The document discusses substance misuse as the nation's number one public health problem, noting the disease of addiction, population risk factors, treatment options, and initiatives at the Center for Addiction Medicine. It provides statistics on the prevalence and economic burden of substance use disorders and details factors influencing vulnerability, effective treatment models, and the cost-effectiveness of addiction treatment.
Presentation by Dr. Jacob Kagan on addiction psychiatry, covers the neurobiology of addiction, diagnosis and management od dually-diagnosed patients, relapse prevention, psycopharmacology interventions and more. http://www.jacobkaganmd.com
Addiction is an old enemy of mankind. Here in this presentation, it is discussed how substances having abuse potential causes temporary and permanent changes to neuronal circuits in our brain.
The Centers for Medicare and Medicaid Services (CMS) recently released S&C Memo 13-35-NH, which discusses the use of psychopharmacological medications and behavioral management in America’s Nursing Homes. The management of behavioral or psychological symptoms of dementia (BPSD) is a challenge in Nursing Homes. In this presentation viewers will learn valuable behavioral management techniques that can be utilized to decrease patient dependency on psychopharmacological medication. Important government initiatives, including The Partnership to Improve Dementia Care in Nursing Homes are discussed. The presentation also discusses the recent updates to interpretive guidelines of F309 (Quality of Care) and F329 (Unnecessary Drugs), and details the Seven Dementia Care Principles provided by CMS to assist nursing homes to manage behavioral or psychological symptoms of BPSD.
1. Learn the content of S&C Memo 13-35-NH and the implications of this memo on daily resident care
2. Learn to articulate the intent and impact of F309 and F329 on resident health and well-being, and identify strategies to maintain compliance with the regulatory intent of these regulations
3. Learn about the seven Dementia Care Principles provided by CMS to assist nursing homes to manage behavioral or psychological symptoms of BPSD
4. Identify the seven Dementia Care Principles provided by CMS to assist nursing homes to manage behavioral or psychological symptoms of BPSD
Presentation by Dr. Jacob Kagan on addiction psychiatry, covers the neurobiology of addiction, diagnosis and management od dually-diagnosed patients, relapse prevention, psycopharmacology interventions and more. http://www.jacobkaganmd.com
Addiction is an old enemy of mankind. Here in this presentation, it is discussed how substances having abuse potential causes temporary and permanent changes to neuronal circuits in our brain.
The Centers for Medicare and Medicaid Services (CMS) recently released S&C Memo 13-35-NH, which discusses the use of psychopharmacological medications and behavioral management in America’s Nursing Homes. The management of behavioral or psychological symptoms of dementia (BPSD) is a challenge in Nursing Homes. In this presentation viewers will learn valuable behavioral management techniques that can be utilized to decrease patient dependency on psychopharmacological medication. Important government initiatives, including The Partnership to Improve Dementia Care in Nursing Homes are discussed. The presentation also discusses the recent updates to interpretive guidelines of F309 (Quality of Care) and F329 (Unnecessary Drugs), and details the Seven Dementia Care Principles provided by CMS to assist nursing homes to manage behavioral or psychological symptoms of BPSD.
1. Learn the content of S&C Memo 13-35-NH and the implications of this memo on daily resident care
2. Learn to articulate the intent and impact of F309 and F329 on resident health and well-being, and identify strategies to maintain compliance with the regulatory intent of these regulations
3. Learn about the seven Dementia Care Principles provided by CMS to assist nursing homes to manage behavioral or psychological symptoms of BPSD
4. Identify the seven Dementia Care Principles provided by CMS to assist nursing homes to manage behavioral or psychological symptoms of BPSD
Kevin W. O'Neil, MD, FACP, CMD and Chief Medical Officer of Internal Medicine and Geriatrics reviews how to navigate the intricacies of substance abuse in older adults.
Mental Health Policy - Substance Abuse and Co-Occurring ConditionsDr. James Swartz
These slides are from a mental health policy lecture that focuses on substance use disorders and their relationship to mental health issues. The latter half of the lecture is devoted to discussing key points in the history of drug policy in the US and is based on information from the related text: Substance Abuse in America: A Documentary and Reference Guide
Kevin W. O'Neil, MD, FACP, CMD and Chief Medical Officer of Internal Medicine and Geriatrics reviews how to navigate the intricacies of substance abuse in older adults.
