I.

Psychotic Disorders
MYTH:
A person with psychotic symptoms is
Psychosis dangerous.
The word psychosis is used to describe conditions that
affect the mind, where there has been some loss of
FACT:
contact with reality through:
People experiencing psychosis may be-
 Hallucination
have strangely, they may hear voices, or
 Delusion
see things that do not exist. They may
 Paranoia
be frightened and confused or with-
drawn. However, it is more likely that
Hallucination these people will harm themselves than
Hallucinations are sensations that appear real but are someone else. It is important to help a
created by your mind. They can affect all five of your person with psychotic symptoms get
senses. For example, you might hear a voice that no treatment as quickly as possible.
one else in the room can hear or see an image that is
not real. These symptoms may be caused by mental illness, the side effects of medications, or physical
illnesses like epilepsy or alcoholism. Hallucinations can be auditory, visual, tactile, olfactory or gustatory.

Example of Tactile Hallucination:

”Kailangan kong lagyan ng plastic and ulo ko dahil may mga insekto at ahas na lumalabas dito kapag
nagagalit ako. Ang kati talaga! Kung minsan, sobrang kati, dumudugo na sa kakakamot ko. “

Example of Auditory Hallucination:

”Ano? Sige, sabihin mo pa yan, sasampalin kita. Hindi totoong prosti-
tute ang nanay ko, ha. Bawiin mo ang sinabi mo. Ngayon din!” (Walang
nakikitang kausap)

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Paranoia
Paranoia involves intense anxious or fearful feelings and thoughts often related to persecution, threat, or
conspiracy. Paranoia occurs in many mental disorders, but is most often present in psychotic disorders.

Example of Paranoia:
“Naku, kailangan kong ikandado lahat ng pinto. Kahapon pa nakaparada yung kotse sa kapitbahay. Sabi
nila, bago daw yon, pero ang totoo, yung CIA at FBI ay sunod ng sunot sa akin. Sabi ko na sa kanila sa
telepathy ko na wala akong kinalaman sa pagkapanalo ni Donald Trump. Pag lumabas ako rito, kikidna-
pin nila ako para manalo ulit si Trump.”

Delusion
A delusion is an odd belief that a person firmly insists is true despite evidence that it is not. Cultural be-
liefs that may seem odd, but are widely accepted do not fit the criteria for being a delusion. Two of the
most common types of delusions are delusions of grandeur or persecutory delusions.

Example of Delusion:
“Kami ni Kumpareng Pope Francis, magbest-friend kami niyan. Ako ang dahilan kung bakit siya ang na-
piling mahal na Papa. Tinelepathy ko yung mga Cardinal para piliin siya. Kung may tanong siya sa akin,
nagtetelepathy kaming dalawa. Malakas ang super powers ko. Minsan nga, nung humatsing ako,
nagkaroon ng malakas na lindol sa Alaska. Kailangan kong mag-ingat kundi, baka maraming mamatay
na tao.”

Most Common Psychotic Disorders

Schizophrenia
 Some people have difficulty determining what is real and what is not.
 Some have described it as being similar to “dreaming while awake”
 Other symptoms cause problems with motivation, concentration, and experiencing enjoyment.

Major Symptoms of Schizophrenia

 Hallucinations— auditory, visual, olfactory, tactile, gustatory
 Delusions — false beliefs
 Thought disorders — confused thinking makes it difficult for the person to focus and stay on topic,
form complete sentences, articulate thoughts in an organized way so that others can understand
 Disorganized behaviour — random behaviors that do not make sense to others
 Catatonic behaviour — person stops movement and is immobile for long periods
 Negative symptoms — lack of energy, motivation, pleasure, or emotional expression
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  Cognitive difficulties
 Decline in social or occupational functioning

Watch:
Why Do People With Schizophrenia See Things (Schizophrenia Explained)
Voices: Living with Schizophrenia

What Does This Say About Filipino MH Seeking Services in the Philippines?

Schizophrenia is not the most common mental illness in the Philippines, but Filipinos only tend to seek
help when the situation is already untenable. Most of what we know about mental illness comes from
what media presents to us of people who have schizophrenia which increases mental health stigma.
However, the most common mental health disorders are mood and anxiety disorders.

Not all people with mental disorders know they are ill, so they do not seek help. People with depression
tend to get labeled as lazy, unmotivated, selfish, shy.

