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• Feeling restless or finding it difficult to relax
• Feeling worried or on edge
• A sense of dread
• Racing thoughts
• Difficulty concentrating or an inability to focus
• Irritability

• Difficulty falling or staying asleep
• Tiredness or fatigue
• A noticeable increase in strength or frequency of heart rate (palpitations) or an irregular heartbeat
• Muscle aches or tension
• Shaking or trembling
• Stomach ache, feeling sick, or loss of appetite
• Excessive sweating
• Shortness of breath

As there is not always a clear cause of the anxiety and because people’s symptoms vary so widely, it can be difficult to diagnose GAD. Your doctor might say that you have GAD if you have felt anxious most days over a period of around six months or may want to refer you to another service who specialise in understanding anxiety and other mental health conditions.

GAD is thought to be one of the more common anxiety disorders, with studies suggesting that around 1 in 50 adults will experience it at some point in their lifetime. As with many mental health conditions, the exact cause of GAD is not currently fully understood.  However, various risk factors may play a part. For example, genetic makeup may make people more likely to have an ‘anxious personality’ which can run in families and may put you at higher risk of developing GAD. Experiencing significant negative events in childhood may make you more prone to anxiety in your adult life. It may also be that a major stress in life could ‘trigger’ anxiety, for example, experiencing a significant health problem or bereavement, but unfortunately, the symptoms can persist after the trigger has gone.

As the symptoms associated with GAD are so uncomfortable and unpleasant, you might try to find ways of reducing the anxiety yourself. However, this might result in you avoiding situations that cause you to feel worry or dread.  It is common for people with GAD to withdraw from socialising, or only doing things in a certain way in order to feel safe. For example, you might withdraw from family and friends, or you might find work to be very stressful and then take some time off sick. Unfortunately, while this may reduce the anxiety in the short term, these actions can make you worry even more and can also lead to low self esteem and loss of regular ways of coping, which can have a negative effect on your emotional well-being in the longer term. For example, sometimes it might be helpful to take some time off work, however, this is not a long-term solution, and you may find it even more difficult to go to work after a long time off.

The most helpful thing that you can do if you think you might be experiencing GAD is to talk to someone about how you are feeling. Your General Practitioner (GP) is a good place to start and they will be used to talking to people experiencing similar symptoms. Your GP should be able to can provide you with information about the various treatment options available for GAD if it is confirmed that this is what you are suffering from. It is important to think about the pros and cons of each of these so that you know what to expect and are aware of any potential risks of side effects.

There are three main types of treatment for GAD:

• Self-help resources
• Talking treatments (psychological therapies)
• Medications.

Self Help Resources

Your GP might direct you to an individual self-help course to help you to learn more about GAD and what you can do to help yourself feel better. This usually involves working from a book or a website with occasional contact with your doctor to monitor your symptoms and progress. Alternatively, you may be offered a place in a group with other people who have similar problems where you can learn how to tackle your anxiety. There are lots of helpful resources available to support you through this process.  For some good examples, please see the links in the ‘find out more’ section of this page.

Talking Treatments (Psychological Therapy)

Often people will try a type of self-help treatment for GAD in the first instance. However, if this approach does not work for you, or does not lead to an improvement in your symptoms, or if your symptoms are more severe, your GP may refer you for something called ‘talking treatment’. Talking treatments are a type of psychological therapy and offer some of the most successful treatment options for GAD. Talking therapy involves working through a process with a trained therapist to help you to understand the causes of your anxiety, and to help you to find strategies to help you to manage your symptoms. There are a number of different talking treatments available; however one of the most effective in treating GAD is Cognitive Behavioural Therapy (CBT).  This approach helps you to understand the connection between your thoughts, your behaviour, and your GAD symptoms. This type of psychological therapy involves meeting with a therapist for around one hour a week over a period of a few months. During talking therapy you will develop strategies to cope which are designed to help you to manage your anxiety symptoms independently in the future. It can be described as adding various tools to a toolbox that you can keep and use later.

Medication

If you prefer not to try talking therapy approaches, or if you continue to struggle with symptoms of anxiety, your GP may offer you some medication.  A variety of different medications are available, however, it is important to discuss your symptoms fully with your doctor so that they can match a medicine to suit your individual needs. If you decide to take medication you will need to see your doctor regularly to assess the impact of the medication. As with all medications, there is the risk of side effects and it is important that you tell your GP if you experience side effects as they may be able to adjust your dose or prescribe an alternative.

The four main types of medication you may be prescribed to help you with your GAD symptoms are:

• Antidepressants – these might help you to feel more calm, and may improve your sleep
• Benzodiazepines – these medications will not deal with the cause of your anxiety, but they can help to reduce your symptoms until you are able to consider other treatment options. They should only be used as a temporary measure as it is possible to become dependent on these medications
• Pregabalin – this type of medication can be used to treat GAD. It is normally used to treat epilepsy but is also licensed to treat anxiety
• Beta-blockers – these medications are used less frequently in GAD as they only treat the physical symptoms of anxiety by reducing your level of physiological arousal. They are often more helpful in treating short-lived anxiety, like phobias. They are short acting which means that you will need to keep taking them, and they will not reduce any of your psychological symptoms like worrying thoughts.

GAD is different from ‘normal worry’ and it can be difficult to live with as the anxiety is prolonged and the level of anxiety can be severe. People with GAD feel anxious much of the time and this can affect your ability to complete day-to-day activities or basic tasks.  Because GAD is not specific to a particular situation or as a result of a particular event, you may feel that there is little respite from it and as though it has taken over, making it difficult to think about anything else. The fact that there is often no clear trigger for the anxiety can mean that GAD is difficult for people to understand and often not knowing what is causing you to feel this way can make you feel worse.  You may think that “things are out of your control”, “there isn’t a solution” or “I might always feel this way”. As a result, GAD can have a major impact on your general well-being, your emotional health, your ability to work, and may also affect your relationships. It is also common to have other conditions, such as depression or other anxiety disorders if you have GAD.

NHS Choices website has more information about anxiety disorders including GAD.

Well-being Services South Glasgow website has lots of information about anxiety and includes a self help booklet & also provides video and audio guided relaxation exercises, which you can also use for free.

MIND is a mental health charity which offers a range of helpful information, guides to support and services, and stories from people who have lived experience of anxiety.

Anxiety UK is a charity with over 40 years of supporting people with anxiety. It offers information as well as telephone, email and text support.

The Centre of Clinical Interventions has workbooks about worry and anxiety that you can work through yourself at your own pace.

