Week 5b: Co-ocuring Disorders

Question 1

Co-occurring disorders

Answer 1

• Continuum: evaluation takes position in to account

Psychiatric I——————–I Substance

• Not just do you have it but severity. Some may cycle in and out of diagnosis/severity over time.
• Both DSM5 psyciatric diagnosis (affective/personality) + an SUD diagnosis.
• symptoms, neurobiology, genetics may overlap ➡︎ Proper diagnosis important

Question 2

Co-OC Bipolar Disorder | SUD

Answer 2

Common themes in clients with bipolar disorder + substance abuse include:

• Strong emphasis on depression, as opposed to mania (and
  non-compliance). SU often becomes self-medication
• Predominance of hopelessness
• Specific pattern of medication non-compliance
• Patient labels substance abuse as self-medication

Question 3

CO-OC with Substance Use Disorder

Answer 3

Big 3 (Cannabis, Tobacco, Alcohol)

• Cannabis with alcohol = 50%
• Cannabis with tobacco = 53%
• Tobacco with everything

*Comorbidity with “current alcohol, drug, anxiety, depressive, bipolar, and personality disorders ranges from 22% to 32%.

*Nicotine-dependent smokers are 2.7-8.1 times more likely to have these disorders than nondependent smokers, never-smokers, or ex-smokers.

Question 4

Treating CO-OC SA means:

Answer 4

• addressing both mental illness and substance abuse
• Treating one and ignoring other will result in relapse
• APA produced Practice Guidelines for Treatment of Psychiatric Disorders​

Question 5

Treatment Guideline | CO-OC with SUD

Answer 5

​1. Establish and maintain a therapeutic alliance with the client

2. Manage the client’s psychiatric (and substance use)
   symptoms and monitor the status of these over time.
3. Provide education regarding the disorder(s) and treatment.
4. Determine the need for medications and other specific treatments.
5. Develop an overall treatment plan.
6. Enhance adherence to the treatment plan.
7. Help client and family adapt to psychosocial effects of disorder(s).
8. Promote early recognition of new episodes and identify factors that precipitate or perpetuate episodes.
9. Initiate efforts to relieve and improve family functioning.
10. Facilitate access to services and coordinate resources among different service providers

Question 6

Serious Mental Illness (SMI)

Answer 6

1 in 5 adults experience SMI in Canada PER YEAR

• Only ~12% receiving treatment
• MUST ‘look’ for comorbid disorders

Question 7

Affective Disorders and Suicide

Answer 7

• Depressed patients more likely to experience thoughts of suicide. Drugs increase risk factor
• Suicide 15x higher in those with COOC affective disorders + chems
• Feelings of shame also contribute to the vicious cycle

​Co-occurring Disorders

• Compared to nonsmokers, smokers more frequently report having a major depressive episode
• Alcohol has bidirectional and multigenerational relationships with depression. Seems to be the worst aggravating depression
• Internet addiction linked to depression & insomnia
• Treatment for substance addiction in comorbid depression cases improves depression, but each week of delay in treating the substance use disorder decreases the likelihood of depression improvement. Really important to treat both.

Question 8

CO-OCurring disorders: Prevalence

Answer 8

Common range = 40-60% have a substance use disorder CO-OCurring

• Strongest correlation is cannabis and schizophernia
• Next is Alcohol abuse correlates to __________
• ~50% of individuals affected with severe mental disorders are affected by substance abuse. In Canada, 37% of alcoholics and 53% of other drug abusers also have at least one serious mental illness
• Adults with SMI (serious mental illness) show higher drug abuse. Seem to use more drugs
• Behavioural addictions likely similar: gambling (sex, shopping, work) seem similar.