In the US, it takes approximately 10 years before they start seeking MH help, this is why we need to learn
as community members to identify who needs help and then connect them to appropriate help.

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Warning Signs That Psychosis is Developing

Teens who exhibit these signs do not necessarily have a disorder, but it is something to watch out for
that something may not be right. In the US, 75% of people with schizophrenia experience their first epi-
sode between ages 16 to 30. Males and females are affected equally but males tend to develop symp-
toms at a younger age.

Reasons To Be Optimistic
 There are now effective treatments for schizophrenia
 People with schizophrenia can be taught how to manage symptoms
 Increasing knowledge and awareness about schizophrenia helps the person take more control and
contribute to his/her wellness
 People with schizophrenia can lead productive lives (e.g. John Nash, William Chester Minor, Vaslav
Nijinski)

Bipolar Disorder
It is a mental illness that affects many people. It is sometimes called manic depression. Bipolar disorder
causes symptoms that can interfere with many aspects of people’s lives. Some symptoms cause se-
vere mood swings, from the highest of highs (mania) to the lowest of the lows (depression). Other
symptoms of bipolar disorder can make it difficult to know what is real and what is not real (psychotic
symptoms).

Symptoms of Bipolar Disorder: Mania

 Feeling extremely happy or excited
 Feeling irritable
 Feeling unrealistically self-confident
 Sleeping less
 Talking a lot
 Having racing thoughts

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  Being easily distracted
 Being extremely active
 Having faulty judgement
 Risky behaviors

Symptoms of Bipolar Disorder: Depression

 Being in a sad mood
 Eating too little or too much
 Sleeping too little or too much
 Feeling tired / low energy
 Feeling helpless, hopeless, worthless
 Feeling guilty for things that are not your fault
 Having suicidal thoughts and behaviors
 Having trouble concentrating and making decisions

Symptoms of Bipolar Disorder: Psychosis

 Hallucination – hearing seeing, feeling, or smelling something that is not actually present.
 Delusions- very unusual or unrealistic beliefs that are not shared by others in your culture or
religion.
 Confused thinking – thought disorder

Substance-Induced Psychosis
Symptoms of psychosis because of substance or alcohol:
 Hallucination – hearing seeing, feeling, or smelling something that is not actually present.
 Delusions — very unusual or unrealistic beliefs that are not shared by others in your culture or
religion.
 Disorganized thinking

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Once you notice the mentioned warning signs or symptoms, the next step is to ask whether the person
under observation needs:

Sometimes, the person does not have insight into their condition. You can assist by doing the following:
 Talk to the person privately and be ready to listen.
 Just tell the person that you care and want to help.
 Talk about specific behaviors that are concerning to you
 Ask if they hear voices or see things others do not, and allow them to talk about their experiences
 Tell them there are treatments available, and can point them to the right direction if they want.
 Tell them you are available to talk in the future, and assure them that you are willing to help.

Treatments and Supports

 Medication
 Psychological treatments, such as counseling, cognitive behavioral therapy, and interpersonal
psychotherapy
 Support groups
 Complementary treatments lifestyle changes, such as relaxation and stress management, herbal
remedies, alternative therapies, dietary changes

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Medical/Mental Health Professionals
 Medical doctor
 Psychiatrist
 Nurse/Nurse practitioner
 Mental health professional
 Social workers
 Therapists

II. Mood Disorders

A person with a mood disorder is unable to regulate emotions which can cause social, occupational, aca-
demic impairments. Mood disorders include several different diagnoses—the most common are bipolar
disorder and major depression. A diagnosis of a mood disorder is based on a combination of different
symptoms, their severity, and how long the have been present. Symptoms that occur only when a person
has used alcohol or drugs are not included.

Most Common Mood Disorders

 Major depressive disorder
 Bipolar disorder
 Seasonal affective disorder (SAD)
 Post partum depression

Depression
 One of the most common psychiatric disorders– 15 to 20 percent will experience a period of
serious depression at some point in their lives.
 Depression causes people to have extremely low moods when they feel very sad or “blue”. It can
also cause problems with appetite, sleeping, and energy levels. For some people, depression can
seriously interfere with their work and social lives
 Persistent feelings of sadness and worthlessness and a lack of desire to engage in formerly
pleasurable activities.
 A complex mind/body illness, depression can be treated with drugs and/or therapy.
 It can even be misconstrued as “batugan”
 •Symptoms have persisted for at least 2 weeks.

