What questions are people asking about mental health? Quora posts indicate that misconceptions and myths related to mental illness and addiction prevail. Read the top 40 most unsettling questions on Quora.com.
I turned to Quora (an online platform for asking questions) to see what people today are asking about mental illness. What I found ranged from thought-provoking to comical to disturbing, illustrating how common misconceptions are. Here are some of the worst comments and questions I came across:
10. “Instead of ‘rescuing’ drug addicts who have overdosed, wouldn’t society as a whole benefit from just letting nature take its course?” (If that was the case, shouldn’t we then withhold all types of medical treatment and preventative or life-saving measures… to allow nature to take its course?)
11. “Is there any country in the world that won in the war against drugs by killing the users or the drug addicts?”
12. “Why should we lament drug addicted celebrities dying of drug-related causes? It’s their fault for starting a drug habit.”
16. “Don’t you think it’s time we stop spreading the myth that alcoholism is a disease? You can’t catch it from anyone. One chooses to drink alcohol.”
17. “Why do people who are oppressed/abused never defend themselves and have pride?”
18. “Why don’t I have empathy for people who end up in abusive or unhealthy relationships? I feel that they deserve it for being such a poor judge of character.”
19. “Why do most women put up with domestic violence?” (Most women?? “Put up”??)
20. “Are schizophrenics aware they’re crazy?”
21. “Are schizophrenic people allowed to drive?”
22. “Do people who become schizophrenic become that way because they are morally conflicted?”
23. “Are schizophrenics able to learn?”
24. “Can a schizophrenic be coherent enough to answer a question like ‘What is life like with schizophrenia?’ on Quora?”
25. “Can one ‘catch’ schizophrenia by hanging out too long with schizophrenics?”
26. “Can schizophrenics have normal sex?” (Yes, or kinky, whichever they prefer)
27. “Why do people ignore the positive impact spanking has on raising children?” (See #28)
28. “Is being spoiled as a child a cause of mental illness such as depression?” (No, but spanking is linked to mental disorders and addiction in adulthood.)
29. “Should mentally ill people be allowed to reproduce?”
30. “Should people with mental illness be allowed to vote?”
31. “Are we breeding weakness into the gene pool by treating and allowing people with physical and mental illnesses to procreate?”
32. “Why are we allowing mental illnesses of sexual orientation disturbance and gender identity disorder that were changed for political reasons, to be accepted like race?”
33. “Why do some people with mental illness refuse to work and live off the government when they are perfectly capable of working?”
34. “Why are mentally disturbed women allowed to have children?”
35. “I feel no sympathy for the homeless because I feel like it is their own fault. Are there examples of seemingly “normal” and respectable people becoming homeless?”
36. “How is poverty not a choice? At what point does an individual stop blaming their parents/society/the government and take responsibility for their own life?” (White privilege at its finest)
37. “Why are mental disorders so common nowadays? Is it just an “excuse” to do bad or selfish things?”
38. “Are most ‘crazy’ people really just suffering from a low IQ?”
39. “Why do some people have sympathy for those who commit suicide? It is very cowardly and selfish to take your life.”
40. “Is suicide part of the world’s survival of the fittest theory?”
(Updated 4/9/23) The following list is comprised of links to over 500 free printable workbooks, manuals, toolkits, and guides that are published online and are free to use with clients and/or for self-help purposes. Some of the manuals, including Individual Resiliency Training and Cognitive Behavioural Therapy for Psychotic Symptoms, are evidence-based.
Free Printable Workbooks, Manuals, & Self-Help Guides for Mental Health Professionals & Consumers
Disclaimer: Links are provided for informational and educational purposes. I recommend reviewing each resource before using for updated copyright protections that may have changed since it was posted here. When in doubt, contact the author(s).
Substance Use Disorders & Addiction
Free printable workbooks, manuals, toolkits/self-help guides for substance and behavioral (i.e., food, gambling, etc.) addictions and recovery
Other great places to look for free printable workbooks and resources for addiction include education/advocacy and professional membership organization sites. (Refer to the Resource Links page on this site for an extensive list.)
💜 = Resource for Veterans 🏳️🌈 = LGBTQ+ Resource
12 Step Workbook | (A list of free printable workbooks by Al Kohalek)
The MISSION-VET Consumer Workbook | (Printable workbook) Source: David A. Smelson, PsyD, Leon Sawh, MPH, Stephanie Rodrigues, PhD, Emily Clark Muñoz, Alan Marzilli, JD, Julia Tripp, & Douglas Ziedons, MD, MPH, U.S. Department of Veterans Affairs, 183 pages
Free printable workbooks and other resources for anxiety (generalized, social phobia/anxiety, panic attacks), depressive and bipolar disorders, and prenatal/postpartum anxiety and depression
Self-Help Guide (For survivors of rape or sexual abuse who want to understand and process their own personal reactions to their experience) | Source: Somerset & Avon, 36 pages
Acceptance and Commitment Therapy Anger Group | Source: Megan M. Foret, PsyD & Patricia Eaton, PsyD, Kaiser Permanent Department of Psychiatry, Vallejo Medical Center, 72 pages (2014)
Anger Management: Client Handbook Series | Source: Carleton University, Criminal Justice Decision Making Laboratory & Ontario Ministry of Community Safety and Correctional Services, 13 pages (2015)
Breakup Recovery Kit | (Printable workbook) Source: Christina Bell, 24 pages (2017) (Additional downloads from Christina Bell here)
Bridging Differences Playbook | (Printable guide for learning research-based strategies to promote positive dialogue and understanding) Source: Greater Good Science Center, 49 pages
Free printable workbooks, manuals, and guides for diet, physical activity, and health
Basic Nutrition | (Printable workbook) Source: Nutrition Services Section/Nutrition Education/Clinic Services Unit/Texas Department of State Health Services, 46 pages (2012)
Nutrition and Exercise for Wellness and Recovery Leader Manual (42 pages) and Participant Manual (70 pages) | Source: Center on Integrated Health Care and Self-Directed Recovery
Cognitive Behavioral Therapy Strategies | Source: KRISTI L. CRANE, PSYD & KRISTY M. WATTERS, PSYD, VA South Central Mental Illness Research, Education and Clinical Center (MIRECC), 103 pages
This article is inspired, in part, by an ignorant (not ill-intended) meme posted by a healthcare worker on social media.
The meme said,
“So if a kid has an allergic reaction the parents have to pay a ridiculous price for an Epi pen. But a junkie who has OD’d for their 15th time gets Narcan for free? What a screwed up world we live in.”
Implication: A “junkie” doesn’t deserve a second chance at life. (#JunkieLivesDontMatter) They’re a waste of resources because they lack the willpower to stop using. A person with a substance use disorder is choosing that life. Why interfere? (Especially when all that money could be spent saving more deserving lives.)
If you believe it is screwed up for a “junkie” to have a chance at life (and recovery) because they “chose addiction,” your opinion is contrary to the National Institute of Health, the American Medical Association, the American Psychiatric Association, and decades of scientific research. You’re also a part of the movement: #JunkieLivesDontMatter
Many have joined the movement, as evidenced by the following social media posts:
“Out of all of the houses, 2 hobos decided to overdose on my front steps… thank god the medics got here in time to ensure they could die another day…”
“I think we had less ODs before Narcan came on board. They realize they can be saved if gotten to in time. Maybe they need to be locked up & not let out until they attend rehab while in jail.”
“If it can be easily established that they have a recent history of drug [abuse]… then yes… withhold the lifesaving drug because they chose this. It’s harsh, but justice is not served by saving them.”
“If you don’t have it figured [out] by the 3rd overdose, you are just prolonging the inevitable and wasting tax payers money.”
“If we are repeatedly saving your life and you are not willing to change this behavior, why should we be obligated to keep saving you?”
“My personal opinion is we can’t keep letting people overdose and saving them just so they can repeat the cycle.”
“By continuously administering Narcan, sure, we’re saving their life, but are they really living? I don’t think so.”
