Faith Communities & Mental Illness: Tools for Response and Care

Faith Communities & Mental Illness: Tools for Response and Care Addiction and Mental Illness Bill B. Burnett, M.Ed., MAC April 27, 2012

Objectives    

To understand the connection between substance use, abuse and dependence with mental illness. To review some substance abuse facts and figures. To understand the importance of neurobiology in substance abuse. To review some information about alcohol and marijuana.

Bill B. Burnett, M.Ed., MAC

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Outline of Presentation Definitions of mental disorder, substance abuse and dependence (addiction) Facts and figures about of substance use and abuse Neurobiology simplified Alcohol information Marijuana information

Bill B. Burnett, M.Ed., MAC

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WHAT IS A MENTAL DISORDER? A mental disorder or mental illness is a diagnosable illness that: affects a person’s thinking, emotional state, behavior, and disrupts the person’s ability to: – – –

work carry out other daily activities, and engage in satisfying relationships. 4

What are the substances of abuse? The DSM IV includes 11 classes of substances – – – – –

Alcohol Amphetamines Caffeine Cannabis Cocaine

– – – – – –

Hallucinogens Inhalants Nicotine Opioids Phencyclidine (PCP) Sedatives

Diagnostic Diagnosticand andStatistical StatisticalManual Manualof ofMental MentalDisorders Disorders––Fourth FourthEdition, Edition,American AmericanPsychiatric Psychiatric Association. Association. Bill B. Burnett, M.Ed., MAC

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Substance Abuse The essential feature of Substance Abuse is a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substances. There may be repeated failure to fulfill major role obligations, repeated recurrent social and interpersonal problems. Diagnostic Diagnosticand andStatistical StatisticalManual Manualof ofMental MentalDisorders Disorders––Fourth FourthEdition, Edition,American AmericanPsychiatric Psychiatric Association. Association. Bill B. Burnett, M.Ed., MAC

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Substance Dependence The essential feature of Substance Dependence is a cluster of cognitive, behavioral and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems. There is a pattern of repeated selfadministration that usually results in tolerance, withdrawal, and compulsive drug-taking behavior. Diagnostic Diagnosticand andStatistical StatisticalManual Manualof ofMental MentalDisorders Disorders––Fourth FourthEdition, Edition,American AmericanPsychiatric Psychiatric Association. Association. Bill B. Burnett, M.Ed., MAC

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Mental Illness: FACTS and Numbers One in four adults – approximately 57.7 million American experience a mental health disorder in a given year. One in 17 lives with a serious mental illness. Anxiety disorders affect 18.7% of adults An estimated 5.2 million have co-occuring mental health and addiction disorders. Suicide is the 11th leading cause of death for people ages 10-24 years. http://www.nami.org/Template.cfm?Section=About_Mental_Illness&Template=/ContentManagement/ContentDisplay.cfm&ContentID=53155

Addiction and Mental Illness

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2001 U.S. Drug Use in Past Month Alcohol

48.3%

108.9 million

Cigarettes

24.9%

60.4 million

Marijuana

5.4%

12.2 million

Ecstasy

3.6%

8.1 million

Cocaine

0.7%

1.7 million

Heroin

0.1%

123 thousand

Epidemiology of Substance Abuse

Bill B. Burnett, M.Ed., MAC

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P ercent using in past m onth

Alcohol is the Most Commonly Used Drug Among 12-20 Year Olds 45 40 35 30 25 20

Alcohol Cigarettes Marijuana

15 10 5 0 8th

Epidemiology Substance NSDUHofSurvey, Abuse

2002

10th

12th

Grade Bill B. Burnett, M.Ed., MAC

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U.S. High School Seniors 30-Day Drug Use - 2002 25.4%

