Substance Abuse and Mental Health Disorders

Substance Abuse & Mental Health Disorders

Angela Penny, Cirque Lodge, 4/13/2016

Substance Abuse is a Mental Disorder● Addiction changes the brain in fundamental ways,

disturbing a person's normal hierarchy of needs and desires and substituting new priorities connected with procuring and using the drug. The resulting compulsive behaviors override the ability to control impulses despite the consequences.

● Substance use disorders occur when the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home. According to the (DSM5) a diagnosis of substance use disorder is based on evidence of impaired control, social impairment, risky use, and pharmacological criteria.

Substance Use Disorders (SUDs)Approximately 21.5 million people aged 12 or older in 2014 had SUDs in the past year, including 17.0 million people with an alcohol use disorder and 7.1 million people with an illicit drug use disorder

An estimated 2.6 million people aged 12 or older had both an alcohol use disorder and an illicit drug use disorder in the past year.

1.3 Million of people with an SUD in the last year were aged 12 - 17

Any Mental Illness (AMI)● Mental illnesses are common in the

United States.

● AMIs include mental, behavioral, or emotional disorders (excluding developmental and substance use disorders);

● In 2014, there were an estimated 43.6 million adults aged 18 or older in the United States with an AMI in the past year. This number represented 18.1% of all U.S. adults.

Serious Mental Illness (SMI)● In 2014, there were an

estimated 9.8 million adults aged 18 or older in the United States with SMI. This number represented 4.2% of all U.S. adults.

Co Occuring Disorders● The coexistence of both a mental

health disorder and a substance use disorder is referred to as co occurring disorders. This used to be referred to as dual diagnosis.

● In 2014, an estimated 43.6 million (18.1%) Americans ages 18 and up experienced some form of mental illness. In the past year, 20.2 million adults (8.4%) had a substance use disorder. Of these, 7.9 million people had both a mental disorder and substance use disorder.

Complicated to Diagnose● People with mental health disorders are more likely than people without mental health disorders to

experience an alcohol or substance use disorder.

● Co occurring disorders can be difficult to diagnose due to the complexity of symptoms, as both may vary in severity. Are people depressed because they are alcoholic or are they using alcohol to self medicate depression?

● When someone is treated primarily for a substance abuse disorder they need to be clean of all substances for 30 days before they can receive a secondary diagnosis. Many psychiatrists won’t do it before 60 days.

● People with co occurring disorders are best served through integrated treatment. Addressing each of the disorders separately and together.

Most Common co occuring disordersAnxiety Disorders

Anxiety can be a symptom of a substance abuse problem, including alcohol and caffeine. It is also caused by withdrawal from certain drugs. It often co occurs with depression and bipolar disorder.

A person may find that they have problems making daily decisions and remembering commitments as a result of lack of concentration/preoccupation with worry.

The term anxiety covers four aspects of experiences that an individual may have: mental apprehension, physical tension, physical symptoms and dissociative anxiety. The emotions present in anxiety disorders range from simple nervousness to bouts of terror.

Mood Disorders

Mood disorders represent a category of mental disorders in which the underlying problem primarily affects the persistent emotional state of an individual.

Major depression is one of the most common mental disorders in the United States.

In 2014, an estimated 15.7 million adults aged 18 or older in the United States. had at least one major depressive episode in the past year. This number represented 6.7% of all U.S. adults.

Women are 50% more likely to experience depression than men.

Anxiety Disorders★ Anxiety is the most common mental disorder

experienced by Americans. 28.8% of all adults will experience excessive anxiety in their lifetime. Women are 60% more likely to experience anxiety disorders than men.

★ It is a normal reaction to stress and is beneficial in some situations. For some people, however, anxiety can become excessive, and while the person suffering may realize this, they still may also have difficulty controlling it and it may negatively affect their daily life.

★ Common treatment options include lifestyle changes, therapy, and medications. Medications are typically recommended only if other measures are not effective.

Generalized Anxiety Disorder (GAD)● Generalized anxiety disorder (GAD) is characterized by excessive worry about a variety of everyday problems for at least

6 months. For example, people with GAD may excessively worry about and anticipate problems with their finances, health, employment, and relationships. They typically have difficulty calming their concerns, even though they realize that their anxiety is more intense than the situation warrants.

