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A First Steps guide to managing

Alcohol, drugs and emotional well-being

First Steps, Version 2, February 2013


Alcohol, drugs and emotional well-being

What is in this booklet?

Page Introduction Drugs that may affect emotional well-being

1. Alcohol 2. Amphetamines (speed); Methamphetamine (Crystal Meth) 3. Anabolic Steroids 4. Benzodiazepines 5. Caffeine 6. Cannabis 7. Cocaine; Crack Cocaine 8. Ecstasy (MDMA/MDEA) 9. Heroin (Diamorphine) 10. Ketamine; Phencyclidine (PCP) 11. Khat 12. LSD ((Lysergic acid diethylamide) 13. Magic Mushrooms 14. Methadone 15. Buprenorphine (trade name Temgesic) 16. Mephedrone 17. Research Chemicals (Legal Highs) 18. Solvents

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Self-help tips for emotional well-being Challenging negative thinking Support networks Keeping a balance The stress jug analogy Communication and assertiveness Relaxation exercises Goal setting Distraction techniques Useful contacts

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Alcohol, drugs and emotional well-being

Of all the people diagnosed with a mental health condition, 29% stated they misuse alcohol or drugs. Drinking or using other drugs to deal with difficult feelings or symptoms of mental illness is sometimes called self-medication by people in the mental health field. If this self-medication becomes a regular tool for coping, a person can become psychologically dependent. All drugs (medicinal as well as illegal) have the potential for unwanted, and often unexpected, effects. They are usually substance and individual specific. Also, some recreational drugs have been scientifically proven to be physically addictive. These are: Alcohol (Booze) Tobacco (Chewing and Smoking) Heroin (Brown, Skag, Smack, Gear, Horse, H) Cocaine (Coke, Charlie, C, Snow, Toot, White) Methamphetamine (Crystal Meth, Ice, Tina)

If you rely on drugs to help you feel less anxious or depressed or to improve your mood, you may be becoming psychologically dependent. If you rely on drugs to achieve certain physical effects or you cant face the unpleasant physical effects of not taking the drugs, you may be becoming physically addicted. In fact, most drug-related problems generally involve physical and psychological symptoms and sometimes it is difficult to separate the two. Other signs that you could be becoming dependent on drugs are:

if obtaining and taking drugs is more important than anything else in your life if you use drugs to block out both physical and emotional pain if you use drugs to distance yourself from problems such as loneliness, family or relationship problems, low self-esteem, poverty or housing difficulties, unemployment or lack of opportunities

Being physically and/or psychologically addicted (or dependent) means that you will crave more of the drug, even though it may be doing you physical or psychological harm. Someone may notice withdrawal symptoms after a period of regular use, which may encourage them to continue using. This applies for illegal drugs such as cocaine and heroin, as well as legal drugs such as alcohol.

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Alcohol, drugs and emotional well-being

Withdrawal from a drug can make you very unwell in the short term, so it is important that you inform your GP before deciding to stop use of any drug, so that you can access the right type of support. Also it is important to remember that there may be many more unwanted side effects from taking illegal drugs or alcohol.

The effects of a drug may vary according to the mental state of the person taking it. A strong mood-altering substance may trigger, or bring out an underlying emotional difficulty Drugs may interact with each other (including legal ones such as alcohol). Some mixtures may even prove life- threatening With any illicit drug there is no quality control so there is a constant danger of variable strength and they can be mixed with other substances to bulk up the drug Injecting drugs involves the risk of introducing infections directly into the blood-stream. Sharing of needles is particularly dangerous as it may lead to cross-infections (e.g. HIV and hepatitis) Drugs taken during pregnancy may damage the foetus

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Alcohol, drugs and emotional well-being