Any illicit drug

Steroids

0.5% 1.4%

Inhalants

1.5%

Heroin

Cocaine Hallucinogens MDMA Tranquilizers Amphetamines Smokeless tobacco

2.3% 2.3% 2.4% 3.3% 5.5% 6.5% 21.5%

Marijuana

26.9%

Cigarettes

48%

Alcohol

0%

Epidemiology of Substance Abuse

10%

20%

30%

Bill B. Burnett, M.Ed., MAC

40%

50%

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New Users Non-prescribed Prescription drugs

Alcohol – 2009 – 4.6 million 12,500 new users daily

– 2009 – 2.6 million 7,000 new users daily

Tobacco

Any Illicit Drug

– 2009 – 2.5 million

– 2009 – 3.1 million

6,900 new users daily

8,500 new users daily

Methamphetamine

Marijuana

– 2009 – 154,000

– 2009 – 2.4 million 6,575 new users daily

422 new users daily

National Survey on Drug Use and Health (NSDUH) – 2009 Epidemiology of Substance Abuse

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Prevalence of Lifetime Use of Heroine, Cocaine, and Psychotherapeutics among Adults Aged 26 or Older, by Age of Marijuana Initiation: 1999 and 2000

Epidemiology of Substance Abuse Office of Applied SAMHSA,

13 Bill B. Burnett, M.Ed., MAC Studies, National Household Survey on Drug Abuse, 1999 and 2000.

Additional Risks Related to Alcohol Use and Aging Elderly individuals are more likely to be affected by chronic illness and use of medications Alcohol and prescription drug problems are frequently: Under-identified Under-treated Epidemiology of Substance Abuse

Under-diagnosed Under-estimated

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Scope of Alcohol/Drug Problems “Fifty percent of our (US) population either has a problem with drinking or use of illegal drugs or has a family member with the problem.”

Roger Bensinger – Board Member of the National Council on Alcoholism and Drug Dependence Inc. (NCADD) – a quote in March 22, 2004 Alcoholism & Drug Abuse Weekly.

Epidemiology of Substance Abuse

Bill B. Burnett, M.Ed., MAC

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Colleges Battle Dangerous Drinking Alcohol abuse plagues universities – The death toll from alcohol has risen among US College students from 1,440 in 1998 to 1,825 in 2005 – College responses have varied from denial that the problem exists to a complete ban of all alcohol on college property. NIAAA Epidemiology of Substance Abuse

Bill B. Burnett, M.Ed., MAC

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Percent of Prisoners with Alcohol or Drug Problems Between 50 and 85 of percent of prisoners are incarcerated because of problems related to drug and alcohol abuse. Two-thirds of adult and one-half of juvenile arrestees tested positive for at least one illicit drug. Nearly one in five state inmates said that had committed the offense to obtain money to buy drugs. National Assembly: Drugs, Alcohol Abuse and the Criminal Offender - ONDCP, 2000. Epidemiology of Substance Abuse

Bill B. Burnett, M.Ed., MAC

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Odds of an Alcohol-Dependent Individual Having a Co-occurring Disorder (General Population) DSM-IV 12-month Prevalence Odds Anxiety Disorders Panic disorder with agoraphobia

3.6x

Panic disorder without agoraphobia

3.4x

Social phobia

2.5x

Specific

2.2x

Generalized Anxiety

3.1x

Mood Disorders Major depression

3.7x

Dysthymia

2.8x

Mania

5.7x

Hypomania

5.2x

Drug Dependence Antisocial Personality Disorder

36.9x 7.1x

NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003.

