{"id":150233,"date":"2023-01-17T22:21:38","date_gmt":"2023-01-18T03:21:38","guid":{"rendered":"https:\/\/effectsofanxiety.net\/?p=150233"},"modified":"2023-01-18T10:10:25","modified_gmt":"2023-01-18T15:10:25","slug":"common-co-occurring-issues-in-addiction-addiction-counselor-exam-review","status":"publish","type":"post","link":"https:\/\/effectsofanxiety.net\/archives\/150233","title":{"rendered":"Common Co Occurring Issues in Addiction | Addiction Counselor Exam Review"},"content":{"rendered":"<div class=\"jetpack-video-wrapper\"><iframe loading=\"lazy\" title=\"Common Co Occurring Issues in Addiction | Addiction Counselor Exam Review\" width=\"660\" height=\"371\" src=\"https:\/\/www.youtube.com\/embed\/fBBbb4_d0aI?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe><\/div>\r\n\r\nthis episode was pre-recorded\r\nas part of a live continuing\u00a0\u00a0 education webinar on-demand CEUs are\r\nstill available for this presentation\u00a0\u00a0 through all CEUs registered at all\r\nCEUs comm slash counselor toolbox I’d like to welcome everybody to today’s\r\npresentation on common co-occurring issues\u00a0\u00a0 exploring the interaction between mental health\r\nphysical health and addiction so we’re kind of\u00a0\u00a0 putting together the stuff that we’ve been\r\ntalking about for a couple of sessions now\u00a0\u00a0 we’re going to start by talking about some\r\nquestions and then reviewing what a healthy\u00a0\u00a0 person needs and then going through and talking\r\nabout how different addictions may cause or be\u00a0\u00a0 caused by mood disorders and physical health\r\nissues and we’re going to talk about things\u00a0\u00a0 that you may see in private practice or the\r\na facility that you’re working in just real quickly\u00a0\u00a0 for those of you who are here how many people if\r\nyou would just type in the chat window if you’re\u00a0\u00a0 a mental health counselor type mhm if you are a\r\naddictions counselor type SI or whatever so just\u00a0\u00a0 kind of so and know who I’m talking to you okay\r\nso mostly mental health ok cool so what we’re going to look at is what you may\r\nsee in private practice or a mental health\u00a0\u00a0 setting because these clients a lot of clients\r\nthat have substance abuse or addiction issues\u00a0\u00a0 and I use the term addiction because we’re\r\ntalking about behavioral addictions too many\u00a0\u00a0 times they don’t meet the criteria for admission\r\nfor substance abuse because they don’t meet that\u00a0\u00a0 threshold of a substance use disorder tolerance\r\nwithdrawal yay yay so substance abuse agencies\u00a0\u00a0 can’t get funding to provide the treatment so\r\nthey end up in a mental health facility or a\u00a0\u00a0 mental health counselor’s office and they may\r\nbe dealing with some of these addiction issues\u00a0\u00a0 and wanting to address them or they may not be\r\nbut those issues are out there and exist so\u00a0\u00a0 we want to know how they interact so told you\r\nwe’re gonna have a couple of questions to think\u00a0\u00a0 about and I’m just asking you to ponder these for\r\nright now and you can add throughout the class if\u00a0\u00a0 you want but we’re gonna talk about it more at\r\nthe end how can we and why is it important\u00a0\u00a0 to address chronic illness and disabilities\r\nthat result from or that cause mood disorders\u00a0\u00a0 or addictions so thinking about you know like\r\nHIV or hepatitis are two of the big one’s cirrhosis of the liver chronic obstructive\r\npulmonary disease from smoking so these are\u00a0\u00a0 things that can result from addiction why or how\r\nis it important for us as clinicians mental health\u00a0\u00a0 clinicians mainly to think about addressing these\r\nhow can we address depression and\/or anxiety kind\u00a0\u00a0 of our mood disorder genre and hopelessness that\r\nresults from or causes depression and anxiety so\u00a0\u00a0 we know that thinking back affects acceptance\r\nand commitment therapy there’s clean discomfort\u00a0\u00a0 which is what he calls your initial emotion\r\nwhen you feel something if you feel depressed\u00a0\u00a0 if you feel anxious that’s how you feel and\r\nit’s uncomfortable but it’s clean it is it is\u00a0\u00a0 what it is and then he calls dirty discomfort\r\nthe feelings that we have about those feelings\u00a0\u00a0 so we can get angry that we are depressed we can\r\nget depressed that we’re still depressed and he\u00a0\u00a0 calls that dirty discomfort because we’re kind of\r\nlayering on and piling in think about just kind of\u00a0\u00a0 throwing somebody into a hole and piling more\r\ndirt on top of them so we want to think about\u00a0\u00a0 how can we address these issues that result from\r\ndepression or anxiety or sleeping eating or energy\u00a0\u00a0 changes so if you’ve got somebody who is dealing\r\nwith a chronic illness or something else has\u00a0\u00a0 happened or they’re they’ve got some sort of\r\nan addiction and they are not eating well not\u00a0\u00a0 sleeping well it could trigger depression or\r\nanxiety so we’re going to talk about that how\u00a0\u00a0 can we address sleeping eating and energy changes\r\nseems like we’re getting repetitive we’re looking\u00a0\u00a0 at how each one interface and how can we address\r\nthese things that are caused by or cause mood\u00a0\u00a0 disorders or addictions because we know when we\r\nlook at the diagnostic criteria for depression\u00a0\u00a0 for example sleeping eating and energy changes\r\nprimary in there and how can we address guilt\u00a0\u00a0 and regret which may accompany addiction recovery\r\nor the diagnosis of the disease as the result of\u00a0\u00a0 addiction such as lung cancer or HIV or cirrhosis\r\nof the liver and people who have liver disorders\u00a0\u00a0 cirrhosis of the liver and hepatitis are at a\r\ngreater risk of liver cancer so that can they\u00a0\u00a0 can have some additional anxiety that is related\r\nto that so they may look back and go I wish I\u00a0\u00a0 hadn’t well you have so how can we help you deal\r\nwith that and come to some level of acceptance so\u00a0\u00a0 my little editorialized soapbox when we’re talking\r\nabout addictions I mean sometimes we don’t want to\u00a0\u00a0 think that they exist we want to pretend that our\r\nclients are coming in their mental health clients\u00a0\u00a0 otherwise their perfectly healthy things are\r\ngoing great well that may not be the trick the\u00a0\u00a0 case a lot of people begin to use and I mean\r\nthink about ourselves when we’re when we were\u00a0\u00a0 in high school and college or you know even later\r\nsome people use it for recreation you know they want\u00a0\u00a0 to go out have a few beers do whatever cool you\r\nknow that’s fine some people drink or use it for\u00a0\u00a0 relaxation my son has a love of we will use that\r\nword videogames and he will get on his videogames\u00a0\u00a0 and we’ll kind of get lost in it it helps him\r\nescape from you know life as we know it for a\u00a0\u00a0 little bit of time some people use\r\nbecause of peer pressure you know it’s everybody’s\u00a0\u00a0 doing it or you know you’re at a football party\r\nor something and everybody’s having a beer and\u00a0\u00a0 somebody offers you one and you don’t want to be\r\nrude things like that can happen and some people\u00a0\u00a0 begin to use straight up for self-medication\r\nthey’re like I feel crappy I need something to\u00a0\u00a0 help me feel better or numb the pain so there’s\r\na lot of reasons people begin to use so then you\u00a0\u00a0 might say well why don’t they just say no because\r\nit’s easy to say no well it’s not some\u00a0\u00a0 people start to use it because they’re bored and\r\nthey want something to bring some excitement some\u00a0\u00a0 euphoria to their life and we’re talking about\r\neverything from sex addiction to internet addiction to cocaine use I mean we’re running the gamut here\r\nthey may lack the awareness of the dangers or how\u00a0\u00a0 quickly you can become addicted I know when I was\r\nworking in the facility in Florida there was the\u00a0\u00a0 sort of knowledge if you will and