1. Uppers, Downers and All Arounders
Chapter 10
Mental Health and Drugs

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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)

12. 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

13. 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

14. 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

15. 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.

16. 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

17. 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)

18. 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