Addiction- Dual Diagnosis
Which of following drugs are CNS depressants
Alcohol, heroin, sleeping pills, valium, codeine
What is the most effective mode of treatment of dual diagnoses?
- A more integrative approach allows for the attention of people with a dual diagnosis
What are the cluster C personality disorders and what are they characterised by?
- Avoidant personality disorder - Dependent personality disorder - OCD All disorders share these similar things, anxious/ avoidant. Also hypersensitivity to shame and rejection - anxiousness, obsessiveness Mentality= "I must avoid unpleasant situations at all costs."
Differences between cluster A and cluster B in executive functioning?
- Cluster A = - more problems in attention and inhibition - Difficulty shifting between tasks - Cluster B = - Difficulty in executive functioning such as working memory compared to non- comorbid group - However as they are a high anxiety group it may impair their performances on cognitive tasks
What are the cluster B personality disorders?
- Narcissistic - Histrionic - Borderline personality disorder - Antisocial personality disorder All are impulsive and attention seeking Mentality= "If I want something I will do anything to obtain it"
Why do many psychiatric disorders emerge during adolescence?
- Sensitive period - Drugs linked to personality disorders, affective disorders (depression and bipolar) - Correlation between peak brain development and onset of drug use
What are the three components of Zinberg's model?
- drug - - set - setting
What are the five different pathways that may drive impulsive behaviour?
- lack of premeditative thought - lack of perseverance - sensation seeking - negative urgency - positive urgency
A physician- if the patient is experiencing _______________ psychiatric symptoms, a clinician should employ appropriate _______________ treatments, even if those symptoms are observed to be ____________________.
- psychiatric symptoms - pharmacological treatments - substance induced/substance withdrawal
What are the stages of treatment for dual diagnosis?
1. Establish good therapeutic relationship - must be non- confrontational, optimistic, empathetic, avoid making moralistic judgements 2. Persuasion - Explaining relationship with client and their psychiatric disorder - 3. Active treatment - identifying triggers so that coping skills are developed, in order to prevent - group therapy is of great value in this stage as it may
What are the most impressionable years for individuals to develop drug addiction?
13-16
It is estimated that __________% of clients with a personality disorder have an SUD. _________ % of individuals with an AUD met the criteria for a personality disorder.
50- 60% 40%
Schizophrenic patients have a higher suicide risk, estimated at ___________ .
60-120%
What is a conduct disorder?
A childhood condition, characterised y outbursts and sometimes poor academic performance in a child with normal intelligence
What is the telescoping effect?
A term applied to the accelerated progression from substance use through abuse to addiction. Women statistically are more likely to have this.
Which of the following statements is true? Individuals with bipolar affective disorder: a. poor compliance with medication is uncommon b. have a low functional impairment c. have a high risk of suicide d. Withdrawal from substances does not exacerbate individuals pre- existing psychiatric distress e. 1/3 of patients have an SUD
ANSWER = c. They have a high risk for suicide a.- individuals with bipolar disorder as most individuals with a dual diagnosis mores susceptible to poor compliance with medication b.- BP with SUD, DD , tend to have low functional impairment d.- withdrawals from the substance will exacerbate pre- existing psychiatric symptoms
What are the treatment of options for those with a dual diagnosis of anxiety and SUD?
ANXIOLYTIC PROPERTIES - Selective Seretonin repuptake inhibitors (SSRIS's) are viewed as the most effective from of treatment for individuals with A and SUD - Benzodiazepine is effective for ST anxiety symptoms- however not effective in treating - monoamine oxidase inhibitors (MAOI)
What is generally the best treatment interventions for individuals with a dual diagnostic?
Generally the best treatment method is addressing the mental illness and treating it alongside with the SUD
As discussed in class, all opiate based pain medication are in what general category?
CNS depressants
Which of the following drugs are stimulants
Caffeine, crack, nicotine, meth, diet pills
What are the temperamental dimensions?
Effortful control - conscientiousness - inhibitory control Surgency - low levels of fear - high intensity in pleasure Negative affectivity - irritability - frustration Affiliativeness - affiliation - perceptual sensitivity - pleasure sensitivity
TRUE or FALSE Discharging a patient into an environment where they were previously abusing substances will have no effect on them and will not act as a trigger for relapse.
FALSE Discharging a patient into the environment where they were previously abusing substances increases the likelihood of them relapsing
TRUE or FALSE Temperament is something that is acquired as the individual grows and matures.
