Sophie-9305_web | American Addiction Centers

<h2>Why Do I Need Same Day Detox?</h2>
Potential situations where quick admission to a <a href="https://americanaddictioncenters.org/drug-detox">detox program</a> may help avert dangerous consequences (if a person is already experiencing significant symptoms or another emergency, call 911):
<ul>
 	<li>Patient is experiencing or is at risk of experiencing <a href="https://americanaddictioncenters.org/withdrawal-timelines-treatments/alcohol">alcohol withdrawal</a>. (Alcohol withdrawal can be lethal.1)</li>
 	<li>Patient is experiencing or is at risk of experiencing sedative-hypnotic withdrawal. (Sedative-hypnotic withdrawal, such as withdrawal from barbiturates or benzodiazepines, may be life-threatening.1,3)</li>
</ul>
Many substances should never be stopped “cold turkey,” or suddenly, as withdrawal symptoms can be significant and even life-threatening. Quality medical drug detox centers don’t use these "cold turkey" methods; rather they provide <a href="https://americanaddictioncenters.org/addiction-medications">medications</a> and therapy to manage withdrawal symptoms.

Additionally, same day admission to an "emergency" detox program for you or a loved one might be beneficial if a patient is experiencing or is at risk of experiencing <a href="https://americanaddictioncenters.org/withdrawal-timelines-treatments/opiate">opioid withdrawal symptoms</a>. Abstinence from opioids can decrease tolerance, so a smaller amount of opioids might cause an overdose in a relapse, which could be fatal.4 If an individual pursuing addiction treatment warrants pharmacological treatment but maintenance treatment is impractical, is not indicated, or is turned down, then detoxification is indicated.1

Better results correlate with methadone or buprenorphine treatment that is ongoing than with medically supervised withdrawal. Relapse to opioid use will occur, research indicates, for the majority of individuals who have opioid use disorder and go through medically supervised withdrawal, though psychosocial strategies can be beneficial during and after. After an adequate amount of time without using opioids, injectable extended-release naltrexone can be used, which is better at lowering the likelihood of using opioids again than no medicine or placebo.5

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<h4 style="text-align: center;">Call American Addiction Centers</h4>
In many cases, the right time to begin detox may be right now. But care must be taken. Abruptly quitting some types of drugs or alcohol can be uncomfortable and, at times, result in a dangerous withdrawal syndrome. At American Addiction Centers, you may be able to enter a program immediately in order to medically detox and then move on to treatment that can get you on the road to long-term recovery. If you’re struggling with a substance use disorder or an alcohol use disorder, please connect with one of our <a href="/admissions">admissions navigators</a> at [phone] You can also fill in our insurance verification form below in order to see if treatment may be covered by your insurance provider.
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[vob]
<h2>What is the Detox Process?</h2>
According to a consensus panel, there are three crucial elements in the detox process:1
<ol>
 	<li>“Evaluation”: This involves testing for substances of abuse, checking for co-occurring health problems (physical and psychological), assessing any health problems present, and evaluating the individual's social circumstances.</li>
 	<li>“Stabilization”: This includes helping a person to get through any current state of intoxication and withdrawal. Medical and/or psychosocial interventions may be used. Also included is helping individuals become acquainted with their part in their addiction treatment and their recovery as well as with what they should anticipate in the treatment environment.</li>
 	<li>“Fostering the patient’s entry into treatment”: This component includes, through emphasizing that continuing on with the whole treatment continuum is important, getting an individual ready to enter addiction treatment programs. Patients with a history of repeatedly detoxing but not participating in substance abuse treatment after might be motivated to do so by signing a treatment contract early, once sufficiently stable.</li>
</ol>
These elements do not have to happen one at a time in practice.1
<h2>Intensity of Detox Care</h2>
There are several factors to consider when determining the appropriate care for your, or a loved ones detoxification, for example:1
<ul>
 	<li>Admission to a hospital or another setting that provides 24/7 medical care may generally be preferable for detox for sedative-hypnotic withdrawal, alcohol withdrawal, and opioid withdrawal.</li>
 	<li>It should be a suitable setting for any existing physical or <a href="https://americanaddictioncenters.org/co-occurring-disorders">mental health issues</a>.</li>
</ul>
<div class="panel-block bg-dkblue pad-all text-white">

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<h2>Initial Evaluation in Rehab Treatment</h2>
<img class="alignright wp-image-35679 size-medium" src="https://admin.americanaddictioncenters.org/wp-content/uploads/2015/10/calling-for-treatment-300x200.jpg" alt="person using computer and phone at the same time" width="300" height="200" />

<a href="https://americanaddictioncenters.org/rehab-guide/residential/whats-day-like-rehab">One thing to expect</a> when being admitted to a detox program is an initial evaluation, which may include:1
<ul>
 	<li>Obtaining a substance abuse history: This may include questions about what substances the patient abused, how often the patient used them, what amount(s) the patient used, and how long it has been since the patient last used them.</li>
 	<li>Getting information on any prior detoxes and/or treatments for substance abuse: Whether the patient has gone through withdrawal before and, if so, how many times and what happened, ought to be part of this.</li>
 	<li>Laboratory tests: Determining blood alcohol content (BAC), checking breath alcohol levels, and/or urine drug screening may be part of the evaluation. Lab tests may also be used to assess nutritional status and to screen for health problems.</li>
 	<li>Physical assessment: Through a physical exam, the patient can be assessed for any health concerns.</li>
 	<li>Gathering a history concerning overall health: Questions may include inquiring if the patient has any mental health conditions, any physical health conditions, and/or any allergies, as well as if the patient has had any surgeries and/or has ever had seizures.</li>
 	<li>Assessing the person’s current living situation: Assessing living situation may include asking if the patient is homeless, stays in a shelter, or lives with others.</li>
 	<li>Evaluating risk of suicide or violence.</li>
</ul>
Other elements may also be included in an initial evaluation.1
<h2>How Long Does Detox Treatment Take?</h2>
The length of stay for an inpatient detox program may vary based on the substance used and your individual experiences and needs. Detox can last anywhere from a few days (3, 5, 7, 10 day detox) to a few weeks depending on the substance. Once stabilized through the detox process, patients will typically enter an <a href="https://americanaddictioncenters.org/rehab-guide/inpatient">inpatient rehab program</a> at the same facility where they will attend therapy and learn techniques for long term recovery. Insurance may also be able to cover all or part of the program depending on your coverage.
<h2>Can I Walk-In for Same Day Detox or Treatment?</h2>
Individuals may prefer to walk-in for same day, emergency, or urgent detox treatment. We recommend calling us to work with one of our admissions navigators to get to treatment as everyone's needs and expectations can differ. After calling, there may be an opportunity to enter treatment the same day.

</div>
<h2>Conclusions on Same Day Detox for Drugs or Alcohol</h2>
<img class="alignright wp-image-31718 size-medium" src="https://admin.americanaddictioncenters.org/wp-content/uploads/2016/04/detox-help-300x160.jpg" alt="Addiction doctor hands writing on a clipboard." width="300" height="160" />

Quick admission to a detox program may be helpful and possibly lifesaving in some circumstances. Assessing the patient, stabilizing the individual, and promoting treatment entrance for that individual are crucial elements of detox.1 Commonly, if detox is not followed by treatment, there will be a relapse.2 However, one detox goal is to promote treatment entrance and recovery.1

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 	<li><a href="https://americanaddictioncenters.org/rehab-guide/with-a-job">Can I Get Fired for Going to Rehab?</a></li>
</ul>
[/link-bank]

[sources]
<ol>
 	<li>Center for Substance Abuse Treatment. (2015). <a href="https://store.samhsa.gov/sites/default/files/d7/priv/sma15-4131.pdf" target="_blank" rel="noopener noreferrer">Detoxification and substance abuse treatment: A treatment improvement protocol TIP 45</a>.</li>
 	<li>National Institute on Drug Abuse. (2018). <a href="https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery" target="_blank" rel="noopener noreferrer">Treatment and recovery</a>.</li>
 	<li>Guina, J. &amp; Merrill, B. (2018). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5852436/" target="_blank" rel="noopener noreferrer">Benzodiazepines II: Waking up on sedatives: Providing optimal care when inheriting benzodiazepine prescriptions in transfer patients</a>. Journal of Clinical Medicine, 7(2), 20.</li>
 	<li>Joudrey, P. J., Khan, M. R., Wang, E. A., Scheidell, J. D., Edelman, E. J., McInnes, D. K., &amp; Fox, A. D. (2019). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6463640/" target="_blank" rel="noopener noreferrer">A conceptual model for understanding post-release opioid-related overdose risk</a>. Addiction Science &amp; Clinical Practice, 14(1), 17.</li>
 	<li>Substance Abuse and Mental Health Services Administration. (2018). <a href="https://store.samhsa.gov/product/TIP-63-Medications-for-Opioid-Use-Disorder-Full-Document/PEP21-02-01-002" target="_blank" rel="noopener noreferrer">Medications for opioid use disorder: For healthcare and addiction professionals, policymakers, patients, and families: Treatment Improvement Protocol TIP 63</a>.</li>
</ol>
[/sources]
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Patient is experiencing or is at risk of experiencing sedative-hypnotic withdrawal. (Sedative-hypnotic withdrawal, such as withdrawal from barbiturates or benzodiazepines, may be life-threatening.)
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Same Day Admission to an Inpatient Detox Program

How Long Does Cocaine Stay in Your System?

[content-overview]

Seasonal affective disorder, or SAD, is a <a href="https://americanaddictioncenters.org/treating-depression-substance-abuse">form of depression</a> that affects some people at about the same time each year, usually beginning in the late fall or early winter and dissipating in the spring or summer.1 SAD is associated with biochemical brain changes that occur with decreased sunlight and changes to a person’s internal clock (also known as their <a href="https://www.nigms.nih.gov/Education/Pages/Factsheet_CircadianRhythms.aspx" target="_blank" rel="noopener">circadian rhythm</a>).2

[/content-overview]
People sometimes minimize SAD, thinking it is just the normal feeling of being a little down in the winter when it’s cold and difficult to spend a lot of time enjoying the outside. However, SAD is more than that and can be so severe as to impair a person’s day-to-day functioning.2
Per the American Psychiatric Association, about 5% of adults in the U.S. suffer from seasonal affective disorder, and they usually experience symptoms roughly 40% of the year; however, SAD occurs less often in people who live in places with more hours of sunlight in the winter. Generally, the farther one lives from the equator, the more likely they are to develop SAD. According to one study, less than 2% of people surveyed in Florida experienced SAD, as opposed to almost 10% of those surveyed who lived in New Hampshire.3

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), SAD is not a separate disorder but rather <a href="https://americanaddictioncenters.org/treating-depression-substance-abuse/major">a type of major depressive disorder</a>, called major depressive disorder with seasonal pattern. Thus, the individual must meet the normal criteria for major depressive disorder. Furthermore, the episodes must correlate with certain seasons and must fully remit during the rest of the year. This pattern needs to have occurred twice in the last 2 years and there cannot be any other depressive episodes during that period. Lastly, over the course of the individual’s lifetime, there must be markedly more seasonal episodes must than nonseasonal episodes.4
<h2>Symptoms</h2>
Symptoms of major depression may include:1

<img class="size-medium wp-image-55347 alignright" src="https://admin.americanaddictioncenters.org/wp-content/uploads/2019/02/2_558962893_sadwinter-300x200.jpg" alt="" width="300" height="200" />
<ul>
 	<li>Depressed mood.</li>
 	<li>Feeling hopeless.</li>
 	<li>Feeling worthless.</li>
 	<li>Lack of interest in previously enjoyed activities.</li>
 	<li>Lethargy and increased fatigue.</li>
 	<li>Agitation of sluggishness.</li>
 	<li>Problems concentrating.</li>
 	<li>Sleep problems.</li>
 	<li>Changes in appetite or significant, unintentional changes in weight.</li>
 	<li>Suicidal thoughts or attempt(s).</li>
</ul>
Rarely, SAD episodes occur during the summer months, although it is much more common during the cold, dark months of late fall, winter, and early spring. Whether the person experiences SAD episodes during the winter or summer months makes certain symptoms more likely. Those who suffer from SAD episodes in the colder seasons may be more prone to:1
<ul>
 	<li>Sleeping too much.</li>
 	<li>Lack of energy.</li>
 	<li>Overeating and weight gain.</li>
 	<li>Craving carbs.</li>
 	<li>Withdrawing socially or “hibernating”.</li>
</ul>
Individuals impacted by SAD episodes in the warmer months may be more prone to:1
<ul>
 	<li>Eating less than normal and losing weight.</li>
 	<li>Problems sleeping.</li>
 	<li>Agitation.</li>
 	<li>Anxiety.</li>
 	<li>Violent outbursts.</li>
</ul>
Risk Factors

