1. SOCW 4340 Introduction to Alcohol/Drug Addiction
CHAPTER 10 Mental Health and Drugs

2. 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

3. 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.

4. Determining factors
Heredity
Environment
Use of drugs

5. Determining factors Heredity Schizophrenia Bipolar Depression Anxiety
Binge eating
Gambling
ADHD
Greatly increased risk if stressed by environment or drugs

6. Determining factors Environment Stress depletes norepinephrine
Abuse/molestation – 75% of female addicts
Environment potentiates risk of abuse

7. 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

8. 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

9. Dual diagnosis Must distinguish between symptoms and the disease
Abusers often present with symptoms that may disappear with sobriety

10. Dual diagnosis Epidemiology Alcohol 44% Drugs 64%
Mentally ill 29-34% abusers
Manic depressive 61%
Schizophrenia 47%
Prisoners with mental illness 81%

11. Dual diagnosis Patterns Preexisting – self medication
Substance induced – neurotransmitter imbalance

12. 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

13. 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

14. 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

15. 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

16. 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

17. Multiple diagnosis Polydrug use Other medical problems Chronic pain
Hepatitis
Epilepsy
Cancer
Heart/kidney disease
Diabetes
Sickle cell
Sexual dysfunction
HIV – triple diagnosis

18. 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

19. Disorders Thought – schizophrenia Usually late teens/early adult
Drugs mimic
Stimulants
Steroids
Mdma/marijuana
Psychedelics
Withdrawal from downers

20. 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

21. Disorders Major depressive disorder Alcohol Amphetamine withdrawal
Psychedelic
80% due to drugs, not heredity

22. 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

23. Disorders Bipolar affective disorder Usually begins in 20s Drugs
Stimulants
Psychedelics

24. 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

25. 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

26. Disorders Somatoform Physical symptoms without obvious cause
Hypochondria
Munchausen’s
Stimulant psychosis – bugs
Psychedelics

27. Disorders Personality
Inflexible behavior leading to distress/impairment
Anger
Disruptive behavior
Hard to treat

28. Disorders Eating Weak impulse control
Co-occur with many other disorders and substance use – depression/PTSD

29. Disorders Gambling Impulse control Alcohol
Stimulants, esp. methamphetamine

30. Substance-induced Disorders
Alcohol induced
Impulse control
Violence
Suicide
Unsafe sex
High risk behavior
Sleep
Suppresses REM Sleep

31. 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

32. 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

33. 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

34. Substance-induced Disorders
Stimulant induced
Depression
Imbalance of neurotransmitters
Can last 10 weeks
Antidepressants helpful during detox only
Anxiety
Intoxication
Withdrawal
Treatment

35. 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

36. 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

37. Substance-induced Disorders
Panic
While intoxicated
Amotivational syndrome
Chicken and egg question

38. 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

39. Treatment Stabilize both mental and substance abuse problems
Homicidal/suicidal
Detox
Diagnosis
Psycho-pharmaceuticals helpful

40. 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

41. 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

42. Treatment Therapies Counseling Group Psychopharmacology
Primary treatment for mental illness
1st Achieve abstinence
2nd Maintain abstinence
3rd Continued therapy – emphasis on abstinence

43. 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

44. Psychopharmacology Prescribed vs. street Most not addicting
Compliance is a problem
Sense of control

45. 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

46. Psychopharmacology Bipolar Lithium Stabilizes mostly highs
Side effects
Non-compliance
Requires monitoring

47. Psychopharmacology Psychoses Phenothiazines Haldol, etc.
Excess dopamine related
Medications block receptors
Treat symptoms, not disease
Muscle problems, tremor, sedation, apathy

48. 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

49. Psychopharmacology Compliance Patient must take the med for it to work
Feedback and face-to-face required