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    Complete presentation -_cashain_david Complete presentation -_cashain_david Presentation Transcript

    • Core Skills I&II - Dual Diagnosis Cashain David Prisons and beyond 2008
    • Dual Diagnosis in 8 minutes !
    • Stress, Vulnerability, and “Normal Deviations”-(Understanding Drugs and Mental Health in Eight Minutes…)
    • Dual-Diagnosis is an expression that describes the institutions, not the patient.
    • Mental Health Sector Alcohol and Other Drug Sector
    • Mental Health Sector Alcohol and Other Drug Sector Corrective Services
    • Mental Health Sector Alcohol and Other Drug Sector Triple-Diagnosis? Corrective Services
    • Normal Distribution- Bell curve.
    • Normal Distribution- I.Q. scores.
    • Normal Distribution- human gestation period- (live births).
    • The effect of lighting a cigarette upon bus arrival times. A B
    • DSM: IV and the range of human behaviour and belief.Illness Normal Illness
    • The Stress Vulnerability Model.
    • Psychological and Physiological Responses to Environmental Stressors.
    • Stress, Anxiety and Depression may motivate us to modify our environment.
    • If you can’t alter your external environment, you mayuse techniques designed to “internally” modify the levels of stress you are experiencing.
    • Some use more immediate means to alter their state of consciousness.
    • Environmental Factors modulate genetic predispositions, potentially shifting anyone either up or down the Stress / Vulnerability Gradient.
    • Social isolation, disconnection, and discrimination are all risk factors for psychosis and other symptoms of mental illness.
    • Social inclusion, extended families, rewarding relationships, andother broad social supports can outweigh the effects of pre-existing vulnerabilities.
    • Some environments greatly elevate stress, or are characterized byalternating periods of “Hypo-stress” with short bursts of “Hyper- stress”.
    • Some environments are deliberately designed to induce adverse changes in mental state.
    • The same social and environmental stressors that increasesusceptibility to mental illness, can also encourage problematic or dependent patterns of drug use.
    • 18.7% of America’s homeless are veterans of war, and veterans are more than twice as likely to be homeless as those in thegeneral population. With 141,000 homeless war veterans in America, there are currently more troops living rough on U.S. streets than there are serving in Iraq.
    • If you lack the social and economic means to alter yourenvironment, it is always easy to alter your perceptions of that environment.
    • Most people use drugs to regulate their mood.
    • Drug use can increase or decrease our individualvulnerability to symptoms of mental illness.It depends on the drug, the person, the dose and frequency of use, and the setting. -- < Me ill. > Me well again.
    • Non-medical drug use may be functional, relaxing or sociallyenabling. Sometimes, it can prove to be problematic, stressful and socially isolating. Illicit drug use may increase susceptibility to mental illness not only through acute intoxication, but also through chronic use, through withdrawal, or through other factors, such as poverty, or fear of arrest .
    • Drug use may be one of many environmental factors that can increase or decrease our vulnerability to symptoms of mental illness. When problematic patterns of use evolve from a “copingstrategy”, this may be a symptom of an intolerable environment or social circumstances in which the person feels powerless to realistically effect any change.
    • Understanding Co-Morbidity in one sentence… Treating problematic drug use, or mental illness, in isolation from each other, and without addressingbroader social and economic circumstances, is treating the symptoms, not the causes, of “co-morbid” disorders.
    • Comments and questions ?
    • Components of the Community of Self CONSCIENCE WILL REASON DRIVESCommunity of Self MEMORY SENSES EGO Cashain David Prisons and Beyond 2008
    • Na’im Akbar is a Clinical Psychologistin the Department of Psychology atFlorida State University inTallahassee..Dr. Akbar, a Muslim, says that none ofthe concepts in his works are limitedto any particular cultural group.It was written for the uninitiated and itcan and should be used as a tool tohelp us understand ourselves andgrow ourselves.In his book, Dr. Akbar explains howthe Community of Self has specialistswithin it just like one would find in anyother community.
