively pursue intense sensory experiences and are often drawn to environments that provide heightened stimulation. They tend to crave loud environments, bright colors, and high levels of movement. Sensation seekers often thrive in situations that involve excitement and novelty. 

For example, they may enjoy engaging in contact sports such as football or rugby, where the physicality and intensity provide both sensory input and an adrenaline rush. Similarly, thrilling amusement park rides, like roller coasters, offer the fast movement and sensory overload they enjoy. Additionally, these individuals may find pleasure in activities such as dancing at loud clubs, racing motorcycles, or participating in extreme sports like skydiving or rock climbing, where the combination of physical exertion and sensory excitement is high. Sensation seekers are often drawn to high-energy, sensory-rich environments because they help satisfy their need for stimulation.

Sensation Avoiding

People with sensation avoiding patterns feel uncomfortable with strong sensory stimuli and actively limit their exposure to prevent stress or overwhelm. These individuals are particularly sensitive to intense or overstimulating environments, and they often seek out quiet, calm spaces to feel more in control and at ease. The key characteristic of sensation avoiders is that they make a conscious effort to avoid situations that may lead to sensory overload. 

For instance, they may prefer online shopping over visiting crowded stores because the noise, bright lights, and large crowds can cause distress. Similarly, they may choose to eat and converse at home rather than going to noisy restaurants, where the sounds, smells, and social interactions can be overwhelming. In other contexts, sensation avoiders might prefer a peaceful walk in nature over attending a crowded event or concert. They may also avoid certain types of music or films that feature loud noises or flashing lights due to their heightened sensitivity. By actively limiting sensory exposure, sensation avoiders can maintain a sense of comfort and reduce anxiety caused by overstimulation.

Sensory Sensitivity

Sensory-sensitive individuals, like sensation avoiders, are highly attuned to sensory stimuli and can become overwhelmed or anxious when exposed to certain sounds, sights, or other sensations. They are particularly responsive to environmental inputs, such as bright lights, strong odors, or loud noises. However, the key distinction between sensory sensitivity and sensation avoidance lies in their reaction to these stimuli. While sensation avoiders actively work to limit their exposure to sensory triggers, sensory-sensitive individuals do not necessarily avoid them. Instead, they confront and endure these sensory experiences, often feeling the full intensity of the distressing sensations. 

For example, a sensory-sensitive individual might attend a concert despite being sensitive to loud music, or they might work in a busy office environment even though the noise and activity create discomfort. The difference here is that, rather than avoiding these situations, they are exposed to them and may struggle to manage their heightened sensitivity, leading to feelings of overwhelm, irritability, or anxiety.

Low Registration

Individuals in this category may not notice sensory input readily, requiring stronger or more intense stimuli to respond. This can make them appear inattentive or uninterested in their surroundings, as they may not pick up on subtle sensory cues that others might notice immediately. For example, they may not be aware of a ringing phone, a colleague speaking to them, or even a change in the temperature of the room until the sensory input becomes more intense or disruptive. Because of this, people with low registration might be perceived as daydreaming, disengaged, or disinterested, but in reality, they are simply less responsive to sensory input.

These individuals often need support systems built into their environment to help them stay on track and become more aware of important stimuli. For example, they might benefit from the use of alarms to signal tasks or appointments, sticky notes as reminders for daily responsibilities, or bright, noticeable signs to highlight important information. These external cues help trigger their attention and provide necessary prompts to remain engaged with their environment.

In some cases, individuals with low registration may not respond to social cues or environmental changes unless they are more extreme. For example, they may not notice a subtle shift in tone when someone is upset with them, but if the person becomes visibly angry or vocal, they are more likely to react. Similarly, they might not notice a decrease in room temperature until it becomes very cold or uncomfortable. The challenge lies in their ability to process and respond to sensory stimuli only when the input reaches a certain threshold of intensity. While this pattern of sensory processing may not necessarily cause distress or anxiety for these individuals, it can lead to difficulties in social or work environments, where a heightened awareness of sensory details and a more timely response are often necessary.

It is important to know sensory processing is not always uniform across all sensory modalities, and people may display different patterns depending on the type of sensory input they encounter. For example, while someone might avoid certain auditory stimuli, they may actively seek out specific tactile or oral sensory experiences. This complexity emphasizes the importance of tailoring sensory interventions to the unique needs of each individual, ensuring that therapeutic approaches are both comprehensive and personalized. 

The Relevance of Sensory Processing in Mental Health
Many individuals with mental health conditions, including anxiety disorders, depression, ADHD, OCD, and post-traumatic stress disorder (PTSD), exhibit sensory processing differences (Brown et al., 2019). For those with anxiety, sensory overload can exacerbate symptoms, leading to panic and avoidance behaviors. An individual with sensory avoidance patterns may steer clear of crowded social events, often resulting in isolation and increased feelings of loneliness.

Additionally, a study by Jerome and Liss (2005) explored the relationship between sensory processing patterns and attachment types. The authors found that sensory sensitivity correlates with relationship anxiety, while sensory avoidance relates to relationship avoidance; low registration is associated with both forms of relationship discomfort, and sensory seeking is linked to secure attachment.

Sensory processing can also play a key role in building resilience and supporting recovery. Engaging in positive sensory experiences promotes overall well-being and helps individuals feel grounded during times of distress. Interventions that include sensory-based strategies, such as mindfulness practices and grounding exercises, have been shown to support nervous system regulation (Miller et al., 2007). For example, practicing deep breathing while focusing on tactile sensations like a soft blanket or stress ball can induce relaxation in overwhelming situations. Weighted blankets, in particular, offer deep pressure stimulation that activates calming sensory pathways, reduces anxiety, and boosts melatonin production, fostering a sense of safety and relaxation (Yu et al., 2024). Additionally, introducing a noxious stimulus, such as a sour taste, during a panic attack can help redirect attention. This interrupts the cycle of distress and engages neural pathways that regulate emotional responses (Rainville, 2013).

Practical Strategies for Engaging with Sensory Processing Differences
Understanding one’s sensory processing patterns can lead to effective coping strategies that enhance engagement in daily life. Here are specific strategies tailored to each processing category:

  • For Sensation Seekers: Structured physical activities such as rock climbing or martial arts provide the significant sensory input that sensory seekers benefit from, promoting physical and emotional regulation through intense engagement. Similarly, practices like yoga or tai chi enhance grounding and body awareness through controlled movement. For those craving excitement, adventure activities such as zip-lining offer stimulating sensory experiences while fostering a sense of community and connection with others.
  • For Sensation Avoiders: Gradual exposure to challenging environments, like shopping during off-peak hours, allows sensory avoiders to build tolerance without overwhelming their senses. Comfort tools such as noise-canceling headphones or sunglasses provide instant relief in overstimulating situations. Additionally, calmer venues with softer lighting create a sensory-friendly atmosphere for social interactions, contributing to more positive experiences.
  • For Sensory Sensitivity: Designating a safe space at home equipped with weighted blankets and sensory-friendly items can provide a calming refuge for sensory-sensitive individuals. Mindfulness techniques such as deep breathing and gentle stretching focus on regulation, reducing the effects of sensory overload. Engaging with nature through activities like gardening or hiking can also help mitigate sensory overwhelm by offering grounding sensory input in a peaceful environment.
  • For Low Registration: Individuals with low registration often miss sensory cues, making tools like alarms, sticky notes, or digital reminders valuable in fostering engagement and awareness. For example, placing a sticky note on a desk as a visual cue and pairing it with a timed phone alarm can help reinforce tasks that might otherwise go unnoticed. Incorporating tactile or flavorful experiences into routines, such as savoring meals or exploring varied textures, can further enhance sensory awareness and promote meaningful interaction with one’s environment.