In addition to living farther from the equator, other factors that can play a role in the likelihood that someone will develop seasonal affective disorder may include:1,2
<ul>
 	<li>Age: SAD can affect people of any age, but it is more common to start in younger adults. SAD is most likely to first appear when an individual is between the ages of 18 and 30, although even children and teens are sometimes affected.</li>
 	<li>Gender: Females are more likely to be diagnosed. In fact, women are diagnosed with SAD 4 times more often than men.</li>
 	<li>Family History: Those with family members who’ve suffered from any kind of depression are more likely to develop SAD.</li>
 	<li>Existing mood disorders: In people with depression or bipolar disorder, depressive symptoms may worsen with the seasons. However, SAD is only diagnosed if the seasonal depressive episodes notably outnumber nonseasonal episodes.</li>
</ul>
<h2>Causes of SAD</h2>
Although the precise cause of seasonal affective disorder is unknown, there are three main factors that seem to be involved, all of which are or may be related to the changing nature of the environment due to seasonal cycles.1,5
<ul>
 	<li>Lower availability of serotonin: Serotonin is one of the brain’s neurotransmitters, and it is thought to be responsible in part for feelings of wellbeing and happiness. Additionally, an article in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3779905/" target="_blank" rel="noopener">Innovations in Clinical Neuroscience</a> reports that human skin might have the ability to generate serotonin, which may be stimulated by exposure to sunlight. With shorter days in winter, less exposure to sunlight could mean less serotonin, leading to symptoms of depression. Another study found that people who suffer from SAD have slightly more serotonin transporters in winter months than in the summer, leaving less of the neurotransmitter available at the synapse.</li>
 	<li>Increased levels of melatonin: Melatonin is a hormone that helps to regulate sleep and wake cycles. It is produced in higher levels in darkness, so one’s level of melatonin will rise during winter months. This can lead to oversleeping or a lack of daytime energy. People with SAD may overproduce this hormone.</li>
 	<li>Underproduction of Vitamin D: Vitamin D may be linked to serotonin activity. With an inadequate amount of the vitamin, depressive symptoms may arise. Vitamin D is produced when sunlight transforms a chemical in a person’s skin, so production can decrease in the dark winter months.6</li>
</ul>
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<h2>The Relationship between SAD and Substance Abuse
</h2>
When the dark days come, and the symptoms of SAD present themselves, some people may self-medicate with substances. A lack of energy may cause some to turn to stimulants. Others may seek to numb the pain of depression with drugs like opioids or alcohol. <a href="https://www.sciencedirect.com/science/article/abs/pii/S0010440X0300169X" target="_blank" rel="noopener">Research</a> has shown that some individuals with alcoholism <a href="https://americanaddictioncenters.org/alcoholism-treatment">misuse alcohol</a> seasonally, so they may be self-medicating SAD.7

[quote]Approximately 50% of all people who struggle with a mental health disorder will also experience a substance use disorder at some point.[/quote]

Self-medicating with substances may lead to addiction. Additionally, the use of alcohol and drugs may worsen the symptoms of SAD,8 so while self-medicating may feel like it’s effective in the moment, it may worsen depressive symptoms overall and set the person on a path to a substance use disorder.

Per the <a href="https://adaa.org/understanding-anxiety/co-occurring-disorders/substance-abuse" target="_blank" rel="noopener">Anxiety and Depression Association of America</a>, about 20% of Americans with an anxiety or mood disorder, such as SAD, also struggle with a substance use disorder, and vice versa.9 According to the National Institute on Drug Abuse, approximately 50% of all people who struggle with a mental health disorder will also experience a substance use disorder at some point.10
<h2>Treatment Options 
</h2>
If someone suffers from both SAD and a substance use disorder, <a href="https://americanaddictioncenters.org/co-occurring-disorders">both conditions should be treated simultaneously</a>.10 If only the addiction is addressed, the untreated seasonal affective disorder may trigger a relapse back to substance abuse, and an untreated substance use disorder may worsen depressive symptoms. For individuals with both mental illness(es) and substance use disorder(s), integrated treatment that addresses all psychiatric disorders provides better results.11

Psychotherapy can be useful for both substance use disorders and seasonal affective disorder. For example, cognitive behavioral therapy (CBT) may be a core part of treatment for both disorders.1,10

Treatment for seasonal affective disorders fall into three main areas: phototherapy, psychotherapy, and medication.
<h3>Phototherapy</h3>
<img class="size-medium wp-image-22842 alignright" src="https://admin.americanaddictioncenters.org/wp-content/uploads/2015/10/rehab-guides-300x200.jpg" alt="" width="300" height="200" />Since seasonal affective disorder is believed to be related to a reduction in exposure to sunlight, the first line of treatment is often increased exposure to light, or phototherapy. While many studies on the effects of phototherapy do not have a clinically rigorous design due to the challenges of creating a placebo, “multiple systematic reviews and meta-analyses evaluating the available data support the use of light therapy as an effective treatment for SAD,” according to American Family Physician.12

Phototherapy involves sitting, usually for at least 20 minutes a day, in front of a light therapy box that emits bright light but filters out the UV rays.2

In some countries that sit at more northern latitudes, communities are experimenting with novel approaches to light therapy. In Rjukan, Norway, the town <a href="https://www.theatlantic.com/health/archive/2017/03/seasonal-affective-disorder-mosaic/519495/" target="_blank" rel="noopener">has installed three large rotating mirrors</a> on one of the two mountains that tower over Rjukan. The mirrors reflect the sunlight into the town square, where residents can gather in winter months to soak up the rays. In Umeå, Sweden, the school Dragonskolan has <a href="https://www.theguardian.com/world/2015/jan/24/swedish-school-light-dark-days-winter" target="_blank" rel="noopener">installed full spectrum lamps</a> in several of the classrooms, bathing the students in light, with the goal of improving student attendance and performance.

Some companies have created small light sources using LED bulbs for at-home treatment. A <a href="https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-7-38">study</a> of the effectiveness of one such product for the treatment of SAD has shown promising results.13

Phototherapy is unlikely to be available in a substance abuse treatment program. However, many are located in sunnier climates, which could be beneficial for individuals with SAD, especially if they make a point to regularly spend some time outdoors. Additionally, the options listed below often are available at addiction treatment centers.
<h3>Cognitive Behavioral Therapy</h3>
Cognitive behavioral therapy (CBT) is a form of therapy that helps an individual change harmful thoughts, beliefs, and behaviors into more accurate and functional ones, which can improve his or her mood. CBT can be a helpful treatment for depression, trauma-related disorders, anxiety, substance use disorders, and more.14,15 One study found that a type of CBT specifically for SAD had better effects on those who suffer from SAD the second winter after acute treatment than light therapy did.16
<h3> Medication</h3>
Selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant, are sometimes prescribed for SAD.2 These drugs can increase the amount of available serotonin in the brain by preventing cells from reabsorbing serotonin.17
<h2>Ways to Support Treatment for SAD</h2>
While anyone who thinks they may have SAD should seek professional treatment, there are some things you can do to help relieve symptoms.8,12
<ul>
 	<li>Get outside. Aim to get more natural sunlight.</li>
 	<li>Open the blinds. Try to get more sunlight in your home and work environments as well, opening up the blinds and shades to let the maximum amount of light in.</li>
 	<li>Eat a balanced diet. Although more research is needed, eating a diet high in vegetables, fruits, and fish may decrease the likelihood of feeling depressed.18</li>
 	<li>Get moving. Several studies have indicated that exercise may be beneficial for individuals with SAD.19</li>
 	<li>Seek out support. Lean on friends and family when possible. Seasonal affective disorder often leaves people with the urge to withdraw socially, but it’s usually better to spend time with others and let them help you. Having a trusted loved one to talk to may help improve your mood.</li>
</ul>
It is common to feel a reduction in energy and change in mood during the winter months, but if your mood is affecting your ability to take pleasure in life, or you feel like you don’t have the energy to get through your day, or if you are suffering or struggling in other ways, talk to a medical professional about seasonal affective disorder. If you are misusing drugs or alcohol to alleviate your symptoms and you can’t stop, don’t wait to get help. Treatment programs exist that treat comorbid substance use and mood disorders.
<h3>References:</h3>
<ol>
 	<li>National Institute of Mental Health. (2016). <a href="https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder" target="_blank" rel="noopener">Seasonal Affective Disorder.</a></li>
 	<li>American Psychiatric Association. (2017). <a href="https://psychiatry.org/patients-families/seasonal-affective-disorder" target="_blank" rel="noopener">Season Affective Disorder (SAD)</a>.</li>
 	<li>Roecklein, K. A., &amp; Rohan, K. J. (2005). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004726/" target="_blank" rel="noopener">Seasonal affective disorder: an overview and update</a>. Psychiatry (Edgmont (Pa. : Township)), 2(1), 20-6.</li>
 	<li>American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013</li>
 	<li>Sansone, R. A., &amp; Sansone, L. A. (2013). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3779905/" target="_blank" rel="noopener">Sunshine, serotonin, and skin: a partial explanation for seasonal patterns in psychopathology?</a>. Innovations in clinical neuroscience, 10(7-8), 20-4.</li>
 	<li>Mayo Clinic. (2017). Vitamin D.</li>
 	<li>Sher, L. (2004). <a href="https://www.sciencedirect.com/science/article/abs/pii/S0010440X0300169X?via%3Dihub" target="_blank" rel="noopener">Alcoholism and seasonal affective disorder</a>. Comprehensive Psychiatry, 45(1), 51-56.</li>
 	<li>University of Rochester Medical Center. (n.d.) <a href="https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=85&amp;contentid=P00755" target="_blank" rel="noopener">Seasonal Affective Disorder or SAD.</a></li>
 	<li>Anxiety and Depression Association of America. (n.d.). <a href="https://adaa.org/understanding-anxiety/co-occurring-disorders/substance-abuse" target="_blank" rel="noopener">Substance Use Disorders</a>.</li>
 	<li>National Institute on Drug Abuse. (2018). <a href="https://nida.nih.gov/publications/research-reports/common-comorbidities-substance-use-disorders/introduction" target="_blank" rel="noopener">Comorbidity: Substance Use Disorders and Other Mental Illnesses</a>.</li>
 	<li>Kelly, T. M., &amp; Daley, D. C. (2013). Integrated treatment of substance use and psychiatric disorders. Social work in public health, 28(3-4), 388-406.</li>
 	<li>Kurlansik, S. &amp; Ibay, A. (2013). <a href="https://www.aafp.org/pubs/afp/issues/2012/1201/p1037.html" target="_blank" rel="noopener">Seasonal Affective Disorder</a>. Indian Journal of Clinical Practice, 24(7).</li>
 	<li>Desan, P., et al. (2007). <a href="https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-7-38" target="_blank" rel="noopener">A controlled trial of the Litebook light-emitting diode (LED) light therapy device for treatment of Seasonal Affective Disorder (SAD)</a>. BMC Psychiatry, 7(38).</li>
 	<li>American Psychiatric Association. (2016, July). What is Psychotherapy?</li>
 	<li>McHugh, R. K., Hearon, B. A., &amp; Otto, M. W. (2010). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2897895/" target="_blank" rel="noopener">Cognitive behavioral therapy for substance use disorders</a>. The Psychiatric clinics of North America, 33(3), 511-25.</li>
 	<li>Rohan, K. J., Meyerhoff, J., Ho, S. Y., Evans, M., Postolache, T. T., &amp; Vacek, P. M. (2015). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939843/" target="_blank" rel="noopener">Outcomes One and Two Winters Following Cognitive-Behavioral Therapy or Light Therapy for Seasonal Affective Disorder</a>. The American journal of psychiatry, 173(3), 244-51.</li>
 	<li>Mayo Clinic. (2018). <a href="https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825" target="_blank" rel="noopener">Selective serotonin reuptake inhibitors (SSRIs)</a>.</li>
 	<li>Zeratsky, K. (2018). Junk food blues: Are depression and diet related?</li>
 	<li>Peiser, B. (2009). <a href="https://www.tandfonline.com/doi/abs/10.1080/09291010802067171" target="_blank" rel="noopener">Seasonal affective disorder and exercise treatment: a review</a>. Biological Rhythm Research, 40(1), 85-97.</li>
</ol>