FALSE Temperament refers to the more biological aspects of personality and is believed to be an innate rather than learned part of an individuals personality
TRUE or FALSE Victimisation such as assault or abuse is believed to be cause personality change and SUD's
FALSE Victimisation is often mistaken as a "post hoc ergo hoc" to SUD's (is based upon the mistaken notion that simply because one thing happens after another, the first event was a cause of the second event)
What variables should be considered when treating an individual with TBI (traumatic brain injury)?
Generally concurrent and treatments adjusted to individual levels of function and possible mental abilities etc. should be considered when treating TBI's
Schizophrenic patients exhibit ____________ urges to take cocaine thus may need intensive treatment
Higher
What is histrionic personality disorder?
Histrionic personality disorder (HPD) is defined by the American Psychiatric Association as a personality disorders characterised by a pattern of excessive attention-seeking emotions, usually beginning in early adulthood, including inappropriately seductive behaviour and an excessive need for approval.
Dissociative Disorders (DD)
Individual is able to detach from reality for periods of time to escape extreme psychological stress.
What is borderline personality disorder (BPD)?
Individuals with BPD alternate between over- idealisation of significant others and total rejection and distrust of the same person by the slightest bit of rejection. E.g. Patient waiting for therapist and they come 5 minutes late- person will automatically mistrust them
What are the main substances used during adolescents?
Inhalants, marijuana and opioids (cannabis)
The Dopamine D2 hypothesis suggests that this receptor subtype
Is found mainly in regions of the brain involved in the positive reward cascade process.
Other than naltrexone which drug has been effective in treating gambling disorder? a. benzodiazepine b. lithium c.seretonin re- uptake inhibitor d. cocaine
Lithium carbonate (Lithium), used to treat concurrent bipolar disorder, have also been found to decrease compulsive gambling
How are traumatic brain injuries assessed? a. SGS b. GCS c. GSC d. GGS
Often assessed using the Glasgow Coma Scale (GCS) - it is assessed on a spectrum mild 13-15 medium 9-12 severe 3-8
Which of following substances are in the hallucinogen category of drugs
PCP, ecstasy, LSD, psilocybin mushrooms, peyote
What are the mental illnesses that are commonly associated with persisting drug use?
Persobality dorders have a poor remission in substance use disorders ○ Antisocial personality disorder ○ Borderline personality disorder ○ Schizofrenia
The __ effect of a drug is the desired effect
Primary
Ventral striatum
Region of the brain involved in the integration of signals from the amygdala (emotional responses) with regions of the brain such as the hippocampus (memory functions) and cognitive/executive functions carried out by the prefrontal cortex regions of the brain.
What are Greyanders and Patels stages of adolescent drug abuse?
STAGE 1= initiation- first use (alone or within peer group) STAGE 2= Learning the mood swing
The __ effect of a drug is an unwanted side effect
Secondary
TRUE or FALSE adolescent cigarette smokers are more likely to develop an alcohol use disorder later in life
TRUE
TRUE or FALSE retrograde amnesia may develop where the individual doesn't even remember taking drugs prior to their TBI- denial is thus often a problem in treating people with a TBI
TRUE
TRUE or FALSE Untreated depression could potentially act as a "relapse trigger."
TRUE
OCD- obsessive compulsive disorder TRUE or FALE it is disputable whether OCD is concurrent with SUD's
TRUE however it is estimated that roughly 36% of patients with OCD have a coexisting SUD
TRUE or FALSE Adolescents are able to tolerate more amounts of alcohol and drugs than adults
TRUE Adolescent able to tolerate much more alcohol and drugs. Self regulatory ability doesn't happen as effectively as an adult, thus adolescents can take more than we would have if we are an adult.
TRUE or FALSE At different stages bipolar use different types of substances.
TRUE When they are in a depressive state tend to use alcohol Manic state use stimulants such as cocaine
Although the self-medication hypothesis is a theory, which of the following is true? a. It has not been supported by clinical research. b. Clinical evidence supports the possibility that people use compounds that dovetail nicely with their mental health issues. c. It is quite useful in clinical practice. d. Non-psychoanalytic therapists have embraced it because it is so insightful.
a.
Research has suggested that families in which one member has an alcohol use disorder: a. require up to five times the expenditure for health care as family members in a home without alcohol addiction. b. require up to 10 times the expenditure for health care as family members in a home without alcohol addiction. c. are in the majority of cases unwilling to participate in the treatment of the addicted member. d. are usually unable to be involved in the addicted person's treatment.
a.
