Addictions 101: Diagnosis & Treatment for Mental Health Professionals

Addictions 101: Diagnosis & Treatment for Mental Health ProfessionalsJessica Holton, MSW, LCSW, LCASHolton, 201211Addictions 101: Treatment & DiagnosisLearning Objectives:Participants will be able to describe the difference between substance abuse and substance dependence according to the DSM IV-TR.Participants will be able to list four predisposing factors of addiction: Biological, Social, Cultural, and Spiritual.Participants will be able to apply knowledge about the correlations between addiction and the brain. Holton, 20122Learning Objectives:Participants will be able to identify the five Stages of Grief, the Five Stages of Healing, and the five Stages of Change. Participants will be able to teach and incorporate adaptive coping skills, such as Mindfulness, as components of Recovery.Holton, 20123Evidence-Based PracticeSteps for using Evidence-Based Practice:Conduct a Biopsychosocial assessmentMaking the diagnosis and selecting appropriate practice guidelinesUsing practice guidelines to identify problemsDevelop goals or planned target of changeUsing practice guidelines to develop the intervention planUsing practice guidelines to establish outcome measuresEvaluationHolton, 20124Assessing the Assessor4Is ADDICTION a choice?

Many professionals use the term, Drug of Choice? Is addiction an actual choice?Is addiction a series of behaviors that eventually turns into a habit?Is it due to a chemical imbalance in the brain?Is it attributed to hereditary and genetics?

Holton, 20125Before determining a diagnosis, the Clinician must FIRST rule out:

Medical ConditionsANDSubstance-Related DisordersHolton, 20126Substance-Related DisordersSubstance Dependence Physiological Dependence (Tolerance and/or withdrawal)Without Physiological Dependence (compulsive use)Substance AbuseDo not meet criteria for Dependence (no tolerance or withdrawal and not using compulsively)Substance IntoxicationSubstance Withdrawal

** Must rule out substance-related disorders since they can mimic most mental health disorders.Holton, 20127Addictions 101: Treatment & Diagnosis7Quick Quiz (C.A.G.E.)1. Have you ever felt you should cut down on your drinking?2. Have people annoyed you by criticizing your drinking?3. Have you ever felt bad or guilty about your drinking?4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)?Holton, 20128ADDICTION

Ones first experience with drug use can be divided into Thirds:

1) Think it 2) Terrified 3) Absolutely is okay, but by it! Will Loves It!! It doesnt need never use is euphoric. it. it again. It is their medicine.

Holton, 20129Georgi, J. M., 2004What factors lead to an addiction?BiologicalPsychologicalSocial (Cultural)SpiritualHolton, 201210

Holton, 201211 Biological Vulnerability *Some people have higher levels.

Some people are more resistant.

Georgi, J. M., 2004

Holton, 201212 PsychologicalLiability*SHAME Type A Personalities with Anger, Frustration, & Negative Thinking.

Georgi, J. M., 2004

Holton, 201213 Social Context *CULTURE

Society, up-bringing, childhood

Person In Environment Georgi, J. M., 2004

Holton, 201214 SpiritualBankruptcy *No hope or belief

False sense of control.

Georgi, J. M., 2004

Holton, 201215 Biological + Psychological + Social + Spiritual Vulnerability Liability Context Bankruptcy EQUALS

ADDICTIONGeorgi, J. M., 2004Holton, 201216 Society teaches us that if something hurts, take a pill for it. Fix it.

We live in a shamed based society. If one has cancer, treatment takes place and everyone is proud. If one has an addiction, or mental illness, society places stigmas. Georgi, J. M., 2004Holton, 201217 Shamp, J., 2005CHRONIC DISEASES:HYPERTENSION - 30% followed recommendations from doctors; 50-60% relapsed within 12 monthsDIABETES - Less than 30% follow recommendations, thus leading to 30-50% needed re-treatmentASTHMA - Less than 30% take medication as prescribed, thus 60-80% have frequent doctor/hospital visits.Holton, 201218 Shamp, J., 2005ADDICTION IS A CHRONIC DISEASE, LIKE HYPERTENSION, DIABETES & ASTHMA, HOWEVER IT HAS STIGMAS AND NEGATIVE PERCEPTIONS: People with addictions are sinners. Addiction leads to crimes and other negative activities. Addiction burdens and/or destroys relationships, careers, finances, etc. People with an addiction do not want help or treatment.

Holton, 201219Shame has been defined as, pain in the soul that can not be tolerated, thus one tends to find their own medicine.

Addiction = Unhealthy Coping SkillsGeorgi, J. M., 2004The brain weighs approximately 3 pounds, however it uses about 33% of the bodies energy.Holton, 201220Georgi, J. M., 2004The Brain

Holton, 201221The mid-brain is responsible for emotions.Hypothalamus - Master Gland or Thermostat Regulates hormones Hippocampus Functions after 2 yr. old; Short and Long Term Memory.Amygdala - Functions at birth. Fight or Flight; Automatic (Auto-pilot); Makes a decision in a split second; Stores past experiences; Reacts (depending on the past experience(s), it may over react). Holton, 201222Georgi, J. M., 2004The Brain

Holton, 201223The Brain

Holton, 201224The Brain

Holton, 201225Information enters through the hind-brain. It travels through the mid-brain, then finally reaches the forebrain.The hind-brain is responsible for basic body functions.The forebrain is responsible for decision making.The brain is, essentially, placed on hold at the age the chemical use (addiction) began!

Dependence/Addiction Vs Habitual Use

Mid-Brain ForebrainHolton, 201226Georgi, J. M., 2004The Brain

Holton, 201227The Brain

Holton, 201228

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Holton, 201230The Brain After Drugs.Holton, 201231

Normal2 weeks after stopping cocaine use 4 months after stopping cocaine use So is ADDICTION an actual choice?

