Mental Health & Substance Use A Non-Clinical, Harm Reduction Based Perspective Braunz Courtney, Programs Manager Michael Snow, Screening Coordinator HIV EDUCATION AND PREVENTION PROJECT OF ALAMEDA COUNTY

PRESENTATION GOALS To understand Substance use as a self medicating benefit The intersection of trauma, substance use and increased HIV and hepatitis infection Basic harm reduction based strategies to increase self prioritization of health

TRAUMA & HEALTH RISKS Depression Suicide attempts As the number of traumatic events experiences from childhood into adulthood increase, the risk for the following health problems increases: Depression Suicide attempts Inability to manage minor (peer relations, time pressures) and major (death, family separation, divorce) stressors High stress Uncontrollable anger

AFRICAN AMERICAN SPECIFIC TRAUMA Some trauma-focused theories note the effects of racism and discrimination as having an emotionally injurious effect. Afro-centric theories define white racism as a traumatic threat , particularly those that are lower-income, urban, because white racism threatens their collective survival. The concentration of community poverty leading to rising crime rates, domestic violence, increased substance use. These issues in other populations might be addressed through public services. however, in our community they (police, social services, etc.) were often corrupt, abusive, and discriminatory and therefore historically distrusted. African American women are underdiagnosed with depression as symptoms manifest differently (often due to coping through hard work and determination over physical and mental well-being = “Wonder Woman Complex”)

HEPPAC PARTICIPANTS & TRAUMA In 2015, 54% of HEPPACs syringe exchange survey participants self reported to have received a PTSD diagnosis in their lifetime Of the 54%, over half (36%) self reported to have been placed on a legal hold (5150) at least once within the past two years Of the sample size of 100 active users, 92% self reported to engage in substance use at least twice per day Common reason for substance use; “to deal with all my shit” Shit = homelessness, chronic physical pain, re-occurring PTSD triggers, lack of family connection/support, lack of basic needs, etc.

SYSTEMIC BARRIERS/CHALLENGES Discriminatory drug laws ; cocaine vs. crack; same substance different penalties; ethnically specific Non - Intersectional funding resources ; public health department operate in isolation; lack of collaborative efforts to address mental health and substance use Warped public and civic substance use lense;rooted in criminalization, not viewed as an illness THE WAR ON DRUG APPROACH

The Four Quadrant Framework for Co-Occurring Disorders More severe mental disorder/ more severe substance abuse disorder Less severe mental disorder/ more severe substance abuse disorder More severe mental disorder/ less severe substance abuse disorder Less severe mental disorder/ less severe substance abuse disorder

LEVEL I EXPERIENCED PARENTS DIVORCE DURING EARLY ADOLESCENCE PARTICIPATED IN FORMAL COUNSELING/THERAPY/NO PSYCH MEDS WORKING INDIVIDUAL HAS FAMILY SOCIAL ALCOHOLIC MANAGES DAILY/MINOR STRESSORS WITH NICOTINE HABIT INCREASED ALCOHOL CONSUMPTION DURING MAJOR STRESS EVENTS

LEVEL II Formally diagnosed with PTSD, post long-term family sexual trauma EXPERIENCED during youth strong family, peer support college student Consistent counseling/therapy/no psych meds Recreational marijuana AND ALCOHOL use Engages in unprotected sex with various partners to increase personal perception of self-worth Consistent sti infection /increased HIV risk

LEVEL III SINGLE MOTHER LACK OF FAMILY SUPPORT MINIMAL WORK EXPERIENCE / CHALLENGES FINDING STABLE WORK EXPRESSES INABILITY TO SLEEP TO PRIMARY PHYSICIAN/PRESCRIBES XANAX BEGINS OVERUSING TO DEAL WITH LATE NIGHT ANXIETY (RACING THOUGHTS OF INABILITY TO COPE)/ PHYSICIAN STOPS REFILLS AND PROVIDES REFERRAL FOR COUNSELING/THERAPY DOESN’T SEEK COUNSELING/THERAPY AND BUYS BENZOS FROM STREET DEALERS TO MAINTAIN SUBSTANCE USE

LEVEL IV

HARM REDUCTION BASED STRATEGY PROVIDE IMMEDIATE SENSE OF SAFETY Provide HEPPAC participants who are “Level IVs” with a safe place No threshold to access safe place Provide basic needs (food, confidentiality, temporary shelter from the streets Provide space for “Level IVs” to socialize with peers; consistent access to peers creates a social network that extends beyond, safe space Consistent utilization of safe space will address basic needs, which can lead to participant wanting to deal with other issues (pre-contemplation to contemplatation)