Strategies for Effective Case-Planning in Clients with Co-Occurring Mental Illness and Substance Use Disorders - PowerPoint PPT Presentation

Loading...

PPT – Strategies for Effective Case-Planning in Clients with Co-Occurring Mental Illness and Substance Use Disorders PowerPoint presentation | free to download - id: 629a84-ZTVhZ



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Strategies for Effective Case-Planning in Clients with Co-Occurring Mental Illness and Substance Use Disorders

Description:

Strategies for Effective Case-Planning in Clients with Co-Occurring Mental Illness and Substance Use Disorders Ohio Justice Alliance for Community Corrections Conference – PowerPoint PPT presentation

Number of Views:257
Avg rating:3.0/5.0
Slides: 66
Provided by: cdel59
Learn more at: http://ojacc.org
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Strategies for Effective Case-Planning in Clients with Co-Occurring Mental Illness and Substance Use Disorders


1
Strategies for Effective Case-Planning in
Clients with Co-Occurring Mental Illness and
Substance Use Disorders
Ohio Justice Alliance for Community Corrections
Conference October 10, 2013
  • Christina M. Delos Reyes, MD
  • Chief Clinical Officer
  • ADAMHS Board of Cuyahoga County

2
(No Transcript)
3
(No Transcript)
4
(No Transcript)
5
www.centerforebp.case.edu
6
Learning Objectives
  • Overview of mental illnesses and addiction
  • Strategic approach to clients with co-occurring
    mental illness and substance use disorders
  • Principles of differential diagnosis to
    understand client non-adherence and resistance to
    change
  • How to write an effective case-plan, which takes
    into account individual client needs and goals

7
The Human Brain
  • Most complex organ in the body
  • Different brain areas control different things
  • Brain stem? critical life functions such as heart
    rate, breathing, sleeping, etc.
  • Limbic system? reward circuit (ability to feel
    pleasure), perception of emotions, motivation,
    etc.
  • Cerebral cortex? sensory processing, thinking,
    planning, solving problems, making decisions, etc

8
(No Transcript)
9
What Is Mental Illness?
  • Mental illness or a mental disorder is a
    diagnosable condition that
  • Affects a persons thinking, emotional state, and
    behavior
  • Disrupts the persons ability to
  • Work
  • Carry out daily activities
  • Engage in satisfying relationships

10
Prevalence of Mental Illness
  • U.S. Adults with a Mental Disorder in Any One
    Year
  • Type of Mental Disorder Adults
  • Anxiety disorder 18.1
  • Major depressive disorder 6.7
  • Substance use disorder 3.8
  • Bipolar disorder 2.6
  • Eating disorders 2.1
  • Schizophrenia 1.1
  • Any mental disorder 26.2

11
Mood Disorders
  • Types of Mood Disorders
  • Major depressive disorder
  • Bipolar I disorder
  • Bipolar II disorder
  • Dysthymia
  • Postpartum depression
  • Seasonal depression

12
Depression vs. Major Depressive Disorder
  • What Is Depression?
  • Everyday blues, sadness or a short-term depressed
    mood is common
  • Many individuals may cope with these feelings
    without significant impact on their everyday
    life.
  • Episodes of Major Depressive Disorder
  • last for at least 2 weeks
  • affect a persons emotions, thinking, behavior,
    and physical well-being
  • Ability to work and have satisfying relationships

13
Signs and Symptoms of Depression Emotions
  • Sadness
  • Anxiety
  • Guilt
  • Anger
  • Mood swings
  • Lack of emotional responsiveness
  • Feelings of helplessness/hopelessness
  • Irritability

14
Signs and Symptoms of DepressionThoughts
  • Frequent self-criticism
  • Self-blame
  • Pessimism
  • Impaired memory and concentration
  • Indecisiveness and confusion
  • Tendency to believe others see you in a negative
    light
  • Thoughts of death and suicide

15
Signs and Symptoms of Depression Behaviors
  • Crying spells
  • Withdrawal from others
  • Neglect of responsibilities
  • Loss of interest in personal appearance
  • Loss of motivation
  • Slow movement
  • Use of drugs and alcohol

16
Signs and Symptoms of Depression Physical
  • Fatigue/lack of energy
  • Sleeping too much or too little
  • Overeating or loss of appetite
  • Weight loss or gain
  • Constipation
  • Headaches
  • Irregular menstrual cycle
  • Loss of sexual desire
  • Unexplained aches and pains

