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SOCW 4340 Introduction to Alcohol/Drug Addiction
CHAPTER 10 Mental Health and Drugs
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Introduction 33% of People with mental illness also abuse substances
50-70% of drug abusers have mental disord Neurotransmitters same Drugs may cause symptoms Stimulants – mania, anxiety, psychosis Stimulant withdrawal – depression, anxiety Depressants – depression Psychedelics – hallucination/psychosis
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Substance related disorders
Substance use Dependence – impairment - continue in spite of consequences Abuse – disruption of life function - continue in spite of consequences Substance induced Intoxication Withdrawal Disorders – delirium, dementia, amnesia, etc.
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Determining factors Heredity Environment Use of drugs
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Determining factors Heredity Schizophrenia Bipolar Depression Anxiety
Binge eating Gambling ADHD Greatly increased risk if stressed by environment or drugs
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Determining factors Environment Stress depletes norepinephrine
Abuse/molestation – 75% of female addicts Environment potentiates risk of abuse
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Determining factors Psychoactive drugs
Change balance of neurotransmitters Drugs may induce mental disorder in any person Predisposed brain more likely to suffer permanent harm Type of drug impacts type of harm Predisposed to depression – alcohol/sed-hyp Predisposed to schizophrenia - psychedelics
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Dual diagnosis Mental disorder and substance abuse Preexisting
Thought – psychotic/schizophrenia Mood – affective - depression. Bipolar Anxiety panic/ADHD Substance induced Stimulant induced psychotic disorder Alcohol induced mood disorder Marijuana induced delirium
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Dual diagnosis Must distinguish between symptoms and the disease
Abusers often present with symptoms that may disappear with sobriety
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Dual diagnosis Epidemiology Alcohol 44% Drugs 64%
Mentally ill 29-34% abusers Manic depressive 61% Schizophrenia 47% Prisoners with mental illness 81%
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Dual diagnosis Patterns Preexisting – self medication
Substance induced – neurotransmitter imbalance
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Diagnosis Address all symptoms
Avoid making diagnosis until abuser sober Factors Particular pattern Preexisting mental illness Self medication Age of onset Relationship of the symptoms to substance use
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Diagnosis Increased population on streets Decreasing IP facilities
Substance abuse up Increase in number and expertise of practitioners Increased awareness OP pays more – over-diagnosis Disruptive – unwanted at substance abuse centers or at psychiatric treatment centers
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Mental health vs. substance abuse
Cure the disease, abuse will go away Get them sober, MH problems will resolve MH – partial recovery OK MH – stigma MH/some SA – medications MH – shepherding, SA – self-reliance MH – supportive, SA - confrontive
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Mental health vs. substance abuse
MH sharing info easier MH – more professionals, SA recovering addicts MH – scientific approaches, SA, less structured MH – prevent getting worse, SA hit bottom MH – individual, SA – one size fits all
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Mental health vs. substance abuse
Must treat simultaneously SA must connect with MH Each must see the other as a complement Case management improves outcome
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Multiple diagnosis Polydrug use Other medical problems Chronic pain
Hepatitis Epilepsy Cancer Heart/kidney disease Diabetes Sickle cell Sexual dysfunction HIV – triple diagnosis
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Disorders Thought – schizophrenia Mostly inherited Hallucinations
Delusions Inappropriate affect Ambivalence Poor association Impaired ability to care for oneself Autism Poor job performance Strained social relations
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Disorders Thought – schizophrenia Usually late teens/early adult
Drugs mimic Stimulants Steroids Mdma/marijuana Psychedelics Withdrawal from downers
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Disorders Major depressive disorder 15% of all have in lifetime
9% per year Depressed mood Diminished interest Diminished pleasure Sleep disturbance Inability to concentrate Worthlessness Suicidal thoughts Most of the day for 1 week
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Disorders Major depressive disorder Alcohol Amphetamine withdrawal
Psychedelic 80% due to drugs, not heredity
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Disorders Bipolar affective disorder Depression/normalcy/mania
Depression can be suicidal Mania Persistent elevated, expansive, irritated mood Inflated self esteem Depressed need for sleep Talkative Flight of ideas Distractibility Goal directed activity Excessive involvement with pleasurable activities
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Disorders Bipolar affective disorder Usually begins in 20s Drugs
Stimulants Psychedelics
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Disorders Anxiety 16% of adults per year
PTSD – persistent re-experience 20-25% of those in drug treatment Panic - intense fear/discomfort when no real danger Agoraphobia Social phobia Simple (specific) phobia OCD GAD Toxic effects of stimulants Withdrawal from opioids, sed/hyp or alcohol