knowledge is not\r\nthe right word rule I guess that with crack\u00a0\u00a0 cocaine for some people, it was a one-hit wonder\r\nyou did it once and you were hooked and several drugs can be highly addicting\r\nquickly especially if they’re taken either\u00a0\u00a0 through injection or inhalation but we’ve talked\r\nbefore about the fact that our bodies can start\u00a0\u00a0 developing tolerance to opiates within 3 to 5\r\ndays so you know people may not a lot of people\u00a0\u00a0 don’t realize when they go in and their doctor\r\nwrites him a script for two weeks of opiates and\u00a0\u00a0 they take it as prescribed that they’re actually\r\nbecoming somewhat addicted to those opiates if\u00a0\u00a0 they take the whole prescription so they may not\r\nunderstand that some people don’t say no because\u00a0\u00a0 they have low self-esteem so they’re looking for\r\ncomfort to help them relax to help them loosen\u00a0\u00a0 up so they can be more fun at the party and or\r\nto peer pressure somebody tells them why don’t use or why don’t come out and go drinking\r\nwith us or whatever the case may be so to fit in\u00a0\u00a0 they may try to use it to fit in to feel\r\npart of a crowd and part of it can also be you\u00a0\u00a0 know with that peer pressure just generally the\r\nculture promoting this kind of behavior going\u00a0\u00a0 it’s ok I think I’ve shared with you before at\r\nAt the beginning of some of the original Beverly\u00a0\u00a0 Hillbillies episodes they still advertised Winston\r\ncigarettes, like they are the greatest thing and cool people, have them and that’s the thing to\r\ndo so if that message gets out people may start\u00a0\u00a0 believing it and not do their research so to\r\nspeak on what the true problems or risks may be and then again self-medication some people may\r\nbe struggling just to get by from day to day and\u00a0\u00a0 this helps them survive the best they can with the\r\ntools they have until we give them some new tools\u00a0\u00a0 so just saying you know I had I grown up\r\nduring the era of Nancy Reagan and you know God loves her she was trying to help and for a certain\r\nsmall percentage she probably did but for a larger\u00a0\u00a0 percentage just saying no is not that easy we need\r\nto give people the tools so they can say no so\u00a0\u00a0 they don’t so they aren’t relying on these drugs\r\nfor some reason because when people start using it for recreation and relaxation some people may not\r\nhave a big big issue with it other people may\u00a0\u00a0 start throwing their neurotransmitters kind of out\r\nof whack depending on how much how often they use\u00a0\u00a0 what combinations if they’re on any medication so\r\npeople may inadvertently start messing with their\u00a0\u00a0 neurotransmitters and creating and we’ll talk\r\nabout this creating depression or anxiety\u00a0\u00a0 that they end up trying to self-medicate so that\r\nthat is my soapbox for it is not that easy to just\u00a0\u00a0 say no we as a culture not just as clinicians\r\nhave some work to do so what do we need to do to help people be able to just say no\r\nthey need to have access to healthy nutrition\u00a0\u00a0 and knowledge of what that means my son and it’s\r\nstill like drawing fingernails on a blackboard\u00a0\u00a0 to me today this week, I told his sister that you\r\nno, he didn’t understand why she was so concerned\u00a0\u00a0 with the nutrition he’s a guy he doesn’t need to pay\r\nattention to nutrition it’s just whatever and I\u00a0\u00a0 was just like oh my gosh you know everything I’ve\r\nsaid has fallen on deaf ears but okay we’ll back\u00a0\u00a0 up and figure out a way they need access to\r\nit and then they also need to eat it you know if\u00a0\u00a0 we have healthy foods available but people are\r\nstill eating peanut butter and jelly sandwiches\u00a0\u00a0 for every single meal it’s not going to help so we\r\nneed to make sure people understand what a healthy\u00a0\u00a0 diet looks like and how to do it in a way that’s not\r\npainful you know we’re not asking you to just eat\u00a0\u00a0 rabbit food as my daddy used to say but so what\r\ndoes it look like to eat a diet or nutrition that\u00a0\u00a0 makes you feel good that’s happy that makes you\r\nfeel happily fulfilled you like it tastes good\u00a0\u00a0 whatever you want to say but that’s also\r\nhealthy you know it’s not just pizza or just\u00a0\u00a0 peanut butter we need to educate people and a\r\nlot of adults that I work with have no clue about\u00a0\u00a0 sleep hygiene you know they know they’re supposed\r\nto try to go to sleep but they don’t know anything\u00a0\u00a0 about turning off the blue turning on blue light\r\nfilters so the blue lights are not keeping them\u00a0\u00a0 up so we need to do some education here ideally in\r\nelementary schools but if we can get it out to the\u00a0\u00a0 community so they can pass it on to their little\r\nminions we’ll be on a good path to pain control we\u00a0\u00a0 need people to start having pain control but\r\nwe need to also have them have alternatives to\u00a0\u00a0 pain control besides opiates and there are a lot\r\nof them out there again people don’t know about\u00a0\u00a0 so we must educate and we’re not\r\nprescribing pain control that’s not our job but\u00a0\u00a0 if we have a client who’s in chronic pain we can\r\nsuggest that they work with their doctor that they\u00a0\u00a0 look into options for pain control you can google\r\nit and find a lot of different alternatives now\u00a0\u00a0 if they don’t want to go to the doctor but you\r\nknow there are a lot of different things from\u00a0\u00a0 acupressure it attends units to things that are\r\nnonpharmacological that can help people manage\u00a0\u00a0 their pain so they can sleep which will help\r\nthe rest and rebalance to deal with fatigue and\u00a0\u00a0 be able to deal with life kind of on life’s terms\r\nbecause they won’t be in this constant state of\u00a0\u00a0 stress people need access to regular medical care\r\nto prevent problems so you know we want to prevent\u00a0\u00a0 this thing on your face from becoming skin cancer\r\nwe want to prevent anything else that that might\u00a0\u00a0 trigger problems and early intervention so like\r\nwith Lyme disease, if people get early intervention\u00a0\u00a0 mentioned they don’t end up with the chronic\r\nproblems with HIV the earlier the intervention\u00a0\u00a0 the better same thing with hepatitis you know\r\nthe list goes on so we want to make sure that if\u00a0\u00a0 people have some sort of issue that’s disrupting\r\ntheir ability to get enough sleep process\u00a0\u00a0 nutrition go to work do any of these things that\r\nthey have access to some method whatever method\u00a0\u00a0 they need to address it so sometimes it’s medical\r\nsometimes it’s mental health it’s social\u00a0\u00a0 services they need safe housing so we’re on to\r\nsocial services now and that includes a roof\u00a0\u00a0 over their head that they’re not worried when\r\nthey go to sleep at night but also being safe\u00a0\u00a0 from domestic violence and things like that safety\r\nand this kind of goes with safe housing and I put\u00a0\u00a0 internal and external because you know the first\r\npart is external safety we want to be able to know\u00a0\u00a0 that our patients can relax wherever they’re at\r\nthey have enough money to keep a roof over their\u00a0\u00a0 head in a safe place and you know typically that’s\r\nnot something that we think about as mental health\u00a0\u00a0 counselors we think about helping them deal with\r\ntheir anxiety but if they can’t get enough sleep\u00a0\u00a0 and they never feel safe when they’re at home\r\nthey’re not going to be able to rest and they’re\u00a0\u00a0 at best their recovery is going to be impeded at\r\nworst you know it’s going to contribute to the\u00a0\u00a0 issue that they’re seeing us for so safe housing\r\nis important we’re not going to get it for them\u00a0\u00a0 but we can point them in the right direction your\r\nlocal United Way which is 2-1-1 and most places\u00a0\u00a0 generally has a listing of different resources\r\nfor