It is important to remember that whilst suffering from Generalised Anxiety Disorder your family member or friend is not themselves, and this means that you may need to adjust your expectations and the way you interact with them.  Although you might not understand how they feel, or why they are feeling this way, it is helpful to try to adopt a non-judgemental approach rather than trying to dispel the anxiety with ‘logical’ arguments. There are a number of specific things that you can do which may help a friend or family member when they are suffering from anxiety:

• Try to find out more about anxiety so that you can learn more about the condition yourself. This might help you to be understanding and supportive. Let your friend or family member that you are there to support them, and ask them what you can do to help – they might already have ideas about how you can support them or what they need from you. This might be things such as talking to them calmly about how they are feeling or doing deep, slow breathing exercises with them.
• Stay calm and listen to your family member or friend’s wishes.
• Try not to pressure them – seeing a family member or friend suffer from anxiety can be distressing and make you want to ‘fix’ it for them or find practical solutions. However, it can be very distressing for someone with anxiety to feel under pressure and it could even make them feel more worried.
• Encourage them to seek help from their GP or access self-help resources.  It may be helpful to ask if it would help to accompany them to a GP appointment, or even call to organise one.  
• Look after yourself – it can be stressful supporting someone else and it is important to take care of your own well-being.  This can help you to be in the best position to help someone else.

Further information for carers is available on our NHS Greater Glasgow and Clyde carers site

See Emily’s story about living with anxiety at University  

Hear Alex talk about the physical symptoms of anxiety and the impact they had on him 

Hear Zoe’s story about living with GAD after her Dad passed away 

NHSGG&C BSL A-Z: Mental Health – Anxiety

Anxiety is a feeling that we can all get but sometimes it can become excessive and stop you from doing the things you want to. These feelings can become a problem when they cause distress or make us feel uncomfortable. There are various types of anxiety disorders depending on how often they occur or if they are triggered by certain things. Examples might be when the feelings of anxiety can occur all the time for no apparent reason with lots of worrying thoughts and physical symptoms such as a racing heart, feeling breathless, knot in your stomach, increased sweating. This is called Generalised Anxiety. Sometimes these symptoms can occur without warning for short periods of time for no apparent reason. These are called Panic attacks. Sometimes the feelings of aniety can be brought on by specific things such as a fear of heights or crowded places or spiders etc. These are described as Phobias.

Please note that this video is from a range of BSL videos published by NHS Greater Glasgow & Clyde

• Intense fear of being and/or becoming fat
• Restricting food intake leading to a significantly low body weight for a person’s age, height, gender, developmental trajectory and physical health
• Distorted perception in how their body is viewed (e.g., thinking that they are fat when they are in fact very thin)
• Subtypes: Restricting & Binge/Purge.

• Recurrent episodes of binge eating whereby a large amount of food is eaten over a discrete amount of time in what feels like an out of control manner
• Behaviours to compensate for the binge such as self-induced vomiting; misuse of laxatives and diuretics; over-exercise and fasting or restricting
• This happens at least once a week for 3 months
• The person’s view of themselves is unduly influenced by their body shape and weight.

Recurrent episodes of binge eating whereby a large amount of food is eaten over a discrete amount of time in what feels like an out of control manner.

The episodes of binge eating are not accompanied by compensatory behaviours such as self-induced vomiting or over-exercising.

The episodes are associated with three or more of the following:

• Eating much more quickly than normal
• Eating until they feel uncomfortably full
• Eating a large amount of food even when they don’t feel physically hungry
• Isolating themselves whilst eating due to embarrassment about how much they are eating
• Feeling depressed, guilty and disgusted with themselves after the binge.

This happens at least once a week for 3 months.

OSFED is diagnosed when there are feeding or eating behaviours that cause significant distress and impairment to daily life but that do not meet the full criteria for any other feeding or eating disorder.

OSFED includes;

• Atypical Anorexia Nervosa –all the criteria for anorexia are met but despite significant weight loss, weight remains within or above the normal limit
• Binge Eating Disorder (of low frequency and/or limited duration) –all the criteria for BED are met but the episodes of bingeing occur less than once a week and/or have been occurring for less than 3 months.
• Bulimia Nervosa (of low frequency and/or limited duration) – all the criteria for bulimia are met but occur less than once a week and/or have been occurring for less than 3 months
• Purging Disorder – Occurs in the absence of binge eating and is characterised by recurrent purging behaviour to influence weight or shape
• Night Eating Syndrome – Recurrent episodes of night eating either by excessive food consumption throughout the evening after the main meal or awakening from sleep to eat during the night. This is diagnosed when the behaviour is not better explained by another mental health disorder (for example, BED).

• This diagnosis applies when the behaviours cause significant distress and impairment to day-to-day functioning but do not meet the full criteria of any of the feeding or eating disorders.
• This diagnosis may be given if the clinician does not have enough evidence that the behaviours meet criteria for another feeding or eating disorder.

• Anxiety around food, eating and/or meal times
• Avoiding mealtimes or eating situations
• Counting calories/weighing food
• Sudden avoidance of previously enjoyed foods
• Labelling of foods as “good and bad”
• Significant loss of weight
• Rigid patterns around eating (e.g., eating food in a certain order or cutting food up in a certain way)
• Social isolation and avoidance of social situations involving food
• Signs of binge eating (e.g., food missing from the cupboard or fridge; food wrappers hidden or disposed of secretively)
• Frequent trips to the bathroom after eating (which may be a sign of self-induced vomiting or laxative misuse)
• Feeling faint or actually fainting
• Tiredness and difficulty concentrating
• Swollen cheeks and/or puffy eyes may be a sign of self-induced vomiting
• Periods may become irregular or stop
• Evidence of compulsive exercise (e.g., exercising in bad weather or exercising despite having an injury)
• Feeling and being cold
• Lanugo hair (a fine hair that grows all over the body)
• Wearing loose clothing to hide weight loss
• Frequent fluctuations in weight
• Distorted perception of one’s shape and size
• Intense fear of gaining weight
• Preoccupation with weight, shape and food
• Displays distress at mealtimes
• Low self-esteem; feelings of worthlessness
• High expectations of oneself/attempting to attain ‘perfection’ in life

Accessing appropriate and timely treatment through your GP is an important step towards recovery from your eating disorder. This may involve psychological work to understand where the disorder might have developed from; nutritional education and physical monitoring. Treatment is more effective if the individual themselves is committed to recovery. Having supportive family and friends to lean on during recovery is also invaluable. There are also 3^rd sector organisations such as the UK’s leading eating disorder charity, Beat, who offer telephone support and message boards to those affected by eating disorders. Further details can be found under the Find Out More section of this page.

Referral Pathway

If you are concerned that you or someone that you care for may have an eating disorder, the first point of contact for seeking help would be your GP. The GP can then make a referral to your local Community Mental Health Team (CMHT) as appropriate. For most people, eating disorders can be managed within the CMHT. A CMHT is comprised of psychiatrists; psychologists; community psychiatric nurses (CPNs) and occupational therapists. If your eating disorder is more severe, your CMHT psychiatrist or key worker may choose to make a referral to the Adult Eating Disorder Service (AEDS).

The Greater Glasgow and Clyde Adult Eating Disorder Service (AEDS) is a specialist service offering intensive input for individuals with moderate to severe eating disorders. It also offers support for all professionals working with eating disorders across this area.  AEDS offers a holistic and recovery orientated psychological approach to the treatment and management of eating disorders, supporting individuals and their carers through this difficult journey. The multi-disciplinary team consists of practitioners from various disciplines including psychology, psychiatry, nursing, dietetics, and occupational therapy. These practitioners are trained in a variety of therapeutic interventions.

