IOP Part 2: Co-Occurring Disorders, Self-Medication and Physiological Effects of Addiction

Review of Last Week

0We talked about the basics of addiction0How will life be different when you are sober0Review your journal and tell the group about 3 things

that made you feel0 Angry/Frustrated/Irritated/Resentful0 Happy/Grateful0 Anxious/Stressed

0Do the things that led to negative feelings have anything in common? (Out of your control, Failure, the Unknown, Rejection…)

Objectives

0 Define Co-Occurring Disorders0 Identify the symptoms of the most common mental health

issues0 Discuss how substances may be used to self-medicate

mental health issues0 Discuss medical conditions and how they may mimic

mental health issues0 Identify how certain medications can produce symptoms

of depression or anxiety0 Understand why a bio-psycho-social approach to recovery

is so important

AD/HD0DSM-IV Diagnostic Criteria for ADHD Either (1) or (2):

0 Six (or more) symptoms of inattention have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level: 0Often fails to pay attention to details or makes careless mistakes0Often has difficulty sustaining attention in tasks or play activities 0Often does not seem to listen when spoken to directly 0Often does not follow through on things0Often has difficulty organizing tasks and activities 0Often avoids, dislikes or is reluctant to engage in tasks that require

sustained mental effort (such as schoolwork or homework) 0Often loses things necessary for tasks0 Is often easily distracted by extraneous stimuli 0 Is often forgetful in daily activities

06 of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months and are inconsistent with developmental level:

Hyperactivity 0Often fidgets with hands or feet or squirms in seat 0Often leaves seat in classroom or in other situations in

which remaining seated is expected 0Often runs about or climbs excessively in situations in which

it is inappropriate (in adolescents or adults, may be feelings of restlessness)

0Has difficulty playing or engaging in leisure activities quietly 0Is often "on the go" or often acts as if "driven by a motor" 0Often talks excessively

0Impulsivity 0Often blurts out answers before questions

have been completed 0Often has difficulty awaiting turn 0Often interrupts or intrudes on others

0 Some symptoms that caused impairment were present before age 7 years.

0 Impairment is present in two or more settings0 Clinically significant impairment

Adult AD/HD

0Adult symptoms 0 Hyperactivity and poor concentration 0 Affective 0 Lability/Hot temper 0 Inability to complete tasks and disorganization 0 Stress intolerance 0 Impulsivity

Axis I: Mood DisordersPart A: Anxiety

Anxiety: Generalized0 At least 6 months of "excessive anxiety and worry" about a

variety of events and situations. 0 There is significant difficulty in controlling the anxiety and worry. 0 The presence for most days over the previous six months of 3 or

more (only 1 for children) of the following symptoms: 0 1. Feeling wound-up, tense, or restless0 2. Easily becoming fatigued or worn-out0 3. Concentration problems0 4. Irritability0 5. Significant tension in muscles0 6. Difficulty with sleep

0 The symptoms are not part of another mental disorder. 0 The symptoms cause "clinically significant distress“ 0 The condition is not due to a substance or medical issue

Anxiety: Panic Disorder0 Symptoms

0 A discrete period of intense fear/discomfort, in which 4 of the following developed abruptly and peaked within 10 minutes:0 palpitations, pounding heart, or accelerated heart rate0 sweating0 trembling or shaking0 sensations of shortness of breath or smothering0 chest pain or discomfort0 nausea or abdominal distress0 feeling dizzy, unsteady, lightheaded, or faint0 derealization (feelings of unreality) or depersonalization (being

detached from oneself)0 fear of losing control or going crazy0 fear of dying0 paresthesias (numbness or tingling sensations)0 chills or hot flushes

Anxiety: PTSD0Symptoms0The person has been exposed to a traumatic that involved

actual or threatened death or serious injury, or a threat to self or other and the person's response involved intense fear, helplessness, or horror.

