Substance Use Disorders in Mental Illness

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Substance Use Disorders in Mental Illness

• Dual Diagnosis

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Definition of Substance Use Disorders (SUD)
How much is too much?

• At Risk Drinking
• 5 or more drinks for men
• 4 or more drinks for women
• On a single occasion

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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

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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.

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ALCOHOL

• 1994 National Comorbidity study
• gt50 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.

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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

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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.

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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.

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Drugs that Cause Psychotic Symptoms

• During Intoxication
• Amphetamine, methamphetamine, cocaine
• Hallucinogens LSD, Ecstasy, PCP, others
• Marijuana
• Opioids
• During Withdrawal
• Alcohol, Benzodiazepines, barbiturates
• Marijuana

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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.

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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.

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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
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Treat Addiction
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