The AEDS complements the intervention offered by the CMHT, it is able to offer more intensive multidisciplinary input as required across out-patient, day programme, and in-patient.

The AEDS offers training, education, and consultation to other staff and services working alongside people with eating disorders.

Living with an eating disorder is an exhausting and draining experience whereby your daily life is consumed by thoughts of food and weight. You may find yourself thinking about food constantly; for example, you may like baking for others but would never eat what you baked yourself; you may find yourself obsessed by cooking shows; diets in magazines and the weight of celebrities. You will most likely be preoccupied by what you’ve eaten recently and when you will next be eating. Eating is followed by intense feelings of shame, guilt and disgust. The preoccupation with food and weight may become so severe that it stops you being able to function in other areas of your life. This may lead to you needing to take time out from studying and/or work. You may withdraw from your friends socially because you lack the energy to engage with them or because you are fearful that the interaction may involve food. You may become very aware of what others around you are eating and you may feel distressed and/or irritable if you perceive them to be eating less than you. In addition, you may find yourself critically comparing your weight, shape and size with strangers leading to feelings of worthlessness and disgust. It is likely that you will prefer to eat on your own when there is no-one around to watch you.

Often people who have an eating disorder feel as though they don’t deserve nice things unless they weigh X amount or follow a rigid eating pattern without deviating from it. This creates immense amounts of pressure. These expectations are often unrealistic and so when they are not met, they result in the individual feeling like a failure leading to further unrealistic expectations being made.

If you are underweight, you may feel cold, faint, and tired lots of the time. You may find it difficult to concentrate on things like reading a book or watching a television show. If you are female, your periods may become irregular or even stop leading to longer term complications like osteoporosis and fertility issues. Combined, these factors can often lead to depression and/or suicidal ideation because life becomes restricted only by the perceived success of manipulating your weight, shape, size and diet. If you binge eat, this may result in feelings of disgust, shame, and worthlessness. You may also find that your day is preoccupied by when you are next going to binge and planning what you are going to binge on.

• BEAT – Beating Eating Disorders
• Eating Disorders – NHS Choices
• NICE Guidelines on Eating Disorders  
• Centre for Clinical Interventions including Eating Disorders
• Link to online version of the EDE-Q

It can be very difficult to watch someone that you love and care for struggle with an eating disorder. You may feel confused, frightened, or angry with them. It can be very easy to focus on weight and food and believe that if they would ‘just eat’, everything would be OK. It is important to realise that the behaviours you see are your loved ones way of controlling, avoiding, and managing emotional distress. It may help to gently express your concern without becoming overly emotional; listen to your loved one if they want to talk about things and offer them support to seek help from their GP if they choose to do so. Only the person suffering from the eating disorder can make the changes necessary to recover but having supportive family and friends can go a long way in making the journey towards recovery more manageable.

Unhelpful things to say to someone with an eating disorder

• ‘Why don’t you just eat this?’
• ‘Why are you putting me through this?’
• ‘Look at what you’re doing to everyone around you’
• ‘You look like you’ve put on weight’
• ‘You don’t look that thin’
• ‘I’m trying this new diet because I feel so fat’
• ‘It’s not that hard to eat’.

Helpful things to say to someone with an eating disorder

• ‘You’re doing really well, I know how hard this is for you’
• ‘I believe in you’
• ‘I’m here for you’
• ‘If you need someone to talk to, you can always speak to me’
• ‘You’re not alone’
• ‘I can see this is tough for you but I’m proud of you’
• ‘You’re showing lots of strength and determination’.

Caring for someone with an eating disorder can be very draining so it is also very important to look after yourself throughout this process. Make sure to schedule in activities that you enjoy and supportive people you can talk to when things feel overwhelming.

Further information for carers is available on the NHS Greater Glasgow and Clyde carers site

NHSGG&C BSL A-Z: Mental Health – Anorexia Nervosa

A type of eating disorder where the person will restrict the amount of food they take in with a view to losing weight or maintaining a low body weight that is unhealthy. It is frequently associated with an increased pre-occupation with their weight and possibly perceiving themselves as being fat or over-weight even when this might not be the case.

NHSGG&C BSL A-Z: Mental Health – Bulimia Nervosa

A type of eating disorder where a person goes through periods where they eat a lot of food in a very short amount of time (binge eating) and then are deliberately sick, use laxatives (medication to help them poo) or do excessive exercise, or a combination of these, to try to stop themselves gaining weight.

Please note that this video is from a range of BSL videos published by NHS Greater Glasgow & Clyde, and is not a description of the text on this website.

Depression is a very personal experience.  Symptoms can vary from person to person but usually include changes to your: 

• Thoughts (for example feeling worthless or to blame, hopeless and incapable)
• Mood (feeling persistently down, anxious, or numb)
• Behaviour (for example losing interest or pleasure in previously enjoyed activities). 

You may also notice physical changes such as loss of appetite, tiredness, or aches and pains.

Depression can come on gradually so it can be difficult to notice something is wrong. 

Many people continue to cope with their symptoms without realising they are ill. It can take a friend or family member to suggest that something might be wrong. 

The most common symptoms of depression are:  

• Little interest or pleasure in life
• Feeling down, hopeless, numb or empty
• Sleep disturbances. Difficulty falling or staying asleep. Sleeping too much
• Tiredness and lack of energy
• Appetite disturbances. Not eating enough, or overeating
• Feeling bad about yourself. Feeling like a failure, believing that you have let other people down
• Difficulty concentrating on things like reading or watching television
• Moving or speaking much more slowly. Or becoming fidgety or restless
• Thinking about death and dying. Thinking about harming yourself. Wondering if you would be better off dead.

People may find themselves worrying excessively over the smallest things, blaming themselves for everything that goes wrong, and feeling irritated by those around them.

Depression has been described as a “heavyweight” “a state where nothing tastes, smells or feels right” or “being in a world without colour or laughter”. 

Depression can cause bleak and distressing thoughts, including suicidal thinking and planning. With support and treatment, the negative feelings often pass.

If you are unsure whether what you are experiencing is depression, the following questionnaire might help you decide whether you should get help PHQ9.

Anxiety is a feeling of unease, worry, or fear. Everyone feels anxious sometimes, but for others, it can be an ongoing problem. A bit of anxiety can be helpful; for example, anxiety before an exam can keep you alert and improve performance.  Too much anxiety, however, affects focus and concentration. 

Some of the most common symptoms of anxiety are:

• Feeling uneasy a lot of the time
• Having difficulty sleeping, feeling tired
• Poor concentration
• Being irritable
• Being extra alert
• Feeling on edge, not being able to relax
• Needing lots of reassurance from others
• Tearfulness

When you’re anxious or stressed, your body releases stress hormones, such as adrenaline and cortisol. These cause the physical symptoms of anxiety which include:

• A pounding heartbeat
• Breathing faster
• Palpitations (an irregular heartbeat)
• Feeling sick
• Chest pains
• Headaches
• Sweating
• Loss of appetite
• Feeling faint
• Needing the toilet
• “Butterflies” in your stomach.

