Microsoft powerpoint - cip co-occurring handout [compatibility mode]

• Research targets “cleaner” populations • What percentage (approx.) of your clients/ • Clinicians/ agencies do not communicate • One question or problem related to CODs • Alcohol and drug dependence can present with symptoms suggestive of psychiatric disorders – Drug interactions– Aggravating medical problems • Underlying/ Primary problem progresses – Develop treatment resistance?– Therapeutic nihilism • Ineffective treatment
• Caution: patient/ family attribution is not Mental Health Commissioners and Substance Abuse Directors would broadened to include other disabilities, physical health, and infectious disease.
• Best approach is an integrated system both across disciplines and systems.
• Lack of History (old and recent records)• Lack of lab data (drug screens) • Diagnosis only as good as the interview • Exposure to substances can mimic other – Methamphetamine induced psychosis vs. – Alcohol withdrawal vs. anxiety disorder • No tests can replace clinical assessment – No “biomarkers”- Except for substance use – Meth can have significant cognitive deficits • Meth may have other stigmata: teeth, – Steroid psychosis, Huntington’s disease • Mood Disorder secondary to substance – Depression symptoms present but doesn’t • Damage to the brain’s serotonin system – Sadness, apathy, irritability, mood swings • No evidence that antidepressants help – 2/3 report depression “unchanged” compared Resolution of depressive symptoms with abstinence (2 - 4 wk) is important Onset of alcohol use problems before the development of depression Obviates need for anti depressants (side effects, cost, utilisation of scant resources- Remission from depressive symptoms following periods of abstinence from alcohol (> 1 month), Resolution of depression can act as a major A positive family history of alcohol dependence A prescription may suggest to the current drinker that mood improvement is possible Earlier age of onset of alcohol dependence The presence of other substance use disorders Onset of depression before the development of alcohol dependence No remission from depression despite periods of abstinence from alcohol (> 1 month) Generally wait 2-4 weeks following withdrawal then reassess mood and treat if depressed A positive family history of affective disorder The absence of other substance use disorders Remission of Depressive
Symptoms
with Abstinence
s
s 30%
D 20%
d 10%
Abstinence
– incr activity (school, work, sex, social) – activities with neg. consequences (shopping Brown S, Schuckit M. J Stud Alcohol. 1988;49:412-417.
• Rapid Cycling less common (4+ episodes – LSD, stimulants (meth, meth, meth), PCP decrease to near normal during 4 weeks of abstinence – Irritability, sleep problems, memory deficits • Substance use interferes with treatment of Brown S, Irwin, M. Schuckit M. J Stud Alcohol.
1991;52:55-61.
PTSD Diagnosis
PTSD-adaptive hyper-vigilance through sensitization of stress response • Persistent and debilitating problems for
at least a month
Sedative/ hypnotics/ alcohol interrupt this • Three symptoms clusters make of
augmentation, reduce hyper-arousal (early diagnosis
– Intrusive Recall (1 symptom)
– Avoidance and Emotional Numbing (3
symptoms)
– Arousal (2 symptoms)
Severity of PTSD symptoms (hyper arousal/ re-experience) associated with greater drug abuse severity • Structured topics, 25 sessions• Does not focus on trauma – No exposure-based components– “Here and now” Developmental: Adolescence
• Neuroadaptations to drugs different
than adult brains
– Nicotine, alcohol, cannabinoids
• Greater vulnerability to addiction as
• Greater vulnerability to developing
secondary/ co-occurring psychiatric
problems
Adolescents
• Drug use often starts before they are
capable of making informed decisions
• Drug use changes brain function
– Impulse control, decision making and
reward system altered
• Acute and chronic phases of treatment – Multidimensional family therapy (MDFT) – Contingency management (CM)– Minnesota 12 Step Model • Heavy sustained substance use probably 2. Require patient attendance at 12 Step 3. Psychological evaluation/ screening on 1. Pharmacotherapy is part of the treatment 4. Medication changes will be prescribed psychosocial components are neglected.
2. Urine or blood testing may be done at 5. Medication is for target symptoms; if prescribed; changes will be discussed with clinicians.
2. Require 12 Step3. Psych screening all patients 7. Meds used only as Rx’d8. Med changes 1 at a time 9. Meds DC’d if not effective for target symptomsMD guide: http://www.csam- • Support Together for Emotional/ Mental • DTR in a psychiatric day treatment program improved abstinence and adherence to psych treatment (Margura, 2008) – Dual Recovery Anonymous– Dual Diagnosis Anonymous– AA/ NA/ CMA/ EA– What is in our community? 2. Require 12 Step3. Psych screening all patients4. Family groups 5. Meds stop if no attendance6. Urine/ BAC screens 7. Meds used only as Rx’d8. Med changes 1 at a time9. Meds DC’d if not effective for target symptoms Disorders http://www.ncbi.nlm.nih.gov/books/NBK14528/ • National Center for Trauma Informed Care

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