Additional Considerations in Recovery
It’s crucial for centers and programs to have formal sensory assessments such as the Adolescent/adult Sensory Profile, as this helps to understand the unique sensory profiles of the individuals in their care. A formal assessment provides valuable insight into how sensory processing may be affecting their clients’ daily functioning, helping programs identify when sensory processing is a barrier. This enables them to implement targeted interventions and accommodations, ensuring that sensory needs are met. Furthermore, understanding the sensory profiles of individuals allows providers to offer personalized support strategies and create environments that foster greater comfort and engagement. Sensory processing is a foundational aspect of how we navigate the world, and understanding its complexities enables us to support individuals in overcoming challenges so that they can thrive in their daily lives. 

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The Importance of Neuroaffirming Care in Mental Health and Substance Use Treatment: Dr. Sarah Anderson

In recent discussions surrounding mental health and substance use treatment, the concept of neuroaffirming care has emerged as an essential paradigm shift. A neuroaffirming approach not only emphasizes each person’s individuality but also recognizes and respects the diverse range of neurocognitive profiles within our world. In this article, I will look into why neuroaffirming care matters, share its key ideas, explore its background, and highlight how it’s vital in mental health and substance use treatment.

Understanding Neuroaffirming Care

Neuroaffirming care is a progressive model grounded in an understanding of the diverse ways individuals think, process information, and interact with the world. It recognizes that neurocognitive differences—such as those found in individuals with autism (ASD), ADHD, dyslexia, and other learning disabilities—are not deficits or disorders to be fixed, but rather distinct variations that enrich how individuals perceive and interact with the world around them.

This perspective sees neurodiversity as an integral part of humanity, encouraging a more inclusive approach in therapeutic settings. Unlike traditional care models, which often apply a one-size-fits-all framework, neuroaffirming care tailors interventions to meet the unique needs and preferences of each individual. Traditional approaches may standardize assessments and treatments, potentially overlooking the nuances of a person’s lived experience. In contrast, neuroaffirming care acknowledges that neurodivergent individuals may process sensory information, social cues, and cognitive tasks differently, requiring interventions that are flexible and adaptive. (Chapman & Botha, 2023)

Examples of Neuroaffirming Care:

1. Inclusive Practices: Tailoring treatment plans to align with the client’s cognitive style, preferences, and personal history.

Example: A therapist working with a neurodivergent client adapts a mindfulness exercise by allowing them to focus on a sensory object, such as holding a stress ball or rubbing a textured fabric, instead of expecting them to sit still with their eyes closed, which might feel overwhelming or inaccessible.

2. Respecting Autonomy: Allowing clients to make informed choices about their treatment and respecting those decisions, even when they differ from standardized protocols.

Example: A client with ADHD requests shorter therapy sessions to maintain focus. Rather than insisting on traditional 50-minute sessions, the therapist offers 25-minute sessions and gradually builds toward longer durations as the client feels ready.

Examples of Non-Neuroaffirming Care:

1. Rigid Protocols: Applying standardized treatment methods that do not consider a client’s neurodivergent traits, potentially leading to frustration and disengagement.

Example: Forcing a neurodivergent client to participate in a large group therapy session despite their expressed discomfort in group settings, leading them to withdraw or avoid further sessions.

2. Invalidating Experiences: Dismissing or questioning the lived experiences of neurodivergent individuals, failing to recognize and honor their reality.

Example: A therapist tells a client with sensory sensitivities that their discomfort with bright lights in the therapy room is “just in their head” instead of addressing the environmental trigger.

Statistics on Neurodivergence in Mental Health Treatment

Neurodivergent individuals often encounter significant barriers in accessing effective mental health and substance use treatment. Research indicates that approximately 73% to 81% of adults with autism have at least one co-occurring psychiatric disorder (Buck et al., 2014; Madhavan, & Sambamoorthi, 2016). Additionally, substance use disorder rates are disproportionately higher among neurodivergent individuals. Research indicates that about 50% of individuals with substance use disorders also have ADHD, and people diagnosed with ADHD are six times more likely to face challenges related to substance use (Davis et al., 2015). This statistic emphasizes the need for tailored interventions that specifically address these challenges and underscore the importance of implementing neuroaffirming care. 

While neuroaffirming care is gaining recognition, its adoption in mental health settings varies widely. Some progressive clinics and therapists are beginning to embrace neuroaffirming approaches, especially in environments that prioritize inclusivity and holistic care. However, many traditional mental health settings still rely on standard practices that may not adequately account for neurodiversity and its implications in treatment. Neuroaffirming care is more likely to be found in specialized settings, such as those focusing on developmental disorders, community mental health programs that emphasize inclusivity, and practices run by clinicians who are informed about neurodiversity principles. In contrast, more traditional settings may struggle to integrate these principles into their practices, resulting in ongoing gaps in care for neurodivergent individuals. This inconsistency in the availability of neuroaffirming care further emphasizes the need for systemic changes in mental health and substance use treatment approaches.

Historical Context of Neuroaffirming Care

The emergence of neuroaffirming care can be traced back to the neurodiversity movement, which gained momentum in the late 1990s and early 2000s (Chapman & Botha, 2023). Advocates began challenging the traditional medical model that treated neurological differences solely as deficits or disorders. Instead, they promoted the idea that neurodiversity is a natural variation of human cognition, deserving of respect and understanding. For instance, the neurodiversity movement challenged stereotypes surrounding autism, emphasizing the strengths and unique perspectives that autistic individuals bring to the table, such as innovative problem-solving and attention to detail. This paradigm shift inspired mental health professionals to rethink their approaches, focusing on affirming and accommodating differences rather than attempting to “fix” them.

Neuroaffirming Interventions in Mental Health

Neuroaffirming interventions in mental health can vary widely but generally aim to create a supportive environment that is responsive to the specific cognitive and emotional needs of neurodivergent individuals.

1. Cognitive Behavioral Therapy (CBT) Adaptations

Traditional CBT can be adjusted to incorporate the client’s unique thought processes and emotional responses, making it relevant to their experiences.

Example: A neurodivergent client with autism might struggle with abstract concepts like “challenging negative thoughts.” The therapist adapts CBT by using concrete, visual tools, such as a thought diary with emojis or a color-coded chart, to help the client identify and manage their emotions in a structured way.

In contrast, a non-neuroaffirming approach might involve using overly abstract CBT techniques that leave the client feeling confused and unsupported, causing disengagement.

2. Mindfulness Practices

Mindfulness can be tailored to fit different sensory preferences, allowing clients to engage in exercises in ways that feel comfortable.

Example: A client with sensory sensitivities may find traditional deep-breathing exercises difficult due to the focus on internal bodily sensations. Instead, the therapist encourages them to practice mindfulness by listening to calming music or focusing on a weighted blanket’s pressure.

Non-neuroaffirming practices might force clients to adhere to rigid mindfulness techniques that increase their anxiety, such as insisting on silent meditation in a setting that feels overstimulating.

3. Strength-Based Approaches

Focusing on the individual’s strengths rather than their challenges fosters a sense of empowerment and self-efficacy.

Example: A therapist working with a neurodivergent teenager emphasizes their talent for drawing as a tool for emotional expression and problem-solving, integrating art therapy into their sessions.

Conversely, non-neuroaffirming practices might focus solely on deficits, such as repeatedly pointing out the client’s difficulties with time management, without offering constructive solutions.

Neuroaffirming Care in Substance Use Treatment

Substance use treatment, much like mental health treatment, benefits immensely from a neuroaffirming approach. Individuals with neurodivergent traits may face unique challenges in recovery, including heightened sensitivity to triggers, social cues, and emotional stimuli.

1. Individualized Treatment Plans

Tailoring recovery programs to the cognitive and emotional profile of clients enhances engagement and success rates.

Example: A client with ADHD might struggle with rigid schedules in traditional 12-step programs. A neuroaffirming approach would offer flexible scheduling options or introduce apps for task management to support the client’s executive functioning challenges.

2. Peer Support Alternatives

Creating support networks that resonate with neurodivergent individuals allows them to share their experiences in a safe space.

Example: A recovery program sets up a small, sensory-friendly peer support group for neurodivergent clients, ensuring the environment is free of harsh lighting and loud noises to accommodate sensory sensitivities.

