Mental Illness & Addication

1. Mental Illness & Addication The Chicken or the Egg?

2. Objectives: Understand the life forces that underline developmental vulnerabilities for addiction and mental illness Distinguish between temperament, attachment and psychological domains as they relate to emotional resiliency Understand how these forces come together in illness and addictions. Identify the shared features of mental illness and addiction Consider intervention and treatment options in recovery using an individualized ‘root cause analysis’

3. Developmental forces Fate We all have a relationship to drugs, alcohol and habits (compulsive activities). Mental illness and Substance Use Disorders are an end stage of this developmental process. Four major forces come together to define that relationship. Environment Temperament Genetics

4. National Institute of Mental Illness Research Domains (Rdoc)

6. Attachment Secure Consistent, adequate mirroring of infant Caretaker stimulation and neutrality is responsive to child needs By six months of age, infant researchers can determine attachment type. By 12 months of age, the infant’s attachment behavior can predict adult pathology at age 21 Insecure Inconsistent affection—hit or miss, anxious or avoidant Caretaker response associated with adult’s needs/concerns Chaotic Disruptive, abusive or neglectful attention Caretaker is dysregulated in their own behavior--threat.

8. Reflexive Emotions—Frontal lobe radiations/associative memories Reactive Emotions—Amygdala response to threat or danger: Fight, Flight, Freeze

9. Traumatic Experience, over time, consolidate into the character traits of victimization—victim as an identity of self in relationship to others It gets ‘hard wired’ or locked into how the individual perceives the world and interactions with us in treatment

10. ADDICTION & Mental Illness Co-morbid or One and the same? Features and Implications:

11. Mental Illness or Addiction

12. Neuropsychological resiliency is compromised--Reward • Brain reward systems are hypoactive during acute “incidents”, episodes or withdrawal states • Self-regulation of associative memory and experience is lost • Persistent hypoactivity and deficits in self-regulation occurs with repeated states of dis-ease (Down regulation) . Neuropsychological states of Distress are amplified • Increased sensitization to states of deprivation occur during acute “incidents”, episodes and withdrawal states • Repeated exposure to neuroceptive ‘threat’ (e.g. danger, loss and social isolation) reinforces maladaptive behavior. • Stressed states remain activated during protracted deficit (up-regulated) Mental ILLNESS & Dependence as Deficit Disorders

13. Which comes first: chicken or egg?

14. ASAM Criteria: Dimensions of Assessment

15. Early Childhood Relationships & Attachments • Adverse Lifetime events • Alcohol/Drug and Behavioral Exposure—Inventory of “Use” • How did the use begin? • Did a “good” relationship (reward) turn negative? • If so, when, how and what were the antecedent events? • Did the use start in the midst of distress? • Current State of Mental Health: NIMH rDOC • Motivation to Change or Stage of Change • Prochaska and DiClemente’s Stages of Change Model • Resources Treatment Tasks

16. The Matrix of Treatment

17. Questions & Comments