this episode was pre-recorded
as part of a live continuing education webinar on-demand CEUs are
still available for this presentation through all CEUs registered at all
CEUs comm slash counselor toolbox I’d like to welcome everybody to today’s
presentation on common co-occurring issues exploring the interaction between mental health
physical health and addiction so we’re kind of putting together the stuff that we’ve been
talking about for a couple of sessions now we’re going to start by talking about some
questions and then reviewing what a healthy person needs and then going through and talking
about how different addictions may cause or be caused by mood disorders and physical health
issues and we’re going to talk about things that you may see in private practice or the
a facility that you’re working in just real quickly for those of you who are here how many people if
you would just type in the chat window if you’re a mental health counselor type mhm if you are a
addictions counselor type SI or whatever so just kind of so and know who I’m talking to you okay
so mostly mental health ok cool so what we’re going to look at is what you may
see in private practice or a mental health setting because these clients a lot of clients
that have substance abuse or addiction issues and I use the term addiction because we’re
talking about behavioral addictions too many times they don’t meet the criteria for admission
for substance abuse because they don’t meet that threshold of a substance use disorder tolerance
withdrawal yay yay so substance abuse agencies can’t get funding to provide the treatment so
they end up in a mental health facility or a mental health counselor’s office and they may
be dealing with some of these addiction issues and wanting to address them or they may not be
but those issues are out there and exist so we want to know how they interact so told you
we’re gonna have a couple of questions to think about and I’m just asking you to ponder these for
right now and you can add throughout the class if you want but we’re gonna talk about it more at
the end how can we and why is it important to address chronic illness and disabilities
that result from or that cause mood disorders or addictions so thinking about you know like
HIV or hepatitis are two of the big one’s cirrhosis of the liver chronic obstructive
pulmonary disease from smoking so these are things that can result from addiction why or how
is it important for us as clinicians mental health clinicians mainly to think about addressing these
how can we address depression and/or anxiety kind of our mood disorder genre and hopelessness that
results from or causes depression and anxiety so we know that thinking back affects acceptance
and commitment therapy there’s clean discomfort which is what he calls your initial emotion
when you feel something if you feel depressed if you feel anxious that’s how you feel and
it’s uncomfortable but it’s clean it is it is what it is and then he calls dirty discomfort
the feelings that we have about those feelings so we can get angry that we are depressed we can
get depressed that we’re still depressed and he calls that dirty discomfort because we’re kind of
layering on and piling in think about just kind of throwing somebody into a hole and piling more
dirt on top of them so we want to think about how can we address these issues that result from
depression or anxiety or sleeping eating or energy changes so if you’ve got somebody who is dealing
with a chronic illness or something else has happened or they’re they’ve got some sort of
an addiction and they are not eating well not sleeping well it could trigger depression or
anxiety so we’re going to talk about that how can we address sleeping eating and energy changes
seems like we’re getting repetitive we’re looking at how each one interface and how can we address
these things that are caused by or cause mood disorders or addictions because we know when we
look at the diagnostic criteria for depression for example sleeping eating and energy changes
primary in there and how can we address guilt and regret which may accompany addiction recovery
or the diagnosis of the disease as the result of addiction such as lung cancer or HIV or cirrhosis
of the liver and people who have liver disorders cirrhosis of the liver and hepatitis are at a
greater risk of liver cancer so that can they can have some additional anxiety that is related
to that so they may look back and go I wish I hadn’t well you have so how can we help you deal
with that and come to some level of acceptance so my little editorialized soapbox when we’re talking
about addictions I mean sometimes we don’t want to think that they exist we want to pretend that our
clients are coming in their mental health clients otherwise their perfectly healthy things are
going great well that may not be the trick the case a lot of people begin to use and I mean
think about ourselves when we’re when we were in high school and college or you know even later
some people use it for recreation you know they want to go out have a few beers do whatever cool you
know that’s fine some people drink or use it for relaxation my son has a love of we will use that
word videogames and he will get on his videogames and we’ll kind of get lost in it it helps him
escape from you know life as we know it for a little bit of time some people use
because of peer pressure you know it’s everybody’s doing it or you know you’re at a football party
or something and everybody’s having a beer and somebody offers you one and you don’t want to be
rude things like that can happen and some people begin to use straight up for self-medication
they’re like I feel crappy I need something to help me feel better or numb the pain so there’s
a lot of reasons people begin to use so then you might say well why don’t they just say no because
it’s easy to say no well it’s not some people start to use it because they’re bored and
they want something to bring some excitement some euphoria to their life and we’re talking about
everything from sex addiction to internet addiction to cocaine use I mean we’re running the gamut here
they may lack the awareness of the dangers or how quickly you can become addicted I know when I was
working in the facility in Florida there was the sort of knowledge if you will and knowledge is not
the right word rule I guess that with crack cocaine for some people, it was a one-hit wonder
you did it once and you were hooked and several drugs can be highly addicting
