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Concurrent Disorders

Weekly Round up Meeting

Department weekly meeting

02. 12. 2019

AGENDA

AGENDA

01. Common terms used in concurrent disorders

02. How substance use and mental health problems interact

03. Exploring treatment approaches

Types of Substances

This section describes three major types of substances:

  • depressants: drugs that slow the central nervous system (CNS) functions (e.g., make people feel more relaxed and less conscious of their surroundings)
  • stimulants: drugs that increase CNS activity (e.g., speed up mental processes to make people feel more alert and energetic)
  • hallucinogens: drugs that alter perceptions and sense of time and place; drugs that can produce hallucinations.

Substance Abuse

People who abuse substances regularly and who may experience ongoing serious problems without being dependent on the substance.

Some of these problems are:

• inability to fulfil responsibilities

• dangerous use

• legal problems

• social and family problems

Substance Dependence

People who are dependent on substances have major physical, mental and behaviour problems that can have serious effects on their lives.

Some of the signs of substance dependence are:

• tolerance

• withdrawal

• time investment

• retreat from usual activities

• ongoing use

Substance Use Disorder

If three or more of these problems are ongoing during a 12-month period

Diagnostic criteria involve:

  • impaired control
  • social impairment
  • risky use
  • pharmacological criteria

Substance Dependence Disorder

Types of Dependence

psychological dependence

physical dependence

Addiction

Most people use the term more broadly to refer to compulsive behaviours, including substance use, that cause problems. People persist with these behaviours in spite of strong negative consequences.

Characterized by:

  • craving
  • loss of control of amount or frequency of use 
  • compulsion to use
  • use despite consequences

DSM IV criteria

  • Tolerance (increase in amount; decrease in effect)
  • Characteristic withdrawal symptoms; substance taken to relieve withdrawal
  • Substance taken in larger amount and for longer period than intended
  • Persistent desire or repeated unsuccessful attempt to quit
  • Much time/activity to obtain, use, recovery
  • Important, social, occupational or recreational activities given up or reduced
  • Use continues despite knowledge of adverse consequences (e.g., failure to fulfill role obligation, use when physically hazardous)

Definition

Co-occurring disorders is another way of describing a situation where someone has one or more mental health disorders and one or more substance use disorders.

The Relationship between Mental Illness and Substance Abuse

The Relationship between Mental Illness and Substance Abuse

Researchers have suggested four types of interaction:

• substance use and mental health problems may be triggered by the same factor

• mental health problems may influence the development of substance use problems

• substance use problems may influence the development of mental health problems

• substance use and mental health problems may not interact

The Relationship between Mental Illness and Substance Abuse

Mental health problems

Substance use problem

Common factor

TYPES OF SUBSTANCES

WHY DO PEOPLE DEVELOP ADDICTIONS?

As the biopsychosoical model suggests, the causes of addictive behaviours are complex, and can include the following:

BIOLOGICAL FACTORS

The

biopsychosocial

Model

SOCIAL

FACTORS

Psychological

FACTORS

Treatment

Treatment

Most integrated programs have been developed for clients who have severe mental health problems. They have common features including:

  • assertive outreach (see “Assertive community treatment,” p. 133–134)
  • staged interventions (see “States of change” and “Stages of treatment” on p. 121–122)
  • motivational interventions (see “Motivational approaches to treatment,” p. 119–121)
  • social support interventions (e.g., housing and employment support)

Treating Concurrent Disorders

The treatment provider investigates how the substance use and mental health problems interact.

During an assessment, people are often asked to discuss things such as:

• why they have come for help, what kind of help they are looking for and what has helped in the past

• general life problems, troubling thoughts or feelings, substance use problems, as well as how long problems have lasted

• whether they have experienced or seen violence (e.g., physical or sexual assault, war), even if it occurred years before

• whether there is a history of substance use or mental health problems in their family

• what their life is like (e.g., how they feel, what they think, how they sleep, if they exercise

and socialize, how they do at school or work, how their relationships with friends and family are)

Applied Stages of Change Model

Recovery Based Interventions

Group and individual sessions guided by the Stages of Change model and Health Canada Best Practices for the treatment of Concurrent Disorders interventions operate within a harm reduction approach and trauma informed care perspective. 

Treatment approaches includ:

cognitive behavioural therapy

dialectical behavioural therapy strategies

structured relapse prevention

motivational interviewing

Cognitive-Behavioural Therapy

Cognitive-behavioural therapy (CBT) is based on the theory that thoughts have an

important influence on how people behave. Therapists help people to identify unhelpful

thoughts and behaviours and learn healthier skills and habits.

Dialectical Behaviour Therapy (DBT)

In DBT, people look at how their background and their life experience affect how they control their emotions. It teaches clients how to:

• become more aware of their thoughts and actions (“mindfulness”

• tolerate distres

• manage their emotion

• get better at communicating with other

• improve their relationships with other peopl

Structured Relapse Prevention

Structured Relapse Prevention (SRP) uses a cognitive-behavioural approach to help

people with moderate to severe problems gain more control over their use of alcohol

and other drugs.

Motivational Approach to Treatment

Motivational approaches are also useful in encouraging people to identify their goals, and in building hope and commitment to change and recovery.

Motivational approaches use the client’s perspective on his or her mental health and substance use problems as the starting point for treatment.

The long-term objective is to help the client set goals and recognize that his or her current lifestyle interferes with achieving these goals.

Therapeutic Engagement and Support

Psychoeducation

Development of Coping Skills and Strategies

Goal planning

Relapse Prevention

Referral to community agencies

Family education

Pharmaceutical Therapy for Substance Use Problems

Treatment strategies include:

• withdrawal management

• substitution therapy

• antagonist therapy

• aversive therapy

Withdrawal management

The main objective in the pharmacological treatment of drug withdrawal is to prevent severe complications, particularly seizures in the case of some drugs (e.g., alcohol, barbiturates, benzodiazepines) that can happen when people stop using substances.

Discuss CIWA and COWS

Substitution therapy

In substitution therapy, the substance of abuse is replaced with a medication that is less likely to be abused.

Substituting methadone, a synthetic opioid, for heroin is one example of substitution therapy.

Antagonist therapy

Antagonist therapy blocks the effects of opioids. For example, naltrexone (ReVia) is sometimes used to block the effects of alcohol and opioids. It is used to help maintain abstinence following withdrawal from these substances.

Aversive therapy

A medication is prescribed that will cause unpleasant side-effects if substances are also used and

discourages use of the substance.

Disulfiram (formerly marketed under the trade name Antabuse) is an example of aversive therapy to discourage alcohol use.

The symptoms that result when disulfiram is combined with alcohol include:

• nausea and dry mouth

• flushing, sweating, throbbing head and palpitations.

What is relapse?

A relapse occurs when a person in recovery re-experiences problems or symptoms associated

with his or her disorders.

With substance use disorders, a relapse means a return to problem substance use after a period of abstinence or controlled use.

With mental health disorders, a relapse is a flare-up of symptoms that are associated with the disorder.

A relapse of one disorder can sometimes trigger relapse of the other.

Relapse & Recovery

“Relapse means failure”

  • For some people relapse is an important part of recovery they may have not experienced enough discomfort to persuade them that they can’t safety drink/use
  • Relapse can be used a chance to learn about the things that can lead to another relapse

“Relapse can’t be prevented”

  • Less about willpower more about preparation (relapse prevention strategies)
  • An opportunity to renew a plan of action to continue on the path of recovery
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