Seasonal Affective Disorder

[content-overview]The Substance Abuse and Mental Health Services Administration (SAMHSA) compiles data regarding substance abuse according to industry. A report on the data (collected from the National Surveys on Drug Use and Health (NSDUH) from 2008 through 2012) was <a href="https://www.samhsa.gov/data/sites/default/files/report_1959/ShortReport-1959.pdf" target="_blank" rel="noopener">published in 2015</a>. The NSDUH gives insight into the use of alcohol and illicit drugs. Heavy alcohol use is defined in the survey as consuming 5 or more alcoholic drinks on the same occasion on 5 or more days within the past 30-day period. This page will provide an overview of the trends in substance use according to industry. [/content-overview]

The 2008-2012 NSDUHs included questions to assess how many respondents met criteria for substance abuse or dependence. Questions were based on diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). However, in the report, they combined substance dependence and abuse into one category, referred to as “substance use disorder”.

<img class="size-medium wp-image-55358 alignright" src="https://admin.americanaddictioncenters.org/wp-content/uploads/2019/02/2_176869352_employeeburnout-300x217.jpg" alt="" width="300" height="217" />

The data used in the report was from full-time workers aged 18 to 64. The data showed that:
<ul>
 	<li>An average of 8.7% of <a href="https://americanaddictioncenters.org/alcoholism-treatment/stress-and-alcohol-abuse-in-middle-class-professionals">full-time workers used alcohol heavily</a> in the month prior to the survey.</li>
 	<li>An average of 8.6% of the workers across all occupations used illicit drugs in the previous month.</li>
 	<li>An average of 9.5% met the criteria for a substance use disorder within the year previous to the completion of the survey.</li>
</ul>
For purposes of this article, the top 5 industries for past-month heavy alcohol use, past-month illicit drug use, and past-year substance use disorder will be presented. The figures represent the percent of surveyed individuals within an industry that engaged in the particular behavior or met criteria for a substance use disorder.
<h2>Past-Month Alcohol Use</h2>
According to the surveys, the industries with the highest rates of past-month <a href="https://americanaddictioncenters.org/alcohol-rehab">heavy alcohol use</a> were:
<ul>
 	<li>Mining: 17.5%</li>
 	<li>Construction: 16.5%</li>
 	<li>Accommodations and food service industry: 11.8%</li>
 	<li>Art, entertainment, and recreational fields: 11.5%</li>
 	<li>Utilities industry: 10.3%</li>
</ul>
The 5 industries with the lowest levels of past-month heavy alcohol use were:
<ul>
 	<li>Healthcare and social assistance: 4.4%</li>
 	<li>Educational services: 4.7%</li>
 	<li>Public administration: 6.6%</li>
 	<li>Finance and insurance: 7.4%</li>
 	<li>Professional, scientific, and technical services: 7.7%.</li>
</ul>
<h2>Past-Month Illicit Drug Use</h2>
The industries with the highest levels of illicit drug use in the month prior to the survey were:
<ul>
 	<li>Accommodations and food service: 19.1%</li>
 	<li>Arts, entertainment, and recreation: 13.7%</li>
 	<li>Management: 12.1%</li>
 	<li>Information: 11.7%</li>
 	<li>Construction: 11.6%</li>
</ul>
The 5 industries with the lowest rates of illicit drug use in the month prior to taking the survey were:
<ul>
 	<li>Public administration: 4.3%</li>
 	<li>Educational services: 4.8%</li>
 	<li>Mining: 5%</li>
 	<li>Healthcare and social assistance: 5.5%</li>
 	<li>Agriculture, forestry, fishing, and hunting: 5.7%</li>
</ul>
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<h2>Rates of Substance Use Disorder by Industry</h2>
According to the data, the industries with the highest rates of past-year substance use disorder were:
<ul>
 	<li>Accommodations and food service: 16.9%</li>
 	<li>Construction: 14.3%</li>
 	<li>Arts, entertainment, and recreation: 12.9%</li>
 	<li>Mining: 11.8%</li>
 	<li>Utilities: 11.5%</li>
</ul>
Those with the lowest rates of past-year substance use disorder included:
<ul>
 	<li>Educational services: 5.5%</li>
 	<li>Healthcare and social assistance: 5.7%</li>
 	<li>Public administration: 7.2%</li>
 	<li>Professional, scientific, and technical services: 8.8%</li>
 	<li>Transportation and warehousing: 9.1%</li>
</ul>
<h2>What Does It All Mean?</h2>
Data regarding percentages of workers in specific types of industries with substance use or substance abuse issues can be very interesting and informative; however, there are numerous caveats that should be taken into account before making assumptions or drawing conclusions from the data.

First, many have probably heard the phrase, “Correlation does not imply causation.” The type of data presented in this report or any research that investigates the degree that one variable, such as occupation, ethnicity, or geographical location, is associated with another variable, such as substance abuse, is <a href="https://cirt.gcu.edu/research/develop/research_ready/correlation/1" target="_blank" rel="noopener">correlational research</a>. Correlational research can enable predictions based on the pattern, but these predictions must be done with care. These studies can also provide useful information that can be used to develop experimental hypotheses used to investigate what is in fact causing or contributing to the correlation.

Still, this type of data only looks at relationships or associations. It cannot identify all of or isolate any of the influences that can account for the relationships observed in this data. Therefore, researchers cannot make any claims regarding what causes the relationship, let alone make the claim that being in the mining industry causes a higher percent of those workers to heavily drink alcohol than workers in any other industry.

There are numerous other influences that could contribute to the relationships observed in these studies. One cannot assert, based on this data, that working in a particular industry causes a specific pattern of substance use or causes the development of a substance use disorder. However, if this data was replicated across different studies, it may suggest that members of certain groups have an increased risk of abusing alcohol, using illicit drugs, and/or having a substance use disorder. Again, however, this does not imply causation.

The fact that several of the same industries (e.g., the accommodations and food industry, the mining industry, and the construction industry) were among those with the highest percentages for more than one of the measures suggests that there may be factors associated with these industries that contribute to the increased risk for problems with substance use.

[callout]

Potential <a href="https://www.ccohs.ca/oshanswers/psychosocial/substance.html" target="_blank" rel="noopener">factors</a> might include:
<ul>
 	<li>Stressful working conditions.</li>
 	<li>Long hours.</li>
 	<li>Irregular shifts.</li>
 	<li>Poor management.</li>
 	<li>Dissatisfaction with one’s job.</li>
 	<li>Easily available alcohol and/or drugs.</li>
 	<li>High demand combined with low control.</li>
 	<li>Repetition/boredom.</li>
 	<li>Isolation/lack of social interaction at work.</li>
 	<li>Fatigue.</li>
 	<li>Little opportunity for career advancement.</li>
</ul>
[/callout]
<h2>Addressing the Problem</h2>
Because issues with substance use may decrease worker productivity and negatively impact the workplace in other ways, it is in an organization’s own self-interest to offer resources for individuals with substance use problems. Some organizations offer employees the opportunity to participate in counseling for issues with stress, mental illness, and substance misuse.

Many organizations now offer <a href="https://www.opm.gov/frequently-asked-questions/?fid=4313c618-a96e-4c8e-b078-1f76912a10d9&amp;pid=2c2b1e5b-6ff1-4940-b478-34039a1e1174" target="_blank" rel="noopener">Employee Assistance Programs</a> (EAPs), which are voluntary programs through workplaces that offer free assessments, transient counseling, referrals for further treatment, and follow-up services for employees who have work-related problems or personal issues. These programs can be used to assist employees with various difficulties, including family issues, stress, grief, mental health disorders, and substance abuse.

Counselors in EAP programs may also work with managers and supervisors to help attend to organizational and individual needs and problems.

The law, specifically the Americans with Disabilities Act (ADA), provides <a href="https://www.usccr.gov/files/pubs/ada/ch4.htm" target="_blank" rel="noopener">some protections for employees who have a history of addiction</a> but are not currently using illegal drugs. The ADA insists that employers must provide reasonable accommodations to qualified individuals. For example, reasonable accommodations for an individual in recovery from drug addiction (who is not currently using any illegal drugs) may include an altered work schedule to enable the individual to attend 12-step meetings or a leave of absence to attend treatment.
<h2>Conclusions</h2>
Prevalence rates of heavy alcohol use, illicit drug use, and substance use disorders are not consistent across different industries. The mining, construction, and accommodations and food service industries are a few of the fields that were among the highest percentages for more than one of the measures. However, it is important to remember that correlation does not equal causation. Simply being employed in a specific industry does not cause a person to use or abuse any kind of substance or to develop a substance use disorder.

Based on the data presented above, one could anticipate that a person working in an industry category that is in the top tier for rates of heavy alcohol use, illicit drug use, or substance use disorders might observe some of the <a href="https://www.ccohs.ca/oshanswers/psychosocial/substance.html" target="_blank" rel="noopener">possible workplace ramifications of substance use issues</a>. Such ramifications may include:
<ul>
 	<li>Absenteeism and/or illness.</li>
 	<li>Decreased production.</li>
 	<li>Impacts on the individual that hinder his/her ability to work safely or to make safe decisions.</li>
 	<li>Impaired job performance.</li>
 	<li>Diminished concentration and attention.</li>
 	<li>Illegal activities occurring at work.</li>
</ul>
In addition, there might be some level of peer pressure for employees to use drugs or alcohol in industries where a high percentage of workers have heavy alcohol use, illicit drug use, or a substance use disorder.

Employers, especially those in high-risk industries, should consider offering assistance for their employees who struggle with <a href="https://americanaddictioncenters.org/rehab-guide/substance-use-disorder">substance use</a>. These employers may implement prevention programs, screen employees for issues with substance use, and/or provide treatment-related resources to their workers.