Addiction is a scientifically-proven brain disease. Despite this, many persist in the belief that it’s a choice, or worse… a moral failing.
The notion comes from an early model of addiction, “the moral model,” which was deeply rooted in religion. Addiction was attributed to a sinful nature and weakness of character. Therefore, the addict must repent… or suffer the consequences of his/her actions; addiction warranted punishment, not empathy. Unsurprisingly, this created stigma. It also prevented those struggling with addiction from seeking treatment.
Centuries later, many hold on to the view that an individual suffering from a substance use disorder is lazy or weak… or a worthless junkie.
Today, in the midst of the opioid epidemic, stigma’s unrelenting grip perseveres. Stigma is a poison; it’s dehumanizing. It’s easy to forget a person is a person when you view them as garbage, trash… a “junkie.” Stigma tells us, “Take out the trash.” #JunkieLivesDontMatter
To fully recognize stigma’s impact, compare addiction to other diseases. Consider common medical emergencies; many are related to lifestyle. Imagine being hospitalized after your third stroke, and the doctor telling you, “This is the third time I’ve saved your life, yet you refuse to exercise. I shouldn’t be obligated to continue to provide life-saving care.” Or, imagine a long-time smoker who develops lung cancer; they’re not demeaned, called names, or denied treatment.
Moreover, an EMS worker wouldn’t withhold CPR from an individual in cardiac arrest if they were obese. It’s not a debate.
When it comes to someone else’s alcohol or drug use, how can you tell the difference between helping and enabling, and how can you help a loved one with addiction?
In my work at a residential treatment center, I’ve worked with family members who inadvertently fueled their loved one’s addiction. They “helped” by bailing them out of jail, giving them money, etc., which only enabled the individual to continue to get high. It’s hard for family members to differentiate between behaviors that help versus enable.
If you’re unfamiliar with the term “enable,” it means “to provide with the means or opportunity” or “to make possible, practical, or easy” (according to Merriam-Webster). When applied to substance use, it means a person in active addiction is provided with the means to continue to use.
Helping a person in active addiction means supporting their basic needs, such as food, water, shelter, and clothing. (If someone is in jail or treatment, their basic needs are met; therefore, bailing them out would be enabling.) Thinking in terms of “needs vs. wants” helps you to recognize enabling and therefore, to help a loved one with addiction.
When a parent has a son or daughter with an addiction, it’s especially difficult to make the distinction between helping and enabling. A parent’s natural inclination is to nurture and protect from harm. It’s heart-wrenching to see your child in pain. But if a parent doesn’t set (and adhere to) healthy boundaries, they will quickly become emotionally drained (as they enable their child’s addiction).
Here are some ways to help a loved one with addiction who’s actively using:
1. Never (ever) offer money.
If asked for cash for food, for example, buy groceries instead (or offer to take them to lunch). I worked with a father who bought a bag of groceries for his son, who struggled with severe alcoholism and was homeless, on a weekly basis. This is an excellent example of how to help a loved one with addiction versus enabling their drug use.
If your loved one doesn’t have to pay the electric bill, they’ll probably spend that money on drugs or alcohol. Furthermore, if you protect them from the consequences of not paying bills (i.e. having the power shut off), your loved one is less likely to see a need for change. (People don’t change when they’re comfortable.)
3. If your loved one is addicted to opioids (heroin, morphine, hydrocodone, etc.), attend a training or take an online course on opioid overdose reversal (Narcan [naloxone] administration).
If you’re unsure where local trainings are offered, a Google search for “Narcan training” or “opioid reversal training” will link you to resources in your area. Most trainings are free. Keep a Narcan kit on your person at all times. Provide your loved one with a kit (or two) as well.
This is not enabling. Help a loved one with addiction by potentially saving their life, thereby giving them the opportunity to recover. (A dead opioid-user doesn’t recover.)
4. Offer to help them get into treatment.
Become familiar with the different treatment options in your area. Don’t give ultimatums (i.e. “If you don’t get treatment, I’ll divorce you”) or make threats (especially if you’re not willing to follow through).
Be supportive, not judgmental. Be patient; when your loved one is emotionally and physically drained from addiction’s painful consequences (or when they hit “rock bottom”), they may decide it’s time to get help. And you’ll be ready.
5. Recognize that your loved one is not the same person they were before addiction.
Substance use disorder is a debilitating disease that damages the brain; it changes how a person feels and thinks. With addiction, the brain’s reward center is rewired, resulting in a biological “need” for drugs/alcohol. (Compare this to your need for food or water or air.)
Recognize that your loved one’s addiction will lie to you. They will do whatever it takes to get their “needs” met. Your loved one’s addiction will steal from you. (Lock up your valuables if they have access to your home… and even if they don’t. I’ve worked with more than a few individuals who have broken into their parents’ home for either money for drugs or valuables to pawn for money for drugs.)
Your loved one’s addiction will betray you. Accepting the nature of addiction will help you to set healthy boundaries.
By engaging with others with similar struggles, you’ll learn more about supporting your loved one (without enabling their addiction). You’ll also build a supportive network by connecting with others, strengthening your emotional health.
7. When in doubt, try asking yourself one (or all) of the following questions:
Will my actions help my loved one to continue to drink or use?
Is this a “want” or a basic need?
Will my actions prevent them from experiencing a natural consequence?
Conclusion
Addiction is a devastating, but treatable, disease. The road to recovery is difficult and long (with many detours).
While you can never control someone else’s behaviors, there are ways to help a loved one with addiction. Be kind and compassionate; they’re in an unthinkable amount of pain. They didn’t choose addiction. The best way to support them is by setting healthy boundaries to ensure you’re not enabling continued use.
Boundaries allow you to help them without furthering their addiction. Boundaries also serve as protection for you and your emotional health; you’re in no position to help if you’re emotionally, financially, and spiritually depleted.
Please share in a comment your suggestions for helping a loved one with addiction.
(Updated 9/20/22) This is a list of over 500 free online assessment screenings for clinical use and for self-help purposes. While an assessment cannot take the place of a diagnosis, it can give you a better idea if what you’re experiencing is “normal.”
Decisional Balance Scales | Several PDF versions available to measure pros/cons of substance use, includes scoring information (Source: The HABITS Lab at UMBC)
Drinking Patterns Questionnaire | 28-page PDF assessment, can be completed online or printed. No scoring instructions, find more information here
Drug Abuse Screening Test (DAST) | Online interactive screening with scoring information (Source: Counselling Resource) (Click here for PDF version from UMKC SBIRT)
Gambling Test | Interactive test (Source: HealthyPlace)
Process of Change Questionnaire | Several PDF versions available to assess the change process for alcohol, drugs, and smoking, includes scoring information (Source: The HABITS Lab at UMBC)
Self-Efficacy Scales | Several PDF versions available to assess for confidence to abstain, includes scoring information (Source: The HABITS Lab at UMBC)
Self-Report Measures | A modest collection of assessments for addiction (Source: Addiction Research Center)
Substance Abuse History Interview | The SAHI is an interview to assess periods of drug use (by drug), alcohol use, and abstinence in a client’s life over a desired period of time. The SAHI combines the drug and alcohol use items from the Addiction Severity Index (ASI) and the Time Line Follow-back Assessment Method to collect information about the quantity, frequency, and quantity X frequency of alcohol and drug consumption. Citation: McLellan, A. T., Luborsky, L., Woody, G. E., & O’Brien, C. P. (1980). An improved diagnostic evaluation instrument for substance abuse patients: The Addiction Severity Index. Journal of Nervous and Mental Disease, 168, 26-33. (Source: University of Washington Center for Behavioral Technology)
Yale Food Addiction Scale | PDF scale and scoring instructions (Source: Measurement Instrument Database for the Social Sciences [MIDSS])
Anxiety & Mood Disorders
PDF and interactive online assessment tools for anxiety, depression, and bipolar disorders
ADAA Screening Tools | The Anxiety and Depression Association of America provides links to both printable and interactive tests for depression, generalized anxiety disorder, OCD, panic disorder, PTSD, social anxiety disorder, and specific phobias. This site does not provide test results. (It’s recommended that you print your results to discuss with a mental health practitioner.) This is an excellent resource for clinicians to print and administer to clients.
