Faith Communities & Mental Illness: Tools for Response and Care

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1 Faith Communities & Mental Illness: Tools for Response and Care Addiction and Mental Illness Bill B. Burnett, M.Ed., MAC April 27, 2012

2 Objectives To understand the connection between substance use, abuse and dependence with mental illness. To review some substance abuse facts and figures. To understand the importance of neurobiology in substance abuse. To review some information about alcohol and marijuana. Bill B. Burnett, M.Ed., MAC 2

3 Outline of Presentation Definitions of mental disorder, substance abuse and dependence (addiction) Facts and figures about of substance use and abuse Neurobiology simplified Alcohol information Marijuana information Bill B. Burnett, M.Ed., MAC 3

4 WHAT IS A MENTAL DISORDER? A mental disorder or mental illness is a diagnosable illness that: affects a person s s thinking, emotional state, behavior, and disrupts the person s s ability to: work carry out other daily activities, and engage in satisfying relationships. 4

5 What are the substances of abuse? The DSM IV includes 11 classes of substances Alcohol Amphetamines Caffeine Cannabis Cocaine Hallucinogens Inhalants Nicotine Opioids Phencyclidine (PCP) Sedatives Diagnostic Diagnostic and and Statistical Statistical Manual Manual of of Mental Mental Disorders Disorders Fourth Fourth Edition, Edition, American American Psychiatric Psychiatric Association. Association. Bill B. Burnett, M.Ed., MAC 5

6 Substance Abuse The essential feature of Substance Abuse is a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substances. There may be repeated failure to fulfill major role obligations, repeated recurrent social and interpersonal problems. Diagnostic Diagnostic and and Statistical Statistical Manual Manual of of Mental Mental Disorders Disorders Fourth Fourth Edition, Edition, American American Psychiatric Psychiatric Association. Association. Bill B. Burnett, M.Ed., MAC 6

7 Substance Dependence The essential feature of Substance Dependence is a cluster of cognitive, behavioral and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems. There is a pattern of repeated self- administration that usually results in tolerance, withdrawal, and compulsive drug-taking behavior. Diagnostic Diagnostic and and Statistical Statistical Manual Manual of of Mental Mental Disorders Disorders Fourth Fourth Edition, Edition, American American Psychiatric Psychiatric Association. Association. Bill B. Burnett, M.Ed., MAC 7

8 Mental Illness: FACTS and Numbers One in four adults approximately 57.7 million American experience a mental health disorder in a given year. One in 17 lives with a serious mental illness. Anxiety disorders affect 18.7% of adults An estimated 5.2 million have co-occuring occuring mental health and addiction disorders. Suicide is the 11 th leading cause of death for people ages years. Addiction and Mental Illness 8

9 2001 U.S. Drug Use in Past Month Alcohol 48.3% million Cigarettes 24.9% 60.4 million Marijuana 5.4% 12.2 million Ecstasy 3.6% 8.1 million Cocaine 0.7% 1.7 million Heroin 0.1% 123 thousand Epidemiology of Substance Abuse Bill B. Burnett, M.Ed., MAC 9

10 Alcohol is the Most Commonly Used Drug Among Year Olds Percent using in past month NSDUH Survey, 2002 Epidemiology of Substance Abuse 8th 10th 12th Grade Alcohol Cigarettes Marijuana Bill B. Burnett, M.Ed., MAC 10

11 U.S. High School Seniors 30-Day Drug Use Any illicit drug Heroin Steroids Inhalants Cocaine 0.5% 1.4% 1.5% 2.3% 25.4% Hallucinogens MDMA Tranquilizers Amphetamines 2.3% 2.4% 3.3% 5.5% Smokeless tobacco Marijuana Cigarettes 6.5% 21.5% 26.9% Alcohol 48% 0% 10% 20% 30% 40% 50% Epidemiology of Substance Abuse Bill B. Burnett, M.Ed., MAC 11

12 New Users Alcohol million 12,500 new users daily Any Illicit Drug million 8,500 new users daily Marijuana million 6,575 new users daily Non-prescribed Prescription drugs million 7,000 new users daily Tobacco million 6,900 new users daily Methamphetamine , new users daily National Survey on Drug Use and Health (NSDUH) 2009 Epidemiology of Substance Abuse Bill B. Burnett, M.Ed., MAC 12

13 Prevalence of Lifetime Use of Heroine, Cocaine, and Psychotherapeutics among Adults Aged 26 or Older, by Age of Marijuana Initiation: 1999 and 2000 Epidemiology of Substance Abuse Bill B. Burnett, M.Ed., MAC 13 SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 1999 and 2000.

