303 Special Series -Counseling People with Co-Occurring Disorders SAMHSA TIP 42 Part 9

Summary: 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