Non-neuroaffirming practices might involve placing neurodivergent clients in large, overstimulating group settings without addressing their needs, potentially driving them away from recovery efforts.

Providing Neuroaffirming Care as a Mental Health Occupational Therapist

As a mental health occupational therapist, I prioritize neuroaffirming care in my practice by actively incorporating the principles of this approach into my therapeutic relationships. This commitment not only fosters a sense of safety and respect but also empowers clients to take an active role in their healing journey.

1. Personalized Assessments:

   In my practice, I conduct thorough and personalized assessments that go beyond standardized tools. For example, I might observe a client’s sensory responses in various environments, such as noting whether fluorescent lighting in the office causes discomfort. These observations inform the design of therapy sessions and treatment goals. Additionally, I encourage clients to share their preferences and experiences, allowing for a more nuanced understanding of their unique needs and challenges.

2. Flexible Therapy Sessions:

   Recognizing that each client has different sensory sensitivities and processing styles, I ensure that my therapy sessions are flexible. For a client with sensory sensitivities, I might introduce noise-canceling headphones or provide breaks during sessions to prevent overstimulation. This adaptability allows clients to engage more comfortably and effectively in their therapy, promoting a collaborative and supportive atmosphere.

3. Collaborative Goal Setting:

   Collaboration is at the heart of my practice. When a client expresses frustration with meeting deadlines, for instance, we work together to create achievable and meaningful goals. By implementing strategies like time-blocking, the client feels ownership and agency in their progress. I emphasize that all goals are client-driven; I will never set goals that clients do not choose for themselves. This process not only fosters a sense of empowerment but also enhances motivation and commitment to the therapeutic process.

4. Creating Safe Spaces:

   A significant aspect of neuroaffirming care involves creating safe and comfortable environments. I maintain a quiet, visually calming therapy room with sensory tools like weighted blankets, fidget toys, and dimmable lights. Clients are encouraged to customize their space and choose the tools that make them feel secure and comfortable. This environment reflects a respect for their individual needs and enhances their ability to focus and engage.

5. Ongoing Feedback:

   I prioritize ongoing feedback throughout our therapeutic relationship. Regularly asking clients how they feel about the therapy process and the strategies we employ allows me to adjust approaches as needed. For example, if a client feels overwhelmed by a particular technique, we can quickly shift to a different method that aligns better with their preferences. This responsiveness is a core component of neuroaffirming care, ensuring that each client feels heard and validated.

Conclusion

Neuroaffirming care represents a critical advancement in mental health and substance use treatment paradigms, offering a more personalized and respectful approach to care that takes into account the diverse neurocognitive profiles of individuals. Specific, practical interventions—such as adapting CBT, tailoring mindfulness, and creating sensory-friendly environments—illustrate how this approach can transform the therapeutic experience for neurodivergent individuals.

With increasing awareness and acknowledgment of neurodiversity, the mental health field must continue to evolve by embracing neuroaffirming principles. In doing so, we can enhance access to treatment and support for neurodivergent individuals, ultimately contributing to their overall wellbeing and quality of life.

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Attention Deficit Hyperactivity Disorder (ADHD) and Substance Use Disorders: Dr. Sarah Anderson

There is a strong relationship between Attention Deficit Hyperactivity Disorder (ADHD) and substance use disorders. Research indicates that up to 50% of individuals with a substance use disorder also have an ADHD diagnosis, and those with ADHD are estimated to be six times more likely to struggle with substance abuse compared to those without the diagnosis (Davis et al., 2015). So, what accounts for this connection? 

Some evidence points to personality traits associated with ADHD that may predispose individuals to substance use. Other research has examined differences in the dopamine reward pathway between those with and without ADHD. The impulsivity and self-regulation challenges linked to ADHD, along with difficulties in executive functioning, is another factor that potentially increases the risk of substance use. 

Although we may not be able to alter inherent personality traits or easily address the complexities of the dopamine system, therapy can play a vital role in supporting and enhancing executive functioning skills.

Executive Functioning and Its Role in Recovery 

Executive functioning encompasses the cognitive processes necessary for planning, organizing tasks, following through, and achieving long-term goals. Additionally, executive functioning skills are needed to maintain a job, live independently, and successfully engage in one’s daily life. Executive dysfunction can pose barriers to recovery. Individuals with executive dysfunction experience challenges in organizing their environment, accurately remembering facts/dates/appointments, and completing tasks (Barkley, 2015). 

Additionally, the inability to manage impulses, initiate tasks, and self-regulate can result in significant stress and hinder one’s ability to manage life independently, which may lead to relapse (Mannuzza et al., 2008).  Therefore, when it comes to designing a path for sustainable recovery, individuals struggling with both ADHD and substance use disorders must engage in therapy that focuses on building executive functioning skills.

Occupational Therapy, Executive Functioning & Substance Use Recovery 

As an occupational therapist specializing in mental health and substance use recovery, my role differs from that of other mental health therapists. My primary focus is on supporting the development of independent living skills, which includes a range of activities such as household management, job responsibilities, driving, grocery shopping, cooking, and budgeting. Executive functioning plays a crucial role in a person’s ability to live independently; I believe it is one of the most important skills necessary for successful independent living. Currently, I work at a mental health and substance use recovery center. Many of the clients I work with have difficulties maintaining employment, keeping their environment organized and clean, consistently taking their medications, engaging in basic self-care activities, managing their emotions, handling their finances, and structuring their time. I can confidently say, based on client reports, that the vast majority of clients I’ve worked with experienced challenges with executive functioning prior to their substance use. Furthermore, many clients who sought treatment before arriving at the center have mentioned that issues related to executive dysfunction, such as boredom—which is closely associated with difficulties in task initiation and time management—function as triggers for relapse.

Therefore, to ensure they can maintain their recovery, it is essential that we focus on fostering the development of their executive functioning skills.

Key Areas of Executive Functioning

Understanding the relationship between ADHD, substance use disorders, and long-term recovery requires an exploration of the key components of executive functioning that are often affected in individuals facing these co-occurring diagnoses. Below, I break down each of these areas, highlighting their impact on recovery and strategies that can help enhance these skills for improved outcomes.

Planning and Prioritizing

Individuals with ADHD often face challenges with planning and prioritizing, which can lead to difficulties in breaking tasks into manageable steps and organizing their responsibilities. Clients I have worked with who struggle with these skills often have trouble paying bills on time, cooking, grocery shopping, and arriving at work punctually. Additionally, they may find it difficult to balance their time between work, family, friends, and other responsibilities. 

Challenges with planning and prioritizing can pose significant issues in early recovery, as many individuals who are newly discharged are tasked with managing new responsibilities, including completing step work, regularly attending meetings, and independently handling everyday life activities. Effective strategies to assist clients in these areas include the use of planners or digital calendar tools, which help establish a structured framework for daily activities (Cole et al., 2024). Other strategies such as time-blocking and creating actionable task lists can further enhance the ability to stay organized. 

The Eisenhower Matrix is an incredibly useful tool for prioritizing tasks, as it allows individuals to categorize their responsibilities based on urgency and importance (Jyothi & Parkavi, 2016). The matrix divides tasks into four quadrants: 

  1. Urgent and Important: Tasks that require immediate attention and are critical to achieving goals. These should be done right away. 
  2. Important but Not Urgent: Tasks that are essential for long-term goals but do not require immediate action. These should be scheduled for later. 
  3. Urgent but Not Important: Tasks that require immediate attention but are not necessarily tied to your personal objectives. These can often be delegated to others. 
  4. Neither Urgent nor Important: Tasks that have little significance; these should be minimized or eliminated from your to-do list. 

Using the Eisenhower Matrix can help individuals visualize their tasks and prioritize effectively, ensuring they focus their time and energy on what truly matters. 

