Counselor Toolbox Podcast

Organizational Guidelines for Trauma Informed Care Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC Objectives ~ What do we mean by trauma? ~ What do we mean by a trauma-informed approach? ~ What are the key principles of a trauma-informed approach? ~ What is the suggested guidance for implementing a trauma-informed approach? ~ What are the core […]

Health Education Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Counselor Education Podcast Host: Counselor Toolbox and Happiness Isn’t Brain Surgery Objectives ~ 1.Describe the prevalence and patterns of tobacco use ~ 2.Explain the role of a comprehensive tobacco control program. ~ 3.Utilize the findings of national reports and guidelines on tobacco treatment. ~ 4.Explain the factors that prevent tobacco use and dependence. ~ 5.Explain the health consequences of tobacco use and benefits of quitting, and the basic mechanisms of the more common tobacco induced disorders. ~ 6.Describe how tobacco dependence develops ~ 7.Summarize valid and reliable diagnostic criteria for tobacco dependence. ~ 8.Describe the chronic relapsing nature of tobacco dependence ~ 9.Provide information that is culturally sensitive and appropriate to learning style ~ 10.Identify evidence-based treatment strategies ~ 11.Be able to discuss alternative therapies Prevalence and Patterns ~ Describe the prevalence and patterns of tobacco use, and how rates vary across demographic, economic and cultural subgroups. ~ Tobacco cigarettes: Nearly 90 percent of adult smokers began smoking before age 18 and 11 percent of high school seniors reported smoking in the last month. ~ Smokeless tobacco: Use of smokeless tobacco among adolescents is less common than cigarette smoking. ~ Hookahs: Hookahs are no safer than other forms of tobacco smoking and may deliver even higher levels of toxic substances. ~ Flavored little cigars: Of middle and high school students who used tobacco products in 2014, more than 60 percent smoked flavored little cigars. Prevalence ~ Describe the prevalence and patterns of tobacco use, and how rates vary across demographic, economic and cultural subgroups. ~ E-cigarettes: ~ From 2011 to 2016, the percentage of 12th-grade students who had ever used an e-cigarette increased from 4.7 to 13 percent, down from a peak in 2015 of 16 percent.2 ~ For the first time in 2014, more teenagers used e-cigarettes or vaped nicotine than smoked cigarettes—a trend that continues. In 2017, 8 percent of high school students reported vaping nicotine at least once in the past 30 days. Prevalence ~ American Indians/Alaska Natives have a higher risk of experiencing tobacco-related disease and death due to high prevalence of cigarette smoking and other commercial tobacco use. ~ The risk of developing diabetes is 30–40% higher for smokers than nonsmokers.10 ~ More American Indian/Alaska Native women smoke during their last 3 months of pregnancy—26.0% compared to other ethnicities. ~ Cigarette smoking varies by Asian American subgroups as a result of a number of cultural, social, environmental, and individual factors. ~ Cigarette smoking during pregnancy is less common among Asian American/Pacific Islander women compared to other racial/ethnic groups.11 Comprehensive Tobacco Control ~ Explain the role of treatment for tobacco use and dependence within a comprehensive tobacco control program. ~ Primary Prevention: Prevent a problem ~ Secondary Prevention aims to reduce the impact of a disease or injury that has already occurred and prevent secondary problems. ~ Treatment to reduce cancer, lung problems, reduce absenteeism, reduce effects of second hand smoke, improve health of babies ~ Tertiary prevention aims to help people learn to live with the issue ~ Treatment to help people quit smoking after a diagnosis like emphysema National Reports ~ Utilize the findings of national reports, research studies and guidelines on tobacco treatment. ~ Office on Smoking and Health ~ The Health Consequences of Smoking—50 Years of Progress. Surgeon General ~ Cochrane Reviews ~ Tobacco, Nicotine and E-Cigarettes Consumer Education (NIDA) Prevention Strategies ~ Explain the societal and environmental factors that prevent tobacco use and dependence. ~ Attitudes ~ Reduction in advertising and visual triggers ~ Youth stress management and health promotion programs ~

Management of Tobacco Use Part 2 Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC Executive Director, AllCEUs.com Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery Objectives ~ Barriers to Engagement ~ Screening ~ Preparing for Change ~ Practical Interventions ~ Relapse Prevention ~ Essential Education ~ Motivational Interviewing Techniques ~ Tips for Supporters Barriers to Engagement ~ Lack knowledge about: ~ How to identify smokers quickly and easily ~ Which treatments are effective ~ How such treatments can be delivered ~ Relative effectiveness of different treatments. ~ Inadequate clinic or institutional support for routine assessment and treatment of tobacco use ~ Time constraints ~ Lack of insurance coverage for tobacco use treatment, or inadequate payment for treatment Getting Started: Screening ~ 5 As ~ Ask about tobacco use ~ Advise quitting ~ Assess needs and readiness for change ~ Assist in quit attempt or employ a motivational intervention ~ Arrange Helping Clients Get Ready: STAR ~ Set a quit date within 2 weeks. ~ Tell family, friends, and coworkers about quitting, and request understanding and support. ~ Anticipate challenges to the upcoming quit attempt, particularly during the critical first few weeks. ~ Remove tobacco products from your environment. ~ TIP: Prior to quitting, avoid smoking in places where you spend a lot of time (e.g., work, home, car). ~ TIP: Make your home smoke-free Practical Tools ~ Abstinence. ~ Past quit experience: Identify what helped and what hurt in previous quit attempts. Build on past success. ~ Quitline support (1-800-QUIT-NOW). Practical Skills ~ Relapse Triggers and Traps (Baseline and chaining) ~ Negative affect (Boredom, depression, anger, anxiety) ~ Being around other tobacco users ~ Experiencing urges ~ Smoking cues and availability of cigarettes ~ Strengths Based Coping Skills ~ Anticipate and avoid temptation and trigger situations Practical Skills cont ~ Accomplish lifestyle changes that reduce stress, improve quality of life, and reduce exposure to smoking cues. (Define a RML) ~ Learn cognitive and behavioral activities to cope with urges and improve mood ~ Activities, Contributions, Comparisons, Emotions, Pushing away, Thoughts, Sensations ~ Imagery, Meaning, Prayer, Relax, One at a time, Vacation, Encouragement Practical Skills cont… ~ Create peaceful times in your everyday schedule. ~ Try relaxation techniques ~ Rehearse and visualize your relaxation plan. ~ When you quit smoking, drinking coffee or tea without smoking may make you feel sad. Focus on what you’ve gained by quitting. ~ Switch to decaffeinated coffee or tea for a while, particularly if you are irritable or nervous. ~ Avoid foods that increase your urge to smoke Practical Skills cont… ~ Call a friend or take a walk as soon as you’ve finished eating. ~ Brush your teeth or use mouthwash right after meals or even chew on a toothpick ~ Wash the dishes by hand after eating—you can’t smoke with wet hands! Emergency Options for Distress ~ Wait 15 minutes, and then ask yourself if you can wait another 15 minutes, etc. ~ Hold ice ~ Bite into a hot pepper or chew a piece of ginger root. ~ Rub liniment or Vicks Vapor Rub under your nose. ~ Take a cold bath/shower. ~ Scream or scream-sing your favorite song. ~ Stomp your feet…a lot. In heavy shoes (not heels…) ~ Flatten cans or boxes for recycling, as fast as possible ~ Rip an old newspaper or phone book apart. ~ Throw a tennis ball against a wall ~ Crank up the music and move. ~ Run up and down the stairs at work Education ~ Addictive nature of tobacco ~ Effects of E-Cigarettes ~ Relapse Prevention: Any smoking (even a single puff) increases the likelihood of a full relapse ~ Understanding Withdrawal: Symptoms typically peak within 1–2 weeks after quitting but may persist for months. ~ These symptoms include negative mood, urges to smoke, and difficulty concentrating. ~ How To Handle Withdrawal Symptoms and Triggers Education cont… ~ Details about the harm-

