1. 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

2. 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

3. 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

4. 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”)

5. 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.

6. 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

7. 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

8. 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

9. 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

10. 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

11. LEVEL IV

12. 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)