14 Additional Risks Related to Alcohol Use and Aging Elderly individuals are more likely to be affected by chronic illness and use of medications Alcohol and prescription drug problems are frequently: Under-identified Under-treated Under-diagnosed diagnosed Under-estimated estimated Epidemiology of Substance Abuse Bill B. Burnett, M.Ed., MAC 14

15 Scope of Alcohol/Drug Problems Fifty percent of our (US) population either has a problem with drinking or use of illegal drugs or has a family member with the problem. Roger Bensinger Board Member of the National Council on Alcoholism and Drug Dependence Inc. (NCADD) a quote in March 22, 2004 Alcoholism & Drug Abuse Weekly. Epidemiology of Substance Abuse Bill B. Burnett, M.Ed., MAC 15

16 Colleges Battle Dangerous Drinking Alcohol abuse plagues universities The death toll from alcohol has risen among US College students from 1,440 in 1998 to 1,825 in 2005 College responses have varied from denial that the problem exists to a complete ban of all alcohol on college property. NIAAA Epidemiology of Substance Abuse Bill B. Burnett, M.Ed., MAC 16

17 Percent of Prisoners with Alcohol or Drug Problems Between 50 and 85 of percent of prisoners are incarcerated because of problems related to drug and alcohol abuse. Two-thirds of adult and one-half of juvenile arrestees tested positive for at least one illicit drug. Nearly one in five state inmates said that had committed the offense to obtain money to buy drugs. National Assembly: Drugs, Alcohol Abuse and the Criminal Offender - ONDCP, Epidemiology of Substance Abuse Bill B. Burnett, M.Ed., MAC 17

18 Odds of an Alcohol-Dependent Individual Having a Co-occurring Disorder (General Population) Anxiety Disorders Panic disorder with agoraphobia Panic disorder without agoraphobia Social phobia Specific Generalized Anxiety Mood Disorders Major depression Dysthymia Mania Hypomania Drug Dependence DSM-IV 12-month Prevalence Antisocial Personality Disorder Odds 3.6x 3.4x 2.5x 2.2x 3.1x 3.7x 2.8x 5.7x 5.2x 36.9x 7.1x NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003.

19 Possible Causes Causes of Alcohol Addiction Genetic family history of addiction Emotional Makeup may use alcohol to block pain in life Psychological persons with low self esteem or depression Social availability, peer pressure Frequency drinking regularly Age young people are at great risk Gender men are more likely to become addicted Causes of Mental Illness Genetics Infections Brain defects or injury Prenatal damage Substance abuse Other nutrition, exposure to toxins Psychological Environmental death, dysfunctional family, changing jobs or schools, social expectations, parental substance abuse Addiction and Mental Illness 19

20 Addiction and Mental Illness At least 60% of persons battling one are battling both disorders When there is a genetic or biological vulnerability to any type of mental health problem substance may trigger the onset of that problem Substance use is not the cause, but can be a precipitating factor that causes the condition to manifest Some researchers are now saying that certain forms of mental illness and addictions may be a single disease not a dual diagnosis Addiction and Mental Illness 20

21 Neurobiology Simplified Neurobiology Simplified Bill B. Burnett, M.Ed., MAC 21

22 The Cellular Battery All living cells are batteries capable of storing an electrical charge. Surrounding every cell is a membrane composed of a layer of lipids (fats) and proteins that limits the flow of materials into and out of the cell. This flow is strictly controlled. Neurobiology Simplified Bill B. Burnett, M.Ed., MAC 22

23 Dendrites and Axons Dendrites are receivers of information - input. They collect signals from other neurons and send this information to the cell body. Axons are transmitters of information - output. They send this information to other neurons. Neurobiology Simplified Bill B. Burnett, M.Ed., MAC 23

24

25 Axon - Synapse - Dendrite

26 How Drugs Work The meeting place between electricity and chemistry - the synapse, is where the drugs have their impact. In various ways drugs interfere or modify the orderly manufacture, the orderly release, and the orderly reabsorption or breakdown of neurotransmitters. Neurobiology Simplified Bill B. Burnett, M.Ed., MAC 26

27 Neurotransmitters Transmitters come in all shapes and sizes. Some are inhibitory - they close the channels in the postsynaptic membrane making it more negative than normal. Others are excitatory - they open the channels in the postsynaptic membrane making this section less negative than normal. Neurobiology Simplified Bill B. Burnett, M.Ed., MAC 27

28 Neurotransmitter, Impact and Drug Mimic

29 Some Neurotransmitters Dopamine (DA) Serotonin (SER) Endorphins (END) Gamma-Amniobutyric Acid (GABA) Glutamate (GLU) Neurobiology Simplified Bill B. Burnett, M.Ed., MAC 29

30 Serotonin Normal Functions mood stability, appetite, sleep control, sexual activity, aggression, self esteem Neurobiology Simplified Bill B. Burnett, M.Ed., MAC 30

31 Serotonin Non-pharmaceutical Drugs That Disrupt Serotonin Alcohol, nicotine, amphetamine, cocaine, PCP, LSD, MDMA, Ecstasy Neurobiology Simplified Bill B. Burnett, M.Ed., MAC 31

32 Serotonin Mental Illnesses associated with the disruption of Serotonin Anxiety, depression, bipolar disorder, obsessive-compulsive disorder Neurobiology Simplified Bill B. Burnett, M.Ed., MAC 32

