Uppers, Downers and All Arounders

1
Uppers, Downers and All Arounders

• Chapter 10
• Mental Health and Drugs

2
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

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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
• 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

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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

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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
• Stimulant induced psychotic disorders
• Alcohol induced depression
• Marijuana induced delirium
• Common for people to present with personality
  disorders, particularly borderline and antisocial
  personalities

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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

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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
• Chronic pain
• Hepatitis
• HIV/AIDS
• Diabetes
• High blood pressure
• Kidney disease

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Preexisting Mental Disorders

• Schizophrenia (Thought Disorder)
• Affects 1 of population
• Believed to be inherited
• Characterized by
• 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

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Preexisting Mental Disorders

• Major Depressive Disorder (Affective disorder)
• Mood disorder
• Bi-polar affective disorder
• Dysthymia (mild depression)
• 15 of Americans in their lifetime
• 8.6 in any year
• Characterized by
• 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

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Preexisting Mental Disorders

• Bi-polar Affective Disorder (Manic Depression)
• Characterized by
• 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 20s
• Affects both men and women
• Toxic Effects of stimulants and psychedelic abuse
  can mimic bi-polar disorder

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Other Mental Disorders

• Anxiety Disorder
• 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)

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Other Mental Disorders

• Dementia
• Alzheimers Disease
• Heavy marijuana use and various prescription
  drugs can mimic Alzheimers 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

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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

14
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

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PRINCIPLES OF TREATMENT FOR PSYCHIATRIC AND
SUBSTANCE USE DISORDERS

• Establish and Maintaining Therapeutic Alliance
• Managing Clients 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.

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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

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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)

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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