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Title: 2009 Knowledge is Power Series: Part 3 Concurrent Disorders October 8, 2009


1
2009 Knowledge is Power Series Part 3
Concurrent Disorders October 8, 2009
Christene Walsh, MSW Katherine Kopec Heather Anam
Cara, RPN Dr. Heather McDonald Deborah
Linthout
2
(No Transcript)
3
Overview
  • Concurrent Disorders
  • Mental Health
  • Substance Abuse/Dependency
  • Addiction
  • Mental Health Addiction
  • Change
  • Ways to help.
  • Resources

4
Concurrent Disorders
  • Someone said to be experiencing both a mental
    illness and a substance use problem may be
    diagnosed with a Concurrent Disorder. Hence, a
    concurrent disorder is a general term referring
    to a broad range of mental illnesses and
    addictions a person could have.  For example,
    someone struggling with an alcohol dependency and
    anxiety may have a concurrent disorder. 
  • You may know someone and/or have been diagnosed
    with a concurrent disorder yourself and, this
    condition may seem overwhelming to treat.  Yet,
    with understanding and helpful support, its
    manageable.  There is hope.    

5
Definition of Concurrent Disorders
  • Otherwise known as co-occurring disorders,
    co-morbidity or dual diagnosis, the definition of
    concurrent disorders is
  • Any combination of mental/emotional/psychiatric
    illnesses (Axis I or II) and substance use
    disorders (alcohol and/or other psychoactive
    drugs).
  • Nearly 60 of adults with addiction also have a
    mental disorder.
  • Dr. Kenneth Minkoff, 2003 Best Practices,
    Health Canada, 2001
  • Integrated treatment is the best approach for
    treating co-occurring disorders.
  • The Journal of Addiction Mental Health,
    Sept/Oct 1998

6
What is Mental Health?
  • The World Health Organization (WHO) definition
    of mental health is a state of well-being
  • - in which the individual realizes his or her
    own abilities,
  • - can cope with the normal stresses of life,
  • - can work productively and fruitfully,
  • - and, via being here is able to make a
    contribution to his or her community.

7
Mental illness Addiction
  • People who generally experience addiction and
    other related health issues often
  • - Do not typically feel a state of well-being,
  • - Often, are not able to recognize his or her
    own abilities,
  • - Usually do not cope well with normal
    stressors of life,
  • - Tend not to work productively and fruitfully,
  • - And, are not generally able to make a
    contribution to his or her community.

8
Everybody IS Different
  • When you have met one individual diagnosed with a
    concurrent disorder, you have met one person
    diagnosed with a concurrent disorder.

9
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10
What is Substance Abuse?
  • Substance abuse is defined in the DSM-IV as a
    maladaptive pattern of substance use leading to
    clinically significant impairment or distress, as
    manifested by one (or more) of the following,
    occurring within a 12 month period
  • Recurrent substance use resulting in the failure
    to fulfill major role obligations at work, school
    or home.
  • Recurrent substance use in situations which it is
    physically hazardous.
  • Recurrent substance-related legal problems.
  • Continued substance use despite having persistent
    or recurring social or interpersonal problems
    caused or exacerbated by the effects of intake.

11
What is Chemical Dependency?
  • According to the DSM-IV criteria, Substance
    dependence is a maladaptive pattern of substance
    use, leading to clinically significant impairment
    or distress, as manifested by (3 or more)
  • greater tolerance, withdrawal, increased use,
    inability to reduce or eliminate use, altering
    events of daily living to support use, changing
    interests/other activities to maintain intake
    and, substance use is continued despite
    knowledge of having a persistent or recurrent
    physical or psychological problem caused or
    exacerbated by use.

12
3 Cs of Addiction
  • Inability to control usage (not referring to an
    inability to stop),
  • Continued use despite repeated negative
    consequences (what happens when they use how it
    affects them health well-being and the health
    well-being of others),
  • Psychological compulsion (think about it all the
    timeand dont realize that most people do not
    think this way.
  • Tolerance decreased effect of same dose taken
    so, increase dose to produce the same effect.
  • Focus on behaviour, not the drug!

