[sujunew]

A trait/symptom of BPD is non-compliance with medications and/or the use and misuse of alcohol, drugs or food. I've been trying to work out when the use or misuse of drugs/alcohol becomes an issue in itself. At what stage does it become a issue in it's own right, and not as a symptom/trait of BPD? I guess what I am especially curious about is when should a client be referred for drug and alcohol counselling if they are misusing drugs in any way rather than addressing it as part of the BPD? And when I read the descriptions for BPD and they talk about drugs/alcohol etc does it mean illegal drugs only, or does it broaden to include all drugs:- prescription and other? I think since I have been doing my social work study I have been looking at things so differently; possibly far more deeply than I would have before. Thank you for any input I receive; like I said I have been over-thinking this myself, but what I believe is that "drugs" here includes the use and/or misuse of prescription drugs, but I just can't figure out what I think re. referrals for drug and alcohol counselling over treating the client for the symptoms of BPD- would I encourage the client to get that specialist help which in turn will address that BPD symptom or by addressing the BPD would that help lessen any drug/alcohol addiction/use or misuse/dependence? Argh. I'm so confused!!!

Mmm...im not sure about this one. I mean you can be, say, an alcoholic and be in rehab yet still experience all the other symptoms of BPD and be in need of treatment for those as well so i don't think its a case of getting seperate treatment for certain symptoms that sets them apart from your disorder because unless its the disorder that caused the issue in the first place surely its all inter-connected in the end?

And surely in the appropriate treatment all symptoms would be given equal importance so im not sure how drug/alcohol abuse would have significance over the other symptoms unless it started taking over the persons life and causing them to have trouble responding to their normal treatment or in some cases being more despondent than ever. I think trying to help treat a borderlines behavioural issues in general would perhaps lower the risk of alcohol/drug dependancy but once that person is an addict they would need specialist treatment obviously. Im not sure how co-existing DBT would affect a rehabilitation programme and if both can indeed be placed side by side but i think something in the way of therapy for the rest of the clients BPD symptoms would be needed so that their overall wellbeing is being accounted for?

Im sorry if my reponse didn't make much sense ive been up all night with nausea so my heads still a little fuzzy. Some interesting thoughts there though - its good to get a question which you can really sink you teeth into. I just hope ive been of some help.

[mazing]

I am also a social work student and recently completed a placement with a mental health facility. I found that addiction could be to both prescription and illegl drugs. A lot of the individuals I worked with had been diagnosed with BPD and if it was severe also what was classified as 'addictive habits to [insert drug/alcohol here]. We had many dual clients with the addictions unit (luckily they were both on the same campus). As part of our therapies we did discuss the drug and alcohol issues and try to work through them with the individuals but also used the specialist help of the drug and alcohol unit (and vice versa when they had clients come to them who they believed may have mental health difficulties as well as addiction issues).

I know that different places have different views about it, but in my placement in Queensland Australia that is how it was handled. Maybe talk to one of your lecturers about your local area? Or do a bit of research online for your local area - it is amazing the amount of information that is out there if you start looking.

[sujunew]

Originally Posted by catgoesmeow

I know that different places have different views about it, but in my placement in Queensland Australia that is how it was handled. Maybe talk to one of your lecturers about your local area? Or do a bit of research online for your local area - it is amazing the amount of information that is out there if you start looking.

I'm in NZ And as you may have seen on the news today our PMs have been talking together...?!

Thanks both bb & catgoesmeow. More ideas to ponder!! I know from asking around here that for someone who is in counselling for issues around their mental health who then present with drug/alcohol issues, it is the ethical duty of that counsellor to refer to a specialist service unless they already specialise in D&A counselling, because it is not within their 'field of expertise'. Sometimes I wonder if our Code of Ethics and our guidelines (in NZ) are...tighter (not sure if this is the right word, maybe stricter, or maybe more limiting) than in other countries?

[RaggedyAnn67]

Form personal experience, I have a couple of thoughts on the alcohol/drug misuse issue.
First, the alcohol issue. I drank when I was on my prescribed meds for the first year or two. In my mind, there were no obvious drug reactions, so what was the problem? When I did drink, I drank...a lot. But, then I noticed that the prescribed meds had to constantly be increased. Hmm, wondered why. Was there a correlation? Then, I considered the fact that I was on prescribed meds that were to help with the calming of my over heightened emotions and ANXIETY. If I was taking meds for that, why did I even need to be drinking in the first place? Alcohol is not needed at all. So, when you are being treated by a professional for these issues, alcohol interferes with the process for getting you on the right meds & dosages that are right for you to be healthier in the first place. The use of any alcohol is disruptive in that process, so no alcohol should be used. And, if you can't stop drinking it at all and at least for the time you are on meds, there is a drinking 'problem' going on, isn't there?
As for the use of illicit and prescribed drugs, abuse does include both. I was in several inpatient facilities and heard a lot of personal stories about abuse with prescribed drugs...the very reason those people were in the inpatient treatment facility. (and had to detox first before they could even get into the inpatient facility)
As for knowing when to send someone for help for either, of course, isn't always easy to make that call. First, always consider the fact that addiction (no matter what it is) is progressive. Some progress faster than others. Start considering a possible problem when any prescribed med is taken against the prescribed dosage (taking 2 instead of one & not discussed with doc...you could keep in touch with that doc, right? My thereapist will.) As for alcohol, as I said before, the use of it at all is not necessary when the doc is trying to find prescribed meds to help the individual. Those not on meds, well, trickier. Watch for how often it is used or how it is used (are the uses becoming more frequent, drinking includes drinking more drinks in one night, drinking at home or alone, drinking more than a glass or two for relieving stress). Key signs include the use of until blacking out, in the morning & throughout the day. Hangovers are really not OK. Why would someone drink so much?
As I write these things, I write them from personal experiences and how I progressed in my alcoholism. These were the signs to look for in me...but I am sure they are useful for others behaviors as well.

[ChaoticSymphony]

It is a dual diagnoses. I drink a lot, I get anxious in the evenings or sometimes I don't. I don't always drink to escape, I drink for fun. It is a consistent thing in my life, one of the only consistent things I do. Watch tv and drink beers. I try to stop and do for a few days then am right back at it. I don't drink more or less, just like ground hogs day, the same thing every night that I drink. My dosage of antidepressant has never been increased or decreased...in the beginning it was but I am back on the same initial dosage.

I will say that bpd traits, especially the compulsion aspect (as with any drunk) are heightened. I have never cut myself while sober. So it is important to acknowledge the alcohol in the diagnoses for bpd because alcohol worsens the thought process on even a sane individual. For people with bpd it is that much worse, the crazy thoughts going on in our sober mind come out easier in our intoxicated mind.

[mazing]

Sometimes I wonder if our Code of Ethics and our guidelines (in NZ) are...tighter (not sure if this is the right word, maybe stricter, or maybe more limiting) than in other countries?

From the research I have done Australia and New Zealand have very similar codes, but they are some of the strictest in the world.. good in some aspects of accountability but I believe that sometimes they can go a bit far towards removing any ability for individual ethics... but that is a completely different thread topic =P

[sujunew]

Thanks for all your thoughts on this. RaggedyAnn, wow! The way you worded what you wrote has really helped me to find some ?perspective and maybe better understanding about this. Especially when I think about my own personal experiences on it (which I had tried to avoid I guess). And catgoesmeow, that may be something I will have to look into- I am taking this year off study so I can fill in some of my time looking at the similarities/diffs between Aus and NZ. It'll be very interesting