CO-OCCURRING DISORDERS Michaelene Spence MA LADC 8/8/12
Activity Chemical Health? Mental Health?
Video- What is Addiction HBO
Terminology MI/CD: Mental Illness/Chemical Dependency IDDT: Integrated Dual Disorder Treatment Levels of Dual Disorders treatment Rule 25: A funding mechanism. 18 page assessment that determines what type of level of care a client needs. Levels of care = detox, inpatient, outpatient Rule 31: The license through the state of MN that sets the standards of care that we must follow. All our policies and procedures are in place because of this license. Rule 29: A similar license that governs mental health clinics SPMI: Serious and Persistent Mental Illness
Mental Health treatment 1700s: Lunatics hospitalized either manic or melancholic 1800s: Idea that environment contributes to mental illness More humane treatment, more research 1850s (Civil War): soldiers came back with mental illnesses (PTSD) shock therapy and opium treatments introduced 1870s: Move to asylums for long-term care reduced stigma, populations skyrocketed Timelines Chemical Dependency treatment 1800s: alcohol and drugs (morphine, cocaine, chloral hydrate) used as medications 1840s: first research on addiction, first temperance groups formed 1900s: aversion treatments for chemical abuse 1930s: Lobotomies 1920s-30s: Prohibition 1935: Bill W started Alcoholics Anonymous 1950s: Psychotropic medications (Thorazine) 1950s: Al-Anon and Alateen started, Minnesota first DSM Model start to include families in treatment 1950s-60s: Family therapy began to gain popularity 1960s: first halfway houses and detox centers 1960s-70s: Move to deinstitutionalize clients 1970s: treatment focused on all chemicals, not just origins of outpatient mental health clinics alcohol Chemical dependency problems are moved to mental health departments, with controversy 1980: DSM-III includes substance abuse and dependence as mental health conditions 1990s-present: Co-occurring and Integrated Dual Disorders treatment programs develop
Origins of Mental Illness and Chemical Dependency Genetic factors a predisposition to mental illness and/or chemical dependency can be inherited from parents (nature) Environmental factors some risk factors for mental illness and/or chemical dependency are acquired by the context in which we live (nurture) This distinction is important in terms of how we treat MI/CD in our clients
Researchers today have shown that both play a role McLeod, S. A. (2007). Nature Nurture in Psychology. Retrieved from http://www.simplypsychology.org/naturevsnurture.html
Drug categories and effects Depressants vs. Stimulants (Central Nervous System) Depressants Alcohol Marijuana Opiates Benzodiazepines Barbiturates Stimulants Hallucinogens Cocaine Amphetamines Anabolic Steroids Inhalants Methamphetamine Tobacco
Substance Abuse/Dependence Statistics Alcohol Illicit Drugs * Marijuana % of US adults diagnosed with Abuse/Dependence * Medications * Heroin % of US adults diagnosed with Abuse/Dependence * Hallucinogens * Inhalants 0 2 4 6 8 10 Substance Abuse and Mental Health Services Administration (2010). http://www.samhsa.gov
Mental Illness Statistics Any Disorder Anxiety Disorders Mood Disorders % of US adults diagnosed Personality Disorders Substance % of US adults diagnosed Eating Disorders Attention Disorders Psychotic Disorders 0 10 20 30 National Institute of Mental Health (2012). http://www.nimh.nih.gov
Mental Illness categories and symptoms Anxiety Disorders Excessive, uncontrollable fear or worry, possibly panic attacks Mood Disorders Unstable mood, ranging from depressive to manic Personality Disorders Patterns of personality that are maladaptive Eating Disorders Body dysmorphia and related disordered eating habits Attention Disorders Attention deficits and/or hyperactivity Psychotic Disorders Disturbance of reality
Diagnosis and Symptoms Chemical Abuse Substance abuse is used to describe a pattern of substance (drug) use leading to significant problems or distress such as failure to attend work/school, substance use in dangerous situations (driving a car), substance-related legal problems, or continued substance use that interferes with friendships and/or family relationships. Substance abuse, as a disorder, refers to the abuse of illegal substances or the abusive use of legal substances. Alcohol is the most common legal drug of abuse. Chemical Dependence A diagnosis of drug dependence requires that a person have symptoms of intoxication and withdrawal