13
Points to consider.
  • The effects of substances on individuals with
    concurrent disordered, impacting themselves
    their families and/or friends depends on the
    type, amount, frequency, pattern methods of
    use.
  • Effects are also influenced by dependence level,
    diet, physical health, habits, psychological
    functioning, severity of co-existing psychiatric
    disorders, high risk behaviours social setting.
  • Daley Moss, 2002

14
Typical Warning signs of Addiction?
  • Physical health problems (hangovers, blackouts,
    stomach problems, scabs on body, broken/rotten
    teeth, chronic appearance of cold/sniffing,
    sweaty, nodding-off, itchy, etc.),
  • Mental health concerns (depression, sudden mood
    swings, anxiety, guilt.),
  • May be angry when asked alcohol other drug use
    questions,
  • Work/school life interrupted, no money /debt ,
  • Wear sun glasses overcast weather, long sleeve
    clothes (hide track marks) in warm weather,
  • Weight loss (stimulants), weight gain (marijuana,
    ETOH),
  • Family life negatively impacted, poor hygiene,
  • Social life (altered/changed/reduced),
  • Financial concerns, Legal Issues (theft),
  • Secretive, Distant, reluctant to talk,
  • Loss of control (Abuse)
  • Violence, no-limits with substances.

15
Five stages of Drug Effects for those Concurrent
Disordered
  • 1. Pre-intoxication
  • coming down with something not noticeably
    drunk, high or stoned but with subtle effects
    on mood.
  • The effects of even a small amount of alcohol or
    other drugs on someone who is depressed,
    impulsive, having mood swings, or having trouble
    keeping thoughts on track may be
    disproportionately strong.
  • The change in mood or thinking in the
    pre-intoxication stage may make it impossible to
    think about what comes next and to stop using
    before becoming intoxicated.
  • Those who are addicted, the first drink or hit of
    the drug is already too much.

16
2. Intoxication Stage
  • During intoxication, the person is clearly under
    the influence of the drug. The drug
    concentration in the brain is high enough to
    change brain functioning related to feelings,
    thinking and behaviour.
  • Marijuana the user might decide that a task is
    silly and Alcohol the user might get into a
    fight, have an accident, or get arrested for
    drunk driving.
  • unimportant, or might become paranoid about the
    task.
  • Cocaine Intense but brief high before the
    crash.
  • For persons with psychiatric illnesses, the
    change in mood, thinking and behaviour may become
    extreme.
  • User may become psychotic during intoxication
    hear voices, see things, peculiar ideas, think
    others are plotting against him or planning to
    hurt her.
  • Extreme excitement or unmanageable rage.
  • User may become violent with self or others.
  • Promote hospital admission due to extreme
    reaction to drugs.

17
  • 3. Post-intoxication recovery
  • Aftermath of the drug effect hangover and/or
    feel tired, depressed, irritability, stomach
    upset.
  • For someone with a psychiatric diagnosis
  • Its more difficult to return to a stable mood or
    to get ones thoughts in order. The aftermath
    may last much longer.
  • The intoxication stage may have led to serious
    trouble such as an acute episode of mental
    illness, hospitalization or a night in jail.
  • Getting back to normal a major undertaking
    complications.
  • A job, living arrangement or important
    relationships may have been lost.
  • It may be tempting to use more alcohol or other
    drugs in an attempt to escape these troubles.
    Quickest method to get away from the pain.
  • For chemically dependent individuals, physical
    health may be compromised because of the progress
    of the addiction.

18
  • 4. Lingering (residual) effects
  • Depression, irritability, anxiety, paranoid
    thoughts, confused thinking may linger for
    weeks or months (how long depends on the drug
    used impact on the brain)
  • For concurrent disordered clients
  • Lingering effects might add to users pre-existing
    symptoms and troubles. Depression, anxiety, etc.
    might be more difficult to manage when the
    effects of substance use is added.
  • Depression may intensify to the point of suicidal
    impulses, anxiety might turn into panic, anger
    might take the form of rage/violence and a
    passive attitude may become apathy and isolation.
  • Effects of substance use may be seen as mental
    illness no opportunity to know the user as
    clean/straight.