Management of Tobacco Use Part 1 Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC Executive Director, AllCEUs.com Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery Based on the VA/DoD Guidelines Objectives ~ Gain information on the assessment of tobacco use ~ Identify clinical interventions, both for patients willing and unwilling to make a quit attempt at this time ~ Identify intensive interventions for motivated patients ~ Examine systems interventions for health care administrators, insurers, and purchasers ~ Review the scientific evidence supporting the Guideline recommendations ~ Explore information relevant to specific populations Why Do I Care ~ Clinicians can make a difference with even a minimal (less than 3 minutes) intervention ~ A relation exists between the intensity of intervention and tobacco cessation outcome ~ Even when patients are not willing to make a quit attempt at this time, clinician-delivered brief interventions enhance motivation and increase the likelihood of future quit attempts ~ Tobacco users are being primed to consider quitting by a wide range of societal and environmental factors Why Do I Care ~ There is growing evidence that smokers who receive clinician advice and assistance with quitting report greater satisfaction with their health care than those who do not ~ Tobacco use interventions are cost effective ~ tobacco use has a high case fatality rate (up to 50% of long-term smokers will die of a smoking-caused disease 3 Truths About Tobacco Use ~ All tobacco products—not just cigarettes—exact devastating costs on the Nation’s health and welfare ~ For most users, tobacco use results in true drug dependence, comparable to the dependence caused by opiates, amphetamines, and cocaine. ~ Both chronic tobacco use and dependence warrant clinical intervention and, as with other chronic disorders, these interventions may need to be repeated Variables to Consider ~ Success ~ High motivation ~ Ready to change ~ Moderate to high self-efficacy ~ Supportive social network ~ Relapse ~ High nicotine dependence ~ Psychiatric comorbidity and/or substance use ~ High stress level ~ Exposure to other smokers Motivation Enhancement ~ Why do I want to quit? (Rewards, risk reduction, RML) ~ Why do I use? ~ Mental: Concentration, obsessive thoughts, rationalizing ~ Emotional: Boredom, dysphoria ~ Environmental: Access, triggers ~ Physical: Dependence, pain, weight management ~ Social: Peers smoke ~ You can add stop-gaps, but you need to address the underlying issues for use Develop a Plan ~ Obstacles to quitting (Roadblocks) ~ Triggers ~ Mental ~ Unhook and urge surf ~ Radical acceptance of thoughts ~ Decisional balance ~ Efficacious self talk Develop a Plan ~ Obstacles to quitting ~ Triggers ~ Emotional ~ Distress Tolerance Exercises ~ Stress Management ~ Deep Breathing ~ Work toward acceptance of the loss/dialectics ~ Keep active (boredom, distract don’t react) Develop a Plan ~ Obstacles to quitting ~ Triggers ~ Environmental ~ Times of day/activities Change your routine ~ Morning ~ Driving ~ Football ~ Avoid things linked to smoking (Alcohol) ~ Remove sensory triggers (Sounds (Willie Nelson, Pink Floyd), smells, sights) ~ Have an emergency or exit plan Develop a Plan ~ Obstacles to quitting ~ Triggers ~ Physical ~ Withdrawal ~ Medication (Cravings or mood issues) ~ Good sleep hygiene ~ Pain Pain management techniques ~ Oral fixation  Have something else in your mouth (toothpick, gum, straw) Develop a Plan ~ Obstacles to quitting ~ Triggers ~ Social ~ Avoid being around people when they are smoking or vaping ~ Don’t sit next to people who smell like smoke ~ Find alternative activities to smoke breaks ~ Have something else to do with your hands Medications ~ Use of approved cessation medication, except when contraindicated ~ The first-line medications include ~ Bupropion SR ~ NRT: Nicotine gum, lozenge, patch or nasal spray ~ Varenicline ~ Second-line medications include ~ Clonidine ~ Nortriptyline ~ Alco

