Drugs can help people beat mental problems or push them over the edge. In the second-part of a mini-series on mental health The Royal Gazette looks at why 'self-medicating' isn't a great idea.

If shelling out vast sums for illegal drugs which will destroy your life seems like the height of insanity that's because it very often it is.

Addicts are often seeking temporary relief from psychological conditions they don't know how to cope with.

But instead of reducing their mental agony the self-medicating merely compounds it.

Indeed Mid Atlantic Wellness Institute psychiatrist Chantelle Simmons said research showed that even among those aged 14 to 21 cannabis use was associated with a significant increase in development of psychotic symptoms later in life.

She told The Royal Gazette: "I tell those who think that cannabis use is natural, that it's a 'erb no, it's clearly associated with doubling or even quadrupling the development of psychotic symptoms later in life.

"These are things such as hearing voices, paranoia, perhaps thinking people are out to get you or trying to read your mind or control your thoughts.

"There's visual hallucination. The most common disorder would be schizophrenia."

It's a high price to pay for puffs of weed.

And the alarming findings are backed up by respected medical journal The Lancet which in July 2007 published a summary of 35 studies assessing whether there was evidence to connect cannabis use to psychotic or mental health disorders.

It found that individuals who had used cannabis were 41 percent more likely than those who had never used the drug to have psychosis.

The risk increased relative to dose, with the most frequent cannabis users more than twice as likely to have a psychotic outcome.

Sandy Butterfield, head of drugs counselling service FOCUS, believes around 40 percent of clients coming to her are suffering from mental illnesses such as personality disorder or schizophrenia. They are referred to mental health professionals at Turning Point.

And she believes a significant proportion of those mentally challenged drug users are suffering from fetal alcohol syndrome brain damage caused by exposure to alcohol in the womb.

"They have a cognitive disability. It could be that they process information a little slowly or they have difficulty learning."

It is vital to treat all the problems, both mental and addiction problems said Mrs. Butterfield.

"If someone hears voices and you stop the drugs, the voices will be predominant and they will go back to the drug of choice. If they can be seen by a psychiatrist then we can get a balance."

Dr. Philip Brownell, a Bermuda-based psychiatrist at Benedict Associates, worked at a psychiatric hospital in the US treating drug addicts with psychological disorders where a twin-pronged approach was taken.

Previously addicts were urged to beat their habit before looking at their mental problems. Then the trend moved to treating both at once.

"We would get a lot of lower socio-economic people coming in.

"They couldn't afford to get the regular prescribed medications for things like serious mental disorder and schizophrenia, so what they would do is get the drugs on the street because they needed to do something to alter that agony.

"They were really self-medicating, treating themselves with drugs."

Hard drugs are the most obvious forms of self-medicating, but Dr. Brownell said everything people did altered their brain chemistry in some way, for better or worse.

"When you go out and run like mad your endorphins go up." The reaction has similarities to heroin-type substances but when not overdone won't be harmful.

Over-eating, overspending, gambling, sexual addiction, overwork and rage will all alter the brain chemistry said Dr. Brownell.

Addicts didn't randomly pick their drugs, said Dr. Brownell, they choose the ones that felt right to them.

"The term 'drug of choice' isn't a flippant term, they choose the one because they like what it does for them.

"Some people gravitate towards uppers because they want stimulation, others are driven up a wall already, they want to dampen everything, go semi-conscious."

Drugs will leave their mark in their own ways, said Dr. Brownell.

"If you have a strong experience like cocaine, that etches the brain, the brain wants to run everything down that channel again.

"It is very hard to break out of that channel and find another way to live because you want to live like that again.

"There was a commercial on TV a few years back saying they don't call it dope for nothing. That is kind of like what marijuana does, it dulls a person's ambition, motivation, striving for achievement.

"It makes people super laid-back, and because of the power of the drug compared to (how it was in) the 60s and 70s it is much more powerful so the statistic of people becoming psychotic is significant," said Dr. Brownell.

"People get into a lot of paranoia with drug use, it is not just about getting caught doing something illegal. People get pretty scrambled.

"If you apply these different drugs people can develop serious mental disorders."

Some people can handle it, but no-one knows if they are going to get lucky.

Those who don't sometimes end up in his sessions where he counsels drug addicts to make fundamental changes in their life so they don't relapse.

"That's the approach I look at when I think about any psychological disorder. You can go down one of two roads in treating it."

Medication will merely blunt the symptoms whereas psychotherapy will chart a lifestyle change to ensure success in the long haul, believes Dr. Brownell. Sometimes it means going over problems in childhood, sometimes it's more about changing the way they look at life now rather than looking backwards.

It involves instilling discipline with diet, sleep and exercise. Good habits become automatic. Not only do people feel healthier but they have the ability to say 'yes' and 'no' to themselves.

"You have to say yes, I am going to exercise, no I am not staying in bed," said Dr. Brownell.

"If you build up that capacity when the triggers come that normally lead to relapse you will have more capacity to say yes to the positive things, no to the negative things."

And, according to the Mid Atlantic Wellness Association's Dr. Simmons, not all of Bermuda's drug abusers are interacting with the backstreet dealers, some are fiddling the medical system and abusing prescription drugs.

She said: "I have been involved with a few cases since I have been back which is only since August. People are obtaining prescriptions from multiple physicians.

"We referred a client for treatment who had been obtaining opioids from multiple GPs in the community."

Ironically properly prescribed medicine can be the mental patient's saviour.

Dr. Simmons said the importance of keeping up with the medicine was as important with mental illness as physical illness. Failure to do so was a significant cause of relapse.

But mixing illegal drugs with prescribed medication can be lethal heroin for example combined with prescription drugs can interfere with the breathing mechanism and be fatal.