quickly especially if they’re taken either through injection or inhalation but we’ve talked
before about the fact that our bodies can start developing tolerance to opiates within 3 to 5
days so you know people may not a lot of people don’t realize when they go in and their doctor
writes him a script for two weeks of opiates and they take it as prescribed that they’re actually
becoming somewhat addicted to those opiates if they take the whole prescription so they may not
understand that some people don’t say no because they have low self-esteem so they’re looking for
comfort to help them relax to help them loosen up so they can be more fun at the party and or
to peer pressure somebody tells them why don’t use or why don’t come out and go drinking
with us or whatever the case may be so to fit in they may try to use it to fit in to feel
part of a crowd and part of it can also be you know with that peer pressure just generally the
culture promoting this kind of behavior going it’s ok I think I’ve shared with you before at
At the beginning of some of the original Beverly Hillbillies episodes they still advertised Winston
cigarettes, like they are the greatest thing and cool people, have them and that’s the thing to
do so if that message gets out people may start believing it and not do their research so to
speak on what the true problems or risks may be and then again self-medication some people may
be struggling just to get by from day to day and this helps them survive the best they can with the
tools they have until we give them some new tools so just saying you know I had I grown up
during the era of Nancy Reagan and you know God loves her she was trying to help and for a certain
small percentage she probably did but for a larger percentage just saying no is not that easy we need
to give people the tools so they can say no so they don’t so they aren’t relying on these drugs
for some reason because when people start using it for recreation and relaxation some people may not
have a big big issue with it other people may start throwing their neurotransmitters kind of out
of whack depending on how much how often they use what combinations if they’re on any medication so
people may inadvertently start messing with their neurotransmitters and creating and we’ll talk
about this creating depression or anxiety that they end up trying to self-medicate so that
that is my soapbox for it is not that easy to just say no we as a culture not just as clinicians
have some work to do so what do we need to do to help people be able to just say no
they need to have access to healthy nutrition and knowledge of what that means my son and it’s
still like drawing fingernails on a blackboard to me today this week, I told his sister that you
no, he didn’t understand why she was so concerned with the nutrition he’s a guy he doesn’t need to pay
attention to nutrition it’s just whatever and I was just like oh my gosh you know everything I’ve
said has fallen on deaf ears but okay we’ll back up and figure out a way they need access to
it and then they also need to eat it you know if we have healthy foods available but people are
still eating peanut butter and jelly sandwiches for every single meal it’s not going to help so we
need to make sure people understand what a healthy diet looks like and how to do it in a way that’s not
painful you know we’re not asking you to just eat rabbit food as my daddy used to say but so what
does it look like to eat a diet or nutrition that makes you feel good that’s happy that makes you
feel happily fulfilled you like it tastes good whatever you want to say but that’s also
healthy you know it’s not just pizza or just peanut butter we need to educate people and a
lot of adults that I work with have no clue about sleep hygiene you know they know they’re supposed
to try to go to sleep but they don’t know anything about turning off the blue turning on blue light
filters so the blue lights are not keeping them up so we need to do some education here ideally in
elementary schools but if we can get it out to the community so they can pass it on to their little
minions we’ll be on a good path to pain control we need people to start having pain control but
we need to also have them have alternatives to pain control besides opiates and there are a lot
of them out there again people don’t know about so we must educate and we’re not
prescribing pain control that’s not our job but if we have a client who’s in chronic pain we can
suggest that they work with their doctor that they look into options for pain control you can google
it and find a lot of different alternatives now if they don’t want to go to the doctor but you
know there are a lot of different things from acupressure it attends units to things that are
nonpharmacological that can help people manage their pain so they can sleep which will help
the rest and rebalance to deal with fatigue and be able to deal with life kind of on life’s terms
because they won’t be in this constant state of stress people need access to regular medical care
to prevent problems so you know we want to prevent this thing on your face from becoming skin cancer
we want to prevent anything else that that might trigger problems and early intervention so like
with Lyme disease, if people get early intervention mentioned they don’t end up with the chronic
problems with HIV the earlier the intervention the better same thing with hepatitis you know
the list goes on so we want to make sure that if people have some sort of issue that’s disrupting
their ability to get enough sleep process nutrition go to work do any of these things that
they have access to some method whatever method they need to address it so sometimes it’s medical
sometimes it’s mental health it’s social services they need safe housing so we’re on to
social services now and that includes a roof over their head that they’re not worried when
they go to sleep at night but also being safe from domestic violence and things like that safety
and this kind of goes with safe housing and I put internal and external because you know the first
part is external safety we want to be able to know that our patients can relax wherever they’re at
they have enough money to keep a roof over their head in a safe place and you know typically that’s
not something that we think about as mental health counselors we think about helping them deal with