Organization:

Organization directly impacts a person’s ability to manage various aspects of daily life. Effective organization helps individuals create a structured environment, prioritize tasks, and manage important responsibilities, including appointments, medication schedules, and personal commitments. For those recovering from substance use, the ability to stay organized can significantly reduce feelings of overwhelm and stress, which are often triggers for relapse (Kitzinger et al., 2023). 

When I work with clients, I help them create systems to declutter their living spaces, use visual reminders, and implement paper or digital organizers to keep track of their tasks. I also support them in developing personalized routines that foster consistency and accountability, which ultimately empowers them to manage their recovery journey more successfully.

Task Initiation

A common hurdle for clients with ADHD is difficulty in starting tasks, which often leads to procrastination and avoidance, further exacerbating feelings of anxiety and overwhelm. Two of my favorite methods to use with clients are the “5-minute rule” and the “Pomodoro Technique,” as they encourage them to work on tasks in smaller, more manageable time intervals. 

The Pomodoro Technique, in particular, involves breaking work into 25-minute focused intervals, known as “Pomodoros,” followed by a 5-minute break (Biwer et al., 2023). After completing four Pomodoros, clients take a longer break of 15 to 30 minutes. This method not only makes tasks feel more manageable but also helps sustain attention and reduce distractions. By creating a structured approach to work, the Pomodoro Technique allows clients to cultivate a rhythm that can enhance productivity and concentration. 

Additionally, this technique promotes a sense of accomplishment as clients complete each interval, reinforcing positive behavior and making it easier to tackle larger tasks over time. The regular breaks also provide opportunities for clients to engage in self-care or relaxation, further reducing feelings of stress and anxiety that can often hinder their progress (Gnanavel et al., 2019). Implementing the Pomodoro Technique can be a powerful tool for fostering time management skills and improving overall task initiation. 

Impulsivity Control

Enhancing impulse control, particularly when it comes to making unhealthy choices during times of distress or dysregulation, is essential for recovery. Interventions aimed at improving impulse control involve teaching clients mindfulness techniques to help them pause and reflect before acting on their impulses (Zylowska et al., 2008). Incorporating games and activities that promote impulse control, such as Jenga and Simon, can also significantly aid in fostering self-regulation. Lastly, cognitive-behavioral strategies can be utilized to help clients identify and challenge the thought patterns that contribute to impulsive decisions. 

Emotional Regulation

Improving emotional regulation is crucial for reducing ADHD symptoms and minimizing substance use behaviors. Difficulty in managing emotions effectively can result in increased stress, strained relationships, and other life challenges, all of which can potentially contribute to relapse. Teaching clients techniques like sensory modulation strategies, deep breathing exercises, and coping skills can empower them to manage their emotions more effectively. Incorporating expressive arts, such as drawing or painting, or physical activities, such as exercise, can also serve as healthy outlets for emotions (Hasegawa et al., 2017).

Working Memory 

Deficits in working memory significantly affect a person’s ability to engage in daily life. Difficulties in short-term memory can lead to issues such as forgetting important appointments, mismanaging medication schedules, or failing to recall coping strategies during stressful situations, all of which can increase the risk of relapse. To address this area, therapists implement memory aids, such as written reminders or digital apps, that assist in retaining important information and instructions. Training in mnemonic devices and visualization techniques can also enhance memory recall (Martin & Marsh, 2009). 

Additionally, engaging in mindfulness practices has been shown to enhance short-term memory. Research indicates that mindfulness can improve cognitive functions, including memory retention and recall abilities, by promoting focused attention and reducing distractions (Zeidan et al., 2010; Killingsworth & Gilbert, 2010).

Self-Monitoring 

Self-monitoring skills are important because they help individuals notice how they are doing and make changes to their behavior when needed. Clients often benefit from learning how to evaluate their performance on tasks and reflect on their emotions and thoughts throughout the process. Journaling or using mobile apps can facilitate self-reflection by allowing individuals to document their thoughts, feelings, and experiences regularly. 

For example, someone might use a journal to reflect on their daily challenges and successes, helping them identify patterns in their behavior over time. Similarly, mood tracking apps can encourage clients to log their emotions throughout the day, providing insights into triggers for anxiety or stress. This process of self-reflection can lead to more effective self-regulation, as they become more aware of their emotional responses and can devise strategies to manage them (Barkley, 2015).

Comprehensive Assessment and Goal Setting

To help clients enhance their executive functioning skills, the process begins with a thorough assessment aimed at identifying both strengths and weaknesses. This assessment is crucial, as it not only reveals specific executive functioning deficits but also ensures that the interventions used are relevant and effective. Without a comprehensive evaluation, important areas of need may go unrecognized, resulting in interventions that do not adequately address the client’s deficits. Standardized tools, interviews, and observations provide valuable insight into how these limitations impact daily life engagement. Once the assessment is complete, establishing goals collaboratively is essential. This process empowers clients to choose goals that are meaningful to them, fostering a sense of ownership in their recovery journey. 

By creating a collaborative environment, clients are more likely to make significant progress. This tailored approach not only addresses specific challenges associated with ADHD and substance use disorders but also promotes a greater sense of agency and self-efficacy. When clients feel that their needs are understood and prioritized from the start, they are better equipped to engage in the therapeutic process and achieve lasting change.

Key Points

The significant connection between ADHD and substance use disorders presents unique challenges that require a comprehensive approach to support sustainable recovery. Addressing executive functioning skills — such as organization, time management, impulse control, and emotional regulation — is essential for individuals with these dual diagnoses. By focusing on enhancing these skills, individuals in recovery can learn how to manage their daily lives more effectively and navigate the complexities associated with both ADHD and substance use.

Recognizing the specific needs of individuals with this dual diagnosis is crucial for developing effective treatment strategies. Tailored interventions that target executive functioning can lead to improved recovery outcomes and a better overall quality of life. A holistic focus on these skills not only helps individuals address the symptoms of ADHD but also empowers them to take control of their lives, establish meaningful goals, and create a sustainable path toward lasting recovery.

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What Causes Depression?

Multiple causes and factors contribute to depression. It can vary between two siblings, and certainly between people all over the world. As clinicians and the general public gradually become more and more aware of what causes depression, more identified causes have come to light—as have treatments. 

Depression is characterized by feelings of low mood, hopelessness, and sadness1 affecting your daily life for 2+ weeks. Some people experience severe symptoms, like suicidality, while others may experience persistent but low-level symptoms. Some types of depression correlate with the seasons. It’s always best to seek a diagnosis from your doctor to determine the type of depression.

Arguably, there’s a treatment solution for every type and cause of depression. Whether it’s caused by genetics, environment, situations, or anything else, you have resources to heal. 

Is Depression Caused by Chemical Imbalance?

Sometimes, yes. An imbalance of neurotransmitters in the brain can poorly affect your mood2 and cause clinical depression. But, this popular “cause” of depression is becoming less and less validated. 

Harvard Medical School2, for example, says, “…depression doesn’t spring from simply having too much or too little of certain brain chemicals. Rather, there are many possible causes of depression, including faulty mood regulation by the brain, genetic vulnerability, and stressful life events.”

Chemicals and neurotransmitters are part of the picture, but not nearly all of it. For example, antidepressant medications raise neurotransmitter levels immediately2, but it takes weeks to see results. This suggests the issue goes much deeper than an imbalance; instead, research finds new nerve connections must form2 and strengthen in the brain to bring relief. 

What Is the Leading Cause of Depression?

Everyone reacts differently to life events, adversity, and abuse. Similarly, everyone has their own unique levels of neurotransmitters and nerve connections in the brain. That’s why a leading cause of depression can’t be identified. 

Some events and predispositions can better predict the onset or likelihood of depression. For example, 80% of those who experienced a major negative life event developed an episode of major depression3. A negative life event could include abuse, loss of a loved one, job loss, and homelessness. 

Pregnancy can cause postnatal depression3, due to a sudden change in hormones, stress, and sleep deprivation after birth. Between 10-20% of new mothers develop depression. Like trauma and abuse, pregnancy can make the likelihood of depression higher, but not guarantee its development.