Watch:
Its name is depression (Spoken Word Poetry)
This Is What It Feels Like To Be Depressed

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Physical Signs and Symptoms of Depression
 Fatigue  Weight loss or gain
 Lack of energy  Headaches
 Sleeping too much or too little  Irregular menstrual cycle
 Overeating or loss of appetite  Loss of sexual desire
 Constipation  Unexplained aches and pains

Behavioral Signs of Depression

 Crying spells  Loss of motivation
 Withdrawal from others  Slow movement
 Neglect of responsibilities  Use of drugs and alcohol
 Loss of interest in personal appearance

Psychological Symptoms of Depression

 Sadness  Frequent self-criticism
 Anxiety  Self-blame
 Guilt  Pessimism
 Anger  Impaired memory and concentration
 Mood swings  Indecisiveness and confusion
 Lack of emotional responsiveness  Tendency to believe others see one in a
 Feelings of helplessness negative light

 Hopelessness  Thoughts of death and suicide

 Irritability

Impact of Depression

High risk of suicide

are those with:

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Who is at High Risk for Depression?
 People going through stress
 Loss of friend or loved one
 Being victim of abuse or violence
 People at transition points (Lifestyle, Body, Social roles, Value to others)
 The elderlies have no structure after retirement, are forgotten, have more illnesses,
lost friendship systems
 Children without stable homes do not have the sympathetic nest to take care of them that buff-
ers against the strife in life.
 Adolescents are vulnerable to depression due to hormonal changes. They are leaving child-
hood and starting to think about what lies ahead.

Why are Women More Vulnerable to Depression?

There are no definite answers, but it could be due to:
 Social role
 Overwork
 Hormones
 A disempowered status
 Learned helplessness
 A biological marker

Once you notice the warning signs or symptoms of depression, the next step is to ask whether the
person under observation needs:

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III. Anxiety Disorders
 Anxiety disorder is different from daily stress and worry. Its symptoms are more pervasive, con-
stant, and more severe
 Symptoms of anxiety when untreated affects a person’s ability to care for self, work, and sustain
relationships.

Behavioral Warning Signs of Anxiety

 Isolation
 Discomfort in social situations
 Phobia
 Obsessing about thoughts or things
 Giving into compulsions

Psychological Warning Signs of Anxiety

 Racing thoughts  Lack of sleep

 Forgetfulness  Nightmares
 Anger/irritation/annoyance  Unreasonable fear/worry
 Confusion  Indecisiveness
 Nervousness
 Feeling tired

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Physical Warning Signs of Anxiety

 Stomach ache, nausea, vomiting, diarrhea,  Headache, sweating, numbness, dizziness,

dry mouth tingling
 Shortness of breath, feeling of environment  Muscle aches, shaking, unable to relax
closing in, blurred vision  Racing heart/ chest pains

Who is At Risk of Anxiety Disorders?

 Those who have no control of their own envi-  People who have depression
ronment  People who have chronic medical and mental
 Personality who is more prone to worry condition
 People who have ongoing stress in their lives  People adjusting to life events (marriage, di-
 Children who have been exposed to conflict vorce, new school, etc.)

 Those who have experienced a traumatic  Hormones/chemical imbalance

event  Those using alcohol and substances

Different Types of Anxiety Disorders

 Generalized Anxiety Disorder (GAD)
 Phobias
 Post traumatic stress disorder
 Panic disorder
 Obsessive-compulsive disorder
 Social anxiety disorder

Generalized Anxiety Disorder

 People with generalized anxiety disorder (GAD) feel extremely worried or feel nervous about daily
worries and other things—even when there is little or no reason to worry about them.
 People with GAD find it difficult to control their anxiety and stay focused on daily tasks.
 It is severe and persistent that it affects:
 Work/school – performance,
A healthy lifestyle can also help combat anxi-
 finances,
ety. Make sure to get enough sleep and exer-
 Relationships
cise, eat a healthy diet, and turn to family and
 Ability to self care
friends who you trust for support.

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Obsessive Compulsive Disorder
Obsessive-Compulsive Disorder (OCD) is a common, chronic and long-lasting disorder in which a person
has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels
the urge to repeat over and over.