This podcast episode is based on Journey to Recovery: A Comprehensive Guide to Recovery from Mental Health and Addiction Issues by Dr. Dawn-Elise Snipes  Read it for free on Amazon Kindle Unlimited. Journey to Recovery Series Adjunct Interventions: Sleep Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Podcast Host: Counselor Toolbox & Happiness isn’t Brain Surgery CEUs are available for this presentation at https://www.allceus.com/member/cart/index/product/id/924/c/ Objectives ~ Learn about sleep ~ The function of sleep ~ Sleep cycles ~ How much is enough ~ How lack of sleep contributes to feelings of depression, anxiety and irritability ~ Understand the connection between sleep and circadian rhythms ~ Learn techniques for sleep hygiene Why I Care/How It Impacts Recovery ~ People whose circadian rhythms are off ~ Have a difficult time getting restful sleep ~ Usually have higher cortisol levels ~ Often report being tired at all the wrong times ~ Have difficulty concentrating ~ Confuse sleep and hunger cues What is the Function of Sleep ~ Sleep is time to rest and restore ~ Adequate sleep improves memory and learning, increases attention and creativity, and aids in concentration and decision making. ~ Toxins that accumulate in the brain are thought to be cleared out during sleep ~ Healing and repair of cells takes place during sleep ~ Sleep helps to maintain the balance of hormones in the body: ~ Ghrelin and leptin, which regulate feelings of hunger and fullness ~ Insulin, which is responsible for the regulation of glucose in the blood Functions cont… ~ Sleep deficiency is also linked to a higher risk of ~ Cardiovascular disease ~ Stroke ~ Diabetes ~ Kidney disease ~ Sleep deprivation is correlated to ~ Difficulty concentrating ~ Irritability ~ Fatigue/Loss of energy Understanding Sleep Cycles ~ Stage 1 NREM sleep is when you drift in and out of light sleep and can easily be awakened. ~ Stage 2 NREM brainwaves slow with intermittent bursts of rapid brain waves, the eyes stop moving, the body temperature drops and the heart rate begins to slow down. ~ This stage usually lasts for approximately 20 minutes ~ Stage 3 NREM sleep, also known as deep sleep or delta sleep, is marked by very slow delta brainwaves. There is no voluntary movement. You are very difficult to wake. ~ This stage usually lasts for approximately 30 minutes ~ The largest percentage of Deep Sleep comes in the early part of the total night's sleep pattern Understanding Sleep Cycles ~ REM Sleep (Rapid Eye Movement) is characterized by temporary paralysis of the voluntary muscles and fast, irregular breathing, inability to regulate body temperature, faster brain waves resembling the activity of a person that is awake. ~ Most dreams occur during REM sleep How Much is Enough? Sleep and Hormones ~ Estrogen usually improves the quality of sleep, reduces time to fall asleep, and increases the amount of REM sleep ~ Too little or too much testosterone may affect overall sleep quality ~ Cortisol is your stress hormone and prevents restful sleep ~ Thyroid hormones which are too high can cause insomnia and too low can cause fatigue and lethargy Nutrition and Sleep ~ Tryptophan is used to make serotonin ~ Serotonin is used to make melatonin ~ Melatonin functions to help you feel sleepy ~ Caffeine is a stimulant with a 6-hour half life ~ Nicotine is a stimulant with a 2-hour half life ~ Decongestants are stimulants with a 2 hour half life ~ Antihistamines make you drowsy but contribute to poor quality sleep ~ Alcohol blocks REM sleep and can cause sleep apnea Nutrition cont… ~ Eat a high protein dinner to ensure you have enough tryptophan in the body ~ Make sure you are getting enough ~ Selenium ~ Vitamin D ~ Calcium ~ Vitamin A ~ Magnesium ~ Zinc Function of Sleep ~ Allows the brain to focus on rebuilding and repairing ~ Animals deprived entirely of sleep lose all immune function and die in just a matter of weeks. ~ Prisoners deprived of sleep entirely often de

Light and Exercise Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Objectives ~ Learn about light, light therapy and circadian rhythms ~ Define exercise ~ Highlight the benefits of exercise: Emotional, Mental, Physical and Social. ~ Review points about exercise that every person should know ~ Explore how exercise can be incorporated into a daily routine Light ~ Circadian rhythms must be synchronized on a regular basis ~ Suprachiasmatic (supra-ki-asmatic) nucleus (SCN) of the hypothalamus as the central circadian pacemaker ~ The SCN receives direct input from the retina ~ This is reinforced through downstream neural (thinking), neuroendocrine (stress), and autonomic (breathing/heart rate/temperature) outputs. (social training) ~ Normal sunlight has the benefit of setting circadian rhythms as well as helping the body produce Vitamin D which makes neurotransmitters more bioavailable. Light ~ Daily interactions between the hypothalamic and the (SCN) regulate: ~ Body temperature ~ Cortisol, sex hormone, serotonin, melatonin levels ~ Feeding rhythms, energy expenditure, thermogenesis, and active and basal metabolism. Light ~ Intensity (>200lux/6000 kelvin/

This podcast episode is based on Journey to Recovery: A Comprehensive Guide to Recovery from Mental Health and Addiction Issues by Dr. Dawn-Elise Snipes  Read it for free on Amazon Kindle Unlimited. Journey to Recovery Series Complimentary Interventions Nutrition Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs CEUs are available at https://www.allceus.com/member/cart/index/product/id/924/c/ Objectives ~ Review the nutritional building blocks for health and wellness ~ Examine how these nutrients (or lack thereof) contribute to neurotransmitter balance ~ Identify several nutrient dense foods that you can include in your diet ~ Note: Nutritional changes should always be made under the supervision of a registered dietician or your primary physician. This presentation is for general informational purposes only. Why I Care/How It Impacts Recovery ~ In early recovery, nearly every person’s neurotransmitters are out of balance. ~ This causes feelings of depression, apathy, anxiety, and/or exhaustion. ~ Understanding why you feel the way you do is the first step ~ Figuring out how to help yourself feel better is the next What are Neurotransmitters ~ The human brain is composed of roughly 86 billion neurons. ~ These cells communicate with each other via chemical messengers called neurotransmitters. ~ Neurotransmitters regulate ~ Mood ~ Cravings, addictions ~ Energy ~ Libido ~ Sleep ~ Attention and concentration ~ Memory ~ Pain Sensitivity Neurotransmitters Cont… ~ About 86% of Americans have suboptimal neurotransmitter levels — our unhealthy modern lifestyle being largely to blame. ~ Chronic stress, poor diet, environmental toxins, drugs (prescription and recreational), alcohol, nicotine, and caffeine can cause neurotransmitter imbalances. Think about it ~ How do you feel when you are not getting enough oxygen? (Hint: You yawn) ~ What effect might a low carb diet have on mood? ~ What effect might a low protein diet have on mood? (Most non-vegan Americans get plenty of protein) ~ Why do doctors test for vitamin-D levels in patients with depressive symptoms? Amino Acids (Protein Building Blocks) Essential Amino Acids ~ Must be acquired from diet: ~ Valine ~ Isoleucine ~ Leucine ~ Lysine ~ Methionine ~ Phenylalanine ~ Threonine ~ Tryptophan Complete vs. Incomplete Proteins ~ Complete proteins are those that contain all essential amino acids: ~ Meat ~ Fish ~ Dairy products (milk, yogurt, whey) ~ Eggs ~ Quinoa* ~ Buckwheat* ~ Chia seed* ~ Spirulina* Complete vs. Incomplete Proteins ~ Incomplete proteins are those that don’t contain all 9 essential aminos ~ Nuts & seeds ~ Legumes ~ Grains ~ Vegetables Amino Acids (Proteins) ~ Protein Digestibility-Corrected Amino Acid Score, PDCAAS Tryptophan ~ Food Sources: Egg whites, chia seeds, sesame seeds, wheat germ, turkey ~ Needs Iron, magnesium, B6 and Vitamin C to convert tryptophan to serotonin ~ More readily absorbed when eaten with high carbohydrate meal. ~ Insulin causes competing amino acids to be absorbed into the tissues ~ Only precursor to serotonin ~ Focus on Tryptophan by John W. Crayton, MD, Professor of Psychiatry at Loyola University Medical School, Maywood, Illinois. NOHA* NEWS, Winter 2001 ~ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908021/ L-Tryptophan: Basic Metabolic Functions, Behavioral Research and Therapeutic Indications Int J Tryptophan Res. 2009; 2: 45–60. Important Non-Essential Amino Acids ~ Arginine helps with insomnia ~ Glutamine GlutamateGABA ~ Theanine: Increases GABA and serotonin levels (Green Tea) ~ Tyrosine: Used to make dopamine and norepinepherine and thyroid hormones. ~ Parmesan, mozzarella, swiss cheeses, lean beef, pork or salmon, tuna or mackerel, chicken breast, pumpkin seeds, peanuts, sunflower seeds, dairy, beans B Vitamins ~ Low levels of B vitamins may be linked to depression. ~ Vitamin B3 (Niacin) ~ Food sources: Poultry, fish, meat, whole grains, and fortified cereals ~ What it does: ~ Helps with digestion and changing food into

