Drugs and alcohol

Virtually all so-called recreational or illicit drugs have mind-altering properties. After all, that’s why people take them. As such, they all have the potential to bring on DPAFU or make it worse. Cannabis (marijuana) may be used by some people because they find it relaxing. However, in our clinical experience cannabis above all other drugs, and especially the stronger forms (e.g. ‘skunk’) is most likely to cause DPAFU. Some people also find that it makes them anxious and paranoid.

The use of drugs and/or alcohol as a coping strategy may be very appealing for some people. In the short term they can appear useful in blotting out, or numbing, sensations associated with DPAFU. This is especially true when people feel they can’t cope with these sensations. But drugs and alcohol are rarely, if ever, a helpful long-term strategy. On the other hand, many sufferers of DPAFU avoid drugs and/or alcohol altogether. Some people believe that taking illicit drugs, or drinking excessively, led to the onset of their DPAFU (see Jay’s example on page 15). Others notice that even with one or two alcoholic drinks their symptoms or sensations of DPAFU increase. This can worry some people and lead to them avoiding alcohol at all costs. A few people in our clinic have remarked that it is the hangover stage that is particularly bad if you are prone to depersonalization. Abstaining from alcohol shouldn’t be viewed as a problem in its own right, but it can become an issue. Think back to our discussion of safety-seeking behaviors. How does avoidance of alcohol fit with this? If you find yourself turning down invitations to social events because you no longer drink, ask yourself whether you’re using it as an excuse not to go. If you think it may be an issue for you, try re-reading the section on avoidance and safety-seeking behaviors (page 33).

The usual approach when someone actively avoids a given situation because it increases anxiety is to encourage them to face it. In the case of illicit drug use this clearly wouldn’t be appropriate. We don’t advocate illicit activity, and neither do we advocate taking prescription medicine that has not been prescribed for you, nor taking too much of something that has been prescribed.

It’s a bit different for alcohol. Drinking isn’t a criminal activity and is often a big part of social life. But if used to excess it can be extremely harmful and can have far-reaching consequences. You’ll need to exercise judgement in deciding what’s right for you. If you find this difficult to do, you may wish to discuss the issue with friends, family or work colleagues. While specific advice on overcoming drink or drug problems is outside the scope of this book, we strongly advise you to seek professional help if you feel you’re developing a problem with alcohol or drugs.

Other types of treatment Psychological therapies

There are a wide variety of talking therapies and most of them are available on the NHS. They’re usually delivered by either clinical psychologists, counselling psychologists, counsellors or nurses trained as therapists. However, if treatment is on the NHS, there’ll be a waiting list and this may vary between two weeks to over a year. You will need to see your GP to get a referral to the local psychology, psychotherapy or counselling department. The therapy may take place at an outpatient unit within a local hospital, at your GP surgery or at a dedicated unit within the community. You may have a preference for the type of therapy you feel would best match your needs. Alternatively, you may have an assessment and the assessing team will advise on what they think would best suit you. The Department of Health produces a booklet entitled Choosing Talking Therapies? and it’s well worth a read. You can access it from the Department of Health’s website (see the section on Further Information on page 232).

Very briefly, one of the main therapies is counselling, which focuses on your problems in the here and now. You will be encouraged to talk about how you feel. The therapist will tend not to tell you what to do, such as suggesting coping strategies, but will instead allow you the space to explore how you feel and the impact this has on your life. Therapy lasts between 6–12 sessions and isn’t especially intensive. Theoretically, counselling is a person-centred technique, but the counsellor may have a preference for either a more cognitive behavioral approach (and will use strategies similar to those we’ve described in this book) or psychodynamically orientated therapy, where the emphasis is on exploring early relationships and the effect they have on you now. Counsellors should have undertaken a recognized training course and be registered with an appropriate body (such as the British Association for Counselling and Psychotherapy), to whom they are accountable. This is particularly important if you decide to obtain private counselling because it’s not illegal for anyone to call themselves a counsellor!

It is, however, illegal for someone to call themselves a clinical psychologist without the proper training. It takes three years of full-time training, in addition to an undergraduate degree in psychology, to become a clinical psychologist. Training includes a large research project that’s equivalent to a PhD. The British Psychological Society holds a register of people allowed to practise as a clinical psychologist and it also regulates them. However, someone who has completed an undergraduate degree in the subject and has no clinical training may call themselves a psychologist. Again, this is something to be aware of if you look for a therapist privately. If you see a therapist via the NHS, their employers will have checked out their qualifications. By the way, a psychiatrist is a medically qualified specialist in mental health problems. Some psychiatrists have additional qualifications and experience in various therapies, but all will have a working knowledge of psychological treatments and the use of medication. In the UK the main qualification is membership of the Royal College of Psychiatrists (MRCPsych).

Other than CBT, the main therapy offered is either psychodynamic or psychoanalytic psychotherapy. Psychotherapy usually involves exploring the connections between your present feelings and behaviors and past events and early relationships in your life. It aims to provide you with a greater understanding of yourself. Some therapists say very little and are more interpretive and analytical, focusing on the underlying meanings of what you say and do, while others are more interactive and supportive. This form of therapy may last from 16 weeks to several years and may be either one-to-one or in a group. It can be effective for people with long-term difficulties such as relationship problems, low self-esteem, and depression. Some people find this form of treatment difficult because you’ll be expected to talk about potentially painful past experiences without necessarily being given the tools to help you cope. Instead you have to self-manage your emotions during the course of the therapy.

There are other forms of therapy that are well-respected but not always routinely available on the NHS, such as cognitive analytic therapy (CAT). This is a form of psychotherapy that blends the principles of CBT and psychoanalysis. It’s analytical, but it also uses some of the tools and coping strategies of CBT. You may also come across systemic, humanistic, experiential or interpersonal psychotherapy, and art, drama or music therapy groups may also be available. These are all forms of psychotherapy that may be available to you either privately or on the NHS. Each has a distinct theoretical perspective that guides therapy. Because so little research has been conducted into the treatment of DPAFU we’re not in a position to say if any or all of these forms of therapy would be of benefit and so we don’t go into detail about them here. A useful book that describes the variety of talking therapies is Individual Therapy: A Handbook, edited by Windy Dryden.

There are risks associated with all talking therapies. You may well feel worse when you begin to talk about your problems. You may also begin to have difficulties in your relationships as you begin to change as a person. It is not uncommon to experience strong feelings of guilt, shame or anger during therapy, as these may have been previously kept under wraps. This may be particularly true with DPAFU because the main benefit of feeling numb is, of course, that you don’t feel anything. If you begin to deal with all the feelings you have protected yourself from for so long, you may very well feel worse before feeling better. But beware of stopping the therapy before you’ve had a proper chance to see whether it can help you.