19
  • 5. Permanent Effects
  • Structural damage to brain and/or other organs
    and cannot be reversed. The most familiar
    example of permanent effects is brain damage
    caused by years of heavy drinking.
  • For someone with a psychiatric illness, permanent
    organic damage can mean loss of important brain
    or body functions.
  • Ryglewicz, Pepper Massaro, 2003

20
Substance Abuse related Health Risks
  • Some Social risks
  • Poor nutrition,
  • Inadequate finances,
  • Loss of employment,
  • Lack/loss of emotional social supports,
  • Promotes isolation,
  • Victimization,
  • Non-adherence to Medication,
  • Homelessness/transient (require address for
    social assistance),
  • Self-destructive/impulsive behaviours,
  • Limited access to mental health other services.
  • Some Medical risks
  • May mask timely identification subsequent
    treatment of life threatening illness and other
    disorders.
  • Illicit drug use via intravenous may cause
    infection/disease.
  • May impair judgment create mistrust.
  • May promote increased risk for various site
    cancers, higher than the general population.
  • May reduce life expectancy.

21
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22
Concurrent Disorders manifest itself in several
different ways
  • Substance abuse and psychiatric disorders may
    co-occur by coincidence.
  • Substance use may cause psychiatric conditions or
    increase the severity of psychiatric symptoms.
  • Psychiatric disorders may cause or increase the
    severity of substance use disorders.
  • Both disorders may cause a third condition.
  • Substance use and withdrawal may produce symptoms
    that mimic those of a psychiatric disorder.
  • Meyer 1989, from Addictions and Mental Health,
    Irene Ralph, R.P.N., 2001

23
What came first, the chicken or the egg?
  • If alcohol or other drug use began in childhood,
    it probably began before the mental/emotional
    problems surfaced for an emotionally vulnerable
    child.
  • Ryglewicz, Pepper, Massaro, 2003
  • If alcohol or other drug use began later in
    adolescence or young adulthood, the psychiatric
    problems probably came first, either in the form
    of depression anxiety as the first signs of a
    major mental illness.

24
Are Substance Use and Mental Illness linked? YES!
  • Studies estimate that
  • At least 50 of people with mental illness abuse
    illegal drugs or alcohol, compared to 15 of the
    general population.
  • 12-18 of people with anorexia and 30-70 of
    people with bulimia also have substance use
    disorders.
  • 47 of people with schizophrenia exhibit problem
    drug use Cocaine in particular.
  • 56 of people with bipolar disorder have a
    substance use disorder.
  • More than a third of people with an anxiety
    disorder also have a substance use disorder.
  • Drug of choice usually alcohol followed by
    marijuana then cocaine.
  • BC Partners for Mental Health Addictions
    Information, 2003

25
Psychiatric Disorders most often seen in
concurrent disorders,
  • Major Depression
  • Schizophrenia (Thought Disorder)
  • Bi-Polar Illness
  • Anxiety Disorders
  • Personality Disorders
  • Inappropriate and dangerous to wait for the
    concurrent disordered client to hit rock bottom
    before assistance is offered/accepted.
  • Inaba Cohen, 1997

26
Just the facts Stigma Busting Activities (CAMH,
2003)
  • MYTH
  • People with concurrent mental health and
    substance use problems are less likely to seek
    treatment than people with only one problem.
  • FACT
  • People with concurrent disorders are more likely
    to actively seek treatment than people with only
    one problem. (1)
  • They are also more likely to be stigmatized and
    excluded from existing services. (2)
  • (1) Health Canada (2001)
  • (2) Rassool (2002)