Perhaps use language such as:Drug(s) that you are dependent on?

Drug(s) that you abuse?

Drug(s) that you have used?Using different terms does nottake away personal responsibility.

Holton, 201232Georgi, J. M., 2004Types of CopingAction-based copingAction-based coping involves actually dealing with a problem that is causing stress. Examples can include getting a second job in the face of financial difficulties, or studying to prepare for exams. Examples of action-based coping include planning, suppression of competing activities, confrontation, self-control, and restraint.Emotion-based copingEmotion-based coping skills reduce the symptoms of stress without addressing the source of the stress. Sleeping or discussing the stress with a friend are all emotion-based coping strategies. Other examples include denial, rationalization, repression, wishful thinking, distraction, relaxation, and humor. There are both positive and negative coping methods.

Holton, 201233Unhealthy Coping SkillsHarmful coping methodsSome coping methods are more like habits than skills, and can be harmful. Overused, they may actually worsen one's condition. Alcohol, cocaine, and other drugs may provide temporary escape from one's problems, but, with excess use, ultimately result in greater problems. Other less extreme cases involve skin biting, nail biting, and hair pulling.

Holton, 201234Addiction TimelineHolton, 201235First useExperimentalSocialDailyAddictionTreatmentContinued UseRecoveryAddictions 101: Treatment & Diagnosis35PERSON-IN-ENVIORNMENT (PIE) APPROACHIt is essential to get the whole picture, first hand, and consider various perceptions. Individuals grow and change, thus understand that they are often at a different level (either better or worse) as their experiences change.If co-occurring diagnosis are present, realize that the conditions need to be addressed at the same time!Holton, 201236UNDERLYING ISSUES & ADDICTIONAre their links between the addiction and mood symptoms? Which occurred first?Is there patterns of unhealthy behaviors, such as anger outbursts, turbulent relationships (codependency), minimizing issues (denial), control issues (external locus of control), low self-esteem, low self-worth, etc?

It is necessary to understand feelings and emotions. Holton, 201237What triggers unhealthy coping skills? How to cope with the triggers and cravings in a healthy way?Methods to re-train the middle brain. It takes tools, time and practice to re-train that survival center of the brain.Establish and practice positive, supportive and safe interactions to encourage replacing the dysfunctional behaviors to functional behaviors. Living compared to Surviving Being a Witness rather than a Victim!Holton, 201238Georgi, J. M., 2004Grieving Process:1) Shock/Denial2) Anger3) Bargaining4) Depression5) AcceptanceMarrone, 1997Holton, 201239Holton, 201240Revised Healing Process:

1) Denial2) Bargaining3) Anger (Projection) 4) Depression (Blah, Guilt)5) Acceptance (Sobriety)Holton, 201241Stages of Change Its A ProcessPrecontemplation (Denial): Not thinking of quitting Feel that things are fine Do not see a problemContemplation(Bargaining): Thinking of quitting Thinking of how others have been affected Try small changesPreparation (Bargaining & Anger): Have a plan to quite May have cut down on use Can see the positives of being cleanAction(Anger & Depression): Have quit using Avoiding triggers Ask others for helpMaintenance (Acceptance): Have not used in a long time Accept self and sobriety Help others who still useVelasquez, Maurer, Crouch, & DiClemente.,2001Mindfulness - Shells Dealing with stress, cravings, flashbacks of traumas, mood fluctuations, pain, triggers, anger, etc. is difficult. Practice healthy coping skills:1) Recognize what is going on (Observe)2) Figure out how you are feeling (Describe)3) Do something about the feelings (Participate)

Most people only complete the initial step. Many do not actively participate in recognizing emotions and changing their thinking and behaviors.

Georgi, J. M., 2004 (as cited in Linehan, 1993)

Holton, 201242Therapeutic Group Sessions: Utilizing Metaphors and Visual Aids 201142HEALTHY COPING SKILLS (REACTIONS)RECOGNIZING SITUATIONS / EVENTSUNDERSTANDING EMOTIONSADDRESS AND DEAL WITH ISSUES AS THEY COME (DO NOT STUFF ISSUES)INTERNAL LOCUS OF CONTROLCONTROL OF THOUGHTS AND BEHAVIORSHEALTHY SELF-ESTEEMSENSE OF SELF-WORTHSELF-AWARENESSHOPEFULNESS AND FAITHFULNESSHolton, 201243THOUGHTS, COMMENTS OR QUESTIONS?Holton, 201244Addictions 101: Treatment & Diagnosis44For more information, contact:Jessica Holton MSW, LCSW, LCAS

Jessica Holton, PLLChttp://www.jessicaholton.com 3491 Evans StreetSuite AGreenville, NC 27834252-987-3039jessica_holton_lcsw@jessicaholton.com

Holton, 201245Addictions 101: Treatment & Diagnosis45ReferencesGeorgi, J. M. (2004). Treatment issues for dual diagnosis: Post traumatic stress disorder and substance abuse. Presentation sponsored by Eastern AHEC. Greenville, NC.Shamp, J. (2005). Fighting the stigma linked to addiction. Retrieved April 18, 2005, from http://herald-sun.com/durham/4-598156.htmlSidbury, L. & Owens, C. (2005). Critical incident stress and emergency response. Presentation sponsored by Pitt Community College. Greenville, NC.Valasquez, M.M., Gaylyn, G.M., Crouch, C. & DiClemente, C.C. (2001). Group treatment for substance abuse: A stages-of-change therapy manual. New York: The Guilford Press.

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