accessing safe housing if you don’t work\u00a0\u00a0 in a facility that’s used to dealing with that\r\nand then internal safety that’s shutting up that\u00a0\u00a0 internal critic that’s being able to go through\r\na day without being derogatory to yourself and that’s something that we definitely can\r\nhelp with we can help people shut down that\u00a0\u00a0 internal critic or that internal person that\r\nis always calling gloom and doom and you know\u00a0\u00a0 waiting for the other shoe to drop or whatever\r\nthe case maybe we can help clients change their\u00a0\u00a0 cognitions so it’s safe inside their head\r\nand then people need love and acceptance and\u00a0\u00a0 this should sound pretty familiar are you\r\nknow Maslow’s hierarchy here kind of in Reverse\u00a0\u00a0 but people need love and acceptance but in order\r\nfor love to have love and acceptance in many cases\u00a0\u00a0 they also need to love and accept themselves so\r\nwe’re gonna work on self-esteem we’re gonna help\u00a0\u00a0 people develop relationship skills hopefully there\r\nare some people in their life that have provided\u00a0\u00a0 some level of love and acceptance maybe not the\r\nunconditional positive regard we’ve hoped for but\u00a0\u00a0 they’re there so these are things that the healthy\r\nhappy person needs and these are things in large\u00a0\u00a0 part we can do through education referral and direct\r\nservices help people get so why do we care about\u00a0\u00a0 co-occurring issues as mental health counselors\r\nwell 35 percent of people with anxiety disorders\u00a0\u00a0 have according to one of these studies abused\r\nopiates so that’s a lot if you’ve got somebody\u00a0\u00a0 with an anxiety disorder this isn’t just panic\r\nthis isn’t just something you know severe\u00a0\u00a0 this is you know any of your anxiety disorders\r\none in three roughly have abused opiates they’ve\u00a0\u00a0 used some sort of opiate drug to help them kind of\r\nchill out of opiate or alcohol dependent patients\u00a0\u00a0 20% have major depressive disorder so of that\r\n35% you know there’s going to be a percentage\u00a0\u00a0 of them who may be opiate or alcohol dependent\r\nand there are a lot of our clients that we see in\u00a0\u00a0 mental health treatment who are not willing to be\r\ntruthful about how much they really drink or how\u00a0\u00a0 often they drink because they might be\r\nsuspecting it’s a little bit of a problem but\u00a0\u00a0 they’re not wanting to go there yet they’re in\r\nwhat we call pre-contemplation okay so let’s\u00a0\u00a0 just go with this in mind that there may be some\r\nunderlying other stuff that they haven’t told us\u00a0\u00a0 about opiate or alcohol-dependent patients 20%\r\nhave major depressive disorder so you know we’re\u00a0\u00a0 taking them and we may be seeing them in the clinic\r\nfor depression and we do want to be suspect of\u00a0\u00a0 whether there’s either some opiate or alcohol\r\nissues there depression and opioid-dependent patients including pain management patients so\r\nthose who are opiate-dependent by prescription have been associated with poorer physical health\r\ndecreased quality of life increased risk-taking behaviors and suicidality am I saying that pain\r\nmanagement clinics are bad no but what I’m saying\u00a0\u00a0 is those who are in pain management clinics for a\r\nvariety of reasons are at a high in a higher risk\u00a0\u00a0 category I mean think about it if your pain is\r\nbad enough that you need to be going to a pain\u00a0\u00a0 management clinic think about how much that must\r\nhurt think about how much that must impair your\u00a0\u00a0 daily life think about the impact of the drugs\r\nthat you’re taking on your mood your energy levels\u00a0\u00a0 and the stigma in some cases associated with it\r\nsome people here suboxone and they’re like yeah\u00a0\u00a0 whatever my neighbor takes that other person here\r\nsuboxone and they’re like ah you can’t be taking\u00a0\u00a0 that so there is still a lot of social stigmas that\r\ngoes along with medication-assisted therapies so there are a lot of things that may contribute\r\nto depression in opioid-dependent patients\u00a0\u00a0 the prevalence and severity of depression tend to\r\ndecline within the first few weeks after treatment\u00a0\u00a0 initiation so if they are trying to get off of\r\nyou know ideally their detox and they’re\u00a0\u00a0 trying to you know remain sober the prevalence\r\nand the severity of depression tends to decline so we\u00a0\u00a0 need to get them off of it first and get them through\r\nthat acute withdrawal from a depressant\u00a0\u00a0 including alcohol and I know this slide is boring\r\nbut we’re gonna be through in a second withdrawal\u00a0\u00a0 from depressants including alcohol opioids and\r\neven stimulants invariably include potent anxiety\u00a0\u00a0 symptoms so it’s important to pay attention and\r\nwithdrawal from stimulants can also include potent\u00a0\u00a0 depressive symptoms if they’ve been on a crack\r\nbinge for you know five days that won’t sleep for\u00a0\u00a0 a while many people with substance use disorders\r\nmay exhibit symptoms of depression that fade over\u00a0\u00a0 time and are related to acute with drawl well we\r\ntalk about acute withdrawal we’re talking about\u00a0\u00a0 the first three months we’re not talking about\r\nthe detox period which is generally three days so\u00a0\u00a0 encourage people who’ve gone through detox and\r\nmaybe they’re seeing you on an outpatient basis\u00a0\u00a0 encourage people to you know be patient and work with\r\nthe treatment team if they need to but the first\u00a0\u00a0 three months is always the hardest so chicken or\r\nthe egg you know did the person start using and become\u00a0\u00a0 depressed or was the person depressed so they self\r\nmedicated does it matter depression and anxiety\u00a0\u00a0 are associated with addiction because because\r\nif you have stimulant withdrawal or recovery\u00a0\u00a0 that period after you quit using that’s maybe\r\na week maybe two weeks where your body is going\u00a0\u00a0 whew that was a run people may feel depressed\r\nfatigued have difficulty concentrating which can\u00a0\u00a0 impact how well they eat it’ll impact\r\ntheir sleep they’re gonna sleep a lot more but the\u00a0\u00a0 quality of sleep may be poor so they can mess\r\nup their circadian rhythms and you know they\u00a0\u00a0 may not have access to the social support that\r\nthey wanted they may but really with stimulant\u00a0\u00a0 withdrawal we’re looking at nutrition\r\nand sleep so we want to educate patients if they\u00a0\u00a0 decide to stop taking stimulants what they need\r\nto look at stimulant use can also be associated\u00a0\u00a0 with depression and anxiety because many people\r\nnot you know the majority but a lot of people\u00a0\u00a0 out there will self-medicate depression with\r\nstimulants from anything from caffeine which\u00a0\u00a0 you know maybe like mild dysthymia but if you\r\nabuse enough caffeine you know it starts getting\u00a0\u00a0 into your system you become dependent on it but if\r\nyou start combining caffeine and nicotine plus oh\u00a0\u00a0 let’s add in some workout supplements or you know\r\nthe occasional Ritalin or something not suggesting\u00a0\u00a0 it then it’s these things can wear the body down\r\nwhich can lead to additional depression but people\u00a0\u00a0 may use these things to try to feel better because\r\nthink depression is related for some people\u00a0\u00a0 they may not feel like they can wake up they’re\r\nfatigued they’re lethargic all the time and\u00a0\u00a0 they’re feeling blue so if they take stimulants\r\nthey get that dopamine rush they’re starting\u00a0\u00a0 to feel good and they’re awake stimulant\r\nuse can cause anxiety well the so if you’ve got\u00a0\u00a0 somebody who already has maybe they are depressed\r\nbut they’ve also got some anxiety and they start\u00a0\u00a0 using stimulants which may make the anxiety way worse\r\nalcohol or opiate use some people use these things\u00a0\u00a0 to numb or to forget and that’s just your\r\nthe standard used