their anxiety but if they can’t get enough sleep and they never feel safe when they’re at home
they’re not going to be able to rest and they’re at best their recovery is going to be impeded at
worst you know it’s going to contribute to the issue that they’re seeing us for so safe housing
is important we’re not going to get it for them but we can point them in the right direction your
local United Way which is 2-1-1 and most places generally has a listing of different resources
for accessing safe housing if you don’t work in a facility that’s used to dealing with that
and then internal safety that’s shutting up that internal critic that’s being able to go through
a day without being derogatory to yourself and that’s something that we definitely can
help with we can help people shut down that internal critic or that internal person that
is always calling gloom and doom and you know waiting for the other shoe to drop or whatever
the case maybe we can help clients change their cognitions so it’s safe inside their head
and then people need love and acceptance and this should sound pretty familiar are you
know Maslow’s hierarchy here kind of in Reverse but people need love and acceptance but in order
for love to have love and acceptance in many cases they also need to love and accept themselves so
we’re gonna work on self-esteem we’re gonna help people develop relationship skills hopefully there
are some people in their life that have provided some level of love and acceptance maybe not the
unconditional positive regard we’ve hoped for but they’re there so these are things that the healthy
happy person needs and these are things in large part we can do through education referral and direct
services help people get so why do we care about co-occurring issues as mental health counselors
well 35 percent of people with anxiety disorders have according to one of these studies abused
opiates so that’s a lot if you’ve got somebody with an anxiety disorder this isn’t just panic
this isn’t just something you know severe this is you know any of your anxiety disorders
one in three roughly have abused opiates they’ve used some sort of opiate drug to help them kind of
chill out of opiate or alcohol dependent patients 20% have major depressive disorder so of that
35% you know there’s going to be a percentage of them who may be opiate or alcohol dependent
and there are a lot of our clients that we see in mental health treatment who are not willing to be
truthful about how much they really drink or how often they drink because they might be
suspecting it’s a little bit of a problem but they’re not wanting to go there yet they’re in
what we call pre-contemplation okay so let’s just go with this in mind that there may be some
underlying other stuff that they haven’t told us about opiate or alcohol-dependent patients 20%
have major depressive disorder so you know we’re taking them and we may be seeing them in the clinic
for depression and we do want to be suspect of whether there’s either some opiate or alcohol
issues there depression and opioid-dependent patients including pain management patients so
those who are opiate-dependent by prescription have been associated with poorer physical health
decreased quality of life increased risk-taking behaviors and suicidality am I saying that pain
management clinics are bad no but what I’m saying is those who are in pain management clinics for a
variety of reasons are at a high in a higher risk category I mean think about it if your pain is
bad enough that you need to be going to a pain management clinic think about how much that must
hurt think about how much that must impair your daily life think about the impact of the drugs
that you’re taking on your mood your energy levels and the stigma in some cases associated with it
some people here suboxone and they’re like yeah whatever my neighbor takes that other person here
suboxone and they’re like ah you can’t be taking that so there is still a lot of social stigmas that
goes along with medication-assisted therapies so there are a lot of things that may contribute
to depression in opioid-dependent patients the prevalence and severity of depression tend to
decline within the first few weeks after treatment initiation so if they are trying to get off of
you know ideally their detox and they’re trying to you know remain sober the prevalence
and the severity of depression tends to decline so we need to get them off of it first and get them through
that acute withdrawal from a depressant including alcohol and I know this slide is boring
but we’re gonna be through in a second withdrawal from depressants including alcohol opioids and
even stimulants invariably include potent anxiety symptoms so it’s important to pay attention and
withdrawal from stimulants can also include potent depressive symptoms if they’ve been on a crack
binge for you know five days that won’t sleep for a while many people with substance use disorders
may exhibit symptoms of depression that fade over time and are related to acute with drawl well we
talk about acute withdrawal we’re talking about the first three months we’re not talking about
the detox period which is generally three days so encourage people who’ve gone through detox and
maybe they’re seeing you on an outpatient basis encourage people to you know be patient and work with
the treatment team if they need to but the first three months is always the hardest so chicken or
the egg you know did the person start using and become depressed or was the person depressed so they self
medicated does it matter depression and anxiety are associated with addiction because because
if you have stimulant withdrawal or recovery that period after you quit using that’s maybe
a week maybe two weeks where your body is going whew that was a run people may feel depressed
fatigued have difficulty concentrating which can impact how well they eat it’ll impact
their sleep they’re gonna sleep a lot more but the quality of sleep may be poor so they can mess
up their circadian rhythms and you know they may not have access to the social support that
they wanted they may but really with stimulant withdrawal we’re looking at nutrition
and sleep so we want to educate patients if they decide to stop taking stimulants what they need
to look at stimulant use can also be associated with depression and anxiety because many people
not you know the majority but a lot of people out there will self-medicate depression with
stimulants from anything from caffeine which you know maybe like mild dysthymia but if you