27
How effective is treatment for co-occurring
disorders?
  • Although people with co-occurring disorders may
    have a more difficult challenging recovery than
    those with a single disorder, they can greatly
    benefit from combined treatments of medication,
    therapy and/or a rehabilitation program.
  • Common treatments are individual and group
    focused interventions that are measured by their
    ability to stop or reduce substance use, improve
    physical emotional health, improve
    relationships, increased employability and fewer
    legal problems.
  • Daley Spear, 2003

28
Treatment Considerations
  • Initial step in treatment is to address
  • Both the psychiatric illness substance use
    disorder.
  • Identify high risk conditions that require
    immediate intervention.
  • Life threatening medical illness
    suicidal/homicidal ideation unmet basic needs,
    etc. Seek help Consult with family physician.
  • Long-term management should include a primary
    care case manager who coordinates other
    appropriate services to ensure focus remains on
    concurrent disorders.
  • Encourage family/friend and other community
    support.
  • Group therapy, based on behavioural
    psychoeducational perspective is often effective.
    Groups should start later in the day last about
    an hour Concurrent disorders group at AD
    other groups based on need.
  • Educational information should be frequently
    repeated presented in a concrete form.
  • Hodgins, 1998

29
Potential individual barriers to wellness
  • People said to have little motivation are less
    likely to appear for appointments, etc. Assess
    potential barriers.
  • The individuals beliefs about the substance use
    and/or psychiatric disorder may affect their
    willingness to change. (Denial,
    Cultural/familial beliefs, etc.)
  • People who feels stigmatized for having a
    concurrent disorder diagnosis may resist
    treatment due to guilt, shame, embarrassment.
    Assist/support.
  • Expectation those who expect to fail, without
    support encouragement WILL FAIL.
  • Practical considerations. (child care, etc.)

30
Readiness to change?(Stages of Change Model)
  • Precontemplation
  • Not thinking of quitting.
  • Contemplation
  • Quitting in next 6 months.
  • Preparation
  • Quitting in next 30 days.
  • Action
  • Continuously quit lt6 months.
  • Maintenance
  • Continuously quit gt6 months.

31
Example Causes Consequences of Addiction
Anxiety Disorders (a lot of symptoms to endure.)
  • Anxiety (Causes)
  • Stress threatened loss of significant
    relationships, achievements status, Changes in
    brain chemistry and function,
  • Hereditary environmental factors
  • Anxiety (Symptoms)
  • Muscle tension overactive bodily responses
    pounding heart, trembling, etc.
  • Hypervigilance,
  • Severe anxiety and worry,
  • Avoidance of feared situations,
  • Physical, interpersonal, social, occupational,
    spiritual problems,
  • Hospitalization, immobilization, suicide.
  • Evans, 2003
  • Addiction (Causes)
  • Alcohol and other Drug use,
  • Changes in brain chemistry and function,
  • Hereditary environmental factors,
  • Addiction (Symptoms)
  • Tolerance, withdrawal, progression,
  • Denial, Loss of Control,
  • Continued use despite negative consequences,
  • Physical, Interpersonal, social, occupational,
    spiritual problems,
  • Hospitalization, imprisonment, .death.

32
Treatment of Addiction Anxiety Disorders
  • Learn assertiveness boundary setting,
  • Accepts disease(s),
  • Seeks support from others,
  • May need medication,
  • Learns relaxation skills (AD/MH Groups),
  • Starts positive thinking,
  • Physical exercise, healthy eating,
  • Faces dreaded situations,
  • Functions better overall,
  • Relationships improve, confidence grows.

33
One persons experience in chaos.
  • Female 5 siblings 2 parent household (Mother
    alcoholic/Dad CJ involved),
  • Alcohol other drug abuser (onset age 11Heroin
    age 36),
  • Sex trade involvement (age 38),
  • Diagnosed with depression (at age 13 - prescribed
    Valium),
  • Hospitalized x3 for serious suicide attempts by
    age 17,
  • Suffered from intermitted Bulimia, Anorexia
    (prescribed requested diet pills weight 110),
    quit school end of grade 12.
  • Saw psychiatrists, counsellors, alternative
    medicine, even a psychic! Multiple hospital
    visits and admissions.
  • Mental illness Diagnosed bipolar affective
    disorder,
  • History of violent, co-dependent relations after
    stable relationship (commenced at age 17 2
    children) ended,
  • 1997 serious car accident (attempted
    murder/suicide by ex-boyfriend) multiple injuries
    coma/life support broken pelvis, punctured
    lung, broken ribs, spleen removed, tore
    ligaments, contused heart
  • 1999 Hepatitis C diagnosis (chronic alcoholic).