● Symptoms include: fatigue, fidgeting, headaches, nausea, numbness in hands and feet, muscle tension, muscle aches, difficulty swallowing, excessive stomach acid buildup, stomach pain, vomiting, diarrhea, bouts of breathing difficulty, difficulty concentrating, trembling, twitching, irritability, agitation, sweating, restlessness, insomnia, hot flashes, rashes, and inability to fully control the anxiety

● GAD is also common in individuals with a history of substance abuse. Long term use of benzodiazepines can worsen underlying anxiety, with evidence that reduction of benzodiazepines can lead to a lessening of anxiety symptoms.

Similarly, long term alcohol use is associated with anxiety disorders, with evidence that prolonged abstinence can result in a disappearance of anxiety symptoms. However, it can take up to two years for anxiety symptoms to return to baseline in about a quarter of people recovering from alcoholism.

Generalized Anxiety Disorder STATS● In a given year, approximately 3.1%

of American adults experience GAD.

● It is seen in women twice as much as men.

● About a third of the variance for generalized anxiety disorder has been attributed to genes.

● It is the most common cause of disability in the workplace.

● Once GAD develops. it may become chronic, but can be managed or eliminated with proper treatment.

Other Types of Anxiety DisordersSocial Phobia Among Adults | (6.8% in 2014) 12.1% lifetime prevalenceSocial phobia is characterized by a persistent, intense, and chronic fear of being watched and judged by others and feeling embarrassed or humiliated by their actions. This fear may be so severe that it interferes with work, school, and other activities and may negatively affect their ability to form relationships.

Post Traumatic Stress Disorder (PTSD) | (3.5% of US Adults in 2014) 6.8% lifetime prevalence(PTSD) is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which there was the potential for or actual occurrence of grave physical harm. Traumatic events that may trigger PTSD include violent personal assaults, natural or human caused disasters, accidents, and military combat. People with PTSD have persistent frightening thoughts and memories of their ordeal. They may experience sleep problems, feel detached or numb, or be easily startled.

Obsessive Compulsive Disorder (OCD) | (1% of US pop, 1.6% in lifetime) 50% severeCharacterized by intrusive thoughts that produce anxiety (obsessions), repetitive behaviors that are engaged in to reduce anxiety (compulsions), or a combination of both. While many are concerned about germs or leaving their stove on, people with OCD are unable to control their anxiety producing thoughts and their need to engage in ritualized behaviors. As a result, OCD can have a tremendous negative impact on daily functioning.

Social Anxiety DisorderSocial Anxiety DisorderPeople with social anxiety disorder (sometimes called “social phobia”) have a marked fear of social or performance situations in which they expect to feel embarrassed, judged, rejected, or fearful of offending others. Social anxiety disorder symptoms include:

● Feeling highly anxious about being with other people and having a hard time talking to them● Feeling very self conscious in front of other people and worried about feeling humiliated,

embarrassed, or rejected, or fearful of offending others● Being very afraid that other people will judge them● Worrying for days or weeks before an event where other people will be● Staying away from places where there are other people● Having a hard time making friends and keeping friends● Blushing, sweating, or trembling around other people● Feeling nauseous or sick to your stomach when other people are around

Panic Disorders & ADHDPanic Disorder (2.7 % of Adult Population, 44.8% severe, 4.7% in Lifetime)People with panic disorder have recurrent unexpected panic attacks, which are sudden periods of intense fear that may include: palpitations, pounding heart, an accelerated heart rate, sweating, trembling or shaking, shortness of breath, smothering or choking sensations, or a feeling of impending doom.Panic disorder symptoms include:

● Sudden and repeated attacks of intense fear

● Feelings of being out of control during a panic attack

● Intense worries about when the next attack will happen

● Fear or avoidance of places where panic attacks have occurred in the past

Attention Deficit Hyperactivity Disorder (4.1% in past 12 months, 8.1% in lifetime)Attention deficit hyperactivity disorder (ADHD) is defined by a persistent pattern of inattention (for example, difficulty keeping focus) and/or hyperactivity, impulsivity (for example, difficulty controlling behavior, excessive and inappropriate motor activity).

Mood DisordersMood disorders represent a category of mental disorders in which the underlying problem primarily affects an emotional state (their mood). The statistics below, derived from the National Comorbidity Survey – Replication (NCSR), represent people experiencing major depressive disorder, dysthymic disorder, and/or bipolar disorder.

Depressive Disorders (Including MDD)In 2014, an estimated 15.7 million adults aged 18 or older in the United States. had at least one major depressive episode in the past year. This number represented 6.7% of all U.S. adults.