Mental Health Policy - Substance Abuse and Co-Occurring ConditionsDr. James Swartz
These slides are from a mental health policy lecture that focuses on substance use disorders and their relationship to mental health issues. The latter half of the lecture is devoted to discussing key points in the history of drug policy in the US and is based on information from the related text: Substance Abuse in America: A Documentary and Reference Guide
Psychiatric Disorders in Chemically Dependent Individuals - October 2012Dawn Farm
This program provides an overview of co-occurring addiction and psychiatric illness, including standard diagnostic criteria, individual considerations for determining the appropriate course of treatment, available treatment interventions, and the perspectives of both the addict and the treatment provider on addiction and psychiatric illness. It is presented by Dr. Patrick Gibbons, LMSW, DO; Adjunct Clinical Instructor in Psychiatry at the University of Michigan; Medical Director of the WCHO Community Crisis Response Team; consultant with Pain Management Solutions in Ann Arbor; Medical Director of the Michigan Health Professionals Recovery Program, and Medical Director of Dawn Farm. This program is part of the Dawn Farm Education Series, a FREE, annual workshop series developed to provide accurate, helpful, hopeful, practical, current information about chemical dependency, recovery, family and related issues. The Education Series is organized by Dawn Farm, a non-profit community of programs providing a continuum of chemical dependency services. For information, please see http://www.dawnfarm.org/programs/education-series.
Drug addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences.
Brain changes that occur over time with drug use challenge an addicted person’s self-control and interfere with their ability to resist intense urges to take drugs. This is why drug addiction is also a relapsing disease.
Relapse is the return to drug use after an attempt to stop. Relapse indicates the need for more or different treatment.
Most drugs affect the brain's reward circuit by flooding it with the chemical messenger dopamine. This overstimulation of the reward circuit causes the intensely pleasurable "high" that leads people to take a drug again and again.
Comprehensive Guide to Understanding Addiction.pdfaspirefriscotx
Navigate the complexities of addiction with the 'Comprehensive Guide to Understanding Addiction,' a vital resource for anyone seeking in-depth knowledge about this critical issue. This guide delves into the various types of addictions, from substance abuse to behavioral dependencies, providing a thorough exploration of the causes, effects, and treatments available.
Running head and connection to substance abuse1comorbidity an.docxtoddr4
Running head: and connection to substance abuse 1
comorbidity and connection to substance abuse 6Literature Review
Comorbidity and Its Connection to Substance Abuse, Treatment, and Relapse
Paula King
Walden University
Capstone
Dr. Jane Lyons
June 23, 2019
Comorbidity and Its Connection to Substance Abuse, Treatment, and Relapse
Comorbidity is considered as two or more conditions that occur in one person. These disorders can happen one after another or at the same time. Comorbidity has a strong connection with substance abuse, treatment, as well as relapse (Kelly & Daley, 2013). It is essential to note that many of those who suffer from substance use disorder usually develop other mental disorders, which is a similar case to many of those diagnosed with mental disorders. Research indicates that about half of those experiencing mental illnesses have a high probability of experiencing substance abuse disorders at some time in their life. Some few research have been conducted on children, and the result indicates that youths with substance abuse disorder typically have a high rate of co-occurring mental diseases like anxiety and depression (Child, 2012). Clinicians must find an effective way to treat individuals with substance use and addictions mental health disorders. To be effective they need to prescribe the right medication to treat alcohol, opioid, and nicotine addiction and there are also medications to alleviate symptoms of mental disorders. There are some behavioral therapies that have promise in treating comorbid conditions. The programs are tailored for the clients according to age, drug misused, and other factors, which can be used alone or with medication. Some effective therapies for treating comorbid conditions: cognitive behavioral therapy, Dialectical therapy, assertive community treatment, therapeutic communities, and contingency management (Kelly & Daley, 2013).