Journey to Recovery Series Mindfulness Overview Presented by: Dr. Dawn-Elise Snipes Executive Director: AllCEUs CEUs are available at https://www.allceus.com/member/cart/index/product/id/924/c/ Podcast Host: Counselor Toolbox & Happiness isn’t Brain Surgery Objectives ~ Differentiate between mindLESSness and mindFULness ~ Understand where mindLESSness came from ~ Define mindFULness ~ Explore ways mindFULness can help ~ Reduce emotional and physical distress and pain ~ Improve sleep ~ Improve Relationships ~ Explore activities that will help you ~ Become truly aware of your feelings, wants and needs ~ Develop skills that will help you observe, describe and participate What is MindLESSness ~ Mindlessness ~ Auto-pilot ~ Go-with-the-flow ~ What has always been done ~ Examples ~ Getting home and not remembering the drive ~ Eating without realizing it or when you are not hungry ~ Having intense feelings (or relapses) come from “out of the blue” How Did We Learn Mindlessness ~ Messages ~ Because I said so = Don’t ask why ~ Suck it up = Don’t feel, just do ~ Nobody cares/ignore it = Don’t trust ~ That’s what everyone does = Don’t think ~ Hurry. Hurry. Hurry. No time to feel. ~ Activity: Alice in Wonderland ~ Themes: Mindlessness, impulsivity, identity crisis, frantically trying anything, things are not as they appear to be, time punishes by standing still, hopelessness and helplessness, always looking for something better can lead to trouble What is Mindfulness ~ Mindfulness ~ Awareness in the present moment ~ Stop-Look-Listen-Feel-Interpret ~ What is going on ~ Inside you ~ Around you ~ Side Note: ~ Introverts often find it easier to be aware of what is going on inside you and more difficult to understand others. ~ Extroverts often find it easy to “read” the crowd, but much more difficult to tune in to what is going on inside. How Can Mindfulness Help ~ Transition from reacting to acting (Be proactive) ~ Retrospective mindfulness activity: Look back over the day yesterday. Had you been mindful… ~ What vulnerabilities could you have prevented? ~ What stressful events could you have prevented? ~ If you had been aware of your vulnerabilities, how might you have conducted your day differently? ~ Makes more efficient and effective use of energy by making the right decisions the first time. (Begin with the end in mind) ~ Encourages self-awareness and compassion (Seek first to understand yourself, then understand others) How Can Mindfulness Help ~ Reduces inefficiency through planning and prioritizing ~ Helps you maintain awareness to prevent or mitigate discomfort ~ Helps you balance and renew your resources, energy, and health to create a sustainable, long-term, effective lifestyle. (Sharpen the saw) ~ What do you need right now? ~ What options do you have to meet those needs in the present, while still moving toward future goals? Activity ~ Anchored Mindfulness ~ Before each meal, consider without judgment…. ~ What is your mood and why? ~ How do you feel physically and why? ~ Is your attitude positive/ambivalent/negative, and why? ~ How is your concentration (Do you have monkey mind?) ~ What vulnerabilities are or will be present today and how can you mitigate them? ~ What do you need to do now to… ~ Improve the moment ~ Adjust to your current state of being Core Mindfulness Core Mindfulness ~ Wise Mind How (do you do it) Skills ~ Nonjudgmental: Observable, measurable ~ One mind: Focus on the task at hand. Clear your mind of everything else ~ Do what works ~ Note: Be compassionate with yourself. Core Mindfulness ~ Wise Mind What (do you do) Skills ~ Observe: Be a detective. Take in the whole situation. ~ What is going on (Big picture)? ~ What might I be missing? ~ How might someone else perceive this situation? ~ Describe: Name your experiences (Explore the emotional mind) ~ This situation is… ~ I feel… ~ Participate: Be actively involved in the moment ~ What can I do to improve the next moment? ~ What is the best choice of action based