Source: Substance Abuse and Mental Health Services Administration. (2015). <a href="https://www.samhsa.gov/data/sites/default/files/report_1959/ShortReport-1959.pdf" target="_blank" rel="noopener">The CBHSQ Report.</a>

Occupations Associated with Substance Abuse

[content-overview]Premenstrual dysphoric disorder (PMDD) is a serious condition characterized by a severe change in mood in the one or two weeks leading up to a woman’s period.1 PMDD should not be confused with premenstrual syndrome (PMS), a common condition that also involves symptoms that occur in the week or two before menstruation, possibly resulting from falling levels of certain hormones after ovulation.2

[/content-overview]

<img class="size-medium wp-image-55300 alignright" src="https://admin.americanaddictioncenters.org/wp-content/uploads/2019/02/shutterstock_303416633-300x207.jpg" alt="Woman with depersonalization disorder putting head in hand" width="300" height="207" />

PMDD is similar to PMS but involves more severe symptoms, such as severe depression, tension, and irritability. One of the requirements to be diagnosed with PMDD is that the symptoms must interfere with the woman’s functioning or cause significant distress.3 PMDD may necessitate the use of medication.1

People also sometimes struggle to <a href="https://americanaddictioncenters.org/treating-depression-substance-abuse">differentiate premenstrual dysphoric disorder from depressive disorders</a>. Some of the symptoms are similar; however, PMDD is linked to a woman’s menstrual cycle. The symptoms start in the week or two before the woman’s period and will usually resolve within a few days after the start of the woman’s menstrual cycle.1,4

The condition affects up to 5% of women of childbearing age. There are different approaches to treatment, including stress management techniques, specific birth control pills, and <a href="https://americanaddictioncenters.org/antidepressants-guide">some antidepressant medications</a>.1 Multiple treatments may be used together.
<h2>What Causes PMDD?</h2>
It’s not clear what causes PMDD. The disorder might be an abnormally severe reaction to hormonal changes associated with a woman’s menstrual cycle.1,5

It’s also been suggested that serotonin levels might play a role. A woman’s serotonin levels fluctuate throughout her menstrual cycle, and some women may be more sensitive to these fluctuations.1,5

[callout]

Certain risk factors make it more likely that a woman will develop premenstrual dysphoric disorder. These include:5
<ul>
 	<li>Family history of PMDD or PMS.</li>
 	<li>Personal or family history of depression or other mood disorders.</li>
</ul>
Other possible risk factors include:5,6
<ul>
 	<li>Significant stress.</li>
 	<li>Lower education level.</li>
 	<li>Smoking cigarettes.</li>
</ul>
[/callout]
<h2>Symptoms</h2>
Symptoms vary between women but may include:1,3
<ul>
 	<li>Anxiety.</li>
 	<li>Mood swings.</li>
 	<li>Crying suddenly or often.</li>
 	<li>Feeling overwhelmed or out of control.</li>
 	<li>Problems focusing.</li>
 	<li>Loss of interest in normal day-to-day activities.</li>
 	<li>Persistent irritability or feelings of anger.</li>
 	<li>Sadness or feelings of despair.</li>
 	<li>Panic attacks.</li>
 	<li>Suicidal thoughts.</li>
 	<li>Fatigue.</li>
 	<li>Insomnia.</li>
 	<li>Changes in appetite and eating patterns.</li>
 	<li>Bloating.</li>
 	<li>Tender breasts.</li>
 	<li>Headaches.</li>
</ul>
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<h2>Diagnosis</h2>
In order for a woman to be diagnosed with premenstrual dysphoric disorder, she will need to experience 5 or more PMDD symptoms (at least one of which must be mood-related).1

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) states that a subset of symptoms must be present in the week before her menstrual cycle begins, improve within a few days after her period starts, and resolve or become minimal in the week after menstruation in order for a woman to be diagnosed with PMDD. This pattern must have occurred in most menstrual cycles in the previous year.

The symptoms need to be severe enough to cause a significant disruption to her daily life (interfering with work, school, social activities, or relationships) or to cause significant distress. The symptoms cannot be caused by <a href="https://americanaddictioncenters.org/co-occurring-disorders">another mental illness</a> or other medical condition, a drug, or a medical intervention.3
<h2>Treatment for PMDD</h2>
The recommended treatment plan for PMDD varies according to each woman’s individual needs. Options include:1,7,8
<ul>
 	<li>Medication:
<ul>
 	<li>Antidepressants: Fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil) are selective serotonin reuptake inhibitors, or SSRIs, approved to treat PMDD.</li>
 	<li>Birth control pills: A birth control pill containing drospirenone and ethinyl estradiol has been approved to help alleviate symptoms.</li>
 	<li>Over-the-counter medication: OTC pain medications, such as ibuprofen, may help relieve breast tenderness, cramps, headaches, backaches, and joint pain.</li>
</ul>
</li>
 	<li>Therapy: Cognitive behavioral therapy (CBT), in particular, may be <a href="https://www.tandfonline.com/doi/abs/10.3109/01674820209074672" target="_blank" rel="noopener">an effective treatment</a>.</li>
 	<li>Lifestyle changes: Stress management techniques may help treat PMDD. Cutting back on sugary and salty foods and drinks, eating a healthy mix of foods, and getting exercise may also help to relieve some of the symptoms of PMDD. However, if a woman is experiencing serious symptoms or if these lifestyle changes are not effective, she should schedule an appointment with a health care provider. Anyone considering harming herself or others should call 911 immediately. </li>
</ul>
<h2>Controversy</h2>
Browse through articles discussing PMDD and you may find sources <a href="https://www.apa.org/monitor/oct02/pmdd" target="_blank" rel="noopener">questioning its reality</a>. The disorder has not been accepted by all in the health care community for various reasons.

Some health care professionals believe that PMDD can be explained by depression or other mental health disorders. Some say that women shouldn’t need to be diagnosed with a mental health disorder for others to recognized their suffering or to get assistance.9 However, a 2010 study found that PMDD and major depression are linked to different biological stress responses, supporting the claim that they are biologically distinct disorders.

Controversy is common when studies reveals different pieces of information, which can be due to variation in what exactly is being investigated, the methods used in the research, and more. This is why it is important that research into PMDD, its causes, and the most effective treatment approaches for the disorder continue.
<h2>Is There a Link Between Premenstrual Difficulties and Substance Use?</h2>
In 2018, a review article was published that found that <a href="https://bmjopen.bmj.com/content/8/3/e019490" target="_blank" rel="noopener">alcohol intake was linked to a higher risk of PMS</a>. Their study didn’t investigate cause and effect, but it also found that heavy alcohol intake was associated with an even higher risk of PMS.10

A 2015 study found that past-year illicit drug use was linked to a higher risk of PMS.11<a href="#_edn11" name="_ednref11"></a>

­­
<h2>Co-Occurring Disorders</h2>
Evidence suggests that women with PMDD may be at an increased risk of experiencing mood disorders and anxiety disorders. An analysis published by the <a href="https://www.psychiatrictimes.com/view/premenstrual-dysphoric-disorder-and-psychiatric-comorbidity" target="_blank" rel="noopener">Psychiatric Times</a> reports that anxiety disorders and mood disorders occur more frequently in women with PMDD than in the general population. Panic disorder co-occurs in approximately a quarter of women with PMDD, social phobia in about 1 in 5, and obsessive-compulsive disorder in about 12%. Studies have found that 18% to 69% of women with retrospectively diagnosed PMDD had a depressive disorder.12

[quote]Anxiety disorders and mood disorders occur more frequently in women with PMDD than in the general population.[/quote]

According to the <a href="https://adaa.org/understanding-anxiety/co-occurring-disorders/substance-abuse" target="_blank" rel="noopener">Anxiety and Depression Association of America</a>, approximately 20% of Americans who struggle with an anxiety or mood disorder also have a substance use disorder.13 A woman who suffers from PMDD along with anxiety and/or depression <a href="https://americanaddictioncenters.org/adult-addiction-treatment-programs/self-medicating">may turn to substances for relief</a>. Although this might work temporarily, symptoms are often worse, longer-lasting, and more difficult to treat in individuals with both a substance use disorder and another mental illness.14

For individuals with both mental illness(es) and substance use disorder(s), integrated treatment that addresses all psychiatric disorders provides better results.15
<h2>PMDD Today</h2>
Research into PMDD is ongoing. Women are dealing with the consequences of the disorder every day.

In addition to sharing some symptoms, major depressive disorder and premenstrual dysphoric disorder also share some treatment approaches. Medication, therapy, and lifestyle changes can be helpful for both conditions. With treatment, most women suffering from PMDD have their symptoms decrease to tolerable levels or go away completely.16
<h3>References:</h3>
<ol>
 	<li>U.S. Department of Health and Human Services. (n.d.). <a href="https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome/premenstrual-dysphoric-disorder-pmdd" target="_blank" rel="noopener">Premenstrual dysphoric disorder (PMDD).</a></li>
 	<li>U.S. Department of Health and Human Services. (n.d.). <a href="https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome" target="_blank" rel="noopener">Premenstrual Syndrome (PMS).</a></li>
 	<li>American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.</li>
 	<li>Kennedy S. H. (2008). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181882/" target="_blank" rel="noopener">Core symptoms of major depressive disorder: relevance to diagnosis and treatment.</a> Dialogues in clinical neuroscience, 10(3), 271-7.</li>
 	<li>Johns Hopkins Medicine. (n.d.). <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/premenstrual-dysphoric-disorder-pmdd" target="_blank" rel="noopener">Premenstrual Dysphoric Disorder (PMDD).</a></li>
 	<li>Skrzypulec-Plinta, V., Drosdzol, A., Nowosielski, K., &amp; Plinta, R. (2010). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992541/" target="_blank" rel="noopener">The complexity of premenstrual dysphoric disorder--risk factors in the population of Polish wome</a><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992541/" target="_blank" rel="noopener">n</a>. Reproductive biology and endocrinology : RB&amp;E, 8, 141.</li>
 	<li>Ricciotti, Hope. (2015). <a href="https://www.health.harvard.edu/blog/premenstrual-dysphoric-disorder-when-its-more-than-just-pms-201510128415" target="_blank" rel="noopener">Premenstrual dysphoric disorder: When it’s more than just PMS.</a></li>
 	<li><a href="https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/premenstrual-syndrome-management-green-top-guideline-no-48/" target="_blank" rel="noopener">Management of premenstrual syndrome</a>. BJOG 2016; DOI: 10.1111/1471-0528.14260.</li>
 	<li>Daw, Jennifer. (2002). <a href="https://www.apa.org/monitor/oct02/pmdd" target="_blank" rel="noopener">Is PMDD Real?</a> Monitor on Psychology, 33(9), 58.</li>
 	<li>Fernández MDM, Saulyte J, Inskip HM, et al. <a href="https://bmjopen.bmj.com/content/8/3/e019490.citation-tools" target="_blank" rel="noopener">Premenstrual syndrome and alcohol consumption: a systematic review and meta-analysis</a>. BMJ Open 2018;8:e019490.</li>
 	<li>Ju, H., Jones, M., &amp; Mishra, G. D. (2015). <a href="https://pubmed.ncbi.nlm.nih.gov/25920763/" target="_blank" rel="noopener">Illicit drug use, early age at first use and risk of premenstrual syndrome: A longitudinal study</a>. Drug and alcohol dependence, 152, 209-217.</li>
 	<li>Kim, D. &amp; Freeman, E. (2010). <a href="https://www.psychiatrictimes.com/view/premenstrual-dysphoric-disorder-and-psychiatric-comorbidity" target="_blank" rel="noopener">Premenstrual Dysphoric Disorder and Psychiatric Comorbidity</a>. Psychiatric Times, 27(4).</li>
 	<li>Anxiety and Depression Association of America. (n.d.). <a href="https://adaa.org/understanding-anxiety/co-occurring-disorders/substance-abuse" target="_blank" rel="noopener">Substance Use Disorders.</a></li>
 	<li>National Institute on Drug Abuse. (2018). <a href="https://nida.nih.gov/publications/research-reports/common-comorbidities-substance-use-disorders/what-are-some-approaches-to-diagnosis" target="_blank" rel="noopener">Common Comorbidities with Substance Use Disorders: What are some approaches to diagnosis?</a></li>
 	<li>Kelly, T. M., &amp; Daley, D. C. (2013). Integrated treatment of substance use and psychiatric disorders. Social work in public health, 28(3-4), 388-406.</li>
 	<li>U.S. National Library of Medicine, Medline Plus. (2019). <a href="https://medlineplus.gov/ency/article/007193.htm" target="_blank" rel="noopener">Premenstrual dysphoric disorder.</a></li>
</ol>

Premenstrual Dysphoric Disorder (PMDD)

Major Depressive Disorder (MDD) & Addiction

Persistent Depressive Disorder

<h2>What Is Dissociation?</h2>
<img class="size-medium wp-image-55817 alignright" src="https://admin.americanaddictioncenters.org/wp-content/uploads/2019/02/2_1255118944_dissociation-1-300x200.jpg" alt="" width="300" height="200" />

The word dissociation is used to refer to a mental process whereby a person disconnects (or dissociates) from their feelings, thoughts, memories, or identity. Dissociation, in itself, is a common phenomenon. All of us have likely experienced some form of dissociation at some point. For example, if you’ve ever driven home and realized you can’t remember your drive, you probably dissociated to some degree on your drive. Even daydreaming is considered mild dissociation.1,4