Diagnosis and Symptoms (continued) Intoxication drunkenness; inebriation; great elation; the act of intoxicating; poisoning Withdrawal the period a drug addict or alcoholic goes through following abrupt termination in the use of narcotics, alcohol or other drugs, usually characterized by physical and mental symptoms, including: Emotional Withdrawal Symptoms Anxiety Restlessness Irritability Insomnia Headaches Poor concentration Depression Social isolation Physical Withdrawal Symptoms Sweating Racing heart Palpitations Muscle tensions Tightness in the chest Difficulty breathing Tremor Nausea, vomiting, or diarrhea
Diagnosis and symptoms (continued) Dangerous Withdrawal Symptoms Alcohol and tranquilizers produce the most dangerous physical withdrawal. Suddenly stopping alcohol or tranquilizers can lead to seizures, strokes, or heart attacks in high risk patients. A medically supervised detox can minimize your withdrawal symptoms and reduce the risk of dangerous complications. Some of the dangerous symptoms of alcohol and tranquillizer withdrawal are: Grand mal seizures Heart attacks Strokes Hallucinations Delirium tremens (DTs)
Types of treatment for chemical dependency Detoxification Services A medically supervised treatment program for alcohol or drug addiction designed to purge the body of intoxicating or addictive substances and used as a first step in overcoming physiological or psychological addiction. Intensive Residential Treatment (inpatient) At Wayside this is the first 30 days in which a client comes to our treatment center. During this phase they are only allowed to leave the building with staff supervision and have more intensive programming Residential treatment (inpatient) Days 30 up to 90 (and sometimes longer) in which clients attend programming, outside appointments and self help groups, and begin transitioning into life outside of treatment Non-Residential (outpatient) Clients live on their own (usually in sober, supportive, or transitional housing while still attending 6 or more hours of treatment for 8 to 12 weeks at Wayside House Recovery Maintenance (outpatient) Clients begin decreasing the amount of services they receive at Wayside by only coming one time per week for two hours for 12 weeks. After this they can attend Commencement
Types of treatment for mental illness Medication management Outpatient therapy Community based services Intensive Outpatient programs Partial Hospitalization Day treatment Inpatient Hospitalization Medical monitoring Residential Treatment Short-term Long-term
Co-occurring Disorders History of this idea Rates of co-occurrence Adults with any mental illness and co-occurring substance abuse or dependence = 4% of all adults Among adults with substance use disorder, 42.8% had a co-occurring mental illness 37% of alcohol abusers and 53% of drug abusers also have at least one serious mental illness Of all people diagnosed as mentally ill, 29% abuse either alcohol or drugs this is almost 3 times as high as in population who are not mentally ill 47% of individuals with schizophrenia also had a substance abuse disorder (more than four times as likely as the general population) 61% of individuals with a bipolar disorder also had a substance abuse disorder (more than five times as likely as the general population) Substance Abuse and Mental Health Services Administration (2003-2009). http://www.samhsa.gov
Co-occurring Disorders Treatment options Among the 8.9 million adults with any mental illness and a substance use disorder: 44% received substance use or mental health treatment in the past year 13.5% received both mental health treatment and substance use treatment 37.6% did not receive any treatment
Addiction Only Services Dual Diagnosis Capable Dual Diagnosis Enhanced Integrated Dual Disorder Treatment Dual Diagnosis Enhanced Dual Diagnosis Capable Mental Health only Services Co-occurring disorders and Treatment Options
Principles of Integrated co-occurring disorders treatment Cross-training for clinicians Continuity in treatment Motivational interventions to facilitate client engagement and progress Behavioral interventions Case management Culturally sensitive treatment Long-term care
Principles of co-occurring disorders treatment Care that matches client s stage of recovery and stage of change Stages of addiction Pre-occupation Attempts to Control Use Destructive Behaviors to self or Others Negative impacts on all life areas with continued use Using more than intended Using alone/isolation Using less of a substance and still becoming intoxicated Tolerance becomes nil Body disease and eventual death
Prochaska et al Stages of Change
Principles of co-occurring disorders treatment Psychoeducation and self-help groups Inclusion of the client s social network and family Medical interventions when necessary Therapeutic alliance between clients and staff Dual recovery philosophy among staff
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