the depressant some people will\u00a0\u00a0 use either one of these but especially opiates to\r\ndeal with physical pain to medicate depression or\u00a0\u00a0 anxiety remember there are a lot of trials not\r\nseveral trials right now that are looking at\u00a0\u00a0 using opiates to treat intractable depression\r\nbut a lot of people also use opiates off-label illegally to address anxiety so if you’ve got a\r\nclient with depression or anxiety just kind of\u00a0\u00a0 be alert for how they’re behaving if they’ve\r\ngot pinpoint pupils or if they’re itching and\u00a0\u00a0 picking all the time I mean not the occasional\r\nare winter and the heat just turned on I’ve got\u00a0\u00a0 dry skin itch but constantly itching and picking\r\nand you know where you’re like please just settle\u00a0\u00a0 down detox from opiates can all often produce\r\ndepression produces a lot of flu-like symptoms\u00a0\u00a0 which can make people feel crappy and the\r\nflu-like symptoms I won’t get graphic impaired\u00a0\u00a0 nutrient absorption impaired sleep you know\r\nthey’re sleeping a lot because they feel like\u00a0\u00a0 crap but they’re also having to get up every\r\n10 minutes to go to the bathroom sometimes so\u00a0\u00a0 this first week or so during the initial if they\r\ngo cold turkey so to speak can be rough\u00a0\u00a0 detox from alcohol as I’ve talked about before\r\ncan produce anxiety symptoms so understanding\u00a0\u00a0 that when people are going through detox whether\r\nthey are alcohol dependent and have been drinking\u00a0\u00a0 a whole lot which needs to be medically monitored\r\nI can’t say this enough and I’ll say it a lot more\u00a0\u00a0 tomorrow when we talk about where Nikki Korsakoff\r\nsyndrome but people who are detoxing from alcohol\u00a0\u00a0 will have anxiety symptoms and a period of high\r\nblood pressure and sometimes depression and anxiety are associated with addiction just because they\r\nsober up one morning and they look at their life\u00a0\u00a0 and they’re like what the hell have I done so\r\nyou know and you’re looking at them going yeah\u00a0\u00a0 I don’t blame you for feeling that way now let’s\r\nsee what we can do to improve the next moment\u00a0\u00a0 so make sure that we understand that these\r\nthings are going to go hand in hand and to be\u00a0\u00a0 on the lookout because like I said a lot of people\r\naren’t forthcoming even about alcohol use which is\u00a0\u00a0 legal but if they’re using something illegally\r\nor using maybe their kid’s Ritalin or something\u00a0\u00a0 they’re pretty much almost guaranteed not to tell\r\nyou so we want to be on the lookout for signs and\u00a0\u00a0 symptoms bipolar disorder can be triggered by drug\r\nuse so we just know that we can the person could\u00a0\u00a0 get worn down mess with the neurotransmitters\r\nenough they’re not exactly sure how it happens\u00a0\u00a0 but we have seen the initial acute episode of\r\nbipolar disorder-triggered mania triggered by\u00a0\u00a0 drug use it is more common for people with bipolar\r\nto use stimulants when they’re depressed and just\u00a0\u00a0 about anything when they’re manic now if you’re\r\nworking with somebody with bipolar you know\u00a0\u00a0 you’re probably already having these discussions\r\nabout how you stay safe when you’re in a manic\u00a0\u00a0 episode people with ADHD may use to self-medicate\r\nand we’re talking cannabis is a big one for ADHD\u00a0\u00a0 to help people feel like they’ve got more focus\r\nand not feel like they’ve got so much coming in\u00a0\u00a0 and so much stimulation all the time which can be\r\nexhausting and after the use of any of the substances\u00a0\u00a0 of abuse the disruption and neurotransmitters\r\ncan make people feel like they’ve got ADHD-type symptoms faculty concentrating difficulty\r\nfollowing through with things etc so understanding\u00a0\u00a0 that even if things don’t meet the threshold for\r\nDSM-5 diagnosis we want to look at what symptoms\u00a0\u00a0 are there and how can we help people manage them\r\nso they’re getting adequate sleep nutrition pain\u00a0\u00a0 control social support and safety borderline and\r\nantisocial personality just kind of threw those\u00a0\u00a0 in there because we see those a lot when we’re\r\nworking in dual diagnosis facilities more people\u00a0\u00a0 are more likely to use addictions to cope with a\r\nlack of sense of self and their emotional lability\u00a0\u00a0 if they’re borderline so I mean their world is so\r\nchaotic many people with borderline personality\u00a0\u00a0 disorder are likely to use to try to get some calm\r\nin the storm now I will put out my other soapbox\u00a0\u00a0 here with both of these personality disorders\r\nwhen you see somebody in active addiction or early recovery they probably have symptoms that\r\nwould meet diagnosis you know their symptoms\u00a0\u00a0 are pervasive in multiple areas of life their\r\nsymptoms would meet the diagnosis for one of these\u00a0\u00a0 two personality disorders during this period\r\nbut it resolves as recovery becomes the norm\u00a0\u00a0 as the neurotransmitter stabilizes they develop\r\ninterpersonal skills so you know giving people\u00a0\u00a0 a little bit of time before we say it’s borderline\r\npersonality disorder versus borderline personality\u00a0\u00a0 characteristics if you will be helpful because\r\nboth of these diagnoses can block people from\u00a0\u00a0 getting into certain treatment centers and getting\r\nsome of the services they need okay so we’re going\u00a0\u00a0 to move on to some of our more common addictions\r\nalcoholism is associated with eating disorders\u00a0\u00a0 there’s a really strong Association and it usually\r\nflip-flops between bulimia and alcoholism so if\u00a0\u00a0 somebody’s symptomatic for bulimia they may not\r\nbe drinking a lot of alcohol but they may during\u00a0\u00a0 periods of remission from the bulimia drink a lot\r\nmore alcohol become alcohol dependent so there’s\u00a0\u00a0 a lot of research out there that shows there’s\r\na strong correlation between these two things and\u00a0\u00a0 it’s also associated with binge eating disorder\r\nbut especially bulimia nutritional deficiencies\u00a0\u00a0 from alcoholism can cause mood disorders so\r\neven if somebody is not and I use the term\u00a0\u00a0 I should have put alcohol instead of alcoholism\r\nbecause even the term heavy use without physical\u00a0\u00a0 dependence can cause nutritional deficiencies that\r\ncan cause ulcers it can cause physical problems\u00a0\u00a0 physical exhaustion which can disrupt sleep\r\nalcohol impairs sleep quality alcohol makes\u00a0\u00a0 apnea worse so if you’ve got a client who has\r\nsleep apnea they’re drinking they’re probably\u00a0\u00a0 gonna sleep even worse than they normally do\r\ndepression is the result of using well alcohol as a depressant so what do people expect well most\r\npeople expect to relax they don’t think about the\u00a0\u00a0 rest of the stuff that’s going on in neurochemical\r\nimbalances because the alcohol exits our system a\u00a0\u00a0 lot faster than our brain can catch up and go okay\r\nit’s not in there anymore so I need to adjust the\u00a0\u00a0 temperature and in sleep disruption anxiety can\r\nalso, be triggered as a result of use I’ve said\u00a0\u00a0 before say it again after that initial period\r\nwhere people feel the depressant or relaxing\u00a0\u00a0 effects of alcohol there is an upsurge in anxiety\r\nso a lot of people have another drink to kind of\u00a0\u00a0 quell that anxiety feeling but you know people\r\nwith anxiety disorders are gonna feel it more\u00a0\u00a0 prominently and the neurochemical imbalances\r\nthat alcohol use causes can worsen pre-existing\u00a0\u00a0 anxiety conditions or trigger anxiety conditions\r\nnicotine is another one that we see a lot even\u00a0\u00a0 in just straight-up mental health clinics not\r\nco-occurring so what effect does nicotine have\u00a0\u00a0 well anxiety and depression are 70% more likely in\r\nsmokers so that’s one of those statistics we want\u00a0\u00a0 to look at nicotine triggers dopamine release okay\r\nso