Anxiety symptoms can happen occasionally or regularly. They may start suddenly or come on gradually. They can be a nuisance or extremely disabling.  Specific anxiety disorders include:

• Panic disorder (when you have panic attacks)
• Post-traumatic stress disorder
• Generalised anxiety disorder
• Social anxiety
• Specific phobias 

Regular exercise can be very effective in lifting mood and increasing energy levels. Exercise can help improve appetite and sleep. The research behind this shows that physical activity stimulates chemicals in the brain called endorphins, which can help you to feel better. Inactivity can cause a vicious circle: the less you do, the less you want to do.  It is also important to eat well. If you aren’t eating regular healthy meals, your body won’t have enough energy, leaving you lethargic and slow.  

Although you may not feel like it, keeping in touch with people can help you feel a bit more grounded and sometimes put things in perspective. Try a short phone call to a close friend or relative, or an email or text.

Try to avoid too much stress, including work-related stress. If you’re employed, you may be able to work shorter hours or work in a more flexible way, particularly if job pressures seem to trigger your symptoms.

Be kind to yourself! Depression and anxiety can make you feel inadequate or worthless. It’s hard to do nice things for yourself when you feel like that. As soon as you feel able, do something enjoyable for yourself or someone else. 

Depression and anxiety can make everyday tasks overwhelming. It can help to break things down into smaller, more manageable steps. Set yourself a goal each day, starting with something small and working up to bigger tasks that you may have been putting off.

When you feel ready, you may find it helpful to do something to help other people, as this may help overcome feelings of isolation, take your mind off your own problems and make you feel better about yourself. The Scottish Recovery Network encourages people to share their personal journeys to recovery. Reading and sharing stories of hope, optimism, and strength can help balance the negativity of depression and can help an individual feel more in control of their own life again.

Learning how to relax and be mindful can also be helpful in your recovery.

Overcoming depression and anxiety can take time but there is treatment available. Most people recover. Understanding yourself helps – learning to recognise your own ‘warning signs’ of how you react under stress, or when things become difficult, is an important part of staying well in the future.

There are times in our lives when many of us will experience feelings of low mood and anxiety.

There is more information about the symptoms of anxiety and panic from NHS Choices.

The Scottish Association for Mental Health offer community-based services for people with mental health problems and has a role in policy development and campaigning on mental health issues.

There is a helpful information sheet if you’re worried about someone you care about or care for who is depressed.

If you’re caring for someone with a mental health difficulty these organisations can offer support:

• Glasgow Association for Mental Health
• MIND

Self Help Resources

There are self-help guides on depression and anxiety available from Get Self Help and Rethink Mental Illness

Depression and anxiety cause feelings of sadness, guilt, despair and hopelessness. Self- esteem and confidence can be badly shaken.

People with depression or anxiety may avoid their friends and relatives rather than ask for help or support. This is often when they need your help and support most.

How do you help someone who may not want your help, or feel they deserve help? You can help by just being there. Showing a real interest in them, not just their problems. Be prepared to listen, and to spend time with them. This can help counter the unpleasant, negative thoughts they will have about themselves.

Someone who is depressed may need a lot of encouragement to get help. You could find out about local support groups, relaxation classes, or self-help literature. You could offer to go with them to a group or doctor’s appointment.

Sometimes it can feel that the person you know and love has changed so much, you find it hard to recognise them. If you have serious concerns about their well-being or think they may be suicidal urgent help is needed. You can call their GP or go to accident and emergency.

Supporting a friend or relative who is depressed or anxious can be an opportunity to build a closer and more satisfying relationship. However, it can be hard work and frustrating. You might feel helpless or annoyed if the person won’t accept your help. Unless you pay attention to your own needs, it can make you feel unwell too. Finding a support group and talking to others in a similar situation might help.

Further information for carers is available on the NHS Greater Glasgow and Clyde carers site.

NHSGG&C BSL A-Z: Mental Health – Depression

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn’t worth living.

NHSGG&C BSL A-Z: Mental Health – Anxiety

Anxiety is a feeling that we can all get but sometimes it can become excessive and stop you from doing the things you want to. These feelings can become a problem when they cause distress or make us feel uncomfortable. There are various types of anxiety disorders depending on how often they occur or if they are triggered by certain things. Examples might be when the feelings of anxiety can occur all the time for no apparent reason with lots of worrying thoughts and physical symptoms such as a racing heart, feeling breathless, knot in your stomach, increased sweating. This is called Generalised Anxiety. Sometimes these symptoms can occur without warning for short periods of time for no apparent reason. These are called Panic attacks. Sometimes the feelings of aniety can be brought on by specific things such as a fear of heights or crowded places or spiders etc. These are described as Phobias.

Please note that this video is from a range of BSL videos published by NHS Greater Glasgow & Clyde.

The assessment of bipolar disorder is complicated and there can be significant delays in individuals receiving a diagnosis due to the complexity involved. Research suggests that it can take on average 6 years for a person to receive a diagnosis after the person first experiences symptoms.

Bipolar experiences are typically initially understood within the context of depression. This is usually due to the fact that depression is the initial mood episode that brings individuals to seek support from mental health services. On the contrary, episodes of hypomania are often experienced as relatively positive by individuals with bipolar symptoms (especially when they occur in the context of recurrent depression) and they are often not raised as a problem during initial encounters with services. In addition, difficulties related to hypomania are often difficult for mental health services to separate from ‘normal’ behaviour or attributed to other potential causes, such as alcohol or substance misuse.

Manic episodes usually begin abruptly and last for between two weeks and four to five months. You might experience some of the following symptoms (though it is unlikely you will experience all of them).

Signs and symptoms of mania:

• Increased energy, activity, and restlessness
• Excessively high, overly good, euphoric mood
• Extreme irritability
• Racing thoughts and talking very fast, jumping from one idea to another
• Distractibility, cannot concentrate well
• Little sleep needed
• Unrealistic beliefs in one’s abilities and powers
• Poor judgement
• Risky behaviour
• Spending sprees
• A lasting period of behaviour that is different from usual
• Increased sex drive
• Abuse of drugs
• Provocative, intrusive, or aggressive behaviour
• Denial that anything is wrong

People with bipolar disorder can experience a milder form of mania known as hypomania (“under mania” or “less than mania”). As the term suggests, the symptoms of hypomania are often less severe and they can resolve after a shorter period of time. However, these episodes can also contribute to the distress experienced by people with bipolar disorder and their families and friends, depending on the circumstances and how they are managed.

Episodes of moderate or severe depression are often more readily recognised by people with bipolar disorder and their families. When people are depressed they can often find it very difficult to manage day-to-day commitments, such as work, relationships, or family events. Depression can make people feel as if they are not worthy of any assistance. This in turn can make it difficult for people to ask for help, which can contribute to further feelings of hopelessness and a sense that things will never get better. When people are feeling very low, they can experience recurrent thoughts that life is not worth living and have thoughts of harming or killing themselves.

If you have had recent thoughts of harming yourself or taking your own life, please see our ‘Urgent Help’ page.