34
A life worth living.what happened?
  • 4 years in recovery from chronic alcoholism (14
    years recovery from Heroin and other drugs),
  • 4 years with managed mental health symptoms
    Physical health work in progress ?
  • What helped?
  • Good psychiatrist (saw even when intoxicated),
  • Activated safety plan created by Katherine and
    mental health social worker (component of
    treatment) and left co-dependent relationship,
  • Went to AG Safe Centre then supportive housing,
  • Attended local addictions clinic and completed
    Residential Addictions Treatment Program (Aurora
    women), Concurrent disorders group,
  • Adhered to taking medication as prescribed,
  • Set realistic and manageable goals (aspirations),
  • Established a support system!!!!!!!!!!!!!!!!!!!!!!
    !!!!!!!!
  • Now a mother (2 adult children), sister,
    daughter, employee, friend.

35
How to help?
  • Offer hope!!!!!!!!!!
  • Housing in supportive environments is the key
    to success.
  • Effective intervention is possible through
    integrated, interdisciplinary care that responds
    to the basic needs of individuals as well as
    their need for treatment for both their mental
    illness and substance misuse.
  • Self-care

36
Team work
  • Individuals with severe persistent mental
    illness substance use disorders have great need
    for psychosocial supports. Beyond acute
    treatment medication management, long-term
    positive outcomes require a broad psychosocial
    approach, including housing, employment, income
    and key social supports.

- Best Practices, 2002
37
Commencing counselling/treatment
  • People are encouraged to engage in treatment
    via counselling/groups - even if they do NOT
    accept or agree with the presence of a substance
    disorder.
  • Individuals may first participate on the basis of
    their interest to learn more or, to be a support
    to others.
  • It is anticipated, over time, once the individual
    has developed trust in the empathetic, supportive
    process, he/she may be willing to disclose own
    views/concerns about own behaviour.
  • Motivational Interviewing, evolved in the field
    of addictions is suggested as one treatment
    approach as it does not view relapse as treatment
    failure and maintains a hopeful vision for
    possibility of change.
  • Sciacca, 1997

38
Change is work so why do it?
  • It is impossible to assist a person engage in
    harm reduction leading to abstinence if, the
    rationale for use or non-adherence to care
    recommendations is not addressed. If, for
    example, helping to socialize is said to be a
    reason for abusing substances, unless the
    individual develops other ways to help him/her be
    with people, no change will be sustained.

It is also crucial to be aware why altering
personal lifestyle choices would be deemed a
healthy action. Rationale is important.
39
Motivating Change
  • When helping individuals diagnosed with or
    suspected of having a concurrent disorder(s),
    support, encouragement and the belief in the
    possibility of change is essential.
  • For individuals who have severe mental health
    symptoms that may impair a vision for the future,
    their family, friends and formal supports must
    envision a positive outcome of proposed plans for
    change and share such possibilities with this
    person.
  • The individual must participate in developing any
    plan for change with the hope that he/she is
    eventually able to see/believe in the possibility
    of change too!
  • Miller, Rollnick, 2002 Sciacca, 1997

40
How do we make changes?
  • Change is a process not simply an event.
  • For example, think of running a marathon, to
    achieve this action involves planning, training,
    practice, setbacks, endurance, patience, humour,
    etc.
  • We can coach change successful change relies
    much on reinforcement than punishment.
  • Rieb, 1999

41
Understanding resistance.
  • Think of an important decision youve been trying
    to make one thats hanging over your head right
    now. Choose a situation that really matters to
    you. Now, answer this question for how long
    have you been trying to make this decision?
  • Imagine that you must decide, right now, what you
    are going to do. Your decision must be definite
    and permanent not only must you stick to it, but
    also must actively work to realize it. And, no
    matter how hard the decision is, or how many
    obstacles presented, uncertainty will be judged
    as evidence that you are not serious about your
    decision.