nicotine is one of the most addictive drugs on\u00a0\u00a0 the planet and you’re thinking I thought that was\r\nopiates well opiates are in there but nicotine\u00a0\u00a0 not only is nicotine legal but it’s also one of\r\nthe most addictive drugs on the planet so that’s\u00a0\u00a0 another important point to think about people are\r\nusing their trigger and dopamine release their\u00a0\u00a0 brain gets used to being flooded with dopamine so\r\ntheir receptors on the other end start sensitizing\u00a0\u00a0 so we’re creating an artificial environment\r\nbasically when people are smoking blood vessel\u00a0\u00a0 changes when people smoke it causes blood vessel\r\nchanges that can cause high blood pressure as well\u00a0\u00a0 as depression and fatigue and confusion in the blood\r\nvessels narrow and get stiffer so the oxygenated\u00a0\u00a0 blood has a harder time getting to where it needs\r\nto be so people start feeling blah and that can\u00a0\u00a0 cause them to think that they’re starting to feel\r\ndepressed can also cause those cause loss of\u00a0\u00a0 energy people with severe and persistent mental\r\nillnesses are two to three times more likely than\u00a0\u00a0 the general population to use nicotine so that’s\r\njust an interesting little fact to have out there\u00a0\u00a0 if you work with people with SP MI and people\r\nwith ADHD may smoke because it increases their\u00a0\u00a0 concentration and attention for about five minutes\r\nliterally, for about five minutes but during that\u00a0\u00a0 five minutes they’re like oh my gosh it’s a relief\r\nI can like focus for half a second so we\u00a0\u00a0 want to look at what else is going on whether the\r\na person has adult ADHD for example physical health\u00a0\u00a0 mental nicotine is linked with COPD and emphysema\r\nand lung cancer so you know all kinds of lung\u00a0\u00a0 and cardiopulmonary stuff well when that happens\r\nyou know we have less oxygenated blood efficient\u00a0\u00a0 efficiently getting through the system we’re going\r\nto have increased fatigue increased confusion some\u00a0\u00a0 grief that may go along with that especially if\r\npeople are starting to have to carry an oxygen\u00a0\u00a0 tank around with them or something you know we may\r\nhave to help them deal with disability acceptance\u00a0\u00a0 and depression and stroke because smoking like\r\nI said increases blood pressure and reduces\u00a0\u00a0 circulation so cutting off or greatly reducing\r\ncirculation to the brain they have shown that\u00a0\u00a0 people who smoke especially heavy smokers are at a\r\nmuch greater risk of stroke and addiction nicotine\u00a0\u00a0 is strongly correlated with other addictions a\r\na lot of people when they’re in the bar well not\u00a0\u00a0 so much anymore since smoking is not allowed in\r\npublic places but used to be when they were in\u00a0\u00a0 the bar they would also be smoking but a lot of\r\npeople associate alcohol and nicotine or nicotine\u00a0\u00a0 and other drugs so if somebody is using other\r\ndrugs likely they’re smoking now it doesn’t work\u00a0\u00a0 the other way around just because they’re smoking\r\ndoesn’t mean they’re likely using other drugs the\u00a0\u00a0 reason this is more important is that people\r\nwho continue to smoke after they have gone into\u00a0\u00a0 recovery for their drug of choice have a relapse\r\nrates as high as 68 percent higher than for people\u00a0\u00a0 who quit smoking so we start thinking about that\r\nand we say well why is that well because nicotine is a mood-altering substance you know we don’t\r\nthink of it as such because it’s not a\u00a0\u00a0 woohoo it’s Marva hey okay it’s not as prominent\r\nof interaction as maybe cocaine or something\u00a0\u00a0 but it does change the balance and people still\r\ndo use smoking to cope with life when things get\u00a0\u00a0 stressful they smoke well if things get stressful\r\nand you know they’re too stressed for smoking to\u00a0\u00a0 handle then they may start going back to what\r\nelse can I take use or do that will make this\u00a0\u00a0 feeling go away right now we know also that was\r\nsmoking and that repeated release of dopamine\u00a0\u00a0 they’re messing with the neurochemical balances\r\nin their brain, so it makes sense that eventually\u00a0\u00a0 just like tolerance to other drugs happens it may\r\nnot be enough at a certain point and they may fall\u00a0\u00a0 back into other habits nicotine has been known to\r\nsuppress appetite and but whether it keeps weight\u00a0\u00a0 off or not they haven’t shown alcohol\r\nand nicotine both are appetite suppressants which\u00a0\u00a0 is another reason people with bulimia tend to\r\ndrink and one of the reasons why people quit\u00a0\u00a0 smoking they tend to be hungrier so helping\r\nthem get through that period now whether it\u00a0\u00a0 helps them keep weight off the party that deals with\r\nthe reason that they eat it’s not really that it’s\u00a0\u00a0 suppressing their or increasing their metabolism\r\nso much its nicotine suppresses the anxiety\u00a0\u00a0 and sometimes the desire the hunger but if people\r\nare still eating out of anxiety if they’re still\u00a0\u00a0 eating under stress eating then you know when they stop\r\nsmoking and they don’t have a cigarette to put\u00a0\u00a0 in their mouth when they’re stressed they tend to\r\ngo for other things and so we need to help people\u00a0\u00a0 figure out when they stop smoking are you\r\neating because you’re hungry or are you eating\u00a0\u00a0 because you’re stressed if they’re eating\r\nbecause they’re hungry and they’re getting heavier\u00a0\u00a0 than they want to be they need to talk with their\r\ndoctor about you know thyroid tests and also let\u00a0\u00a0 their doctor educate them on biological setpoint\r\ntheory of you know not everybody’s going to be\u00a0\u00a0 a zero so you know that may be something we can\r\nhelp them deal with body acceptance issues if\u00a0\u00a0 you know maybe they’re programmed genetically to\r\nbe you know a size X whatever that is and they’re\u00a0\u00a0 not happy because they want to be a zero which our\r\nculture does tell us to do as clinicians\u00a0\u00a0 we can help them look at you know the costs and\r\nbenefits of continuing to smoke and what being\u00a0\u00a0 you know a size zero means for them to opiate\r\nabuse there’s a lot of physical stuff and we’re\u00a0\u00a0 just gonna run through it real quick because\r\nyou’re not as concerned with it the physical\u00a0\u00a0 stuff the doctors are gonna see but we need to be\r\naware of from a clinical point because it can keep\u00a0\u00a0 people from getting their basic needs met blood\r\nand injection site infections you know that’s\u00a0\u00a0 probably going to lay them up for a while but if\r\nthey have repeated infections and are repeatedly\u00a0\u00a0 out of work they can lose their job they can lose\r\ntheir housing they can you know get some sort\u00a0\u00a0 of MRSA or something else which can be really\r\nexpensive it can be life-threatening ya-ya\u00a0 \u00a0collapsed veins and this is more common obviously\r\nthis is only for injection drug users but\u00a0\u00a0 collapsed veins just as you would expect keep the\r\noxygenated blood from getting where it needs to be\u00a0\u00a0 so people are more likely to experience strokes\r\nand may have certain forms of vascular dementia\u00a0\u00a0 because of the strokes dementia we’re familiar\r\nwith endocarditis is the inflammation around\u00a0\u00a0 the heart so again this is only for needle\r\ndrug users but if you’ve got a client who is using\u00a0\u00a0 needles to inject any kind of drug be aware\r\nof that and what they get and what they inject is\u00a0\u00a0 rarely pure so knowing what else they’re injecting\r\ninto their system if they’re you know crushing\u00a0\u00a0 pills from the pharmacy you’re a little bit more\r\nsure about what they’re getting as opposed to if\u00a0\u00a0 it’s from the corner dealer and sometimes\r\nthey’re cut with really nasty things like\u00a0\u00a0 you know comic bathroom cleaner and stuff HIV if\r\npeople get HIV from injection or some other