“Getting dressed in the morning was tough because I had to follow my routine or I would
become very anxious and start getting dressed all over again. I always worried that if I didn’t
follow my routine, my parents were going to die. These thoughts triggered more anxiety and
more rituals. Because of the time I spent on rituals, I was unable to do a lot of things that
were important to me. I couldn’t seem to overcome them until I got treatment.”

it is normal to worry about some things like locking doors, turning off the stove, etc. However, when
it starts interfering with social life, self care, work, it is concerning and needs professional help.

Signs and Symptoms

People with OCD may have obsessions, compulsions, or both. Some people with OCD also have a tic dis-
order. Motor tics are sudden, brief, repetitive movements, such as eye blinking, facial grimacing, shoulder
shrugging, or head or shoulder jerking. Common vocal tics include repetitive throat-clearing, sniffing, or
grunting sounds.

Obsessions May Include

 Fear of germs or contamination
 Fear of losing or misplacing something
 Worries about harm coming towards oneself or others
 Unwanted and taboo thoughts involving sex, religion, or others
 Having things symmetrical or in perfect order

Compulsions May Include

 Excessively cleaning or washing a body part
 Keeping or hoarding unnecessary objects
 Ordering or arranging items in a particular, precise way
 Repeatedly checking on things, such as making sure that the door is locked or the oven is off
 Repeatedly counting items
 Constantly seeking reassurance

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Treatment
 CBT Cognitive Behavioral Therapy
 Exposure and Response Prevention (EX/RP)
 Medication

Post-Traumatic Stress Disorder

 PTSD is a disorder that develops in some people who have experienced a shocking, scary, or dan-
gerous event.
 It is natural to feel afraid during and after a traumatic situation. Fear triggers many split-second
changes in the body to help defend against danger or to avoid it. This “fight-or-flight” response is a
typical reaction meant to protect a person from harm. Nearly everyone will experience a range of
reactions after trauma, yet most people recover from initial symptoms naturally.
 Those who continue to experience problems for more than 1 month may be diagnosed with PTSD.
People who have PTSD may feel stressed or frightened even when they are not in danger.

Watch:
Brain Model of PTSD — Psychoeducation Video
The Limbic Brain And Its Role in Trauma

PTSD — Re-experiencing Symptoms

 Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or
sweating
 Bad dreams
 Frightening thoughts
 Re-experiencing symptoms may cause problems in a person’s everyday routine. The symptoms
can start from the person’s own thoughts and feelings. Words, objects, or situations that are re-
minders of the event can also trigger re-experiencing symptoms.

PTSD — Avoidance Symptoms

 Staying away from places, events, or objects that are reminders of the traumatic experience
 Avoiding thoughts or feelings related to the traumatic event
 Things that remind a person of the traumatic event can trigger avoidance symptoms. These symp-
toms may cause a person to change his or her personal routine.
 For example, after a bad car accident, a person who usually drives may avoid driving or riding in a
car.

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PTSD — Arousal and Reactivity Symptoms
 Being easily startled
 Feeling tense or “on edge”
 Having difficulty sleeping
 Having angry outbursts
 Arousal symptoms are usually constant, instead of being triggered by things that remind one of the
traumatic events. These symptoms can make the person feel stressed and angry. They may make
it hard to do daily tasks, such as sleeping, eating, or concentrating.

PTSD — Mood and Cognition Symptoms

 Trouble remembering key features of the traumatic event
 Negative thoughts about oneself or the world
 Distorted feelings like guilt or blame
 Loss of interest in enjoyable activities
 Cognition and mood symptoms can begin or worsen after the traumatic event, but are not due to
injury or substance use. These symptoms can make the person feel alienated or detached from
friends or family members.

PTSD — Signs in Children and Adolescents

 Children and teens can have extreme reactions to trauma, but their symptoms may not be the same
as adults. In very young children (less than 6 years of age), these symptoms can include:
 Wetting the bed after having learned to use the toilet
 Forgetting how to or being unable to talk
 Acting out the scary event during playtime
 Being unusually clingy with a parent or other adult
 Older children and teens are more likely to show symptoms similar to those seen in adults. They
may also develop disruptive, disrespectful, or destructive behaviors. Older children and teens may
feel guilty for not preventing injury or deaths. They may also have thoughts of revenge.

