Chemical Dependency

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Chemical Dependency Dual Diagnosis

• Presented by David Red Wiget CADC-II

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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.      Objectiv
es     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.      
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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

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• 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-

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Igor Koutsenok, MD University of California San
Diego, Department of Psychiatry, Center for
Criminality Addiction Research, Training
Applications
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13 yrs of Heroin abuse
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8 years of meth abuse
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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 OTCs 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..

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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), Somas.
• Meth is another popular drug of abuse among
  teens.

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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, DUIs etc.
• 11 of pregnant women use a psychoactive drug.
  This includes tobacco and caffeine.

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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
• DUIs

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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.

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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.

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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.

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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
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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
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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

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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

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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.

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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).

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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.

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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.

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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.

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THE END