this episode was pre-recorded as part of a live continuing   education webinar on-demand CEUs are still available for this presentation   through all CEUs registered at all CEUs comm slash counselor toolbox I’d like to welcome everybody to today’s presentation on common co-occurring issues   exploring the interaction between mental health physical health and addiction so we’re kind of   putting together the stuff that we’ve been talking about for a couple of sessions now   we’re going to start by talking about some questions and then reviewing what a healthy   person needs and then going through and talking about how different addictions may cause or be   caused by mood disorders and physical health issues and we’re going to talk about things   that you may see in private practice or the a facility that you’re working in just real quickly   for those of you who are here how many people if you would just type in the chat window if you’re   a mental health counselor type mhm if you are a addictions counselor type SI or whatever so just   kind of so and know who I’m talking to you okay so mostly mental health ok cool so what we’re going to look at is what you may see in private practice or a mental health   setting because these clients a lot of clients that have substance abuse or addiction issues   and I use the term addiction because we’re talking about behavioral addictions too many   times they don’t meet the criteria for admission for substance abuse because they don’t meet that   threshold of a substance use disorder tolerance withdrawal yay yay so substance abuse agencies   can’t get funding to provide the treatment so they end up in a mental health facility or a   mental health counselor’s office and they may be dealing with some of these addiction issues   and wanting to address them or they may not be but those issues are out there and exist so   we want to know how they interact so told you we’re gonna have a couple of questions to think   about and I’m just asking you to ponder these for right now and you can add throughout the class if   you want but we’re gonna talk about it more at the end how can we and why is it important   to address chronic illness and disabilities that result from or that cause mood disorders   or addictions so thinking about you know like HIV or hepatitis are two of the big one’s cirrhosis of the liver chronic obstructive pulmonary disease from smoking so these are   things that can result from addiction why or how is it important for us as clinicians mental health   clinicians mainly to think about addressing these how can we address depression and/or anxiety kind   of our mood disorder genre and hopelessness that results from or causes depression and anxiety so   we know that thinking back affects acceptance and commitment therapy there’s clean discomfort   which is what he calls your initial emotion when you feel something if you feel depressed   if you feel anxious that’s how you feel and it’s uncomfortable but it’s clean it is it is   what it is and then he calls dirty discomfort the feelings that we have about those feelings   so we can get angry that we are depressed we can get depressed that we’re still depressed and he   calls that dirty discomfort because we’re kind of layering on and piling in think about just kind of   throwing somebody into a hole and piling more dirt on top of them so we want to think about   how can we address these issues that result from depression or anxiety or sleeping eating or energy   changes so if you’ve got somebody who is dealing with a chronic illness or something else has   happened or they’re they’ve got some sort of an addiction and they are not eating well not   sleeping well it could trigger depression or anxiety so we’re going to talk about that how   can we address sleeping eating and energy changes seems like we’re getting repetitive we’re looking   at how each one interface and how can we address these things that are caused by or cause mood   disorders or addictions because we know when we look at the diagnostic criteria for depression   for example sleeping eating and energy changes primary in there and how can we address guilt   and regret which may accompany addiction recovery or the diagnosis of the disease as the result of   addiction such as lung cancer or HIV or cirrhosis of the liver and people who have liver disorders   cirrhosis of the liver and hepatitis are at a greater risk of liver cancer so that can they   can have some additional anxiety that is related to that so they may look back and go I wish I   hadn’t well you have so how can we help you deal with that and come to some level of acceptance so   my little editorialized soapbox when we’re talking about addictions I mean sometimes we don’t want to   think that they exist we want to pretend that our clients are coming in their mental health clients   otherwise their perfectly healthy things are going great well that may not be the trick the   case a lot of people begin to use and I mean think about ourselves when we’re when we were   in high school and college or you know even later some people use it for recreation you know they want   to go out have a few beers do whatever cool you know that’s fine some people drink or use it for   relaxation my son has a love of we will use that word videogames and he will get on his videogames   and we’ll kind of get lost in it it helps him escape from you know life as we know it for a   little bit of time some people use because of peer pressure you know it’s everybody’s   doing it or you know you’re at a football party or something and everybody’s having a beer and   somebody offers you one and