abuse enough caffeine you know it starts getting into your system you become dependent on it but if
you start combining caffeine and nicotine plus oh let’s add in some workout supplements or you know
the occasional Ritalin or something not suggesting it then it’s these things can wear the body down
which can lead to additional depression but people may use these things to try to feel better because
think depression is related for some people they may not feel like they can wake up they’re
fatigued they’re lethargic all the time and they’re feeling blue so if they take stimulants
they get that dopamine rush they’re starting to feel good and they’re awake stimulant
use can cause anxiety well the so if you’ve got somebody who already has maybe they are depressed
but they’ve also got some anxiety and they start using stimulants which may make the anxiety way worse
alcohol or opiate use some people use these things to numb or to forget and that’s just your
the standard used the depressant some people will use either one of these but especially opiates to
deal with physical pain to medicate depression or anxiety remember there are a lot of trials not
several trials right now that are looking at using opiates to treat intractable depression
but a lot of people also use opiates off-label illegally to address anxiety so if you’ve got a
client with depression or anxiety just kind of be alert for how they’re behaving if they’ve
got pinpoint pupils or if they’re itching and picking all the time I mean not the occasional
are winter and the heat just turned on I’ve got dry skin itch but constantly itching and picking
and you know where you’re like please just settle down detox from opiates can all often produce
depression produces a lot of flu-like symptoms which can make people feel crappy and the
flu-like symptoms I won’t get graphic impaired nutrient absorption impaired sleep you know
they’re sleeping a lot because they feel like crap but they’re also having to get up every
10 minutes to go to the bathroom sometimes so this first week or so during the initial if they
go cold turkey so to speak can be rough detox from alcohol as I’ve talked about before
can produce anxiety symptoms so understanding that when people are going through detox whether
they are alcohol dependent and have been drinking a whole lot which needs to be medically monitored
I can’t say this enough and I’ll say it a lot more tomorrow when we talk about where Nikki Korsakoff
syndrome but people who are detoxing from alcohol will have anxiety symptoms and a period of high
blood pressure and sometimes depression and anxiety are associated with addiction just because they
sober up one morning and they look at their life and they’re like what the hell have I done so
you know and you’re looking at them going yeah I don’t blame you for feeling that way now let’s
see what we can do to improve the next moment so make sure that we understand that these
things are going to go hand in hand and to be on the lookout because like I said a lot of people
aren’t forthcoming even about alcohol use which is legal but if they’re using something illegally
or using maybe their kid’s Ritalin or something they’re pretty much almost guaranteed not to tell
you so we want to be on the lookout for signs and symptoms bipolar disorder can be triggered by drug
use so we just know that we can the person could get worn down mess with the neurotransmitters
enough they’re not exactly sure how it happens but we have seen the initial acute episode of
bipolar disorder-triggered mania triggered by drug use it is more common for people with bipolar
to use stimulants when they’re depressed and just about anything when they’re manic now if you’re
working with somebody with bipolar you know you’re probably already having these discussions
about how you stay safe when you’re in a manic episode people with ADHD may use to self-medicate
and we’re talking cannabis is a big one for ADHD to help people feel like they’ve got more focus
and not feel like they’ve got so much coming in and so much stimulation all the time which can be
exhausting and after the use of any of the substances of abuse the disruption and neurotransmitters
can make people feel like they’ve got ADHD-type symptoms faculty concentrating difficulty
following through with things etc so understanding that even if things don’t meet the threshold for
DSM-5 diagnosis we want to look at what symptoms are there and how can we help people manage them
so they’re getting adequate sleep nutrition pain control social support and safety borderline and
antisocial personality just kind of threw those in there because we see those a lot when we’re
working in dual diagnosis facilities more people are more likely to use addictions to cope with a
lack of sense of self and their emotional lability if they’re borderline so I mean their world is so
chaotic many people with borderline personality disorder are likely to use to try to get some calm
in the storm now I will put out my other soapbox here with both of these personality disorders
when you see somebody in active addiction or early recovery they probably have symptoms that
would meet diagnosis you know their symptoms are pervasive in multiple areas of life their
symptoms would meet the diagnosis for one of these two personality disorders during this period
but it resolves as recovery becomes the norm as the neurotransmitter stabilizes they develop
interpersonal skills so you know giving people a little bit of time before we say it’s borderline
personality disorder versus borderline personality characteristics if you will be helpful because
both of these diagnoses can block people from getting into certain treatment centers and getting
some of the services they need okay so we’re going to move on to some of our more common addictions
alcoholism is associated with eating disorders there’s a really strong Association and it usually
flip-flops between bulimia and alcoholism so if somebody’s symptomatic for bulimia they may not
be drinking a lot of alcohol but they may during periods of remission from the bulimia drink a lot
more alcohol become alcohol dependent so there’s a lot of research out there that shows there’s
a strong correlation between these two things and it’s also associated with binge eating disorder
but especially bulimia nutritional deficiencies from alcoholism can cause mood disorders so
even if somebody is not and I use the term I should have put alcohol instead of alcoholism
