Dual Diagnosis and Harm Reduction: Practical Support and Resources for People with Co-Occurring Mental Health and Alcohol and Other Drug Issues

In 2015, the North Brisbane Partners in Recovery consortium approached QNADA to undertake a project working with community managed mental health services to improve access to harm reduction resources and specialist AOD treatment services for people with severe and persistent mental illness.

An initial survey of community managed mental health workers identified high levels of willingness to provide harm reduction information to their clients, but low levels of self reported skills in delivering harm reduction information, as well as a reliance on Dr Google for locating harm reduction information.

Additionally, our scoping of resources available online identified that while there is a wealth of harm reduction information available, there was a gap in readily accessible information on potential interactions between licit or illicit drugs and commonly prescribed mental health medications.  So we set out to plug the gap with the help of a psychopharmacologist, an addiction medicine specialist, a social worker and a psychologist.

The psychopharmacologist provided advice on how commonly prescribed mental health medications were understood to work on the brain, as well as some of the more common side effects people experience.

The addiction medicine specialist provided advice on how licit and illicit drugs were understood to work on the brain and the potential physical effects people using them might experience.

We then took this information and sat our experts around a table with a social worker and a psychologist who specialise in supporting people with AOD issues and asked them to think about what they thought people should know about the potential risks associated with mixing mental health meds and licit or illicit drugs and ways to mitigate those risks.

The result is two sets of 66 harm reduction resources, one aimed at people who use drugs and one aimed at the professionals who might be working to support them.  The table below lists the medications and drugs covered in the resources.

Medications Drugs
Selective Serotonin Reuptake Inhibitors (SSRIs) Alcohol
Selective Noradrenaline Reuptake Inhibitors (SNRIs) Nicotine
Tricyclic Antidepressants (TCAs) Stimulants
Monoamine Oxidase Inhibitors (MAOIs) Hallucinogens
Noradrenergic and Specific Serotonergic Antidepressants (NaSSAs) Opioids
Mood Stabilisers Cannabis
Benzodiazepines
Typical Anti-psychotics
Atypical Anti-psychotics
Attention Deficit Hyperactivity Disorder (ADHD) medication
Lithium

 

Each resource is double sided A4 and includes information about the intended impact of the medication, common side effects and a visual representation of how the medication works in the brain on one side.  The other side includes information on the drug, including the good, the bad and the very bad potential effects, as well as information on potential interactions between the medication and the drug.  Each resource also encourages the reader to consult with their GP for more individualised advice.

The resources are available for download at www.qnada.org.au.

This article was kindly provided by Rebecca Lang, who presented at the 2017 Australian & New Zealand Addiction Conference.

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