According to Woody and Blaine (1979) for over 25 years there has been a correlation between substance abuse illnesses and other mental disorders is not a visible indication that one resulted in another, albeit one came after another. Understanding the directionality or causality can sometimes be difficult because of different reasons. For instance, emotional or behavior issues may not be severe enough to raise the alarm for diagnosis. However, sub-clinical mental health concerns may prompt abuse of drugs. The main factors that contribute to comorbidity between mental illnesses and drug abuse disorders include the aspect of conventional risk factors, the possibility of mental diseases contributing to addiction and drug abuse, and the possibility of drug abuse and addiction contributing to the growth of mental health disorders (Bukstein & Horner, 2015). Drug use and mental health illnesses can result from coinciding aspects such as epigenetic and genetic exposures, concerns with related parts of the brain, and environmental factors.
Grund sifaneck-cross-cultural dimensions of self-regulation-towards a multi-d...
Cheif Presentation - Jerrold Frank Rosenbaum
1. Agenda
I. Introduction & Overview
II. The Disease of Addiction
III. Population and Risk Factors
IV. Treatment
V. Center for Addiction Medicine Initiatives
1
2. Substance Misuse: The Nation‟s
Number One Public Health Problem
There are more deaths, illnesses, and disabilities from substance
use than from any other preventable health condition
Of the more than 2 million deaths each year in the US, 1 in 4 is
attributable to alcohol, tobacco, and illicit drug use
Alcohol alone causes about 20–30% of esophageal cancer, liver
cancer, cirrhosis of the liver, homicide, epileptic seizures, and motor
vehicle accidents worldwide (WHO, 2002).
Over 22.6 million Americans have problem with alcohol or other
drugs
More than half of all families in the US has or has had a family member
suffering from alcohol dependence (NIAAA, 2005)
Alcohol use is involved in 25-50% of suicides
37% of those with alcohol dependence and 53% of those with
dependence on an illicit drug have another psychiatric illness
2
3. Economic Burden
The economic burden associated with alcohol misuse
alone is approaching $200 billion annually, far exceeding
the cost associated with other medical conditions such
as cancer ($107 billion) and heart disease ($96 billion).
When combined with other drugs the economic burden
is close to $400 billion annually.
Gruel and Rehm. 2003
3
4. MGH Facts/Figures
At MGH Outpatient Addiction Services, approximately 2
out of 3 patients have co-occurring mental health and
substance use disorder diagnoses
Inpatients with an SUD primary or secondary diagnoses
had a LOS of 2.5 days longer than those without
Patients with alcohol use issues comprise 5% of all ED
visits, but 7.2% of ED bed hours, or 3 beds in any 24
hour period
32% admitted, compared to 26% of other patients
4
6. Reduced D2 Receptor Expression Experimentally
Induced by Social Stress and Correlation with
Cocaine Self Administration
Morgan, et al., 2002, Nat Neurosci 6
8. 3-D Iso-surface Representation of Amygdala
in Cocaine Addiction Showing 23% Volume
Reduction
Superior
Right Amygdala
Right Lateral Ventricle = red Posterio Anterior
Left Lateral Ventricle = green r Patients
Normal Controls
Makris et al., 2004 Neuron
Common 8
9. Model of addiction
Addictive agent
Euphoria/
Positive Reinforcement
activated reward pathways
Drug Administration/ Neuroadaptations
Drug-Seeking Behavior Withdrawal and Tolerance
Failed impulse suppression Protracted hedonic dysregulation
Drug Craving/
Negative Reinforcement
Dysregulated reward pathways
Drug-related cues
Limbic activation
Stress
9
10. Addiction
Addiction is a disorder of brain reward centers that normally
insure the survival of organisms and the species
Drugs activate and dysregulate endogenous reward systems such
that attention, motivation, behavior are directed away from
survival goals and toward drug-related cues
Dackis and O‟Brien, 2001
Defined by loss of control over intense urges to take the drug
despite adverse consequences
Volkow and Fowler, Cereb Cortex 2000
10
11. Onset
Substance use disorders typically have onset during
adolescence and young adulthood and tend to have a chronic
course without intervention - 90% of all adults with
alcohol/drug dependence started using under the age of
18, half under the age of 15 (NSDUH, 2006)