Drugs that may affect emotional well-being

Alcohol Alcohol is the most toxic of the commonly used drugs, but moderate use is not usually a problem. Short-term effects: initially you feel relaxed and more sociable, but alcohol is essentially a depressant, and as this effect sets in you may be tempted to drink more in order to recreate the pleasant effects. Large amounts tend to make people uninhibited and aggressive. Long-term effects: if you become addicted to alcohol, you may use it as an escape, or as a means of coping with difficulties. If you drink a lot over a long period, you may find it difficult to form new memories, so that you cannot remember recent events; you may not be able to think clearly; and may you have difficulty with problem solving and concentrating. You can recover from these problems if you stop drinking. Dependency and withdrawal: alcohol withdrawal causes sweating, anxiety, trembling and delirium (which may include confusion, disorientation and hallucinations). Note: If you are addicted, it is very dangerous to stop drinking suddenly. Alcohol in excess can lead to serious physical and mental health conditions. Mental health problems not only result from drinking too much alcohol. They can also cause people to drink too much. Put very simply, a major reason for drinking alcohol is to change our mood - or change our mental state. Alcohol can temporarily alleviate feelings of anxiety and depression; it can also help to temporarily relieve the symptoms of more serious mental health problems. Alcohol problems are more common among people with more severe mental health problems. This does not necessarily mean that alcohol causes severe mental illness. Self medicating to deal with difficult feelings or symptoms of mental illness is often why people with mental health or emotional problems drink. But it can make existing mental health or emotional problems worse. Evidence shows that people who consume high amounts of alcohol are vulnerable to higher levels of mental ill health and it can be a contributory factor in some mental illnesses, such as depression. When we have alcohol in our blood, our mood changes, and our behaviour then also changes. This change depends on how much we drink and how quickly we drink it. Alcohol depresses the central nervous system, and this can make us less inhibited in our behaviour. It can also help numb our emotions, so we can avoid difficult issues in our lives. Alcohol can also reveal or magnify our underlying feelings. This is one of the reasons that many people become angry or aggressive when drinking. If our underlying feelings are of anxiety, anger or unhappiness, then alcohol can magnify them. One of the main problems associated with using alcohol to deal with anxiety and depression is that people may feel much worse when the effects have worn off. This can lead some people to drink more, to ward off these difficult feelings, and a dangerous cycle of dependence can develop.

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Alcohol, drugs and emotional well-being

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

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

Amphetamines (Speed); Methylamphetamine (Crystal meth) Short-term effects: Amphetamines increase attention and alertness and reduce tiredness. They make you feel energetic and confident. Long-term effects: as the drug is eliminated from your body, you may feel drowsy, anxious, depressed, and irritable. Amphetamines may also cause a psychotic reaction, with paranoia, especially if you already have a diagnosis of mental health problems. Withdrawal: symptoms include tiredness and depression. The effects of crystal meth are similar to crack cocaine (see below) but longer lasting. The acute effects include agitation, paranoia, confusion and violence.

Anabolic steroids Anabolic steroids are taken to increase muscle bulk and enhance sporting performance. The possible adverse effects on mental health are aggression, dramatic mood swings, confusion, sleeping problems, depression and paranoia; these subside after stopping the steroids. Dependence: if you have become psychologically dependent on them, you may become lethargic and depressed, even after you stop taking them.

Benzodiazepines Benzodiazepines work by helping to calm the brain down. They are prescribed for anxiety and as sleeping pills. Regular street drug users may take them illegally if they cant get their usual drug; when they want to add to the effects of other similar drugs, such as alcohol or opiates; or to treat the effects of stimulants, including ecstasy or amphetamines, or to help with stopping smoking. Short-term effects: they relieve tension and anxiety and make you feel calm and relaxed, while allowing you to still think clearly. Sometimes they may have the opposite effect and make you feel agitated, hostile and aggressive. Dependency and withdrawal: they should only be prescribed for short-term use, because it is very easy to become dependent on them, and withdrawal may be very difficult. Withdrawal symptoms include sleeping problems, anxiety, shaking, irritability, nausea, vomiting, and heightened senses.

