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Substance Use Disorders in Mental Illness

Substance Use Disorders in Mental Illness. “Dual Diagnosis”. Definition of Substance Use Disorders (SUD). “At Risk” Drinking 5 or more drinks for men 4 or more drinks for women On a single occasion. How much is too much?. Definitions of Substance Use Disorders.

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Substance Use Disorders in Mental Illness

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  1. Substance Use Disorders in Mental Illness “Dual Diagnosis”

  2. Definition of Substance Use Disorders (SUD) “At Risk” Drinking • 5 or more drinks for men • 4 or more drinks for women On a single occasion How much is too much?

  3. Definitions of Substance Use Disorders Abuse (1 or more of following) • Use resulting in failure to meet major obligations • Use in situations that are physically hazardous • Use resulting in legal problems • Use despite problems or symptoms exacerbated by use

  4. Definition of Substance Use Disorders Dependence (3 or more of the following) • Tolerance • Withdrawal • Using in greater amounts than intended • Unsuccessful efforts to cut down or control use. • Spending a large amount of time getting or using substance. • Giving up social, occupational or recreational activities. • Use despite physical or psychological problems related to the substance.

  5. ALCOHOL • 1994 National Comorbidity study: • >50% of patients with serious mental illness also have an SUD. • 25-50% of suicides involve alcohol. • 50% of trauma beds in U.S. filled by patients injured under the influence of alcohol.

  6. Schizophrenia and SUD 47% of patients with schizophrenia will also have a substance use disorder in their lifetime. 34% - alcohol 28% - other drugs 70-90% nicotine dependent

  7. Schizophrenia and SUD Patients with schizophrenia and SUD • Poorer quality of life • More suicide attempts • More hospitalizations • Earlier onset of schizophrenia compared to schizophrenia patients without SUD Cocaine and marijuana may increase risk of tardive dyskinesia.

  8. Is it Schizophrenia or Is it SUD ? Drugs and alcohol can cause psychosis 1) When under the influence 2) During withdrawal 3) By precipitating or exacerbating an underlying psychotic disorder. 4) Due to noncompliance with anti-psychotic meds.

  9. Drugs that Cause Psychotic Symptoms During Intoxication Amphetamine, methamphetamine, cocaine Hallucinogens – LSD, Ecstasy, PCP, others Marijuana Opioids During Withdrawal Alcohol, Benzodiazepines, barbiturates Marijuana

  10. Is it Schizophrenia or Is it SUD ? 1) History of symptoms of psychosis before using drugs. 2) Psychosis due to drugs usually resolves after use is discontinued, but may last up to 4 wks, particularly with marijuana, PCP, amphetamines. 3) Wait. Try off antipsychotics after abstinent for awhile.

  11. Treatment • Medical detox for withdrawal if psychotic symptoms present. • Complete abstinence from drugs and alcohol is the goal, but harm reduction is important. Early remission 30-50%, length of abstinence periods not that different than in SUD w/out schizophrenia. • Medications for addictions.

  12. Special Considerations in Treatment • Dual Diagnosis (MI and CD) programs (residential or outpatient) - Positive alliance with therapist/counselor - Motivational enhancement - Relapse prevention - 12-step groups (Dual Diagnosis Anonymous) - Consideration for other issues due to the mental illness • Medication compliance, social skills, leisure skills. • Community resources, housing, finance management. Rx

  13. Treat Addiction Save Lives

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