Some of the problems in working with dual diagnosis clients can include all of the following EXCEPT: a. confrontational families who wish to wreck vengeance for the years of torment the dual diagnosis client has put them through. b. the constant need to address ancillary psychosocial issues such as housing, etc. c. the need to monitor and address client medication compliance. d. the need to monitor the possible side effects of each medication prescribed for the patient.
a.
What are some difficulties associated with dealing with individuals with DD- EXCEPT? a. DD's exist on a broad spectrum thus making it difficult to assess individuals b. Individuals with DD tend to be coerced into treatment by family/friends etc. c. Professional blindness
a.
Which of the following statements is NOT true, according to your text? a. Clinicians are able to rely on clear definitions of "childhood" and "adulthood." b. Adolescence in industrialized countries seems to have been extended. c. Some clinicians believe that experimental drug use is a regular aspect of adolescence. d. Many clinicians believe that any substance use during childhood and adolescence is a sign of a serious problem.
a.
Which group is more likely to overdose? a. Elderly b. Adolescence c. Women d. Children
a. - this may be due to age related changes in the body, such as increased body fat content, decreased blood flow
According to your text, it is often necessary to do all of the following with a patient's past psychiatric and substance use history EXCEPT: a. wait 2-8 weeks for the patient to stabilize and fully recover from the drug's effects before making a definitive diagnosis. b. totally ignore their presenting symptoms at this time. c. ask the patient whether he or she told previous mental health treatment professionals about the substance abuse problem before accepting the diagnosis from past treatment centers as being a valid diagnosis. d. provide treatment for interim symptoms until they stabilize.
b.
Children have at least a rudimentary knowledge of alcohol and its effects ________, according to your text. a. depending on whether they have older siblings or not b. by preschool c. by the time of entry into third grade d. by the time that they graduate from grade school
b.
In industrialized societies, ________ has been extended to allow the individual time to learn necessary vocational skills. a. early adolescence b. the entire period of adolescence c. late adolescence d. middle adolescence
b.
Part of the therapeutic process involves: a. not making the client responsible for change. b. not protecting the individual from the logical and natural consequences of his or her behavior. c. making the client a passive recipient of the insights offered by the more experienced therapist. d. not identifying unhealthy elements in the client's environment as this would take the focus away from his or her own recovery.
b.
The diagnostic picture for an assessor working with dual diagnosis clients: a. should be clear within 5-7 days. b. might require 2-8 weeks to become clear. c. probably will never be clear. d. should be clear within 72 hours.
b.
Women in substance abuse rehabilitation programs often report that: a. they had the substance use disorder before becoming involved in a relationship. b. their partners introduced them to the drug of abuse. c. they progressed to intravenous drug abuse more slowly than would a man who abused the same compound. d. they began to abuse chemicals in an attempt to cope with the multiple demands on their lives.
b.
Women who enter substance abuse rehabilitation are ________ to suffer from a psychiatric disorder than/as men at the time of admission to a rehabilitation program. a. less likely b. more likely c. about as likely d. as likely, but their psychiatric problems develop later in life than those of men who abuse chemicals
b.
How many patients with DD have a coexisting SUD? a. 25% b. 1/3 c. 2/3 d. 1/4 e. 3/4
b. 1/3
Which form of eating disorder is closely related to SUD?
binge eating
All of the following are true about dual diagnosis patients EXCEPT: a. they hope that their substance use will prove to be less stigmatizing than their mental illness. b. they lack trust in treatment center staff. c. Social Security disability payments are increased since the patient has two concurrent disorders. d. they often fear loss of entitlements and thus hide evidence of their substance use disorder from the assessor.
c.
As a group, women who develop cocaine use disorders: a. are more likely to have suffered some form of sexual trauma in childhood than have male cocaine abusers. b. tend to be overweight and use the anorexic effects of cocaine to help them control their weight. c. begin to use cocaine earlier in life than do male cocaine users. d. tend to use this compound by "snorting" rather than intravenously, whereas men with cocaine use disorders have the opposite pattern of cocaine use.
c.
As a group, women who develop opioid use disorders: a. are more likely to use opioids in groups, whereas men are more likely to use them in isolation. b. are more likely to have had anorexia nervosa prior to the development of their substance use disorder than women who abuse other drugs. c. begin to use these drugs later in life than do men with opioid use disorders. d. tend to abuse drugs in order to help them express their anger.
c.
In contrast to men, women are more likely to obtain their drugs of choice from: a. illicit drug dealers. b. other women who abuse the same compound. c. physicians. d. the medicine cabinets of family members.
c.
