1. Co-Occurring Disorders June 13, 2013 by Andrew Parrish, MS, LMFT

2.  Co-occurring disorders involve:  A mental health diagnosis  Major depressive disorder  Bipolar disorder  Schizophrenia  Generalized anxiety disorder  Attention Deficit Hyperactivity Disorder (ADHD)  Post-Traumatic Stress Disorder (PTSD)  A substance abuse/dependence diagnosis  Abuse: consistent problems with use of a substance on an inconsistent basis  Dependence: significant problems due to using a substance on a very consistent basis What is a co-occurring disorder?

3.  Substances are divided into two categories  Depressants (“Downers”)  Alcohol (beer, wine, spirits, mixed beverages)  Marijuana (cannabis, pot, weed, hashish)  Opiates (heroin, prescription pain killers)  Benzodiazepines (Xanax™, Klonipin™, Ativan™)  Stimulants (“Uppers”)  Cocaine  Methamphetamines  Prescription medications (Adderall™, Ritalin™) Understanding Substances

4.  Major depressive disorder  Involves periods of intense emotional and mental distress marked by sadness, irritability and even suicidal ideations  Can be connected to the seasons  Can occur at regular intervals (every 2 years)  Has no manic or hypomanic stage  Significantly impacts interacting with others  Why would someone use a depressant?  Why would someone use a stimulant? Understanding Depression

5.  Bipolar disorder  Characterized by two distinct moods  Depressed mood  Period of sadness, isolation, sometimes suicidal ideations  Manic/hypomanic mood  Period of increased mood, agitation, extreme happiness, impulsivity, grandiose thinking  Moods fluctuate over time  Significantly impacts interacting with others  Why would someone use a depressant?  Why would someone use a stimulant? Understanding Bipolar Disorder

6.  Schizophrenia  Marked by experiencing positive (added) symptoms (hallucinations, paranoia) during active stage  Marked by experiencing negative (blocking) symptoms (catatonic, isolated, withdrawn) during residual stage  Significantly impacts interacting with others  Why would someone use a depressant?  Why would someone use a stimulant?  Bonus question: what is the overlap of a mood disorder (depression or bipolar) and schizophrenia called? Understanding Schizophrenia

7.  Schizoaffective Disorder  Overlap of symptoms from:  Schizophrenia  Positive symptoms  Hallucinations and paranoia  Negative symptoms  Isolation, socially withdrawn  Mood disorder  Depression  Bipolar disorder  Is someone with schizoaffective more or less likely to use than someone with schizophrenia? Understanding Schizoaffective Disorder

8.  Generalized Anxiety Disorder  Significant periods of time worrying about life stressors  Significantly impacts interacting with others  Can follow significant trauma  Can sometimes be “irrational”  Often times, irrational anxiety is the result of thoughts being influenced by emotions and emotional responses  Is someone more likely to use stimulants or depressants with this illness? Understanding Generalized Anxiety Disorder

9.  Attention Deficit Hyperactivity Disorder  Can be predominately inattentive (formerly ADD)  Marked by inability to focus or pay attention  Completion of tasks is low even if instructions are clear  Can be predominately hyperactive  Marked by inability to calm down and engage  Completion of tasks is low due to impulsivity  Significantly impacts interactions with others  Would a person with ADHD be more likely to use a depressant or a stimulant?  Bonus question: What is a commonly prescribed medication for ADHD that is not a stimulant? Understanding ADHD

10.  Post-Traumatic Stress Disorder  Response follows a traumatic event  Death of a loved one  Potential damage to a person that could harm or kill them  Severe abuse or mistreatment  Witnessing severe abuse or mistreatment of others  Returning from a war zone  Significantly impacts interacting with others  Is someone with PTSD more likely to use a stimulant or a depressant? Understanding PTSD

11.  Substance abuse and substance dependence no longer exist as a diagnosis  Instead, substance diagnoses fall into four categories that describe symptoms  Substance use disorder  Use of a substance becomes more problematic over time with tolerance levels increasing and impacts to daily functioning being significant  Substance intoxication  Recent use of a substance resulting in marked changes to normal behavior  Substance withdrawal  Recent cessation (stopping) or “cutback” of a substance resulting in marked changes to normal behavior  Other substance related disorder  Substance use resulting in problematic functioning that does not fall in the above categories Changes in DSM-5

12.  Psychosocial Rehabilitation (PSR) can assist in  Developing coping skills  Developing healthy interaction skills  Learning more about your diagnosis  Overcoming fears  Identifying triggers for mental health or substance relapses  Taking personal responsibility for yourself  Strategies to stay clean and/or sober  Talking with a counselor or PSR staff member is helpful  Remember, mental health workers are there to help you get better!! How do you deal with co-occurring problems?