Dialectical Behavior Therapy Techniques Emotion Regulation Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Podcast Host: Counselor Toolbox & Happiness isn’t Brain Surgery with Doc Snipes President: Recovery and Resilience International Objectives ~ Review the basic premises of DBT ~ Learn about the HPA-Axis ~ Define emotion regulation ~ Identify why emotion regulation is important and how it can help clients ~ Explore emotion regulation techniques Basic DBT Premises ~ Dialectical Theory ~ Everything is interconnected ~ Reality is not static ~ Constantly evolving truth can be found by synthesizing differing points of view DBT Assumptions ~ People do their best ~ People want to get better/be happy ~ Clients need to work harder and be more motivated to make changes in their lives ~ Even if people didn’t create their problems, they still must solve them ~ The lives of suicidal [or addicted] people are unbearable ~ People need to learn how to live skillfully in all areas of their lives. ~ People cannot fail in treatment What is Emotion Regulation ~ Emotional dysregulation results from a combination of ~ High emotional vulnerability ~ Extended time needed to return to baseline ~ Inability to regulate or modulate one’s emotions ~ Emotional vulnerability refers to [situation] in which an individual is more emotionally sensitive or reactive than others ~ Differences in the central nervous system and HPA Axis play a role in making a person more emotionally vulnerable/reactive ~ The environments of people who are more emotionally reactive are often invalidating What is Emotion Regulation ~ According to Linehan, “Emotional regulation is the ability to control or influence which emotions you have, when you have them, and how you experience and express them.” ~ Emotion Regulation ~ Prevents unwanted emotions by reducing vulnerabilities ~ Changes painful emotions once they start ~ Teaches that: ~ Emotions in and of themselves are not good or bad ~ Suppresses emotions makes things worse Emotion Regulation ~ Emotions are effective when: ~ Acting on the emotion is in your best interest. ~ Expressing your emotion gets you closer to your [ultimate] goals. ~ Expressing your emotions will influence others in ways that will help you. ~ Your emotions are sending you an important message. The HPA-Axis ~ Hypothalamic Pituitary Adrenal (HPA) axis is our central stress response system ~ Hypothalamus ~ releases a compound called corticotrophin releasing factor (CRF) ~ Pituitary ~ Triggers the release of adrenocorticotrophic hormone (ACTH) ~ Adrenal ~ ACTH is released and causes the adrenal gland to release the stress hormones, particularly cortisol and adrenaline HPA Axis ~ The Adrenals ~ Control chemical reactions over large parts of your body, including your ‘fight-or-flight’ response. ~ Produce even more hormones than the pituitary gland ~ Steroid hormones like cortisol (a glucocorticoid) increasing availability of glucose and fat ~ Sex hormones like DHEA, estrogen ~ Stress hormones like adrenaline ~ Once the perceived threat passes, cortisol levels return to normal ~ What if the threat never passes? HPA Axis ~ The amygdala and hippocampus are intertwined with the stress response (Higgins & George, 2013) ~ The amygdala modulates anger and fear / fight or flight ~ The hippocampus helps to develop and store memories ~ The brain of a child or adolescent is particularly vulnerable because of its high state of plasticity. ~ Bad things are learned ~ Emotional upset prevents learning new, positive things to counterbalance ~ People who live in a chronically stressful environment may also have an overactive HPA-Axis The Brain and Stress ~ What happens to the brain when there is a chronic threat to safety and a constant underlay of anxiety? ~ As it learns, people’s brains forge synaptic connections from experience and prune away connections that are not utilized. ~ People who feel a lack of control over their environment are particularly vulnera

This podcast episode is based on Journey to Recovery: A Comprehensive Guide to Recovery from Mental Health and Addiction Issues by Dr. Dawn-Elise Snipes  Read it for free on Amazon Kindle Unlimited. Journey to Recovery Series Biopsychosocial Aspects of Emotions Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs CEUs are available at https://www.allceus.com/member/cart/index/product/id/924/c/ Objectives ~ Learn how to help clients understand, identify and modify ~ Physiological causes and mitigators of emotions ~ Psychological/ Cognitive causes and mitigators of emotions ~ Social causes and mitigators of emotions Physiological ~ Neurotransmitter balance ~ Sleep & Circadian rhythms ~ Depressive disorders are associated with various neurobiological alterations like hyperactivity of the hypothalamic-pituitary-adrenal axis, altered neuroplasticity and altered circadian rhythms (Fortschr Neurol Psychiatr. 2018 May;86(5):308-318) ~ Circadian disruption is reliably associated with various adverse mental health and wellbeing outcomes, including major depressive disorder and bipolar disorder. (Lancet Psychiatry. 2018 Jun;5(6):507-514) ~ Prefrontal cortex is particularly susceptible to the effects of sleep loss (Prog Brain Res. 2010;185:105-29) ~ Reduced quantity of sleep increases risk for major depression, which in turn increases risk for decreased sleep (Sleep. 2014 Feb 1;37(2):239-44. BMC Public Health. 2018 Jun 11;18(1):724) Physiological ~ Neurotransmitter balance ~ Sleep & Circadian rhythms ~ Balancing circadian rhythms ~ Improving sleep quality Physiological ~ Neurotransmitter balance ~ Nutrition ~ Proteins and vitamins (absorption) ~ Blood sugar ~ Anxiety is associated with low blood sugar ~ Nervousness and fatigue are associated with high blood sugar ~ Hydration ~ Nutritional Interventions (Under medical supervision) ~ Good nutrition ~ Improve absorption ~ Stabilize blood sugar Physiological ~ Neurotransmitter balance ~ PTSD/Hypocortisolism ~ Stress is associated with an increased activity of the HPA-axis, increased cortisol levels and a decreased downregulation. ~ Hypoactivity of the HPA-axis develops out of chronic stress, in stress-related disorders such as PTSD, chronic fatigue syndrome & burn out. PLoS One. 2014; 9(6): e98682 ~ Cushing’s and Addison’s disease are characterized by altered cortisol levels, and both exhibit high rates of depression which can be reversed when cortisol is normalized. ~ Organic dysregulation Physiological ~ Neurotransmitter balance ~ PTSD/Hypocortisolism & Organic dysregulation ~ Identify and address vulnerabilities ~ Stress and stress stimuli (emotional or physical (illness, over-exercise)) ~ Sleep deprivation ~ Pain ~ Sudden discontinuation of glucocorticoids after prolonged glucocorticoid therapy ~ Mindfulness to prevent or mitigate vulnerabilities ~ Address trauma Physiological ~ Neurotransmitter balance ~ Inflammatory Conditions (Autoimmune conditions: Chron’s, Rheumatoid Arthritis) ~ Fatigue, anhedonia, low mood, social isolation and irritability ~ Inflammation activates IDO (indolamine-2,3-dioxygenase) IDO is an enzyme which converts tryptophan into kynurenine, which competes for tryptophan with the serotonin pathway and produces neurotoxic byproducts. ~ Childhood trauma permanently upregulates proinflammatory molecules Physiological ~ Hyper or hypothyroid ~ Medications ~ Hormones ~ Beta-blockers (Depression) ~ Calcium channel blockers (Depression) ~ Statins (Depression ~ Opioids ~ Stimulants (decongestants, ADHD medications) ~ Antidepressants (esp. anxiety and mania) ~ Antianxiety (Benzodiazepines, barbiturates) ~ Steroids (anxiety and mania) ~ Herbs (Yohimbe, 5-HTP, St. Johns Wort, SAM-e, Valerian) Psychological/Cognitive ~ Schema and prior learning ~ Emotion = arousal + cognition ~ Updates pending… ~ Overriding the amygdala ~ Negativity bias ~ 5:1 ratio for happiness ~ Dialectics ~ Mindfulness and serenity ~ Attributional style ~ Internal/External (LOC) ~ Global/Specific