Signs and symptoms of depression

• Lasting sad, anxious, or empty mood
• Feelings of hopelessness or pessimism
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in activities once enjoyed
• Decreased energy, a feeling of fatigue, or being slowed down
• Difficulty concentrating, remembering, or making decisions
• Restlessness or irritability
• Sleeping too much or can’t sleep
• Change in appetite and/or unintended weight loss or gain
• Chronic pain or other persistent bodily symptoms not caused by physical illness or injury
• Thoughts of death or suicide, or suicide attempts

In a ‘Mixed State’, individuals can experience both depression and agitated or elated mood at the same time, with an increase in risk-taking and impulsive ideas as outlined above, occurring at the same time as ideas related to low self-worth and hopelessness about the future. Individuals experiencing a ‘Mixed state’ are in particular, at increased risk of suicide.

Episodes of depression tend to last longer. Like mania or hypomania, episodes of depression often follow stressful life events or other emotional upsets but the presence of such stress is not essential for the diagnosis. It is important to note that depression is very treatable. Please see the link to our depression page for further information. There are particular considerations that are required in the treatment of bipolar depression that you can discuss with your GP or Psychiatrist.

There are ways that you can help you to manage your Bipolar Disorder. Follow the links below to download information about staying well, noting when things are deteriorating and how to cope when not feeling at your best due to your Bipolar Disorder.

It is important to understand that many people are able to self-manage their lifestyle to stay well and to minimise factors that can prevent a Bipolar episode from starting.

Getting help as soon as possible is often key to a speedy recovery, therefore it is vital to be able to identify your early warning signs of a Bipolar Disorder episode.

It is useful to have things to do when you become unwell, and have some general coping strategies in place to lessen the impact of the Bipolar episode.

Should you feel in low mood or depressed there are some depression specific coping strategies, there are also mania specific coping strategies for when your mood is elevated.

Some people are prescribed medication as part of maintaining their well being, or for the treatment of the symptoms experienced as a result of either the low or elevated mood associated with Bipolar Disorder.

Community Mental Health Teams (CMHT) work together with families, carers, and other agencies involved and offer and oversee a range of interventions to help people with Bipolar disorder. In addition to interventions from doctors and psychologists, CMHTs offer input from community psychiatric nurses and occupational therapists. Input offered includes help and support regarding medication, physical health monitoring related to this, advice and direction about mood monitoring and self management, emotional support and coping strategies work, and relapse prevention.

If the information and strategies outlined here are not sufficient for you, it may be that a referral for psychological therapy could be helpful. You can discuss referral for assessment with your GP, Psychiatrist, or key worker within the CMHT.

Psychological therapies (talking therapies) can help people with Bipolar disorder by helping to treat episodes of depression, reduce vulnerability to relapse, and can help people to learn to identify and manage their symptoms of depression and mania early, before they become severe. Our mood states can be driven by our temperaments, the experiences we have in life, and our understandable responses to these experiences. For some people, bipolar disorder is influenced by high ambitions or extreme perfectionistic standards.  For others, they find it difficult to live with the fear and worry about mania or depression returning after they have recovered. For some others, anxiety or previous experience of trauma may impact our mood. An assessment with a clinical psychologist and an individualised understanding of your mood episodes may identify difficulties that could be addressed in psychological therapy.

Helpful rules to follow during a crisis:

• Third party agreement: This refers to an agreement not to make any significant decisions without consulting a third party. The third party is best being your partner or doctor.
• Coping steps: This is a step wise plan of action if you feel you are not coping. It might involve speaking to your partner, making an appointment to see your doctor, beginning your self-monitoring and self-regulation.
• No decisions rule: This is a self-applied rule not to make any decisions without prior consultation.
• Two day delay: This involves agreeing not to do anything for at least two days. If something is a good idea now, it will still be a good idea in 2 days time.

There may well be additional things you have done in the past that are helpful. Try to remember to write them down as reminders:

1.

2.

3.

4.

Bipolar Scotland is a leading service user group for people who experience bipolar disorder. They actively support self-management approaches within their membership and deliver Self-Management Training Courses. They are active across Scotland and it is very likely there is a regular meeting of this group in your local area. Contact details are available on their website for further information. Self management approaches often involve learning to understand individual mood variation, responses to stress and identify ways of dealing with ups and downs of mood that are helpful or unhelpful. In terms of learning about bipolar disorder, Bipolar Scotland’s ‘Bipolar Disorder – The Essential Guide’ is a useful place to start.

Advance Statements 

Occasionally, people who experience symptoms of bipolar disorder require to access acute mental health care services. Advance statements can be used to specify what forms of treatment you would want to have or avoid during such episodes of care. These are particularly important for individuals who are admitted to hospital in situations where they are deemed to have temporarily lost capacity under the terms of Mental Health (Care and Treatment) (Scotland) Act 2000, further information is available in the Your Rights section.

Bipolar Disorder is often a long-term, relapsing/remitting condition. Seeing someone you care for become unwell during a relapse of bipolar can be very distressing.  People who have bipolar disorder usually have a good understanding of their condition. However, during manic episodes, and severe depression, this insight is often lost.

Seeing someone you care for go through a manic episode can be highly distressing for family, friends and carers. They will act out of character and behave in a way that causes distress to those around them.  It may be possible to talk about this when the episode has been treated and the person is well again.

People with bipolar disorder and their families benefit from maintaining an as stress-free family environment as possible. This is equally important when the person with bipolar disorder is doing well in life as a recurrence of depression or mania can be linked to positive, mixed, or negative life events / scenarios impacting on a whole family. Families who develop a sensitive awareness of bipolar disorder and the person’s individual triggers, early warning signs, and preferred responses from family members can have a significant role in supporting the person with bipolar disorder whilst ensuring family members do not become over-whelmed. Practicing communication skills and how to swiftly solve problems / achieve important goals in the family can be very helpful.

Additional Carer information and advice is available from the Meriden Family Programme, MIND, and Bipolar Scotland

It can be exhausting looking after an unwell relative or friend. Try to take some time away from caring, if possible.

You may also find support and understanding from:

• Your own GP
• A local Carers Group
• On-Line Carers Groups

Further information for carers is available on the NHS Greater Glasgow and Clyde carers site  

NHSGG&C BSL A-Z: Mental Health – Bipolar Disorder

Bipolar disorder is a mental health problem that affects your mood. It is characterised by prolonged changes to the person’s mood. These usually last several weeks or months and are far beyond what most of us experience. The person might experience:

• Periods of feeling very low and down
• Periods of feeling excessively happy and energetic for no apparent reason
• Sometimes the person may have unusual experiences, strange thoughts or might behave out of character during these periods.

These episodes would usually affect the persons day to day life and make it difficult for them to function as they normally would.

Please note that this video is from a range of BSL videos published by NHS Greater Glasgow & Clyde.