Risk Factors for PTSD

 Living through dangerous events and traumas
 Getting hurt
 Seeing another person hurt, or seeing a dead body
 Childhood trauma
 Feeling horror, helplessness, or extreme fear
 Having little or no social support after the event

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  Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a
job or home
 Having a history of mental illness or substance abuse

Resilience Factors to PTSD (Gabay)

 Seeking out support from other people, such as friends and family
 Finding a support group after a traumatic event
 Learning to feel good about one’s own actions in the face of danger
 Having a positive coping strategy, or a way of getting through the bad event and learning from it
 Being able to act and respond effectively despite feeling fear

Disaster Situations

Prepare:
 Be informed about what has happened and be aware about safe and unsafe zones.
 Be prepared and informed about emergency measures and resources. You need to know where
provisions are for
–Medical help
–Basic needs: shelter, food, clothing, clean water
 Do not get in the way of emergency response teams. If you are asked to help by these organiza-
tions, comply and stick to your role.

Psychological First Aid: Look

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Psychological First Aid: Listen

Psychological First Aid: Link

 Help people address basic needs and access services.
 Help people cope with problems.
 Give information.
 Connect people with loved ones and social support.

Frequent Needs:
»» Basic needs, such as shelter, food, and water and sanitation.
»» Health services for injuries or help with chronic (long-term) medical conditions.
»» Understandable and correct information about the event, loved ones and available services.
»» Being able to contact loved ones, friends and other social supports.
»» Access to specific support related to one’s culture or religion.
»» Being consulted and involved in important decisions.

Panic Disorder
Marked by one or two behaviors over a period of 1 month:
–Continual and marked fear of having panic attacks in the future
–Shift in a person’s behavior designed to avoid the attacks

What are panic attacks?

 A panic attack is the abrupt onset of intense fear or discomfort that reaches a peak within minutes
and includes at least four of the following symptoms :

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  Palpitations,
 Pounding heart, or accelerated heart rate
 Sweating
 Trembling or shaking
 Sensations of shortness of breath or smothering
 “Feels like a heart attack”
 “I feel like I’m going crazy”

 These attacks are a symptom of panic disorder, a type of anxiety disorder that affects some 2.4
million U.S. adults. The disorder most often begins during the late teens and early adulthood and
strikes twice as many American women as men. No one knows what causes panic disorder, though
researchers suspect a combination of biological and environmental factors, including family histo-
ry (panic disorder seems to run in families), stressful life events, drug and alcohol abuse, and think-
ing patterns that exaggerate normal physical reactions.
 Generally, a panic attack leaves the sufferer looking as if they had just been sprinting.

When Panic Attacks Impair Work, Self-care, Relationships

 Over time, many who suffer panic attacks develop an on-going fear of having another attack. This
fear can severely hamper daily activities and overall quality of life. Some people refuse to leave
their houses or to put themselves in situations that remind them of their previous at-
tacks. Agoraphobia (a fear of being outside of known and safe surroundings) or other mental prob-
lems may follow.
 For this very reason, Rothbaum says, panic attacks are doubly frightening. "Because there is no re-
al danger that provokes them, these episodes can happen anytime, anywhere"-including while
walking down the street, dining out with a group of friends, grocery shopping-even sleeping, ac-
cording to the National Institute of Mental Health.

Crisis for Untreated Anxiety Disorders

Left untreated and unresolved, anxiety can result to:
–Suicidal thoughts
–Suicidal behaviors
–Non-suicidal self injury
–Panic attack

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Once a participant notices the warning signs or symptoms of Anxiety/PTSD/OCD/Social phobia, the next
step is to ask whether the person under observation needs:

Refer To Professional When The Person Has Been Feeling The Following For At Least One Month
 Anticipatory anxiety is when you feel anxious and tense in between panic attacks instead of getting
back to your normal routine. This fear is almost always present, and when left untreated, it can be
debilitating.
 Phobic avoidance occurs when you avoid the environment where the attack occurred or the situa-
tions that you feel caused the attack. In your mind, avoiding these places and situations will pre-
vent future panic attacks. You may also avoid places that you feel would provide you with limited
escape routes. When phobic avoidance is taken to its extreme, you could develop a fear of going
into any open or public spaces. This is known as agoraphobia, which often develops as a compli-
cation of panic attacks.

Helping Someone With A Panic Attack

 Stay with the person and keep calm. Ask the person to sit if possible
 Offer medicine if the person usually takes it during an attack.
 Don't make assumptions about what the person needs. Ask.
 Speak to the person in short, simple, coping and assuring sentences
 Be predictable. ...
 Help slow the person's breathing by breathing with him or her or by counting slowly to 10.