Journey to Recovery Series: Relapse Prevention Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Host: Counselor Toolbox Objectives ~ Define Relapse, Relapse Triggers and Relapse Warning Signs ~ Explore the Function of Relapse and Differentiate from Resistance ~ Identify Essential Components for a Relapse Prevention Plan Stages of Relapse Prevention Planning ~ Stabilization ~ Assessment of the situation and any negative patterns or problems that contributed to past relapses are identified ~ Relapse Education: The person and his or her supports must understand the process of relapse ~ Warning Signs Identification and Management ~ Trigger identification and Management ~ Recovery Planning: Putting it Together ~ Mindfulness Training: to anticipate, evaluate, and avoid high-risk situations. ~ Family Involvement. ~ Follow up: Recovery is never static. What is Relapse ~ Relapse is a return to a prior state of functioning ~ Relapse stages (Cognitive Triad) ~ Emotional ~ Mental ~ Physical ~ Relapses often start long before the person has a return to the prior state. ~ Backward chain a depressive episode ~ Backward chain a smoking relapse ~ Relapses indicate that the old way is more rewarding than the new way. Why? What was missed? ~ Relapse prevention planning means developing a recovery based lifestyle that includes emergency plans. Relapse Prevention Plan ~ Why did you use/eat/gamble/get depressed etc? ~ What other strategies do you have to cope? ~ When you are not symptomatic, what is different? ~ Why do you want to change? (MEEPS) ~ What triggers your unpleasant mood or desire to use? (MEEPS) ~ How can you prevent and mitigate each one ~ What potential obstacles do you envision and how can you deal with them? ~ What are some old behaviors, thoughts or feelings that warn you that a relapse might be coming? ~ What are your expectations about relapse? Relapse Prevention Plan ~ What does a RML look like for you? ~ Imagine that it’s your last day on earth. What would you do? Who would you spend it with? Would you be satisfied with the way your life turned out? If not, what do you wish you had done? ~ Who are your helpful social supports? ~ What is your mindfulness plan? ~ What is your self-care plan? ~ Mental ~ Emotional ~ Environmental ~ Physical ~ Social Essential Skills ~ Mindfulness ~ Vulnerability Prevention ~ Distress Tolerance Skills ~ Urge Surfing ~ ACCEPTs & IMPROVE ~ Unhooking ~ Coping Skills ~ Radical Acceptance: “This is really uncomfortable, but at least my withdrawal symptoms will go away within a few days.” ~ Problem solving ~ ABCs ~ Behavior Modification Essential Skills ~ The 4 Ds ~ Delay – Cravings and emotions crest in about 20 minutes. ~ Distract – Craving/distress time passes more quickly when engaged in a distracting activity for a few minutes. ~ Deep breathing (De-Stress) – Deep breathing exercises and focused mindfulness can keep you from making rash decisions. ~ De-Catasrophize – ~ Challenge your thoughts ~ What are the facts for and against? (Do I have enough info to make a judgement?) ~ Is this emotional reasoning? ~ Am I focusing on just one aspect of the situation? ~ What parts are in my control? ~ Am I confusing high and low probability events? Essential Skills ~ Relapse Prevention Card ~ Fold a paper into four squares: ~ On the first square, write The Four Ds (Delay, Distract, Deep Breathe, De-Catastrophize ~ On the second square, write 3 to 5 distraction ideas ~ On the third square, write 3 or 4 of your most significant reasons for wanting to recover ~ On the fourth square, write some negative but accurate predictions for what will happen if you stop following your recovery plan. Relapse Triggers ~ Relapse triggers are stimuli or conditions that prompt the person to think about or start returning to the previous state of functioning ~ Mental ~ Emotional ~ Environmental (Visual, Olfactory, Auditory) ~ Physical (Pain, exhaustion, poor nutrition) ~ Social (Peer pressure, rela

Journey to Recovery:  Behavior Modification Basics Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Host: Counselor Toolbox Objectives ~ Define behavior modification ~ Explore how behavior modification can be useful in practice ~ Learn basic behavior modification terms: ~ Unconditioned stimulus and response ~ Conditioned stimulus and response ~ Discriminitive stimuli ~ Learned helplessness ~ Reinforcement ~ Punishment ~ Extinction Burst ~ Premack Principle Why Do I Care ~ Behavior modification principles will help you understand some of the reasons people act/react the way they do ~ By understanding what rewards(causes and motivates) people’s behavior or discourages (punishes/Strains) their behavior, we can better address their issues ~ The focus on observable, measurable conditions to the exclusion of cognitive interpretation underscores the mind-body connection How can this be useful in practice ~ Traditional (strict) behavior modification can be quite useful in simplifying stimulus/reaction ~ Integrating the cognitive interpretations (labels) can help people in identifying and addressing what is causing their “distress” (Behaviorists would refer to excitatory response) ~ Understanding what causes feelings can also give people a greater sense of empowerment. Example ~ Organisms learn behavior through direct and observational reinforcement and correction ~ Puppy 1 tackles puppy 2  threat ~ Puppy 2 responds by tackling puppy 1  counter threat ~ Both puppies get a surge of adrenaline ~ The puppy that dominates receives a dopamine surge that reinforces the prior behaviors — do that again. ~ If Puppy 1 plays too rough, then puppy 2 will either become more aggressive or leave. ~ Either way, puppy 1s behavior is punished. Example 2 ~ In addition to direct and observational learning, humans learn to label certain internal experiences with feeling words (angry, scared, happy) ~ Sally goes to a pet store. ~ A puppy comes out, sits in her lap and puts is head on her leg. This contact (we know from studies) usually causes the release of dopamine and oxytocin –both reward chemicals. Sally calls this “happy” ~ If Sally had previously had a threatening experience with a dog, when she saw it, her body would likely respond by secreting adrenaline, kicking off the fight or flight reaction. Sally would label this as “fear” Points ~ People with dysphoria or unhelpful behaviors may need to: ~ Recondition X is not actually a threat (anymore) ~ Relabel the state ~ Stressed vs. hungry vs. bored vs. tired ~ Explore the dialectics: Excitement/Fear ~ Unhook– X is causing me to have the feeling that… Basic Terms ~ Unconditioned stimulus and response ~ Something that evokes an unconditioned/automatic response in an infant and adult ~ Loud noises ~ Pain ~ Excessive cold/heat ~ Contact Basic Terms ~ Conditioned Stimulus ~ Something that in itself has no meaning to the person (yellow light) ~ Conditioned Response ~ The person’s reaction to the stimulus (slow down or floor it) ~ Stimuli and responses can be traced back to survival: Fight-Flee-Forget-Repeat Basic Terms ~ Discriminitive stimulus ~ The stimulus which triggers the reaction. (Includes vulnerabilities) ~ Going to work ~ Good day ~ Bad day ~ Learned Helplessness “Damned if I do, damned if I don’t” ~ A response which occurs when people have tried and failed. Giving up. Fight or Flee ~ Stimuli that present a threat of pain or death can trigger the excitatory fight or flight response ~ A useful intervention is to identify ~ The threat ~ If it is actually a threat ~ Break down parts of the situation into controllable and uncontrollable Conditioning ~ Mindfulness can help people identify ~ Positive stimuli  dopamine  “happy” ~ Negative stimuli  adrenaline  fight or flee ~ Little things build up and lead to a big reaction. (Pressure cooker) ~ Stimuli that trigger a negative reaction can be reconditioned as neutral by ~ Embracing the dialectics: Find the positive (snowy d