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Alcohol, drugs and emotional well-being

Caffeine Coffee, tea and chocolate all contain caffeine. It is also added to some soft drinks and energy drinks as well an ingredient in some painkillers and cold remedies. The average cup of coffee contains around 40mg of caffeine per cup, a can of cola around 23mg, and some energy drinks have four times that amount. Plain chocolate has 40mg caffeine per 100g nearly three times as much as milk chocolate Sensitivity to caffeine varies from person to person, but too much can make you anxious, restless, irritable, jittery and sleepless. It can also give you headaches, stomach pain, nausea, muscle twitching or palpitations. Cutting out caffeine in one go can be difficult because you may experience withdrawal symptoms, including severe headaches as well as nausea, anxiety, fatigue and depression. One way to avoid this is to gradually decrease the amount of caffeine you consume, either by drinking fewer cups of coffee each day or by gradually switching to decaffeinated coffee. Its important not to switch to other substances that also have high levels of caffeine, such as cola or chocolate.

Cannabis Largely seen as a harmless drug, it can have serious impacts on your emotional health and well-being. It has effects which mimic stimulants, depressants and hallucinogens, although is classed as a depressant. Many people take cannabis as a way of relaxing and getting high. The effects will depend largely on your expectations and mood, the amount taken and your situation. Short-term effects: a pleasurable state of relaxation, talkativeness, bouts of hilarity and feeling excited by the things you see, hear and feel. People often feel hungry. Low doses have more of a depressant effect, while high doses can distort your perceptions, and make you forgetful. If you are anxious, depressed or have not used cannabis before, and you take a high dose, you may become very distressed and confused. In some people, cannabis may trigger psychotic experiences (hallucinations and other experiences which others dont share). The reasons that some people get these while others do not are genetic, and also associated with the strength of the cannabis used. The psychotic experiences may include experiences such as hallucinations, fantasies, depersonalisation and derealisation (feeling out of touch with yourself or your surroundings), feeling a loss of control, fear of dying, irrational panic and paranoid ideas. These can stop once the effects of cannabis have worn off, but in some cases cannabis can trigger a longlasting illness that may be diagnosed as schizophrenia. As there is no way of knowing whether you carry the gene that can put you at risk or not, it is safer to not use. Long-term effects: Psychotic illness in some people. Some people may develop depression as a result of using cannabis as teenagers. In addition, cannabis has been shown to impair brain function.

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

short-lived effects such as anxiety, panic, depression and psychosis, which usually occur after excessive consumption of the drug effects on pre-existing mental illness it can make them worse cannabis as a risk factor for mental illness dependency and withdrawal feeling lethargic finding it difficult to communicate with others having a general lack of ambition

Although the majority of adolescents are not harmed by using cannabis, a small minority are. Research in young people suggests that using cannabis as a teenager increases the likelihood of experiencing symptoms of schizophrenia in adulthood, and the younger you are when you use it, the more you are at risk of developing schizophrenia. Cannabis use alone does not cause psychosis, but it is one of the things that may contribute to its development; therefore, using cannabis increases the risk, and some cases of psychosis could be prevented by discouraging cannabis use among young people. It was also found that those who used more cannabis were more likely to develop depression and anxiety, and this was more marked in girls. Young women who used cannabis daily were five times more likely to have depression and anxiety than non-users, and using cannabis weekly doubled the rates of anxiety and depression. There was no evidence that girls who were already depressed before using cannabis were more likely than others to use it. Other studies, using self-reported questionnaires with groups of users, have reported panic attacks and anxiety in a significant number of users, and depression, tiredness and low motivation.

Cocaine; Crack cocaine Cocaine comes in two forms: cocaine powder which is snorted, and crack cocaine which is smoked. Both forms can be injected. Short-term effects: initially you feel wide-awake, energetic and confident. These effects are short-lived, which means that people tend to take them repeatedly, over a number of hours. Regular users may experience depression, anxiety, panic attacks, and paranoia. High doses may cause hallucinations and delusions, depression and suicidal thoughts. Long-term effects: Cocaine can make existing mental health problems worse. Long-term use causes irreversible brain damage, in particular to the areas of the brain which control judgment and planning. This is one of the reasons why cocaine addiction is hard to treat, as the part of the brain needed to make rational decisions is no longer able to function properly. Dependency and withdrawal: Cocaine is very addictive. The brain adapts to it, so that increasing doses are needed to create the same effect. Dependency may cause loss of energy, psychosis, depression, and akathisia (a feeling of intense restlessness also associated with antipsychotic medication). Cocaine is often mixed with other substances. If you combine cocaine with alcohol, they produce a very poisonous substance which has been associated with a 25-fold increase in sudden death.