75% of High School students have tried alcohol
Nearly 50% of seniors drink at least once a week
1 out of 4 seniors uses illicit drugs
1 out of 3 teens, age 14-17, have used an illegal drug more than once
Brain development continues well into mid-20‟s
Sustained binge drinking may affect this process, may result in damage
to frontal-cortical regions
Early intervention and recovery management offers hope for shortening
the intensity and course of the illness
11
12. Age at Onset of DSM-IV Drug
Abuse and Dependence
Compton et al. Arch Gen Psychiatry/ Vol 64, May 2007; 45(11): 1294 - 1303 12
13. Who is Vulnerable?
Adolescents
40-60% of vulnerability for addiction genetically influenced
Addiction is more prevalent in people who have the following
childhood psychiatric disorders:
Depression and Bipolar Disorder*
Anxiety
Schizophrenia
Post-Traumatic Stress Disorder
Attention Deficit Hyperactivity Disorder
Conduct Disorder*
* Denotes largest risk factor: Over half develop substance abuse
N. Volkow, 2007, Director National Institutes on Drug Abuse
Goldman, et al; ‘05 Nature Rev. Gen.; Hiroi, et al; ‘05 Mol Psychiatry
13
14. Substances of Abuse are Deleterious
in Adolescent Brain Development
Negative CNS
effects of chronic
Prefrontal structures alcohol use in
teens:
- Learning
- Information
recall, memory
(verbal, nonverbal)
- Vocabulary
- Sleep (mood,
attention)
Striatum & Hippocampus
Medial Wall 14
15. Relationship between Mental Health
and Substance Use Disorders
Complex, multifaceted
Genetics/ neurobiological
Affected by multiple systems of adolescent/young adult life
Family, Community/ School, Peers, Media
Life stresses, academic and social issues
Dynamics-self medication
Changes with maturation, normal development
Substance use can worsen the severity of pre-existing mental
health conditions; untreated mental health issues exacerbate
substance use
15
16. Clinical Imperative
Substance Use Disorders are Highly Prevalent,
Under-recognized and Under-treated
Screening is fast and effective
Even brief intervention can effect salutary change
Early Intervention is optimal
16
17. What Can Be Done?
Treatment works; extensive models are best suited
to the nature of addiction
Effective treatments exist:
Pharmacotherapy
Rarely Prescribed
Cognitive-behavioral therapy
Motivational Interventions
Community Reinforcement Model
12-step facilitation
Family therapy
17
18. Innovative Models of Care
Extensive models are best suited to the nature of
addiction
“Aftercare” – Continuing Care – Treatment
Case monitoring
Recovery management
Assertive Continuing Care
Mutual Help Groups/Peer Support
Program Evaluation
Science-based practice
Practice-based science
Intermediate Outcomes/Theory
Provides for systematic evaluation; identification of patient
subgroups/non-responders
19
19. Treatment Challenges - Stigma
Conceptualized as a disorder of „Free Will‟
“substance abuser”
Perhaps even more than other mental illness, patients with
substance use disorders feel strong sense of
shame/embarrassment, and self-loathing
Shame associated with substance use creates a barrier to
accessing treatment and disclosure/open communication
Substance use disorder is a chronic health condition similar to
hypertension, diabetes and yet is not treated as such
20
20. Is Substance-Related
Treatment Worth Its Cost?
Addiction treatment is highly cost-effective
Every $1 invested in addiction treatment programs yields a
$4-7 saving in reduced drug-related crime, criminal justice
costs, and theft alone.
When health care savings are included, total exceeds costs by
ratio of 12 to 1
Major savings to the individual and society also come from
significant drops in interpersonal conflicts, improvements in
workplace productivity, and reductions in drug-related
accidents.
Measuring and Improving Cost, Cost-Effectiveness, and Cost-Benefit for Substance Abuse Treatment Programs, U.S.
DEPARTMENT OF HEALTH AND HUMAN SERVICES, NIH, NIDA 1999.
21