Pseudohallucinations – OK to see things?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Hallucination

Hallucinations.
Photo courtesy of Pixabay.

Pseudohallucinations – sometimes we expect people to “see things.”

Sometimes it’s okay to see things that are not really there. When someone is under

the influence of drugs, particularly hallucinogens or powerful stimulants, it is common for them to see things that others don’t.

When crack cocaine first became common, the emergency rooms in large cities experienced a rash of people who were “seeing things.” Many of these people received a diagnosis of schizophrenia or a related psychosis.

The same phenomenon occurred again when methamphetamine became cheap and readily available. More recently we are seeing people under the influence of “bath salts,” who are hallucinating.

None of these drug-induced hallucinations should be used as symptoms for making the diagnosis of schizophrenia or related psychosis.

True hallucinations can be a feature of several mental illnesses. In addition to schizophrenia, people with severe major depressive disorder, bipolar disorder, and other mental illnesses may experience hallucinations. Sometimes people with severe mental illness also use drugs which can create Pseudohallucinations. Sorting out the meaning of hallucinations is a job for a professional.

Some authorities differentiate between Hallucinations, Pseudohallucinations, and Parahallucinations.

If someone is experiencing hallucinations and they know it is the result of “good drugs,” this is a Pseudohallucination and likely will be diagnosed as a drug intoxication disorder, Hallucinogen Persisting Perception Disorder F16.983 or stimulant-induced psychotic disorder if the hallucinations continue after withdrawal from a stimulant.

Alcohol can also cause hallucinations.

When chronic alcoholics are withdrawing from alcohol that can experience a condition called delirium tremens or the DT’s for short. DT’s consists of shakes and hallucinations when the level of alcohol in the bloodstream declines. This is a very serious condition and can lead to death. If someone has ever had the shakes or hallucinated while withdrawing from alcohol they should be sent to a hospital to detox. Friends don’t let friends die from DT, s.

Staying connected with David Joel Miller

David Joel Miller MS is a Licensed Marriage and Family Therapist (LMFT) and a Licensed Professional Clinical Counselor (LPCC.)  Mr. Miller provides supervision for beginning counselors and therapists and teaches at the local college in the Substance Abuse Counseling program.

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

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For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

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What if you go to the hospital drunk or high?

What if you go to the hospital drunk or high?
Photo courtesy of pixabay.

By David Joel Miller.

Hospital emergency rooms are filling up with people under the influence.

This is causing a whole lot of problems for hospitals, the emergency room staff, and society in general. There is no special reason why someone needs to go to a hospital because they are drunk or high unless they also have a medical or psychiatric emergency.

They end up there because of the other problems drug and alcohol use cause to the person and to society. Often this happens because there is just no other place to send them. Hospitals do not function as an extension of law enforcement and patient privacy is strongly enforced so unless you are in prison when the emergency occurs don’t worry about seeking help because of the legal consequences.

People who are drunk or high are a lot more likely to slip, fall or otherwise injure themselves. The emergency room staff is used to this and unless you broke some major law like hitting someone while driving drunk and you are already in custody, their goal is to get you patched up and out of there.

Some under-the-influence people really really need to be in the hospital.

If someone has the Delirium Tremens (DT’s), they need to be in the hospital, this is life-threatening. But most drunks are just a pain to the workers in the ER. They argue, try to go places and do things that just get in the way.

Heroin and other opiate abusers need an injection to reverse the effects of the overdose, but most enlightened emergency responders carry the injection to do this on the ambulance so that by the time the patient reaches the hospital the emergency is over.

Drunks are most problematic because the alcohol impairs their judgment. They are often suicidal or violent. No not everyone who drinks gets suicidal or violent but many suicidal people abuse substances. A binge drinker is 55 times more likely to attempt suicide than a non-drinker.

Substance abusers make up a significant proportion of admissions to psychiatric facilities. While they are under the influence they are prone to be violent and irresponsible. Some of them are still suicidal or violent after the drugs and alcohol wear off and need further treatment.

Since we don’t know if the current psychiatric problem is only a result of the substance or do they have these issues at other times. Most suicidal, self-harming or violent people who are under the influence end up staying until the drugs and alcohol wear off and they can rationally answer questions about their behavior and intent.

One very effective approach to this overflow of under-the-influence people filling up the hospital ER’s has been the creation of sobering centers.

Situated close to the hospital and under the supervision of medical staff, trained Para-professionals such as substance abuse counselors and mental health professionals can screen patients for medical necessity and supervise detoxification. These systems have worked well. Unfortunately, when budgets get tight, detox, as well as other services for substances abusers and the mentally ill, get cut.

At the time the need is the greatest detox and sobering centers are the most likely to get cut and throw their work back on the already overused ER’s.

Hospitals are also seeing a surge in irrational people as a result of synthetic drug use. (See 7 new drugs parents should be aware of.) Sometimes that psychosis goes away once they detox but other times it seems to be long-term and results in a psychiatric hospital admission.  Professionals are debating whether the new drugs are creating the psychosis or just a stressor that causes the first occurrence of the disorder.

I am convinced that drug use is damaging some brains and creating mental illness which would not have occurred without the drug use. I understand not everyone agrees with this position.

So the conclusion to all this is that if you or someone around you is drunk or high and there appears to be a medical or psychiatric emergency you should go to the hospital and get checked out and do not worry about the police finding out about this as a result of your visit. If there is no medical or psychiatric problem and no past history of problems most people do not need to go to the hospital. When in doubt call 911, the doctor or hospital first, not your therapist or the social worker.

 

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Pink elephants kill – Dangers of Delirium Tremens (DT’s)

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Inebriated people.

Alcoholism.
Photo courtesy of Pixabay.

Seeing bugs when drinking?