because even the term heavy use without physical dependence can cause nutritional deficiencies that
can cause ulcers it can cause physical problems physical exhaustion which can disrupt sleep
alcohol impairs sleep quality alcohol makes apnea worse so if you’ve got a client who has
sleep apnea they’re drinking they’re probably gonna sleep even worse than they normally do
depression is the result of using well alcohol as a depressant so what do people expect well most
people expect to relax they don’t think about the rest of the stuff that’s going on in neurochemical
imbalances because the alcohol exits our system a lot faster than our brain can catch up and go okay
it’s not in there anymore so I need to adjust the temperature and in sleep disruption anxiety can
also, be triggered as a result of use I’ve said before say it again after that initial period
where people feel the depressant or relaxing effects of alcohol there is an upsurge in anxiety
so a lot of people have another drink to kind of quell that anxiety feeling but you know people
with anxiety disorders are gonna feel it more prominently and the neurochemical imbalances
that alcohol use causes can worsen pre-existing anxiety conditions or trigger anxiety conditions
nicotine is another one that we see a lot even in just straight-up mental health clinics not
co-occurring so what effect does nicotine have well anxiety and depression are 70% more likely in
smokers so that’s one of those statistics we want to look at nicotine triggers dopamine release okay
so nicotine is one of the most addictive drugs on the planet and you’re thinking I thought that was
opiates well opiates are in there but nicotine not only is nicotine legal but it’s also one of
the most addictive drugs on the planet so that’s another important point to think about people are
using their trigger and dopamine release their brain gets used to being flooded with dopamine so
their receptors on the other end start sensitizing so we’re creating an artificial environment
basically when people are smoking blood vessel changes when people smoke it causes blood vessel
changes that can cause high blood pressure as well as depression and fatigue and confusion in the blood
vessels narrow and get stiffer so the oxygenated blood has a harder time getting to where it needs
to be so people start feeling blah and that can cause them to think that they’re starting to feel
depressed can also cause those cause loss of energy people with severe and persistent mental
illnesses are two to three times more likely than the general population to use nicotine so that’s
just an interesting little fact to have out there if you work with people with SP MI and people
with ADHD may smoke because it increases their concentration and attention for about five minutes
literally, for about five minutes but during that five minutes they’re like oh my gosh it’s a relief
I can like focus for half a second so we want to look at what else is going on whether the
a person has adult ADHD for example physical health mental nicotine is linked with COPD and emphysema
and lung cancer so you know all kinds of lung and cardiopulmonary stuff well when that happens
you know we have less oxygenated blood efficient efficiently getting through the system we’re going
to have increased fatigue increased confusion some grief that may go along with that especially if
people are starting to have to carry an oxygen tank around with them or something you know we may
have to help them deal with disability acceptance and depression and stroke because smoking like
I said increases blood pressure and reduces circulation so cutting off or greatly reducing
circulation to the brain they have shown that people who smoke especially heavy smokers are at a
much greater risk of stroke and addiction nicotine is strongly correlated with other addictions a
a lot of people when they’re in the bar well not so much anymore since smoking is not allowed in
public places but used to be when they were in the bar they would also be smoking but a lot of
people associate alcohol and nicotine or nicotine and other drugs so if somebody is using other
drugs likely they’re smoking now it doesn’t work the other way around just because they’re smoking
doesn’t mean they’re likely using other drugs the reason this is more important is that people
who continue to smoke after they have gone into recovery for their drug of choice have a relapse
rates as high as 68 percent higher than for people who quit smoking so we start thinking about that
and we say well why is that well because nicotine is a mood-altering substance you know we don’t
think of it as such because it’s not a woohoo it’s Marva hey okay it’s not as prominent
of interaction as maybe cocaine or something but it does change the balance and people still
do use smoking to cope with life when things get stressful they smoke well if things get stressful
and you know they’re too stressed for smoking to handle then they may start going back to what
else can I take use or do that will make this feeling go away right now we know also that was
smoking and that repeated release of dopamine they’re messing with the neurochemical balances
in their brain, so it makes sense that eventually just like tolerance to other drugs happens it may
not be enough at a certain point and they may fall back into other habits nicotine has been known to
suppress appetite and but whether it keeps weight off or not they haven’t shown alcohol
and nicotine both are appetite suppressants which is another reason people with bulimia tend to
drink and one of the reasons why people quit smoking they tend to be hungrier so helping
them get through that period now whether it helps them keep weight off the party that deals with
the reason that they eat it’s not really that it’s suppressing their or increasing their metabolism
so much its nicotine suppresses the anxiety and sometimes the desire the hunger but if people
are still eating out of anxiety if they’re still eating under stress eating then you know when they stop
smoking and they don’t have a cigarette to put in their mouth when they’re stressed they tend to
go for other things and so we need to help people figure out when they stop smoking are you
eating because you’re hungry or are you eating because you’re stressed if they’re eating
because they’re hungry and they’re getting heavier than they want to be they need to talk with their