Causes of Depression

The causes of depression can exist independently or overlap. For example, someone with depression may be genetically predisposed to it and experience abuse. The causes will vary for each person. Some people will also experience the causes but not develop depression. 

Family History/Genetics

Depression runs in families4. Children with a depressed parent are 1.5-3% more likely to develop depression than other populations. Bipolar depression has particularly high chances of affecting immediate family members. Identical twins, for example, are 60-80% likely to share their diagnosis of bipolar with the other.  

Several genes affect how we respond to stress4, which can increase or decrease the likelihood of developing depression. Genes turn off and on to help you adapt to life, but they don’t always adapt helpfully. They can change your biology enough to lower your mood and cause depression, even if it doesn’t run in your family.

Medication

Depression and medical illnesses commonly co-occur5, which led researchers to wonder if medications could cause depression (unrelated to the distress of medical conditions). They found that to be the case in some situations.

Several medications 5 were found to potentially cause depressive symptoms and clinical depression. Medications can also cause symptoms like fatigue, sleepiness, or low appetite, which can progress into depression. 

Abuse

Physical, psychological, and sexual abuse can cause depression6. Abuse can change how you see yourself and the world around you, which can lead to feelings of sadness, low self-worth, and hopelessness. Those feelings can then contribute to, or solely cause, depression.

Victims of abuse may also isolate themselves and shut down, which can make depression more likely to develop. Emotional abuse and childhood abuse tend to correlate strongly with adult depression6. Largely, any kind of abuse makes the development of depression more likely. 

Illness

Depression is more common in those with physical illnesses7 like diabetes, autoimmune diseases, and other chronic conditions. Feeling hopeless, unwell, and discouraged because of a health condition contributes to depression developing. Short-term illness, like being hospitalized and immobile after an accident, can also cause an episode of depression. Those with chronic illnesses may experience more frequent and long-lasting depressive episodes. 

Depression can reduce normal functioning, and even life expectancy7, in those with co-occurring physical illnesses. Treatment for depression can improve symptoms of physical ailments, too.

Drugs and Alcohol

Drugs and alcohol can cause physical and emotional symptoms that lead to depression8. For example, feeling dependent on a substance may cause discouragement and hopelessness, which can then progress into depression. Plus, coming down from a substance-induced high mood can make low moods even more profound. Losing relationships due to challenges with drugs and alcohol can erode support systems and lead to isolation. Sickness and ongoing effects of substance use can make you feel physically ill, which also connects to depression.

Effective treatment for substance use and depression addresses each disorder with the proper approach.

Death Or A Loss

Grief can be a powerful catalyst. The loss of a loved one, sudden or not, can cause low mood, hopelessness, and intense emotional pain. Though healthy grief cycles do include pain and depression, these emotions can become severe9 and interfere with your ability to function. 

Sometimes, those in grief need professional help to navigate the loss and feelings associated with it. This is especially true for anyone with thoughts of suicide or experiencing severe loss of function (can’t get up in the morning, can’t work, can’t eat).

Can You Develop Depression?

Anyone can develop depression. It’s most common in young adults10, but anyone of any age, sex, and race can become clinically depressed. You don’t need a history of depression, nor get depression by a certain age, to develop it. 

Depression can come on suddenly, or as a gradual build-up of symptoms. For example, the loss of a loved one could spur a quick onset of depression. On the other hand, stress and anxiety can more slowly progress into depression. In these cases, depression isn’t always noticeable until it’s glaring.  

Sometimes, catching stress, grief, and anxiety early-on can prevent them from progressing or contributing to depression. Other times, situations completely beyond your control can contribute to and cause depression. Examples include genetics, hormones, and simply how your unique brain works.  

Find Additional Help for Depression

Navigating clinical depression isn’t something you have to do on your own. You can begin your journey by talking with your primary care provider, who can refer you to 1:1 and group therapy. They may also prescribe antidepressants to work in tandem with therapy. 

Your therapist may use therapies like cognitive behavioral therapy (CBT), which aims to improve unhealthy thought patterns. You may also try dialectical behavioral therapy (DBT), which focuses more on managing emotions and thoughts in a healthy, productive way. 


You can also attend a treatment program for depression. Browse our collection of depression treatment centers to find a facility that fits your needs—see what insurance they accept, reviews, photos, and more.

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Stress And Addiction: How Are They Related?

Stress and addiction can feed into and cause each other. “Stress” could be anything that taxes or exceeds your ability to healthily adapt1. For example, stress could prompt you to drink to cope with negative emotions. Similarly, having a heavy drinking habit could cause stress when it affects your life and well-being.

The bi-directional, sometimes cyclical relationship between stress and addiction can seem tricky to separate and treat. But with therapy and the right approach to treatment, you can heal from each and find an improved quality of life.

What Is The Relationship Between Stress And Addiction?

The relationship between stress and addiction is complex and multifaceted. Numerous studies have investigated their relationship and have provided insights into how stress can increase the risk of addiction.

Crucially, stress can cause someone to take and crave substances2. Chronic stress can further increase the risk of drug use and addiction. Stress can induce changes in neural pathways and cravings, which can contribute to substance-related disorders. The stress response system, including the hypothalamus-pituitary-adrenal (HPA) axis, plays a critical role3 in the development and maintenance of addiction.

Stress can also impact your ability to control impulses or other inappropriate behaviors, along with craving instant gratification.

Ultimately, the effects of stress can all lead to substance use. The American Psychological Association (APA) reveals that “stress is one of the most commonly reported precipitants of drug use4” and relapse. 

More stress, or chronic stress, is also associated with a higher risk of substance use2 and addiction. 

The Neurological Relationship

Stress can raise your levels of dopamine5, which is a neurotransmitter responsible for feeling good and reinforcing the activity that feels good. Alcohol and drugs increase your levels of dopamine6, too. Stress-induced alterations in dopamine transmission can increase the risk of addictive behavior.

Because it releases dopamine, you can even become addicted to stress7. And with stress and substance use affecting the system, it can be more difficult to disconnect one from the other and cope without the dopamine they produce. 

The dopamine-intertwined relationship between stress and addiction can have negative but treatable effects on mental health and overall wellness.

Individual Factors

The relationship between stress and addiction is also influenced by individual factors, such as coping strategies and resilience. Effective coping strategies8 can protect individuals from the maladaptive effects of stress that can contribute to addiction.

On the other hand, maladaptive coping strategies, such as procrastination9, can increase the risk of addiction. Using substances as a maladaptive coping skill certainly increases the risk, too.

Additionally, those with lower levels of psychological resilience may be more susceptible to the effects of stress10 and more prone to developing addiction.

Effects of Stress And Addiction on Mental Health

Stress makes addiction and mental health conditions more likely to develop2. The untreated effects of stress increase your risk of anxiety, depression, and other mood-related disorders. In some cases, stress can cause trauma11 and conditions like post-traumatic stress disorder (PTSD). 

Multiple stressors or chronic stress can also be the catalyst2 between using a substance and becoming addicted to one. The more stressors you have in your life, the more likely you are to develop an addiction. 

How to Treat Stress and Addiction

Treatment that addresses your stress and addiction simultaneously can help you heal from both conditions. Therapy, wellness activities, and at-home coping strategies can help you manage stress and recover from addiction.

Therapies for Stress and Addiction

  • Stress management skill training1: This therapy can reduce emotional reactions to stress, helping you avoid relapses. You’ll usually attend 12 sessions in group therapy, learning a specific skill each time.  
  • Cognitive behavioral therapy (CBT)1: CBT can help you regulate your emotions and how to respond to stress without using substances. You’ll learn and practice coping skills in and out of therapy. 
  • Mindfulness meditation12: This therapeutic intervention helps you enter a state of meditation where you’re mindful of what you’re feeling and accepting how the emotions feel in your mind and body. Meditation practices can then lower your breathing and slow your heart, helping you calm your mind and body simultaneously. 
  • Dialectical behavioral therapy (DBT)13: A mindfulness-based behavioral therapy focusing on emotional regulation. Similar to mindfulness meditation, you’ll work on becoming more aware of what you’re feeling and accepting the emotions. Then, you’ll learn how to regulate your emotions and your stress, which can help lower stress and prevent relapse. 