risky\u00a0\u00a0 behavior they’re probably going to experience\r\nsome depression and a lot of times HIV from\u00a0\u00a0 opiate abuse they’re gonna experience depression\r\nremorse regret all that kind of stuff anxiety\u00a0\u00a0 about how long they’re going to live what’s\r\ngoing to happen and oh those medication side\u00a0\u00a0 effects those the antiretroviral medications that\r\nthey have to take are doozies I’ve seen people go\u00a0\u00a0 through the induction weeks on their medications\r\nand it is a rough time so helping people\u00a0\u00a0 get through it so they are medication compliance\r\nso they can continue to live we need to help them\u00a0\u00a0 maintain hope and self-efficacy and all that kind\r\nof stuff to maintain that forward movement to get\u00a0\u00a0 through the induction period liver damage from\r\nacetaminophen can set people up for you know\u00a0\u00a0 physical pain among other things and it decreased\r\npain tolerance now this generally the decreased\u00a0\u00a0 pain tolerance goes away after the\r\nthe body starts producing its endorphins and\u00a0\u00a0 natural painkillers again but that initial period\r\n<a href=\"https:\/\/www.facebook.com\/beatanxietynow\/shop\/?view_public_for=592572510779219&amp;ref_code=mini_shop_profile_featured_shop_card_cta&amp;ref_surface=profile\" target=\"_blank\" rel=\"noopener\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone\" src=\"https:\/\/i.ibb.co\/Nrww7gF\/Stevie-Wright-rare-interview.png\" alt=\"Stevie-Wright-rare-interview\" width=\"562\" height=\"531\" border=\"0\" \/><\/a>\r\nif somebody quits using and maybe you know you are seeing them as a mental health client and\r\nthey had an accident or had surgery or something\u00a0\u00a0 they started using pills they got a couple of\r\nrefills then the doctor said no I’m cutting you\u00a0\u00a0 off and now they’re going through a detox period\r\ndetox from opiates is unpleasant but it is rarely\u00a0\u00a0 life-threatening unless somebody becomes their\r\nelectrolytes get imbalanced because of the flu\u00a0\u00a0 symptoms but we still may see this in private\r\npractice in mental health practice because\u00a0\u00a0 of the scenario I just told you people can start\r\ntaking painkillers as prescribed for something\u00a0\u00a0 they may get addicted you know take them for\r\na month or so then when they get off of them\u00a0\u00a0 not only do they feel like you know really bad\r\nbut their pain is also back and it may be they\u00a0\u00a0 had their wisdom teeth out that pain may be gone\r\nbut other aches and pains and everything you feel is probably going to be intensified until the\r\nbody kicks back in so educating clients about\u00a0\u00a0 this is what happens you know it’s not uncommon\r\nif you think it’s too bad go see your\u00a0\u00a0 doctor helping them make sure they’re getting\r\ngood nutrition you know it’s hard if you’ve got\u00a0\u00a0 flu symptoms to feel like you want to eat or\r\nhold anything down so what can you do to make\u00a0\u00a0 sure your body has the building blocks to make the\r\nstuff that it needs to help you feel better what\u00a0\u00a0 can you do to improve your sleep and a lot of our\r\nclients and you know where I used to work we\u00a0\u00a0 had a methadone clinic and we also had a mother\r\nbaby unit and as soon as the mothers would give\u00a0\u00a0 birth then the doctor would start them on\r\ntheir detox from methadone and he didn’t believe\u00a0\u00a0 in the kinder gentler taper he was just like okay\r\nbaby’s gone threats gone because you can’t detox\u00a0\u00a0 from somebody from opiates when they are pregnant\r\nbecause it can cause the baby to die anyway\u00a0\u00a0 so as soon as they would stop or as soon as\r\nthey weren’t pregnant anymore he would just\u00a0\u00a0 D see them and they would feel really bad I mean\r\nnot only did they just push an 8-pound something\u00a0\u00a0 out of their body but they also are experiencing\r\na decreased pain tolerance because they’re not\u00a0\u00a0 on the opiates anymore and all they want to do is\r\nsleep it’s just like please so understanding that\u00a0\u00a0 is important in helping people get through\r\nthat period even though they may want to sleep\u00a0\u00a0 all the time helping them understand that it’s\r\nimportant to maintain their circadian rhythms\u00a0\u00a0 if they have to take two or three ten-minute\r\npower naps throughout the day to get through\u00a0\u00a0 the day you know more power to them but if they\r\ncan practice good sleep hygiene they’re gonna\u00a0\u00a0 be way better off in the long run OPD opiate\r\nabuse is also or opiate use is also associated\u00a0\u00a0 with the treatment of depression but it can cause\r\ndepressive symptoms due to its pharmacological\u00a0\u00a0 properties I mean it slows everything down from\r\nyou’re gastrointestinal to your heart rate to your\u00a0\u00a0 respiration you’re not breathing as much you’re\r\nnot getting as much oxygen in you’re gonna have\u00a0\u00a0 more fatigue you’re gonna have more confusion\r\nyou’re going to have more of those symptoms of\u00a0\u00a0 depression for some people they find it is and\r\ncertain opiates they find it is a powerful way\u00a0\u00a0 to reduce anxiety it makes them feel like they’ve\r\ngot a ton of energy because they’re not stressed\u00a0\u00a0 out anymore and this last one is one of the\r\nThe main reason that I find people don’t want to give\u00a0\u00a0 up opiates is that they finally feel better when\r\nthey’re on the eating disorders commonly a coat\u00a0\u00a0 co-occur with depression and anxiety which can\r\nbe caused by nutritional deficiencies you know\u00a0\u00a0 you’re not giving your body the building blocks\r\nso it can’t make the neurotransmitters it needs\u00a0\u00a0 and it also probably disrupts your sleep some\r\nand depression anxiety can cause or trigger or\u00a0\u00a0 whatever you want to say eating disorders because\r\npeople with eating disorders may fear becoming fat\u00a0\u00a0 have low self-esteem have a sense of lack of\r\nself-control or have body dysmorphic disorder\u00a0\u00a0 so we also want to be aware that there are mental\r\nhealth stuff that can trigger dysfunctional eating\u00a0\u00a0 patterns there’s about a 24% prevalence of PTSD\r\namong people with eating disorders so if you’ve\u00a0\u00a0 got a client with eating disorders especially\r\nbulimia be on the lookout for depression anxiety\u00a0\u00a0 body dysmorphic disorder alcoholism and PTSD they\r\nmaybe smoking too but of the things, I just listed\u00a0\u00a0 that’s probably the least of their worries it’s\r\nall eating disorders are also associated with\u00a0\u00a0 alcoholism and smoking I said physical health\r\nissues now you’re seeing somebody with an eating\u00a0\u00a0 disorder it’s a mild eating disorder you’re seeing\r\nthem once a week outpatient so you’re not and you\u00a0\u00a0 have you know you have training and\r\nworking with eating disorders or maybe it’s\u00a0\u00a0 mild enough that you’re just getting supervision\r\non treating this issue whatever being aware that\u00a0\u00a0 people with eating disorders anorexia or bulimia\r\ncan have irregular heartbeats and cardiac arrest\u00a0\u00a0 due to potassium imbalances and electrolyte\r\nimbalances so if they’re not eating or if\u00a0\u00a0 they are binging and purging in some way shape or\r\nform and that includes excessive exercise which can\u00a0\u00a0 trigger a lot of heart problems they may have\r\nloss of bone mass and osteoporosis so they may\u00a0\u00a0 break bones a little bit easier going back up to\r\nthe heartbeat not to belabor the point but again\u00a0\u00a0 heart problems mean a lack of available oxygen\r\nmean confusion fatigue potential difficulty\u00a0\u00a0 sleeping depressive symptoms and you know cardiac\r\narrest in and of itself is bad kidney damage from\u00a0\u00a0 Doretta caboose and low potassium can also\r\npotentially drain damaged the adrenals which\u00a0\u00a0 are on the kidneys and so it’s important to be\r\naware of what people are using a lot of people\u00a0\u00a0 with eating disorders are going to