Prevention, Identification, Recovery and Management of Substance Abuse and Mental Illness

Talk. They Hear You. Campaign

• Reduce underage drinking and substance use for youths (under the age of 21)

• Provide resources for parents and caregivers to discuss topics with children

Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD)

• Coordinate 15 federal agencies to develop A Comprehensive Plan for Preventing and Reducing Underage Drinking

STOP Underage Drinking

• ICCPUD website with research, federal and state resources, and fundraising opportunities to reduce and prevent underage drinking

National Prevention Week (May)

• Promote community involvement, resource distribution, and partnerships to increase public awareness of substance use and mental disorders

Communities Talk to Prevent Alcohol and Other Drug Misuse

• National initiative providing resources and stipend for community-based organizations, institutions of higher education, and statewide or state-based organizations

• Organize activities to raise awareness of the harmful consequences of alcohol and other drug misuse in youth and young adults aged 12 to 25 years old

National Children’s Mental Health Awareness Day (May)

• Increase public awareness of the needs of children with serious mental illness and severe emotional disturbance

• Share children’s mental health initiatives that promote positive youth development, recovery, and resilience

Federal Commission on School Safety

• Recommend policy and best practices for school violence prevention

National Child Traumatic Stress Initiative (NCTSI)

• Raise awareness about the impact of trauma on children and adolescents as a behavioural health concern

• Develops and implements evidence-based interventions to reduce the mental health impact of traumatic experiences on children and adolescents

Medication

• Medication is the most commonly used of the medical therapies

Electroconvulsive Therapy (ECT)

• Is used in some severe cases of depression that do not respond to other treatments

• The patient is anesthetized and given a muscle relaxant before the induction of general seizures, which are produced by electricity applied through electrodes on the head

Psychosurgery

• The attempt to improve psychological disorders through the use of brain surgery

Brain Stimulation

• Electrical stimulation applied through surgically implanted electrodes that is used to treat some anxiety and mood disorders

Neurofeedback

• A type of biofeedback used to treat attention deficit hyperactivity disorder and seizures by teaching the client to keep measures of brain activity within a certain range

Approaches to treating psychological disorders

Treating autism spectrum disorder (ASD)

• Although Autism spectrum disorder (ASD) is accompanied by abnormalities in the neurotransmitters serotonin, GABA (Gamma-aminobutyric acid), and glutamate, no medication has been proved effective in alleviating symptoms

• The most commonly used psychological treatment for ASD is ABA (applied behaviour analysis), which relies on the principles of operant conditioning

• ABA focuses on observable, socially important behaviours such as language and should produce lasting improvements that generalize to settings outside the therapy setting

Treating attention deficit hyperactivity disorder (ADHD)

• Many children with a diagnosis of ADHD are treated with medication, either alone or in combination with behaviour therapy

• The most commonly prescribed drugs for ADHD are closely related stimulations methylphenidate (Ritalin), dextroamphetamine (Dexedrine or Dextrostat), and a combination of amphetamine salts (Adderall)

  • These drums increase the activity of dopamine and norepinephrine

  • The rationale for stimulant treatment of ADHD suggests that impulsive hyperactivity occurs if the parts of the brain responsible for planned, thoughtful behaviour, such as the basal ganglia and frontal lobes, are not active enough

Treating schizophrenia

• The medication, phenothiazines, reduce psychosis, which acts as dopamine antagonists, blocking dopamine at the receptor sites

  • Problem: nearly one quarter of patients with schizophrenia do not respond to these drugs

  • The drugs successfully reduce psychotic symptoms, such as hallucinations and delusions, but are often less effective in reducing negative symptoms, such as social withdrawal and emotional disturbance

  • Tardive dyskinesia: a syndrome that results from the use of phenothiazines by some patients; the syndrome produces tremors and involuntary movements, especially of the face and tongue

• Most individuals with schizophrenia are treated with medication, but psychological treatments still have much to offer

Treating bipolar disorder

• The primary method of treating bipolar disorder is medication

• The most commonly prescribed medication is a simple salt, lithium carbonate

  • Lithium’s actions are specific to bipolar disorder - people who do not have bipolar symptoms show no changes in behaviour when given lithium

  • Has unpleasant and potentially dangerous side effects

    • Toxic levels of lithium produce nausea, vomiting, muscular tremors, seizures, and even coma

    • Because of these risks, patients must have regular blood tests to monitor their lithium levels

• Most individuals with bipolar disorder appear to require medication to alleviate their symptoms, and psychotherapy alone is not typically considered an option

Treating major depressive disorder

• Given the range of suspected causal factors in depression, treatment approaches are equally diverse

• Treatment ranges from medical, to cognitive, to behavioural, to simple aerobic exercise, and combinations of these approaches are common

