Quitting drug use after a first psychotic episode
When a person experiences a first psychotic episode, they disconnect from reality. This means they may see, hear, or feel things that aren't there , or develop false beliefs, such as thinking that other people can read their minds or are persecuting them—something that can generate fear and distrust of those around them. The causes of a first psychotic episode can be varied:
- Intense or prolonged stress.
- History of trauma.
- Social and economic factors.
- Genetic predisposition.
- Substance use in people vulnerable to psychosis.
A first psychotic episode can be treated with professional help, so with the right support, people can recover.
How might substance use affect me if I have psychosis?
Quitting substance use can be key to preventing further psychotic episodes. Substances like cannabis, cocaine, amphetamines, and hallucinogens can increase this risk. It's also important to identify other substances, such as alcohol, that can facilitate the use of other drugs. But how do drugs affect someone with psychosis?
Some drugs increase dopamine levels in the brain through various mechanisms. Dopamine is a neurotransmitter that transmits signals between neurons, contributing to intense emotions, fear, and paranoia, which can make it difficult to distinguish between reality and fantasy .
Some substances, such as cannabis or cocaine, increase dopamine levels, which can make it harder to distinguish between reality and fantasy. Quitting drugs is key to preventing further psychotic episodes.
Imagine your brain as a large orchestra, with each part of your brain being an instrument playing a part in the same song. Dopamine acts as the conductor, giving the signals so that all the instruments play in an orderly and synchronized manner. When the orchestra is well conducted, the music sounds harmonious and peaceful.
Now, imagine that the conductor gets carried away and starts giving orders in a chaotic and erratic manner . The instruments will start playing out of turn; the violin will sound out of tune and shrill, the flute like a cat meowing, and the pianist will play a score different from the rest of the orchestra. This can be interpreted in a confusing way, causing fear and bewilderment .
First psychotic episodes and substance abuse
Relapse as part of the process
Quitting drugs is a real and complex challenge , and relapse is normal. However, a relapse doesn't necessarily mean failure, but rather a part of the process of change. This phenomenon is known as the "relapse spiral." After a period of abstinence, a relapse can generate feelings of guilt, frustration, anguish, and hopelessness, which increase the urge to use again.
With the right support and effective strategies, it's possible to try again and achieve long-term abstinence . Therefore, the process of changing habits isn't linear; you'll encounter multiple stages of transition and risk of relapse. These may feel like setbacks, but you haven't returned to square one, as periods of use and abstinence are distinct. When you resume recovery treatment, you do so with greater knowledge and experience.
The process of changing habits is not linear, and we encounter multiple stages of transition and risk of relapse. Quitting drugs is a complex challenge.
Another concern you might have is: what if I lose my friends if I stop using? It's understandable that you feel vulnerable or even need to distance yourself from certain environments or people you associate with drug use. Sometimes, the people around us aren't aware of the impact drugs can have on others, so talking about it, to the extent you feel comfortable with, could help them better understand your situation.
If this is a sensitive topic, seek support from loved ones or professionals who can help you make decisions and provide the support you need. You can practice how to communicate the information you want to share, finding and agreeing on the words that best reflect your changing situation. Therefore, it's a good idea to surround yourself with people who support you in your process and respect your boundaries.
Strategies to reduce or stop substance use
Each person is unique and faces different challenges, so strategies must be adapted to their situation and context:
Seek professional help
There are group therapies with other people in a similar situation where you can create a safe space to share your recovery process and be part of that of others.
Regarding individual therapy, it may be helpful to assess your specific situation and, based on this, design a strategy to address the factors that perpetuate your substance use. It's also possible to work in therapy with specific strategies for anxiety without resorting to the substance. We may need to assess your socioeconomic situation and assist you with that, as well as coordinate with your school to explore how we can best support you.
There is a lot of information online that can be confusing regarding the use of substances in therapeutic settings. The medical community is researching the use of psychedelics, marijuana for managing chronic pain, and the role of CBD, among other things. Since it's a complex issue and it's understandable that you might find it contradictory, it's important to discuss it with a doctor and get information from a reliable source that can guide you through your questions and help you adapt the information to your specific medical situation.
The social approach in adolescents with a first psychotic episode
Identify what leads you to use, why you use, and how to avoid risky situations
It's important to recognize which places, people, or circumstances might lead you to use . We talk about environmental restructuring when we suggest avoiding certain environments or risky situations.
If that's not possible, or if you prefer another approach, you can create a relapse prevention plan. For example, if you're going to a gathering where you know drugs will be present, set clear boundaries with yourself beforehand. When you finally feel ready and safe to attend, it can be helpful to practice responses to rejection or think about how to leave if you feel peer pressure. This way, you avoid having to improvise and reduce the risk of giving in. Additionally, if you have a trusted friend who understands your desire to avoid drug use, they can also be a source of support during a crisis.
David Millana
Create a support network
Having people who support you can make a complicated process easier. Imagine you're trying to climb a mountain, and the summit is quite far away. Although you're very motivated, doubts begin to creep in about whether you're ready, you're hungry, and you're starting to get tired. You're about to give up and turn back, but then you meet other people along the way who also want to reach the top. Some know shortcuts to take or share half their sandwich with you to give you energy. In this example, these people who accompany you could represent your friends, your family, or others who are struggling in a similar situation.
Design a healthy routine and set personal goals
Staying busy with activities reduces cravings. For example, when you exercise, your body releases endorphins, the famous "happiness hormones," natural chemicals that provide a sense of well-being and activate pleasure receptors. In addition, exercise reduces stress and anxiety, and can help you meet other people. Structuring your day will help you take better control of your choices.
Redefinition of identity
Identity is shaped by your beliefs, experiences, worldview, what matters to you, and your direction. It's like a map of yourself, which changes as you learn and grow. Therefore, redefining your identity involves the process of reevaluating and transforming how you perceive yourself .
It involves examining the beliefs, values, and narratives a person holds about themselves, allowing for a reconfiguration of their identity based on new perspectives, learning, or experiences . In this way, the aim is to give new meaning to past events, constructively integrating the painful aspects of the experience, which can help the person find new ways of understanding themselves and relating to the world. Therefore, it is a form of adaptation in which the person can recover their sense of purpose after making a change in their life.
In conclusion, people turn to drugs to change how they feel, to fit in, or to alleviate psychological distress. Each individual is unique, with their own life story and experiences, so there are likely no universal solutions, and it's advisable to seek help to feel supported and guided through this process. Remember that relationships can persist even with drugs, and creating new, healthy ones will be crucial in this process.
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