17
Some Risk Factors for Depression
  • Distressing and uncontrollable event
  • Exposure to stressful life events
  • Difficult childhood
  • Ongoing stress and anxiety
  • Another mental illness
  • Previous episode of depression
  • Family history
  • More sensitive emotional nature
  • Illness that is life threatening, chronic, or
    associated with pain
  • Medical conditions
  • Side effects of medication
  • Recent childbirth
  • Premenstrual changes in hormone levels
  • Lack of exposure to bright light in winter
  • Chemical (neurotransmitter) imbalance
  • Substance misuse

18
Bipolar Disorder Symptoms of Mania
  • Increased energy and over activity
  • Need less sleep than usual
  • Elated mood or severe irritability
  • Rapid thinking and speech
  • Lack of inhibitions
  • Grandiose delusions
  • Lack of insight

19
What is Psychosis?
  • Condition in which a person has lost some contact
    with reality
  • A person may have severe disturbances in
    thinking, emotion, and behavior
  • Usually occurs in episodes not a constant or
    static condition
  • Psychotic disorders are not as common as
    depression and anxiety disorders

20
Psychotic Disorders
  • Types of Disorders in Which Psychosis Occurs
  • Schizophrenia
  • Schizoaffective disorder
  • Bipolar disorder
  • Psychotic depression
  • Drug-induced psychosis

21
Risk Factors for Psychotic Disorders
  • Genetic factors
  • Biochemistry
  • Stress
  • Alcohol and Drug Use
  • Other factors

22
Characteristics of Schizophrenia
  • Delusions
  • Hallucinations
  • Thinking difficulties
  • Loss of drive
  • Blunted emotions
  • Social withdrawal

23
Anxiety Disorders
  • Anxiety disorders differ from normal stress and
    anxiety
  • An anxiety disorder is more severe, lasts longer
    and interferes with work, regular activities and
    relationships
  • Anxiety can range in severity from mild
    uneasiness to a panic attack or a flashback
  • Often co-occurs with mood disorders and substance
    use

24
Types of Anxiety Disorders
  • Generalized Anxiety Disorder
  • Persistent, overwhelming and unfounded
    anxiety/worry accompanied by multiple physical
    and psychological symptoms
  • Panic Disorder
  • Recurring panic attacks persistent worry about
    possibility of a future attack
  • Phobic Disorders
  • Avoids or restricts activities due to fear of
    specific objects/situations
  • Post-Traumatic Stress Disorder Acute Stress
    Disorder
  • Anxiety after experiencing a distressing or
    catastrophic event
  • Obsessive-Compulsive Disorder
  • Obsessive thoughts behaviors accompanying
    anxiety

25
Prevalence of Anxiety Disorders
  • U.S. Adults with an Anxiety Disorder in Any One
    Year
  • Type of Anxiety Disorder Adults
  • Specific phobia 8.7
  • Social phobia 6.8
  • Posttraumatic stress disorder 3.5
  • Generalized anxiety disorder 3.1
  • Panic disorder 2.7
  • Obsessivecompulsive disorder 1.0
  • Agoraphobia (without panic) 0.8
  • Any anxiety disorder 18.1

26
Signs and Symptoms of Anxiety Physical
  • Cardiovascularpounding heart, chest pain, rapid
    heartbeat, blushing
  • Respiratory fast breathing, shortness of breath
  • Neurological dizziness, headache, sweating,
    tingling, numbness
  • Gastrointestinal choking, dry mouth, stomach
    pains, nausea, vomiting, diarrhea
  • Musculoskeletal muscle aches and pains
    (especially neck, shoulders and back),
    restlessness, tremors and shaking, inability to
    relax

27
Signs and Symptoms of AnxietyPsychological and
Behavioral
  • Psychological
  • Unrealistic or excessive fear and worry (about
    past and future events), mind racing or going
    blank, decreased concentration and memory,
    indecisiveness, irritability, impatience, anger,
    confusion, restlessness or feeling on edge or
    nervous, fatigue, sleep disturbance, vivid dreams
  • Behavioral
  • Avoidance of situations, obsessive or compulsive
    behavior, distress in social situations, phobic
    behavior

28
Symptoms of a Panic Attack
  • Palpitations, pounding heart, or rapid heart rate
  • Chest pain or discomfort
  • Sweating
  • Chills or hot flashes
  • Trembling and shaking
  • Numbness or tingling
  • Shortness of breath, sensations of choking or
    smothering
  • Dizziness, light-headedness, feeling faint,
    unsteady
  • Abdominal distress or nausea
  • Feelings of unreality
  • Feelings of being detached from oneself
  • Fear of losing control or going crazy
  • Fear of dying

