Faith Communities & Mental Illness: Tools for Response and Care
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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
Bill B. Burnett, M.Ed., MAC
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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
Bill B. Burnett, M.Ed., MAC
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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
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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
Bill B. Burnett, M.Ed., MAC
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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.
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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
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Neurotransmitters Depleted Acetylcholine, serotonin, endorphins and GABA.
Marijuana
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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
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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
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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
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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
Bill B. Burnett, M.Ed., MAC
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