Co-occurring Alcohol and Other Drug and Mental Health Conditions in Alcohol and other Drug Treatment Settings - PowerPoint PPT Presentation


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Co-occurring Alcohol and Other Drug and Mental Health Conditions in Alcohol and other Drug Treatment Settings


Co-occurring Alcohol and Other Drug and Mental Health Conditions in Alcohol and other Drug Treatment Settings Session 2: Classification of Mental Disorders – PowerPoint PPT presentation

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Title: Co-occurring Alcohol and Other Drug and Mental Health Conditions in Alcohol and other Drug Treatment Settings

Co-occurring Alcohol and Other Drug and Mental
Health Conditions in Alcohol and other Drug
Treatment Settings
  • Session 2
  • Classification of Mental Disorders

Comorbidity Guidelines
  • Refer to
  • Chapter 5

Classification - Key Points
  • Disorders represent particular combinations of
    signs and symptoms grouped together to form
    criteria as per DSM-IV-TR
  • Certain number of criteria need to be met within
    a certain time frame for a person to be diagnosed
    as having a disorder
  • Not all AOD workers are able to formally diagnose
    the presence or absence of mental health disorders

Classification Key Points (2)
  • Diagnoses of mental health disorders should only
    be made by suitably qualified and trained health
  • Useful for all AOD workers to be aware of
    characteristics of disorders so are able to
    describe and elicit mental health symptoms when
    undertaking screening and assessment, and to
    inform treatment planning

Symptoms without Diagnosis
  • Classified as mental health disorder must meet
    diagnostic criteria
  • However, large number in AOD services who display
    symptoms but do not meet criteria
  • (Eg anxiety but without an anxiety disorder)
  • Can still impact significantly on functioning and
    treatment outcomes

Categories of MH Disorders in Comorbidity
  • Mood disorders
  • Anxiety disorders
  • Personality disorders
  • Psychotic disorders
  • Substance-induced disorders

Mood Disorders
  • Major depressive episodes
  • Manic episodes
  • Mixed episodes
  • Hypomanic episodes.

Major depressive episode
Manic episode
Hypomanic episode
Normal mood
Depressed mood
Elevated mood
Major Depressive Episode
  • Some of following symptoms experienced nearly
    every day for at least 2 weeks
  • Depressed mood or loss of interest or enjoyment
    in activities
  • Reduced interest or pleasure in almost all
  • Change in weight or appetite
  • Difficulty concentrating or sleeping (i.e.,
    sleeping too much or too little)

Major Depressive Episode (2)
  • Restlessness and agitation
  • Slowing down of activity
  • Fatigue or reduced energy levels
  • Feelings of worthlessness or excessive/inappropria
    te guilt
  • Recurrent thoughts of death, suicidal thoughts,
    attempts or plans

Manic Episode
  • Person experiences abnormally elevated,
    expansive, or irritable mood for at least 1 week
    characterised by
  • Inflated self-esteem
  • Decreased need for sleep
  • Increased talkativeness or racing thoughts
  • Distractibility
  • Agitation or increase in goal directed activity
    (e.g., at work or socially)
  • Excessive involvement in pleasurable activities
    that have a high potential for negative

Hypomanic and Mixed Episodes
  • Hypomanic same as manic episode but is less
  • May only last 4 days and does not require the
    episode to be severe enough to cause impairment
    in social or occupational functioning
  • In mixed episode, person experiences both a manic
    episode and major depressive episode for at least
    1 week

Anxiety Disorders
  • Many people feel anxious because they have reason
    to eg trouble with law, homelessness
  • Many in AOD treatment will experience anxiety as
    consequence of intoxication, withdrawal, or
    living without using AOD
  • Usually reduces over time with period of
  • Problematic when persistent, or so frequent and
    intense that prevents person from living his/her
    life in the way that he/she would like

Panic Attack
  • Sweating
  • Shaking
  • Shortness of breath
  • Feeling of choking
  • Light headedness
  • Heart palpitations, chest pain or tightness
  • Numbness or tingling sensations
  • Chills or hot flushes
  • Nausea and/or vomiting
  • Fear of losing control, going crazy or dying
  • Feelings of unreality or being detached from

Types of Anxiety Disorders
  • Generalised anxiety disorder (GAD)
  • Obsessive compulsive disorder (OCD)
  • Panic disorder
  • Agoraphobia
  • Social phobia
  • Specific phobia
  • Post traumatic stress disorder (PTSD)
  • Acute stress disorder.

  • Can develop after traumatic event
  • May experience some of following
  • Intrusions re-experiencing event as nightmares,
    or flashbacks
  • Avoidance avoiding thoughts, feelings, people,
    places or activities that remind him/her of the
  • Hyperarousal increased startle response,
    irritability or anger, difficulty sleeping and

Personality Disorders
  • Enduring destructive patterns of thinking,
    feeling, behaving, and relating to other people
    across wide range of social and personal
  • Maladaptive traits are stable and long lasting
  • Tend to develop in adolescence or early adulthood
    and are generally lifelong
  • Most common in AOD context ASPD and BPD

AOD and Personality Disorders
  • AOD use disorders may cause fluctuating symptoms
    that mimic symptoms of personality disorders
  • Eg impulsivity, aggressiveness,
    self-destructiveness, relationship problems, work
    dysfunction, engaging in illegal activity,
    dysregulated emotions and behaviour
  • Can be difficult to determine whether a person
    has a personality disorder

Antisocial Personality Disorder
  • Failure to conform to social norms with respect
    to lawful behaviour
  • Disregard for the wishes, rights and feelings of
  • Deceptive and manipulative in order to gain
    personal profit or pleasure may repeatedly lie
    or con others
  • Reckless disregard for own or others safety