Classroom Anxiety Measure | Printable scale with scoring instructions (Citation: Richmond, V. P., Wrench, J. S., & Gorham, J. (2001). Communication, affect, and learning in the classroom. Acton, MA: Tapestry Press).
DBSA Mental Health Screening Center | The Depression and Bipolar Support Alliance offers screening tools for both children and adults (including versions for parents to answers questions about their child’s symptoms). Take an online assessment for depression, mania, and/or anxiety.
Depression Self-Assessment | A simple self-assessment tool. Results are provided on a spectrum, ranging from “None” to “Severe” depression. (Source: Kaiser)
Edinburgh Postnatal Depression Scale (EPDS) | 2-page PDF with scoring instructions (Citations: Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782-786 and K. L. Wisner, B. L. Parry, & C. M. Piontek. (2002). Postpartum depression, N Engl J Med, 347(3), 18, 194-199.)
Fear of Physician (FOP) | Printable scale with scoring instructions (Citation: Richmond, V. P., Smith, R. S., Heisel, A. M., & McCroskey, J. C. (1998). The impact of communication apprehension and fear of talking with a physician and perceived medical outcomes. Communication Research Reports, 15, 344-353).
Hamilton Depression Rating Scale (HDRS) | 2-page PDF (Citation: Hamilton, M. (1960). A rating scale for depression. J Neurol Neurosurg Psychiatry, 23, 56–62.)
Mood Disorder Questionnaire | A PDF screening tool with scoring instructions to assess symptoms of bipolar disorder (Source: South African Depression and Anxiety Group)
The Penn State Worry Questionnaire (PSWQ) | 2-page PDF, includes scoring information (Citation: Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28, 487-495.)
Personal Report of Public Speaking Anxiety (PRPSA) | Printable scale with scoring instructions (Citation: McCroskey, J. C. (1970). Measures of communication-bound anxiety. Speech Monographs, 37, 269-277.)
Self-Consciousness Scale (SCS-R) | Downloadable assessment (Source: Measurement Instrument Database for the Social Sciences [MIDSS])
Shyness Scale | Printable scale with scoring instructions (Citation: McCroskey, J. C., & Richmond, V. P. (1982). Communication apprehension and shyness: Conceptual and operational distinctions. Central States Speech Journal, 33, 458-468.)
Social Anxiety Questionnaire for Adults | A PDF questionnaire to assess for social anxiety (Source: Measurement Instrument Database for the Social Sciences [MIDSS])
Social Phobia Inventory (SPIN) | 2-page PDF, includes scoring information (Source: Bianca Lauria-Horner, (2016). From The Primary Care Toolkit for Anxiety and Related Disorders: Quick, Practical Solutions for Assessment and Management. Brush Education Inc.)
Social Phobia Scale (SPS) | 1-page PDF assessment, scoring instructions not included (Source: Oxford Clinical Psychology)
Test Anxiety | Printable scale with scoring instructions (Citation: Richmond, V. P., Wrench, J. S., & Gorham, J. (2001). Communication, affect, and learning in the classroom. Acton, MA: Tapestry Press.)
Young Mania Rating Scale (YMRS) | 3-page PDF (Citation: Young, R. C., Biggs, J. T., Ziegler, V. E., & Meyer, D. A. (2000). Young Mania Rating Scale. In: Handbook of Psychiatric Measures. Washington, DC: American Psychiatric Association, 540-542.)
Trauma, Stress, & Related Disorders Online Assessment Tools
ACE Questionnaire | Adverse childhood experiences (ACEs) are associated with a variety of health (both physical and mental) conditions in adults. To find your ACE score, take an interactive quiz. Learn more about ACEs on the CDC’s violence prevention webpage. You can also download the international version (PDF) from the World Health Organization’s Violence and Injury Prevention webpage.
Initial Trauma Review – Revised (ITR-R) | A behaviorally-anchored, semi-structured interview that allows the clinician to evaluate most major forms of trauma exposure
Kessler Psychological Distress Scale (K10) | Citation: Kessler, R. C., Barker, P. R., Colpe, L. J., Epstein, J. F., Gfroerer, J. C., Hiripi E., et al. (2003). Screening for serious mental illness in the general population. Arch Gen Psychiatry, 60(2), 184-9.
Life Events Checklist for DSM-5 (LEC-5) | A PDF self-report measure designed to screen for potentially traumatic events in a respondent’s lifetime (Source: U.S. Department of Veterans Affairs)
Perceived Stress Scale (PSS) | Downloadable assessment (Source: Measurement Instrument Database for the Social Sciences [MIDSS])
Posttraumatic Maladaptive Beliefs Scale (PMBS) | 4-page PDF, includes scoring information (Citation: King, L. A., King, D. W., Vickers, K., Davison, E. H., & Spiro, A. I. (2007). Assessing late-onset stress symptomatology among aging male combat veterans. Aging & Mental Health, 11, 175-191. doi:10.1080/13607860600844424)
Stress Assessments | PDF packet of tests (Source: Write Your Own Prescription for Stress (2000). Kenneth B. Matheny, Ph.D., ABPP, & Christopher J. McCarthy, Ph.D.)
Stress Self-Assessments | A variety of self-assessments to measure stress (Source: American Institute of Stress)
Brief Obsessive-Compulsive Scale (BOCS) | PDF assessment based on Wayne Goodman’s Yale-Brown Obsessive-Compulsive Scale and Children’s Yale-Brown Obsessive-Compulsive Scale (Author: S. Bejerot)
Children’s Yale-Brown Obsessive-Compulsive Scale | 14-page PDF assessment (Citation: Scahill, L., Riddle, M. A., McSwiggin-Hardin, M., Ort, S. I., King, R. A., Goodman, W. K., Cicchetti, D. & Leckman, J. F. (1997). Children’s Yale-Brown Obsessive Compulsive Scale: reliability and validity. J Am Acad Child Adolesc Psychiatry, 36(6), 844-852.)
Obsessive-Compulsive Inventory (OCI) | PDF inventory with scoring instructions (Authors: Foa, E. B., Kozak, M. J., Salkovskis, P. M., Coles, M. E., & Amir, N.)
Borderline Symptom List and Scoring Instructions | Citation: Bohus M., Limberger, M. F., Frank, U., Chapman, A. L., Kuhler, T., Stieglitz, R. D. (2007). Psychometric properties of the Borderline Symptom List (BSL). Psychopathology, 40, 126-132. (Source: University of Washington Center for Behavioral Technology)
Difficulties in Emotion Regulation Scale (DERS) | 1-page PDF, includes scoring information (Citation: Gratz, K. L. & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26, 41-54.)
Measure of Attachment Qualities | Downloadable assessment (Source: Measurement Instrument Database for the Social Sciences [MIDSS])
Original Attachment Three-Category Measure | PDF assessment (Citation: Hazan, C., & Shaver, P. R. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52, 511-524.)
Interpersonal Communication Skills Inventory | PDF self-assessment designed to provide insight into communication strengths and areas for development. Includes scoring instructions.
Learn Your Love Language | Choose your version: Couples, Children’s Quiz, Teens, or Singles. An online assessment to determine your primary love language. (You are required to enter your information to get quiz results.)
Danger Assessment Screening Tool | Clinicians can download this PDF version of the assessment, which helps predict the level of danger in an abusive relationship; this screening tool was developed to predict violence and homicide.