Possible Causes Causes of Alcohol Addiction

Causes of Mental Illness

Genetic – family history of addiction Emotional Makeup – may use alcohol to block pain in life Psychological – persons with low self esteem or depression Social – availability, peer pressure Frequency – drinking regularly Age – young people are at great risk Gender – men are more likely to become addicted

Genetics Infections Brain defects or injury Prenatal damage Substance abuse Other – nutrition, exposure to toxins Psychological Environmental – death, dysfunctional family, changing jobs or schools, social expectations, parental substance abuse

http://www.drug-addiction-support.org/Alcohol-Addiction-Causes.html http://www.webmd.com/bipolar-disorder/features/bipolar-disporder-and-substance-abuse?page=3

Addiction and Mental Illness

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Addiction and Mental Illness At least 60% of persons battling one are battling both disorders When there is a genetic or biological vulnerability to any type of mental health problem substance may trigger the onset of that problem – Substance use is not the cause, but can be a precipitating factor that causes the condition to manifest

Some researchers are now saying that certain forms of mental illness and addictions may be a single disease – not a dual diagnosis http://www.webmd.com/bipolar-disorder/features/bipolar-disporder-and-substance-abuse

Addiction and Mental Illness

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Neurobiology Simplified Neurobiology Simplified

Bill B. Burnett, M.Ed., MAC

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The Cellular Battery All living cells are batteries capable of storing an electrical charge. Surrounding every cell is a membrane composed of a layer of lipids (fats) and proteins that limits the flow of materials into and out of the cell. This flow is strictly controlled.

Neurobiology Simplified

Bill B. Burnett, M.Ed., MAC

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Dendrites and Axons Dendrites are receivers of information input. They collect signals from other neurons and send this information to the cell body. Axons are transmitters of information output. They send this information to other neurons.

Neurobiology Simplified

Bill B. Burnett, M.Ed., MAC

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Axon - Synapse - Dendrite

How Drugs Work The meeting place between electricity and chemistry - the synapse, is where the drugs have their impact. In various ways drugs interfere or modify the orderly manufacture, the orderly release, and the orderly reabsorption or breakdown of neurotransmitters.

Neurobiology Simplified

Bill B. Burnett, M.Ed., MAC

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Neurotransmitters Transmitters come in all shapes and sizes. Some are inhibitory - they close the channels in the postsynaptic membrane making it more negative than normal. Others are excitatory - they open the channels in the postsynaptic membrane making this section less negative than normal.

Neurobiology Simplified

Bill B. Burnett, M.Ed., MAC

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Neurotransmitter, Impact and Drug Mimic

Some Neurotransmitters Dopamine (DA) Serotonin (SER) Endorphins (END) Gamma-Amniobutyric Acid (GABA) Glutamate (GLU)

Neurobiology Simplified

Bill B. Burnett, M.Ed., MAC

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Serotonin

Normal Functions – mood stability, appetite, sleep control, sexual activity, aggression, self esteem

Neurobiology Simplified

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Serotonin

Non-pharmaceutical Drugs That Disrupt Serotonin – Alcohol, nicotine, amphetamine, cocaine, PCP, LSD, MDMA, Ecstasy

Neurobiology Simplified

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Serotonin

Mental Illnesses associated with the disruption of Serotonin – Anxiety, depression, bipolar disorder, obsessive-compulsive disorder

Neurobiology Simplified

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Serotonin

Medications Used To Rebalance Serotonin – BuSpar, tricyclic antidepressants, Prozac, Zoloft, tryptophan, Ritanserin, Anafranil, Paxil

Neurobiology Simplified

Bill B. Burnett, M.Ed., MAC

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Dopamine Normal Functions – Muscle tone/control, motor behavior, energy, reward mechanism, attention span, pleasure, emotional stability, hunger/thirst/sexual satiation.

Neurobiology Simplified

Bill B. Burnett, M.Ed., MAC

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Dopamine Non-pharmaceutical Drugs That Disrupt Dopamine – Cocaine, nicotine, PCP, amphetamine, caffeine, LSD, marijuana, alcohol, opioid

Neurobiology Simplified

Bill B. Burnett, M.Ed., MAC

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Dopamine Mental Illnesses associated with the disruption of Dopamine – Schizophrenia, Parkinson’s Disease, Attention Deficit Disorder

