Week 10 Addiction and mental health

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Week 10 Addiction and mental health by Mind Map: Week 10 Addiction and mental health

1. Facts

1.1. No matter where you work, you will likely encounter someone who has problems related to substance abuse or mental health.

1.2. Heavy drinking was reported among 22.7% of males and 13.2% of females aged 12 or older in 2014 (Stats Can, 2015)

1.3. 11% of Canadians aged 15 or older report illicit drug use (CTADS, 2013)

1.4. The overall rate of psychoactive pharmaceutical use among Canadians aged 15 years and older was 22% (CTADS, 2013)

1.5. 20% of Canadians will experience a mental illness in their lifetime (CMHA)

2. Definition

2.1. An unhealthy relationship between a person and a mood-altering substance, experience, event or activity which contributes to life problems and their recurrence.

3. Types of addicitons

3.1. Ingestion

3.1.1. Addictions to substances that are deliberately taken into the body (i.e. alcohol and other drugs).

3.2. Process

3.2.1. When one becomes hooked on a process - a specific series of actions/interactions (e.g., gambling or shopping)

4. Cycle of Addiciton

4.1. Cycle of Addiciton

4.2. Non-addicted Brain

4.2.1. Stop

4.3. Addiction Brain

4.3.1. Addiction Brain

5. Psychoactive drugs

5.1. Depressants

5.1.1. decrease a person’s state of alertness

5.1.2. diminish the impact of the environment on the thoughts and feelings of the user

5.1.3. Slow CNS activity (brain, heart, respiration)

5.1.4. Most commonly used and abused drugs because of the diminished impact of the environment—stress and anxiety reduction

5.1.5. Many non-psychoactive drugs also depress the CNS (antihistamines, cough and cold remedies, some heart medications)

5.2. Stimulants

5.2.1. increase the state of alertness of the user

5.2.2. make the user feel excited, euphoric and all-powerful

5.2.3. Increase CNS activity

5.2.4. Fewer people use these than depressants, but those who do really like them One possible reason for lower use is these drugs produce anxiety-like states, and anxiety is the most commonly experienced mental health disorder

5.2.5. The most commonly used drug in the world is a stimulant—caffeine

5.3. Hallucinogens

5.3.1. alter the perception of reality of the person using them

5.3.2. induce sensory and cognitive distortions

5.3.3. There are thousands of naturally occurring hallucinogens in the world Nutmeg is one example, but you would need to consume a pound of nutmeg to get any effect. Many people think because hallucinogens occur in nature, they are not harmful The most widely used hallucinogens today are ‘designer drugs’—those produced in chemical laboratories—LSD, PCP (Angel Dust), Ecstasy

5.4. Cannabis

5.4.1. Products containing cannabis are derived from the plant Cannabis sativa.

5.4.2. Cannabis is a unique drug with ‘sedative-euphoriant-psychadelic’ properties.

5.4.3. Cannabis has become its own category in the past 5 to 7 years.

5.4.4. Formerly, the medical community classed it as a sedative (depressant)

5.4.5. The addictions community classed it as an hallucinogen

5.4.6. Now there is recognition that it produces all three types of effects, simultaneously while acting on different parts of the CNS

5.4.7. There is renewed talk of decriminalizing Cannabis Decriminalization is different from legalization—would still be illegal, but would not result in criminal records for users. (This was first recommended in the 1970’s by a Royal Commission, the LeDain Commission) Decriminalization is a form of harm reduction.

6. Treatment

6.1. A formal, counsellor-facilitated, goal-oriented, time-limited process aimed at effecting positive change in a client’s life.