    • The Community of Self CONSCIENCE WILLREASON DRIVES MEMORY SENSES EGO
    • The earliest citizens in the self community,says Akbar, are the drives or instinctswhich are the movers of the self. There aretwo types/classes of drives. One ismovement towards what gives pleasureand the other is the reverse in that it movesone away from what causes pain ordissatisfaction. In a word, we humans havean affinity for pleasure and an aversion topain. "If the drives are given free rein, theywill drive the entire community to seek onlypleasure."
    • Senses are defined as the windows of thecommunity into the outside world. "Thesenses are to the community of self whatcommunication is to communities ofpeople." They give only incompleteinformation about things and are thereforenot capable of making judgments. "Wemust conclude, says Akbar, "that thesenses are an important part of thecommunity, but they make a poor rulerover the self."
    • Another prominent citizen of the selfcommunity is the ego. The ego uses thetool of emotion to speak up for the rights ofthe individual and is therefore vital for thelife of the community. And when it is notproperly developed, the community fails tosupport itself. An overdeveloped ego,however is a detriment to the community.The ego fails to concern itself with thingswhich it cannot see and can therefore be atyrannical ruler over the community. Akbartherefore concludes that ego is anecessary citizen but "not an appropriateruler over the self."
    • Memory is another important member ofthe community of self. Like a library, it"stores the many records of experiencethat have gone into the building of theperson." "Without memory, there would belittle continuity in the community," saysAkbar, "But, we can also see that ifmemory rules the community, thecommunity lives in the past."
    • Reason is another important member ofselfhood. "Reason brings order andorganization to the information brought inby the senses." It lets know that our sensesgive us incomplete information and worksthroughout the community keeping orderand organization. Reason judges only onthe basis of facts and if it tried to rule thecommunity, the self becomes like amachine because unfeeling order destroyspeace and happiness within the self.
    • As the conscience begins to develop, theelement of justice is introduced into thecommunity. Conscience gives upwarddirection to the community of self, butAkbar warns us that, "An uncheckedconscience, however, can be as disruptiveto the self community as the other partspreviously discussed. The over-developedconscience can demand nothing short ofperfection and its self-sacrificing tendencycan become greedy for punishment."Conscience doesn’t have the restraint torule the community.
    • Dr. Akbar tells us the ruler over the selfcommunity is the Will. He says man’s Willhas the ability to pull the mind and flesh inthe direction of Truth. Akbar defines theWill as "the Divine representative within theperson when working with the higher partsof conscience and guided by the properdirection." And "when the Will achievesrulership over the self community, the selfgrows to be the proper ruler over theearth." In a word, if we are to restore ourcommunities, we must first understand anddevelop our communities of self.
    • Questions / Comments ?
    • CASE STUDYPrisons and Beyond
    • Our client (M) is 40 years old afro-Caribbean male.He has been diagnosed with paranoidSchizophrenia and he believes nothingwrong with him but little depression in thepastHe also has a long history of poly-substance misuse, including cannabis,crack cocaine and heavy alcohol use
    • Past historyThere is no M has long forensicinformation held history over 100about M`s childhood convictions of theftor family history but One conviction forborn and brought up violence in 89in London by One other forgrandparents which possession ofhe describes as very shotgun in 92religious
    • Past historyThrough out his late teens and twenties heoften lived rough on the streets as he hadbeen made homeless whilst going “in andout” of prisonAlthough he has auditory hallucinations inthe third person,He was very long time non-compliant withmedication
    • Current presentationM believes because of his stealing God iswhich he refers as Jesus angry with himand punish him with this voices, “all Goddoing” and “Jesus is not forgiven”He believes he should give up anddisgusted with alcohol and after effectseach time he drinks….butHas no problem with his smoking cannabisas he controls it
    • currentHe lives in a dual diagnosis residentialhouse with other forensic clients and hedoes not likes itHe likes playing music, drinking, smokingand nothing elseAlthough he wants a job when he has hegive up easilyPlan is move him independent living
    • The TaskIn groups / pairsUse one member of the community of selfto consider one key intervention that wouldbe helpful10 minutesFeedback to wider group