Treatment of Persons with Co-Occurring Disorders Based on SAMHSA TIP 42 Part 8 Host: Dr. Dawn-Elise Snipes Executive Director: AllCEUs Counselor Education Podcast Host: Counselor Toolbox and Addiction Counselor Exam Review ~ A Brief Overview of Specific Mental Disorders and Cross-Cutting Issues ~ Cross-Cutting Issues ~ Personality Disorders ~ Mood Disorders and Anxiety Disorders ~ Schizophrenia and Other Psychotic Disorders ~ Attention Deficit/Hyperactivity Disorder (AD/HD) ~ Posttraumatic Stress Disorder (PTSD) ~ Eating Disorders ~ Pathological Gambling Cross Cutting Issues ~ Suicidality ~ 25 to 30 percent of ambulatory clients in general medical practices have a diagnosable psychiatric condition, and a further 10 to 15 percent of people suffering from major psychiatric illnesses such as affective disorder, schizophrenia, and alcoholism will end their lives by suicide ~ Suicide is also more likely among those with the personality traits of impulsivity, hopelessness, or cognitive rigidity ~ Abuse of alcohol or drugs is a major risk factor in suicide, both for people with COD and for the general population. ~ Alcohol abuse is associated with 25 to 50 percent of suicides. Between 5 and 27 percent of all deaths of people who abuse alcohol are caused by suicide, with the lifetime risk for suicide among people who abuse alcohol estimated to be 15 percent. ~ There is a particularly strong relationship between substance abuse and suicide among young people. ~ Comorbidity of alcoholism and depression increases suicide risk. ~ The association between alcohol use and suicide also may relate to the capacity of alcohol to remove inhibitions, leading to poor judgment, mood instability, and impulsiveness. ~ Substance intoxication is associated with increased violence, both toward others and self. ~ Screen for suicidal thoughts or plans with anyone who makes suicidal references, appears seriously depressed, or who has a history of suicide attempts. Treat all suicide threats with seriousness. ~ Assess the client's risk of self-harm by asking about what is wrong, why now, whether specific plans have been made to commit suicide, past attempts, current feelings, and protective factors. ~ • Develop a safety and risk management process with the client that involves a commitment on the client's part to follow advice, remove the means to commit suicide (e.g., a gun), and agree to seek help and treatment. Avoid sole reliance on “no suicide contracts.” ~ • Assess the client's risk of harm to others. ~ • Provide availability of contact 24 hours per day until psychiatric referral can be realized. Refer those clients with a serious plan, previous attempt, or serious mental illness for psychiatric intervention or obtain the assistance of a psychiatric consultant for the management of these clients. ~ • Monitor and develop strategies to ensure medication adherence. ~ • Develop long-term recovery plans to treat substance abuse. ~ • Review all such situations with the supervisor and/or treatment team members. ~ • Document thoroughly all client reports and counselor suggestions. ~ What is wrong? ~ Personal narrative about the nature of the problem(s), reasons for suicide and measure of psychological pain and suffering ~ Why now? Elements of the current crisis: ~ Sudden and unacceptable changes in life circumstances; for example, the client just received a serious or terminal diagnosis, relapse, onset of possible symptoms (e.g., sleeplessness) ~ History of real or imagined losses or rejections, possible anniversary phenomena ~ With what? The means of suicide under consideration ~ Where and when? Possible location and timing of a suicide attempt ~ When and with what in the past? ~ Social response to past attempts: Persons who may or may not be helpful in managing the client ~ Why not now? ~ One or more protective factors (reasons for living) ~ Spiritual or religious prohibitions ~ Duties to others or pets and residual “loose ends” Nicotine ~ Daily smokers and

