Uppers, Downers and All Arounders

1. Uppers, Downers and All Arounders Chapter 10 Mental Health and Drugs

2. Mental Health and Drugs: An Overview • 40 million Americans suffer from mental health issues • 7-10 million have mental health and substance abuse issues • Studies show that neurotransmitters affected by drugs and alcohol are the same ones affected by mental illness • Many people with mental health issues use psychoactive drugs in an effort to rebalance their brain chemistry and control • Agitation • Depression • Other problems

3. Mental Health and Drugs: An Overview • Heredity, environment and use of psychoactive drugs are 3 main factors that affect the central nervous system • Heredity and mental balance • Closely linked to • Schizophrenia • Bipolar disorder • Depression • Anxiety • Susceptible brain + hostile environment + drug or alcohol use = increase risk of mental disorder • Doesn't mean it Will occur, just a greater risk

4. Mental Health and Drugs: An Overview • Environment and Mental Health • Closely related • Neurochemistry to extreme stress like physical or sexual abuse can disrupt and unbalance reactions to normal situations • Psychoactive Drugs and Mental Balance • Nervous system impacted by enough psychoactive drugs can cause individual to develop mental illness • Heavy use of alcohol, sedative-hypnotics or withdrawal from stimulant drugs can aggravate depression • Brain predisposed to schizophrenia can develop it • Psychotic episode can be triggered by psychedelics

5. Dual Diagnosis (Co-occurring Disorders) • Definition • Refers to a co-occurrence of an interrelated mental disorder and substance abuse disorder • Two categories • Preexisting • Schizophrenia, mood disorders and anxiety disorders • Substance Induced • Stimulant induced psychotic disorders • Alcohol induced depression • Marijuana induced delirium • Common for people to present with personality disorders, particularly borderline and antisocial personalities

6. Dual Diagnosis (Co-occurring Disorders) • 44% of Alcohol users and 64% of drug addicts presented with one serious mental illness in treatment • Assessment • Important to assess for mental illness after the client has had time to sober up • Substance abuse treatment centers without mental health components are reluctant to admit persons with mental illness • Mental health try to avoid persons who have substance abuse issues in addition to mental illness

7. Dual Diagnosis (Co-occurring Disorders) • Integrated treatment is the best option for persons with co-occurring disorders • Best treatment programs have mental health and substance abuse treatment • Important to find linkages for programs that only address one area • Many substance abusers also have extreme health problems • Chronic pain • Hepatitis • HIV/AIDS • Diabetes • High blood pressure • Kidney disease

8. Preexisting Mental Disorders • Schizophrenia (Thought Disorder) • Affects 1% of population • Believed to be inherited • Characterized by • Hallucinations • Delusions • Poor association • Impaired ability to care for oneself • Onset is late teens and early adulthood • Cocaine, methamphetamines and steroids can cause psychosis • Paranoia caused by marijuana can be mistaken for thought disorder & withdrawal from downers

9. Preexisting Mental Disorders • Major Depressive Disorder (Affective disorder) • Mood disorder • Bi-polar affective disorder • Dysthymia (mild depression) • 15% of Americans in their lifetime • 8.6 % in any year • Characterized by • Depressed mood • Diminished interest and pleasure in most activities • Sleep & appetite disturbances • Decreased ability to concentrate • Feelings of worthlessness\suicidal thoughts • Excessive use of alcohol, stimulant withdrawal

10. Preexisting Mental Disorders • Bi-polar Affective Disorder (Manic Depression) • Characterized by: • Alternating periods of depression, normalcy and mania • Untreated can cause suicide attempts • Persistent elevated and irritated moods • Increased self-esteem or grandiosity • Decreased need for sleep • Pressure to keep talking • Excessive involvement in pleasurable activities that have high potential for painful consequences • Onset is in early 20’s • Affects both men and women • Toxic Effects of stimulants and psychedelic abuse can mimic bi-polar disorder

11. Other Mental Disorders • Anxiety Disorder • Most common • Affects 16% of adults • Includes PTSD • Panic Disorder with or without agoraphobia • Recurrent panic attacks • Fear or discomfort in absence of real danger accompanied by somatic, cognitive or physical symptoms • Induced by stimulants, marijuana • Agoraphobia (fear of open spaces) • Social Phobia (fear of being seen by others) • Obsessive Compulsive Disorder (uncontrollable intrusive thoughts and irresistible often distressing actions) • Generalized Anxiety (Unrealistic Worry about several life situations)

12. Other Mental Disorders • Dementia • Alzheimer’s Disease • Heavy marijuana use and various prescription drugs can mimic Alzheimer’s Disease • Developmental Diseases • Heavy and frequent use of psychedelics and PCP can be mistaken for developmental disorders. ADHD, Mental retardation, autism, communication disorders) • Somatoform • Physical symptoms without know causes • Stimulants can cause delusion of skin infestations • Personality Disorders • Borderline and anti-social personality disorders are common • Usually coexist with substance abuse

13. Other Mental Disorders • Eating Dusorders • Anorexia • Bulimia • Often found in conjunction to major depression and PTSD • Pathological Gambling • More common with alcoholics • Gamblers may use methamphetamine in gambling trips to Casinos

14. Substance Induced Disorders • Alcohol Induced Disorders • Violence • Sleep disorders • Unsafe sex • High risk behaviors • 45% present with major depressive disorders • After 6 weeks of sobriety on 6% present with depression • Capable of causing dementia with prominent cognitive deficits • May occur after decades of use

15. PRINCIPLES OF TREATMENT FOR PSYCHIATRIC AND SUBSTANCE USE DISORDERS • Establish and Maintaining Therapeutic Alliance • Managing Client’s Psychiatric or Substance Use • Providing Education about Disorders and TX • Determining need for medications (referrals) • Developing and negotiating TX Plan • Enhancing adherence to TX plan • Helping the Client and family adapt to the psychosocial effects of the disorders • Helping client identify factors that precipitate or perpetuate these disorders • Initiating efforts to improve functioning • Facilitating access to services and coordinating resources among different service providers.

16. STRATEGIES TO IMPROVE TREATMENT ADHERENCE • Prepare client for treatment participation • Focus on enhancing the clients motivation to change • Attend to the therapeutic relationship • Facilitate the transition between levels of care • Focus on the treatment process • Elicit support from family or significant others • Monitor major symptoms • Monitor medication use, side effects, and potential problems • Incorporate systems changes in clinical care

17. Clinical Guidelines • Assess the cultural identity of the individual (different cultural groups at risk) • Assess the Cultural schemas regarding substance use (reasons for using, religious, social or economic) • Assess substance use within the cultural and psychological environment (social stressors and motivations to use; self medicating behaviors, race, class gender dominance)

18. Clinical Guidelines • Assess cultural Aspects of the Clinical relationship • Clinicians need to critically reflect on own concepts of mood altering substance use • American Disease Model should not be used as the only approach Assess cultural Aspects of the Clinical relationship