Group BCoral, Krystal, Shade, Nani, & Christina

Mental Illness & a CSAC’s Approach

What do we need to know about the severely

mentally ill person as substance abuse

counselors? Even though we don’t treat it, how can

we provide support to clients with this issue?

What resources are there in Hawaii to treat them?

We believe that in order for a CSAC to properly treat a client with a mental health disorder

they must first understand mental health issues,

familiarizing themselves with causes, symptoms and

treatments. Secondly, but equaly as important, is be able to

identify these symptoms and have knowledge of the resources available within the community to properly diagnose and treat the

client.

We chose to focus on five commonly diagnosed

mental illness disorders

Bi-polar

SCHIZOPHRENIADepression

PTSD

Schizophreniais a mental disorder characterized by abnormalities in the perception or expression of reality. It most commonly manifests as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking with significant social or occupational dysfunction. ...

CausesThere are many theories and hypothesis about

the causes of Schizophrenia • Genetic and environmental factors are thought to act in

combination to trigger the onset of the disorder• Changes in the neurotransmitters such

as dopamine, GABA, nor epinephrine, serotonin, glutamate, and acetylcholine

• Auto-immune damage• Some believe it is a neurodegenerative

disorder• Some believe it is an inherited disorder

that is exacerbated by stress and hormonal changes

SymptomsPositive symptoms: • Paranoia• Delusions• hallucinations (usually auditory)

• thought disorder• disorganized speech• psychosis

Negative symptoms:• flat or blunted affect and emotion• poverty of speech• anhedonia (the inability to experience

pleasure)• lack of desire to form relationships• lack of motivation

There are several subtypes of schizophrenia each defined by their predominant clinical

symptoms. Three common types are:– Disorganized: symptoms include grimaces, bizarre

mannerisms, hypochondriacally complaints, extreme social withdrawal, and other behavioral oddities associated with schizophrenia.

– Paranoid: symptoms include hallucinations, persecutory or grandiose delusions, anxiety, anger, become argumentive and violence.

– Catatonic: symptoms include mutism, psychomotor disturbance that may involve stupor or excitement, negativism, rigidity, or posturing.

Treatment • Developing a treatment “TEAM”

which includes:– Psychiatrist– Primary Care Physician– CSAC– LCSW or case manager– Family Members

• Stabilize the positive symptoms with anti-psychotic medication such as but not limited to: – Clozaril– Seroquel– Risperdal– Haldol– Anti-depressants

• Cognitive Behavioral Therapy:– which helps them decrease some symptoms and

improve their ability to function socially• Therapy to improve:– coping skills– money management skills– problem solving skills– medication management skills

Treatment cont…

challenges in treating a

Schizophrenic• Denial of disorder• Disorganized – can’t remember to take meds

or keep appointments• Substance abuse• A treatment plan that is

too complicated• Medication side effects

Schizophrenia Statistics and Facts•A person with Schizophrenia is more than four times more likely to

have a substance-abuse problem than someone without Schizophrenia.•Approximately 47% of patients with Schizophrenia have a diagnosis of substance abuse.•Approximately 1.2% (3.2 million) of Americans have Schizophrenia•According to Paul at BISAC about 60% of their clientele have a dual-diagnosis or co-occurring mental disorders.•Approximately 20% of the United States prison population could be classified as dually-diagnosed.•The most common onset of schizophrenia is during adolescence or early adulthood. •The most common drugs abused by schizophrenics are nicotine and alcohol, followed by marijuana, cocaine, meth, and tranquilizers.•Psychoactive drugs such as cocaine, meth, PCP, LSD, ecstasy and special K may cause some symptoms that mimic schizophrenia or may cause present symptoms to intensify. •Symptoms of alcohol withdrawal such as hallucinations may mimic those of Schizophrenia.

