Women with Co-Occurring Disorders: Double Trouble Neuroscience Meets Recovery March 9, 2006

1. Women with Co-Occurring Disorders: Double Trouble  Neuroscience Meets RecoveryMarch 9, 2006 Susan Kaye Blank, MD Southeastern Pain Specialists, PC Southern Recovery Center, PC susan.blank@southeasternpain.com

3. Dual Diagnosis: Double Trouble A diagnosis of Addiction + another Psychiatric Disorder= Double Trouble Disease of Addiction + Personality Disorders = Double Trouble A diagnosis of Addiction + Another Medical Condition = Double Trouble A diagnosis of multiple addictions, chemical, and behavioral, such as, eating, gambling, exercising, pornography, etc. = Double Trouble

6. Neurotransmitters

7. Neurotransmitters

8. Neurotransmitters

9. Neurotransmitters

10. Neurotransmitters

11. Here is the Problem�Similar Symptoms, Different Diagnosis ETOH W/D Panic Attacks Cocaine Intox Pulse Heart Rates Tachycardia Sweating Sweating Perspiration Hand Tremor Trembling Chills Nausea Nausea Nausea Anxiety Fear Agitation Temp. Temp

12. Talbott Recovery Campus DATA Jan. 1, 2000-Dec. 31, 2006

13. Course of Treatment in Females Talbott Recovery Campus (TRC) for Years 2000, 2001, 2002, total of 1325 patients Report of 352 Female (26%) Patients with comparative data on 974 Male (73.4%) Patients Average Age: Females 41.6 (18-80) Males 42.6 (19-73)

14. Previous Treatment for Addiction

15. Relationships

16. Children

17. Final Diagnoses 33 of 233 patients or 14% were discharged with diagnoses confined to AXIS I AXIS II 122patients, or 35% of Cases under review were diagnosed with personality disorders or traits. 192 patients, 54% of cases under review were diagnosed with general medical abnormalities on AXIS III

18. AXIS I Final Diagnoses-CD Females Males

19. Summary of Non-CD AXIS I Females: 12% had an eating disorder 5% had a Cognitive Disorder 2% had ADHD 11% had an Anxiety Disorder 64% had a Depressive Disorder 9% had Bipolar Disorder

20. Summary of Non-CD AXIS I Males: No one had an eating disorder 6% had a Cognitive Disorder 3% had ADHD 5% had an Anxiety Disorder 42% had a Depressive Disorder 6% had Bipolar Disorder

21. AXIS I Final Diagnoses- Mood Females Males

22. AXIS I Final Diagnoses- Anxiety Females Males

23. AXIS I Final Diagnoses- Other Females Males

24. When a woman was admitted:

25. When a man was admitted:

26. IQ Tests Scores

27. Summary: Women and Treatment Areas of Concern Further along in their �disease� upon admission More likely to have multiple treatments/relapses More likely to have relationship problems Less likely to have licensure issues

28. Assessment and Treatment Considerations for Aftercare for Women

29. Assessment Considerations Axis I- Assess the signs and symptoms of depression, anxiety, eating disorders, and PTSD Axis II- Be aware of the more primitive personality disorders and their impact on level and types of coping skills and world view. Axis III- Assess the medical health issues, toxic effects of alcohol, thyroid problems, especially STD�s, smoking related issues, trauma

30. Assessment Considerations AXIS IV- Be aware of stressors, including financial, legal, domestic violence, and support system issues. AXIS V- Level of functioning and after care implications.

31. Treatment Considerations Integrated treatment for mood, addiction, eating disorders and health related issues Monitor closely for re-emergence of eating disorders Support system may not be patient�s family If possible, have a psychiatrist prescribing medication who is familiar with CD

32. Treatment Considerations May need more cognitive support and training Assertiveness training, sex education and strategies for coping with violence May have more guilt and shame related to their disease because of cultural issues Consider some gender specific groups within the treatment program

33. After Care Needs Career, legal, and financial issues, as well as transportation and child care support are needed to help patient cope with recovery plan Acceptance and ontic courage may be more important in successful recovery than other aspects Follow up for other AXIS I, II and III diagnoses are very important to sobriety

34. MORE STUDY IS NEEDED Attention to early interventions/prevention Attention to children at risk Criminal justice system Domestic violence/abuse Physical effects of drugs and ETOH on women and health related treatment Improvement in treatment programs and aftercare to support good recovery Decrease in drug use and smoking overall, but increase in rate of women/girls using Prenatal, peri natal effects of drugs and ETOH on children, also environments Women constitute the fastest growing segment of the criminal justice populations. Effects on drug use, recovery and relapse Little is known about drugs other than ETOH, need to know what physical problems may be related, how to screen for and treat these problems What works best for women, gender specific goals, types of programs and special continuing care issuesDecrease in drug use and smoking overall, but increase in rate of women/girls using Prenatal, peri natal effects of drugs and ETOH on children, also environments Women constitute the fastest growing segment of the criminal justice populations. Effects on drug use, recovery and relapse Little is known about drugs other than ETOH, need to know what physical problems may be related, how to screen for and treat these problems What works best for women, gender specific goals, types of programs and special continuing care issues