It is now acknowledged that gender influences the process of rehabilitation for all of the following reasons EXCEPT: a. different social support systems. b. hormonal changes. c. stress of being caregivers to elderly parents. d. neurochemical changes during menstruation.
c.
Which of these is not a TRUE in terms of some of the aspects to the parallel treatment approach ? a. There could be a lack of communication between the treatment groups b. After the first phase of treatment having to move them to a different floor interferes with the development of a strong therapeutic bond in one unit c. Treatment would occur in completely separate buildings d. Treatment would occur in different sections of the same building
c.
Which of these is false: Post concussion syndrome (PCS): a. PCS is a subgroup of TBI and is usually characterised by a mild concussion b. Dizziness and personality problems/ changes can occur c. Prognosis is better for the individual if they have a concussion at the time of injury d. weeks, months or in some cases years can go by before symptoms resolve
c. Prognosis is worse if the person is has lost consciousness at the time of injury
Although a mainstay in many treatment centers, there is ________ that confrontation helps clients make therapeutic change. a. mixed evidence b. limited evidence c. a great deal of evidence d. virtually no evidence
d.
External barriers that interfere with a woman's access to rehabilitation typically include all of the following, EXCEPT: a. pregnancy. b. parenthood. c. lack of access to a rehabilitation program. d. having to remain at the helms of their own businesses to avoid having to close while they are in treatment.
d.
Individuals with a dual diagnosis often have problems with medication treatment approaches, which of the following is not true: a. They are often shunned by psychiatric and substance abuse clinics b. Lack of access for care as funding is often difficult to obtain for clinics c. <10% of SUD treatment interventions offer integrative treatment d. Individuals with DD's are not coerced into treatment
d.
It has been suggested that adolescent cigarette smoking is possibly an expression of: a. the attempt to use nicotine's stimulant effects to stay awake in school. b. a desire to self-medicate adolescent angst. c. repressed anger. d. rebellion against parental authority
d.
Recovery from PCS (Post concussion syndrome) is influenced by the following EXCEPT: a. If individual sees potential gains from injury b. Genetic factors c. Person pre-injury state d. Whether or not they are coerced into treatment
d.
Social drinking for the dual diagnosis client: a. decreases the probability that a dual diagnosis client will need to be hospitalized for psychiatric treatment. b. has no effect on the individual's psychiatric disorder or its treatment. c. is possible, once the individual's primary psychiatric disorder is controlled. d. increases the probability that a dual diagnosis client will need to be hospitalized for psychiatric treatment.
d.
Unlike their parents, for whom the medication was probably prescribed, children who take narcotic analgesics from the medicine cabinet without their parents' knowledge or permission are at an increased risk of death because: a. their body size magnifies the effects of the drug ingested. b. their lack of experience with the medication's effects cause severe anxiety or panic, resulting in poor decision making on their part. c. they tend to use more than one tablet at a time in the mistaken belief that one is not enough to make them high. d. they are more likely to also use alcohol at the time that they ingest the tablet.
d.
Which of these are not professionals involved in prevention: a. GPs b. Nurses c. Case managers/social workers/vocational trainers d. Health branding marketing experts e. Dentists
e.
Which of these is NOT an example of a behavioural addiction? a. sex, b. gambling, c. eating d. shopping e. cocaine
e. As behavioural addictions are non- drug centred
Which drug has been found by emerging research to potentially be an effective treatment for gambling disorder? a. naltereone b. lithium c. nalterexine d. nalterexone
naltrexone hydrochloride (Naltrexone), an opioid antagonist used to block the excitement of addictive drugs such as alcohol, cocaine, and heroin. mitigate the frequent and intense cravings experienced by compulsive gamblers who are receiving treatment
There is __________ ________________ _____________________ between "normal" patients and coexisting illnesses SUD's with DD
no apparent difference
What does it mean when someone is classified as either a type a or type b drinkers?
type a is late onset type b is early onset
With a dual diagnosis what is/are the most common mental health disorders that coexist with drug use?
○ Most common mental health disorders that coexist with drug use - depression - anxiety - personality disorders
What is the difference between substance induced and substance independent?
○ Substance induced coexist with psychiatric symptoms and substance use. Symptoms subside after drug abstinence . However abstaining from drugs do not decrease substance independent symptoms. ○ Substance induced tend to show more symptoms than those with substance independent disorders
What is the critical time period for assessing a drug dual diagnosis? Why?
○ The timing should be at least 3 months after drug abstinence This is to rule out any residual drug effects a it can be difficult to distinguish between substance induced and independent diagnoses.