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Alcohol, drugs and emotional well-being

Ecstasy (MDMA Adam; MDEA Eve) Short-term effects: causes release of serotonin, making you feel happy and relaxed. It also causes release of oxytocin, a hormone involved in childbirth and social bonding, which produces feelings of empathy, openness, caring and emotional closeness to others. Long-term effects: markedly reduces the amount of serotonin stored in the brain. This can cause depression, which is difficult to treat, because it does not respond to antidepressants. After heavy use, you may also experience loss of confidence, shakiness, anxiety and confusion. Jitteriness and teeth clenching; panic attacks after repeated use; hallucinations and paranoia after repeated high doses.

Heroin (Diamorphine) The main effects of heroin are pain relief, and euphoria but also depression. Short-term effects: It causes a rush of pleasure, followed by a calm, warm, dreamy contentment. Some people become very drowsy; others may be very talkative. It may also cause loss of appetite, insomnia and lethargy. Long-term effects: Long-term use can lead to physical and mental health problems, as you lose your appetite, become apathetic and stop paying proper attention to safety and hygiene. As heroin is a painkiller (prescribed as diamorphine), after long-term use, you may experience generalised pain when the level of drug in your system drops. Dependency and withdrawal: Heroin causes no serious mental health problems, but it is extremely addictive, leading to craving and severe physical withdrawal symptoms. The craving often comes to dominate users lives, leading to serious social problems including crime. The withdrawal symptoms are very unpleasant, but not life-threatening. They may last for up to ten days, but can make you feel unwell for several months. You are very likely to become tolerant of the drug, which means you need to take more of it to achieve the same effect, and obtaining and taking the drug begins to take over your life, with many social consequences. Many drug treatment programmes are geared to helping people who are addicted to heroin and other opioid drugs. People dont always become dependent, and some regular users show no symptoms of addiction.

Ketamine; Phencyclidine (PCP) Ketamine and PCP are anaesthetics, mainly used in animals. Short-term effects: poor concentration, changed perception of surroundings things not looking right or not feeling right; feeling stuck in your chair, and feelings of being out of touch with reality and with your surroundings; delusions, paranoia, dream-like states, feeling you have no thoughts. The symptoms may be confused with schizophrenia. A bad trip may make you violent, suicidal or likely to harm yourself. Long-term effects: difficulty thinking clearly; depression. PCP may also cause long-lasting psychosis.

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Dependence and withdrawal: you are more likely to become dependent on PCP than ketamine, and more likely to have withdrawal symptoms, including depression and sleeping a lot.

Khat Khat is a green, leafy plant that has been chewed in East Africa for thousands of years. It is similar to alcohol in that it produces relaxation and aids socialisation, and people may go to khat houses (mafreshi) in a very similar way to going to the pub. And, as with alcohol, problems come with over-use, leading to financial problems, an inability to work, loss of selfrespect, relationship problems and so on. Short-term effects: it can make you feel elated and energetic; you cant sleep and may not feel like eating. If you take a lot, you may hear voices and become paranoid. Afterwards you may be tired, depressed, anxious and irritable.

LSD (Lysergic acid diethylamide) LSD is a synthetic drug that was first made in the 1940s. It causes random and sometimes frightening effects which may be delayed. Short-term effects: these include feelings of detachment from your surroundings, an altered sense of space and time, and hallucinations. You may have feelings of insight, mysticism and spirituality. You may feel you can fly and put yourself in serious danger. Some people have accidentally killed themselves under the influence of LSD and related drugs. People may have good or bad trips, at different times. A bad trip can give you acute anxiety and panic. Afterwards you may get flash-backs of bad trips, when you feel they are happening to you all over again. The users own intentions, and other peoples suggestions, can influence the experience, so friendly reassurance can help someone on a bad trip. If you already have a diagnosis of schizophrenia, LSD is very likely to make your symptoms worse. It may also cause you to recall unpleasant memories. Long-term effects: there is no evidence of long-term damage, though some people, who were prescribed LSD in the 1960s and 70s to help recover repressed thoughts and feelings during psychoanalysis, reported that their mental health had been damaged by it and they had never recovered. This may be associated with the whole treatment method and the way it was applied at that time, and not simply the use of LSD.

