Relapse Prevention and Co-Occurring Disorders

Relapse Prevention: - FA relapse must be aggressively processed by the client and the counselor so that the causes can be identified and strategies developed to avoid future slips and relapses. JCognitive Deficits: - FAbout 30% to 80% of substance abusers suffer from mild to severe cognitive impairments. Patients often appear normal during the early phase of treatment but are actually experiencing an inability to fully understand and process the treatment curriculum. It may take weeks or months after detoxification for reasoning to return to a point where the individual can begin to fully engage in treatment. JPost-Acute Withdrawal Symptoms (PAWS) & Cognitive Impairments: - FPAWS are a group of emotional and physical symptoms that appear after major withdrawal symptoms have gone. The syndrome can persist for 6 to 18 months or longer. Symptoms include sleep disturbances, memory problems, inability to think clearly, anxiety, and physical coordination difficulties. JCravings - FAbuse of an addictive drug disrupts brain chemistry resulting in an imbalance and a depletion of certain neurotransmitters which reinforces drug craving. Counseling, education, support from a sponsor, stress-reduction therapies, and participation in 12-step meetings are common treatment strategies. JEndogenous Triggers (Internal or Interpersonal Triggers): - FNegative emotional and physical states or internally motivated attempts to regain control in order to use. JEnvironmental Triggers (External or Interpersonal): - FEnvironmental triggers are manifested by true physiological responses to psychological triggers. Often precipitate drug cravings e.g., relationship conflicts, social pressures, lack of support systems, negative life events, sensory stimuli, and people, places, and things. JRelapse Prevention Strategies: - FAddicts must: -Recognize their personal triggers -Develop behaviors to avoid external triggers -Have an automatic reflex strategy that will prevent them from responding to internal or external cues. JCue Extinction: - FDesensitization retrains brain cells to avoid reacting when confronted by environmental cues (cue extinction). JPsychosocial Support: - FInitial abstinence is the phase during which addicts start to put their lives back in order. Building a support system is vital. JNatural Highs: - FHumans can create virtually every sensation and feeling from natural life situations, (sports, art, dance, travel) that drugs create. JOutcomes and Follow-Up Evaluations: - FClient outcomes and follow-up evaluations are a major element in treatment program activities. All types of addiction treatment have demonstrated positive client outcomes. JDual Diagnosis (Co-Occurring Disorders): - FCo-occurring disorders are defined as the existence of a mental illness and an independent substance use disorder. A mental illness can be pre-existing or substance induced (temporary or permanent). JBrain Chemistry: - FBecause the neurotransmitters affected by psychoactive drugs are also associated with mental illness, many people with mental problems are drawn to psychoactive drugs in an effort to rebalance their brain chemistry and control their agitation, depression, or other mental problems. The opposite is also true. Unbalanced chemistry due to drug abuse can aggravate a pre-existing mental illness or mimic the symptoms of one. JSubstance Use Disorders (SUDs): - FInvolve patterns of drug use and are divided into substance dependence and substance abuse. JSubstance Dependence: - FA maladaptive pattern of substance use leading to clinically significant impairment or distress. JSubstance Abuse: - FContinued use despite adverse consequences. JSubstance-Induced Disorders: - FConditions that are caused by the use of the specific substances. Disorders include intoxication, withdrawal, and certain mental disorders (e.g., delirium, dementia, psychotic disorder, etc). JDetermining Factors: - FThe main factors that affect the central nervous system's balance and, therefore a person's susceptibility to mental illness as well as addiction are heredity, environment, and the use of psychoactive drugs. JHeredity and Mental Balance: - FResearch has already shown a close link between heredity and schizophrenia, bipolar disorder, depression, and anxiety. If a person's genetically susceptible brain chemistry is stressed by a hostile environment and/or psychoactive drug use, that person has an increased likelihood of developing mental illness. Excess dopamine is a key contributor to both real psychosis and drug-induced psychosis. JEnvironment and Mental Balance: - FThe same environmental factors that can induce a susceptibility to drug abuse can induce mental/emotional problems. The neurochemistry of people subject to extreme stress can be disrupted and unbalanced to a point where their reactions to normal situations are different from those of most other people. JPsychoactive Drugs and Mental Balance: - FIf a nervous system is affected by enough psychoactive drugs, any individual could develop mental/emotional problems, but it is the predisposed brain that is more likely to have prolonged or permanent difficulties. The brain that is not predisposed is the one most likely to return to its normal functioning during abstinence. Also, the type of drug used has a great impact on symptoms of co-occurring disorders. JPre-Existing Mental Illness: - FA person who has a clearly defined mental illness and uses drugs, often to self-medicate symptoms of the mental illness. Some mentally ill people have a concurrent substance-abuse problem that does not involve self-medication. JSubstance-Induced Mental Illness: - FBecause of substance abuse and/or withdrawal, the user develops psychiatric problems because the toxic effects of the drug disrupt the brain chemistry. The chemical imbalance associated with this type of diagnosis is usually temporary, and the mental illness disappears with abstinence within a few weeks to a year. JRecommendations to Treat Dual Diagnosis: - F-The dual-diagnosis patient must be treated for both disorders simultaneously. -They are best treated in a single program when appropriate resources are available. -SA programs must establish links with MH service providers and vice versa to provide both short-term and long-range services to address the problems of dual diagnosis. -Research has found that intensive case management was associated with the greatest improvement. JDr. Kenneth Minkoff's Four-Quadrant Model: - FThis model has differing levels of mental health and substance abuse and is useful when determining the most appropriate treatment placement and direction for a dual-diagnosis client. JThe four quadrants are: - FQuadrant 1: Less severe (MD) and Less Severe (SUD) Quadrant 2: More severe (MD) and Less Severe (SUD) Quadrant 3: Less Severe (MD) but More Severe (SUD) Quadrant 4: More Severe (MD) and More Severe (SUD) JPre-Existing Mental Illnesses: - FThought Disorder (schizophrenia), Major Depressive Disorder, Bipolar Affective Disorder, Anxiety Disorders, Dementias, Developmental Disorders, Somatoform Disorders, Personality Disorders, Borderline Personality Disorder (BPD), Eating Disorders, Gambling Disorder. JThought Disorder (schizophrenia): - FSeveral abused drugs mimic schizophrenia and psychosis. Methamphetamine, steroids, MDMA, and sometimes marijuana can induce a toxic psychosis, paranoia, or dissociation from reality as can withdrawal from downers.