Co-Occurring DisordersJune 13, 2013

by Andrew Parrish, MS, LMFT

Co-occurring disorders involve: A mental health diagnosis

Major depressive disorder Bipolar disorder Schizophrenia Generalized anxiety disorder Attention Deficit Hyperactivity Disorder (ADHD) Post-Traumatic Stress Disorder (PTSD)

A substance abuse/dependence diagnosis Abuse: consistent problems with use of a substance on an

inconsistent basis Dependence: significant problems due to using a

substance on a very consistent basis

What is a co-occurring disorder?

Substances are divided into two categories Depressants (“Downers”)

Alcohol (beer, wine, spirits, mixed beverages) Marijuana (cannabis, pot, weed, hashish) Opiates (heroin, prescription pain killers) Benzodiazepines (Xanax™, Klonipin™, Ativan™)

Stimulants (“Uppers”) Cocaine Methamphetamines Prescription medications (Adderall™, Ritalin™)

Understanding Substances

Major depressive disorder Involves periods of intense emotional and mental

distress marked by sadness, irritability and even suicidal ideations

Can be connected to the seasons Can occur at regular intervals (every 2 years) Has no manic or hypomanic stage Significantly impacts interacting with others

Why would someone use a depressant? Why would someone use a stimulant?

Understanding Depression

Bipolar disorder Characterized by two distinct moods

Depressed mood Period of sadness, isolation, sometimes suicidal ideations

Manic/hypomanic mood Period of increased mood, agitation, extreme happiness,

impulsivity, grandiose thinking

Moods fluctuate over time Significantly impacts interacting with others

Why would someone use a depressant? Why would someone use a stimulant?

Understanding Bipolar Disorder

Schizophrenia Marked by experiencing positive (added) symptoms

(hallucinations, paranoia) during active stage Marked by experiencing negative (blocking) symptoms

(catatonic, isolated, withdrawn) during residual stage Significantly impacts interacting with others

Why would someone use a depressant? Why would someone use a stimulant? Bonus question: what is the overlap of a mood

disorder (depression or bipolar) and schizophrenia called?

Understanding Schizophrenia

Schizoaffective Disorder Overlap of symptoms from:

Schizophrenia Positive symptoms

Hallucinations and paranoia Negative symptoms

Isolation, socially withdrawn Mood disorder

Depression Bipolar disorder

Is someone with schizoaffective more or less likely to use than someone with schizophrenia?

Understanding Schizoaffective Disorder

Generalized Anxiety Disorder Significant periods of time worrying about life

stressors Significantly impacts interacting with others Can follow significant trauma Can sometimes be “irrational”

Often times, irrational anxiety is the result of thoughts being influenced by emotions and emotional responses

Is someone more likely to use stimulants or depressants with this illness?

Understanding Generalized Anxiety Disorder

Attention Deficit Hyperactivity Disorder Can be predominately inattentive (formerly ADD)

Marked by inability to focus or pay attention Completion of tasks is low even if instructions are clear

Can be predominately hyperactive Marked by inability to calm down and engage Completion of tasks is low due to impulsivity

Significantly impacts interactions with others Would a person with ADHD be more likely to use a

depressant or a stimulant? Bonus question: What is a commonly prescribed

medication for ADHD that is not a stimulant?

Understanding ADHD

Post-Traumatic Stress Disorder Response follows a traumatic event

Death of a loved one Potential damage to a person that could harm or kill

them Severe abuse or mistreatment Witnessing severe abuse or mistreatment of others Returning from a war zone

Significantly impacts interacting with others Is someone with PTSD more likely to use a

stimulant or a depressant?

Understanding PTSD

Substance abuse and substance dependence no longer exist as a diagnosis

Instead, substance diagnoses fall into four categories that describe symptoms Substance use disorder

Use of a substance becomes more problematic over time with tolerance levels increasing and impacts to daily functioning being significant

Substance intoxication Recent use of a substance resulting in marked changes to normal behavior

Substance withdrawal Recent cessation (stopping) or “cutback” of a substance resulting in

marked changes to normal behavior Other substance related disorder

Substance use resulting in problematic functioning that does not fall in the above categories

Changes in DSM-5

Psychosocial Rehabilitation (PSR) can assist in Developing coping skills Developing healthy interaction skills Learning more about your diagnosis Overcoming fears Identifying triggers for mental health or substance

relapses Taking personal responsibility for yourself Strategies to stay clean and/or sober

Talking with a counselor or PSR staff member is helpful Remember, mental health workers are there to help

you get better!!

How do you deal with co-occurring problems?