Chemical Dependency & Dual Diagnosis

1. Chemical Dependency & Dual Diagnosis Presented by: David “Red” Wiget CADC-II

2. CHEMICAL DEPENDENCY & DUAL DIAGNOSIS GOAL: The goal of this module is to examine the basic principles and dynamics of chemical dependency and components related to the dual diagnosed individual and population specifics. Objectives: 1.      Identify and discuss some concepts of chemical dependency. 2.      Explain and discuss the components of dual diagnosis. 3.      Identify and discuss relapse prevention. 4.      Explain and discuss symptoms and phases of addiction. 5.      Identify and discuss treatment for substance abuse/dual diagnosis. 6.      Discuss population specific components. 7.      Identify and discuss components related to charting.

3. What is Chemical Dependency? • CD is the continued need for alcohol and or other drugs despite negative consequences. An obsession of the mind, allergy of the body and a spiritual malady. It is a brain disease. • Chronic • Progressive • Fatal

4. Myths: • Addicts are weak willed • They wear trench coats and push shopping carts, while drinking paint thinner. • They live on skid row. • Only men are addicts • You cant get addicted to marijuana -and the list goes on-

5. Igor Koutsenok, MD University of California San Diego, Department of Psychiatry, Center for Criminality & Addiction Research, Training & Applications

7. 13 yrs of Heroin abuse

8. 8 years of meth abuse

10. Population Specific ComponentsYouths: • One third of High School seniors take an illegal drug in month. • Alcohol is the drug most frequently used by 12-17 year olds, and the one that causes the most negative health consequences. • The drug of choice with this population is marijuana. • The abuse OTC’s are another epidemic with teens and younger kids: i.e. “Triple C” (Coricidin), Inhalants: aerosols such as Wizard and other air fresheners, computer cleaner, NOS (Nitrous Oxide), paint, glue, gas ect..

11. Youths cont. • Hallucinogens: MDMA (Ecstasy), LSD, Magic Mushrooms, “Specail K”, and PCP • Prescription drugs i.e. Ritalin, Aderall and Rx pain meds: Vicodin, Oxycontin, Benzos (Valium, Ativan), Soma’s. • Meth is another popular drug of abuse among teens.

12. Abuse/Addiction Among Adults Alcoholism was once seen as a disease that primarily afflicted middle-aged men. Today its influence cuts across the sexes and many age groups. • Women • Seeking psychological benefits. • Statistics indicate that the number of female alcoholics will increase. • Already, an estimated 10% of adult women in the U.S. show signs of alcohol dependency, and 5% have suffered adverse reactions related to drinking such as: domestics problems, traffic accidents, DUI’s etc. • 11% of pregnant women use a psychoactive drug. This includes tobacco and caffeine.

13. Adults Cont.The longer and more frequently one uses and progression takes over, the more desperate one becomes. • Pain management • Vicodin, Oxycontin • ETOH abuse • Meth • Cocaine • Self-medication • Domestics Violence • DUI’s

14. The Elderly Alcoholic • Alone and unnoticed. • Alcoholism represents a far more common phenomenon among the elderly than most people realize. • Social drinking often escalates into alcoholism after retirement, especially for those with few outside interest or hobbies. • Elderly people that take prescription drugs and remain uniformed about potentially dangerous situations. • Elderly people visit several doctors and obtain prescriptions for various mood-altering drugs. • Be alert for symptoms of withdrawal when elderly participants entering the hospital.

15. What is Dual Diagnosis? • A person who has both an alcohol and or drug addiction and an emotional/psychiatric problem is said to have a dual diagnosis. To recovery fully, the person needs treatment for both problems.

16. Epidemiology • For many years service professionals used the term “dual diagnosis” to refer to persons were mentally retarded who also had a coexisting psychiatric disorder (D/O). • A.)For one with preexisting mental illness self-medication is a big factor in causing Dual Dx. • B.)For one with a preexisting drug and or alcohol addiction is another cause of Dual Dx.

17. How common is Dual Dx? • Over 50% of addict/alcoholics entering treatment today are suffering from a preexisting or drug enhanced mental illness. This epidemic is supported by Dr. Ikramullah, Dr. Snyder, Dr. Unruh, The World Health Organization, American Medical Association, American Psychiatric Association and the U.S. Department of Health and Human Services combined with the number of dual diagnosis patients admitted to Aurora BHC last year 2005 is solid evidence that is a growing problem that needs continued attention. NMHA fact sheet: Substance Abuse - Dual Diagnosis

18. Cont. • According to a report published by the Journal of the American Medical Association: • Thirty-seven percent of alcohol abusers and fifty-three percent of drug abusers also have at least one serious mental illness. • Of all people diagnosed as mentally ill, 29 percent abuse alcohol or other drugs. Mental Health Articles and Updates

20. What kind of mental or emotional problems are seen in people with Dual DX? • Depressive disorders, such as depression and bipolar disorder. • Psychiatric disorders, such as schizophrenia and personality disorders. • Anxiety disorders, including GAD, panic disorder, obsessive compulsive disorder, and phobias

21. Signs and Symptoms • Signs and symptoms or “warning signs” are sometimes difficult to notice and sometimes obvious. (This is not an exhaustive list). • A.)Social problems • 1.)Change in friends (no longer associating with non-abusers) • 2.)Inability to attend social gatherings without a “ pre-function” (drugs or alcohol used prior to the function) • 3.)Friends complaining about use of chemical or behavior associated with substance abuse • B.)Family problems • 1.)Increase in family conflict • 2.)Sexual problems with spouse • 3.) Physical illness, depression or acting out of other family members

22. Effective Treatment • Some of the most effective models of treatment for the DDx patient are: • A.)Detoxification is usually the first step in treatment being careful that the patient does not get cross addicted. • B.)Communicating with the doctor and treatment team to get an accurate assessment and diagnosis. • C.)Unless the patient had a documented history of a preexisting mental illness it is best to wait at least thirty days before starting any antidepressants or psychotropic. • D.)Provide the three most important elements of a healing environment: safety, security and structure. • E.)Teaching medication compliance to the DD patient.

23. Relapse Prevention • It is sometimes frustrating to see the same patients time after time (also known as frequent fliers). • A.)It is important as mental health professionals to realize we are dealing with sick people who need to get well, not bad people that need to be good. • B.)Support and encouragement • C.)Aftercare • 12-step involvement i.e. double trudger meetings, sponsorship (one who understands the importance of medication).

25. Consistency • Continue to educate oneself and stay up to date with the changes in the Dual Diagnosis treatment model. • Communicate with each other frequently and offer support to one another.

26. Codependency • loss of objectivity, • warped sense of responsibility, • easily controlled or controlling, • excessive feelings of guilt, hurt and anger, loneliness, • extreme fear of rejection, • excessive fear of failure.

27. Conclusion • Today you have been informed and educated about some of the important aspects for understanding addiction and treating the Dual Dx patient: epidemiological aspects, signs and symptoms, effective models of treatment, population specifics, medication compliance, and relapse prevention. I hope that you feel more equipped and competent with the skills needed to provide the best treatment possible for the Dual Dx patient. Five out of every ten patients that are admitted to this hospital with a hx of CD are Dual Dx and rely on us as mental health professionals to provide them with a healing environment. Be a part of the solution, not the problem, and put what you have learned here today into use.

28. THE END