Treatment of Persons with Co-Occurring Disorders Based on SAMHSA TIP 42 Part 5 Host: Dr. Dawn-Elise Snipes Executive Director: AllCEUs Counselor Education Podcast Host: Counselor Toolbox and Addiction Counselor Exam Review Objectives ~ Guidelines Working With a Client Who Has COD ~ Develop and Use a Therapeutic Alliance To Engage the Client in Treatment ~ Maintain a Recovery Perspective ~ Manage Countertransference ~ Monitor Psychiatric Symptoms ~ Use Supportive and Empathic Counseling ~ Employ Culturally Appropriate Methods ~ Increase Structure and Support ~ Provide Motivational Enhancement Consistent With the Client's Specific Stage of Change ~ Design Contingency Management Techniques To Address Specific Target Behaviors ~ Use Cognitive-Behavioral Therapeutic Techniques ~ Use Relapse Prevention Techniques ~ Use Repetition and Skills-Building To Address Deficits in Functioning ~ Facilitate Client Participation in Mutual Self-Help Groups Develop and Use a Therapeutic Alliance To Engage the Client in Treatment ~ Therapeutic alliance may be impacted by counselor’s discomfort with MH or SA issues due to a lack of experience, training, or mentoring ~ Clinicians who experience difficulty forming a therapeutic alliance should consider if it is related to ~ The client's difficulties ~ A limitation in experience and skills ~ Demographic differences between the clinician and the client (cultural, gender, age) ~ Issues involving countertransference Develop and Use a Therapeutic Alliance To Engage the Client in Treatment ~ Demonstrate an understanding and acceptance of the client. ~ Help the client clarify the nature of his difficulty. ~ Indicate that you and the client will be working together. ~ Communicate to the client that you will be helping her to help herself. ~ Express empathy and a willingness to listen to the client's formulation of the problem. ~ Assist the client to solve some external problems directly and immediately. ~ Foster hope for positive change. Maintain a Recovery Perspective ~ Consumers with mental disorders may see recovery as the process of reclaiming a meaningful life beyond mental disorder, with symptom control and positive life activity. ~ While “recovery” has many meanings, generally, it is recognized that recovery does not refer solely to a change in substance use, but also to a change in an unhealthy way of living ~ The recovery perspective has two main features: ~ It acknowledges that recovery is a long-term process of internal change ~ It recognizes that these internal changes proceed through various stages Recovery Perspective ~ Assess the client's stage of change (see section on Motivational Enhancement below). ~ Ensure that the treatment stage (or treatment expectations) is (are) consistent with the client's stage of change. ~ Use client empowerment as part of the motivation for change. ~ Foster continuous support. ~ Provide continuity of treatment. ~ Recognize that recovery is a long-term process and that even small gains by the client should be supported and applauded. Manage Countertransference ~ Countertransference now is understood to be part of the treatment experience for the clinician. ~ Clinicians are vulnerable to the same feelings of pessimism, despair, anger, and the desire to abandon treatment as the client. ~ The clinician should be aware of strong personal reactions and biases toward the client. ~ The clinician should obtain further supervision where countertransference is suspected and may be interfering with counseling. ~ Clinicians should have formal and periodic clinical supervision to discuss countertransference issues with their supervisors and the opportunity to discuss these issues at clinical team meetings. Monitor Psychiatric Symptoms ~ Monitor symptoms ~ Do a brief mental status and safety exam at every meeting ~ Document changes in symptoms ~ Monitor medication compliance and side effects ~ Consult with physicians Use Supportive and Empathic Counseling ~ Communicate respect

Treatment of Persons with Co-Occurring Disorders Based on SAMHSA TIP 42 Part 9 Host: Dr. Dawn-Elise Snipes Executive Director: AllCEUs Counselor Education Podcast Host: Counselor Toolbox and Addiction Counselor Exam Review Objectives ~ Substance Induced Disorders ~ Substance-induced persisting amnestic disorder ~ Substance-induced psychotic disorder ~ Substance-induced mood disorder ~ Substance-induced sexual dysfunction ~ Substance-induced sleep disorder ~ Substance-induced persisting dementia and ARD ~ FASD In General ~ Substance Induced Disorders ~ Substance-induced persisting amnestic disorder ~ The development of memory impairment as manifested by impairment in the ability to learn new information or the inability to recall previously learned information ~ Substance-induced psychotic disorder ~ Substance-induced mood disorder ~ Substance-induced sexual dysfunction ~ Substance-induced sleep disorder Hallucinogen-Persisting Perception Disorder ~ Flashbacks, echo phenomena and other psychotic manifestations typically occur after drug-free periods and may persist for years ~ Such experiences may take the form of various geometric shapes, objects in the peripheral visual fields, flashes of different colors, enhanced color intensity, trailing and stroboscopic perception of moving objects. ~ Pharmacotherapy of this very distressing condition is limited Ther Adv Psychopharmacol. 2012 Oct; 2(5): 199–205. Delirium ~ Symptoms– Sudden onset of: ~ Disturbance in attention and awareness/orientation ~ Disturbance in cognition, memory, perception ~ May result from use of or withdrawal from a variety of drugs, including: ~ Cannabis ~ Alcohol ~ Amphetamines ~ Opioids/Narcotics ~ Hallucinogens ~ Sedatives/Benzos Alcohol ~ Mood lability and lowered impulse control can lead to increased rates of violence toward others and self. ~ Symptoms of alcohol withdrawal include agitation, anxiety, tremor, malaise, hyperreflexia (exaggeration of reflexes), mild tachycardia (rapid heart beat), increasing blood pressure, sweating, insomnia, nausea or vomiting, hallucinations, delusions, and often seizures. ~ Protracted withdrawal: Continued mood instability, fatigue, insomnia, reduced sexual interest, and hostility for weeks ~ Differentiating protracted withdrawal from a major depression or anxiety disorder is often difficult. Alcohol Related Brain Damage ~ Damage directly caused to the person by exposure to alcohol or other drugs ~ Alcohol Related Dementia (Wernicke-Korsakoff’s syndrome) ~ Vascular Dementia ~ Fetal Alcohol Spectrum Disorders ~ According to the CDC ~ Most excessive drinkers do not meet the criteria for dependence (meaning they may present in mental health clinics for treatment of mood disorder) ~ About 17% of the adult population reported binge drinking, and 6% reported heavy drinking Alcohol Related Brain Disorders ~ Caused by regularly drinking too much alcohol over several years. ~ Covers several different conditions which are similar to, but not actually dementia, including: ~ Wernicke-Korsakoff syndrome ~ Alcoholic dementia. ~ In contrast to dementia (i.e.Alzheimer's disease), most people with ARBD who receive good support and remain alcohol-free ~ Make a full or partial recovery ~ Will not experience a worsening of their condition Alcohol Related Brain Disorders ~ ARBD is greatly undiagnosed. ~ Post-mortem findings indicate it affects about 1 in 200 of the general adult population. ~ Among those with alcoholism, this figure rises to as high as one in three ~ People with ARBD tend to in their 40s or 50s ~ Alcohol-related brain damage is thought to cause more than 10% of ‘dementia' in people under 65. Alcohol Related Brain Disorders ~ Drinking more than the recommended limit for alcohol increases a person's risk of developing common types of dementia such as Alzheimer's disease and vascular dementia. ~ Recommended limits are now a maximum of 14 drinks each week, with a maximum of 2 per day ~ Repeated binge drinking – heav