33 Serotonin Medications Used To Rebalance Serotonin BuSpar, tricyclic antidepressants, Prozac, Zoloft, tryptophan, Ritanserin, Anafranil, Paxil Neurobiology Simplified Bill B. Burnett, M.Ed., MAC 33

34 Dopamine Normal Functions Muscle tone/control, motor behavior, energy, reward mechanism, attention span, pleasure, emotional stability, hunger/thirst/sexual satiation. Neurobiology Simplified Bill B. Burnett, M.Ed., MAC 34

35 Dopamine Non-pharmaceutical Drugs That Disrupt Dopamine Cocaine, nicotine, PCP, amphetamine, caffeine, LSD, marijuana, alcohol, opioid Neurobiology Simplified Bill B. Burnett, M.Ed., MAC 35

36 Dopamine Mental Illnesses associated with the disruption of Dopamine Schizophrenia, Parkinson s s Disease, Attention Deficit Disorder Neurobiology Simplified Bill B. Burnett, M.Ed., MAC 36

37 Dopamine Medications Used To Rebalance Dopamine MAO Inhibitors, Ritalin, phenothiazine antipsychotics, thiazone antipsychotics, tyrpsone, taurine, bromocryphine, amantadine, L-dopaL Neurobiology Simplified Bill B. Burnett, M.Ed., MAC 37

38 ALCOHOL

39 Percentage in each age group who develop first-time alcohol dependence 1.8% 1.6% 1.4% 1.2% 1.0% 0.8% 0.6% 0.4% 0.2% 0.0% Age at Onset of DSM-IV Alcohol Dependence Age Source: NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003

40 Source The product of fermentation of complex carbohydrates and sugars in fruits, vegetables and grains. Bill B. Burnett, M.Ed., MAC 40

41 Neurotransmitters Depleted Gamma amino butyric acid (GABA). Bill B. Burnett, M.Ed., MAC 41

42 Brain Sites Affected Cerebral cortex, cerebellum and brain stem - particularly the breathing center. Bill B. Burnett, M.Ed., MAC 42

43 Initial Mood Alteration Mild euphoria, relaxation and sedation. Bill B. Burnett, M.Ed., MAC 43

44 Acute Side Effects Intoxication Diminished hearing Diminished sense of responsibility Hangover Bill B. Burnett, M.Ed., MAC 44

45 Chronic Side Effects Addiction Cirrhosis of the liver Memory impairment Reasoning impairment Fetal Alcohol Syndrome Bill B. Burnett, M.Ed., MAC 45

46 Alcohol: Social Health Effects Total U.S. Drinking Deaths: 130,000 Drinking is involved in: 40 % of fatal car crashes 50% of all murders 20-36% of all suicides 50% of rapes 25-30% of admissions to hospitals Bill B. Burnett, M.Ed., MAC 46

47 There is no problem so great that drinking cannot make far worse. Anonymous Bill B. Burnett, M.Ed., MAC 47

48

49 1.6% 1.4% 1.2% 1.0% 0.8% 0.6% 0.4% 0.2% 0.0% Age at Onset of DSM-IV Cannabis Use Disorders Percentage in each age group who develop first-time Cannabis Use Disorders Age Source: NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003

50 Neurotransmitters Depleted Acetylcholine, serotonin, endorphins and GABA. Marijuana Bill B. Burnett, M.Ed., MAC 50

51 THC Marijuana is the dried buds and leaves of the Cannabis sativa plant. This plant contains more than 400 chemicals, including delta-9-tetrahydrocannabinol tetrahydrocannabinol (THC), the plant s s main psychoactive chemical. Marijuana Bill B. Burnett, M.Ed., MAC 51

52 Acute Side Effects Reddening of the whites of the eyes, dry throat, elevated appetite, anxiety, panic and paranoia. Short-term term memory impairment. Concentration span impairment. Psychomotor impairment. Marijuana Bill B. Burnett, M.Ed., MAC 52

53 Chronic side effects: Probable respiratory diseases. Possible addiction. Memory damage and decline in other intellectual skills. A marked decline in occupational performance and educational performance in children. Reduced production of reproductive hormones. Impaired ovulation, sperm production and libido. Reduced white blood cell production. Marijuana Bill B. Burnett, M.Ed., MAC 53

54 Marijuana Potency More potent today with more intense effects. THC content can vary from 3 to 25 percent. THC content has been reported greater that 35 per cent on rare occasions. Marijuana Bill B. Burnett, M.Ed., MAC 54

55 Frequent marijuana use leads to more tissue destruction and long-term impairment of our highest intellectual functions than almost any other drug of abuse. Robert Gilkeson, Director Brain Research Institute, California Marijuana Bill B. Burnett, M.Ed., MAC 55

56 The good news is Drug abuse is a preventable behavior And Drug addiction is a treatable disease Bill B. Burnett, M.Ed., MAC 56

57 WEB Sites YRBSS Institute of Medicine NIDA NIAAA NIAAA Epidemiology of Substance Abuse Bill B. Burnett, M.Ed., MAC 57

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