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Disorders Dementias Developmental disorders
Brain dysfunction due to physical changes Marijuana and prescription drugs mimic Developmental disorders Retardation Autism Communication ADHD Psychedelic use can be mistaken for DD
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Disorders Somatoform Physical symptoms without obvious cause
Hypochondria Munchausen’s Stimulant psychosis – bugs Psychedelics
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Disorders Personality
Inflexible behavior leading to distress/impairment Anger Disruptive behavior Hard to treat
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Disorders Eating Weak impulse control
Co-occur with many other disorders and substance use – depression/PTSD
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Disorders Gambling Impulse control Alcohol
Stimulants, esp. methamphetamine
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Substance-induced Disorders
Alcohol induced Impulse control Violence Suicide Unsafe sex High risk behavior Sleep Suppresses REM Sleep
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Substance-induced Disorders
Alcohol induced Anxiety Withdrawal related Last 2-3 days Depression 45% have concurrent major depressive disorder After 4 weeks of sobriety 6% Antidepressants contraindicated
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Substance-induced Disorders
Alcohol Psychosis Develop after decades of heavy drinking Hallucinations Delusional thoughts Antipsychotics effective (not during withdrawal) Dementia Neurotoxic Cognitive deficits May regain some function Mimics Alzheimer’s
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Substance-induced Disorders
Stimulant induced Impulse control Mania Resolve without treatment if only induced Medication not indicated if non-abstinent Panic Drug use increases panic focus – can become chronic even if abstinent
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Substance-induced Disorders
Stimulant induced Depression Imbalance of neurotransmitters Can last 10 weeks Antidepressants helpful during detox only Anxiety Intoxication Withdrawal Treatment
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Substance-induced Disorders
Stimulant induced Psychosis Short term and long term in some For those, each use increases frequency and duration Can last for months after last use Cognitive impairment Transient damage Permanent damage Revealed by high tech imaging
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Substance-induced Disorders
Marijuana Delirium Disturbance of consciousness Change in cognition Memory Multi-step tasking 3 months to clear Psychosis Paranoia Hallucinations Tend to be transient
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Substance-induced Disorders
Panic While intoxicated Amotivational syndrome Chicken and egg question
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Treatment Rebalancing brain chemistry Education – primary prevention
Cannot change hereditary factors Improve environment Avoid stressors Leave abusive relationship Avoid drug users Sleep Avoid bad situations New friends Self-help Nutrition
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Treatment Stabilize both mental and substance abuse problems
Homicidal/suicidal Detox Diagnosis Psycho-pharmaceuticals helpful
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Treatment Impaired cognition 50% of patients
Reasoning, memory impaired May not be ready to help with treatment for weeks/months Treatment must match patient capabilities
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Treatment Developmental arrest Arrested emotional development
Lack of maturation Low frustration tolerance Can’t work toward goal independently Lie to avoid punishment Test limits Feelings expressed as behavior Shallowness of mood Fear of rejection Live in present (no hope) Denial, non-compliant For me or against me - absolutes
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Treatment Therapies Counseling Group Psychopharmacology
Primary treatment for mental illness 1st Achieve abstinence 2nd Maintain abstinence 3rd Continued therapy – emphasis on abstinence
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Psychopharmacology Used only after thorough assessment
Short term, medium term, lifetime basis Increase neurotransmitter release Block receptor Inhibit reuptake Inhibit metabolism (MAO) Enhance Monitor and adjust dose - mandatory
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Psychopharmacology Prescribed vs. street Most not addicting
Compliance is a problem Sense of control
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Psychopharmacology Depression Serotonin/norepinephrine
Most drugs increase SSRI – prozac, zoloft Serotonin syndrome Sexual dysfunction Tricylics work well for chronic MAOs – block metabolism – food drug interactions Stimulants increase norepinephrine - amps
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Psychopharmacology Bipolar Lithium Stabilizes mostly highs
Side effects Non-compliance Requires monitoring
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Psychopharmacology Psychoses Phenothiazines Haldol, etc.
Excess dopamine related Medications block receptors Treat symptoms, not disease Muscle problems, tremor, sedation, apathy
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Psychopharmacology Anxiety disorders Benzodiazepines Buspirone SSRIs
Safer than barbs/mepro Act quickly Addictive-poor choice for addict GABA Buspirone Serotonin modulator 1-2 weeks for 1st response SSRIs OCD – poor results in general Panic - SSRIs
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Psychopharmacology Compliance Patient must take the med for it to work
Feedback and face-to-face required
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