0The traumatic event is persistently reexperienced in one (or more) of the following ways:0Dreams0Flashbacks0Intense distress at exposure to reminders of the event

PTSD cont…0Avoiding reminders of the trauma and numbing

of general responsiveness (not present before the trauma): 0efforts to avoid thoughts, feelings, or conversations

associated with the trauma0efforts to avoid activities, places, or people that arouse

recollections of the trauma0inability to recall an important aspect of the trauma0markedly diminished interest or participation in

significant activities0feeling of detachment or estrangement from others0restricted range of affect (e.g., unable to have loving

feelings)

PTSD cont…

0Persistent symptoms of increased arousal (not present before the trauma)0difficulty falling or staying asleep0irritability or outbursts of anger0difficulty concentrating0hypervigilance0exaggerated startle response

Axis I: Mood DisordersPart B: Depression

Depression and Dysthymia

0Major Depressive Episode0 A. Five (or more) of the following have been present nearly every

day during the same 2-week period0depressed mood most of the day0markedly diminished interest or pleasure in all, or almost all,

activities0significant changes in eating patterns.0 insomnia or hypersomnia0psychomotor agitation or retardation nearly every day0 fatigue or loss of energy0 feelings of worthlessness or excessive or inappropriate guilt0diminished ability to think or concentrate, or indecisiveness, 0 recurrent thoughts of death (not just fear of dying), recurrent

suicidal ideation

Depression cont…0 The symptoms are not due to

0 the direct physiological effects of a substance0 a general medical condition (e.g., hypothyroidism).0 Bereavement, i.e., after the loss of a loved one, the symptoms

persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation

0Dysthymia is a constant, low-grade depression that lasts for months or years.

Bipolar

0Disorder in which the person experiences both manic and depressive type symptoms

0Symptoms can alternate, co-occur(mixed) or be present to a greater or lesser degree (hypomania/dysthymia)

Mania

0Abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week

0 inflated self-esteem or grandiosity

0decreased need for sleep more talkative than usual or pressure to keep talking

0flight of ideas or subjective experience that thoughts are racing

0distractibility 0increase in goal-directed activity (either socially, at work

or school, or sexually) or psychomotor agitation 0excessive involvement in pleasurable activities that have a

high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

Hypomania

0Criteria for Hypomanic Episode (DSM-IV, p. 338)0The manic episode is not severe enough to cause

marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.

Medical Disorders

0Depressive-Like Symptoms0 Diabetes0 Hypothyroid0 Fibromyalgia0 Chronic Fatigue

0Manic-Like Symptoms0 Hyperthyroid

Summary Depressive & Bipolar Disorders0Depression0Dysthymia0Mania0Hypomania0Bipolar I0Bipolar II0Cyclothymia0Differential Diagnosis

Physical Issues

0Physical conditions can mimic intoxication or withdrawal

0Physical conditions can worsen during use or withdrawal

0People use to self-medicate physical (and emotional) conditions

0Effective treatment involves addressing physical AND emotional conditions AND treatment side effects which are unplesant.

Substances and Medications0Depression

0 Opiates0 Anxianxiety/Benzodiazepines0 Depressants/Barbiturates0 Inhalants0 GHB

0Mania0 Ecstasy/MDMA0 Methamphetamine0 Cocaine0 Steroids

Medications0Pain killers (opiates) and antianxiety medications

(benzodiazepines) can produce feelings of tiredness, sluggishness and general apathy.

0Stimulants (decongestants, ADD/ADHD medications) can cause nervousness, shakiness and anxiety-like symptoms. Excessive use can cause depression-like symptoms when not using

0Steroids can cause irritability, depression and dramatic mood swings

Medical Issues0Chronic Fatigue

0 Fatigue0 Sore Throat0 Loss memory and loss of

concentration0 Enlarged lymph nodes in the neck0 Muscle pain that is unexplained0 Joint pain that can move from joint to

joint without any signs or swelling.0 Sleep that is unrefreshing and waking

up as tired0 Headaches0 Exhaustion 0 Pain in the abdominal region0 Having allergies or other sensitivities0 Chest pains0 Bloating/Diarrhea

0 Dry mouth0 Being dizzy when standing up, or

having problems with balance and fainting

0 Irregular heartbeats0 Ear aches0 Morning stiffness0 Pain in your jaw0 Nausea0 Having night sweats and chills0 Depression, anxiety, irritability, panic0 Being short of breath0 Tingling Sensations in your

extremities0 Vision blurring, eye pain, sensitivity

to light or dry eyes.0 Gaining or losing weight.

