©2010 mcgraw-hill higher education. all rights reserved. chapter 10 disorders co-occurring with...

©2010 McGraw-Hill Higher Education. All rights reserved.

Chapter 10

Disorders

Co-occurring with Substance Abuse


Definition of Co-occurring Disorder

Having both a: psychiatric diagnosis and chemical dependency diagnosis

Also called:

dual disorder

co-morbid disorder


Facts about Serious Mental Illness (SMI)

Serious Mental Illness – Findings 2002, National Survey

In 2002, there were 17.5 million adults aged 18 or older with SMI during the 12 months prior to being interviewed. This represents 8.3 percent of all adults in the United States. On average, adults with SMI were younger, less educated, and more likely to be female than adults without SMI.


SMI Facts cont’d

Adults with SMI were more likely to be either unemployed or not in the labor force (36.4 percent) than were persons without SMI (31.2 percent).

Of the three age groups considered in this report, adults aged 18 to 25 had the highest rate of SMI (13.2 percent), followed by adults aged 26 to 49 (9.5 percent) and adults aged 50 or older (4.9 percent).


SMI Facts cont’d

Overall, the rate of SMI was almost twice as high among females (10.5 percent) as it was among males (6.0 percent).

The two racial/ethnic groups with the highest prevalence of SMI were those reporting more than one race (13.6 percent) and American Indians and Alaska Natives (12.5 percent).


SMI Facts cont’d

In 2002, there were 5 million adults aged 18 or older who had SMI and used an illicit drug in the past year. This represented 28.9 percent of all persons with SMI.


Affective Disorders

Classify affective (feeling) disorders by:

Severity Duration Precipitating factors


Categories of Mood Disorders

Some common affective disorders are: Major depression Dysthymic disorder (a low-grade depression) Atypical depression (depression related to sudden loss;

also experienced by Adult Children of Alcoholics) Organic depression Bipolar disorder, formerly referred to as manic-

depressive illness (sever mood wings) Cyclothymic (mood-cycling) disorder (a less severe

form of mood wings)


Depression

Vegetative signs of depression include the following: Disrupted sleep patterns (REM sleep deprived) Difficulty with appetite and weight regulation Decreased cognitive functioning (including problems

with concentration, memory and problem solving) Decreased libido, or sex drive Lack of motivation, decreased energy (anergia) Difficulty experiencing pleasure (anhedonia) Potential for suicide because of shame when

depression associated with using


Co-occurring Bipolar Disorder

Bipolar disorder is the highest affective (feeling) disorder associated with co-occurring disorders.


Co-occurring Bipolar Disorder

Some common themes found with clients who have bipolar disorder and substance abuse are:

A strong emphasis on depression, as opposed to mania

Predominance of hopelessness Specific pattern of medication non-compliance Patients labeling of their substance abuse as self-

mediation (Weiss, 2004) Excessive spending, Grandiosity, Pressured Speech


Personality Disorders

To qualify for a personality disorder diagnosis, an individual’s traits and behaviors must be longstanding and must cause significant impairment in social or occupational functioning or subjective distress.


Personality Disorders cont’d

Cluster A Cluster B Cluster C

Paranoid Antisocial Avoidant

Schizoid Borderline Dependent

Schizotypal Histrionic Obsessive-Compulsive

Narcissistic Passive-Aggressive

The following are the 11 DSM III-R personality disorders:

From American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, Washington, D.C., American Psychiatric Association, 1987.


Personality Disorders

Common personality disorders co-occurring with substance abuse disorders

Antisocial personality disorder Borderline personality disorder (mood instability) Narcississtic personality disorder Dependent personality disorder Self-defeating personality disorder


Treatment of Disorders Co-occurring with Substance Abuse

Treatment of co-occurring disorders means addressing both the mental illness and the substance abuse. Treating one and ignoring the other will only result in relapse.


Treatment Guidelines

American Psychiatric Association (2000) Practice Guidelines for the Treatment of Psychiatric Disorders include:

1. Establish and maintain a therapeutic alliance with the client.

2. Manage the client’s psychiatric (or substance use) symptoms and monitor the status of these over time.


Treatment Guidelines cont’d

3. Provide education regarding the disorder(s) and treatment.

4. Determine the need for medications and other specific treatments.

5. Develop and overall treatment plan.6. Enhance adherence to the treatment plan.7. Help the client and family adapt to the

psychosocial effects of the disorder(s).


Treatment Guidelines cont’d

8. Promote early recognition of new episodes and help identify factors that precipitate or perpetuate these episodes.

9. Initiate efforts to relieve and improve family functioning.

10. Facilitate access to services and coordinate resources among different service providers.

©2010 mcgraw-hill higher education. all rights reserved. chapter 10 disorders co-occurring with...

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