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 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 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 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 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) 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

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 20’s Affects both men and women Toxic Effects of stimulants and psychedelic abuse can mimic bi-polar disorder

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)

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 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