Magic mushrooms The effects of magic mushrooms are similar to LSD (see above). Hallucinations may be quite pleasant and non-threatening but may also be very frightening.

Methadone has similar effects to heroin, but they are milder and longer lasting, so it stops you going through withdrawal, and also doesnt give you the initial high. Changes of mood, hallucinations, restlessness and decreased libido are side effects listed in the information leaflet for this drug.

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

Mephedrone (do not confuse with methadone see above) Short-term effects: increases levels of dopamine, serotonin and noradrenaline in the brain, causing over-stimulation. Its main adverse effect is agitation, with hallucinations (hearing and seeing things and also strange touch sensations) and paranoid delusions. It may also cause you to grind your teeth. In some people it may cause depression and suicidal feelings. All of these are more likely if you already have mental health problems, and you may still get the hallucinations and delusions even if you are taking antipsychotic medication

Research chemicals (legal highs) Legal highs can be bought over the internet and in shops, and are often marketed as common household products (such as plant feed, or room odoriser). There is a myth that because these are legal to produce and buy, that they are safe to use. However this is not the case. Research chemicals are often among the most dangerous to use because there has been no research done on the chemicals to monitor their short and long term effects. If while taking these chemicals, something unfortunate does happen to you, doctors would not always know how to treat you, which can lead to short and long term damage to your physical and mental health, and in some cases even death. It is important to note that these research chemicals also carry along all the other risks of taking Street Drugs they can be mixed with impurities as they are not regulated, they can reduce inhibitions and therefore make you more likely to take up risky behaviours, they can cause feelings of anxiety, depression, insomnia, loss of short term memory, and paranoia, there is a serious risk of overdose as strengths can vary, and in very serious cases, they can lead to seizures, coma and even death.

Solvents Solvents, glues, gases and aerosols are used mainly by a small percentage of young people, usually only for a short period. Short-term effects: The effects are similar to getting drunk, including feeling dizzy, unreal, euphorically happy, and less inhibited. The effects can also include pseudohallucinations, which you know are not real. Repeated sniffing can cause a hangover effect, making you pale, very tired, forgetful and losing concentration. Dependence: Tolerance and dependence may develop over a long period of time, but only for a minority of young people.

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Self-help tips for well-being

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

Maximise the things that make you feel good, and minimise (as far as practical) the things that make you feel bad. Some feel good factors include: Making time for relaxation Being able to express your feelings Having achievable goals to aim for Making time for the things you enjoy Maintaining a healthy diet Starting a sport or exercise you enjoy Work you find rewarding A comfortable balance between work and leisure Time to yourself, to do the things that interest you Time for friends and family Some things to minimise: Unnecessary stress, at home or at work Misusing drugs or alcohol as coping mechanisms it may help you to feel better in the short term, but you will feel worse off in the long term. Use other coping mechanisms which are better for your health, and will help you to sort out any issues, such as talking to a friend or family member. Misusing drugs or alcohol to try and ignore/block out situations you will only have to deal with the situation once your high wears off. Feelings of rage or frustration Expecting too much of yourself and negative thoughts and feelings What things could you increase or need to decrease?

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

Recognising that you can change Change is part of life. We are all products of our environment and experience, but are never fated to live or feel the same way forever. There are three conditions for long-lasting change: a. Understand the present: Don't hide from reality, but see the present clearly. b. Do not be burdened by the past: The past cannot be changed. Do not allow it to weigh you down. Choosing to let go of the past does not mean that you accept or agree with what has happened; just that you recognise that thinking about it is not helpful to you. c. Accept the uncertainty of the future: Much of the future is not under our control. It is in our best interest to accept uncertainty and learn how to face the future with confidence.