Neurobiology Simplified

Bill B. Burnett, M.Ed., MAC

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Dopamine Medications Used To Rebalance Dopamine – MAO Inhibitors, Ritalin, phenothiazine antipsychotics, thiazone antipsychotics, tyrpsone, taurine, bromocryphine, amantadine, L-dopa

Neurobiology Simplified

Bill B. Burnett, M.Ed., MAC

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ALCOHOL

Percentage in each age group who develop first-time alcohol dependence

Age at Onset of DSM-IV Alcohol Dependence

1.8% 1.6% 1.4% 1.2% 1.0% 0.8% 0.6% 0.4% 0.2% 0.0%

5

10

15 18 21 25

30

35

40

45

50

55

60

65

Age Source: NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003

70

75

Source

The product of fermentation of complex carbohydrates and sugars in fruits, vegetables and grains.

Bill B. Burnett, M.Ed., MAC

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Neurotransmitters Depleted Gamma amino butyric acid (GABA).

Bill B. Burnett, M.Ed., MAC

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Brain Sites Affected

Cerebral cortex, cerebellum and brain stem particularly the breathing center.

Bill B. Burnett, M.Ed., MAC

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Initial Mood Alteration

Mild euphoria, relaxation and sedation.

Bill B. Burnett, M.Ed., MAC

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Acute Side Effects Intoxication Diminished hearing Diminished sense of responsibility Hangover

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Chronic Side Effects Addiction Cirrhosis of the liver Memory impairment Reasoning impairment Fetal Alcohol Syndrome

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Alcohol: Social Health Effects Total U.S. Drinking Deaths: 130,000 Drinking is involved in: 40 % 50% 20-36% 50% 25-30%

of fatal car crashes of all murders of all suicides of rapes of admissions to hospitals Bill B. Burnett, M.Ed., MAC

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“There is no problem so great that drinking cannot make far worse.” Anonymous

Bill B. Burnett, M.Ed., MAC

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Percentage in each age group who develop first-time Cannabis Use Disorders

Age at Onset of DSM-IV Cannabis Use Disorders 1.6% 1.4% 1.2% 1.0% 0.8% 0.6% 0.4% 0.2% 0.0% 5

10

15

18

25

30

35

40

45

Age Source: NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003

50

Neurotransmitters Depleted Acetylcholine, serotonin, endorphins and GABA.

Marijuana

Bill B. Burnett, M.Ed., MAC

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THC Marijuana is the dried buds and leaves of the Cannabis sativa plant. This plant contains more than 400 chemicals, including delta-9-tetrahydrocannabinol (THC), the plant’s main psychoactive chemical.

Marijuana

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Acute Side Effects Reddening of the whites of the eyes, dry throat, elevated appetite, anxiety, panic and paranoia. Short-term memory impairment. Concentration span impairment. Psychomotor impairment.

Marijuana

Bill B. Burnett, M.Ed., MAC

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Chronic side effects: Probable respiratory diseases. Possible addiction. Memory damage and decline in other intellectual skills. A marked decline in occupational performance and educational performance in children. Reduced production of reproductive hormones. Impaired ovulation, sperm production and libido. Reduced white blood cell production.

Marijuana

Bill B. Burnett, M.Ed., MAC

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Marijuana Potency More potent today with more intense effects. THC content can vary from 3 to 25 percent. THC content has been reported greater that 35 per cent on rare occasions.

Marijuana

Bill B. Burnett, M.Ed., MAC

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“Frequent marijuana use leads to more tissue destruction and long-term impairment of our highest intellectual functions than almost any other drug of abuse. Robert Gilkeson, Director Brain Research Institute, California

Marijuana

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The good news is… Drug abuse is a preventable behavior And Drug addiction is a treatable disease

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WEB Sites YRBSS http://www.cdc.gov/healthyyouth/yrbs/index.htm Institute of Medicine http://www.iom.edu NIDA http://www.nida.nih.gov NIAAA http://www.niaaa.nih.gov NIAAA http://www.niaaa.nih.gov

Epidemiology of Substance Abuse

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