Mental Disorders – Addiction Treatment Issues

1. Mental Disorders –Addiction Treatment Issues Chapter 8 and Appendix G

2. Overview • Only a few disorders from the DSM-IV-tr covered • (2) Personality Disorders: Antisocial and Borderline • Mood Disorders –Major Depression and Bi-polar • Anxiety Disorders – Generalized and PTSD • Psychotic Disorders – Schizophrenia • Other disorders are mentioned but not covered in this course.

3. Cross-cutting Issue: Suicidality • A high-risk behavior commonly associated with serious mood disorders and substance use disorders • With which mood disorder is it most commonly associated? • Depression • When in the treatment of a person with SUD is he/she most vulnerable to suicide? • When relapse occurs after a period of substantial abstinence • Alcohol abuse is associated with what per cent of suicides? • 25-50 %

4. Why Alcohol? • How does use of alcohol relate to increased suicide risk? • Removes inhibitions - which leads to… • Poor judgment • Mood instability • Impulsiveness • Violence – towards self…………..and others

5. Screening and Assessing Risk • Ask: any thoughts of hurting yourself? Any plans? • Past history of attempts is a RED FLAG • Take all suicidal thought seriously, even without specific plan. • Ask: what is wrong? Why now? Specific plans made? Past attempts? Current feelings? • Develop safety and risk management process • Client commitment to follow advice • Remove means (e.g. pills, weapon) • Agreement to seek help and treatment • Assess risk of harm to others

6. Screening and Assessing Risk – cont’d • Provide 24-hour availability of contact until psychiatric referral is realized. • Refer people with serious plans or past attempts or serious mental illness for psychiatric intervention • Monitor and develop strategies to ensure medication adherence • Develop long-term plans to treat substance abuse. • Review all situations with supervisor/team. • Document THOROUGHLY all client reports and counselor suggestions.

7. Case Study – Beth M. • What is the first indication in the case study that Beth might be at risk of suicide? • She is complaining of drinking too much. • What is the next indication? • She cannot stay sober (“always relapses”) • Not sleeping, eating poorly, avoiding job, crying, thinking morbidly about lost relationship – these are signs of what type of mental disorder? • Depression • Taking “painkillers”…how is this significant? • Impaired judgment, increased risk of accidental overdose

8. Beth M. - continued • What kind of help does the counselor offer to Beth? • Out-patient group • How does this plan work out? • She doesn’t show up • How does the counselor find out what happened to Beth? • He/she calls her home. • What significant information did the counselor miss? • She was feeling depressed, had been drinking and had access to lethal drugs, recent loss of significant relationship.

9. What Should the Counselor Have Done? • Explore the possibility of suicidal thinking. He knew she was depressed – a clear sign. • How does Beth’s culture affect the proper approach? She may not respond to direct questions, requiring sensitivity and a gentler approach. • Can asking about suicide make someone MORE likely to act on it? No – in fact – it can be a great relief to talk about it.

10. Appendix D – p. 330 How might Beth have responded to these questions? Homework: Download the homework form that has the Appendix D-1 Key Questions in a Suicide Risk Review. Complete the form and submit it online by Sunday night, 11 p.m.