Challenging negative thinking

Events themselves do not cause us to feel upset or depressed. It is our beliefs about these events that determine our emotional reaction. We have a tendency to think If I think these thoughts, they must be true. However, when we feel low in mood we are more likely to focus on negative things from the past. We become really good at ignoring any of the positive, and then wonder why we are depressed. Unhelpful thoughts pop into our minds so quickly that it is often difficult to spot them. Think of it this way, we dont get to choose whether or not a bird lands on our heads. We do get to choose, though, whether or not it makes a nest. This is true of our thoughts as well. Just because we think a thought, does not mean that we have to believe it or continue to think about it!

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

All or nothing thinking. Thinking in absolutes, black and white, or good and bad with no middle ground and a tendency to judge people or events using general labels, e.g. Hes an idiot, Im a failure Catastrophizing. Overestimating the chances of disaster, e.g. whatever can go wrong will go wrong or a set back being part of a never-ending pattern of defeat Jumping to conclusions. Making negative interpretations even though there are no definite facts. Also making negative predictions about the future

Negative focus. Ignoring or misinterpreting positive aspects of a situation. Focussing on your own weaknesses and forgetting your strengths Living by fixed rules. Fixed rules and unrealistic expectations, regularly using words such as should, ought, must and cant, leading to unnecessary guilt and disappointment. The more rigid these statements are, the more disappointed, angry and depressed you are likely to feel Personalising. Taking responsibility and blame for everything that goes wrong

When trying to come up with a helpful thought, here are some tips to help you What is the evidence to support the unhelpful thought? What tells you that this thought is correct? What is the evidence that does not support the unhelpful thought? This is the hard part, because it is often overlooked, but ask yourself these questions: How would someone else view the situation? How would I have viewed the situation in the past? What might I say to a friend who was in a similar situation? What is the effect of thinking the way I do? Does it help me or make me feel worse?

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

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Support networks
Social supports (friends, families etc) can be an important way of increasing our mood. When a person feels low in their mood it is not uncommon for them to reduce their contact with their friends/family which can lead to social isolation and the associated negative effects on wellbeing. Increasing our social support is not simply a case of increasing our contact with more people as not all social contacts are positive. For example, only meeting up with somebody who is very low and has a number of difficulties of their own may have an adverse affect on your mood. It is possible to feel lonely even when surrounded by others. Increasing our positive social contact could be through a number of ways including: Pushing ourselves to meet up with friends, family or colleagues Contacting friends via the telephone, internet or email Doing activities which provide us with the opportunity to meet and choose new friends Sharing our experiences with the people around us

Keeping a balance
It is important to keep a balance between things that you have to get done like work, household tasks, paying bills etc. and the things that you enjoy and that help you to feel relaxed. Keeping up your own interests and hobbies is a big part of managing your emotional well-being and allows you to give more to your family and friends. Think about where you can take a break and spend some time on activities that are just for you. This is important for your emotional and physical well-being as it allows you to spend time doing things that you find rewarding, fun and engaging. By doing these activities, you will find enjoyment in things that dont involve using alcohol or other substances.

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The stress jug analogy

As humans, we only have a certain capacity for managing stress. Imagine that all of your stress was in a jug. The fuller your jug is, the greater the symptoms of stress will be. Once the jug is full, your ability to manage any situation that arises is greatly compromised, which is why you may feel less able to cope with matters that would normally have no effect on you. Some of your jug is already filled with the anxieties of life that we cannot avoid, (i.e. money, illness, family, not having enough time for yourself, etc). Therefore, if you have a large source of stress in one area of your life that is filling your jug, your capacity to manage stress in the other areas will be compromised. You may feel that you manage your stressful job very well, for example, but feel that you are unable to cope with any stresses at home or vice versa. If you partially empty your jug on a daily basis, you can avoid it over-flowing which will help you to reduce your symptoms and to feel more in control. It may be that you are unable to change the main contributor to your stress, but if you can do something about your other sources of stress, you will feel better able to cope. You can empty a little out of your jug on a daily basis by using self-help techniques to: Look at your stressors to see if there is anything you can do to reduce the level of stress they produce or if you could manage them in a different way Identify if the stressful situation is really your responsibility. If not, could it be delegated to someone else or could your energy be better used elsewhere? Have time to relax. This may be by completing a relaxation routine, playing a sport or socialising, etc