42
Resistance.is usually a normal reaction to the
idea of change.
  • Reactions to suggesting a change whether it be
    angry, argumentative, quiet, excuse making,
    rationalizing, uncertainty, anxious or avoidant
    demonstrates that the best way to generate
    resistance to change is to insist on change.
  • It is important to offer CHOICE (sense of
    independence and freedom with the decision making
    process) even if some of the outcomes are more
    attractive than others. Then it is up to the
    individual to decide which option to pursue.
  • Daley Zuckoff, 1999

43
Can drug use be good?
  • To relax,
  • Socialize,
  • Combat loneliness,
  • Reduce boredom,
  • Feel good,
  • Increase/decrease energy,
  • Chronic pain,
  • Gain/lose weight,
  • Escape,
  • Etc.

It is always beneficial to discover why the
person uses substances (solution to what?)
when attempting to engage them in safer living.
44
Bad for your health, Soooo?
  • Without positive engagement (good
    connection/rapport established first),
    confrontation about negative health risks
    usually associated with substance use generally
    doesnt work to promote harm reduction and/or
    abstinence for any concurrent disordered
    individual or any other person (especially
    youth).

45
Harm Reduction
  • Harm reduction is used as an approach that first
    seeks to minimize the harms caused by substance
    use, rather than requiring people to stop their
    use immediately (as often not initially a
    practical expectation).
  • This approach does not condone illegal drug use
    instead the focus is on SAFETY stabilization
    for the individual with a long-term goal of
    abstinence (if achievable).

46
Harm Reduction as treatment
  • Harm reduction therapists meet clients where
    they are in terms of readiness to change and
    attempt to reduce harmful consequences of all
    their interrelated problems first via
    stabilization of basic needs.
  • HRT focuses on improvement in the clients
    overall psychosocial functioning, well being, as
    well as the cessation, reduction or moderation of
    substance use.
  • Goal of HRT is to reduce risk harm. Goal
    setting is a collaborative process. The client
    communicates what is important, the
    counsellor/case manager provides feedback,
    information, skills training and support tailored
    to individual client needs. Aware of the
    clients motivation level to aid progression to
    next level of intervention (gradual). Stages
    of change
  • Parks, Anderson Marlatt, 2000

47
Best Practices Treatment Interventions and
Support Services By Diagnosis
  • Co-occurring Substance Use and Mood and Anxiety
    Disorders (eg. Alcohol and Depression)
  • Cognitive Behavioural Approach (based on clients
    history) is recommended as well as drug
    treatment. Relapses are very common so
    longer-term treatment is required, as is ongoing
    assessment.
  • Case conference should occur with the client and
    any available family members or friends who can
    provide support. Build treatment plan on past
    successes and provide education.

48
Co-occurring Substance use and Severe
Persistent Mental Disorders (eg. Alcohol
Schizophrenia)
  • Simultaneous treatment is recommended.
  • Mental Health services, crisis response, housing
    or hospitalization may be needed along with
    motivational interviewing, harm reduction
    approach, cognitive behavioural counselling,
    self-help liaison, work with families, community
    treatment or less structured inpatient treatment.
    Population generally Super-sensitive to small
    amounts of alcohol/other drugs with negative
    consequences. Clinicians should avoid direct
    confrontation as it may impact retention in
    programs.