Dissociation can also <a href="https://nida.nih.gov/publications/research-reports/hallucinogens-dissociative-drugs/what-are-effects-common-dissociative-drugs-brain-body" target="_blank" rel="noopener">occur as a result of substance use</a>, for example from using drugs like PCP or ketamine. However, for those with dissociative disorders, the dissociation is significant and not caused by a substance. It can involve issues with sense of self, memory, feelings, actions, and/or perception. A dissociative disorder may cause an individual to have multiple distinct personalities, or identities, and/or to experience large gaps in their memories.1

The American Psychiatric Association explains that the impact of such a disorder can be so large that it “disrupt[s] every area of mental functioning.”2

Dissociation is a common response to trauma; many people who go through a traumatic event, such as an accident or a violent crime, will experience some degree of dissociation during the event and/or for hours, days, or weeks after. They may feel like they are out of their own body, watching themselves as though they are watching a movie. They may also lose any memory of the traumatic event. For most, the dissociation will end without treatment. Some people, however, will develop a dissociative disorder.4
<h2>Understanding Dissociative Disorders</h2>
While there are several types of dissociative disorders (see below), general symptoms of disorders that fall under this umbrella include:5
<ul>
 	<li>Significant lapses in memory.</li>
 	<li>Feeling outside your body, as though watching events of your life instead of experiencing them.</li>
 	<li>Feeling emotionally detached/numb.</li>
 	<li>A lack of personal identity.</li>
</ul>
<h2>Types of Dissociative Disorders</h2>
[quote]Typically, dissociative disorders develop as a coping mechanism, as a way to separate oneself from trauma. [/quote]

There are several types of dissociative disorders, each of which has its own specific symptoms. These include:4,5,6
<ul>
 	<li>Dissociative amnesia. This condition <a href="https://americanaddictioncenters.org/dissociative-disorders/amnesia-substance-abuse-treat">may involve not remembering or having incomplete memories of a specific event or events</a> (such as abuse or military combat), or it may involve the loss of memory about a great deal of the person’s life or identity.</li>
 	<li>Depersonalization/derealization disorder. This disorder is marked by a sense that one’s life, thoughts, feelings, actions, and/or sensations are apart from oneself, as though happening on television. Sometimes the person’s surroundings may feel unreal (derealization).</li>
 	<li>Dissociative identity disorder (DID). Previously called “multiple personality disorder,” this condition involves the person <a href="https://americanaddictioncenters.org/dissociative-disorders/treating-identity-substance-abuse">alternating between separate and distinct identities</a>. DID may involve large gaps in memory and an inability to recall everyday events, personal information, or traumatic experiences.</li>
</ul>
Often, dissociative disorders develop as a result of <a href="https://americanaddictioncenters.org/co-occurring-disorders/ptsd-addiction">overwhelmingly traumatic experiences</a>.5 According to the American Psychiatric Association, approximately 90% of people in the U.S., Canada, and Europe who have dissociative identity disorder had experienced childhood abuse and/or neglect.

Typically, dissociative disorders develop as a coping mechanism, as a way to separate oneself from trauma. Identity is still developing in a child, so a child can dissociate more easily than an adult.7
<h2>Complications of Dissociative Disorders</h2>
Dissociative disorders are associated with a heightened risk for several issues, including:7
<ul>
 	<li>Problems with sleep, such as insomnia, nightmares, and sleepwalking.</li>
 	<li>Major problems with personal relationships and/or at work</li>
 	<li>Eating disorders.</li>
 	<li>Post-traumatic stress disorder (PTSD).</li>
 	<li>Anxiety disorders.</li>
 	<li>Depression.</li>
 	<li>Personality disorders.</li>
 	<li>Physical symptoms, including non-epileptic seizures and/or lightheadedness</li>
 	<li>Problems with sexual functioning.</li>
 	<li>Substance use disorders.</li>
 	<li>Self-harm.</li>
 	<li>Suicidal thoughts and actions.</li>
</ul>
<h3>Dissociative Disorders and Addiction</h3>
Individuals with dissociative disorders may turn to substances as a further escape from their trauma when their disorder does not provide adequate relief.8 Using psychoactive substances, however, can cause additional harm and may lead to a co-occurring substance use disorder.

In 1999, an article was published in the Journal of Psychoactive Drugs about “the forgotten relationship” between dissociative identity disorder and substance abuse. Specifically, substance use and dependence were among the most common diagnoses in patients with dissociative identity disorder. Practitioners who primarily treat individuals struggling with substance dependence and addiction may care for patients who have DID but fail to recognize the condition.9
<h2>Treating Dissociative Disorders and Substance Use Disorders</h2>
How are dissociative disorders treated alongside substance use disorders? The first step is that both conditions have to be diagnosed. Assessing the patient and making a diagnosis, however, may be difficult, especially in a patient with shifting identity states. Clinicians will generally work with the patient to gather their psychosocial history, including any history of trauma. Other steps may include an intelligence test, personality test(s), questions to determine the individual’s own perception of their dissociation, and an interview to evaluate the individual for dissociative disorders.10 Substance use also complicates the assessment process, so patients may need to be reevaluated after a period of abstinence in order to separate the effects of substance use and/or withdrawal from the symptoms of a co-occurring mental illness.11

Treating dissociative disorders usually requires psychotherapy. Treatment for dissociative disorders aims to address both the symptoms of the disorder and the trauma that caused the development of the disorder. Although there are no medications that directly treat dissociation, medications may be used to treat other symptoms or to treat any other conditions occurring alongside the dissociative disorder, such as PTSD, depression, or anxiety.5 

If a patient presents with both a dissociative and a substance use disorder, simply treating the drug abuse without giving any attention to the dissociative symptoms and their cause is likely to be much less beneficial for the patient’s long-term well-being and mental health.2

One of the key elements of treating dissociative disorders and/or substance use disorders is <a href="https://americanaddictioncenters.org/therapy-treatment">participation in therapy sessions</a>. For patients who present with dissociative disorders, working with a therapist to deal with any past trauma and to learn coping skills can be enormously beneficial. However, a patient with a dissociative disorder should seek a therapist who has experience and/or training in trauma therapy.7 Psychotherapy is also important in drug abuse treatment; not participating in treatment after detoxification often leads to relapse, and therapy can be an effective treatment for substance use disorders.12,13 Patients who present with co-occurring disorders should get integrated treatment, which provides better results.14 Entering a drug addiction rehab program that is ill-equipped to handle co-occurring disorders may do little to help individuals with them.

[vob]

<h3>Therapy</h3>

Cognitive behavioral therapy (CBT) is used in the treatment of both dissociative disorders and substance use disorders. Per the <a href="https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Dissociative-Disorders" target="_blank" rel="noopener">National Alliance on Mental Illness</a>, CBT works by helping patients recognize and change negative thoughts and behaviors.5 CBT is thought to be effective for dissociative identity disorder and may be effective for other dissociative disorders as well.15 Studies have demonstrated that CBT is effective for substance use disorders.16

Other types of psychotherapy that may be used to treat dissociative disorders include:5,17
<ul>
 	<li>Dialectical behavior therapy (DBT). This therapy seeks to help individuals find balance between acceptance and change. It can help decrease destructive behaviors. Individuals learn skills to control their emotions, including techniques such as mindfulness.</li>
 	<li>Eye movement desensitization and reprocessing (EMDR). This therapy is generally used to treat PTSD, and research shows that it can mitigate the suffering associated with traumatic memories. It helps individuals replace negative emotions in response to trauma memories with less powerful or positive responses.</li>
</ul>

Medications may also be used. Although no medications directly treat dissociative disorders, medications may be used to help with some of their symptoms.7 Antidepressants and/or anxiolytics, for example, may be used to treat depression and anxiety symptoms. Antipsychotics may be used to stabilize mood and alleviate intrusive symptoms, psychotic symptoms, and excessive anxiety.18 <a href="https://americanaddictioncenters.org/addiction-medications" target="_blank" rel="noopener">Treatment of substance use disorders may also involve medication;</a>12 however, the treatment team should be careful not to prescribe any medications that will cause dangerous interactions with other medications.

<h2>Dissociation, Addiction, and the Future</h2>
Individuals with substance use and/or dissociative disorders should remain engaged with treatment as long as necessary. It can take a lot of time to work through dissociative disorders in therapy, especially since coping skills and a solid therapeutic relationship often need to be developed before past trauma can safely be addressed.7 For those who struggle with substance use disorders, long-term treatment or repeated episodes of treatment are often needed to sustain recovery.19 Because individuals with co-occurring disorders often have worse symptoms that are more persistent and difficult to treat, staying engaged with treatment as needed is especially important.11 

Staying engaged with treatment also means continuing to take medications as prescribed. Individuals should not change their dose of medication or stop taking any medications without first discussing it with their provider, who can work together with the patient to address the patient’s concerns and find a better treatment option if needed. Suddenly changing doses or stopping medications can be dangerous: symptoms may return, withdrawal symptoms may emerge, and/or adverse effects may develop. Thus, changes should only be made under the guidance of a healthcare professional authorized to prescribe those medications. If a person thinks a medication is causing negative effects, they should contact the prescriber immediately. In an emergency, call 911.

The combination of dissociative disorders and substance use disorders can be challenging both for those experiencing the disorders and for their loved ones. But with treatment, it is possible for individuals with these disorders to learn to manage them and have great improvement in functioning.20

[sources]
<ol>
 	<li>American Psychiatric Association. (2018). <a href="https://psychiatry.org/patients-families/dissociative-disorders/what-are-dissociative-disorders" target="_blank" rel="noopener">What Are Dissociative Disorders? </a></li>
 	<li>McDowell DM1, Levin FR, &amp; Nunes EV. (1999). <a href="https://pubmed.ncbi.nlm.nih.gov/10332641/" target="_blank" rel="noopener">Dissociative identity disorder and substance abuse: the forgotten relationship</a>. Journal of Psychoactive Drugs, 31(1), 71-83.</li>
 	<li>National Institute on Drug Abuse. (2018). <a href="https://nida.nih.gov/publications/research-reports/common-comorbidities-substance-use-disorders/introduction" target="_blank" rel="noopener">Comorbidity: Substance Use Disorders and Other Mental Illnesses</a>.</li>
 	<li>Victoria State Government Better Health Channel. (2012.) <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/dissociation-and-dissociative-disorders" target="_blank" rel="noopener">Dissociation and Dissociative Disorders</a>.</li>
 	<li>National Alliance on Mental Illness. (n.d.). <a href="https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Dissociative-Disorders" target="_blank" rel="noopener">Dissociative Disorders.</a></li>
 	<li>Cleveland Clinic. (n.d.). <a href="https://my.clevelandclinic.org/health/diseases/9789-dissociative-amnesia" target="_blank" rel="noopener">Dissociative Amnesia.</a></li>
 	<li>Mayo Clinic. (2017). <a href="https://www.mayoclinic.org/diseases-conditions/dissociative-disorders/symptoms-causes/syc-20355215" target="_blank" rel="noopener">Dissociative Disorders.</a></li>
 	<li>Somer, E., Altus, L., &amp; Ginzburg, K. (2010). Dissociative psychopathology among opioid use disorder patients: exploring the “chemical dissociation” hypothesis. Comprehensive psychiatry, 51(4), 419-425.</li>
 	<li><a href="https://pubmed.ncbi.nlm.nih.gov/10332641/" target="_blank" rel="noopener">Dissociative Identity Disorder and Substance Abuse: The Forgotten Relationship. </a>(January - March 1999.) Journal of Psychoactive Drugs.</li>
 	<li>Psychiatric Clinics of North America. (2006). <a href="https://pubmed.ncbi.nlm.nih.gov/16530591/" target="_blank" rel="noopener">Psychological Assessment of Patients with Dissociative Identity Disorder</a>.</li>
 	<li>National Institute on Drug Abuse. (2018). <a href="https://nida.nih.gov/publications/research-reports/common-comorbidities-substance-use-disorders/what-are-some-approaches-to-diagnosis" target="_blank" rel="noopener">Common Comorbidities with Substance Use Disorders: What are some approaches to diagnosis?</a></li>
 	<li>National Institute on Drug Abuse. (2018). <a href="https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery" target="_blank" rel="noopener">Drugs, Brains, and Behavior: The Science of Addiction</a>.</li>
 	<li>National Institute on Drug Abuse. (2018). <a href="https://nida.nih.gov/sites/default/files/675-principles-of-drug-addiction-treatment-a-research-based-guide-third-edition.pdf" target="_blank" rel="noopener">Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Behavioral Therapies</a>.</li>
 	<li>Kelly, T. M., &amp; Daley, D. C. (2013). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753025/" target="_blank" rel="noopener">Integrated treatment of substance use and psychiatric disorders</a>. Social work in public health, 28(3-4), 388-406.</li>
 	<li>Brand, B. L., Classen, C. C., McNary, S. W., &amp; Zaveri, P. (2009). <a href="https://pubmed.ncbi.nlm.nih.gov/19752643/" target="_blank" rel="noopener">A review of dissociative disorders treatment studies</a>. The Journal of Nervous and Mental Disease, 197(9), 646-654.</li>
 	<li>McHugh, R. K., Hearon, B. A., &amp; Otto, M. W. (2010). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2897895/?_escaped_fragment_=po=6.25000" target="_blank" rel="noopener">Cognitive Behavioral Therapy for Substance Use Disorders</a>. The Psychiatric clinics of North America, 33(3), 511-25.</li>
 	<li>National Alliance on Mental Illness. (n.d.). <a href="https://www.nami.org/About-Mental-Illness/Treatments/Psychotherapy" target="_blank" rel="noopener">Psychotherapy</a>.</li>
 	<li>Gentile, J. P., Dillon, K. S., &amp; Gillig, P. M. (2013). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3615506/" target="_blank" rel="noopener">Psychotherapy and pharmacotherapy for patients with dissociative identity disorder</a>. Innovations in clinical neuroscience,10(2), 22-9.</li>
 	<li>Volkow, N.D. (2018, January). <a href="https://nida.nih.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/preface" target="_blank" rel="noopener">Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Preface</a>.</li>
 	<li>American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.</li>
</ol>
[/sources]