29
Risk Factors for Anxiety Disorders
  • People who are more likely to react with anxiety
    when they feel threatened are those who
  • Have a more sensitive emotional nature
  • Have a history of anxiety in childhood or
    adolescence
  • Are female
  • Abuse alcohol
  • Experience a traumatic event
  • Medical conditions or side effects of some
    prescription medications
  • Intoxication or withdrawal from alcohol, cocaine,
    sedatives, and anti-anxiety medications

30
Substance Use Disorders
  • The use of alcohol or drugs does not necessarily
    mean a person has a substance use disorder
  • Substances affect a persons brain in different
    ways, and people may use alcohol or drugs because
    of these effects.
  • Substance use disorders may be characterized as
    mild, moderate, or severe
  • Mild corresponds to the old concept of
    Substance ABUSE
  • Moderate/severe corresponds to the old concept
    of Substance DEPENDENCE

31
Substance Use Disorders
  • Deciding to start drugs and experimentation with
    drugs are preventable behaviors
  • Drug Addiction is a treatable brain disease

32
(No Transcript)
33
Explanatory Models of Addiction
  • Moral ? wrong
  • Spiritual ? empty
  • Psychological ? impulse control
  • Behavioral ? habit
  • Medical ? disease

34
Medical model of addiction
  • Sick person seeking wellness
  • SUDs as chronic diseases
  • Biological basis
  • Identifiable signs and symptoms
  • Predictable course and outcome
  • Treatment improves outcomes
  • Lack of treatment may lead to morbidity and
    mortality

35
Medical model of addiction
  • A chronic relapsing disease of the brain
  • Drugs change brain structure and function
  • Brain changes can be long lasting and lead to
    harmful behaviors
  • Characterized by compulsive drug seeking and use
    despite harmful consequences

36
Facts About Substance Use Disorders
  • Lifetime Prevalence is 13-14 (1 in 8)
  • U.S. adults who have a SUD in their lifetime
  • Annual Prevalence is 3.8
  • U.S. adults who have a SUD in any given year
  • Alcohol use disorders are three times as common
    as drug use disorders
  • 75 of people who develop substance use disorders
    do so by age 27
  • Substance use disorders can co-occur with almost
    any mental illness

37
Signs and Symptoms of Substance Use Disorders
  • Increased use over time
  • Increased tolerance for the substance
  • Difficulty controlling use
  • Symptoms of withdrawal
  • Preoccupation with the substance
  • Giving up important activities (work, social,
    family, etc.)
  • Continued use even after recognizing problems
    with substance use

38
Commonly Used Substances
  • Alcohol
  • Tobacco
  • Marijuana
  • Heroin (and other opioids)
  • Sedatives and tranquilizers
  • Cocaine
  • Amphetamines and Methamphetamines
  • Ecstasy and other hallucinogens
  • Inhalants

39
Drug Use Disorders in the United States,
2001-2003
National Epidemiologic Survey on Alcohol and
Related Conditions, 2004
40
Risk Factors for Substance Use Disorders
  • Availability and tolerance of the substance in
    society
  • Learning
  • Social factors
  • Genetic predisposition
  • Sensitivity to the substance
  • Other mental health problems

41
Does relapse treatment failure?
  • NO! Relapse is likely, and is a part of the
    chronic nature of the disease
  • Relapse rates for drug addiction are similar to
    relapse rates in other chronic diseases
  • 40-60 relapse rate for addiction in 1 yr period
  • Relapse often indicates that treatment needs to
    be reinstated, adjusted, or changed to an
    alternate form

42
Comparison of Addiction to Other Chronic Diseases
Med compliance Required hospital stay annually Follow diet behavior change
DM I lt60 40 lt30
HTN lt40 60 lt30
Asthma lt40 60 lt30
43
Addiction and Mental Illness
  • Co-exist commonly
  • Mental illness may precede addiction
  • Drug use and abuse may trigger or worsen mental
    illness in vulnerable individuals

44
Prevalence of substance use disorders in mental
illness
Regier et al., JAMA, 1990
45
A complex relationship
  • Substance use and mental illness may co-occur by
    coincidence
  • Substance use may cause or increase severity of
    mental illness
  • Mental illness may cause or increase severity of
    substance use
  • Both conditions may be caused by a third
    condition
  • Substance use and withdrawal may mimic symptoms
    of mental illness

