Substance Abuse and co-occurring disorders

1. Substance Abuse and co-occurring disorders By Brittany Murphy

2. Treating substance abuse is more complicated than a person simply quitting. A major issue with treating co-occurring substance abuse and mental disorders is finding treatment that deals with both issues. According to the Substance Abuse and Mental Health Administration, “adults with a substance use disorder were almost three times as likely to have serious mental illness as those who did not have a substance use disorder.” When the person is only treated for the substance abuse problem, the underlying issue is not resolved.

3. When a person is only treated for the substance abuse problem, the underlying issue is not resolved. In my observational research, many of the patients had been tossed back and forth between the criminal justice system and treatment that did not cater to their actual problems. (Picture from “Harm Reduction?”)

4. Interdisciplinary Approach Using an interdisciplinary approach to address the issue of substance abuse and co-occurring disorders will be necessary because of the multifaceted aspects of the problem. Knowledge of substance abuse alone will not be sufficient. A combined, unique perspective from behavioral science, social science, and health science will be more successful.

5. Problems in each Discipline • Health and Natural Science • The physical aspect • Often a substance abuse problem is caused by people self medicating themselves. This essentially does not get to the real root of the person’s problem, which could be a co-occurring disorder. • Behavioral and Social Science • Social, psychological, and personal relationship aspects • Many treatments available tend to focus on either the addiction or the mental health disorder and do not cater to both problems. • It is also sometimes difficult to spot a mental health problem until a person is fully detoxified because symptoms from a drug can be similar to symptoms from the disorder. (Fisher)

6. Conflicts between disciplines • Health and Natural Science disciplines look at the physiology of addiction or mental health problems. • For example, the effect that opiates have on dopamine levels in the body. • Did the substance abuse problem have some effect on the person’s brain, causing a mental health disorder to develop? • Behavioral and Social Science disciplines are the opposite and look at the problem from a sociological viewpoint. • For example, an addict’s upbringing might be scrutinized to see what factors influenced this person’s decisions that lead up to a substance abuse problem. • Did a person’s mental health disorder drive them to self medicate, feeding into an inevitable addiction?

7. A Common Ground There are several facilities that treat either a substance abuse problem or a mental health problem. The common ground is that “those persons who have concurrent mental and addictive disorders are not easily accommodated by the current treatment delivery system”. (Fisher, & Harrison, 2000, pg. 146) The only kind of facility that could accommodate this problem would need to specialize in addictions and mental health disorders.

8. Observational Research While spending time in the detoxification unit, I was able to observe the many kinds of people accommodated and noted that the treatment was generalized. Something that stood out to me was that the facility turned away any suicidal patients and many patients that had severe mental health problems. They simply were not equipped to handle the problems these people had. The solution was to send the people to a facility that could better treat their problems.

9. Interdisciplinary Solution • A facility designed to treat people with co-occurring disorders would need a team of people from backgrounds of health, behavioral, social, and psychological sciences. The client would need to be assessed by all and an interdisciplinary plan to treat all of the clients problems would be developed and put into action. A common ground and communication between clinicians would be essential.

10. Health and Natural Science • Many times patients with a health or mental health problem are prescribed very addicting medications, such as opiates. • The body becomes physically addicted. Upon discontinued use of the drug, the person will experience physical withdrawal symptoms. • Basic physical symptoms include: tremors, shakes, vomiting, diarrhea, sweating, feelings of temperature change, seizures, and more flu-like symptoms. • Medication is available to ease the unpleasant effects a person experiences during detoxification. • An example is Acamprosate which “reduces the discomfort that can accompany abstinence” from alcohol. • Other medications can “reduce the pleasurable affects of drinking” when a person consumes alcohol, and another will make the patient get sick. (Nevins)

11. Behavioral and Social Science Substance abuse is an especially bad idea for those with a co-occurring disorder… Alcohol and drugs such as cocaine produce depression as a side effect. Coming down from cocaine or alcohol will only enhance and worsen a mental health disorder. Then the depression warrants use of the drug again, creating a vicious cycle.

12. Psychological Addiction • Psychological addiction is when a person is no longer in control of their actions regarding the drug. • The person now feels they need the drug • The drug is not taken just recreationally or socially. • Most aspects of the addict’s life will revolve around the drug.

13. Effective Treatment In order for treatment to be the most effective, it must cover all of the addict’s issues… • The addiction • Physical problems • Social and family issues • Psychological issues • Behavioral problems

14. Integrated Treatment Plan • Both issues must be treated concurrently. • Plan should include integration of useful tools in disciplines. Tools used in addictions treatment or in mental health treatment can be integrated to provide a customized experience for the patient. • For example, proper medication combined with counseling therapy and mental assessments. • Each plan must be customized for each individual client, as every case is different. (Gorski)

15. Bibliography Califano, Joseph. (2007). High society. Public Affairs. Joseph Califano covers all corners of drug abuse in today’s society from nicotine, alcohol, and meth, to over the counter and prescription drugs. The look into how these drugs have affected our society involves closer scrutiny of physicians, celebrities, our government, and the nation’s money not properly being spent on studying this drug use epidemic. An interesting statement was that women and girls “get hooked faster and suffer harsher consequences sooner”. This writing was useful in proving addiction to affect people from all walks of life which should be a major concern for all of society. Califano’sbackground includes his work as special assistant for domestic affairs in 1965, serving attorney for the Washington Post, was the U.S. Secretary of Health, Education and Welfare, and founded The National Center on Addiction and Substance Abuse in 1992, proving his writing to be credible and knowledgeable. Chi, F., Sterling, S., & Weisner, C. (2006). Adolescents with Co-Occurring Substance Use and Mental Conditions in a Private Managed Care Health Plan: Prevalence, Patient Characteristics, and Treatment Initiation and Engagement. American Journal on Addictions, Vol. 15, p67-79, 13p, 4 Charts. 10.1080/10550490601006022 This article focuses on a study that examined dual diagnosed young females and males. The most useful information was the statistics of treatment. Out of 2,005 participants in the study, only 635 initiated their own treatment. Of those 635, only a little more than half “engaged in dual treatment”, that is treating both substance abuse and mental disorder. So, only 365 participants out of 2,005 actually received the necessary treatment for their problems.