How Are Dissociative Disorders Treated Alongside Drug Abuse?

[content-overview]

Alcohol and methamphetamine are two dangerous substances that, when combined, can have serious—potentially fatal—consequences.

[/content-overview]


[vob]
<h2>What Is Methamphetamine?</h2>
<img class="size-medium wp-image-56054 alignright" src="https://admin.americanaddictioncenters.org/wp-content/uploads/2019/02/2_1281995095_insomnia-300x201.jpg" alt="" width="300" height="201" />

Methamphetamine, commonly referred to as meth, is a central nervous system (CNS) stimulant known for eliciting a powerful high, increasing wakefulness, and decreasing appetite.1 The high from meth is short, however, and people will often binge on it, taking repeated doses, before crashing. Some people will take meth over and over for days in what is referred to as a “run,” giving up food and sleep in favor of staying up and using meth.1 

Meth causes an increase in the release of dopamine in the brain.1 Dopamine, which plays a key role in the brain’s reward system, is a chemical naturally produced by the brain. Dopamine is important for motivation and wanting something, and research shows that increased dopamine levels in certain parts of the brain increase a person’s desire for rewards.2 The increased dopamine after using meth may <a href="https://americanaddictioncenters.org/meth-treatment/facts">propel the person to reach for meth again and again</a>.1

Based on the 2016 NSDUH (National Survey on Drug Use and Health) results, it was estimated that more than 14.5 million people 12 years old and older had used methamphetamine at some point in their lives.3
<h2>Meth’s Effects on the Body</h2>
Possible<a href="https://americanaddictioncenters.org/meth-treatment/side-effects"> short-term effects of meth</a> use include:1
<ul>
 	<li>An increase in alertness and energy levels.</li>
 	<li>Trouble sleeping.</li>
 	<li>Rapid heart rate.</li>
 	<li>Irregular heartbeat.</li>
 	<li>Hypertension (high blood pressure).</li>
 	<li>Increased body temperature.</li>
 	<li>Suppressed appetite.</li>
</ul>
Meth has the potential to cause a long list of physical and mental health problems when used long-term, including:1
<ul>
 	<li>Dental problems (tooth decay and tooth loss in particular), commonly referred to as meth</li>
 	<li>Skin sores due to incessant scratching or picking at the skin.</li>
 	<li>Significant weight loss.</li>
 	<li>Insomnia.</li>
 	<li>Anxiety.</li>
 	<li>Confusion.</li>
 	<li>Aggression/violence.</li>
 	<li>Paranoia.</li>
 	<li>Hallucinations.</li>
</ul>
Studies show that long-term use of methamphetamine is linked to negative impacts on areas of the brain associated with memory, learning, emotion, and coordination.1

Methamphetamine-induced brain changes may take a long time of abstinence from meth to reverse, and, in some cases, may not reverse at all.1
[segment-cta type="value-prop"]
<h2>Alcohol’s Effects on the Body</h2>
Alcohol is easily accessible and commonly abused. And though its use is normalized, it can be just as dangerous as many illicit substances. Abuse of alcohol may result in numerous consequences for the drinker, ranging from minor hangovers to severe accidents and injuries, to addiction or death. Based on 2016 surveys, it is estimated that 6% of adults 18 and over suffered from an alcohol use disorder in the past year.3 

Unlike meth, which stimulates the central nervous system, alcohol depresses it. Thus, many potential effects of alcohol are different from those of meth, although there are some that are similar. Alcohol intoxication can result in effects including:4
<ul>
 	<li>Slurred speech.</li>
 	<li>Problems with motor coordination.</li>
 	<li>Slowed reaction time.</li>
 	<li>Confusion.</li>
 	<li>Impaired judgment.</li>
 	<li>Lowered inhibitions.</li>
 	<li>Memory loss.</li>
 	<li>Blurred vision.</li>
 	<li>Sweating.</li>
 	<li>Dehydration.</li>
 	<li>Nausea and vomiting.</li>
 	<li>Slowed breathing rates.</li>
 	<li>Drop in blood pressure.</li>
 	<li>Coma.</li>
 	<li>Death.</li>
</ul>
In the long term, alcohol abuse is associated with a host of adverse effects, including (but not limited to) increased risk of numerous types of cancer, cardiovascular disease, pancreatitis, liver problems, <a href="https://americanaddictioncenters.org/alcoholism-treatment/dangers-pregnancy">birth defects (if alcohol is consumed during pregnancy)</a>, sexual problems, and addiction.4
<h2>Why Do People Mix These Drugs?</h2>
Polysubstance use – the practice of using two or more drugs at the same time– is not at all uncommon. One study looked at the connection between methamphetamine use and alcohol use among a sample of meth users and found that these drugs are used in predictable patterns and that binge drinking, especially, resulted in a higher likelihood of meth use.5

The study found that any alcohol use at all resulted in an increased chance of same-day meth use among this population, but that binge drinking increased the likelihood even further.5

The effect of alcohol on a person’s motivation to use meth (or vice versa) is thought to be short-lived, based on the study’s findings, and is possibly the strongest right after the initial substance is used, while the subjective effects of that substance are experienced.5

The researchers suggest that this may be because the co-use of meth and alcohol has the potential to both magnify the high of each substance and alleviate some of the adverse effects of each substance.5 For example, alcohol may help to relieve insomnia associated with meth use and meth may relieve alcohol-related sedation.5,6
<h2>Take Our Substance Abuse Self-Assessment</h2>
Take our free, 5-minute substance abuse self-assessment below if you think you or someone you love might be struggling with substance abuse. The evaluation consists of 11 yes or no questions that are intended to be used as an informational tool to assess the severity and probability of a substance use disorder. The test is free, confidential, and no personal information is needed to receive the result.

[self-assessment]
<h2>The Dangers of Mixing Meth and Alcohol</h2>
Studies show that alcohol could interfere with meth metabolism, leading to a higher concentration of meth in the bloodstream.6 Alcohol was found to increase the levels of methamphetamine and amphetamine (meth’s active metabolite) in rabbits and rats.6

If alcohol increases meth levels in the blood, it may enhance the stimulating effects of meth on the heart and brain of users. For example, alcohol use in combination with meth was found to increase heart rate even further than meth used alone.6

[quote]Studies show that alcohol could interfere with meth metabolism, leading to a higher concentration of meth in the bloodstream.[/quote]

The co-administration of alcohol and meth to rats was also shown to impair learning and discriminating behavior more than meth administered alone.6

Meth may also reduce the subjective detrimental effects of alcohol,6 which could lead to an individual drinking more alcohol and developing alcohol toxicity.
<h3>Alcohol Poisoning</h3>
<a href="https://americanaddictioncenters.org/alcoholism-treatment">Alcohol</a>, by itself, can have a sedating effect and impair cognitive and motor function. After a few drinks, people generally feel drunk. For example, they may begin stumbling, may feel excessively sleepy, and might begin seeing double. These effects can prompt the individual to stop drinking or can indicate to those around the individual that they should not give him or her more alcohol.

However, when people use meth along with alcohol, it can mask the sedating effects, leading people to drink past the point where they would otherwise stop, increasing their risk of alcohol overdose, also known as alcohol poisoning.6

<a href="https://americanaddictioncenters.org/alcoholism-treatment/overdose">Alcohol poisoning</a> is a condition wherein an excessive amount of alcohol in the bloodstream causes certain areas of the brain that control important life-sustaining functions—such as heart rate, breathing, and temperature control—to shut down.7

[callout]

Signs of alcohol poisoning include:7
<ul>
 	<li>Confusion/stupor.</li>
 	<li>Falling unconscious and/or inability to wake up.</li>
 	<li>Slowed breathing and heart rate.</li>
 	<li>Irregular breathing pattern.</li>
 	<li>Vomiting.</li>
 	<li>Clammy feel to skin.</li>
 	<li>Extreme drop in body temperature.</li>
 	<li>Pale or bluish color to skin.</li>
 	<li>Seizures.</li>
 	<li>Dulled gag reflex.</li>
</ul>
[/callout]

People who overdose on alcohol might pass out in many cases and may be left to “sleep it off.” Leaving an extremely intoxicated person passed out on their own may have devastating results. Blood alcohol content can continue to rise even after the person has stopped drinking as alcohol in the stomach and intestines enters the blood.7

Further, an unconscious person may choke on their own vomit and die, as extremely high levels of alcohol in the body can impair signals in the brain that control the gag reflex.7

If a severely intoxicated person shows any of the symptoms of alcohol poisoning, they should be hospitalized immediately. Alcohol poisoning is a condition that should only be treated in a hospital. Leaving them to sleep it off can be deadly, and no amount of home remedies (like cold showers or coffee) can reverse the effects of alcohol toxicity. In fact, such attempts could actually worsen the person’s condition. If you suspect that someone may be overdosing on alcohol, call 911 immediately and stay with the person until help arrives. Try to position them in a sitting or partially upright position on the ground. If the person is unconscious and begins to vomit, roll them on their side to prevent choking.7

[callout]
<h4>Dangers of Mixing Alcohol and Drugs</h4>
<ul>
 	<li><a href="/bath-salts-abuse/mix-alcohol">Bath Salts</a></li>
 	<li><a href="/cocaine-treatment/mixing-with-alcohol">Cocaine</a></li>
 	<li><a href="/ecstasy-abuse/mixing-alcohol">Ecstasy</a></li>
 	<li><a href="/marijuana-rehab/mixing-alcohol">Marijuana</a></li>
 	<li><a href="/methadone-addiction/mixing-alcohol">Methadone</a></li>
 	<li><a href="/alcoholism-treatment/mixing-opiates">Opiates</a></li>
 	<li><a href="/synthetic-cannabinoids/mixing-alcohol">Synthetic Cannabinoids</a></li>
</ul>
[/callout]
<h3>Other Risks</h3>
Meth may counteract some of the effects of drinking, such as impaired performance and sedation. As a result, a person using both might think they are sober enough to drive or engage in other dangerous behaviors.

