The LOSS Model · The LOSS Model Mental Illness and Substance Use Disorders Amy L. Griffith, LPC...

The LOSS Model Mental Illness and Substance Use Disorders

Amy L. Griffith, LPC

Director of Forensic Services

RHA Health Services, Inc

*LOSS models were develop by Paul Lilley, CIT Coordinator and consultant with the Criminal Justice

Coordinating Center of Excellence. For more info contact lilley.consulting@gmail.com.

The LOSS Model

1. Loss of Reality

2. Loss of Hope

3. Loss Of Control

4. Loss of Perspective

1. Loss Of Reality

• Delusions

• Hallucinations

• Command Hallucinations

1. Diagnoses

• Schizophrenia

• Bipolar Disorder

• Schizoaffective Disorder

• Depression

1. Typical Medications

Antipsychotics

Abilify,

Risperdal,

Zyprexa,

Cogentin,

Ativan

Mood Stabilizers

Depakote,

Lithium,

Lamictal,

Tegretol

2. Loss Of Hope

• Depression

• Feelings of sadness,

helplessness, hopelessness

• Grief and loss

2. Diagnoses

• Depression

• Bipolar Disorder

• Bereavement

• Age-Related Cognitive

Decline

2. Typical Medications

•Antidepressants

Seroquel

Prozac

Celexa

Zoloft

3. Loss Of Control

• Anger

• Hostility

• Frustration

• Powerlessness

3. Diagnoses

• Bipolar Disorder

• Personality Disorders

• Intermittent Explosive

Disorder

3. Typical Medications

• Antipsychotics

• Mood Stabilizers

4. Loss Of Perspective

• Anxiety

• Excessive worry

• Nervousness

• Panic

4. Diagnoses

• Generalized Anxiety Disorder

• Panic Disorder

• PTSD

• Dementia

4. Typical Medications

• Anti-anxiolytics

Klonopin

Xanax

Ativan

Valium

Mood Stabilizers

Paxil

Zoloft

Prozac

Seroquel

Aricept

Xelon

Substance Use Disorders

Abuse: Failure to fulfill major roles

Use despite risk of

hazardous situations

Use despite legal

consequences

Use despite interpersonal

consequences

No history of Dependence

Dependence: Tolerance*

Withdrawal*

More use than intended

Failed attempts to stop

Excessive time spent

getting, using, recovering

Loss of functioning at

home, work, etc.

Use despite negative

consequences

DSM-V Mild 2-3 symptoms

Moderate 4-5 symptoms

Severe 6 + symptoms

More use than intended

Failed attempts to stop

Excessive time obtaining, using, recovering

Cravings

Failure to fulfill major roles

Use despite interpersonal consequences

Social, occupational, recreational activities are given up due to use

Use despite risk of physically hazardous situations

Use despite knowledge of secondary physical/psychological problems

Tolerance*

Withdrawal*

Loss of functioning at home, work, etc.

Substance Use & the LOSS Model LOSS of Reality

◦ Bath salts, hallucinogens, amphetamines, opiates,

benzos, withdrawal from alcohol…

LOSS of Hope

◦ Alcohol, opiates, withdrawal from amphetamines,

meth, cocaine…

LOSS of Control

◦ Methamphetamine, cocaine, alcohol, bath salts,

hallucinogens, benzos…

LOSS of Perspective

◦ K-2, marijuana, bath salts, alcohol, amphetamines,

meth, benzos, opiates, cocaine…

Intellectual & Developmental

Disorders (IDD)

• Autism spectrum disorders • LOSS of Control, LOSS of Reality

• Traumatic brain injuries • LOSS of Control, LOSS of Hope, LOSS of

Perspective, LOSS of Reality

• “Mental retardation” • LOSS of Control, LOSS of Perspective

Homelessness

39 % report mental health problems

20-25 % meet criteria for serious mental illness

66 % report either substance use &/or mental

health problems

46 % report chronic health conditions 1996 data from SAMHSA's National Mental Health Information Center.

On any given night, 200,000 veterans are

homeless. 2009 data from NOW on PBS.

Trauma

Typical Events:

Serious accidents

Assaults

Witnessing violence

Threats of violence

Natural disasters

Combat

Typical Reactions:

Sleeplessness

Reliving the experience

Startles easily

Irritability

Drug and alcohol use

Anxiousness

Sadness

Post Traumatic Stress Disorder

The person experienced the event.

The event involved actual or threat of

serious injury/death.

The person’s response involved fear,

helplessness, horror.

PTSD

Re-experiencing

Recollections

Dreams

Flashbacks

Triggers

Physical reactions

Avoiding & Numbing

Thoughts, feelings, conversations

Activities, places, people

Loss of recall

Loss of interest

Detachment

Decreased affect

Decreased sense of the future

PTSD

Increased Arousal

Sleeplessness

Irritability

Poor concentration

Hypervigilance

Startle response

Symptoms last for

more than 1 month

Significant

impairment in

functioning

Acute vs. Chronic

Delayed onset

Suicide

• LOSS of Reality

• Delusions and Hallucinations

• LOSS of Hope

• Hopelessness and Helplessness

• LOSS of Control

• Anger and Frustration

• LOSS of Perspective

• Anxiety and Worry

*addition of drugs and alcohol

Resources

Contact:

Amy L. Griffith

828-250-6296

amy.griffith@buncombecounty.org