doctor about you know thyroid tests and also let their doctor educate them on biological setpoint
theory of you know not everybody’s going to be a zero so you know that may be something we can
help them deal with body acceptance issues if you know maybe they’re programmed genetically to
be you know a size X whatever that is and they’re not happy because they want to be a zero which our
culture does tell us to do as clinicians we can help them look at you know the costs and
benefits of continuing to smoke and what being you know a size zero means for them to opiate
abuse there’s a lot of physical stuff and we’re just gonna run through it real quick because
you’re not as concerned with it the physical stuff the doctors are gonna see but we need to be
aware of from a clinical point because it can keep people from getting their basic needs met blood
and injection site infections you know that’s probably going to lay them up for a while but if
they have repeated infections and are repeatedly out of work they can lose their job they can lose
their housing they can you know get some sort of MRSA or something else which can be really
expensive it can be life-threatening ya-ya collapsed veins and this is more common obviously
this is only for injection drug users but collapsed veins just as you would expect keep the
oxygenated blood from getting where it needs to be so people are more likely to experience strokes
and may have certain forms of vascular dementia because of the strokes dementia we’re familiar
with endocarditis is the inflammation around the heart so again this is only for needle
drug users but if you’ve got a client who is using needles to inject any kind of drug be aware
of that and what they get and what they inject is rarely pure so knowing what else they’re injecting
into their system if they’re you know crushing pills from the pharmacy you’re a little bit more
sure about what they’re getting as opposed to if it’s from the corner dealer and sometimes
they’re cut with really nasty things like you know comic bathroom cleaner and stuff HIV if
people get HIV from injection or some other risky behavior they’re probably going to experience
some depression and a lot of times HIV from opiate abuse they’re gonna experience depression
remorse regret all that kind of stuff anxiety about how long they’re going to live what’s
going to happen and oh those medication side effects those the antiretroviral medications that
they have to take are doozies I’ve seen people go through the induction weeks on their medications
and it is a rough time so helping people get through it so they are medication compliance
so they can continue to live we need to help them maintain hope and self-efficacy and all that kind
of stuff to maintain that forward movement to get through the induction period liver damage from
acetaminophen can set people up for you know physical pain among other things and it decreased
pain tolerance now this generally the decreased pain tolerance goes away after the
the body starts producing its endorphins and natural painkillers again but that initial period
if somebody quits using and maybe you know you are seeing them as a mental health client and
they had an accident or had surgery or something they started using pills they got a couple of
refills then the doctor said no I’m cutting you off and now they’re going through a detox period
detox from opiates is unpleasant but it is rarely life-threatening unless somebody becomes their
electrolytes get imbalanced because of the flu symptoms but we still may see this in private
practice in mental health practice because of the scenario I just told you people can start
taking painkillers as prescribed for something they may get addicted you know take them for
a month or so then when they get off of them not only do they feel like you know really bad
but their pain is also back and it may be they had their wisdom teeth out that pain may be gone
but other aches and pains and everything you feel is probably going to be intensified until the
body kicks back in so educating clients about this is what happens you know it’s not uncommon
if you think it’s too bad go see your doctor helping them make sure they’re getting
good nutrition you know it’s hard if you’ve got flu symptoms to feel like you want to eat or
hold anything down so what can you do to make sure your body has the building blocks to make the
stuff that it needs to help you feel better what can you do to improve your sleep and a lot of our
clients and you know where I used to work we had a methadone clinic and we also had a mother
baby unit and as soon as the mothers would give birth then the doctor would start them on
their detox from methadone and he didn’t believe in the kinder gentler taper he was just like okay
baby’s gone threats gone because you can’t detox from somebody from opiates when they are pregnant
because it can cause the baby to die anyway so as soon as they would stop or as soon as
they weren’t pregnant anymore he would just D see them and they would feel really bad I mean
not only did they just push an 8-pound something out of their body but they also are experiencing
a decreased pain tolerance because they’re not on the opiates anymore and all they want to do is
sleep it’s just like please so understanding that is important in helping people get through
that period even though they may want to sleep all the time helping them understand that it’s
important to maintain their circadian rhythms if they have to take two or three ten-minute
power naps throughout the day to get through the day you know more power to them but if they
can practice good sleep hygiene they’re gonna be way better off in the long run OPD opiate
abuse is also or opiate use is also associated with the treatment of depression but it can cause
depressive symptoms due to its pharmacological properties I mean it slows everything down from
you’re gastrointestinal to your heart rate to your respiration you’re not breathing as much you’re
not getting as much oxygen in you’re gonna have more fatigue you’re gonna have more confusion
you’re going to have more of those symptoms of depression for some people they find it is and
certain opiates they find it is a powerful way to reduce anxiety it makes them feel like they’ve
got a ton of energy because they’re not stressed out anymore and this last one is one of the
The main reason that I find people don’t want to give up opiates is that they finally feel better when