Meth tends to increase libido.6 Alcohol tends to lower inhibitions. This is a dangerous combination, as people who use these substances simultaneously might be more likely to engage in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861416/" target="_blank" rel="noopener noreferrer">high-risk sexual activities</a>.
<h2>Long-Term Treatment and Rehabilitation</h2>
<img class="size-medium wp-image-51980 alignright" src="https://admin.americanaddictioncenters.org/wp-content/uploads/2018/10/treatment-for-co-occurring-disorders-1-300x200.jpg" alt="psychologist consulting a woman client indoors discussion therapy, blurred defocused view two women talk" width="300" height="200" />

Abusing any substance alone comes with a set of risks, but adding other substances to the mix can introduce new ones and may amplify the dangers of the original substance. If you or someone you love is unable to stop using alcohol, meth, and/or other drugs, it’s time to seek help. Each time these drugs are abused, there is the potential for grave harm.

People who have developed a dependence on both alcohol and methamphetamine should begin their recovery in medical detox. Alcohol withdrawal may bring on serious and sometimes life-threatening symptoms,8 and meth withdrawal can be distressing both physically and psychologically.9 An inpatient environment where you can receive 24/7 supervision and care may <a href="https://americanaddictioncenters.org/drug-detox/is-it-necessary" target="_blank" rel="noopener noreferrer">prevent potentially fatal complications and can provide a more comfortable detox</a>.10

After detox, treatment should involve therapy and may also include medication.11,12 Common aspects of addiction treatment include group counseling, individual counseling, medication, family therapy, 12-step or non 12-step support groups, recreational and other alternative therapies, drug and mental health education classes, and skill-building groups. Treatment can help you gain the tools you need to build and maintain your recovery from meth and alcohol addiction.

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[columns count="2"]
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[/columns]
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[/callout]

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 	<li><a href="https://americanaddictioncenters.org/meth-treatment/options">Meth Treatment Options</a></li>
 	<li><a href="https://americanaddictioncenters.org/meth-treatment/how-long-in-system">How Long Does Meth Stay In the Body?</a></li>
 	<li><a href="https://americanaddictioncenters.org/meth-treatment/withdrawal">Signs of Meth Withdrawal</a></li>
 	<li><a href="https://americanaddictioncenters.org/insurance-coverage/heroin-cocaine-and-meth">Is Meth Rehab Covered by Insurance?</a></li>
 	<li><a href="https://americanaddictioncenters.org/rehab-guide/meth-drug-hotline">Meth Drug Hotline</a></li>
 	<li><a href="https://americanaddictioncenters.org/drug-detox">Drug Detox Centers</a></li>
 	<li><a href="https://americanaddictioncenters.org/co-occurring-disorders">Co-Occurring Disorder Treatment</a></li>
 	<li><a href="https://americanaddictioncenters.org/rehab-guide/medicare">Medicare for Rehab</a></li>
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 	<li><a href="https://americanaddictioncenters.org/rehab-guide/inpatient">Inpatient Rehab</a></li>
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[/link-bank]
<h3>Sources</h3>
<ol>
 	<li>National Institute on Drug Abuse. (2013). <a href="https://nida.nih.gov/publications/research-reports/methamphetamine/what-methamphetamine" target="_blank" rel="noopener noreferrer">What is methamphetamine?</a></li>
 	<li>Berridge, K. C., &amp; Kringelbach, M. L. (2015). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4425246/" target="_blank" rel="noopener noreferrer">Pleasure systems in the brain</a>. Neuron, 86(3), 646-64.</li>
 	<li>Center for Behavioral Health Statistics and Quality. (2017). 2016 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration, Rockville, MD.</li>
 	<li>Center for Substance Abuse Research. (n.d.). <a href="http://www.cesar.umd.edu/cesar/drugs/alcohol.asp" target="_blank" rel="noopener noreferrer">Alcohol</a>.</li>
 	<li>Bujarski, S., Roche, D. J., Lunny, K., Moallem, N. R., Courtney, K. E., Allen, V., Hartwell, E., Leventhal, A., Rohrbaugh, T., … Ray, L. A. (2014). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4157644/" target="_blank" rel="noopener noreferrer">The relationship between methamphetamine and alcohol use in a community sample of methamphetamine users</a>. Drug and alcohol dependence, 142, 127-32.</li>
 	<li>Althobaiti, Y. S., &amp; Sari, Y. (2016). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4966675/" target="_blank" rel="noopener noreferrer">Alcohol Interactions with Psychostimulants: An Overview of Animal and Human Studies</a>. Journal of addiction research &amp; therapy, 7(3), 281.</li>
 	<li>National Institute on Alcohol Abuse and Alcoholism. (2018). <a href="https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-dangers-of-alcohol-overdose" target="_blank" rel="noopener noreferrer">Understanding the Dangers of Alcohol Overdose.</a></li>
 	<li>U.S. National Library of Medicine. (2019). <a href="https://medlineplus.gov/ency/article/000764.htm" target="_blank" rel="noopener noreferrer">Alcohol withdrawal.</a></li>
 	<li>Zorick, T., Nestor, L., Miotto, K., Sugar, C., Hellemann, G., Scanlon, G., Rawson, R., … London, E. D. (2010). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3071736/" target="_blank" rel="noopener noreferrer">Withdrawal symptoms in abstinent methamphetamine-dependent subjects</a>. Addiction (Abingdon, England), 105(10), 1809-18.</li>
 	<li>Center for Substance Abuse Treatment. (2006). <a href="https://www.ncbi.nlm.nih.gov/books/NBK64119/#A85324" target="_blank" rel="noopener noreferrer">Detoxification and Substance Abuse Treatment</a>. Treatment Improvement Protocol (TIP) Series, 45.</li>
 	<li>National Institute on Drug Abuse. (2013). <a href="https://nida.nih.gov/publications/research-reports/methamphetamine/what-treatments-are-effective-people-who-misuse-methamphetamine" target="_blank" rel="noopener noreferrer">What treatments are effective for people who abuse methamphetamine?</a></li>
 	<li>National Institute on Alcohol Abuse and Alcoholism. (2014). <a href="https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/treatment-alcohol-problems-finding-and-getting-help" target="_blank" rel="noopener noreferrer">Treatment for Alcohol Problems: Finding and Getting Help</a>.</li>
</ol>
&nbsp;

Meth & Alcohol: The Danger of Mixing Substances

[content-overview]De su ultimo uso, la cocaína o sus metabolitos pueden aparecer en un examen de sangre o saliva hasta por 2 días, en un examen de orina hasta por 3 días, y en un examen de cabello durante meses o años. Un usuario frecuente puede resultar positivo de cocaína por hasta 2 semanas.[/content-overview]

El modo de empleo no afecta cuanto dura la cocaína en la orina. Pero otros factores pueden influenciar cuanto tiempo permanece, como el metabolismo, peso, dosis, y frecuencia de uso. El alcohol también puede retrasar la eliminación de la droga del cuerpo.
<a href="https://americanaddictioncenters.org/cocaine-treatment/how-long-in-system" rel="alternate" hreflang="en">English Version</a>

<h2>¿Cuáles Son Los Efectos de la Cocaína?</h2>
La cocaína es un estimulante del sistema nervioso central de acción rápida que produce un gran excitación eufórico pero efímero, que dura unos minutos hasta una hora, dependiente de como se usa. La velocidad de aparición de los efectos de cocaína, así como la duración total de acción, está influido por el modo de empleo. 1,2
<ul>
 	<li>Inhalando: Efectos se sienten dentro de 3-5 minutos y duran hasta 20 minutos</li>
 	<li>Fumando: Efectos se sienten dentro de 5-10 segundos y duran hasta 20 minutos</li>
 	<li>Uso intravenoso: Efectos se sienten dentro de 5-10 segundos y duran hasta 20 minutos</li>
 	<li>Por ingestión oral: Efectos se sienten dentro de 10-30 minutos duran hasta 90 minutos</li>
</ul>
Inyectando o fumando cocaína puede causar un torrente de energía, seguido de un alto, mientras otros modos de empleo solo producen un alto.4 Es común para los individuos de usar cocaína repetidamente en poco tiempo para mantenerse drogado, también conocido como un “high.”5 Un atracón está a menudo seguido por altibajos.6 Los altibajos hacen que la persona busca busque más droga para contrarrestar ese efecto. Uso repetido de cocaína puede fácilmente contribuir a reforzar la tolerancia e incluso adicción.5

Según la Encuesta Nacional sobre el Uso de Drogas y la Salud, aproximadamente 966,000 personas en los Estados Unidos de 12 años de edad o más cumplían los criterios para trastorno por consumo de cocaína—conocido normalmente como la adicción a la cocaína—en 2017.3

[callout]
<h2>Preguntas Frecuentes</h2>
[faqs]
[/callout]
<h2>Como La Cocaína Se Detecta en Los Exámenes de Drogas?</h2>
La vida media de la cocaína es alrededor de una hora.4 Quiere decir que toca aproximadamente una hora para que el cuerpo elimina la mitad de la cocaína actualmente en la sangre.7

Sin embargo, el consumo a largo plazo puede provocar tiempos de eliminación más largos, haciendo que algunos exámenes detecten la droga en el sistema por largos periodos.8

Calendarios de detección por diferentes tipos de exámenes se hallan enumerados más abajo:
<ul>
 	<li>La cocaína o sus metabolitos pueden aparecer en un examen de sangre o saliva por hasta 2 días después del ultimo uso.9</li>
 	<li>Se puede detectar en el cabello por meses hasta años.10</li>
 	<li>Sus metabolitos pueden ser detectados en la orina por hasta 3 días, pero puede seguir detectable por hasta 2 semanas por un usuario frecuente.9</li>
</ul>
A pesar de los diferentes métodos de prueba disponibles, un examen toxicológico de orina sigue siendo el método de prueba más común.9

Cualquier persona que pueda dar positivo al examen de cocaína debería considerar los peligros del consumo de este psicoactivo. Si la persona no puede parar el consumo, probablemente ya tiene una drogadicción.

[link-bank title="Recursos útiles"]
<ul>
 	<li><a href="/rehab-guide/free/esp">Centros gratuitos de Rehabilitación y Desintoxicación </a></li>
 	<li><a href="/rehab-guide/alcohol-drug-hotline/esp">Teléfonos de información sobre alcohol y drogadicciones </a></li>
 	<li><a href="/rehab-guide/public-assistance/esp">¿Cómo puedo permitirme tratamiento en un centro de rehabilitación de abuso de sustancias? </a></li>
 	<li><a href="/alcohol-rehab/cost/esp">Cuánto cuesta la rehabilitación de alcohol? </a></li>
 	<li><a href="/drug-detox/same-day-admittance/esp">Admisión el mismo día a un programa Detox </a></li>
 	<li><a href="/rehab-guide/with-a-job/esp">Ir a un Centro de Tratamiento de Adicciones con un Trabajo </a></li>
 	<li><a href="/drug-detox/esp">Cómo encontrar un centro de desintoxicación de drogas </a></li>
</ul>
[/link-bank]

Si una persona tiene adicción a la cocaína, lo mas recomendable es buscar ayuda profesional lo más pronto posible.
<iframe src="https://www.youtube.com/embed/2t1KqafW4Qw?rel=0&amp;controls=0&amp;showinfo=0" width="853" height="480" frameborder="0" allowfullscreen="allowfullscreen"></iframe>
<h2>¿Cuáles Factores Afectan Cuánto Tiempo La Cocaína Permanece En Su Cuerpo</h2>
Los factores que afectan cuánto tiempo permanece la cocaína en el cuerpo: 11
<ul>
 	<li>La dosis.</li>
 	<li>La frecuencia de uso.</li>
 	<li>La ultima dosis.</li>
 	<li>El pH de la orina.</li>
 	<li>Concentración de la orina.</li>
 	<li>Problemas de riñón o hígado.</li>
 	<li>Masa corporal.</li>
</ul>
<h2>¿Afectará el modo de Empleo Cuanto Tiempo Permanece En La Orina?</h2>
El modo de empleo afecta que tan rápido la droga llega a las células cerebrales, pero no afecta el periodo de residencia en el cuerpo. Independientemente de la manera de consumo, la cocaína y los metabolitos de cocaína aparecerán en la orina 3 a 5 horas después del ultimo uso.4
<h2>¿Como es metabolizada esta droga?</h2>
Cocaína es metabolizada por encimas en el hígado y la sangre. El principal metabolito en la orina es benzoilecgonina, seguido de ecgonina metil ester.12