• Give yourself some time. It is natural to feel sad and distressed following a bereavement
• Be kind to yourself and give yourself some time to heal
• Talking to others and spending time with friends and family can help
• It is important to remember to look after yourself and stick to your normal routines as much as possible including eating regular meals and sleeping
• Try and include regular exercise
• Try to include some enjoyable activities in your life. Do whatever feels manageable in terms of getting out, taking part in hobbies, and socialising. Some people can feel guilty for taking part in enjoyable activities but it is important to look after your own well being
• When you feel ready, find ways to remember the person in your life. You might want to talk about them with others who knew them well and can help you hang onto good memories. Don’t be afraid to keep photos around and it might help to put together a box or album of memories
• You might want to find a way to mark the life of the person who has died.

There is no right or wrong way to feel following bereavement and all these feelings are normal. Feelings can be intense or overwhelming in the early stages and can get in the way of everyday life.

Although bereavement is not something you “get over”, for most people, with time and support the pain becomes gradually easier to live with.

Bereavement is sometimes considered to have four general stages:

• Accepting the loss is real
• Experiencing the pain of grief
• Adjusting to life without the person who has died
• Putting less emotional energy into grieving and putting it into something else or something new.

These stages are just a rough guide. You might not go through all the stages in this order, or find you start to feel better, then go through a period of feeling somewhat worse for a while. Sometimes special occasions such as birthdays, Christmas, or the anniversary of the person’s death can bring difficult feelings to the surface.

Some bereavements can feel more difficult and people can struggle to come to terms with their grief. This can be more common if:

• There is stigma attached to the death (for example suicide or following drug or alcohol addiction)
• The death was unexpected or you thought you would have more time with the person
• The death was with someone you were particularly close to or cared for
• You had a difficult or complicated relationship with the person who has died
• The loss is of a child, including children who pass away before, during, or shortly after birth
• You have other difficulties in your life that are making it hard for you to process the death.

Signs you might need additional support:

• You feel you can’t go on without the person who died or wish you were with them
• The emotions feel intense and out of your control such as crying all the time, feeling anxious and panicky, or getting angry and irritated with other people
• You are neglecting yourself i.e. not eating properly or looking after yourself
• Struggling to get out of bed and do the things you usually do such as work, study, or look after your children.

Initially following a bereavement you might find it difficult to work or lack the energy and motivation to do things. You might find yourself withdrawing from other people to avoid discussing your bereavement or reminders of the person who died. If it has been at least six months, or maybe even years, after the bereavement and you still feel this way, or feel that it is having an impact on your mood you may need additional support to help you process your loss. You can discuss this with your GP, or see the section ‘Further information and support’ below.

You can have a very important role in supporting a friend or family member going through a bereavement. The most important thing you can do is to be available and ready to talk. Grief and loss can feel upsetting to talk about, and sometimes people can shy away from this topic or avoid those who are bereaved for fear of saying the wrong thing. Try to stay in contact and be willing to listen when your friend or family member talks about the person who has died. Remember they are not asking you to solve these problems, often listening is enough. If your family member is distressed or irritable, try not to take this personally.

Remember that birthdays and anniversaries may be a difficult time and they might appreciate extra support at these times.

Also be careful to look after yourself, even if you did not know the person who has died well, it can be emotionally hard to support someone who is grieving.

• Cruse Scotland
• SOBS (Survivors of Bereavement by Suicide)
• Bereavement Through Addiction
• Petal (People who have experienced trauma and loss)
• Child Bereavement Charity (Support for families who have lost a child or children who have experienced a bereavement)
• The Compassionate Friends (Support following the death of a child of any age)
• Sands (Stillbirth and neonatal death charity)
• Miscarriage Association
• Acknowledgement: Peter Cartwright, Bereaved Through Substance Use:Guidelines for those whose work brings them into contact with adults bereaved after a drug or alcohol-related death. University of Bath, 2015. This work was supported by the Economic and Social Research Council [grant number ES/J007366/1]. 

Autism can create significant challenges for people, their families, and friends. 

People with ASD experience problems with social interaction. They may find it difficult to use and to understand non-verbal communication, such as gesture, facial expression and posture, and may find it difficult to use eye contact to regulate interaction. Often, people with ASD tell us that they find it difficult to establish and maintain relationships with other people, or they may find it very difficult to join in with groups of people. Some people with ASD are not particularly motivated to interact with other people. When engaged in social exchanges, people with ASD may find it difficult to know what to say, or how to respond to other people. Difficulties like these can lead to some people feeling anxious about interacting with other people or becoming socially isolated.

Communication can also be an area of difficulty for people with ASD. Some people fail to develop meaningful spoken language. For others, the level of difficulty is subtle. For example, some people may speak very fluently but have a very narrow range of conversational topics, or have difficulties understanding and using abstract or ambiguous language such as metaphors, or sarcasm. Again, for many adults with ASD, these difficulties can make social interaction and communication more challenging. 

The third area of difficulty experienced by people with ASD relates to flexibility of thought and behaviour. People with ASD may experience difficulties because of their level of adherence to repetitive activities or routines. They may find change to routines or planned activities very difficult to accept and tolerate. They may have restricted interests, which can be particularly intense.  Some people may show repetitive motor mannerisms, such as hand-flapping or rocking.

Some people with ASD experience sensory difficulties. They may find it very difficult to tolerate certain types of noise, certain visual stimuli (e.g. bright overhead lighting), or certain smells, tastes or textures.  Exposure to such stimuli can cause people to feel very overwhelmed, and they may struggle to cope in environments where such stimuli are present. They may seek to leave, become distressed and upset or angry, or freeze.

Many people with ASD also describe difficulties with organisation, planning and decision-making. They can find it difficult to attend to activities, or to switch attention between activities.

Taken together, these difficulties can make the demands of everyday life very challenging for people with autism. Some people do learn to negotiate many social situations and social exchanges, but may find the process of doing so exhausting and, at times, overwhelming. 

People with autism can also experience difficulties due to mental health problems. Indeed, there is evidence to suggest that they are more likely than others to experience such problems. This is understandable when we consider the additional challenges they often face in everyday life. People with ASD may experience any type of mental health problem, including anxiety, obsessive compulsive disorder, depression and eating disorders. 

Approximately 30% of people with ASD also have a diagnosis of learning disability. People who have a learning disability in addition to autism are likely to need some support to manage the tasks and activities of everyday living. In most circumstances, adults who have a diagnosis of learning disability will access support, including diagnostic assessment for autism, through local specialist services for people with learning disabilities.

Of course, some people with autism find that their way of viewing the world can be advantageous in some settings. Some people with autism report that their ability to focus intensely on a topic of interest can be very useful. Similarly, there are tasks and activities in which a logical, systematic approach to problem-solving is very valuable. 

ASD is a pervasive disorder and, as such, it usually impacts on multiple aspects of everyday life. There is no cure for ASD, but support and information can help people to manage the condition. The support required varies from person to person according to the difficulties they experience. The difficulties experienced in each domain may also increase or decrease over time, depending on the person’s circumstances.

Understanding the condition can be very beneficial for people with ASD. Knowing why certain situations are stressful and more difficult can help people to prepare for particular experiences or events, and can help them to consider the coping strategies they might employ to manage the situation. Structure and routine can be very useful for people with ASD. Some people find it very helpful to plan their days and weeks carefully. Some people also find it helpful to intersperse periods of social activity with periods of time in which they can be alone, to rest or enjoy an activity they find relaxing. Learning how to recognise and manage stress and anxiety can also be very useful. 