Lifetime – Suicide Attempt Self-Injury Count (L-SASI)InstructionsScoring | The L-SASI is an interview to obtain a detailed lifetime history of non-suicidal self-injury and suicidal behavior. Citation: Linehan, M. M. &, Comtois, K. (1996). Lifetime Parasuicide History. University of Washington, Seattle, WA, Unpublished work. (Source: University of Washington Center for Behavioral Technology)
Lineham Risk Assessment and Management Protocol | Citation: Linehan, M. M. (2009). University of Washington Risk Assessment Action Protocol: UWRAMP, University of WA, Unpublished work. (Source: University of Washington Center for Behavioral Technology)
Non-Suicidal Self-Injury Assessment Tool Brief Version | Full Version | Assessment tool (Source: Cornell Research Program on Self-Injury and Recovery)
NSSI Measures Archives | A collection of instruments for self-harm (Source: International Society for the Study of Self-Injury)
NSSI Severity Assessment | A PDF assessment tool to assess the severity of non-suicidal self-injury (Source: Cornell Research Program on Self-Injury and Recovery)
Reasons for Living Scale Scoring Instructions | RFL Scale (long form – 72 items) | RFL Scale (short form – 48 items) | RFL Scale (Portuguese) | RFL Scale (Romanian) | RFL Scale (Simplified Chinese) | RFL Scale (Traditional Chinese) | RFL Scale (Thai) | The RFL is a self-report questionnaire that measures clients’ expectancies about the consequences of living versus killing oneself and assesses the importance of various reasons for living. The measure has six subscales: Survival and Coping Beliefs, Responsibility to Family, Child-Related Concerns, Fear of Suicide, Fear of Social Disapproval, and Moral Objections. Citation: Linehan M. M., Goodstein J. L., Nielsen S. L., & Chiles J. A. (1983). Reasons for staying alive when you are thinking of killing yourself: The Reasons for Living Inventory. Journal of Consulting and Clinical Psychology, 51, 276-286. (Source: University of Washington Center for Behavioral Technology)
Suicidal Behaviors Questionnaire | SBQ with Variable Labels | SBQ Scoring Syntax | The SBQ is a self-report questionnaire designed to assess suicidal ideation, suicide expectancies, suicide threats and communications, and suicidal behavior. Citation: Addis, M. & Linehan, M. M. (1989). Predicting suicidal behavior: Psychometric properties of the Suicidal Behaviors Questionnaire. Poster presented at the Annual Meeting of the Association for the Advancement Behavior Therapy, Washington, DC. (Source: University of Washington Center for Behavioral Technology)
Suicide Attempt Self-Injury Interview (SASII) SASII Instructions For Published SASII | SASII Standard Short Form with Supplemental Questions | SASII Short Form with Variable Labels | SASII Scoring Syntax | Detailed Explanation of SPSS Scoring Syntax | The SASII (formerly the PHI) is an interview to collect details of the topography, intent, medical severity, social context, precipitating and concurrent events, and outcomes of non-suicidal self-injury and suicidal behavior during a target time period. Major SASII outcome variables are the frequency of self-injurious and suicidal behaviors, the medical risk of such behaviors, suicide intent, a risk/rescue score, instrumental intent, and impulsiveness. Citation: Linehan, M. M., Comtois, K. A., Brown, M. Z., Heard, H. L., Wagner, A. (2006). Suicide Attempt Self-Injury Interview (SASII): Development, reliability, and validity of a scale to assess suicide attempts and intentional self-injury. Psychological Assessment, 18(3), 303-312. (Source: University of Washington Center for Behavioral Technology)
University of WA Suicide Risk/Distress Assessment Protocol | Citations: Reynolds, S. K., Lindenboim, N., Comtois, K. A., Murray, A., & Linehan, M. M. (2006). Risky assessments: Participant suicidality and distress associated with research assessments in a treatment study of suicidal behavior. Suicide and Life-Threatening Behavior, (36)1, 19-33. Linehan, M. M., Comtois, K. A., &, Ward-Ciesielski, E. F. (2012). Assessing and managing risk with suicidal individuals. Cognitive and Behavioral Practice, 19(2), 218-232. (Source: University of Washington Center for Behavioral Technology)
Coping Self-Efficacy Scale | 3-page PDF (Citation: Chesney, M. A., Neilands, T. B., Chambers, D. B., Taylor, J. M., & Folkman, S. (2006). A validity and reliability study of the coping self-efficacy scale. Br J Health Psychol, 11(3), 421-37.)
Fisher Temperament Inventory (FTI) | Interactive test (Source: Brown, L. L., Acevedo, B., & Fisher, H. E. (2013). Neural correlates of four broad temperament dimensions: Testing predictions for a novel construct of personality. PLoS ONE 8(11), e78734. / Open-Source Psychometrics Project)
Jung Typology Test | Interactive assessment based on Carl Jung’s and Isabel Briggs Myers’ personality type theory
Keirsey | Take this interactive assessment to learn your temperament. There are four temperaments: Artisan, Guardian, Idealist, and Rational. (Note: You must create an account and enter a password to view your results.)
MACH-IV Test of Machiavellianism | Interactive test (Source: Christie, R. & Geis, F. (1970). Studies in Machiavellianism. NY: Academic Press.)
SAPA Project | SAPA stands for “Synthetic Aperture Personality Assessment.” This online personality assessment scores you on 27 “narrow traits,” such as order, impulsivity, and creativity in addition to the “Big Five” (Agreeableness, Conscientiousness, Extraversion, Neuroticism, and Openness). You’re also scored on cognitive ability. This test takes 20-30 minutes to complete and you will receive a full report when finished.
The Fear of Happiness Scale| 2-page PDF with scoring information, 2012 (Source: The Compassionate Mind Foundation)
Fitness IQ Test | Interactive test (Source: Psychology Today)
Flourishing Scale (FS) | Includes scoring information (Citation: Diener, E., Wirtz, D., Tov, W., Kim-Prieto, C., Choi, D., Oishi, S., & Biswas-Diener, R. (2009). New measures of well-being: Flourishing and positive and negative feelings. Social Indicators Research, 39, 247-266.)
Happiness Test | Interactive test (Source: Psychology Today)
Inventories of Thriving (CIT & BIT) | Comprehensive and brief versions, includes scoring information (Citation: Su, R., Tay, L., & Diener, E. (2014). The development and validation of Comprehensive Inventory of Thriving (CIT) and Brief Inventory of Thriving (BIT). Applied Psychology: Health and Well-Being. Published online before print. doi: 10.1111/aphw.12027)
Oxford Happiness Questionnaire | 3-page PDF (Citation: Hills, P., & Argyle, M. (2002). The Oxford Happiness Questionnaire: a compact scale for the measurement of psychological well‐being. Personality and Individual Differences, 33, 1073–1082.)
Satisfaction With Life Scale (SWLS) | Includes scoring information (Citation: Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The Satisfaction with Life Scale. Journal of Personality Assessment, 49, 71-75.)
Affect Intensity Measure (AIM) | 40-question and 20-question PDF versions of the assessment (Citation: Larsen, R. J. (1984). Theory and measurement of affect intensity as an individual difference characteristic. Dissertation Abstracts International, 85, 2297B.)
Career Assessments | Self-assessments to assess interests, skills, and work values
Clance Impostor Syndrome Scale | 3-page PDF, includes scoring information (Source: The Impostor Phenomenon: When Success Makes You Feel Like A Fake (pp. 20-22), by P.R. Clance, 1985, Toronto: Bantam Books.)
DBT-WCCL Scale and Scoring | Citation: Neacsiu, A. D., Rizvi, S. L., Vitaliano, P. P., Lynch, T. R., & Linehan, M. M. (2010). The Dialectical Behavior Therapy Ways of Coping Checklist (DBT-WCCL).: Development and psychometric properties. Journal of Clinical Psychology, 66(61), 1-20. (Source: University of Washington Center for Behavioral Technology)
Demographic Data Scale | A self-report questionnaire used to gather extensive demographic information from the client. Citation: Linehan, M. M. (1982). Demographic Data Schedule (DDS). University of Washington, Seattle, WA, Unpublished work. (Source: University of Washington Center for Behavioral Technology)
Focus on Emotions | PDF assessment instruments for children and adolescents from 9 to 15 years. Includes Empathy Questionnaire (EmQue), Mood List, Alexithymia Questionnaire for Children, Emotion Awareness Questionnaire (EAQ), BARQ, Behavioral Anger Response Questionnaire, Worry / Rumination, Somatic Complaint List, Instrument for Reactive and Proactive Aggression (IRPA) Self-Report, Brief Shame and Guilt Questionnaire for Children, Coping Scale, and Social-Emotional Development Tasks
Library of Scales | 25 psychiatric scales (PDF documents) to be used by mental health practitioners in clinical practice. Includes Frequency, Intensity, and Burden of Side Effects Ratings; Fagerstrom Test for Nicotine Dependence; Fear Questionnaire; Massachusetts General Hospital Hair Pulling Scale; and more. (Note: Some of the assessments have copyright restrictions for use.) (Source: Outcome Tracker)
Mental Health Screening Tools | Online screenings for depression, anxiety, bipolar, psychosis, eating disorders, PTSD, and addiction. You can also take a parent test (for a parent to assess their child’s symptoms), a youth test (for a youth to report his/her symptoms), or a workplace health test. The site includes resources and self-help tools.