creatively\r\nuse stimulants to suppress their appetite think\u00a0\u00a0 about any of your diet drugs your enter mean I\r\nthink it’s one of them the ones they give to help\u00a0\u00a0 people lose weight they’re stimulants\r\nthey’re intense stimulants so people who are\u00a0\u00a0 struggling with eating disorders are likely to go\r\ntowards abusing stimulants or at least using them\u00a0\u00a0 which can drain the adrenals it can in some\r\ncases have been linked to the development of\u00a0\u00a0 Addison’s disease liver damage from not eating\r\nor binging and purging causing toxin buildup\u00a0\u00a0 and possibly pain we can help people deal with it\r\nas much as we can anemia which can cause symptoms\u00a0\u00a0 of depression in and of itself so goes back to\r\nthat nutrition making sure they’re getting enough infertility which in and of itself can be\r\ndevastating for young women if they can’t\u00a0\u00a0 have children anymore or can’t have children\r\never that may be a grief issue that we need to\u00a0\u00a0 help them deal with cathartic: and this is\r\nan important one to be aware of because you\u00a0\u00a0 don’t have to have somebody who uses laxatives\r\nall the time but people who regularly use or\u00a0\u00a0 abuse laxatives can become dependent on them so\r\nwhen they don’t use them they have a feeling of\u00a0\u00a0 bloating feeling full and abdominal pain which\r\nespecially in people with eating disorders or\u00a0\u00a0 body morphic disorders surrounding just general\r\nbody fit bad back body fat can greatly increase\u00a0\u00a0 anxiety depression hopelessness and in some\r\ncases of suicidality so again educating people\u00a0\u00a0 is the first step to helping them understand what’s\r\ngoing on and how dangerous laxatives can be but\u00a0\u00a0 also if somebody is trying to cut back on their\r\nuse of laxatives or just recently stopped using\u00a0\u00a0 laxatives like when people stopped using\r\nopiates it takes the body a while to get back\u00a0\u00a0 online but for most people it eventually does\r\npeople with eating disorders also have chronic\u00a0\u00a0 ulcers which are painful and can keep you up at night\r\nAs you know gastric reflux and pancreatitis\u00a0\u00a0 which can flare up at a moment’s notice will is\r\nextraordinarily painful and can cause people to\u00a0\u00a0 lose time from school or work social activities\r\nfeel bad about themselves and also\u00a0\u00a0 pancreatitis causes a lot of bloating\r\nwhich in eating disorders is a huge trigger\u00a0\u00a0 for anxiety and depression pathological gambling\r\nis associated with stimulant abuse especially\u00a0\u00a0 cocaine methamphetamine and Ritalin to stay\r\nfocused disrupted sleep and rebound depression\u00a0\u00a0 when they quit taking that stuff they wake up and\r\nthey’re like oh wow what did I just do alcoholism\u00a0\u00a0 is also associated with pathological gambling\r\nsome people drink to calm their nerves some\u00a0\u00a0 people drink because it’s the culture if you go\r\nto any of the casinos you know their hand-and-out drinks, they’re trying to get you drunk so you\r\nkeep gambling more and there’s as we spoke about\u00a0\u00a0 earlier rebound depression or anxiety smoking\r\nmay help people increase their focus or make\u00a0\u00a0 them think they can increase their focus so if\r\nyou can’t smoke in public places this is more of\u00a0\u00a0 an issue if you have somebody who does a lot of\r\nonline gambling or they gamble at their friend’s\u00a0\u00a0 house or somebody’s house where there’s poker\r\ngames and stuff smoking has some anti-anxiety\u00a0\u00a0 anti-anxiety properties and may be part of the\r\nthe culture I know when my daddy used to have his\u00a0\u00a0 poker games everybody would smoke cigars and even\r\nthe one woman who went there would be smoking a\u00a0\u00a0 cigar with everybody else and it was just the\r\nculture of being there so there are a lot of\u00a0\u00a0 different reasons that people may use substances\r\nin addition to gambling mental health issues from\u00a0\u00a0 gambling anxiety from the stimulant use or from\r\nthe tension and release of am I going to you know\u00a0\u00a0 I’m down $20,000 am I going to make it back ADHD\r\nis also strongly associated with pathological\u00a0\u00a0 gambling bipolar disorder, especially during manic\r\nphases are associated with pathological gambling\u00a0\u00a0 generally you see them co-occurring it’s not\r\nlike gambling causes it it’s you will see co-occur depression can occur due to losses and\r\ngambling can start because somebody’s depressed\u00a0\u00a0 because of their financial situation and their\r\ntrying to figure out a way to you know borrow from\u00a0\u00a0 Peter to pay Paul and get ahead you also see\r\npathological gambling is more strongly associated\u00a0\u00a0 with people who have obsessive-compulsive\r\ndisorder if you’ve got clients with these\u00a0\u00a0 diagnoses just kind of you know be attentive to\r\nthe fact that they are more likely to engage in\u00a0\u00a0 pathological gambling or if they start gambling\r\nit’s more likely to become a problem than for\u00a0\u00a0 people who don’t have these issues internet\r\nan addiction that is diagnoseable so\u00a0\u00a0 you know I’m not just making something up\r\ndepending on your resource affects eight\u00a0\u00a0 point two percent to thirty-eight percent of the\r\ngeneral population now obviously we were looking\u00a0\u00a0 at you know like games versus you know games plus\r\nFacebook plus shopping or something so depending\u00a0\u00a0 on the study you looked at their parameters\r\nwere a little bit different but either way up\u00a0\u00a0 to 38 percent of the population has sacrificed\r\nsignificant personal recreational activities to engage in some sort of internet\r\nbehavior Internet addiction can cause anxiety or\u00a0\u00a0 depression due to eyestrain and chronic headaches\r\nyou know if you’re hurting all the time it can\u00a0\u00a0 make you feel wonky it can also interrupt your\r\nsleep can cause circadian rhythm disorder which\u00a0\u00a0 can trigger depression fatigue reduced stress\r\ntolerance this is a condition when your body\u00a0\u00a0 doesn’t know whether it’s supposed to be awake\r\nor asleep because a lot of people who engage in internet-addictive behaviors do so in the dark or\r\nyou know they don’t pay attention to whether the\u00a0\u00a0 lights are on or not they may just sit there kind of\r\nin their cave carpal tunnel contributes to pain\u00a0\u00a0 and sleep disruption because carpal tunnel does\r\nwake you up at night back ache again may disrupt\u00a0\u00a0 your sleep and can cause chronic pain during the\r\na day which can interrupt your daily activities poor\u00a0\u00a0 nutrition I know a lot of gamers that will sit\r\nthere for an entire weekend and not get up to go\u00a0\u00a0 eat so if it’s not brought to them they don’t eat\r\nthey’ll even wear adult diapers so they don’t have\u00a0\u00a0 to get up to go to the bathroom reduced immunity\r\ndue to exhaustion from not sleeping and job or\u00a0\u00a0 relationship problems I know uh several people\r\nwhose marriages ended over a world of warcraft’\u00a0\u00a0 so internet addiction is a real thing and it’s\r\nsomething that we need to be cognizant of because\u00a0\u00a0 it does cause a lot of problems and a lot of\r\nrelationships and it may be one of many problems\u00a0\u00a0 but it’s something to look at sex addiction\r\ncan cause hepatitis and a variety of different STDs\u00a0\u00a0 which if not treated can cause systemic problems\r\nit’s related to anxiety and depression because sex\u00a0\u00a0 addiction may begin in order because somebody\r\nwants to feel loved or connected maybe after\u00a0\u00a0 a breakup or because they never felt loved you’re\r\nconnected and then they feel that rush and they’re\u00a0\u00a0 like oh I like that I want to do that again part\r\nof it could be engaging in that behavior which is\u00a0\u00a0 so thrilling you know depends on the person\r\npsychological withdrawal from sex addiction\u00a0\u00a0 people who have been engaging in sex addiction\r\ntype behaviors