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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 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”) 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paranoia) during active stage Marked by experiencing negative (blocking) symptoms (catatonic, isolated, withdrawn) during residual stage Significantly impacts interacting with others Why would someone use a depressant?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of symptoms from: Schizophrenia Positive symptoms Hallucinations and paranoia Negative symptoms Isolation, socially withdrawn Mood disorder Depression Bipolar disorder Is someone with schizoaffective more or less likely to use than someone with schizophrenia?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 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 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 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!!