Watch: The Do's of Assisting With Panic Attacks

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Healthy Ways of Coping
 Avoiding alcohol and other drugs
 Spending time with loved ones and trusted friends who are supportive
 Trying to maintain normal routines for meals
 Exercise
 Sleep
 In general, staying active is a good way to cope with stressful feelings

IV. Alcohol and Substance Use Disorders

Behavioral Signs and Symptoms of Alcohol and Substance Use
 Drop in attendance and performance at work or school
 Frequently getting into trouble (fights, accidents, illegal activities)
 Using substances in physically hazardous situations such as while driving or operating a machine
 Engaging in secretive or suspicious behaviors
 Changes in appetite or sleep patterns
 Unexplained change in personality or attitude
 Sudden mood swings, irritability, or angry outbursts
 Periods of unusual hyperactivity, agitation, or giddiness
 Lacking of motivation
 Appearing fearful, anxious, or paranoid, with no reason

Physical Signs and Symptoms of Alcohol and Substance Use

 Bloodshot eyes and abnormally sized pupils
 Sudden weight loss or weight gain
 Deterioration of physical appearance
 Unusual smells on breath, body, or clothing
 Tremors, slurred speech, or impaired coordination

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Social Signs and Symptoms of Alcohol and Substance Use
 Sudden change in friends, favorite hangouts, and hobbies
 Legal problems related to substance use
 Unexplained need for money or financial problems
 Using substances even though it causes problems in relationships
 Involvement in criminal justice system to support substance use

Protective Factors
 Strong and positive family bonds
 Parental monitoring of children's activities and peers
 Clear rules of conduct that are consistently enforced within the family
 Involvement of parents in the lives of their children
 Success in school performance; strong bonds with institutions, such as school and religious or-
ganizations and
 Adoption of conventional norms about drug use

Risk Factors
 Chaotic home environments, particularly in which parents abuse substances or suffer from mental
illnesses
 Ineffective parenting, especially with children with difficult temperaments or conduct disorders
 Lack of parent-child attachments and nurturing
 Inappropriately shy or aggressive behavior in the classroom
 Failure in school performance
 Poor social coping skills
 Affiliations with peers displaying deviant behaviors
 Perceptions of approval of drug-using behaviors in family, work, school, peer, and community envi-
ronments

Co-occurring with Other Mental Illnesses

 Certain illegal drugs can cause people with an addiction to experience one or more symptoms of a
mental health problem
 Mental health problems can sometimes lead to alcohol or drug use, as some people with a mental
health problem may misuse these substances as a form of self-medication
 Mental and substance use disorders share some underlying causes, including changes in brain
composition, genetic vulnerabilities, and early exposure to stress or trauma

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  More than one in four adults living with serious mental health problems also has a substance use
problem. Substance use problems occur more frequently with certain mental health problems, in-
cluding: Depression, Anxiety Disorders, Schizophrenia

Crisis for Alcohol and Substance Use

 Suicide
 Risky behaviors
 Overdose
 Alcohol poisoning
 Aggressive behaviour

Once a participant notices the warning signs or symptoms of alcohol and substance abuse, the next step
is to ask whether the person under observation needs:

Seek immediate help if:

Risky behaviors due to substance or alcohol
 Aggressive behavior
 Homicidal or suicidal intent due to alcohol/substance use
 Alcohol poisoning/delirium tremens (hallucination/confusion)
 Unonscious, unresponsive, shallow and irregular breathing
 Blue / pale skin
 Seizure/ foaming at the mouth

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Screener for Alcohol/Substance (CAGE Screening)
 Has anyone annoyed you or gotten on your nervesby
telling you to cut down or stop (drinking/ using substance)?
 Have you felt you should cut down or stop (dinking/
Any “yes” may indicate
using substance)?
a problem
 Have you felt guilty or bad about how much you (drink/ use
substance)?
 Have you been waking up wanting to (drink/ use substance)?

Start Having a Conversation

 The person may not be ready to talk or change, but reassure the person that you are willing to help
 Listen without judgement or criticizing
 Use I statements
 Gently inform the person what you have observed without criticizing.

Suggest or Recommend
 Self help books
 Support groups
 Increase social/family support

TAG: Module 2. Most Common Mental Health Disorders 22