and I include pornography addiction\u00a0\u00a0 in it for this presentation if they’re not able to\r\naccess that may start feeling anxious or depressed\u00a0\u00a0 they can’t get to that they can’t get to the\r\nthe thing that’s gonna cause the dopamine rush and\u00a0\u00a0 reflection on behaviors that they’ve engaged in\r\nas a part of their sex addiction can also prompt\u00a0\u00a0 anxiety about a spouse finding out you know am I\r\ngoing to develop an STD and am I you know how I feel about what I’ve been doing so as clinicians\r\nif we’re working with somebody who has compulsive\u00a0\u00a0 sexual behaviors even if you know anywhere about that\r\nthe spectrum we need to be aware that these things may\u00a0\u00a0 exist and figure out or help them figure out\r\nhow they feel about it and what they need to\u00a0\u00a0 do to make sure that they’re getting good sleep\r\nthat they’re dealing with their depression and\u00a0\u00a0 their anxiety so that they can have a safe internal\r\nand external environment so back to that global\u00a0\u00a0 perspective how can we and why is it important\r\nto address chronic illness and disabilities\u00a0\u00a0 that result from or cause mood disorders or\r\naddictions how can we address depression anxiety\u00a0\u00a0 and hopelessness that results from or causes\r\ndepression anxiety or physical problems how can\u00a0\u00a0 we address physical problems that are caused\r\nby mood or addictions and how can we address\u00a0\u00a0 guilt or regret which may accompany addiction\r\nrecovery or the realization of a diagnosis of a\u00a0\u00a0 disease caused by the addiction so while you kind\r\nof ponder those there was a question that came in so question what about robbing Peter to\r\npay Paul in association with trauma specifically childhood trauma so if you could clarify that\r\nfor me a little bit I had mentioned robbing Peter\u00a0\u00a0 to pay Paul in terms of gambling so I’m just so\r\nmental health issues can be caused by or trigger\u00a0\u00a0 addictions or physical health issues addictions\r\ncan cause or trigger mental health issues or\u00a0\u00a0 physical health issues that can\r\nbe caused by addictions or mental health issues\u00a0\u00a0 so again chicken-or-egg we don’t necessarily know\r\nwhich one came first when you have any one of\u00a0\u00a0 these it’s probably going to or likely impact\r\neach other person or each other area common\u00a0\u00a0 issues are seen in all three changes in sleeping\r\nchanges in nutrition fatigue and grief effective\u00a0\u00a0 treatment requires addressing the underlying\r\ncauses as well as the ripple effects you know so yes after childhood trauma or trauma\r\nof any sort, some people may spend a lot\u00a0\u00a0 of time feeding the addiction as you put it or\r\nengaging in addictive behaviors to avoid some\u00a0\u00a0 of the PTSD symptoms to avoid thinking about it\r\nto deal with the grief to deal with the shame so\u00a0\u00a0 they may engage in something that makes them\r\nfeel better or helps them forget to cope with the trauma that happened until they\r\nhave other tools so they can come to\u00a0\u00a0 some sort of terms with it and you know as I\r\nsay close that chapter in their book already\u00a0\u00a0 if there are no other questions tomorrow’s\r\nthe presentation I learned a lot creating is\u00a0\u00a0 on alcohol-related dementia and vascular dementia\r\nand fetal alcohol spectrum disorders all three of\u00a0\u00a0 which are issues that are caused by substance\r\nuse and specifically alcoholism and then I’ll\u00a0\u00a0 give you a hint about where an acute Korsakoff a\r\na lot of clients who abuse alcohol but they’re not\u00a0\u00a0 alcohol dependent who decide to stop drinking can\r\ntrigger where Nikki Korsakoff syndrome\u00a0\u00a0 and causes alcohol-related dementia-type symptoms\r\nso again in mental health, we need to be on the\u00a0\u00a0 lookout for it if we hear that our clients\r\nare trying to cut down on their alcohol use\u00a0\u00a0 alrighty everybody and so tomorrow is that\r\npresentation and then Thursday we’re going to\u00a0\u00a0 look at different models of new bottles of\r\ntreatment if you enjoy this podcast please\u00a0\u00a0 like and subscribe either in your podcast player\r\nor on YouTube, you can attend and participate\u00a0\u00a0 in our live webinars with doctor Snipes by\r\nsubscribing at all CEUs com VirtualBox this\u00a0\u00a0 episode has been brought to you in part by all\r\nCEUs calmly provide 24\/7 multimedia continuing\u00a0\u00a0 education and pre-certification training to\r\ncounselors therapists and nurses since 2006 used coupon code consular toolbox to get\r\na 20% discount on your order this month\r\n\r\n&nbsp;\r\n\r\n<img decoding=\"async\" src=\"https:\/\/images.pexels.com\/photos\/7099713\/pexels-photo-7099713.jpeg?auto=compress&amp;cs=tinysrgb&amp;h=650&amp;w=940\" \/>\r\n\r\n&nbsp;\r\n\r\n<a href=\"https:\/\/www.youtube.com\/watch?v=fBBbb4_d0aI\" target=\"_blank\" rel=\"noopener\">As found on YouTube<\/a>\r\n\r\n<a href=\"https:\/\/3be35e-jxxlr2y0zm03m5u6vcl.hop.clickbank.net\">Animated Video Maker – Create Amazing Explainer Videos | VidToon™ #1 Top Video Animation Software To Make Explainer, Marketing, Animated Videos Online It\u2019s EASIER, PRODUCTIVE, FASTER Get Commercial Rights INCLUDED when you act NOW Get Vidtoon™<\/a>","protected":false},"excerpt":{"rendered":"<p>this episode was pre-recorded as part of a live continuing\u00a0\u00a0 education webinar on-demand CEUs are still available for this presentation\u00a0\u00a0 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\u00a0\u00a0 exploring the interaction between mental health physical health and addiction so we’re &hellip; <a href=\"https:\/\/effectsofanxiety.net\/archives\/150233\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Common Co Occurring Issues in Addiction | Addiction Counselor Exam Review<\/span><\/a><\/p>\n","protected":false},"author":3,"featured_media":150231,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[101,97,4771,6],"tags":[38507,34232,59891,37897,37895,59892,38513,38514,37905,38518,38505,38516,59889,59893,37878,38508,38509,59845,38533,38520,37893,37894,38517,38521,38522,38523,38524,37876,2278,34002,38529,38525,38526,38527,37906,38528,40587,38530,59890,38506,35665],"class_list":["post-150233","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-arts-entertainment-events","category-celebrity","category-disasters-accidents","category-reducing-triggers","tag-adacb","tag-addiction","tag-addiction-counselor-exam","tag-cadc","tag-cap","tag-case-management","tag-ccapp","tag-ccdc","tag-ce4less","tag-certification-board","tag-cheap-ce","tag-chemical-dependency","tag-co-occurring","tag-cooccurring","tag-counseling","tag-counselling","tag-counsellor","tag-exam-review","tag-homestudy","tag-ladac","tag-ladc","tag-lcdc","tag-lcsw","tag-licensed-counselor","tag-lmhc","tag-lpc","tag-lpc-ce","tag-lpc-ceus","tag-mental-illness","tag-mindfulness","tag-motivational-interviewing","tag-naadac","tag-nbcc","tag-online-training","tag-quantum-units","tag-relapse-prevention","tag-samhsa","tag-sex-addiction","tag-treatment-planning","tag-unlimited-ce","tag-ytccon"],"jetpack_publicize_connections":[],"jetpack_sharing_enabled":true,"jetpack_featured_media_url":"https:\/\/effectsofanxiety.net\/wp-content\/uploads\/2023\/01\/htmlF_IMG_63c5980668bd3.jpg","_links":{"self":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts\/150233","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/comments?post=150233"}],"version-history":[{"count":7,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts\/150233\/revisions"}],"predecessor-version":[{"id":150272,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts\/150233\/revisions\/150272"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/media\/150231"}],"wp:attachment":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/media?parent=150233"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/categories?post=150233"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/tags?post=150233"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}