you don’t want to be rude things like that can happen and some people   begin to use straight up for self-medication they’re like I feel crappy I need something to   help me feel better or numb the pain so there’s a lot of reasons people begin to use so then you   might say well why don’t they just say no because it’s easy to say no well it’s not some   people start to use it because they’re bored and they want something to bring some excitement some   euphoria to their life and we’re talking about everything from sex addiction to internet addiction to cocaine use I mean we’re running the gamut here they may lack the awareness of the dangers or how   quickly you can become addicted I know when I was working in the facility in Florida there was the   sort of knowledge if you will and knowledge is not the right word rule I guess that with crack   cocaine for some people, it was a one-hit wonder you did it once and you were hooked and several drugs can be highly addicting quickly especially if they’re taken either   through injection or inhalation but we’ve talked before about the fact that our bodies can start   developing tolerance to opiates within 3 to 5 days so you know people may not a lot of people   don’t realize when they go in and their doctor writes him a script for two weeks of opiates and   they take it as prescribed that they’re actually becoming somewhat addicted to those opiates if   they take the whole prescription so they may not understand that some people don’t say no because   they have low self-esteem so they’re looking for comfort to help them relax to help them loosen   up so they can be more fun at the party and or to peer pressure somebody tells them why don’t use or why don’t come out and go drinking with us or whatever the case may be so to fit in   they may try to use it to fit in to feel part of a crowd and part of it can also be you   know with that peer pressure just generally the culture promoting this kind of behavior going   it’s ok I think I’ve shared with you before at At the beginning of some of the original Beverly   Hillbillies episodes they still advertised Winston cigarettes, like they are the greatest thing and cool people, have them and that’s the thing to do so if that message gets out people may start   believing it and not do their research so to speak on what the true problems or risks may be and then again self-medication some people may be struggling just to get by from day to day and   this helps them survive the best they can with the tools they have until we give them some new tools   so just saying you know I had I grown up during the era of Nancy Reagan and you know God loves her she was trying to help and for a certain small percentage she probably did but for a larger   percentage just saying no is not that easy we need to give people the tools so they can say no so   they don’t so they aren’t relying on these drugs for some reason because when people start using it for recreation and relaxation some people may not have a big big issue with it other people may   start throwing their neurotransmitters kind of out of whack depending on how much how often they use   what combinations if they’re on any medication so people may inadvertently start messing with their   neurotransmitters and creating and we’ll talk about this creating depression or anxiety   that they end up trying to self-medicate so that that is my soapbox for it is not that easy to just   say no we as a culture not just as clinicians have some work to do so what do we need to do to help people be able to just say no they need to have access to healthy nutrition   and knowledge of what that means my son and it’s still like drawing fingernails on a blackboard   to me today this week, I told his sister that you no, he didn’t understand why she was so concerned   with the nutrition he’s a guy he doesn’t need to pay attention to nutrition it’s just whatever and I   was just like oh my gosh you know everything I’ve said has fallen on deaf ears but okay we’ll back   up and figure out a way they need access to it and then they also need to eat it you know if   we have healthy foods available but people are still eating peanut butter and jelly sandwiches   for every single meal it’s not going to help so we need to make sure people understand what a healthy   diet looks like and how to do it in a way that’s not painful you know we’re not asking you to just eat   rabbit food as my daddy used to say but so what does it look like to eat a diet or nutrition that   makes you feel good that’s happy that makes you feel happily fulfilled you like it tastes good   whatever you want to say but that’s also healthy you know it’s not just pizza or just   peanut butter we need to educate people and a lot of adults that I work with have no clue about   sleep hygiene you know they know they’re supposed to try to go to sleep but they don’t know anything   about turning off the blue turning on blue light filters so the blue lights are not keeping them   up so we need to do some education here ideally in elementary schools but if we can get it out to the   community so they can pass it on to their little minions we’ll be on a good path to pain control we   need people to start having pain control but we need to also have them have alternatives to   pain control besides opiates and there are a lot of them out there again people don’t know about   so we must educate and we’re not prescribing pain control that’s not our job but   if we have a client who’s in chronic pain we can suggest that they work with their doctor that they   look into options for pain control you can google it and find a lot of