1. ©2010 McGraw-Hill Higher Education. All rights reserved. Chapter 10 Disorders Co-occurring with Substance Abuse

2. ©2010 McGraw-Hill Higher Education. All rights reserved. Definition of Co-occurring Disorder Having both a: psychiatric diagnosis and chemical dependency diagnosis Also called: dual disorder co-morbid disorder

3. ©2010 McGraw-Hill Higher Education. All rights reserved. Facts about Serious Mental Illness (SMI) Serious Mental Illness – Findings 2002, National Survey In 2002, there were 17.5 million adults aged 18 or older with SMI during the 12 months prior to being interviewed. This represents 8.3 percent of all adults in the United States. On average, adults with SMI were younger, less educated, and more likely to be female than adults without SMI.

4. ©2010 McGraw-Hill Higher Education. All rights reserved. SMI Facts cont’d Adults with SMI were more likely to be either unemployed or not in the labor force (36.4 percent) than were persons without SMI (31.2 percent). Of the three age groups considered in this report, adults aged 18 to 25 had the highest rate of SMI (13.2 percent), followed by adults aged 26 to 49 (9.5 percent) and adults aged 50 or older (4.9 percent).

5. ©2010 McGraw-Hill Higher Education. All rights reserved. SMI Facts cont’d Overall, the rate of SMI was almost twice as high among females (10.5 percent) as it was among males (6.0 percent). The two racial/ethnic groups with the highest prevalence of SMI were those reporting more than one race (13.6 percent) and American Indians and Alaska Natives (12.5 percent).

6. ©2010 McGraw-Hill Higher Education. All rights reserved. SMI Facts cont’d In 2002, there were 5 million adults aged 18 or older who had SMI and used an illicit drug in the past year. This represented 28.9 percent of all persons with SMI.

7. ©2010 McGraw-Hill Higher Education. All rights reserved. Affective Disorders Classify affective (feeling) disorders by: Severity Duration Precipitating factors

8. ©2010 McGraw-Hill Higher Education. All rights reserved. Categories of Mood Disorders Some common affective disorders are: Major depression Dysthymic disorder (a low-grade depression) Atypical depression (depression related to sudden loss; also experienced by Adult Children of Alcoholics) Organic depression Bipolar disorder, formerly referred to as manic- depressive illness (sever mood wings) Cyclothymic (mood-cycling) disorder (a less severe form of mood wings)

9. ©2010 McGraw-Hill Higher Education. All rights reserved. Depression Vegetative signs of depression include the following: Disrupted sleep patterns (REM sleep deprived) Difficulty with appetite and weight regulation Decreased cognitive functioning (including problems with concentration, memory and problem solving) Decreased libido, or sex drive Lack of motivation, decreased energy (anergia) Difficulty experiencing pleasure (anhedonia) Potential for suicide because of shame when depression associated with using

10. ©2010 McGraw-Hill Higher Education. All rights reserved. Co-occurring Bipolar Disorder Bipolar disorder is the highest affective (feeling) disorder associated with co-occurring disorders.

11. ©2010 McGraw-Hill Higher Education. All rights reserved. Co-occurring Bipolar Disorder Some common themes found with clients who have bipolar disorder and substance abuse are: A strong emphasis on depression, as opposed to mania Predominance of hopelessness Specific pattern of medication non-compliance Patients labeling of their substance abuse as self- mediation (Weiss, 2004) Excessive spending, Grandiosity, Pressured Speech

12. ©2010 McGraw-Hill Higher Education. All rights reserved. Personality Disorders To qualify for a personality disorder diagnosis, an individual’s traits and behaviors must be longstanding and must cause significant impairment in social or occupational functioning or subjective distress.

13. ©2010 McGraw-Hill Higher Education. All rights reserved. Personality Disorders cont’d Cluster ACluster BCluster C ParanoidAntisocialAvoidant SchizoidBorderlineDependent SchizotypalHistrionicObsessive- Compulsive NarcissisticPassive- Aggressive The following are the 11 DSM III-R personality disorders: From American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, Washington, D.C., American Psychiatric Association, 1987.

14. ©2010 McGraw-Hill Higher Education. All rights reserved. Personality Disorders Common personality disorders co-occurring with substance abuse disorders Antisocial personality disorder Borderline personality disorder (mood instability) Narcississtic personality disorder Dependent personality disorder Self-defeating personality disorder

15. ©2010 McGraw-Hill Higher Education. All rights reserved. Treatment of Disorders Co-occurring with Substance Abuse Treatment of co-occurring disorders means addressing both the mental illness and the substance abuse. Treating one and ignoring the other will only result in relapse.

16. ©2010 McGraw-Hill Higher Education. All rights reserved. Treatment Guidelines American Psychiatric Association (2000) Practice Guidelines for the Treatment of Psychiatric Disorders include: 1. Establish and maintain a therapeutic alliance with the client. 2. Manage the client’s psychiatric (or substance use) symptoms and monitor the status of these over time.

17. ©2010 McGraw-Hill Higher Education. All rights reserved. Treatment Guidelines cont’d 3. Provide education regarding the disorder(s) and treatment. 4. Determine the need for medications and other specific treatments. 5. Develop and overall treatment plan. 6. Enhance adherence to the treatment plan. 7. Help the client and family adapt to the psychosocial effects of the disorder(s).

18. ©2010 McGraw-Hill Higher Education. All rights reserved. Treatment Guidelines cont’d 8. Promote early recognition of new episodes and help identify factors that precipitate or perpetuate these episodes. 9. Initiate efforts to relieve and improve family functioning. 10. Facilitate access to services and coordinate resources among different service providers.