Stress-Reducing Activities

  • Yoga: the guided movements and stretches of yoga can help you manage stress.
  • Mindfulness: everyday mindfulness can help you hone in on big and small experiences, like feeling the wind or noticing the birds in the sky as you walk into work. Mindfulness can calm your body as your focus drifts to what’s happening around you. Mindfulness can effectively reduce stress without alcohol or drugs.
  • Exercise: movement can reduce stress and burn off nervous energy it may cause. You could go on a daily walk, spend time in the gym, or move in any way that feels good to you. 
  • Baths: a warm bath, especially one with epsom salts and essential oils, can calm the mind and body. Baths can also reduce soreness and pain. 
  • Progressive muscle relaxation14: a mindfulness technique where you gradually tense and relax your muscles. You can start at your toes and end at your head, but the pattern is up to you. 
  • Create something: art, music, or writing can take you out of a stressful mindset and help you process what’s stressing you out.
  • Self-compassion15: Dr. Kristin Neff suggests self-compassion as a tool for stress reduction–one you can do at any time. Her research has found self-critical approaches to failure or struggle only results in further stress. Practicing self-compassion can cause greater emotional calm and keep your stress from escalating.

Find Relief for Stress

Treatment can effectively stop the cycle of stress and addiction, help you avoid relapse, and feel better as a whole. You can find rehabs treating stress by browsing our list of rehabs for stress with photos, reviews, and insurance information to help you make an informed decision.

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The Connection Between Narcissism And Addiction

Narcissism can lead to addiction as a way to self-regulate and cope with shame or others’ apparent lack of admiration. Having a narcissistic personality disorder (NPD) doesn’t mean you’ll automatically become addicted to something. But it can make it more likely.

If substance use has started affecting your life, you and your care team might decide on a rehab for narcissism and addiction.

What Is Narcissism?

The DSM-51 defines narcissistic personality disorder as a “pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy.” If someone with NPD doesn’t feel admired, they might turn to substances to cope with that pain. Here’s how narcissistic traits2 might look in someone with narcissistic personality disorder. 

  • They exaggerate their work or educational accomplishments. They may say they got a raise or a new job title but never did, or say they got into a prestigious college when they didn’t.
  • They often monologue and seem annoyed or disinterested when you try to speak. 
  • They believe they are highly special and should only associate with other people and places like them.
  • They expect others to perform favors and respond to their beck and call. If you don’t, they’ll likely get upset.
  • They don’t empathize with you and can’t seem to ever see things from your perspective.
  • They’re inappropriately arrogant or haughty.
  • They might seem jealous of your happiness and success, or assume you’re jealous of them.
  • You feel like they exploit or take advantage of you.

The behaviors of your friend, coworker, loved one, or partner with narcissism may seem strangely out of place or inappropriate. They might lie for no reason other than to gain perceived admiration. They may also belittle, manipulate, or abuse others to maintain their sense of entitlement and control. 

Types of Narcissism

The 3 subtypes of narcissism are: 

  • Grandiose narcissism3, which presents as overconfidence, arrogance, entitlement, and dominance in interpersonal relationships.
  • Vulnerable narcissism3, which presents as hypersensitivity, a tendency to avoid all conflict, extreme defensiveness, and a hidden desire for admiration.
  • Pathological narcissism4, which presents when vulnerable and grandiose narcissism co-occur (or happen at the same time).

Someone with any type of narcissism will need the admiration of others. If they don’t feel admired, they might turn to substances to cope with that pain. They may also use substances to regulate the intense emotions of NPD. 

The Impact of Narcissism on Interpersonal Relationships

Narcissism can strain or break relationships. Someone with narcissism will likely struggle to emphasize with others and reciprocate in relationships, which can damage the relationship. Some relationships, romantic or otherwise, eventually end for these reasons. 

But it’s not always easy to recognize narcissism in your friend, romantic partner, or coworker. People with NPD often radiate charisma and confidence at first. This can make them an attractive friend, partner, or boss. But that thin veil often lifts quickly.

In some situations, someone with NPD may emotionally, physically, or sexually abuse others in their life. This heavily impacts their ability to both make and keep healthy relationships. 

The Link Between Narcissism And Addiction

Understanding Addiction

The National Institute on Drug Abuse (NIDA) defines addiction5 as “a chronic, relapsing disorder characterized by continued use despite negative consequences, and long-lasting changes in the brain.” Someone with an addiction may use a substance, like drugs or alcohol, or have a behavior addiction like gambling, shopping, and sex. 

Addiction can happen to anyone, but some risk factors can make it more likely. These include trauma, chronic pain, genetic susceptibility (parents or other relatives with addiction), and brain injuries, among others.  

Co-Occurring Narcissism And Addiction

Co-occurring narcissism and addiction presents a unique, but manageable, challenge. If you have both, you might be more aggressive and violent2. And since NPD instills a strong sense of superiority, you might not feel like anything could be wrong. The idea might even feel enraging. But addiction isn’t something you’re doing “wrong.” It’s just something you need help managing.

Both narcissism and addiction have compulsivity2 in common. Someone with narcissism will also repeat their actions despite negative consequences, like losing friends. Addiction, as defined, has that same aspect.

Why Do They Co-occur?

Research suggests general functional impairment, not narcissism itself, can cause addiction4. But the effects of narcissism can cause a higher likelihood to drink, or use drugs, or gamble. And the more likely you are to use substances, the more likely addiction becomes.

For example, you may drink or use drugs to lift your self-esteem, which you need to keep high due to your NPD. Doing so often enough can lead to addiction. Alcohol and drugs can also enhance your perception of boring people—people who don’t offer adequate admiration or who aren’t on your level of specialness. Altered mental states can mask shame too, whether it’s shame from not being admired or guilt for needing admiration.

Social media addiction, gambling, excessive spending, and excessive working have similar effects as substance use. That’s because they provide admiration4 (through posting on social media or getting a big win), lift unstable self-esteem, and can cover the shame of not feeling admired. 

The Impact of Addiction on Interpersonal Relationships

Addiction can cause someone to lie, steal, and become untrustworthy. It can strain relationships even without these issues present—watching a loved one suffer never feels okay. And trying to force someone to get help may feel like a losing battle. It’s frustrating for both sides. 

The effects of addiction could also cause you to lose your job, home, and finances. The prices of drugs and alcohol might mean your finances take a hit first, which could also cause strain in your home life, especially if you’re your family’s primary earner. As your addiction worsens, your job performance may as well, resulting in job loss. 

Addiction and narcissism don’t have all the same symptoms and causes, but they do connect in some ways.

Psychological Mechanisms of Addiction And Narcissism

Addiction can fill a narcissistic need for high self-esteem and self-worth. Drinking, using drugs, and shopping, for example, all release dopamine, which makes you feel good and reinforces repetition6. A narcissist’s need to feel good about themselves may drive their addictive behaviors. Or, they may use substances to even-out their emotional states. 

Some drugs, and alcohol especially, depress your central nervous system. This may feel nice if you feel out of control or like your emotions (good and bad) are too intense. 

In either case, you may use substances to cope with the negative effects of narcissism. Even for someone without narcissism, addiction presents a tempting “solution” to low self-esteem and self-confidence. So if you have a highly unstable sense of self-esteem, substance use can feel like an easy way to manage your confidence level. 

Social Factors 

Certain social factors contribute to addiction and narcissism. Growing up with inadequate or excessive praise can lead to narcissism2 in adults. Traits like aggression, poor tolerance of distress, and emotional dysregulation can also lead to narcissism. Childhood trauma or inherited genetics can cause these traits.

Growing up with addicted parents can make you more likely to have an addiction7, through both genetics and mimicry. Similarly, having a narcissistic parent can make you more likely to have NPD8. That’s because a narcissistic parent may overvalue their child, who then assumes they’re more important than everyone else, and that everyone thinks that too.