6.1.1. Treatment Plan The outcome of the assessment process. It is like a map—it outlines a destination and a planned route for getting there, (goals, objectives & strategies). The destination is the next stage of change. Stress that the plan outlines how to get to the next stage of change only, and does not outline how to get someone from precontemplation to life-long abstinence. Goal To reduce involvement or harm associated with the addiction To improve physical and/or psychosocial functioning To improve family an/or social functioning To improve employment and/or educational/ vocational functioning To reduce involvement with the criminal justice system Tx activities Acquiring knowledge & skills Practical problem solving Experiential learning (feelings) Planning for future actions Priorities of treatment planning Approaches

6.2. Barriers Encountered

6.2.1. Denial

6.2.2. Minimization

6.2.3. Rationalization (sincerely deluded?)

6.2.4. Lying

6.2.5. Lack of collateral information

6.2.6. Cognitive problems (ie, FASD, cognitive delays)

7. Stages of Change

7.1. Precontemplation

7.1.1. not considering change: no perceived need for change

7.1.2. Councelling strategies to raise doubts, increase the perception of risks & problems

7.2. Contemplation

7.2.1. the client is thinking about making changes – ambivalent

7.2.2. Councelling strategies tip the decisional balance, evoke reasons to change, risks of not changing, strengthen self-efficacy

7.3. Preparation

7.3.1. preparing to make changes

7.3.2. Councelling strategies Help the client determine the best course of action to take in seeking change

7.4. Action

7.4.1. actively making changes through modifying behaviors

7.4.2. Councelling strategies Help the client take steps towards change

7.5. Maintenance

7.5.1. consistently maintaining changes made over a period of time

7.5.2. Councelling strategies Help the client identify & use strategies to prevent relapse

7.6. Termination

7.6.1. no longer needs to attend to the task of maintaining changes

7.7. Recycle

7.7.1. the client falls back to an earlier stage of change

7.7.2. Councelling strategies Help the client to renew the processes of contemplation, preparation & action without becoming stuck or demoralized because of slip.

8. Substance use and Canadian women

8.1. Women’s drinking rates have historically been lower than men’s – this gap is closing

8.2. Substance use is increasing – especially in younger women & girls

8.3. Psychoactive medications – more likely prescribed to women (sleeping pills, tranquilizers, antidepressants, pain killers & diet pills)

8.4. Tobacco is still a serious concern among women & girls – though rates are decreasing in overall population

8.5. Specific gendered influences affecting women’s substance use, treatment, prevention include:

8.5.1. Sexual/physical abuse and trauma

8.5.2. Life transitions riskier for women

8.5.3. Women use substances more for coping

8.6. Relationships

8.7. Gender role

8.8. Parenting

8.9. Victims of violence

8.10. More rapid progression of alcohol and drug abuse & more problems at presentation

8.11. Key issues for women

8.11.1. Psychological development More motivated by relationship concerns Implications – create environment where women can experience healthy, empathic relationships

8.11.2. Prescribing & medications Women prescribed potentially abusable medications much more than men (often for anxiety & depression) Implications – medications often prescribed for a range of normal life difficulties. Main substance abuse issue in older women is misuse of Rx drugs

8.11.3. Drug effects Women’s physiology (e.g., drug metabolism) is different from men’s Women seem to exhibit more severe consequences from alcohol and other drug abuse. Lesbian/bisexual women abuse alcohol & Rx drugs more than heterosexual women Implications – socioeconomic status greatly influences health risks associated with drug use; practical needs must be considered in programming. Stigma, shame & blame Women experience greater stigma/blame in the media and society. Women often cite feelings of blame, feeling unwelcome/judged as barriers (esp. FASD) Implications – service providers require sensitivity to women seeking help; provide safe & secure environment Treatment access Women may have less family support to enter Tx Specific barriers – money, transportation Social assistance & financial support often inadequate – women feel trapped Implications – centralized services may marginalize women (lack of accessibility) Social services, justice & multiple systems Each system has different rules/guidelines/etc. Navigating systems can be overwhelming Implications – recognize barriers esp. regarding child custody; develop “one stop” service centres

8.12. Role of service/support providers for women

8.12.1. Consider determinants of health

8.12.2. Provide woman-centred care

8.12.3. Fight stigma

8.12.4. Examine partner/social support

8.12.5. Integrate a harm reduction philosophy Implications – service providers require sensitivity to women seeking help; provide safe & secure environment