different alternatives now   if they don’t want to go to the doctor but you know there are a lot of different things from   acupressure it attends units to things that are nonpharmacological that can help people manage   their pain so they can sleep which will help the rest and rebalance to deal with fatigue and   be able to deal with life kind of on life’s terms because they won’t be in this constant state of   stress people need access to regular medical care to prevent problems so you know we want to prevent   this thing on your face from becoming skin cancer we want to prevent anything else that that might   trigger problems and early intervention so like with Lyme disease, if people get early intervention   mentioned they don’t end up with the chronic problems with HIV the earlier the intervention   the better same thing with hepatitis you know the list goes on so we want to make sure that if   people have some sort of issue that’s disrupting their ability to get enough sleep process   nutrition go to work do any of these things that they have access to some method whatever method   they need to address it so sometimes it’s medical sometimes it’s mental health it’s social   services they need safe housing so we’re on to social services now and that includes a roof   over their head that they’re not worried when they go to sleep at night but also being safe   from domestic violence and things like that safety and this kind of goes with safe housing and I put   internal and external because you know the first part is external safety we want to be able to know   that our patients can relax wherever they’re at they have enough money to keep a roof over their   head in a safe place and you know typically that’s not something that we think about as mental health   counselors we think about helping them deal with their anxiety but if they can’t get enough sleep   and they never feel safe when they’re at home they’re not going to be able to rest and they’re   at best their recovery is going to be impeded at worst you know it’s going to contribute to the   issue that they’re seeing us for so safe housing is important we’re not going to get it for them   but we can point them in the right direction your local United Way which is 2-1-1 and most places   generally has a listing of different resources for accessing safe housing if you don’t work   in a facility that’s used to dealing with that and then internal safety that’s shutting up that   internal critic that’s being able to go through a day without being derogatory to yourself and that’s something that we definitely can help with we can help people shut down that   internal critic or that internal person that is always calling gloom and doom and you know   waiting for the other shoe to drop or whatever the case maybe we can help clients change their   cognitions so it’s safe inside their head and then people need love and acceptance and   this should sound pretty familiar are you know Maslow’s hierarchy here kind of in Reverse   but people need love and acceptance but in order for love to have love and acceptance in many cases   they also need to love and accept themselves so we’re gonna work on self-esteem we’re gonna help   people develop relationship skills hopefully there are some people in their life that have provided   some level of love and acceptance maybe not the unconditional positive regard we’ve hoped for but   they’re there so these are things that the healthy happy person needs and these are things in large   part we can do through education referral and direct services help people get so why do we care about   co-occurring issues as mental health counselors well 35 percent of people with anxiety disorders   have according to one of these studies abused opiates so that’s a lot if you’ve got somebody   with an anxiety disorder this isn’t just panic this isn’t just something you know severe   this is you know any of your anxiety disorders one in three roughly have abused opiates they’ve   used some sort of opiate drug to help them kind of chill out of opiate or alcohol dependent patients   20% have major depressive disorder so of that 35% you know there’s going to be a percentage   of them who may be opiate or alcohol dependent and there are a lot of our clients that we see in   mental health treatment who are not willing to be truthful about how much they really drink or how   often they drink because they might be suspecting it’s a little bit of a problem but   they’re not wanting to go there yet they’re in what we call pre-contemplation okay so let’s   just go with this in mind that there may be some underlying other stuff that they haven’t told us   about opiate or alcohol-dependent patients 20% have major depressive disorder so you know we’re   taking them and we may be seeing them in the clinic for depression and we do want to be suspect of   whether there’s either some opiate or alcohol issues there depression and opioid-dependent patients including pain management patients so those who are opiate-dependent by prescription have been associated with poorer physical health decreased quality of life increased risk-taking behaviors and suicidality am I saying that pain management clinics are bad no but what I’m saying   is those who are in pain management clinics for a variety of reasons are at a high in a higher risk   category I mean think about it if your pain is bad enough that you need to be going to a pain   management clinic think about how much that must hurt think about how much that must impair your   daily life think about the impact of the drugs that you’re taking on your mood your energy levels   and the stigma