If you have ASD and are experiencing difficulties with anxiety, depression, or other mental health problems, it is important to seek support with these difficulties from within mental health services. There are a number of suggestions for sources of support under the ‘Find out more’ section of this page.

Pathways to diagnosis

If you think that the difficulties you are experiencing might be due to autism spectrum disorder, you should discuss this with your GP. If you are already linked with another mental health service, you could discuss it with professionals in these services too. It can help to consider the following questions before you approach these discussions:

• What difficulties do you experience in social interaction with other people?
• What difficulties do you experience in communicating effectively with other people?
• What difficulties do you experience because of inflexible, or restricted, patterns of behaviour (for example, consider any unusually intense interests, hobbies or routines, or difficulty coping with change)
• Is there evidence of difficulties in these domains in both childhood and adulthood?

You may find this questionnaire, known as the AQ-10, helpful in considering whether the difficulties you experience may be attributable to ASD.

Your GP, or other healthcare professional, will help you to consider whether it would be appropriate to pursue diagnostic assessment. If you are already involved with mental health services, it may be that professionals within these services will be able to offer the diagnostic assessment.  Alternatively, your GP, or mental health professional, may refer you to the NHS GG&C Adult Autism Team for assessment.

The NHSGGC Adult Autism Team works to support adults (over eighteen years old) with an autism spectrum disorder (ASD). The team offers a diagnostic service, and post-diagnostic information and support for people who have received a diagnosis. The team also offers training and support to other services working with people with ASD.

While the diagnosis of ASD may be helpful, if some of the difficulties you experience are due to co-existing mental health problems, it is likely that you will require support to manage these too.

Not everyone who experiences difficulties that may be associated with ASD wants, or needs, to pursue a formal diagnosis.  For some people, gathering information, particularly with regard to strategies for coping and self-management, will be sufficient.

Support after diagnosis

If you have already received a diagnosis of ASD, the NHSGGC Adult Autism Team (AAT) can support you to increase your knowledge and understanding of the condition, and develop strategies for coping with and managing the associated difficulties. This support is usually offered in a group setting. You can ask your GP, or another mental health professional, to refer you to the AAT for this type of support.

If you are already receiving support from a mental health service, this may continue after diagnosis according to your assessed needs.

Other sources of support

Autism is a pervasive condition, which can impact on many aspects of everyday life. As such, an NHS-based service is not always the best service to respond to all difficulties associated with ASD. Some difficulties may be better addressed by social work services, or third-sector organisations. Some suggestions for helpful organisations are provided below. 

Information

• National Autistic Society (Scotland)
• Scottish Autism
• NHS Choices
• Tony Attwood Website 
• Scottish Intercollegiate Guidelines Network (SIGN). Assessment, diagnosis and interventions for autism spectrum disorders.  Edinburgh: SIGN; 2016. (SIGN Publication no. 145). [June 2016]
• National Institute for Health and Care Excellence (NICE) Autism Spectrum Disorder Guidelines

Recommended reading

• ‘The autistic spectrum: a guide for parents and professionals’ by Lorna Wing (ISBN#1841196746)
• ‘Asperger’s syndrome: a guide for parents and professionals’ by Tony Attwood (ISBN#1853025771)
• ‘Autism: the facts’ by Simon Baron-Cohen and Patrick Bolton (ISBN#0192623273)
• ‘Asperger’s and Girls’ Featuring Tony Attwood and Temple Grandin (ISBN#978-1932565409)

Information for carers

Carers provide substantial and regular unpaid care for another person, such as a relative, partner or friend. Supporting an adult who has ASD can be difficult. Often carers know the person with ASD very well and may do many things to support the person and mediate the impact of autism on the person’s everyday life. It is important that carers also seek information and support for themselves when this is required. 

All carers are entitled to a Carer’s Assessment if they choose. This is usually completed by social work services or carer’s organisations. This can help carers consider what their own needs might be in order to continue to provide care. 

Support for carers can come from a variety of sources. Some local authorities may offer carers’ support groups where you may be able to meet other carers, share experiences and suggestions, and find out information about autism. It is important that carers look after their own physical and mental health needs also. 

Further information for carers is available on the NHS Greater Glasgow and Clyde carers site.

Personal Accounts

• ‘Fingers in the Sparkle Jar: A Memoir’ by Chris Packham (ISBN#978-1785033506)
• ‘Look Me in the Eye: My Life with Asperger’s’ by John Elder Robinson (ISBN#978-0091926335)

If you think you have an alcohol or drug problem, there are lots of ways you can seek help. You could see your GP for advice or contact an organisation that specialises in helping people with alcohol and drug problems. There are local treatment services that will see people even if they’re not ready to stop. These services encourage people to talk about their alcohol or drug problems and what help they might be looking for. 

Groups such as Alcoholics Anonymous and Narcotics Anonymous help many people deal with addictive behaviours.

There are many reasons why people can develop an addiction. Addictive behaviour, including using alcohol or drugs, can be a way of trying to forget about problems/worries or block out distressing thoughts or memories. Many people who have become dependent on alcohol or drugs have had traumatic life experiences and might be struggling to deal with the effects of these. Unemployment and poverty can increase the risk of someone developing addictive behaviour, along with stress and emotional or professional pressure. Environmental factors, such as being around other people with addictions, are also thought to increase the risk.

Drugs and alcohol are substances which affect the way you feel, both physically and mentally. These feelings can be enjoyable and create a powerful urge to use the substances again. When there is addictive behaviour, not having the substance causes withdrawal symptoms, or a “come down”. Because this can feel intolerable, it’s easier to carry on using the substance, and so the cycle continues. Often, using these substances gets out of control because you need more and more to satisfy a craving and achieve the “high”.

As addiction problems become more serious, attention is increasingly focused on obtaining and using alcohol or drugs, with a loss of interest in other aspects of life, including recreational activity, friends and family. In the case of using drugs and alcohol, an addiction can also have serious psychological and physical effects.

If you have a problem with drugs, there is a wide range of services that can help. Some of these services are provided by the NHS, and some are specialist drug facilities run by charities and private organisations. If you have a problem with drugs, you have the same entitlement to care as anyone coming to the NHS for help with any other health problem. With the right help and support, it’s possible for you to get drug free and stay that way.

A good place to start may be to visit your GP. Your GP can discuss your concerns with you, assess the nature of your problems, and help you choose the most appropriate treatment. They might offer to treat you or refer you to your local specialist drug service. Many drug treatment services accept self-referrals, so if you’re not comfortable talking to your GP, you might be able to approach your local drug treatment service directly.

You can find information about local drug treatment services on the FRANK website. If you’re having trouble finding the right sort of help, call the Frank drugs helpline on 0300 123 6600. An adviser can talk to you about the different options.