Military Health System Assessments | Interactive tests for PTSD, alcohol/drug use, relationships, depression, sleep, anxiety, anger, and stress
The Multidimensional Experiential Avoidance Questionnaire (MEAQ) | 3-page PDF with scoring information, 2011 (Citation: Gamez, W., Chmielewski, M., Kotov, R., Ruggero, C., & Watson, D. (in press). Development of a measure of experiential avoidance: The Multidimensional Experiential Avoidance Questionnaire (MEAQ), Psychological Assessment.)
Open Source Psychometrics Project | This site provides a collection of interactive personality and other tests, including the Open Extended Jungian Type Scales, the Evaluations of Attractiveness Scales, and the Rosenberg Self-Esteem Scale.
Other as Shamer Scale (OAS) | 2-page PDF with scoring information, 1994 (Source: The Compassionate Mind Foundation)
Parental Affect Test | The Linehan Parental Affect Test is a self-report questionnaire that assesses parent responses to typical child behaviors. Citation: Linehan, M. M., Paul, E., & Egan, K. J. (1983). The Parental Affect Test – Development, validity and reliability. Journal of Clinical Child Psychology, 12, 161-166. (Source: University of Washington Center for Behavioral Technology)
Patient Health Questionnaire Screeners | This is a great diagnostic tool for clinicians. Use the drop down arrow to choose a PHQ or GAD screener (which assesses mood, anxiety, eating, sleep, and somatic concerns). The site generates a PDF printable; you can also access the instruction manual. No permission is required to reproduce, translate, display or distribute the screeners.
Project Implicit | A variety of interactive assessments that measures your hidden biases
Screening Tools – Autism Canada | Interactive screening tools for autism for toddlers, children, teens, and adults (Source: Autism Canada) 🆕
Sensitivity Test for Adults | A carefully designed questionnaire to measure sensitivity in adults. (There is also a version for children.) 🆕
The Shame Inventory | 3-page PDF (Citation: Rizvi, S. L. (2010). Development and preliminary validation of a new measure to assess shame: The Shame Inventory. Journal of Psychopathology and Behavioral Assessment, 32(3), 438-447.)
Social History Interview (SHI) | The SHI is an interview to gather information about a client’s significant life events over a desired period of time. The SHI was developed by adapting and modifying the psychosocial functioning portion of both the Social Adjustment Scale-Self Report (SAS-SR) and the Longitudinal Interview Follow-up Evaluation Base Schedule (LIFE) to assess a variety of events (e.g., jobs, moves, relationship endings, jail) during the target timeframe. Using the LIFE, functioning is rated in each of 10 areas (e.g., work, household, social interpersonal relations, global social adjustment) for the worst week in each of the preceding four months and for the best week overall. Self-report ratings using the SAS-SR are used to corroborate interview ratings. Citations: Weissman, M. M., & Bothwell, S. (1976). Assessment of social adjustment by patient self-report. Archives of General Psychiatry, 33, 1111-1115. Keller, M. B., Lavori, P. W., Friedman, B., Nielsen, E. C., Endicott, J., McDonald-Scott, P., & Andreasen, N. C. (1987). The longitudinal interval follow-up evaluation: A comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry, 44, 540-548. (Source: University of Washington Center for Behavioral Technology)
Therapist Interview | The TI is an interview to gather information from a therapist about their treatment for a specific client. Citation: Linehan, M. M. (1987). Therapist Interview. University of Washington, Seattle, WA, Unpublished work. (Source: University of Washington Center for Behavioral Technology)
Treatment History Interview | Appendices | The THI is an interview to gather detailed information about a client’s psychiatric and medical treatment over a desired period of time. Citation: Linehan, M. M. &, Heard, H. L. (1987). Treatment history interview (THI). University of Washington, Seattle, WA, Unpublished work. Therapy and Risk Notes – do not use without citation. For clarity of how to implement these items, please see Cognitive-Behavioral Treatment of Borderline Personality Book, Chapter 15. (Source: University of Washington Center for Behavioral Technology)
TTM Measures | To assess for self-efficacy, decision-making, process of change, etc. (Source: HABITS Lab)
Where can you find the help you need? While there are plenty of resources out there for mental health and recovery, they’re not always easy to find… or affordable. (Plus, the Internet is full of scams!) This article is a starting point for getting help when you aren’t sure where to turn. This post offers practical guidelines; all of the resources in this article are trustworthy and reliable… and will point you in the right direction.
This post is not comprehensive; rather, it is a starting point for getting the help you need. There are plenty of resources out there for mental health and recovery, but it is not always easy (or affordable) to find help. The resources in this post are trustworthy and reliable… and will point you in the right direction so you can find help.
If you need treatment for mental distress or substance use but are not sure where to start…
If you have insurance, check your insurer’s website.
For substance use and mental health disorders, you can access the SAMHSA treatment locator. You can find buprenorphine treatment (medication-assisted treatment for opioid addiction) through SAMHSA as well.
Consider using Mental Health America’s interactive tool, Where to Get Help. NeedyMeds.org also has a locator to help you find low-cost mental health and substance abuse clinics.
At campus counseling centers, grad students sometimes offer free or low-cost services.
You could look into community mental health centers or local churches (pastoral counseling).
In some areas, you may be able to find pro bono counseling services. (Google “pro bono counseling” or “free therapy.”) You may also be able to connect with a peer specialist or counselor (for free) instead of seeing a licensed therapist.
As an alternative to individual counseling, you could attend a support group (self-help) or therapy group; check hospitals, churches, and community centers. The DBSA peer-lead support group locator tool will help you find local support groups. Meetup.com may also have support group options.
Additional alternatives: Consider online forums or communities. Watch or read self-help materials. Buy a workbook (such as The Cognitive Behavioral Workbook for Depression: A Step-By-Step Program) from Amazon. Download a therapy app.
Lastly, you could attend a free workshop or class at a local church, the library, a college or university, a community agency, or a hospital.
If you’re under 18 and need help, but don’t want your parents to know…
Some, but not all, states require parental consent for adolescents to participate in therapy. Start by looking up the laws in your state. You may be able to see a treatment provider without consent from a legal guardian. If your state is one that mandates consent, consider scheduling an appointment with your school counselor. In many schools, school counseling is considered a regular educational service and does not require parental consent.
Self-help groups, while not a substitute for mental health treatment, provide a venue for sharing your problems in a supportive environment. (If you suffer from a mental health condition, use NAMI to locate a support group in your state. If you struggle with addiction, consider AA or NA.)
Alternatively, you could join an online forum or group. (Mental Health America offers an online community with over 1 million users and NAMI offers OK2Talk, an online community for adolescents and young adults.)
You could also contact a Mental Health America Affiliate who would be able to tell you about local resources and additional options.
Lastly, consider talking with your pastor or a trusted teacher, reading self-help materials, downloading a therapy app, journaling, meditation or relaxation techniques, exercising, or therapy podcasts/videos.
If a friend or loved one says they’re going to harm or kill themselves…
Call 911 or 988. If you are with that person and are able to, stay with them until help arrives.