• The most popular method for treating major depressive disorder today is the use of medication

  • The most widely prescribed medication are the selective serotonin reuptake inhibitors (SSRIs), which include popular brands like Prozac and Zoloft

    • As their name implies, these medications increase serotonin activity at the synapse by interfering with reuptake of the neurotransmitter

    • As a result, more serotonin is available in the synapse

• A number of psychotherapy alternatives are quite successful in alleviating depression and have the added benefit of producing no adverse side effects

  • One of the most popular approaches is the use of CBT (Cognitive-behavioural therapy)

Treating anxiety disorders

• Anxiety disorders, including general anxiety disorder, phobias, and panic disorder, are typically treated by using medication, CBT, or a combination of the two

• Anxiety is associated with a heightened level of brain activity because of anticipated danger; consequently, most efforts to medicate anxiety attempt to reduce brain activity, or produce a “tranquilizing” effect

• Because GABA is the major inhibitory neurotransmitter in the brain, a common method for slowing brain activity is to enhance the effects of GABA

  • Although these drugs are used occasionally, the antidepressants previously discussed are typically more effective

  • This result might reflect a common underlying cause for both depression and anxiety

Treating obsessive compulsive disorder (OCD)

• OCD can be treated with antidepressant medication, CBT, or a combination of both

• CBT for OCD involves training the person to anticipate compulsive behaviour and then to engage in a competing behaviour

• Meta-analysis shows that CBT is a highly effective approach to treating OCD

Treating body dysmorphic disorders

• CBT is particularly helpful in cases of body dysmorphic disorder

• In CBT, cognitive restructuring can help the individual think more realistically about perceived physical flaws

• Many individuals with this disorder, however, insist on continued treatment by cosmetic surgeons and resist suggestions that they should obtain psychotherapy

Treating post-traumatic stress disorder

• PTSD is typically treated using exposure therapy with or without SSRI medications

• Because many people with PTSD also develop a variety of substance use disorders, additional treatment addressing these disorders is necessary for full recovery

Treating dissociative identity disorder

• The treatment of dissociative identity disorder can be quite controversial, as is the diagnosis of this condition

• Some psychotherapists work on the assumption that dissociative identity disorder is a valid diagnostic category that often results from serious trauma, childhood sexual abuse in particular

• Treatment is aimed toward integrating the various personalities by first identifying and “working through” the traumatic memories related to the disorder

• Hypnosis is commonly used by these therapists to assist in the recovery and resolution of traumatic memories, but this practice is not well advised

  • Under hypnosis a suggestive person might be vulnerable to the manufacture of false memories, and individuals identified as having dissociative identity disorder appear to be far more suggestible than the general public

Treating somatic symptom disorders

• Both biological and psychological treatments are commonly used to treat somatic symptom disorders, which involve physical symptoms such as pain that have no apparent physical basis

• Among the best biological treatments for somatic symptom disorders are medication with antidepressants and increases in physical activity

Treating antisocial personality disorder

• Finding effective treatments for antisocial personality disorder has a high priority, given the extent of harm individuals in this category inflict upon the rest of society

• Effective treatments appear elusive

• No known medications specifically reduce antisocial behaviour, although many incarcerated individuals are treated with tranquilizing drugs, including antipsychotic and anticonvulsant medications, to make their aggressive, violent behaviour more manageable

• Even if effective medications are discovered, individuals with antisocial personality disorders tend to view themselves as “okay,” and not in need of treatment

• Psychological treatments for antisocial personality disorder include learning models that emphasize anger control, social skills, and moral reasoning

Treating borderline personality disorder

• No medications are currently approved specifically for the treatment of borderline personality disorder, but medications are frequently prescribed

• Among the commonly prescribed medications are antidepressants, antipsychotic medications, mood stabilizers (ex. lithium), anti-anxiety medications, and anticonvulsants

• Psychotherapy for borderline personality disorder often takes the form of CBT

  • In this case, the individual learns to manage stress, emotions, and relationships

  • In particular, psychotherapists emphasizes skills aimed at reducing the individuals potential for suicidal thinking and behaviour

  • A therapy specially designed for individuals with BPD, dialectical behaviour therapy (DBT), attempts to address symptoms in the order or their importance: reducing suicidal thoughts, reducing behaviours that interfere with therapy, and finally reducing behaviours that interfere with the quality of life

4 major dimensions of recovery

1. Health: overcoming disease or managing symptoms by making informed health choices that support both physical and psychological well-being (ex. Abstaining from use of alcohol, illicit drugs, non-prescribed medications for addictions)

2. Home: a stable safe place to live

3. Purpose: meaningful daily activities to be independent, earn income, and participate in society (ex. a job, volunteering, family caretaking, creating endeavors)

4. Community: have relationships for a support system, friendship, love, and hope