Transcript Power Point Presentation

Chemical Dependency
& Dual Diagnosis
Presented by: David “Red” Wiget CADC-II
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CHEMICAL DEPENDENCY & DUAL DIAGNOSIS
GOAL: The goal of this module is to examine the basic principles and dynamics of
chemical dependency and components related to the dual diagnosed
individual and population specifics.
Objectives:
1.
Identify and discuss some concepts of chemical dependency.
2.
Explain and discuss the components of dual diagnosis.
3.
Identify and discuss relapse prevention.
4.
Explain and discuss symptoms and phases of addiction.
5.
Identify and discuss treatment for substance abuse/dual diagnosis.
6.
Discuss population specific components.
7.
Identify and discuss components related to charting.
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What is Chemical Dependency?

CD is the continued need for alcohol and
or other drugs despite negative
consequences. An obsession of the
mind, allergy of the body and a spiritual
malady. It is a brain disease.

Chronic
Progressive
Fatal
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Myths:
•
Addicts are weak willed
They wear trench coats and push shopping carts,
while drinking paint thinner.
They live on skid row.
Only men are addicts
You cant get addicted to marijuana
-and the list goes on-
•
•
•
•
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Igor Koutsenok, MD
University of California San Diego,
Department of Psychiatry,
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Center for Criminality & Addiction Research, Training
& Applications
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13 yrs of Heroin abuse
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8 years of meth abuse
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Population Specific Components
Youths:
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One third of High School seniors take an illegal drug in
month.
Alcohol is the drug most frequently used by 12-17 year olds,
and the one that causes the most negative health
consequences.
The drug of choice with this population is marijuana.
The abuse OTC’s are another epidemic with teens and
younger kids: i.e. “Triple C” (Coricidin), Inhalants: aerosols
such as Wizard and other air fresheners, computer cleaner,
NOS (Nitrous Oxide), paint, glue, gas ect..
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Youths cont.
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Hallucinogens: MDMA (Ecstasy), LSD, Magic
Mushrooms, “Specail K”, and PCP
Prescription drugs i.e. Ritalin, Aderall and Rx pain
meds: Vicodin, Oxycontin, Benzos (Valium, Ativan),
Soma’s.
Meth is another popular drug of abuse among
teens.
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Abuse/Addiction Among Adults
Alcoholism was once seen as a disease that primarily afflicted
middle-aged men. Today its influence cuts across the sexes and
many age groups.

Women
Seeking psychological benefits.
 Statistics indicate that the number of female
alcoholics will increase.
 Already, an estimated 10% of adult women in the
U.S. show signs of alcohol dependency, and 5%
have suffered adverse reactions related to drinking
such as: domestics problems, traffic accidents, DUI’s
etc.
 11% of pregnant women use a psychoactive drug.
This includes tobacco and caffeine.
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Adults Cont.
The longer and more frequently one uses and progression
takes over, the more desperate one becomes.
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Pain management
Vicodin, Oxycontin
ETOH abuse
Meth
Cocaine
Self-medication
Domestics Violence
DUI’s
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The Elderly Alcoholic
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Alone and unnoticed.
Alcoholism represents a far more common phenomenon
among the elderly than most people realize.
Social drinking often escalates into alcoholism after
retirement, especially for those with few outside interest or
hobbies.
Elderly people that take prescription drugs and remain
uniformed about potentially dangerous situations.
Elderly people visit several doctors and obtain prescriptions
for various mood-altering drugs.
Be alert for symptoms of withdrawal when elderly
participants entering the hospital.
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What is Dual Diagnosis?

A person who has both an alcohol
and or drug addiction and an
emotional/psychiatric problem is
said to have a dual diagnosis. To
recovery fully, the person needs
treatment for both problems.
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Epidemiology
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For many years service professionals used the
term “dual diagnosis” to refer to persons were
mentally retarded who also had a coexisting
psychiatric disorder (D/O).
A.) For one with preexisting mental illness selfmedication is a big factor in causing Dual Dx.
B.) For one with a preexisting drug and or
alcohol addiction is another cause of Dual Dx.
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How common is Dual Dx?
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Over 50% of addict/alcoholics entering treatment
today are suffering from a preexisting or drug
enhanced mental illness. This epidemic is
supported by Dr. Ikramullah, Dr. Snyder, Dr.
Unruh, The World Health Organization, American
Medical Association, American Psychiatric
Association and the U.S. Department of Health
and Human Services combined with the number
of dual diagnosis patients admitted to Aurora BHC
last year 2005 is solid evidence that is a growing
problem that needs continued attention.
NMHA fact sheet: Substance Abuse - Dual Diagnosis
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Cont.
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According to a report published by
the Journal of the American
Medical Association:
Thirty-seven percent of alcohol
abusers and fifty-three percent of
drug abusers also have at least
one serious mental illness.
Of all people diagnosed as
mentally ill, 29 percent abuse
alcohol or other drugs.
Mental Health Articles and Updates
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What kind of mental or emotional problems are
seen in people with Dual DX?
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Depressive disorders, such as depression
and bipolar disorder.
Psychiatric disorders, such as
schizophrenia and personality disorders.
Anxiety disorders, including GAD, panic
disorder, obsessive compulsive disorder,
and phobias
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Signs and Symptoms
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Signs and symptoms or “warning signs” are
sometimes difficult to notice and sometimes
obvious. (This is not an exhaustive list).
A.) Social problems
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B.)
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1.)
Change in friends (no longer associating
with non-abusers)
2.)
Inability to attend social gatherings without a
“ pre-function” (drugs or alcohol used prior to the
function)
3.)
Friends complaining about use of chemical
or behavior associated with substance abuse
Family problems
1.)
Increase in family conflict
2.)
Sexual problems with spouse
3.) Physical illness, depression or acting out of
other family members
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Effective Treatment
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Some of the most effective models of treatment for the DDx
patient are:
A.) Detoxification is usually the first step in treatment being
careful that the patient does not get cross addicted.
B.) Communicating with the doctor and treatment team to
get an accurate assessment and diagnosis.
C.) Unless the patient had a documented history of a
preexisting mental illness it is best to wait at least thirty days
before starting any antidepressants or psychotropic.
D.) Provide the three most important elements of a healing
environment: safety, security and structure.
E.) Teaching medication compliance to the DD patient.
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Relapse Prevention
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It is sometimes frustrating to see the same
patients time after time (also known as frequent
fliers).
A.) It is important as mental health
professionals to realize we are dealing with sick
people who need to get well, not bad people that
need to be good.
B.) Support and encouragement
C.) Aftercare
12-step involvement i.e. double trudger meetings,
sponsorship (one who understands the
importance of medication).
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Consistency
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Continue to educate oneself and
stay up to date with the changes in
the Dual Diagnosis treatment
model.
Communicate with each other
frequently and offer support to one
another.
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Codependency
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loss of objectivity,
warped sense of responsibility,
easily controlled or controlling,
excessive feelings of guilt, hurt and
anger, loneliness,
extreme fear of rejection,
excessive fear of failure.
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Conclusion
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Today you have been informed and educated about some
of the important aspects for understanding addiction and
treating the Dual Dx patient: epidemiological aspects,
signs and symptoms, effective models of treatment,
population specifics, medication compliance, and relapse
prevention. I hope that you feel more equipped and
competent with the skills needed to provide the best
treatment possible for the Dual Dx patient. Five out of
every ten patients that are admitted to this hospital with a
hx of CD are Dual Dx and rely on us as mental health
professionals to provide them with a healing environment.
Be a part of the solution, not the problem, and put what
you have learned here today into use.
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THE END
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