they’re on the eating disorders commonly a coat co-occur with depression and anxiety which can
be caused by nutritional deficiencies you know you’re not giving your body the building blocks
so it can’t make the neurotransmitters it needs and it also probably disrupts your sleep some
and depression anxiety can cause or trigger or whatever you want to say eating disorders because
people with eating disorders may fear becoming fat have low self-esteem have a sense of lack of
self-control or have body dysmorphic disorder so we also want to be aware that there are mental
health stuff that can trigger dysfunctional eating patterns there’s about a 24% prevalence of PTSD
among people with eating disorders so if you’ve got a client with eating disorders especially
bulimia be on the lookout for depression anxiety body dysmorphic disorder alcoholism and PTSD they
maybe smoking too but of the things, I just listed that’s probably the least of their worries it’s
all eating disorders are also associated with alcoholism and smoking I said physical health
issues now you’re seeing somebody with an eating disorder it’s a mild eating disorder you’re seeing
them once a week outpatient so you’re not and you have you know you have training and
working with eating disorders or maybe it’s mild enough that you’re just getting supervision
on treating this issue whatever being aware that people with eating disorders anorexia or bulimia
can have irregular heartbeats and cardiac arrest due to potassium imbalances and electrolyte
imbalances so if they’re not eating or if they are binging and purging in some way shape or
form and that includes excessive exercise which can trigger a lot of heart problems they may have
loss of bone mass and osteoporosis so they may break bones a little bit easier going back up to
the heartbeat not to belabor the point but again heart problems mean a lack of available oxygen
mean confusion fatigue potential difficulty sleeping depressive symptoms and you know cardiac
arrest in and of itself is bad kidney damage from Doretta caboose and low potassium can also
potentially drain damaged the adrenals which are on the kidneys and so it’s important to be
aware of what people are using a lot of people with eating disorders are going to creatively
use stimulants to suppress their appetite think about any of your diet drugs your enter mean I
think it’s one of them the ones they give to help people lose weight they’re stimulants
they’re intense stimulants so people who are struggling with eating disorders are likely to go
towards abusing stimulants or at least using them which can drain the adrenals it can in some
cases have been linked to the development of Addison’s disease liver damage from not eating
or binging and purging causing toxin buildup and possibly pain we can help people deal with it
as much as we can anemia which can cause symptoms of depression in and of itself so goes back to
that nutrition making sure they’re getting enough infertility which in and of itself can be
devastating for young women if they can’t have children anymore or can’t have children
ever that may be a grief issue that we need to help them deal with cathartic: and this is
an important one to be aware of because you don’t have to have somebody who uses laxatives
all the time but people who regularly use or abuse laxatives can become dependent on them so
when they don’t use them they have a feeling of bloating feeling full and abdominal pain which
especially in people with eating disorders or body morphic disorders surrounding just general
body fit bad back body fat can greatly increase anxiety depression hopelessness and in some
cases of suicidality so again educating people is the first step to helping them understand what’s
going on and how dangerous laxatives can be but also if somebody is trying to cut back on their
use of laxatives or just recently stopped using laxatives like when people stopped using
opiates it takes the body a while to get back online but for most people it eventually does
people with eating disorders also have chronic ulcers which are painful and can keep you up at night
As you know gastric reflux and pancreatitis which can flare up at a moment’s notice will is
extraordinarily painful and can cause people to lose time from school or work social activities
feel bad about themselves and also pancreatitis causes a lot of bloating
which in eating disorders is a huge trigger for anxiety and depression pathological gambling
is associated with stimulant abuse especially cocaine methamphetamine and Ritalin to stay
focused disrupted sleep and rebound depression when they quit taking that stuff they wake up and
they’re like oh wow what did I just do alcoholism is also associated with pathological gambling
some people drink to calm their nerves some people drink because it’s the culture if you go
to any of the casinos you know their hand-and-out drinks, they’re trying to get you drunk so you
keep gambling more and there’s as we spoke about earlier rebound depression or anxiety smoking
may help people increase their focus or make them think they can increase their focus so if
you can’t smoke in public places this is more of an issue if you have somebody who does a lot of
online gambling or they gamble at their friend’s house or somebody’s house where there’s poker
games and stuff smoking has some anti-anxiety anti-anxiety properties and may be part of the
the culture I know when my daddy used to have his poker games everybody would smoke cigars and even
the one woman who went there would be smoking a cigar with everybody else and it was just the
culture of being there so there are a lot of different reasons that people may use substances
in addition to gambling mental health issues from gambling anxiety from the stimulant use or from
the tension and release of am I going to you know I’m down $20,000 am I going to make it back ADHD
is also strongly associated with pathological gambling bipolar disorder, especially during manic
phases are associated with pathological gambling generally you see them co-occurring it’s not
like gambling causes it it’s you will see co-occur depression can occur due to losses and
gambling can start because somebody’s depressed because of their financial situation and their
trying to figure out a way to you know borrow from Peter to pay Paul and get ahead you also see
pathological gambling is more strongly associated with people who have obsessive-compulsive