Benzoilecgonina puede ser detectado en la orina hasta por 4 días, dependiendo de la frecuencia de uso, metabolismo y dosis utilizada.12

Benzoilecgonina es el principal metabolito utilizado en el análisis de drogas porque la concentración en la orina es 50 a  100 veces más que la concentración de cocaína.4

[quote]Cocaína parece ser eliminada mas despacio cuando se mezcla con alcohol.[/quote]
<h2>¿Permanece más tiempo en su Sistema si se Combina con Alcohol?</h2>
El uso de cocaína con alcohol puede causar numerosos problemas para los consumidores.13
<ul>
 	<li>Cocaína puede empeorar dificultades al aprendizaje y deterioro en el rendimiento psicomotor y conducción con el uso de alcohol.</li>
 	<li>La mezcla con alcohol puede ocasionar un incremento en el ritmo cardiaco.</li>
 	<li>El uso de cocaína con alcohol o después del consumo de alcohol puede ocasionar hasta 30% incremento en los niveles de cocaína en la sangre.</li>
 	<li>La combinación también puede producir un metabolito llamado coca-etileno, el cual puede ocasionar efectos cardio tóxicos.</li>
</ul>
Cocaína parece ser eliminado más despacio cuando es combinado con alcohol. Coca-etileno parece ser eliminado más despacio que cocaína:
<ul>
 	<li>Un estudio en humanos concluyó que coca-etileno parece ser eliminado más despacio que cocaína.14</li>
 	<li>Otro estudio en perros concluyó que cocaína y coca-etileno fue eliminado del cuerpo a una velocidad 20% mas despacio cuando es mezclado con alcohol. 15</li>
 	<li>último, otro estudio en ratas concluyó que el repetido uso de alcohol disminuyo la velocidad de eliminación de la cocaína. 16</li>
</ul>
<h2>¿Hay otros Sustancias que puede causar un resultado positivo en un examen de cocaína?</h2>
Falsos positivos con pruebas de detección de drogas en orina con inmunoensayo de cocaína son poco frecuentes, pero pueden ocurrir y el resultado puede generar problemas para la persona. En un caso, un falso positivo para cocaína afectó negativamente una terapia de dolor de un paciente.17

Si usted cree que tuvo una prueba con falso positivo, pregúntele a su medico o a la persona que ordenó la prueba de verificar el resultado con otro tipo de examen, como cromatografía / espectrometría de masas o cromatografía líquida / espectrometría de masas en tándem.14
[cta button="Utilice nuestra herramienta gratuita para obtener más información" link="/verify-insurance/esp"]
¿Su seguro médico cubre algunos o todos los costos del tratamiento?[/cta]

<h2>¿Cuales son los efectos secundarios de la Cocaína a largo plazo?</h2>
Con el tiempo, la cocaína puede causar una serie de daños a los consumidores. La cocaína puede causar posibles efectos secundarios a largo plazo para la salud.  Estos efectos pueden ser influenciados por el tipo de consumo e incluyen: 18
<ul>
 	<li>Mayor riesgo de apoplejía y convulsiones.</li>
 	<li>Inflamación de los músculos del corazón.</li>
 	<li>Reduce la habilidad de contracción en el corazón.</li>
 	<li>Rupturas aórticas.</li>
 	<li>Mayor riesgo de enfermedad de Parkinson.</li>
 	<li>Déficits en atención, inhibición, memoria, toma de decisiones y tareas motoras.</li>
 	<li>Desnutrición.</li>
 	<li>Pérdida de peso.</li>
 	<li>Pérdida del sentido del olfato.</li>
 	<li>Las hemorragias nasales.</li>
 	<li>Dificultad al tragar.</li>
 	<li>Crónica inflamada, secreción nasal.</li>
 	<li>Empeoramiento del asma.</li>
 	<li>Riesgo de VIH y hepatitis.</li>
</ul>
<a href="https://americanaddictioncenters.org/therapy-treatment">Problemas graves pueden evitarse con tratamiento temprano de adicción.</a>

[link-bank title="Por cuánto tiempo permanecen otras drogas en el cuerpo"]
<ul>
 	<li><a href="https://americanaddictioncenters.org/adderall/how-long-system-body">Adderall</a></li>
 	<li><a href="https://americanaddictioncenters.org/alcoholism-treatment/how-long-in-system">Alcohol</a></li>
 	<li><a href="https://americanaddictioncenters.org/ambien-treatment/no-longer-in-system">Ambien</a></li>
 	<li><a href="https://americanaddictioncenters.org/benzodiazepine/how-long-in-system">Benzodiazepine</a></li>
 	<li><a href="https://americanaddictioncenters.org/codeine-addiction/time-to-leave-system">Codeine</a></li>
 	<li><a href="https://americanaddictioncenters.org/fentanyl-treatment/how-long-in-system">Fentanyl</a></li>
 	<li><a href="https://americanaddictioncenters.org/heroin-treatment/how-long-in-system">Heroin</a></li>
 	<li><a href="https://americanaddictioncenters.org/lsd-abuse/how-long-system-body">LSD</a></li>
 	<li><a href="https://americanaddictioncenters.org/marijuana-rehab/how-long-system-body">Marijuana</a></li>
 	<li><a href="https://americanaddictioncenters.org/meth-treatment/how-long-in-system">Meth</a></li>
 	<li><a href="https://americanaddictioncenters.org/ritalin/how-long-in-system">Ritalin</a></li>
 	<li><a href="https://americanaddictioncenters.org/tramadol-abuse/time-to-leave-system">Tramadol</a></li>
 	<li><a href="https://americanaddictioncenters.org/valium-treatment/how-long-in-system">Valium</a></li>
 	<li><a href="https://americanaddictioncenters.org/vyvanse-abuse/how-long-last">Vyvanse</a></li>
 	<li><a href="https://americanaddictioncenters.org/prescription-drugs/vicodin-stay-system">Vicodin</a></li>
 	<li><a href="https://americanaddictioncenters.org/xanax-treatment/how-long-in-system">Xanax</a></li>
</ul>
[/link-bank]
<h2>FUENTES</h2>
<ol>
 	<li>National Institute on Drug Abuse. (2016). <a href="https://nida.nih.gov/publications/research-reports/cocaine/what-are-short-term-effects-cocaine-use" target="blank" rel="noopener noreferrer">What are the short-term effects of cocaine use?</a></li>
 	<li>Substance Abuse and Mental Health Services Administration. (1999). <a href="https://www.ncbi.nlm.nih.gov/books/NBK64323/table/A59093/" target="blank" rel="noopener noreferrer">Treatment for Stimulant Use Disorders</a>.</li>
 	<li>Substance Abuse and Mental Health Services Administration. (2018). <a href="https://www.samhsa.gov/data/report/2017-nsduh-annual-national-report" target="blank" rel="noopener noreferrer">Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health</a>.</li>
 	<li>Preston KL, Epstein DH, Cone EJ, Wtsadik AT, Huestis MA, Moolchan ET. <a href="https://pubmed.ncbi.nlm.nih.gov/12422991/">Urinary elimination of cocaine metabolites in chronic cocaine users during cessation</a>. J Anal Toxicol. 2002 Oct;26(7):393-400. doi: 10.1093/jat/26.7.393. PMID: 12422991.</li>
 	<li>National Institute on Drug Abuse. (2018). <a href="https://nida.nih.gov/publications/drugfacts/cocaine" target="blank" rel="noopener noreferrer">DrugFacts: Cocaine</a>.</li>
 	<li>Redwood Toxicology Laboratory. (2014). <a href="https://supremecourt.nebraska.gov/sites/default/files/Programs/CIP/events/redwood/LAB_Reference_Guide.pdf" target="blank" rel="noopener noreferrer">Laboratory Testing Reference Guide</a>.</li>
 	<li>Boston University School of Medicine. (2004). <a href="https://www.bumc.bu.edu/busm-pm/resources-2/glossary/" target="blank" rel="noopener noreferrer">Glossary of Terms and Symbols Used in Pharmacology</a>.</li>
 	<li>Richards JR, Laurin EG. (2022). <a href="https://www.ncbi.nlm.nih.gov/books/NBK430769/">Cocaine</a>. StatPearls Publishing.</li>
 	<li>University of Rochester Medical Center. <a href="https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&amp;contentid=cocaine_screen" target="blank" rel="noopener noreferrer">Cocaine Screen</a>.</li>
 	<li>Warner, T. D., Behnke, M., Eyler, F. D., and Szabo, N. J. (2011). Early adolescent cocaine use as determined by hair analysis in a prenatal cocaine exposure cohort. Neurotoxicology and teratology, 33(1), 88-99.</li>
 	<li>Moeller, K., Kissack, J., Atayee, R., and Lee, K. (2017). <a href="https://www.mayoclinicproceedings.org/article/S0025-6196(16)30825-4/pdf" target="blank" rel="noopener noreferrer">Clinical Interpretation of Urine Drug Tests: What Clinicians Need to Know About Urine Drug Screens</a>. Mayo Clinic Proceedings.</li>
 	<li>Redwood Toxicology Laboratory. <a href="https://www.redwoodtoxicology.com/resources/drug_info/cocaine" target="blank" rel="noopener noreferrer">Cocaine Drug Information</a>.</li>
 	<li>Pennings, E., Leccese, A., and Wolff, F. (2002). <a href="https://pubmed.ncbi.nlm.nih.gov/12133112/" target="blank" rel="noopener noreferrer">Effects of concurrent use of alcohol and cocaine</a>. Addiction, 97(7), 773-783.</li>
 	<li>McCance-Katz, E. et al. (1993). <a href="https://link.springer.com/article/10.1007/BF02257405" target="blank" rel="noopener noreferrer">Concurrent cocaine-ethanol ingestion in humans: pharmacology, physiology, behavior, and the role of cocaethylene</a>. Psychopharmacology, 111(1), 39-46.</li>
 	<li>Laizure, S.C., Mandrell, T., Gades, N., and Parker, R. (2003). <a href="https://dmd.aspetjournals.org/content/31/1/16.short" target="blank" rel="noopener noreferrer">Cocaethylene Metabolism and Interaction with Cocaine and Ethanol: Role of Carboxylesterases</a>. Drug Metabolism and Disposition, 31(1), 16-20.</li>
 	<li>Hedaya, M. and Pan, W.J. (1996). <a href="https://pubmed.ncbi.nlm.nih.gov/8818580/" target="blank" rel="noopener noreferrer">Cocaine and alcohol interactions in naïve and alcohol-pretreated rats</a>. Drug Metabolism and Disposition, 24(7), 807-812.</li>
 	<li>Kim, J. et al. (2015). <a href="https://academic.oup.com/painmedicine/article/16/6/1073/2460555" target="blank" rel="noopener noreferrer">The Clinical Impact of a False-Positive Urine Cocaine Screening Result on a Patient’s Pain Management</a>. Pain Medicine, 16(6), 1073-1076.</li>
 	<li>National Institute on Drug Abuse. (2016). <a href="https://nida.nih.gov/publications/research-reports/cocaine/what-are-long-term-effects-cocaine-use" target="blank" rel="noopener noreferrer">What are the long-term effects of cocaine use?</a></li>
</ol>

¿Cuánto tiempo dura la cocaína en su sistema?

Sophie Stein, MSN, received her master's of science in nursing from Vanderbilt University and has previously worked as an advanced practice registered nurse at an outpatient psychiatric practice.

Sophie Stein, MSN | American Addiction Centers

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Sophie Stein, MSN

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