Substance Abuse & Mental Illness

1. Substance Abuse& Mental Illness By Veneranda Heffern, LCSW and Julia Matthies, LCSW Arizona State Hospital Family Support Group January 2014

2. Dual Diagnosis/Co-Occurring Disorders • Roughly 50 percent of individuals with severe mental disorders are affected by some form of substance use disorder. • The drug most commonly used is alcohol, followed by marijuana and cocaine. Prescription drugs such as tranquilizers and sleeping medicines may also be abused.

3. Substance Abuse vs. Psychiatric Symptoms • It may be difficult to separate the behaviors due to mental illness from those due to drugs. • What are some effects of the following? • Marijuana • Alcohol • Cocaine • Hallucinogens

4. Psychological Effects of Marijuana • The effects of marijuana on mood vary and may include euphoria, calmness, anxiety, or paranoia. • Other short-term psychological effects of marijuana include: • Distorted sense of time • Paranoia • Magical or "random" thinking • Short-term memory loss • Anxiety and depression • These psychological signs of using pot also generally ease after a few hours. But residual effects can last for days.

5. Psychological Effects of Alcohol • Effects may include: • Euphoria • Mood instability • Decreased impulse control • Increased social confidence • Such symptoms might even appear “hypomanic” • In a person who has many life stresses, losses, and struggles, which is often the case as addiction to alcohol proceeds, the mood instability and lowered impulse control can lead to increased rates of violence toward others and self. Prolonged drinking increases the incidence of depressed mood, anxiety, and violence potential. • Symptoms of alcohol withdrawal include agitation, anxiety, tremor, malaise, exaggeration of reflexes, rapid heart beat, increasing blood pressure, sweating, insomnia, nausea or vomiting, and perceptual distortions.

6. Psychological Effects of Cocaine & Amphetamines • Effects may include: • Euphoria • Sense of internal well-being • Perceived increased powers of thought, strength, and accomplishment • As dosage increases, the chances of impulsive dangerous behaviors also increases. • Chronic heavy users may experience temporary paranoid delusional states. These psychotic states may last for weeks, months, and even years.

7. Psychological Effects of Cocaine & Amphetamines (Cont.) • After intoxication comes a crash in which the person is desperately fatigued, depressed, and often craves more stimulant to relieve these withdrawal symptoms. • Even with several weeks of abstinence, many people who are addicted to stimulants report a low mood that is marked by absence of pleasure and/or anxiety. • Heavy, long-term amphetamine use appears to cause long-term changes in the functional structure of the brain, and this is accompanied by long-term problems with concentration, memory, and, at times, psychotic symptoms.

8. Psychological Effects of Hallucinogens • Hallucinogens include LSD, magic mushrooms, and others. • Produce visual distortions and hallucinations. • Some people who use hallucinogens experience a distortion of their sense of time and feelings of depersonalization. • Hallucinogens may also be associated with drug-induced panic, paranoia, and even delusional states in addition to the hallucinations. • A few people who use hallucinogens experience chronic reactions, involving prolonged psychotic reactions, depression, exacerbations of preexisting mental disorders, and flashbacks.

9. Psychological Effects of Opioids • Opioid intoxication is characterized by intense euphoria and well-being. • Withdrawal results in agitation, severe body aches, gastrointestinal symptoms, low mood, and craving to use more opioids. Symptoms during withdrawal vary—some will become acutely anxious and agitated, while others will experience depression. Even with abstinence, anxiety, depression, and sleep disturbance can persist for weeks. • Phencyclidine (PCP) causes dissociative and delusional symptoms, and may lead to violent behavior and amnesia (“blacking out”) of the intoxication.

10. Psychological Effects of Sedatives • Acute intoxication with sedatives like diazepam is similar to what is experienced with alcohol. • Withdrawal symptoms are also similar to alcohol and include mood instability with anxiety and/or depression, sleep disturbance, autonomic hyperactivity, tremor, nausea or vomiting, and, in more severe cases, transient hallucinations or illusions and grand mal seizures. • Many people who use sedatives chronically seem to experience difficulty with anxiety symptoms, which respond poorly to other anxiety treatments.

11. Integrated Treatment forCo-Occurring Disorders • Integrated Treatment is a research-proven model of treatment for people with serious mental illnesses and co-occurring substance use disorders. • Consumers receive combined treatment for mental illnesses and substance use disorders from the same practitioner or treatment team. They receive one consistent message about treatment and recovery.

12. Practice Principles for Integrated Treatment for Co-Occurring Disorders • Mental health and substance abuse treatment are integrated to meet the needs of people with co-occurring disorders. • Integrated treatment specialists are trained to treat both substance use and serious mental illnesses. • Co-occurring disorders are treated in a stage-wise fashion with different services provided at different stages. • Motivational interventions are used to treat consumers in all stages, but especially in the persuasion stage.

13. Practice Principles for Integrated Treatment for Co-Occurring Disorders • Substance abuse counseling, using a cognitive-behavioral approach, is used to treat consumers in the active treatment and relapse prevention stages. • Multiple formats for services are available, including individual, group, self-help, and family. • Medication services are integrated and coordinated with psychosocial services.

14. Treatment is in aStage-Wise Fashion • Precontemplation — Engagement • Assertive outreach, practical help (housing, entitlements, other), and an introduction to individual, family, group, and self-help treatment formats. • Contemplation and Preparation — Persuasion • Education, goal setting, and building awareness of problem through motivational counseling.

