Download Co-Occurring Disorders

Co-Occurring Disorders
June 13, 2013
by Andrew Parrish, MS, LMFT
What is a co-occurring disorder?
 Co-occurring disorders involve:
 A mental health diagnosis
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Major depressive disorder
Bipolar disorder
Schizophrenia
Generalized anxiety disorder
Attention Deficit Hyperactivity Disorder (ADHD)
Post-Traumatic Stress Disorder (PTSD)
 A substance abuse/dependence diagnosis
 Abuse: consistent problems with use of a substance on an
inconsistent basis
 Dependence: significant problems due to using a substance on a very
consistent basis
Understanding Substances
 Substances are divided into two categories
 Depressants (“Downers”)
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Alcohol (beer, wine, spirits, mixed beverages)
Marijuana (cannabis, pot, weed, hashish)
Opiates (heroin, prescription pain killers)
Benzodiazepines (Xanax™, Klonipin™, Ativan™)
 Stimulants (“Uppers”)
 Cocaine
 Methamphetamines
 Prescription medications (Adderall™, Ritalin™)
Understanding Depression
 Major depressive disorder
 Involves periods of intense emotional and mental distress
marked by sadness, irritability and even suicidal ideations
 Can be connected to the seasons
 Can occur at regular intervals (every 2 years)
 Has no manic or hypomanic stage
 Significantly impacts interacting with others
 Why would someone use a depressant?
 Why would someone use a stimulant?
Understanding Bipolar Disorder
 Bipolar disorder
 Characterized by two distinct moods
 Depressed mood
 Period of sadness, isolation, sometimes suicidal ideations
 Manic/hypomanic mood
 Period of increased mood, agitation, extreme happiness, impulsivity,
grandiose thinking
 Moods fluctuate over time
 Significantly impacts interacting with others
 Why would someone use a depressant?
 Why would someone use a stimulant?
Understanding Schizophrenia
 Schizophrenia
 Marked by experiencing positive (added) symptoms
(hallucinations, paranoia) during active stage
 Marked by experiencing negative (blocking) symptoms
(catatonic, isolated, withdrawn) during residual stage
 Significantly impacts interacting with others
 Why would someone use a depressant?
 Why would someone use a stimulant?
 Bonus question: what is the overlap of a mood disorder
(depression or bipolar) and schizophrenia called?
Understanding Schizoaffective
Disorder
 Schizoaffective Disorder
 Overlap of symptoms from:
 Schizophrenia
 Positive symptoms
 Hallucinations and paranoia
 Negative symptoms
 Isolation, socially withdrawn
 Mood disorder
 Depression
 Bipolar disorder
 Is someone with schizoaffective more or less likely to
use than someone with schizophrenia?
Understanding Generalized Anxiety
Disorder
 Generalized Anxiety Disorder
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Significant periods of time worrying about life stressors
Significantly impacts interacting with others
Can follow significant trauma
Can sometimes be “irrational”
 Often times, irrational anxiety is the result of thoughts
being influenced by emotions and emotional responses
 Is someone more likely to use stimulants or
depressants with this illness?
Understanding ADHD
 Attention Deficit Hyperactivity Disorder
 Can be predominately inattentive (formerly ADD)
 Marked by inability to focus or pay attention
 Completion of tasks is low even if instructions are clear
 Can be predominately hyperactive
 Marked by inability to calm down and engage
 Completion of tasks is low due to impulsivity
 Significantly impacts interactions with others
 Would a person with ADHD be more likely to use a
depressant or a stimulant?
 Bonus question: What is a commonly prescribed medication
for ADHD that is not a stimulant?
Understanding PTSD
 Post-Traumatic Stress Disorder
 Response follows a traumatic event
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Death of a loved one
Potential damage to a person that could harm or kill them
Severe abuse or mistreatment
Witnessing severe abuse or mistreatment of others
Returning from a war zone
 Significantly impacts interacting with others
 Is someone with PTSD more likely to use a stimulant or a
depressant?
Changes in DSM-5
 Substance abuse and substance dependence no longer exist as a diagnosis
 Instead, substance diagnoses fall into four categories that describe
symptoms
 Substance use disorder
 Use of a substance becomes more problematic over time with tolerance levels
increasing and impacts to daily functioning being significant
 Substance intoxication
 Recent use of a substance resulting in marked changes to normal behavior
 Substance withdrawal
 Recent cessation (stopping) or “cutback” of a substance resulting in marked
changes to normal behavior
 Other substance related disorder
 Substance use resulting in problematic functioning that does not fall in the above
categories
How do you deal with co-occurring
problems?
 Psychosocial Rehabilitation (PSR) can assist in
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Developing coping skills
Developing healthy interaction skills
Learning more about your diagnosis
Overcoming fears
Identifying triggers for mental health or substance relapses
Taking personal responsibility for yourself
Strategies to stay clean and/or sober
 Talking with a counselor or PSR staff member is helpful
 Remember, mental health workers are there to help you get
better!!