Depressive Disorders (Including MDD)● Depressive disorders are among the most common mental health disorders in the United States. They are

characterized by a sad, hopeless, empty, or irritable mood, and somatic and cognitive changes that significantly interfere with daily life.

● Major depressive disorder (MDD) is defined as having a depressed mood for most of the day and a marked loss of interest or pleasure in activities. Additional symptoms may include significant weight loss or gain, insomnia or hypersomnia, feelings of restlessness, lethargy, feelings of worthlessness or excessive guilt, distractibility, and recurrent thoughts of death, including suicidal ideation. Symptoms must be present for at least two weeks.

● NSDUH data also show that the prevalence of MDE among adolescents aged 12 to 17 was 11.4% in 2014, while female youths were about three times as likely as male youths to experience a MDE.

● MDD is thought to have many possible causes, including genetic, biological, and environmental factors. Adverse childhood experiences and stressful life experiences are known to contribute to risk for MDD. In addition, those with closely related family members (for example, parents or siblings) who are diagnosed with the disorder are at increased risk.

● Substance use: 27% of individuals with substance abuse disorders (both alcohol and other substances) experience depression. (National Institute of Mental Health, 1999)

Bipolar Disorder (2.6% of Pop)Some bipolar disorder symptoms are similar to other illnesses, which can make it hard for a doctor to make a diagnosis. In addition, many people have bipolar disorder along with another illness such as anxiety disorder, substance abuse, or an eating disorder. People with bipolar disorder are also at higher risk for thyroid disease, migraine headaches, heart disease, diabetes, obesity, and other physical illnesses.

Psychosis: Sometimes, a person with severe episodes of mania or depression also has psychotic symptoms, such as hallucinations or delusions. The psychotic symptoms tend to match their extreme mood. For example:

● Someone having psychotic symptoms during a manic episode may believe she is famous, has a lot of money, or has special powers.

● Someone having psychotic symptoms during a depressive episode may believe he is ruined and penniless, or that he has committed a crime.

As a result, people with bipolar disorder who also have psychotic symptoms are sometimes misdiagnosed with schizophrenia.

Anxiety and ADHD: Anxiety disorders and attention deficit disorder (ADHD) are often diagnosed among people with bipolar disorder.

Substance Abuse: People with bipolar disorder may also misuse alcohol or drugs, have relationship problems, or perform poorly in school or at work. Family, friends and people experiencing symptoms may not recognize these problems as signs of a major mental illness such as bipolar disorder.

Borderline Personality Disorder1.6% of the Population had this in the year 2014

Borderline personality disorder (BPD) is characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. While a person with depression or bipolar disorder typically endures the same mood for weeks, a person with BPD may experience intense bouts of anger, depression, and anxiety that may last for only a few hours to a day. People with Borderline Personality Disorder often have trouble having insight to their disorder.

History of Treatment1750: Alcoholic mutual aid societies (sobriety "Circles") are formed within various Native American tribes. Some are part of, or evolve into, abstinence based Native American cultural revitalization movements and temperance organizations.

1849: The Swedish physician Magnus Huss describes a disease resulting from chronic alcohol consumption and christens it Alcoholismus chronicus. This marks the introduction of the term alcoholism.

1864: The New York State Inebriate Asylum, the first in the country, is opened in Binghamton, NY. A growing network of inebriate asylums will treat alcoholism and addiction to a growing list of other drugs: opium, morphine, cocaine, chloral, ether, and chloroform.

1935: The opening of Shadel Sanatorium marks the introduction of aversive conditioning in an institutional alcoholism treatment setting.

The first federal "narcotics farm" (U.S. Public Health Prison Hospital) opens in Lexington, Kentucky. The second facility opens in Fort Worth, Texas in 1938. This marks the beginning of federal involvement in addiction research and addiction treatment.

Change from DSM 4 to DSM 5● The Substance Abuse diagnosis was substantially simplified from the DSM 4 to the new DSM 5

version published in 2013.

● Now the Substance Abuse diagnosis is enough for most insurance companies to approve the expenditure. You don’t need to have a co occurring disorder to get treatment.

● Stigmas attached to drug addiction and alcoholism are changing. There is more of an understanding that people aren’t choosing to screw up their lives.

● It is important to understand that disorders overlap and impact each other. It is impossible to treat the co occuring disorder if the substance abuse disorder is not addressed.

● It is important stay focused on treatment and a) stay as long as possible, b) be vigilant about health & fitness, therapy and, c) not only treating the alcoholism/drug addiction but also any co occuring mental disorders.

Advocate for thyself as a mental health consumer

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