16. Continued… • Denizet-Lewis, Benoit. (2009). America anonymous. Simon and Schuster. • Benoit Denizet-Lewis, a sex addict, spent almost three years “immersed” in lives of eight people from all over the country who were addicts of all kinds. The most useful information was that of the interviews which involved substance abuse, such as “Bobby”, addicted to heroin, and gave insight into the behavioral aspects as to why they began using. This book was helpful in that it gave a direct perspective from the addicts themselves, which gives the reader a look into the thought process, excuses, history, and daily activities of an addict. • Fisher, G.L., & Harrison, T.C. (2000). Substance abuse: information for school counselors, social workers, therapists, and counselors. Needham Heights, MA: Allyn & Bacon. • The writers of this book, who teach in the counseling department, acknowledge the lack of literature on co-occurring disorders, pointing out the fact that most of the literature is about substance abuse. The book attempts to cover any and all aspects one would need to know about within the counseling field, and does a good job of doing so. The most useful information was about how people with co-occurring disorders often slip through the cracks of treatment types available.

17. Continued… • Gorski, T. (1994, March). A suggestion for conceptualizing dual diagnosis. Behavioral Health Management, p. 50. Retrieved from Academic Search Premier database • This article reviews the reasons why dual diagnosis is difficult to treat, including under-diagnosis, misdiagnosis, and over diagnosis. Treating a dual diagnosis is also more expensive, and the relapse rate of this demographic is high. Discussed in the article are types of treatment like a general holistic treatment plan, which involves relationships, communication, and daily activities, or the disorder specific treatment plan designed for specific disorders and substance abuse. The article was helpful in researching types of treatment. • Harm reduction? (2008, October 07). Retrieved from http://vancityguy.wordpress.com/2008/10/27/harm-reduction-need-a-tourniquet-heres-a-band-aid/ • Henwood, B., & Padgett, D. (2007). Reevaluating the Self-Medication Hypothesis among the Dually Diagnosed. American Journal on Addictions, 16(3), 160-165. doi:10.1080/10550490701375368. • This article, found in the American Journal on Addictions, reviews the excuse of self-medicating as a reason for substance abuse. A four-year study was conducted involving 221 people with a substance abuse problem and mental illness. The study examined the reasons given by these people as to why they abused any substances. The most common reason given was coping, 47%. It was explained as “an attempt to cope with symptoms of a mental disorder”.

18. Continued… • Keegan, Kyle, & Moss, Howard. (2008). Chasing the high. New York, NY: Oxford University Press, USA. • Written by and about him, Kyle Keegan writes of his experience with substance abuse and his addiction to heroine. Keegan takes the reader through the stages of his drug experimentation which lead to his addiction and finally how he was able to get sober. He takes a firm stand stating throughout the book that addiction is a disease, a disease “that causes changes of the brain”, and is biological. The book was useful in providing not only the firsthand perspective of an addict but also valuable resources like the types of treatments available and how to get help. It was especially useful in providing the health science viewpoint about the effect on the brain. • Nevins, Sheila. (2007). Addiction. Home Box Office, Inc. HBO Documentary Films • Addiction is an HBO series of true life films that address issues of relapse, adolescent addiction, brain imaging and addiction, the new craze of opiate addiction, new medications available, and more. It follows substance abusers and their loved ones. The films are interjected with commentary by well respected professionals such as Dr. Nora Volkow, the Director of the National Institute on Drug Abuse, and Dr. Mark Willenbring, the Director of Treatment and Recovery Research at the National Institute on Alcohol Abuse and Alcoholism. Dr. Willenbring provided useful information about treatment types and solidified the importance of specialized care customized for each individual.

19. Continued… • Simon, David, & Chopra, Deepak. (2007). Freedom from addiction. Deerfield Beach, FL: Hci. • Written from the perspective of those at the Chopra Center for wellness, the book provides a guide for the addicted. It begins with questions directing toward helping the addict understand why they are addicted and whether or not they believe they can be helped. The solution in this book relies heavily on meditation, healthy eating, and yoga, stating “we have never seen a person relapse who is meditating regularly”. It also mentions the twelve steps but acknowledges that it is “incompatible with [some people’s] core beliefs”. The merit in this book is that it offers alternative solutions to addiction, as opposed to medicating an addiction. It provides insight into possible treatments. • West, James w. (1997). The betty ford center book of answers. New York, NY: Pocket Books. • This book is a series of real life questions, posed by addicts or their loved ones, and answered by the physician of The Betty Ford Center, James West. He answers the questions not only from a literal standpoint, but also incorporates an empathetic side. The questions range from categories like “who is an alcoholic?” to “cross addictions and dual disorders”. The latter proved to be the most useful chapter providing real life scenarios like a person with bipolar disease who drinks heavily.