Attention Deficit Hyperactivity Disorder

(ADHD)

Neurobehavioral disorder characterized by pervasive inattention and hyperactivity-impulsivity that often results in substantial functional impairment

Symptoms • Inattention• Hyperactivity• Impulsivity

Subtypes• Predominantly hyperactive-impulsive:– 6 or more symptoms in the hyperactivity-

impulsivity categories

• Predominantly inattentive:– 6 or more symptoms in the inattention

category

• Combined hyperactive-impulsive & Inattention:– 6 or more symptoms from hyperactivity-

impulsivity and inattention categories(Most common)

• Genes• Environmental factors (ex. Lead)• Brain injuries• Premature delivery• Tobacco and Alcohol use during pregnancy• Low birth rate

CausesExact cause is unknown butstudy suggests it may be linked to:

Treatment

Treatment can relieve many of the disorder’s symptoms

but can not cure ADHD• Medication• Various types of Psychotherapy• Education and Training• A combination of treatments

Manic depression, severe mood swings that are associated with

highs and lows.

Bi-polar

Causes:

Bipolar is not onset by anything specifically, however there is a great deal of scientific

evidence that indicate chemical imbalance in the brain. A combination of hereditary and

environmental triggers are viable theories that causes this imbalance.

Symptoms

High and optimistic feeling and emotionsExtreme irritability towards others and selfSleep depravation, yet exceedingly energeticRapid speechImpaired judgment and impulsivenessReckless behavior without foresight of consequences

Treatment

Side effects

•Currently, over 115 different medications are used in treatment of Bipolar Disorder.•Some of the more common prescribed medications are Trazodone, Zoloft, and Wellbutrin.•These medications help with stabilizing moods by either increasing or decreasing chemical balances.

Trazodone

Side Effects

• Loss of appetite• Fatigue• Dry mouth• Head aches• Dizziness & many more

•Although there are many side effects, they do vary from person to person because of physiological differences.•If left untreated may result in suicide

Feeling of sadness, worthlessness, hopelessness, etc. to the extent in which it affects your everyday life & activities.

Depression

There is no single absolute cause of depression. Every situation varies drastically. Among all, the one universal quality all causes share is loss.

Causes

• Agitation• Restlessness• Irritability• Change in sleep patterns• Change in appetite• Difficulty concentrating• Fatigue• Lack of energy• Hopelessness• Helplessness• Worthlessness• Self-hatred• Guilt• Withdrawal from usual enjoyed activities• Thoughts of death or suicide

Symptoms

There are several different types of depression. Often they are distinguished by their prevalent features, duration and severity of symptoms.

Types•Major Depressive Disorder: • A major depressive episode occurs

with symptoms that last for most of the day, nearly every day for at least two weeks

•Dysthymic Disorder:• Nearly constant depressed mood for

at least 2 years accompanied by at least two other symptoms

•Manic Depression:(now known as Bipolar Disorder)• This kind of depression includes

periods of mania and depression.

•Situational or Reactive•Postpartum•Seasonal Affective Disorder•Atypical •Chronic •Endogenous •Psychotic

Other types of depression:

TreatmentsDrugs help depression by elevating the two brain chemicals, serotonin and nor epinephrine, which are believed to be associated with mood improvements, especially when combined with psychoactive treatment.

The most common groups of anti-depressions are:

- SSRI's (Selective Serotonin Reuptake Inhibitors)-Tricyclic anti-depressants- MAOI's (monoamine oxidase Inhibitors)

• self-destructive thoughts• heartburn• drowsiness• loss of appetite• dry mouth• constipation• weight gain• sleepiness

Side Affects

Post Traumatic Stress Disorder

Is an anxiety disorder that can develop after exposure to a terrifying event in which grave physical harm occurred or was threatened

•Combat exposure •Rape •Childhood neglect and physical abuse•Sexual molestation •Physical attack •Being threatened with a weapon

Causes

Symptoms of PTSD include

• Startling easily• Becoming emotionally numb• Losing interest in things that were once enjoyable• Aggressive & violent behavior• Difficulty sleeping & concentrating• Flashbacks

• Cognitive therapy:– This type of talk therapy helps you identify and change self-destructive thought

(cognitive) patterns.

• Exposure therapy:– This behavioral therapy technique helps you safely confront the very thing that

you find upsetting or disturbing, so that you can learn to cope effectively with it.

• Eye movement desensitization and reprocessing (EMDR):– This type of therapy combines exposure therapy with a series of guided eye

movements that help you process traumatic memories.