Antisocial Personality Disorder (2)
  • Impulsive behaviour decisions made on spur of
    the moment, without forethought, and without
    consideration of the consequences for self or
  • May lead to sudden change of jobs, residences or
  • Irritability and aggression repeated involvement
    in physical fights or assaults
  • Consistent and extreme irresponsibility

Borderline Personality Disorder
  • Persistent patterns of instability in
    relationships, mood, and self-image
  • Marked impulsivity, particularly in relation to
    behaviours that are self-damaging
  • Extreme efforts to avoid rejection or abandonment
  • Pattern of unstable and intense relationships
  • Unstable self-image or sense of self

Borderline Personality Disorder (2)
  • Impulsivity
  • Recurrent suicidal behaviour, threats or
    self-mutilating behaviour
  • Unstable mood
  • Chronic feelings of emptiness
  • Inappropriate, intense anger
  • Stress-related paranoid thoughts or severe
    dissociative symptoms

Psychotic Disorders
  • Loss of touch with reality
  • Feelings, thoughts and perceptions severely
  • Delusions and Hallucinations
  • May be due to intoxication or withdrawal from
  • If the person experiences psychotic episodes when
    not intoxicated or withdrawing, possible they may
    have one of the disorders described

  • Fixed, false beliefs not consistent with cultural
  • Involve a misinterpretation of perceptions or
  • Eg feel that someone is out to get them, they
    have special powers, or passages from newspaper
    have special meaning for them

  • Disturbance of sensory perceptions
  • Auditory (hearing voices or sounds)
  • Visual (seeing things not present)
  • Olfactory (smelling things not present)
  • Tactile (feeling or sensing something)
  • Gustatory (taste)

Other Symptoms of Psychosis
  • Disorganised speech
  • Grossly disorganised behaviour
  • Catatonic behaviour (eg decreased reactivity)
  • Affect flattening (reduced range of emotional
  • Alogia (restricted thought and speech)
  • Avolition (reduced involvement with activities)

  • Most common and disabling of psychotic disorders
  • Affects ability to think, feel and act
  • To be diagnosed symptoms must have been
    continuing for a period of at least 6 months
  • Symptoms are grouped within 2 types
  • Positive symptoms
  • Negative symptoms

Positive Symptoms of Schizophrenia
  • (Not as in pleasurable!)
  • Presence of excess or distortion of normal
    functioning and include hallucinations,
    delusions, disorganised speech, grossly
    disorganised behaviour and catatonia

Negative Symptoms of Schizophrenia
  • Absence of normal functioning including affective
    flattening, avolition, alogia
  • Can cause significant impairment in a persons
  • Classification of types of schizophrenia
    depending upon the predominance of symptoms
    displayed (paranoid, disorganised, catatonic,
    undifferentiated, residual type)

Other Psychotic Disorders
  • Schizophreniform disorder equivalent to
    schizophrenia except its duration limited to less
    than 6 months
  • Schizoaffective disorder symptoms of
    schizophrenia alongside major depressive, manic
    or mixed episode
  • 2 types i) bipolar type (if manic or mixed) ii)
    depressive type (if major depressive)

Substance-Induced Disorders
  • Occur as direct consequence of AOD intoxication
    or withdrawal
  • Diagnosis requires symptoms only present
    following intoxication or withdrawal
  • If symptoms in absence of intoxication or
    withdrawal, possible they have independent mental
    health disorder
  • Symptoms tend to reduce over time with period of

Examples of Substance Induced Disorders
  • Alcohol use/withdrawal - symptoms of depression
    or anxiety
  • Manic symptoms induced by intoxication with
    stimulants, steroids, hallucinogens
  • Psychotic symptoms induced by withdrawal from
    alcohol, intoxication with amphetamines, cocaine,
    cannabis, LSD or PCP
  • Other disorders - substance-induced delirium,
    amnestic disorder, dementia, sexual dysfunction,
    sleep disorder

Substance-Induced Psychosis
  • Difficult to distinguish substance-induced
    psychosis from other psychotic disorders
  • Substance-induced psychosis - symptoms appear
    quickly and last relatively short time, from
    hours to days until the effects of drug wear off
  • Psychosis can persist for days, weeks, months or
  • Possible individuals already at risk for
    developing psychotic disorder triggered by
    substance use

Substance-Induced Psychosis (2)
  • Visual hallucinations more common in substance
    withdrawal and intoxication
  • Stimulant intoxication more commonly associated
    with tactile hallucinations, person experiences
    physical sensation interpret as having bugs under
    skin ("ice bugs" or "cocaine bugs)
  • Tactile hallucinations can occur in alcohol
    withdrawal auditory and visual hallucinations
    are more common

Substance-Induced Psychosis (3)
  • Stimulant psychosis sometimes more agitated,
    energetic, more difficult to calm with sedating
    or psychiatric medication compared to non-drug
    induced psychosis
  • Difference with schizophrenia - lack of negative
    and cognitive symptoms with return to normal
    inter-episode functioning during periods of

  • Disturbance of consciousness and cognition that
    represents significant change from previous level
    of functioning
  • Reduced awareness of surroundings, difficulty
    concentrating, may be difficult to engage him/her
    in conversation
  • Changes in cognition include short-term memory
    impairment, disorientation (in regards to time or
    place), language disturbance (eg difficulty
    finding words, naming objects, writing)

In sum
  • Not all clients with symptoms of mental illness
    will meet diagnostic criteria
  • Diagnostic labels can be very useful but should
    not be limiting!
  • Diagnosis needs to be undertaken by trained
    professionals however important to be aware of
    symptoms and to be able to communicate with other
    professionals, clients and families/carers