If you’re thinking about hurting or killing yourself…
Check local hospitals and churches for grief support groups; some areas may have nonprofits that offer free services, such as Let Haven Help or Community Grief and Loss Center in Northern Virginia.
Additionally, a funeral home or hospice center may be able to provide resources.
If you are a veteran, you and your family should be able to access free counseling through the VA.
The Compassionate Friends offers support after the loss of a child. Call for a customized package of bereavement materials (at no charge) or find a support group (in-person or online).
Explore Learn to Cope, a peer-led support network for families coping with the addiction of a loved one. Alternatively, you could attend Al-Anon or Nar-Anon.
Keep in mind that it’s almost impossible to help someone who doesn’t want it. You can’t control your loved one or force them into treatment. Instead, find a way to accept that there’s no logic to addiction; it’s a complex brain disorder and no amount of pleading, arguing, or “guilting” will change that.
You can receive free training to administer naloxone, which reverses an opioid overdose. Take an online training course at Get Naloxone Now. You can purchase naloxone OTC in most states at CVS or Walgreens.
In addition to talking to your doctor about medication, the patch, and/or nicotine gum, visit Smoke Free, Be Tobacco Free, or Quit.com for resources, tools, and tips.
Call a smoking cessation hotline (like 1-800-QUIT-NOW) or live chat with a specialist, such as LiveHelp (National Cancer Institute).
Download a free app (like QuitNow! or Smoke Free) or sign up for a free texting program, like SmokefreeTXT, for extra support.
Attend an online workshop or participate in a smoking cessation course; your insurance provider may offer one or you may find classes at a local hospital or community center. You could also contact your EAP for additional resources.
If you or a loved one have a problem with hoarding…
If your therapist is making unwanted sexual remarks or advances…
Contact the licensing board to file a complaint. Each state has a different licensing board. Additionally, contact the therapist’s professional association (i.e. American Counseling Association, American Psychological Association, etc.) Provide your name, address, and telephone number (unless filing anonymously). Identify the practitioner you are reporting by his or her full name and license type. Provide a detailed summary of your concerns. Attach copies (not originals) of documents relating to your concerns, if applicable.
Are mentally ill people violent? Can mental illness be overcome through willpower? Is addiction a choice? This post addresses some of the myths and misconceptions about mental illness.
There is stigma attached to mental illness and substance use. The media, unfortunately, perpetuate stigma by spreading misinformation.
For example, every time a school shooting occurs, the media attributes it to (or at least references) mental illness. Journalists first, and then social media trolls sensationalize news stories about the shooter’s eccentricities and all the signs that were missed. Upon learning that the shooter was having problems at home and didn’t get along with his peers, one might suspect mental illness. And suspicion becomes certainty when mental illness is viewed as the only plausible rationale behind the senseless violence. (It’s also rationalized that ‘normal’ people don’t shoot each other for no reason. So when there is no apparent motive, mental illness is blamed.)
Next, mainstream media circulates the story about the depressed kid turned killer. The message received is “mental illness is dangerous” or “people with mental disorders are criminals.” This misinformation is absorbed and regurgitated in society, online and off, and misconceptions about mental illness persevere.
Unfortunately, misconceptions about mental illness are common, and not just with the media. Even healthcare workers, including mental health professionals, believe common myths.
In this post, I will address some common myths and misconceptions about mental illness.
Ignorance is the root of stigma. The more you know, the less you fear, and the less you’ll stigmatize. Read on to learn about myth versus fact.
9 Myths & Misconceptions About Mental Illness
1. Bad parenting causes mental illness.
MOSTLY MYTH
Even today, there is no single identified cause that explains mental illness.
However, there are multiple known risk factors (biological, environmental, and social) that contribute to the development of mental disorders. Having a genetic predisposition to mental illness is the biggest risk factor. Genetics largely determine if a person will develop schizophrenia, depression, substance use disorder, etc. About 40-60% of mental illness is determined by biology.
Physiological factors (such as structural differences or chemical abnormalities in the brain) are another risk factor. Additional biological risk factors include prenatal damage, brain injury or defects, illness or exposure to toxins, and damage from drug and alcohol use.
Environmental and social factors include fetal exposure to a toxin and childhood trauma, among others.
Childhood abuse and neglect undoubtedly fall into the ‘bad parenting’ category. What’s more, adverse childhood experiences (ACEs) are associated with chronic disease, obesity, decreased immune function, substance use, and mental illness in adulthood.
While childhood abuse, neglect, and even spanking are linked to poorer mental health outcomes, bad parenting does not cause mental illness. Bad parenting can be a risk factor, depending on severity and impact, as well as the presence or absence of protective factors. (Protective factors include resiliency, health, feeling safe at home, etc.) Also, ‘bad’ parenting is somewhat subjective.
Generally, the more risk factors (and fewer protective factors) a person has, the more likely they are to develop a mental illness.
2. Mental illness is not a medical disease.
MYTH
Heart disease affects the heart. Colon cancer affects the colon. Autoimmune disorders affect the immune system. Brain disorders (i.e. mental illness, addiction, brain cancer, dementia, Parkinson’s, Alzheimer’s, etc.) affect the brain.
Like other organs, the brain is susceptible to disease. Brain disease manifests as changes in behaviors, thoughts, memory/processing, speech, emotional regulation, judgment, and more. Because your brain is the body’s control system, brain disease may also impact balance, muscle coordination, the ability to use your sense of taste, smell, touch, etc.
You cannot ‘see’ mental health symptoms the way you can see some physical health symptoms (such a rash or a broken bone), but you also don’t see most physical health symptoms.
When you have a headache, no one else can see it. You don’t even know what’s happening to the neurotransmitters and synapses across the lobes in your brain. You’re solely responsible for describing the pain to your doctor so they can prescribe the right treatment.
In reality, there’s not such a huge distinction between so-called physical and mental illnesses. They can both be painful and debilitating, and may require medical treatment.
3. All sociopaths are dangerous.
MISCONCEPTION
The term ‘sociopath’ (or psychopath) is frequently associated with serial killers. The reality is that you probably know a sociopath and they aren’t a murderer.
In fact, ‘sociopathy’ and ‘psychopathy’ are no longer recognized as diagnoses in the mental health world due to negative connotations. The diagnosis became associated with a sterotypical portrayal of a psychopath as a ruthless and insane serial killer. The stereotype is perpetuated by filmakers and TV producers and continues to show up in movies and series even today, despite the glaring inaccuracies with the diagnosis.
The correct term is antisocial personality disorder (ASPD), a mental illness characterized by an ongoing disregard for and violation of the rights of others. An individual with ASPD may also be exceptionally charismatic. (Some of the most charming and engaging clients I’ve ever worked with had ASPD.)
While it’s a misconception to say all individuals with ASPD are dangerous, the link between ASPD and crime is not unfounded.
4. Mental illness can be overcome with willpower.
MYTH
This is 100% myth. The notion that mental illness can be overcome with willpower goes hand-in-hand with the belief that mental illness is not a ‘real’ medical condition.
A mental disorder typically requires treatment, such as medication and therapy, and ongoing illness management.
All the willpower in the world will not help someone overcome heart disease. And it does not work that way with mental illness either.
5. Addiction is a choice.
MYTH
Substance use disorder is no more of a choice than diabetes or cancer. Like most diseases, addiction develops when a combination of genetic, physiological, psychological, and environmental factors are present. Lifestyle choices also play a role.Unfortunately, the myth that addiction is a moral failing persists.
An individual who has an addiction receives more blame than someone with a heart condition, even though lifestyle choices heavily impact both disorders. I have even heard the argument that addicts who overdose should not be revived because it was their ‘choice’ to use. If that is the logic, then should we stop providing life saving care to someone who is obese when they have a heart attack or to a smoker with lung cancer? Of course not.
At times, we all make poor decisions. For someone with a predisposition for addiction, the choice to drink may lead to alcohol use disorder. For the person with a predisposition for diabetes, eating an unhealthy diet or living a sedentary lifestyle will result in consequences.