But despite the interpersonal and personal symptoms of each condition, you do have resources for recovery.

Treatment And Management

Treatment for narcissism and addiction must address both conditions at the same time. While narcissism has no standard treatment pathway8, certain modalities, like ongoing therapy and a positive therapist-patient relationship, play a positive role. 

Psychoanalytic therapy for narcissism8 focuses on the emotions you express towards your therapist—AKA, someone who’s trying to change or better you. Being in treatment may make you feel inferior and want to lash out. So, this therapy focuses on bringing those emotions to the surface and examining them empathetically.

Schema therapy addresses the unhelpful emotions of narcissism9. It’s an adaptation of cognitive behavioral therapy, which addresses the thoughts that lead to harmful behaviors like addiction. Schema therapy can help you regulate your self-esteem and self-worth without needing others to make you feel whole. 

In treatment for addiction and narcissism, providers address addiction, narcissism, and the underlying causes of each. You might start with detox, which safely removes substances from your body. Next, therapy helps you identify and address the causing factors of addiction and begin treating narcissism. After rehab, you’ll likely stay in outpatient therapy, which providers highly recommend to manage both narcissism and addiction. 
But first, you need to take the first step towards recovery. Do so by browsing our list of rehabs that treat addiction and narcissism to see pricing, photos, reviews and more.

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Understanding the Link Between Addiction and Schizophrenia

Drug addiction and schizophrenia can feel pretty similar. And if you have both, it might be hard to tell where one condition ends and the other begins. Learning about that dynamic is a key part of recovery. That knowledge can empower you to find the right type of treatment for schizophrenia and substance abuse.

Does Drug Addiction Cause Schizophrenia?

In short: no, taking drugs won’t give you schizophrenia. But addiction and schizophrenia have similar causes—and similar symptoms. The same factors that make you vulnerable to one can also make you vulnerable to the other.

If you have schizophrenia, drug use can trigger your symptoms. And depending on what drug you’re taking, being high can even feel like psychosis. That’s because both drug use and schizophrenia tamper with your brain’s reward system. Here’s why.

The Similar Brain Chemistry of Schizophrenia and Addiction

Taking any drug has an impact on your brain’s reward system. And it doesn’t matter what the drug’s actual effects are. The very act of getting high increases your levels of dopamine, a neurotransmitter. So when you take drugs, you feel a sense of reward.

Over time, you’ll need more and more of a drug to achieve that feeling. Reward might be replaced with relief. And as your tolerance goes up, you’ll likely develop a more severe addiction.

Even if you never take drugs, schizophrenia still disrupts your reward system.  In some people, it decreases baseline levels of dopamine. Or, it can make you hypersensitive to dopamine, so doing drugs feels like an even bigger reward. And if you’re taking drugs that reduce the symptoms of schizophrenia, addiction is even more likely.

Self-Medicating to Manage Schizophrenia

While addiction is unhealthy, it often begins as a coping mechanism. You might feel like drug use helps you control the symptoms of schizophrenia. And, in some cases, that might even be true. For example, nicotine reduces psychotic symptoms. But that doesn’t mean cigarettes are good for you.

In the long term, addiction continues to destabilize your reward system. Because of this, ongoing drug use can exacerbate your schizophrenia symptoms. This complicates the process of recovery.

Treatment for Both Schizophrenia and Addiction

Quitting drugs isn’t a cure for schizophrenia. But for some people, it’s an important first step toward healing. And because of the overlap between addiction and schizophrenia, many of the same treatments might help with all your symptoms.

If you’re recovering from both these conditions, you might benefit from treatment for co-occurring disorders. Within that framework, there are several specific therapies that can help.

Motivational Interviewing

Motivational interviewing (MI) helps patients with schizophrenia commit to ongoing treatment. It’s an especially effective treatment for people with both addiction and psychosis.

MI isn’t technically a type of therapy. Instead, it’s a conversation style that many different clinicians apply to treatment. Therapists, doctors, nurses, and others can all use this approach. During MI, they’ll use active listening, pointed questions, and other techniques. This can help you find your personal spark of motivation to heal.

Contingency Management

For patients with both schizophrenia and addiction, contingency Management (CM) can make recovery more likely. This approach rewards your participation in treatment. For example, you might get a gift card, voucher, or even cash for going to a therapy session. You and your care team will write and honor a treatment contract, defining prizes for each activity. In most cases, the value of your rewards will go up over time. For many people, this agreement motivates positive changes.

Dialectical Behavioral Therapy

Dialectical behavioral therapy (DBT) was originally developed to treat borderline personality disorder. Today, it has many additional uses. For example, DBT can help patients with schizophrenia, addiction, and other mental health conditions.

Sessions of DBT can feel more like classes than therapy. You’ll meet with a group, go through a workbook, and even do homework. You might also have 1:1 sessions with your therapist. Patients learn practical skills in 4 modules: mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. These coping strategies can empower you to live a healthier life.

Cognitive Behavioral Therapy

Like DBT, cognitive behavioral therapy (CBT) focuses on practical coping skills. CBT helps patients with addiction and schizophrenia manage their symptoms without drug use.

Instead of trying to change your feelings, CBT shows you new ways to respond. Future episodes of psychosis might always trigger drug cravings. But you’ll learn how to accept that feeling and move on, instead of falling back into addiction.

Specialized Care in Rehab

Schizophrenia is often a lifelong condition. Instead of “fixing” all of your symptoms, treatment empowers you to manage them. These strategies are far more sustainable than addiction. And in an effective rehab program, you can heal from both at the same time.

Browse rehabs that treat schizophrenia to see locations, photos, reviews, and more.

Reviewed by Rajnandini Rathod

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The Complex Relationship Between Addiction and Depression

Depression can be either a cause or symptom of addiction. Some people try to self-medicate their symptoms, which leads to addiction. Others get depressed because of their substance use. But there’s a reason these 2 conditions appear together so often. If you have signs of both, you might need specialized treatment at a rehab for depression and addiction.

Common Causes of Depression and Addiction

Depression and addiction often occur at the same time. And in fact, having depression doubles your chance of developing addiction. But the link goes both ways. Taking drugs can also cause depressive symptoms.

What’s more, these 2 diagnoses have overlapping causes. The same factors that put you at risk for depression can also make you vulnerable to drug abuse:

Addiction and depression cause similar brain activity. And acute symptoms activate the same neural pathways over and over again. If you have depression, that happens during a depressive episode. With addiction, it happens when you take drugs. Both conditions make those pathways more and more sensitive over time. So without proper treatment, either one will continue getting worse. And, you’ll become even more vulnerable to the other.

Getting the Right Diagnosis

To get the right type of treatment, you first need an accurate diagnosis. And that can be more complex than it sounds. For example, if your depression is the result of drug use, your recovery will need to include addiction treatment.

Depression can co-occur with a wide variety of health issues. These can include mental health conditions, like anxiety, and even physical ones. For example, diabetes is linked to depression. And sometimes it’s just a symptom of a more complex diagnosis.

Depression as a Symptom of Bipolar Disorder

Bipolar disorder is a mood disorder that occurs in over 50% of people with addiction. People with this condition experience periods of depression interspersed with mania. And because it’s a primary symptom, bipolar is often misdiagnosed as major depression.

If you get the wrong diagnosis, it can interfere with your recovery. And it doesn’t just delay your progress—it can also make your symptoms worse.  For a person with bipolar, antidepressants can trigger manic episodes. They can also cause intense swings between mania and depression, called rapid cycling.

Addiction can exacerbate your mood disorder symptoms. That’s true whether you have bipolar disorder, major depression, or something else. If you’re healing from both addiction and any other mental health issue, you might consider going to rehab for co-occurring disorders.

Treatments for Depression and Addiction

Depression and addiction are receptive to similar types of treatment. That means you can heal from both simultaneously. You might even find that focusing on one condition helps you heal from the other. For example, data shows that most depressive symptoms resolve during addiction treatment. But that’s not true for everyone.