If you are seen at your local drug treatment service, first of all, you will be assessed. If treatment is appropriate for you, you will then be allocated a keyworker. Your keyworker will help you organise the treatment you need and develop a personalised care plan with you, and will be your first point of call throughout your treatment. You’ll see your keyworker for regular one-to-one sessions during your treatment.

Outside the NHS, there are many voluntary sector and private drug and alcohol treatment organisations that can help you. As well as providing residential rehab centres, voluntary organisations also offer various community services. These include structured day programmes, outreach and harm reduction services, counselling services, aftercare, and housing support services. These organisations will usually be linked to NHS services in your area.

Realising you have a problem with alcohol is the first step to making changes to your alcohol use, but it is often the hardest one.  You may need help if: 

• You always feel the need to have a drink.
• You get into trouble because of your drinking.
• Other people warn you about how much you’re drinking. 

A good place to start can be with your GP, and discussing with them how much you drink will help you work out together what support you might need.  Your GP may refer you to a local community alcohol service. You can ask about free local support groups, day-centre counselling and one-to-one counselling.

If your body has become dependent on alcohol, stopping drinking overnight can be life-threatening, so get advice about cutting down gradually. You may be prescribed medication such as chlordiazepoxide, a sedative, to help with alcohol withdrawal symptoms. Alcohol withdrawal symptoms can range from not sleeping, agitation, anxiety, sweating and tremors, right through to vomiting, diarrhoea, hallucinations and seizures.

Cutting down and stopping drinking is often just the beginning, and most people will need some kind of help to stay alcohol-free in the long term. Getting support – beyond family, friends or carers – is crucial to understanding and overcoming the issues that are connected to your drinking.

If you are supporting someone who is using or trying to come off drugs, there are some common issues you’re likely to face. It can be hard to accept that the person was or is taking drugs to begin with, and when the reality sinks in, it can be difficult to know what to do first.

If you want to know where to get help FRANK is a good place to start. They have a 24-hour helpline (0300 123 66 00) and website that provide in-depth information about drugs, and advice about drugs-related services.

Your GP can talk to you about the kinds of treatment options and services available. They should be able to give you information about the effects of the drugs the person you’re caring for has been taking, including the signs of withdrawal. They will also be able to give details of local support groups.

If you are worried that someone you care for is at risk of an overdose with opiates, you may want to know about recognising overdose and knowing what to do in these situations.

You may not see yourself as a carer or someone with needs of their own. But caring for someone using or coming off drugs can be demanding. If you have someone in your household who is unable to stop using drugs, it can be very stressful, upsetting and frustrating.

Even if your loved one accepts that they have a problem and decides to stop taking drugs, you may need to help them get through the withdrawal and recovery period. There may be some difficult, emotional times during this process.

Sometimes the best option for carers is to let their loved ones face the consequences of continuing their drug use. This can be tough as it’s natural to want to rescue someone from the harmful effects of their addiction, such as poverty or ill health.

But there are lots of support organisations that can help you care for someone using or coming off drugs. Carers often find that talking to someone who knows what they’re going through is really helpful. This could be through workshops, one-to-one sessions with a specially trained counsellor, or simply talking to other carers.

Adfam – A national organisation working with and for families affected by drugs and alcohol. It can advise you about financial worries, understanding how to help during different stages of recovery, and coping with difficult behaviour. 

Families Anonymous run local support groups for the family and friends of people with a current, suspected or former drug problem. Helpline number: 0845 1200 660 (calls costs up to 8p per minute, plus your phone company’s access charge per minute)

“The stigma will affect both the alcoholic and the carer,” says Lindon. “It can affect their ability to ask for and get help.”

Further information for carers is available on the NHS Greater Glasgow and Clyde carers site

If you are a carer for someone with an alcohol problem, finding help can be a frustrating experience, and it may be a struggle to get the recognition and support you’re entitled to. “They have not always been perceived as ‘legitimate’ carers,” says Drew Lindon of The Princess Royal Trust for Carers (now the Carers Trust). “But it is clear from the legislation and the National Carers Strategy that people who take care of problem drinkers should be recognised as carers,” he says.

The shame often associated with alcohol problems, as well as difficulty accepting that there is a problem, can be an obstacle to getting help. “The stigma will affect both the alcoholic and the carer,” says Lindon. “It can affect their ability to ask for and get help.”

Being a carer is hard work and, with so much to do, it can be difficult to find quality time for yourself. Staying well and healthy increases your ability to look after someone. But nobody can plan for every eventuality and we all get ill sometimes. Read about carers’ breaks and respite care for advice on getting help with caring for someone and breaks from caring. “Carers for alcoholics need to be seen as partners in care,” says Lindon. “They are an essential part of the care and treatment process. They need and deserve support for themselves. “If carers are not supported and their health suffers, who will support the person they are caring for? The health and social care system would not survive without carers’ support.”

Al-Anon Family Groups offer support to people affected by someone else’s drinking. These groups meet weekly to offer understanding and encouragement, and share their experience of dealing with their common problem.

Adfam Adfam is a UK charity working to improve life for families affected by drugs and alcohol. Email: admin@adfam.org.uk

Further information for carers is available on the NHS Greater Glasgow and Clyde carers site

Scottish Drug Services – An online Directory to help people find information on all drug treatment and rehabilitation services in Scotland.

Crew – A drugs charity based in Edinburgh providing non-judgemental, relevant information, advice and support. You can chat online confidentially or join in the conversation on their forums.

Scottish Drugs Forum – Providing information on drugs and harm reduction, including information about specific drugs.

SMART Recovery (SMART) – A science-based programme to help people manage their recovery from any type of addictive behaviour. This includes addictive behaviour with substances such as alcohol, nicotine or drugs, or compulsive behaviours such as gambling, sex, eating, shopping, self-harming and so on. SMART stands for ‘Self Management And Recovery Training’.

Gambling

Nicotine

Cognitive Behavioural Therapy

The leaflet ‘Alcohol, Drugs and Addiction’ has information to help the carers of people with alcohol and drug problems (substance misuse)

Scottish Families Affected by Alcohol & Drugs (SFAAD) provide information, help and support for families across Scotland who are affected by alcohol or drug misuse and raise awareness of the issues affecting them.

• SFAAD helpline telephone no: 08080 10 10 11 

• Email: helpline@sfad.org.uk 

Family Addiction Support Service (FASS) is a confidential support service for parents, spouses, partners and adult family members affected by or concerned about a loved one’s drug or alcohol use. They offer support, counselling, advice and information.

• FASS telephone no.: 0141 420 2050 Mon to Fri 9am to 4pm

• Email: info@fassglasgow.org

NHSGG&C BSL A-Z: Mental Health – Addictions

Someone has an addiction or addictive behaviour when doing, taking or using something gets out of control to the point where it could be harmful to them.

Alcohol and drug problems are very common. If you use drugs and/or alcohol and they are causing problems in other areas of your life such as your job, relationships, health, finances or emotional well-being, then this may be an issue for you. There are many other common addiction problems such as gambling, and nicotine, and it’s possible to be addicted to just about anything, including: work, internet, sex, shopping.

Please note that this video is from a range of BSL videos published by NHS Greater Glasgow & Clyde.