Transcript Uppers, Downers and All Arounders

Uppers, Downers and All
Arounders
Chapter 10
Mental Health and Drugs
Mental Health and Drugs: An Overview
• 40 million Americans suffer from mental health
issues
• 7-10 million have mental health and substance
abuse issues
• Studies show that neurotransmitters affected by
drugs and alcohol are the same ones affected by
mental illness
• Many people with mental health issues use
psychoactive drugs in an effort to rebalance their
brain chemistry and control
– Agitation
– Depression
– Other problems
Mental Health and Drugs: An Overview
• Heredity, environment and use of psychoactive
drugs are 3 main factors that affect the central
nervous system
• Heredity and mental balance
– Closely linked to
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Schizophrenia
Bipolar disorder
Depression
Anxiety
• Susceptible brain + hostile environment + drug
or alcohol use = increase risk of mental disorder
– Doesn't mean it Will occur, just a greater risk
Mental Health and Drugs: An Overview
• Environment and Mental Health
– Closely related
– Neurochemistry to extreme stress like physical or
sexual abuse can disrupt and unbalance reactions to
normal situations
• Psychoactive Drugs and Mental Balance
– Nervous system impacted by enough psychoactive
drugs can cause individual to develop mental illness
– Heavy use of alcohol, sedative-hypnotics or
withdrawal from stimulant drugs can aggravate
depression
– Brain predisposed to schizophrenia can develop it
– Psychotic episode can be triggered by psychedelics
Dual Diagnosis (Co-occurring Disorders)
• Definition
– Refers to a co-occurrence of an interrelated mental
disorder and substance abuse disorder
• Two categories
– Preexisting
• Schizophrenia, mood disorders and anxiety disorders
– Substance Induced
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Stimulant induced psychotic disorders
Alcohol induced depression
Marijuana induced delirium
Common for people to present with personality disorders,
particularly borderline and antisocial personalities
Dual Diagnosis (Co-occurring Disorders)
• 44% of Alcohol users and 64% of drug
addicts presented with one serious mental
illness in treatment
• Assessment
– Important to assess for mental illness after the
client has had time to sober up
– Substance abuse treatment centers without
mental health components are reluctant to
admit persons with mental illness
– Mental health try to avoid persons who have
substance abuse issues in addition to mental
illness
Dual Diagnosis (Co-occurring Disorders)
• Integrated treatment is the best option for
persons with co-occurring disorders
• Best treatment programs have mental health
and substance abuse treatment
• Important to find linkages for programs that only
address one area
• Many substance abusers also have extreme
health problems
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Chronic pain
Hepatitis
HIV/AIDS
Diabetes
High blood pressure
Kidney disease
Preexisting Mental Disorders
• Schizophrenia (Thought Disorder)
– Affects 1% of population
– Believed to be inherited
– Characterized by
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Hallucinations
Delusions
Poor association
Impaired ability to care for oneself
Onset is late teens and early adulthood
Cocaine, methamphetamines and steroids can
cause psychosis
• Paranoia caused by marijuana can be mistaken for
thought disorder & withdrawal from downers
Preexisting Mental Disorders
• Major Depressive Disorder (Affective disorder)
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Mood disorder
Bi-polar affective disorder
Dysthymia (mild depression)
15% of Americans in their lifetime
8.6 % in any year
Characterized by
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Depressed mood
Diminished interest and pleasure in most activities
Sleep & appetite disturbances
Decreased ability to concentrate
Feelings of worthlessness\suicidal thoughts
Excessive use of alcohol, stimulant withdrawal
Preexisting Mental Disorders
• Bi-polar Affective Disorder (Manic Depression)
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Alternating periods of depression, normalcy and mania
Untreated can cause suicide attempts
Persistent elevated and irritated moods
Increased self-esteem or grandiosity
Decreased need for sleep
Pressure to keep talking
Excessive involvement in pleasurable activities that have
high potential for painful consequences
• Onset is in early 20’s
• Affects both men and women
• Toxic Effects of stimulants and psychedelic abuse can mimic
bi-polar disorder
Other Mental Disorders
• Anxiety Disorder
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Most common
Affects 16% of adults
Includes PTSD
Panic Disorder with or without agoraphobia
• Recurrent panic attacks
• Fear or discomfort in absence of real danger accompanied
by somatic, cognitive or physical symptoms
• Induced by stimulants, marijuana
• Agoraphobia (fear of open spaces)
• Social Phobia (fear of being seen by others)
• Obsessive Compulsive Disorder (uncontrollable intrusive
thoughts and irresistible often distressing actions)
• Generalized Anxiety (Unrealistic Worry about several life
situations)
Other Mental Disorders
• Dementia
– Alzheimer’s Disease
• Heavy marijuana use and various prescription drugs can
mimic Alzheimer’s Disease
• Developmental Diseases
– Heavy and frequent use of psychedelics and PCP can
be mistaken for developmental disorders. ADHD,
Mental retardation, autism, communication disorders)
• Somatoform
– Physical symptoms without know causes
– Stimulants can cause delusion of skin infestations
• Personality Disorders
– Borderline and anti-social personality disorders are
common
– Usually coexist with substance abuse
Other Mental Disorders
• Eating Dusorders
– Anorexia
– Bulimia
– Often found in conjunction to major
depression and PTSD
• Pathological Gambling
– More common with alcoholics
– Gamblers may use methamphetamine in
gambling trips to Casinos
Substance Induced Disorders
• Alcohol Induced Disorders
– Violence
– Sleep disorders
– Unsafe sex
– High risk behaviors
– 45% present with major depressive disorders
– After 6 weeks of sobriety on 6% present with
depression
– Capable of causing dementia with prominent
cognitive deficits
– May occur after decades of use
PRINCIPLES OF TREATMENT FOR
PSYCHIATRIC AND SUBSTANCE USE
DISORDERS
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Establish and Maintaining Therapeutic Alliance
Managing Client’s Psychiatric or Substance Use
Providing Education about Disorders and TX
Determining need for medications (referrals)
Developing and negotiating TX Plan
Enhancing adherence to TX plan
Helping the Client and family adapt to the psychosocial
effects of the disorders
• Helping client identify factors that precipitate or
perpetuate these disorders
• Initiating efforts to improve functioning
• Facilitating access to services and coordinating
resources among different service providers.
STRATEGIES TO IMPROVE
TREATMENT ADHERENCE
• Prepare client for treatment participation
• Focus on enhancing the clients motivation to
change
• Attend to the therapeutic relationship
• Facilitate the transition between levels of care
• Focus on the treatment process
• Elicit support from family or significant others
• Monitor major symptoms
• Monitor medication use, side effects, and
potential problems
• Incorporate systems changes in clinical care
Clinical Guidelines
• Assess the cultural identity of the
individual (different cultural groups at risk)
• Assess the Cultural schemas regarding
substance use (reasons for using,
religious, social or economic)
• Assess substance use within the cultural
and psychological environment (social
stressors and motivations to use; self
medicating behaviors, race, class gender
dominance)
Clinical Guidelines
• Assess cultural Aspects of the Clinical
relationship
– Clinicians need to critically reflect on own
concepts of mood altering substance use
– American Disease Model should not be used
as the only approach Assess cultural Aspects
of the Clinical relationship