Medical: Diabetes

0Diabetes0 Type 1 Diabetes

0Frequent urination 0Unusual thirst 0Extreme hunger 0Unusual weight loss 0Extreme fatigue and Irritability

0 Mimics depression

Medical: Diabetes

0Hypoglycemia0 nervousness0 sweating0 intense hunger0 Trembling0 weakness0 Palpitations0 Trouble speaking/Word Slurring

0Mimics anxiety disorders

Medical: Fibromyalgia0 Chronic muscle pain, muscle spasms or tightness0 Moderate or severe fatigue and decreased energy0 Insomnia or waking up feeling just as tired 0 Difficulty remembering, concentrating0 Tension or migraine headaches0 Jaw and facial tenderness0 Sensitivity to one or more of the following: odors, noise, bright

lights, medications, certain foods, and cold0 Feeling anxious or depressed0 Numbness or tingling in the face, arms, hands, legs, or feet0 A feeling of swelling (without actual swelling) in the hands and

feet

Medical: Hypertension

0 Hypertension0 Severe headache0 Fatigue or confusion0 Vision problems0 Chest pain0 Difficulty breathing0 Irregular heartbeat0 Blood in the urine0 Pounding in your chest, neck, or ears

If you have any of these symptoms, see a doctor immediately. You could be having a hypertensive crisis that could lead to a heart attack or stroke.

Medical Arrhythmias

Symptoms of Arrhythmias0 Palpitations (a feeling of skipped heart beats, fluttering

or "flip-flops," or feeling that your heart is "running away").

0 Pounding in your chest.0 Dizziness or feeling light-headed.0 Fainting.0 Shortness of breath.0 Chest discomfort.0 Weakness or fatigue (feeling very tired).

Medical: Heart Disease

0Shortness of breath0Palpitations0A faster heartbeat0Weakness or dizziness0Nausea0Sweating

Polycystic Ovarian Syndrome

0 Infrequent, absent, and/or irregular menstrual periods0 Increased hair on the face, chest, torso, thumbs, or toes0 Cysts on the ovaries 0 Acne, oily skin, or dandruff0 Weight gain or obesity, usually around the waist0 Male-pattern baldness or very thin hair0 Patches of skin on the neck, arms, breasts, or thighs that

are thick and dark brown or black0 Pelvic pain0 Anxiety or depression

Medical:ThyroidHyperthyroid HypoThyroid

0 Palpitations0 Heat intolerance0 Nervousness0 Insomnia0 Breathlessness0 Increased bowel movements0 Light or absent menstrual periods0 Fatigue0 Fast heart rate0 Trembling hands0 Weight loss0 Muscle weakness0 Warm moist skin0 Hair loss0 Staring gaze

0 Fatigue0 Weakness0 Weight gain0 Coarse, dry hair0 Dry, rough pale skin0 Hair loss0 Cold intolerance (you can't tolerate

cold temperatures like those around you)

0 Muscle cramps/muscle aches0 Constipation0 Depression0 Irritability0 Memory loss0 Abnormal menstrual cycles0 Decreased libido

Axis III: Medical Issues---Summary

0Many medical conditions have symptoms that mimic substance abuse or mood disorders

0Side effects of medications can also mimic substance abuse

0Some people self medicate physical and/or emotional issues with substances

Homework0Family History:

0 Identify each person in your family from your grandparents and great aunts and uncles to your parents and siblings.

0 List any medical or mental health problems they had, or you suspect they had

0 Identify 2 simple things that you can do each day to help you feel better0 Example:

0 I watch the birds that come to my feeder and play with my pets. Sometimes I garden.

0 I get better rest if I am on a schedule and go to bed at the same time each night.