Furthermore, once a person develops a substance use disorder, physiological and structural changes in the brain dissolve the element of choice. The brain misinterprets a craving for drugs or alcohol. (Remember the last time you experienced extreme thirst? That is what it is like to be addicted to something.)
Having a substance use disorder is miserable, lonely, and shameful. No one chooses that.
6. People with mental illness are violent.
MISCONCEPTION
Having a mental illness does not make someone more likely to commit a crime or act of violence, especially if that person is following treatment recommendations for psychotherapy, medication, etc. Rather, biolocial, psychological, and environmental factors are associated with violent behavior. In the general population, younger males in lower socioeconomic classes with lower levels of education and employment are the most likely to engage in violent acts, not persons with mental illness.
While the media would have us believe that mental illness is at the root of every mass shooting, this isn’t the case. Most people with mental health problems do not commit violent acts or crimes, and most violent acts are not committed by people with mental illness. It’s also true that persons with severe mental illness are more likely to be victims of crime.
Moreover, individuals with mental illness are more likely to die by suicide. Persons with schizophrenia have higher rates of suicide than the general population. Depression, bipolar disorder, and borderline personality disorder are also linked to suicide.
A mental disorder is a medical condition; having weak morals is a personality trait, and while it seems mentally sick, it’s not fair to compare a lack of morals to a condition like depression or anxiety.
7. Mental illness is the same thing as mental retardation.
MISCONCEPTION
I am friends with a nurse who did not know the difference (until I pointed it out). A person with a mental illness may seem less intelligent due to various factors, but mental illness is not comparable to mental retardation. Today, we refer to mental retardation as intellectual disability (due to the negative connotations attached to the word ‘retarded’).
A person with an intellectual disability (ID) struggles to understand, comprehend, and/or form memories. A person with mental illness, on the other hand, may have superior intelligence, but could seem slow due to distractions brought on by their illness. (For example, it is difficult to focus on a conversation when you’re having racing thoughts or hearing voices.)
8. A person with schizophrenia has multiple personalities.
MYTH
A person with schizophrenia may hear voices and even respond to what they hear, but they do not have multiple personalities. Multiple personality disorder (MPD), on the other hand, is associated with distinct personalities.
Today, MPD is referred to as dissociativeidentity disorder (DID). A person with DID has at least two distinct personality states, and suffers from gaps in memory. The prevalence of DID is largely unknown, but it’s estimated that 1-2% of Americans have DID. DID occurs so rarely that its existence was once disputed in the scientific community. There is a strong correlation between DID and childhood trauma and abuse.
With schizophrenia, the voices may be distinct, have their own names, and can be experienced as different personalities (male, female, child adult, friendly, cruel, etc.) or entities, but someone with schizophrenia has only one personality. Dissociation is not a typical symptom of schizophrenia.
In addition to auditory hallucinations, someone with schizophrenia may experience visual hallucinations, delusions, disorganized thoughts, cognitive deficits, and/or what’s referred to as negative symptoms. A negative symptom is a lack of something that is typically present in someone without schizophrenia. For example, a person with schizophrenia may be socially withdrawn or he/she may seem very flat, or without emotion.
9. Alcohol makes you depressed because it is a depressant.
MISCONCEPTION
Yes, alcohol is a depressant. As a depressant, it depresses your central nervous system, leading to slurred speech, trouble with coordination, etc. The intoxicating effects of alcohol are not symptoms of depression.
However, heavy alcohol use is associated with depression and other mental disorders. Someone who has depression or anxiety may drink to self-medicate. Alternatively, someone with an alcohol use disorder may develop depression, as alcohol upsets the chemical balance in the brain. What’s more, a person may regret the things they do while intoxicated, leading to intense guilt, shame, and/or hopelessness.
Help to fight stigma and misconceptions about mental illness by sharing this!
“Every night, I would drink until I passed out, often fully clothed with a beer in hand. I would then wake up, brush my teeth and immediately vomit. I would brush my teeth again and then go to work.” This was the daily routine for JMS, who wore his alcoholism as a badge and didn’t plan to live past 30. In this interview, a recovering alcoholic discusses addiction, sobriety, what everyone should know about alcoholism, and why you might be a jerk if you believe a common myth.
JMS, a recovering alcoholic, has been sober for nearly six years. He started drinking at the age of 13. He continued to drink throughout his 20s, a “dark and miserable existence,” and didn’t think he’d live to be 30. In 2012, a suicide attempt nearly claimed his life. He woke up in a psych unit, having no memory of what happened, and decided he wasn’t ready to die.
JMS’s “official” recovery date is July 5, 2012. The following is an interview about how he got sober, why AA isn’t for everyone, and why you’re a shitty person if you believe addiction is a choice.
What’s your definition of recovery?
JMS: I don’t see recovery as an end goal. To me, recovery is a path towards my end goal, which is contentment. I have found that I will never be content and happy with my life if I am using some sort of substance. For me, recovery is complete sobriety from all mentally and physically altering substances. I have tried and learned that I cannot pick and choose what to use. It does not work for me. More than just abstinence, recovery is a way of life. It is about being accountable for your actions, admitting when you are wrong, trying your best, and letting things go. Just trying to be a better person than I was yesterday.
Is alcoholism a disease?
It is difficult for people to accept that alcoholics suffer from a disease and are not just a bunch of selfish degenerates that don’t care about their lives.
JMS:I feel the word “disease” can be quite polarizing when discussing addiction. Alcoholism is chronic, progressive, and fatal. Much like diabetes, alcoholism is a relapsing disorder that needs a lifetime of monitoring and treatment. Based on these facts, yes, alcoholism is a disease. I feel this is a difficult idea for people to swallow. Much of addiction has been seen as a moral issue or a failing of willpower. It is difficult for people to accept that alcoholics suffer from a disease and are not just a bunch of selfish degenerates that don’t care about their lives.Obesity holds a similar stigma, though fat shaming has started to catch a bad rap.
When did you realize you had a drinking problem?
I knew for a long time that I was unable to stop drinking, but I didn’t care. I never had any intention of making it to 30 years old
JMS: Hmm, that’s a tough question to answer. My gut response here is to say when I went to jail for my 3rd DUI in 2010, which is when I started to actually try to get sober. But if I am honest with myself, I was well aware that there was a problem years before that. I knew for a long time that I was unable to stop drinking, but I didn’t care. I never had any intention of making it to 30 years old.I lived a really dark and miserable existence for most of my 20s. I could identify story after story about when I should have realized that there was a problem. Destroyed friendships, arrests, hospital visits, blackouts, poor choices, breakfast beers, etc. The truth is, I knew that I drank differently from my friends when I was a kid. When we would wake up hung over after a party, I was the one that would sneak vodka shots. So, I think somewhere in there, I was always aware that it was a problem. I come from a family of alcoholics. My father, his sisters, and his parents are/were all alcoholics. So it was almost a badge of honor to be another alcoholic [last name].
In active addiction, how did alcohol affect your health and appearance?
I learned that it is not normal to have diarrhea everyday for 10+ years.
JMS: I lost 60 lbs. when I stopped drinking. I changed absolutely nothing other than cutting out beer and dropped 60 lbs. I looked and felt a lot less bloated. I also learned that it is not normal to have diarrhea everyday for 10+ years. Honestly, the biggest physical change I experienced, that I am still grateful for today, is acid reflux. While drinking, I kept TUMS in business. I never went anywhere without them. Today, I need to eat some TUMS when I eat pizza or spicy food… you know, like a normal person. I never noticed the impact that drinking had on my sleep until I was no longer drinking. The first few months I really struggled to sleep well since I never had healthy sleep hygiene. Allow me to paint you a picture. Every night, I would drink until I passed out, often fully clothed with a beer in hand. I would then wake up, brush my teeth and immediately vomit. I would brush my teeth again and then go to work. Shower or not, I always reeked of alcohol, so showering was not a top priority. I always thought that I never got hangovers, but once sober I realized that I only thought that because being hung-over was my normal and I was experiencing them every morning. Ugh, the physical impact that had on my life is really something I do not miss.