disorder if you’ve got clients with these diagnoses just kind of you know be attentive to
the fact that they are more likely to engage in pathological gambling or if they start gambling
it’s more likely to become a problem than for people who don’t have these issues internet
an addiction that is diagnoseable so you know I’m not just making something up
depending on your resource affects eight point two percent to thirty-eight percent of the
general population now obviously we were looking at you know like games versus you know games plus
Facebook plus shopping or something so depending on the study you looked at their parameters
were a little bit different but either way up to 38 percent of the population has sacrificed
significant personal recreational activities to engage in some sort of internet
behavior Internet addiction can cause anxiety or depression due to eyestrain and chronic headaches
you know if you’re hurting all the time it can make you feel wonky it can also interrupt your
sleep can cause circadian rhythm disorder which can trigger depression fatigue reduced stress
tolerance this is a condition when your body doesn’t know whether it’s supposed to be awake
or asleep because a lot of people who engage in internet-addictive behaviors do so in the dark or
you know they don’t pay attention to whether the lights are on or not they may just sit there kind of
in their cave carpal tunnel contributes to pain and sleep disruption because carpal tunnel does
wake you up at night back ache again may disrupt your sleep and can cause chronic pain during the
a day which can interrupt your daily activities poor nutrition I know a lot of gamers that will sit
there for an entire weekend and not get up to go eat so if it’s not brought to them they don’t eat
they’ll even wear adult diapers so they don’t have to get up to go to the bathroom reduced immunity
due to exhaustion from not sleeping and job or relationship problems I know uh several people
whose marriages ended over a world of warcraft’ so internet addiction is a real thing and it’s
something that we need to be cognizant of because it does cause a lot of problems and a lot of
relationships and it may be one of many problems but it’s something to look at sex addiction
can cause hepatitis and a variety of different STDs which if not treated can cause systemic problems
it’s related to anxiety and depression because sex addiction may begin in order because somebody
wants to feel loved or connected maybe after a breakup or because they never felt loved you’re
connected and then they feel that rush and they’re like oh I like that I want to do that again part
of it could be engaging in that behavior which is so thrilling you know depends on the person
psychological withdrawal from sex addiction people who have been engaging in sex addiction
type behaviors and I include pornography addiction in it for this presentation if they’re not able to
access that may start feeling anxious or depressed they can’t get to that they can’t get to the
the thing that’s gonna cause the dopamine rush and reflection on behaviors that they’ve engaged in
as a part of their sex addiction can also prompt anxiety about a spouse finding out you know am I
going to develop an STD and am I you know how I feel about what I’ve been doing so as clinicians
if we’re working with somebody who has compulsive sexual behaviors even if you know anywhere about that
the spectrum we need to be aware that these things may exist and figure out or help them figure out
how they feel about it and what they need to do to make sure that they’re getting good sleep
that they’re dealing with their depression and their anxiety so that they can have a safe internal
and external environment so back to that global perspective how can we and why is it important
to address chronic illness and disabilities that result from or cause mood disorders or
addictions how can we address depression anxiety and hopelessness that results from or causes
depression anxiety or physical problems how can we address physical problems that are caused
by mood or addictions and how can we address guilt or regret which may accompany addiction
recovery or the realization of a diagnosis of a disease caused by the addiction so while you kind
of ponder those there was a question that came in so question what about robbing Peter to
pay Paul in association with trauma specifically childhood trauma so if you could clarify that
for me a little bit I had mentioned robbing Peter to pay Paul in terms of gambling so I’m just so
mental health issues can be caused by or trigger addictions or physical health issues addictions
can cause or trigger mental health issues or physical health issues that can
be caused by addictions or mental health issues so again chicken-or-egg we don’t necessarily know
which one came first when you have any one of these it’s probably going to or likely impact
each other person or each other area common issues are seen in all three changes in sleeping
changes in nutrition fatigue and grief effective treatment requires addressing the underlying
causes as well as the ripple effects you know so yes after childhood trauma or trauma
of any sort, some people may spend a lot of time feeding the addiction as you put it or
engaging in addictive behaviors to avoid some of the PTSD symptoms to avoid thinking about it
to deal with the grief to deal with the shame so they may engage in something that makes them
feel better or helps them forget to cope with the trauma that happened until they
have other tools so they can come to some sort of terms with it and you know as I
say close that chapter in their book already if there are no other questions tomorrow’s
the presentation I learned a lot creating is on alcohol-related dementia and vascular dementia
and fetal alcohol spectrum disorders all three of which are issues that are caused by substance
use and specifically alcoholism and then I’ll give you a hint about where an acute Korsakoff a
a lot of clients who abuse alcohol but they’re not alcohol dependent who decide to stop drinking can
trigger where Nikki Korsakoff syndrome and causes alcohol-related dementia-type symptoms
so again in mental health, we need to be on the lookout for it if we hear that our clients
are trying to cut down on their alcohol use alrighty everybody and so tomorrow is that
presentation and then Thursday we’re going to look at different models of new bottles of
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