15. Treatment is in aStage-Wise Fashion (Cont.) • Action — Active treatment • Counseling and treatment based on cognitive-behavioral techniques, skills training, and support from families and self-help groups. • Maintenance — Relapse Prevention • Continued counseling and treatment based on relapse prevention techniques, skill building, and ongoing support to promote recovery.

16. Integrated TreatmentRecovery Model • Hope is critical. • Services and treatment goals are consumer-driven. • Unconditional respect and compassion for consumers is essential. • Integrated treatment specialists are responsible for engaging consumers and supporting their recovery.

17. Integrated TreatmentRecovery Model (Cont.) • Integrated treatment is associated with the following positive outcomes: • Reduced substance use • Improvement in psychiatric symptoms and functioning • Decreased hospitalization • Increased housing stability • Fewer arrests • Improved quality of life

18. Ten Ways Families Can Help 1.Do learn the facts about alcoholism and addiction.  Obtain information through counseling, open AA/NA meetings, and AL-Anon. Only when we understand the characteristics and dynamics of addiction can we begin to respond to its symptoms more effectively. Realizing that addiction is a progressive disease will help you to accept your loved one as a “sick person” rather than a “bad person.” No one is to blame, the problem is not caused by bad parenting or any other family shortcoming, and attendance at open AA/NA meetings is important. You are not alone, and there are many other families just like yours involved in this struggle. 2.Don’t rescue the alcoholic or addict. Let him experience the full consequence of his or her disease. Unfortunately, it is extremely rare for anyone to be “loved” into recovery. Recovering people experience a “hitting bottom.” This implies an accumulation of negative consequences related to drinking or drug use which provides the necessary motivation and inspiration to initiate a recovery effort. It has been said that “truth” and “consequences” are the foundations of insight and this holds true for addiction. Rescuing the addicted person from his consequences only ensures that more consequences must occur before the need for recovery is realized.

19. Ten Ways Families Can Help 3.Don’t financially support the addict or their addiction. Money is the lifeblood of addiction. Buying groceries, paying for a car repair bill, loaning money, paying rent, and paying a court fine are all examples of contributing to the continuation of alcohol or drug use. Money is almost always given by family members with the best of intentions, but it always serves to enable the alcoholic or addict to avoid the natural and necessary consequences of addiction. Many addicts recover simply because they could not get money to buy their drug. 4.Don’t analyze the loved one’s drinking or drug use. Don’t try to figure it out or look for underlying causes . Addiction is a disease. Looking for underlying causes is a waste of time and energy and usually ends up with some type of blame focused on the family or others. This “paralysis by analysis” is a common manipulation by the disease of addiction which distracts everyone from the important issue of the illness itself.

20. Ten Ways Families Can Help 5.Don’t make idle threats. Say what you mean and mean what you say. Words only marginally impact the alcoholic or addict. Rather, “actions speak louder than words” applies to addiction. Threats are as meaningless as the promises made by the addicted person.  6.Don’t extract promises. A person with an addiction cannot keep promises. This is not because they don’t intend to, but rather because they are powerless to consistently act up on their commitments. Extracting a promise only serves to increase the anger toward the loved one.

21. Ten Ways Families Can Help 7.Don’t preach or lecture. Preaching and lecturing are easily discounted by the addicted person. A sick person is not motivated to take positive action through guilt or intimidation. If an alcoholic or addict could be “talked into” getting sober, many more people would get sober. 8.Do avoid the reactions of pity and anger. These emotions create a painful roller coaster for the loved one. For any given amount of anger that is felt by a family member in any given situation, that amount, or more, of pity will be felt for the alcoholic or addict once the anger subsides. This teeter-totter is a common experience for family members. They get angry over a situation, make threats or initiate consequences, and then backtrack from those decisions once the anger has subsided and has been replaced by pity. If anger can be avoided then so can pity. The family can then follow through on their decision not to enable.

22. Ten Ways Families Can Help 9.Don’t accommodate the disease. Addiction is a subtle foe. It will infiltrate a family’s home, lifestyle, and attitudes in a way that can go unnoticed by the family. As the disease progresses within the family system, the family will unknowingly accommodate its presence. Examples of accommodation include locking up money and other valuables, not inviting guests over for fear that the addict or alcoholic might embarrass them, adjusting one’s work schedule to be home with the addict or alcoholic, and planning one’s day around events involving the alcoholic. 10.Do focus upon your own life and responsibilities. Family members must identify areas of their lives that have been neglected due to their focus on, or even obsession with, the alcoholic or addict. Other family members, hobbies, job and health, for example, often take a back seat to the needs of the alcoholic or addict and the inevitable crisis of addiction. Turning attention away from the addict and focusing on other personal areas of one’s life is empowering and helpful to all concerned.

23. References • Hughes, Ed. (1/29/2007). “10 Ways Family Members Can Help a Loved One with a Drug or Alcohol Problem.” • National Alliance on Mental Illness. “NAMI: Hearts and Minds.” Created January, 2010. • National Alliance on Mental Illness. “Dual Diagnosis: Substance Abuse and Mental Illness.” Retrieved from http://www.nami.org/Content/ContentGroups/Helpline1/Dual_Diagnosis_-_Substance_Abuse_and_Mental_Illness.htmon December 27, 2013. • National Center for Biotechnology Information. “9 Substance-Induced Disorders.” retrieved from http://www.ncbi.nlm.nih.gov/books/NBK64178/on December 27, 2013. • Substance Abuse and Mental Health Services Administration. http://www.samhsa.gov/