How (and why) did you get sober? Who and/or what helped? Also, share about some things that were not helpful to you.
JMS:I got sober because I did not want to die. I tried to kill myself the last time that I drank. I do not remember what happened, but I remember waking up in a psych unit in the hospital. There are a bunch of people that were integral to the success of my sobriety at this time. My family is number one. They never gave up on me, despite the hell I put them through. I moved back into my mom’s house when I got out of the hospital. She and my siblings were nothing but supportive of me then and still to this day. I do not know if I would be sober today without their unconditional love and support.There are four other people that I owe my life to at this point. My therapist, my addiction counselor, Bob, my friend Alex, and my friend Jon. I had been working with my therapist for a few years prior to my last drinking adventure. She has always been willing to challenge me and has been a safe space for me to work through some of my biggest fears. She has really helped me understand the nature of my addictions and helped me reframe my thinking and processing of my emotions.
I didn’t buy into [AA].
I have been through multiple addiction treatment programs in my life and none of them stuck. I always approached them with a cynical eye and was just going through the motions to get my family or the courts off my back. A condition of my discharge from the hospital was to enroll in an intensive outpatient program. This is where I met Bob. I figured this was another bullshit program that I was going to have to work through to keep people off my back. Bob was different. He encouraged us to go to 12-step meetings. Of course, I refused. I didn’t buy into those programs. Bob challenged me here. He asked that I attend one meeting in the coming week and write a list of everything that I hated in the meeting. I gladly did this and came back and an entire 8.5×11 sheet of paper full of my gripes. Bob listened to my list and challenged me to go to another one the next week and make a new list with different complaints. I rose to this challenge and did it again, glad to prove my point that AA was stupid and not for me. Bob again listened to my list (without arguing against any complaints) and provided another challenge. Bob asked me to go to another meeting and make a list of the things that I liked from the meeting. I did and, as any alcoholic can tell you, you are bound to hear things in an AA meeting that resonate with you, whether you buy in to the program or not. Bob continued to challenge me to go to meetings, not to go and drink the kool-aid and say some prayers, but to see what I can find that I like. There were other aspects of Bob that I couldn’t figure out why I liked him until one day, I walked into an AA meeting and he was sitting at the front table leading the meeting. Bob is an alcoholic. In that moment I knew that he understood my struggle. Bob was sober and doing meaningful work. Bob was ok. I wanted to be like Bob.
I owe my life to Alex.
I met Alex in the IOP [program] that Bob ran. Alex and I came from different worlds (he was smoking crack on the streets in Baltimore [and] I was drinking in bars in DC), but we had the same reality of sobriety or death. Alex went with me to those AA meetings [around the time that] Bob was challenging me. Alex also brought me to the meeting that would become my home group and introduced me to the people that would soon be my AA family. I owe my life to Alex. I would be remiss not to pay homage to Alex. Alex was murdered in an Oxford house a year in to our sobriety. Alex died sober, which was something he never believed would happen. I miss him every single day.
Finally, my friend Jon; he and I started drinking together as kids. He and I lived together after college and blossomed into the full fledged alcoholics we became. And he and I got sober around the same time on different coasts of the country. When I got out of the hospital, Jon moved back east from California and moved into my mom’s basement. He and I went to AA meetings daily, often more than just one each day. We then spent that first year of sobriety living together trying to figure out how to live.
I did not give a damn about anything while in my active addiction, so telling me you were going to breakup with me or I was going to lose my job did not matter.
What was not helpful? Counselors who tried to tell me about sobriety that clearly did not understand addiction. Ultimatums also did not help. I did not give a damn about anything while in my active addiction, so telling me you were going to breakup with me or I was going to lose my job did not matter. Probation was useless. The biggest impact the state had on my drinking was when I was sent to jail.
What prevents you from going back to drinking?
There is nothing in your life that a drink can’t make worse.
JMS: My life now. I love the person I am today. When I was drinking, I hated myself. I never want to be that person again, and I don’t have to be as long as I don’t drink. I have come to the realization that my worst day sober is infinitely better than my best day drinking. I don’t attend AA meetings anymore, but many of the slogans still bounce around in my head. The most important one I ever heard was, “There is nothing in your life that a drink can’t make worse.” I’m not going to lie and say that now I am sober, life is easy and happy and super fun all the time. It’s not. However, I am better equipped to handle the bullshit in life with a clear head. I would be lying to say that I don’t experience cravings but I know that a drink is not the solution to life’s problems.
What’s something you wish you had known before you became addicted to alcohol? (If you could go back in time and have a word with your younger self, what would you say?)
JMS: I feel like most people will expect me to say something like, “I would slap that first drink out of my hand!” That is not true for me at all.I am the person I am today because of my history with drinking. I am proud of the person I have become and I am not sure I would be who I am without the struggles I went through. I would want to assure myself that it was going to turn out okay and that I would not be that miserable forever. I do wish I had understood and cared about (at the time) the severity of the pain and worry I put my mom and siblings through.
What something you wish everyone knew about alcoholism?
JMS: It is not a choice. Alcoholics don’t drink the way they do because they don’t care about you or their families. They drink the way they do because they cannot control the cravings and urges and are overcome by guilt/shame/fear/pain. I am fairly confident that if every alcoholic could “just stop drinking” they would. Alcoholism is exhausting.
What are your thoughts on AA?
JMS: AA can save lives. I attribute my sobriety to the teachings of, and people I met in, AA. That being said, AA does not work for everyone. I like to [view] AA [as] a religion. AA meetings are akin to going to church, the Big Book is the bible, and sobriety is heaven. Some people need to go to church daily to find their way to heaven. Others only need to read the text to understand the tenets of the religion to find their way there. And some people find their way into heaven following other religious texts or none at all. There is no wrong way to get sober. I do have complaints about AA and I feel there are aspects of it that prevent people from finding their way to sobriety. The focus on actual religion in AA is a major turn-off for people. While AA espouses that it is non-denominational and that we alcoholics are welcome to choose the God of our understanding, we are then thrown into a prayer circle to recite the Lord’s Prayer at the end of the meeting. For a low-bottom newly sober person, it is difficult to believe that there is a God that would allow us to sink so low and experience so much pain. But as I mentioned above in my story about Bob, he challenged me to find what I hated (and you better believe that GOD was written in huge letters on that first sheet of paper) and taught me to focus on what I liked.
If you are struggling, try it.
So, my thoughts? If you are struggling, try it. Ignore the God part for now. Listen to other people tell your story and see that it is possible to get better.
How do you feel when people drink around you?
JMS: In a word, annoyed. Slurred speech, glassy eyes, stumbling, and repetitive stories are not a cute look for anyone. I often feel embarrassed for the people I am around as well. It is always a nice reminder of why I don’t drink. I see absolutely nothing attractive to it and I am glad I don’t do that to myself anymore.
What’s the worst thing about being in recovery? The best?
JMS:The worst part [about] being in recovery is trying to explain to people that they don’t have to behave differently around me once they find out. I can’t count the number of times people have asked me if it is okay to drink around me or warned me that there was going to be alcohol at their house. You don’t ask a person with Diabetes if it is okay if you eat a Twinkie, you don’t have to ask me if it is ok for you to have a beer.
There is just an indescribable freedom that comes along with [sobriety].
The best part is being free. I was a slave to my addictions for years. I do not have that struggle anymore. I do not have to worry about where I will find money to buy alcohol. It is a huge struggle in my life that does not exist anymore. There is just an indescribable freedom that comes along with it.
In your opinion, what’s the biggest misconception out there about addiction?
[If you believe addiction is a choice], that just makes you a shitty person.
JMS: I mentioned it above; that addiction is a choice. That idea is closed-minded and short-sighted. And I think it speaks volumes about the person [who] believes that. I cannot fathom believing that someone would do this voluntarily. It is not fun, it does not feel good, and does not make us proud. In my eyes, the belief that this is a choice tells me that you could choose to behave in this manner if you wanted to, and that just makes you a shitty person.
Please share your thoughts on addiction and recovery in a comment!