There are lots of jokes about people seeing things while drinking. Having Delirium Tremens (D.T.’s) is no joke.

Withdrawal from Alcohol can be fatal. When we mention withdrawal from drugs most people think of the physical symptoms of heroin withdrawal. Kicking Heroin can make someone wish they were dead, but alcohol withdrawal is far more likely to kill.

Deaths directly related to alcohol each year exceed all the deaths from other drugs, legal and illegal.

DT’s occur when the drinker is withdrawing from alcohol as the blood level is declining. Before modern medicine was available up to one-third of alcoholics with DT’s died during withdraw. Modern medical treatment has cut that rate dramatically but people do still die while sobering up.

If the drinker has EVER had hallucinations or a seizure when drinking or detoxing they need medical attention and should be detoxed in a hospital.

Other symptoms of DT’s can include fever, shakes, and formication. Tactile hallucinations, bugs or snakes crawling over the skin are commonly associated with the DT’s. These symptoms are sometimes worse at nights and can begin to occur days after the last drink as the body attempts to adjust to the absence of alcohol.

Any unusual symptoms that occur when an alcoholic stops drinking should be checked out by a medical professional.

Can’t remember after drinking

Does a drunk suicidal person go to jail?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Does a drunk suicidal person go to jail?
Picture courtesy of pixabay

When the law, medicine, and mental health intersect.

Sometimes people have more than one problem.

What happens when someone has a medical problem, a psychiatric problem and they break the law? When something interacts with the law the law usually wins. How these cases at the intersection of disciplines are resolved depends on the laws in your jurisdiction. Most places in the United States have similar statutes often based on uniform law statutes. More and more places on earth are recognizing that mental illness is not a choice and that the mentally ill need special consideration in their encounters with the law. Here are some of the possible outcomes of a drunken suicidal person based on what happens here in my jurisdiction.

Partly this depends on the order in which things happen. Do they go to the hospital for a heart attack and then we discover they are drunk and suicidal? Or have they been arrested for driving under the influence first? What if they killed someone while drunk and now are thinking of killing themselves. All very different scenarios.

While I separate medical, psychiatric and correction issues, some places may have facilities for several of these issues. Hospitals may have psychiatric units, in custody units and so on.

Crisis issues should always get the first look.

If someone is having a heart attack or bleeding to death they need immediate medical attention. They go to the hospital. If medical problems show up while they are in jail or the psychiatric facility they should be transferred to a medical hospital unless where they are also offered that second service.

Alcohol is one of the most life-threatening of all the drug from which to detox. People can and do die from alcohol withdrawals. If someone has ever had the Delirium tremens (DT’s) they are at risk to die while sobering up. This needs to be supervised by a medical doctor.

If someone is suicidal they need psychiatric care.

We have a procedure here in California for placing someone on a psychiatric hold (technically a request for evaluation) and getting them sent for an evaluation. That first hold is only good for 72 hours. After that, a psychiatrist needs to say they need to stay or they get discharged. If they committed a crime they might get discharged from the psychiatric facility and still face legal charges.

Once at a psychiatric hospital and under the care of a psychiatrist, they will be evaluated and kept until the crisis resolved. The laws have lots of safeguards to keep people from putting other people they don’t like away and keeping them locked up for long periods of time.

Once upon a time – people stayed in psychiatric hospitals for a long time. Stays of several years or even forever commitments were common. Not anymore. Since the advent of effective medications, stays at psychiatric hospitals are getting shorter and shorter.

Stays of a week or less are now common. A long-term stay in the psychiatric facilities I have worked in would now run two weeks to a month.

Killing yourself or attempting to is illegal in most places, only the most rabid law and order types would even consider chasing someone down and arresting them because they had thought about suicide while drunk.

With the intoxicated person, they are likely to change their mind about suicide once they sober up. Studies show that people who are binge drinkers, when they drink they get drunk, are 55 times more likely to attempt suicide than people with no alcohol in their system.

So generally speaking a drunken suicidal person will not be sent to jail. If nothing else the jail does not want people killing themselves while in jail. Having clients die in your facility is bad for a business even if you run a jail or prison.

No jail for the drunken suicidal person – unless –

If the drunken person has committed a serious crime while intoxicated they are still held liable. Being drunken is not an excuse for bad or illegal behavior. Being mentally ill does not, and should not, get you a pass either.

You may not go to prison, but you will have consequences, like time in a hospital for the criminally insane, until we are sure you understand what you did and are capable of not doing that again.

Jails do have psychiatric units and they do have to put people who were arrested for serious crimes on a suicide watch from time to time. But no, most times, they have no interest in arresting and detaining someone who is suicidal.

For the record – people who are placed on a psychiatric hold are not under arrest. This does not result in a police record or mean you will have to say yes to having been convicted of a misdemeanor or felony on a job application. Your psychiatric treatment record is supposed to be confidential just like your medical treatment record. Do not let fear of legal consequences stop you from calling for psychiatric help if someone is suicidal. Dead people do not worry about having a record.

One consequence of being in the psychiatric hospital will likely be a form you sign at discharge that tells you that you cannot buy or own a firearm for five years after being in a psychiatric hospital. If you want to get a gun, then you will need to appear before a judge and convince him you have a good reason to own one.

But if you are the sort of person who gets drunk and then thinks about killing yourself and others, you are not the kind of person that I would like running around my neighborhood with a weapon.

If someone is medically sick they need to be in a hospital, someone who is suicidal needs psychiatric care and someone who breaks the law gets arrested. When someone has more than one of these issues we may have trouble figuring out what to do.

Hope that answers the question a reader sent in “Does a drunk suicidal person go to jail?” If you have more questions or comments on the issues of suicide, intoxication and our society’s response to people with multiple problems please leave a comment.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

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Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.