8.12.6. Identify concurrent disorders

8.12.7. Prevent relapse

8.12.8. Women centered care Participatory empowering safe focus on social justice respectful of diversity holistic comprehensive individualized

8.12.9. Family programs Family members or friends whose lives have been affected by another person’s alcohol or drug use The person identified as having the problem with alcohol or drugs may, or may not, have entered a treatment program. The family member’s behavior changes to compensate for the addicted person’s behavior to minimize the effect on the family. This can result in the under-functioning / over-funtioning dyad seen in co-dependent relationships. Enabling relationships Effects on family relationships Loss of emotional closeness Loss of trust Isolation Secrecy Shame Guilt Defense Mechanisms Provide information about addiction & how it affects families Allows the family to focus on their own emotional health rather than focusing on the addict & trying to change their behavior Provides an opportunity to process the traumatic experiences & emotional losses which may have occurred in the family. Addiction is a condition which affects the whole family The whole family can be involved in the recovery from addiction.

9. Co-occuring disorders

9.1. Substance-related disorder with a co-existing mental health disorder

9.2. About 50% of persons receiving treatment for either substance abuse or mental health issues experience COD

9.3. Dual diagnosis is an expectation!

9.4. Facts

9.4.1. Some researchers believe that substance abuse may precipitate mental illness in vulnerable individuals. Family history Family history – whether that be from a nature or nurture perspective or both. Trauma Trauma – including incest, sexual exploitation, violence, bullying - impact differs person to person. Gender Gender – certain challenges tend to have gender biases attached – females more prone to mood and anxiety disorders, males to attentional disorders. Social & personal competency Children and youth who struggle with establishing support networks or are sensitive to stress and challenges. Other mental health problems We know the co-morbidity between certain mental health concerns are quite high. – for example depression and anxiety have a co-morbidity rate between 60-70%. Individuals living with schizophrenia are also at higher risk for anxiety, depression and substance-related concerns. Substance use In addition, individuals with substance related concerns have a high co-morbidity to untreated ADHD and PTSD just to name a few. Other risk factors Poor cognitive function Social isolation Anxiety Deficient interpersonal skills Poverty Lack of structured activities Socialization Normalization Extreme sensitivity Moderate doses of alcohol, or caffeine can induce psychotic symptoms in a person with schizophrenia. Small amounts of marijuana, cocaine, or other drugs can precipitate prolonged psychotic relapses.

9.4.2. People with psychiatric disorders use alcohol and other drugs in a misguided attempt to alleviate symptoms of their illnesses or side effects from their medications.

10. Implications for specific drug classes

10.1. Can cause mental illness

10.1.1. Cannabis There is controversy about whether or not marijuana can cause severe mental illness (e.g., schizophrenia or bipolar disorder) Marijuana will increase the number of episodes of mental illness Marijuana can relieve muscle stiffness and shakes. Be aware of anticholinergic psychosis. THC binds to the same nerve receptors as psychotropics

10.2. Pre-existing condition will be exacerbated

10.3. Self-confidence can lead to aggression

10.4. Depression can be treatment-resistant

10.4.1. Opiates Depression and anxiety is exacerbated by use Prognosis for recovery is poorer when using Mental illness is masked by use Opiates are effective in controlling psychotic symptoms in the beginning, but efficacy rapidly subsides

10.5. Once a person has had one drug-induced psychosis, they are very likely to have more

10.5.1. + THC = alcohol poisoning

10.5.2. + Opiates = increase in sedation

10.5.3. + High levels caffeine = wide awake drunk

10.5.4. + Stimulants = “disinhibited tweaker”

10.5.5. + Benzos = overdose/death

10.5.6. + Lithium = increased levels

10.5.7. + Tricyclics = toxicity

10.5.8. + SSRIs = reduced efficacy