49
Co-occurring Substance Use and Personality
Disorders
  • Treatment should be simultaneous for borderline
    personality disorder yet for anti-social
    personality disorder, the substance use issues
    should be addressed first.
  • At present, the best approach is said to be
    Dialectal Behaviour Therapy (DBT), which includes
    behavioural skills training.
  • Case conferencing is recommended, with client
    participation. Outpatient support is a necessity
    as this is a high-needs population that is
    difficult to reach and often exhibits the
    revolving door syndrome.
  • Best Practices, 2002

50
Co-Occurring Substance Use and Eating Disorders
  • Simultaneous treatment is recommended, unless
    there are compelling clinical reasons (eg. Life
    threatening) for focusing on one of the disorders
    first.
  • Combinations of medical management, behavioural
    strategies and psychotherapy, to effect change in
    the eating and substance use behaviour, must
    occur.
  • No treatment plan was documented.
  • Best Practices Concurrent Mental Health and
    Substance Use Disorders, 2002

51
Roadblocks.
  • Most people who enter recovery from addiction
    find that they have unresolved grief and loss
    issues.
  • It could be grief/loss about the life they might
    have lived if not for addiction, death of a
    family member/friend, loss of a meaningful
    relationship, etc.
  • Grief and loss is different from depression and
    typically does not require medication.
  • Dealing with grief/loss does take time and
    support.
  • Unresolved grief/loss is a major trigger for
    substance relapse.

52
Factors influencing wellness
  • The type and severity of the mental illness,
  • The type and severity of the substance use
    disorder,
  • The level of social anxiety,
  • The effects of disorders on current functioning,
  • The effects of disorders on family/significant
    relationships,
  • Demographic characteristics (age, gender,
    employment.),
  • Acceptance level motivation (readiness to
    change),
  • Personality/Cognitive factors (brain injury),
  • Supports professional personal,
  • Appropriate treatment regime.
  • Westermeyer, Weiss
  • Ziedonis, 2003

53
Strategies to help .
  • Family/friend involvement in treatment
    (individual may be more willing to comply may
    reduce enabling).
  • Acknowledge impact of co-occurring disorder on
    the person and others who care about them. Find a
    balance in life.
  • Provide education and resources to promote
    understanding realistic expectations of the
    individual.
  • Support for the individual and those affected by
    their behaviour.
  • Ongoing Communication.
  • Self-care.
  • Acknowledge success but plan for psychiatric
    emergency.
  • Daley Spears, 2003

54
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55
Local Resources
  • Kelowna Alcohol and Drug Clinic _at_250-870-5777
  • Kelowna Friendship Centre _at_250-763-4905 (AD
    counsellor outreach services)
  • Crossroads Detox/treatment _at_250-860-4001
  • Phoenix Detox (Kamloops) _at_1-877-318-1177
  • Alcoholics Anonymous (24 Hour) _at_250-763-5555
  • Narcotics Anonymous (24 Hour) _at_250-861-0354
  • Kelowna General Hospital Emergency _at_250-862-4495
  • Kelowna General Hospital Psychiatry
    _at_250-862-4478/4479
  • Kelowna Drop-In Centre _at_250-763-3311
  • Kelowna Outreach Health Services _at_250-868-2230
  • Kelowna Adult Mental Health Centre _at_250-868-7788
  • Canadian Mental Health Association (outreach)
    _at_250-861-3644
  • BC Schizophrenia Society Kelowna Branch
    _at_250-868-3119
  • New Opportunities for Women Canada (NOW Canada)
    _at_250-763-3876
  • Ministry of Housing Social Development
    welfare _at_250-861-7373
  • Womens Shelter/Alexandra Gardner _at_250-763-2262
  • Gospel Mission _at_250-763-3737 mens shelter
  • Freedoms Door _at_250-717-0472 mens recovery home
  • Men of Destiny _at_250-763-3737 mens recovery
    home

56
Internet resources
  • www.camh.net (Centre for Addiction Mental
    Health) Family Guide to Concurrent Disorders
    and other resources.
  • www.cmha.bc.ca (Primer 42 fact sheets, other
    relevant information).
  • www.heretohelp.bc.ca (individual family
    support).
  • http//carbc.ca (Centre for Addiction Research of
    BC (Alcohol Reality Check)
  • www.amhb.ab.ca (Alberta Health Services on
    line information sessions)
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