46
Strategic Approach to Dual Disorders Decreasing
resistance Increasing Engagement
47
Common Traps How to Avoid Them
  1. Question Answer
  2. Expert
  3. Information Overload
  4. Labeling
  5. Blaming/shaming
  6. Demanding change
  1. Ask and Listen
  2. Shared Responsibility
  3. Check Understanding
  4. Person-Centered
  5. Acceptance of Person
  6. Change is the Persons Decision

48
Question Answer
  • Asking a series of close-ended questions can lead
    to
  • Restricted information
  • Frustration
  • Defensiveness
  • Passivity

49
Solution Ask and Listen
  • Use open-ended questions
  • Some closed questions, as needed
  • Yields more information
  • Communicates understanding
  • Doesnt necessarily take more time
  • People feel heard and engaged in their care

50
Expert
  • Provider telling person what to do can lead to
  • Passivity
  • Half-hearted commitments
  • Verbalized compliance

51
Solution Shared Responsibility
  • Ask permission to share information
  • Avoid jargon
  • Acknowledge persons expertise
  • Information sharing - a two way street
  • Offer options/choices

52
Information Overload
  • Providing too much information at one time can
    lead the person to
  • Feel overwhelmed
  • Be unable to act
  • Stop listening
  • Not absorb Information

53
Solution Check Understanding
  • Share small amounts of information
  • Stop and check understanding before offering
    further information

54
Labeling
  • Referring to person as their condition or in
    negative terms can lead to
  • Barriers in relationship
  • Resistance (people dont like labels)
  • Dissatisfaction with provider

55
Solution Person-Centered
  • Be person-centered
  • Seek to understand the persons experience
  • Treat person with respect
  • Address person according to their preference
  • View person as capable

56
Blaming/Shaming
  • Criticizing person for behavior that may be
    worsening their health condition can lead to
  • Defensiveness
  • Not feeling empowered
  • Decreased motivation to change
  • Increase in unhealthy behavior

57
Solution Acceptance of Person
  • Acceptance of the person
  • Learn what matters to the person
  • Acknowledge behavior change is hard
  • Repeated attempts at change are normal
  • Affirm small change efforts

58
Demanding Change
  • Attempting to force behavior change can lead to
  • Resistance
  • Creates a power struggle nobody wins!

59
Solution Change is the Persons Decision
  • Its the Persons Decision
  • Choice and control belongs to the person
  • View person as capable
  • Express optimism about ability to change
  • Create opportunities for person to voice need for
    change
  • Be a resource

60
Differential Diagnosis of Difficult Behavior
  • Mental illness symptoms
  • Addiction symptoms
  • intoxication, withdrawal, codependency
  • Antisocial traits
  • Medication side effects
  • Other undiagnosed/untreated medical illness
  • Reaction to remote or recent trauma
  • Other reasons?
  • or a combination

61
Case-Planning Areas of Emphasis
  • SUBSTANCE ABUSE
  • MENTAL HEALTH
  • PHYSICAL HEALTH
  • HOUSING
  • CRIMINAL THOUGHTS
  • CRIMINAL PEERS / FRIENDS
  • FAMILY / SOCIAL SUPPORT
  • EDU / EMPL / FINANCIAL
  • LEISURE / RECREATION

62
Case-planning Examples
63
Summary
  • Overview of mental illnesses and substance use
    disorders
  • Six strategies for increasing engagement and six
    traps to avoid
  • Differential diagnosis of difficult behavior
  • Effective case planning for co-occurring disorders

64
Resources
  • National Institute on Mental Health website
    http//www.nimh.nih.gov
  • National Institute on Drug Abuse website
    http//www.nida.nih.gov
  • National Alliance on Mental Illness website
    http//www.nami.org
  • Mental Health First Aid website
    http//www.thenationalcouncil.org/cs/about_the_pro
    gram

64
65
Contact Information
  • Christina M. Delos Reyes, MD
  • Chief Clinical Officer
  • Alcohol, Drug Addiction, and Mental Health
    Services
  • ADAMHS Board of Cuyahoga County
  • 2012 West 25th Street, Cleveland, Ohio 44113
  • Phone 216-241-3400 Fax 216-241-0805
  • delosreyes_at_adamhscc.org
  • Medical Consultant
  • Center for Evidence Based Practices at Case
  • http//www.centerforebp.case.edu
About PowerShow.com