Communication and assertiveness

Being assertive is a way of communicating your thoughts and feelings without hurting others. It is an alternative to being aggressive where you get what you want but hurt others. It is also an alternative to being passive where you dont hurt others but you also do not get what you want. We are unassertive because we have learned to be this way from childhood. Some children are encouraged to express their feelings and some are not. They good news is that as you have learned to be this way, you can learn to be a different way. Being assertive means we can ask for what we want from others; we can say no to others requests; we can express our emotions; and we can express personal opinions without feeling self-conscious. Being aware of your communication style with others is important as it will affect your relationship with them and also the way they communicate with you. Being firm, clear and assertive is likely to get better results when it comes to trying to express your opinion. By learning to communicate effectively and assertively in your everyday life, it is likely to be much easier to maintain this at times when you may be feeling stressed or low.
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Relaxation exercises
Breathing control Taking a deep breath at times of difficulty gives you time to recompose yourself and gather your thoughts, whilst reducing your physical symptoms Irregular or erratic breathing is one of the first responses to severe stress. Unfortunately, this may make you feel more panicky, as you feel the need to gasp for air, which in turn makes you more anxious. However, your breathing is easy to control Your stomach muscles should rise and fall as you breathe - As you inhale your stomach moves out slightly - As you exhale your stomach moves in slightly It will help to count as you breathe. Concentrate on the number three. Breathe in for three counts and out for four counts. Maintain a steady, comfortable rhythm and try to avoid holding your breath in between each count

Muscle relaxation Sit comfortably and take a few deep breaths. Now focus on your body, tensing and relaxing each of the muscle groups in the following order: Feet point your toes away from your body, hold, then relax Calves bend your foot at the ankle towards you, hold, then relax Thighs push your knees together, hold, then relax Bottom clench your buttocks together underneath you, hold, then relax Stomach pull in your stomach muscles, hold, then relax Hands clench your fists, hold, then relax Hands (again) stretch the fingers wide apart, hold, then relax Arms bend your arms at the elbow, bringing your hands up towards the shoulders, hold, then relax Shoulders hunch your shoulders up towards your ears hold, then relax Neck pull your chin forwards on to your chest hold, then relax Neck (again) stretch your chin up, pushing your neck back, hold, then relax Jaw clench teeth together, hold, then relax Lips press tightly together, hold, then relax Eyes screw up eyes tightly, hold, then relax Forehead frown hard, wrinkle forehead, hold then relax

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

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Goal setting
Most people find that working towards realistic goals is motivating and satisfying, but it is important to start off by setting the right goals. This really will have a positive impact on the success of building confidence and self-esteem. Remember, change is not always easy, and there may be slips or lapses along the way. This is normal, and so dont be put off or be hard on yourself if you find that you dont always stick to the plan! S M A Specific Measurable Achievable By being clear about your target goal you will be able to take pride in achieving it Just wanting to build up my social life is not measurable; taking part in a dance class twice a week is. Recognise your limits, if you set goals too high you are more likely to quit and feel that you failed. Challenging yourself is great but dont expect the impossible! The goal has to make sense to you and be something you feel is worthwhile and that applies to your views and lifestyle Think when the best time is for you to fit in your goals and try not to tackle too many goals at once


Relevant Timely

Goal setting is an on-going process E R Evaluate Redo Regularly look again at what has gone well or less well and why this might be the case Set new goals or adapt the ones you have. Give yourself a reward for what you achieve, even if you did not complete the goal, but gave it a good shot!