• Cognitive behavior therapy:– This approach combines cognitive and behavior therapy to help you identify

unhealthy beliefs and behaviors and replace them with positive ones.

• Anti-depressants, anti-anxiety medications: – Selective serotonin reuptake inhibitors (Celexa, Paxil, Prozac, Zoloft)

Treatment

Common issues experienced

by someone with PTSD

• Depression & anxiety

• Substance abuse• Eating disorders • Suicidal thoughts

& actions• Employment &

relationship problems

CSAC’s Approach

After learning about various disorders to better understand them and identify their symptoms we would:

• Assess client, if symptoms are present refer them to their PCP or Psychologist for proper diagnosis.

• Continue to work with the client in the area of substance abuse treatment if recommended by their physician.

• Be an active member of the clients health care team by maintaining regular communication with the clients PCP and/or Psychologist, follow recommended treatment plan and conduct regular follow ups with the client.

a CSAC may face some of the following Roadblocks

• Physicians prescribing narcotics to recovering addicts

• Family enable ling• Client continuing to live in

the same environment • Dual diagnoses– the symptoms of the drug and/or

alcohol addiction may conceal the symptoms of a mental illness or vice versa

Some Disturbing Stats• Over 70% of the prison

population suffer from two or more mental health issues

• 4 out of 10 leading causes of disability in the US and other developed nations are due to mental illness disorders

• 1 in 10 children have a mental health disorder between the ages of 1 and 15

• Globally, over 450 million people suffer from a mental health problem or mental illness

The addicted person with a dual diagnosis may display one or more of the following behaviors

• Difficulty with intimacy• Erratic mood swings• Inability to maintain

employment or attend classes• Difficulty formulating and

conveying thoughts• Become socially inept or

solitary• Inability to manage finances or

control spending• Violent tendencies or

uncontrolled anger

Behavioral Health Resources

• Hilo Adult Mental Health Service• Child and Adolescent Mental

Health Services• Mental Health Kokua

• Residential program for severely mentally ill patients

• Care Hawaii• APS Healthcare• Kahi Mohala Behavioral Health

• Specializes in ADHD treatment

Substance Abuse Resources

• Big Island Substance Abuse

• Al-Anon• Ku Aloha Ola Mau• Narcotics Anonymous• Ke Ala Pono Recovery

Center• Lokahi Treatment

Center• Po`ailani

Statewide Resources• Maui

– Aloha House– Ohana Makamae, Inc.– Malama Na Makua A Keiki– Maui Champ Clinic– Alano Club of Lahaina

• Kauai– Alcoholic Rehabilitation Services of Hawaii, Inc. (ARSH) – Hina Mauka– Ke Ola Pono Recovery Center– Hope Help & Healing

• Oahu– The Institute for family Enrichment– Ho'omau Ke Ola– Kline-Welsh Behavioral Health Foundation– The Queen's Medical Center– Oxford House, Inc.– Alcoholic Rehabilitation Services of Hawaii, Inc. (ARSH)– CARE Hawaii, Inc.

Our Ideal Treatment Facility

• Comprehensive Substance Abuse Treatment Facility:• * Individual & group counseling• * Daily 12-step meetings• * Residential & out patient programs• * 24 hour relapse intervention team • & detox center• * Various levels of treatment facilitated by experienced LCSW, APRN,

CSAC and Licensed Psychologist• Health Care and Wellness Facility:• * Primary care medical center• * Dental clinic• * Fitness center• * Nutrition classes• *Quit smoking program• * Full service cafeteria• Mental Health Treatment Center:• * 24 hour crisis intervention team• * Medication management• * Ongoing psychological screening, diagnosis and treatment by

experienced • Psychiatrist and LCSW• Social Service Support:• * Employment training and placement• * Outreach and legal support services• * Life skills and parenting classes• * Society & family reintegration program• * Family counseling services• * Transportation services• * Childcare facility • * 2 year residential housing complex with both individual and family

units

“Power of Healing”

Our Mission …Our mission is to provide

a comprehensive substance abuse treatment & recovery program to individuals and

their families. We envisioning a healthy

community where everyone has the opportunity to achieve their full potential spiritually,

mentally, and physically. 

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