When you enter recovery, you might not know which condition came first. But you can work with your care team to answer that question. If your depressive symptoms fade after detox, you might just focus on healing from addiction. But if you do have clinical depression, there are several ways to approach treatment.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) teaches patients to cope with difficult thoughts. You’ll learn practical skills that help you live with and regulate even the most intense emotions.

CBT treats depression and addiction by helping people build self-confidence. And data shows that it has lasting effects, supporting your long-term recovery. You can also combine this therapy with other types of treatment, like medication.

Medication for Depression

Depending on your physical health, your care team may recommend prescribed medication. For example, it’s common to treat depression with selective serotonin reuptake inhibitors (SSRIs), like Prozac or Zoloft. Preliminary data shows that SSRIs may also support addiction recovery. Specifically, they might help people quit smoking or heal from sex addiction.

SSRIs typically take full effect after 6 weeks. And while they’re a common treatment for depression, they aren’t right for everyone. You may need to try a few medications before you find the right fit. Or, if you have treatment-resistant depression, you might need to take a different approach.

Alternative Treatments

If traditional therapy and medication aren’t working for you, there are many other ways to treat depression. Some of these methods are experimental, while others are highly researched but less well known.

These alternative treatments aren’t replacements for traditional medical care. But you can combine them with other therapies, or even attend a holistic rehab program. There’s no right or wrong way to plan your recovery—just the way that works best for you.

Clearing the Clouds

Depression and addiction have so much in common, it can be hard to tell which one has the greater impact on your life. But there’s a silver lining to their overlapping symptoms. With the right treatment, recovery can be straightforward. In the long term, you can use the same coping skills to manage any ongoing symptoms. But most importantly, healing means learning about the complex relationship between these conditions. And doing that will teach you more and more about yourself.

Browse rehab centers that treat depression to learn about their amenities, photos, and reviews.

Reviewed by Rajnandini Rathod

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Breaking the Cycle: How to Heal From Addiction and Anxiety

Anxiety can be more than a feeling. It also affects your behavior. And if it’s getting in the way of your daily life, it makes sense that you’d look for ways to cope. But not all coping strategies are healthy. Some—like drug use—can even make your anxiety worse. In rehab for anxiety, you can learn safer, more sustainable skills.

Recognizing Anxiety

Anxiety disorders ((What are the five major types of anxiety disorders? [Text]. 2013, February 9. HHS.Gov. https://www.hhs.gov/answers/mental-health-and-substance-abuse/what-are-the-five-major-types-of-anxiety-disorders/index.html)) look different for different people. They can even be invisible to others. But even for high achievers, anxiety can get in the way of important goals. If anxiety is interfering with your daily life, you may have one of these diagnoses:

Everyone feels stressed from time to time. But if your anxiety interferes with the rest of your life, you might have one of these diagnoses. And while it’s normal to search for ways to manage these feelings, not all coping mechanisms are healthy.

The Connection Between Anxiety and Drug Addiction

Anxiety and addiction ((Smith, J. P., & Book, S. W. (2008). Anxiety and substance use disorders: A review. The Psychiatric Times, 25(10), 19–23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904966/)) are 2 of the most common diagnoses in the U.S. And they often occur together. Some people develop addiction in an attempt to self-medicate anxiety. Others feel anxiety about their addiction. Whichever comes first, one thing is clear: anxiety and addiction are a volatile combination. ((Nguyen, A., Mirbaba, M., Khaleghi, F., & Tsuang, J. (2017). Current treatment options for co-morbid anxiety and alcohol use disorders: A review. Journal of Addictive Behaviors and Therapy, 1(1), 0–0. https://www.primescholars.com/abstract/current-treatment-options-for-comorbid-anxiety-and-alcohol-use-disorders-a-review-106758.html))

What’s more, each of these conditions can make the other one worse. And that’s true even if a drug helps with your short-term symptoms. For example, benzodiazepines are commonly prescribed for anxiety. But some benzos, like Xanax, have a rebound effect. ((Ait-Daoud, N., Hamby, A. S., Sharma, S., & Blevins, D. (2018). A review of alprazolam use, misuse, and withdrawal. Journal of Addiction Medicine, 12(1), 4–10. https://doi.org/10.1097/ADM.0000000000000350)) They’re hugely effective at relieving the symptoms of panic attacks. But, if you reduce your dosage, your anxiety might spike. This can easily lead to relapse.

The complex relationship between addiction and anxiety has an impact on treatment. ((Brady, K. T., Haynes, L. F., Hartwell, K. J., & Killeen, T. K. (2013). Substance use disorders and anxiety: A treatment challenge for social workers. Social Work in Public Health, 28(0), 407–423. https://doi.org/10.1080/19371918.2013.774675)) Specifically, it can be hard to treat underlying anxiety while you’re actively taking drugs. When you’re ready to heal from either of these conditions, you might benefit from treatment for co-occurring disorders.

Treating Both Addiction and Anxiety

There’s a silver lining here. Because these issues are so common, experts have sought out many effective therapies. In residential rehab, you might try one of these, or combine them as part of a comprehensive care plan.

Cognitive Behavioral Therapy

Data shows that cognitive behavioral therapy (CBT) can effectively treat anxiety and co-occurring addiction. ((Alamdarloo, G. H., Khorasani, S. M., Najafi, M., et al. (2019). The effect of cognitive-behavioral therapy on depression, anxiety, and stress levels in iranian males with addiction. SAGE Open, 9(1), 215824401882446. https://doi.org/10.1177/2158244018824466)) This type of talk therapy helps you recognize unhealthy thought patterns. When you understand the reason behind your own behaviors, you can learn to respond in a healthier way.

Your therapist will act as a guide, teaching you practical coping strategies. As you incorporate those skills into your daily life, you’ll learn to regulate your emotions. This healthy behavior can make it easier to work through anxiety without taking drugs.

Yoga

There’s more to yoga than physical exercise. It also teaches mindfulness, breathwork, and emotional endurance. It can even give you a sense of community. For these reasons and more, research shows that yoga reduces anxiety. ((Kuppili, P. P., Parmar, A., Gupta, A., & Balhara, Y. P. S. (2018). Role of yoga in management of substance-use disorders: A narrative review. Journal of Neurosciences in Rural Practice, 9(1), 117–122. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5812135/))

This is part of why yoga is often used in addiction treatment. Specifically, this mind-body practice can reduce drug cravings, helping you kick-start recovery. And over time, it can help you reconnect with yourself in an even deeper way.

Biofeedback

Biofeedback uses sensors to track your physical responses ((Banerjee, S., & Argáez, C. (2017). Neurofeedback and biofeedback for mood and anxiety disorders: A review of clinical effectiveness and guidelines. Canadian Agency for Drugs and Technologies in Health. https://www.ncbi.nlm.nih.gov/books/NBK531603/)) to certain stimuli. For example, you might wear a heart rate monitor during a therapy session. Then, with a clinician’s help, you’ll review the data it collected. This helps patients understand their own reactions to stress.

This treatment gives you valuable information about how your body reacts to certain emotions. You can then use that data to change your physiological response using different relaxation techniques. The goal is to empower you to make different choices—ones that will support your long-term health. As a result, biofeedback reduces both anxiety and drug cravings. ((Khatami, M., Woody, G., O’Brien, C., & Mintz, J. (1982). Biofeedback treatment of narcotic addiction: A double-blind study. Drug and Alcohol Dependence, 9(2), 111–117. https://doi.org/10.1016/0376-8716(82)90056-4))

Moving Forward, on Your Own Terms

Often, anxiety is the fear of things you can’t control. Some of those things—like the weather—will always be out of reach. That’s okay. In recovery, you can learn to accept your emotions just as they are. And by doing that, you can take back control of the best parts of your life.

Browse a list of anxiety treatment centers to learn about their housing, treatment options, insurance, and more.

Reviewed by Rajnandini Rathod