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Alcohol, drugs and emotional well-being

Distraction techniques
Taking a few minutes out of the stressful situation will allow you time to think clearly and rationally. Removing yourself from a situation is not always possible or practical. At this time, distraction techniques may be useful. Try using one of the following: 1. Mental exercises, such as counting backwards from a hundred, reciting a poem from memory, practicing your times tables. Anything that makes you focus your concentration away from the stressful thoughts will help. 2. Physical activity. Give yourself a practical task to do, such as washing up the coffee cups, doing some photocopying or cleaning your desk. Be sure to focus your attention on the task. 3. Focusing on your environment. Choose an object in your immediate environment and concentrate your thoughts on it for a while. Describe the object to yourself; think about its texture, shape, size and colour. Think about the purpose of the object and what makes it unique. 4. Visualisation. A quick way of getting away from a situation without physically leaving Imagine yourself walking to a door Open the door and walk down 3 steps, taking a deep breath for each step You walk into an environment that you have come to associate with relaxation and calmness. This could be a familiar place, a happy memory, or somewhere in your dream What can you see? What can you hear? What can you smell? What can you touch? Spend a few minutes in this place, enjoying the feeling of relaxation When you feel ready, start to make your way back up the steps, taking a breath for each of the 3 steps. Make your way back through the door and back into the present situation

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Alcohol, drugs and emotional well-being

Useful contacts
If you have any questions about your, or others, drug use, would like to find out more information, or would like to know where you can access more support or where to get help for stopping your own or others drug and alcohol use, please contact one of the below organisations.

First Steps Surrey 0808 801 0325 - Monday and Wednesday 10 to 4.30pm and Thursday 11 to 5.30pm. The helpline will be open on a Tuesday following a Bank Holiday. Provides advice and information on a wide range of emotional and mental health issues. Provides information on where to get more support if required, and holds a large directory of local services.

Surrey Drug and Alcohol Care 0808 802 5000 (24 hours a day, 7 days a week) A confidential helpline for all those living and working in Surrey who wants to find out more information about theirs or others drugs and alcohol use and abuse, who are concerned about others or their own drug or alcohol use, want to access treatment for reducing or abstaining their own use, or who require emotional and practical support. This helpline can provide referrals into drug and alcohol services if required.

FRANK 0800 77 66 00 SMS 82111 Provides confidential drugs advice and information to those worried about theirs or others drug or alcohol use. Provides signposting to local services which can offer more long term support.

SADAS Southern Addictions Advisory Service (has various services countywide) 01483 590 150 Provides urgent advice in alcohol, drug or related situations. Also provides drug and alcohol services within the community for those looking to abstain their use or cut down their use. Also provide information on housing and tenancy issues. This service also have a counselling service and run group therapy workshops.

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Alcohol, drugs and emotional well-being

SHOT Surrey Harm Reduction Outreach Team (covers the South East and North West of Surrey) 01483 773242 Provides: needle exchange (including Performance & Imaging Enhancing Drugs) advice, support and information brief interventions for drug & alcohol users, including triage, assessment and other care planned interventions including 1:1 sessions and groups care planned structured interventions including structured psychosocial interventions and other structured drug treatment acts as a treatment referral point for Jobcentre Plus referrals signposting to other services sexual health supplies and advice training programmes on safer drug use services for those affected by other people's substance misuse, i.e. parents and carers

Catch 22 24/7 Surrey 01372 832 888 or 0800 622 6662 (emergency referral and crisis line for young people and families) 24/7 in Surrey is a county-wide specialist treatment service, offering a range of support for young people, aged 11 to 21, who have problems with drugs or alcohol. They have a multi-professional staff team of specialist support workers, social-work qualified workers, qualified education, training and employment-support workers, parent and family workers, mental-health nurses and A&E link workers. They offer:

a 24/7 emergency referral & crisis line for young people: 0800 622 6662 a confidential online referral form (anyone can refer, including the young people themselves) a prompt response before motivation falters and problems get worse a harm-reduction approach which informs young people about the effects of drug and alcohol misuse and the risks involved individually tailored help, based on an assessment of each young persons needs specialist support for mental health problems access to our education, training and employment specialists to open up new opportunities help for the family so theyre better able to support the young person access to prescribing and needle exchange services access to alternative therapies, such as acupuncture social work qualified staff access to mentors and aftercare

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Alcohol, drugs and emotional well-being