in some cases associated with it some people here suboxone and they’re like yeah   whatever my neighbor takes that other person here suboxone and they’re like ah you can’t be taking   that so there is still a lot of social stigmas that goes along with medication-assisted therapies so there are a lot of things that may contribute to depression in opioid-dependent patients   the prevalence and severity of depression tend to decline within the first few weeks after treatment   initiation so if they are trying to get off of you know ideally their detox and they’re   trying to you know remain sober the prevalence and the severity of depression tends to decline so we   need to get them off of it first and get them through that acute withdrawal from a depressant   including alcohol and I know this slide is boring but we’re gonna be through in a second withdrawal   from depressants including alcohol opioids and even stimulants invariably include potent anxiety   symptoms so it’s important to pay attention and withdrawal from stimulants can also include potent   depressive symptoms if they’ve been on a crack binge for you know five days that won’t sleep for   a while many people with substance use disorders may exhibit symptoms of depression that fade over   time and are related to acute with drawl well we talk about acute withdrawal we’re talking about   the first three months we’re not talking about the detox period which is generally three days so   encourage people who’ve gone through detox and maybe they’re seeing you on an outpatient basis   encourage people to you know be patient and work with the treatment team if they need to but the first   three months is always the hardest so chicken or the egg you know did the person start using and become   depressed or was the person depressed so they self medicated does it matter depression and anxiety   are associated with addiction because because if you have stimulant withdrawal or recovery   that period after you quit using that’s maybe a week maybe two weeks where your body is going   whew that was a run people may feel depressed fatigued have difficulty concentrating which can   impact how well they eat it’ll impact their sleep they’re gonna sleep a lot more but the   quality of sleep may be poor so they can mess up their circadian rhythms and you know they   may not have access to the social support that they wanted they may but really with stimulant   withdrawal we’re looking at nutrition and sleep so we want to educate patients if they   decide to stop taking stimulants what they need to look at stimulant use can also be associated   with depression and anxiety because many people not you know the majority but a lot of people   out there will self-medicate depression with stimulants from anything from caffeine which   you know maybe like mild dysthymia but if you abuse enough caffeine you know it starts getting   into your system you become dependent on it but if you start combining caffeine and nicotine plus oh   let’s add in some workout supplements or you know the occasional Ritalin or something not suggesting   it then it’s these things can wear the body down which can lead to additional depression but people   may use these things to try to feel better because think depression is related for some people   they may not feel like they can wake up they’re fatigued they’re lethargic all the time and   they’re feeling blue so if they take stimulants they get that dopamine rush they’re starting   to feel good and they’re awake stimulant use can cause anxiety well the so if you’ve got   somebody who already has maybe they are depressed but they’ve also got some anxiety and they start   using stimulants which may make the anxiety way worse alcohol or opiate use some people use these things   to numb or to forget and that’s just your the standard used the depressant some people will   use either one of these but especially opiates to deal with physical pain to medicate depression or   anxiety remember there are a lot of trials not several trials right now that are looking at   using opiates to treat intractable depression but a lot of people also use opiates off-label illegally to address anxiety so if you’ve got a client with depression or anxiety just kind of   be alert for how they’re behaving if they’ve got pinpoint pupils or if they’re itching and   picking all the time I mean not the occasional are winter and the heat just turned on I’ve got   dry skin itch but constantly itching and picking and you know where you’re like please just settle   down detox from opiates can all often produce depression produces a lot of flu-like symptoms   which can make people feel crappy and the flu-like symptoms I won’t get graphic impaired   nutrient absorption impaired sleep you know they’re sleeping a lot because they feel like   crap but they’re also having to get up every 10 minutes to go to the bathroom sometimes so   this first week or so during the initial if they go cold turkey so to speak can be rough   detox from alcohol as I’ve talked about before can produce anxiety symptoms so understanding   that when people are going through detox whether they are alcohol dependent and have been drinking   a whole lot which needs to be medically monitored I can’t say this enough and I’ll say it a lot more   tomorrow when we talk about where Nikki Korsakoff syndrome but people who are detoxing from alcohol   will have anxiety symptoms and a period of high blood pressure and sometimes depression and anxiety are associated with addiction just because they sober up one morning and they look at their life   and they’re like what the hell have I done so you know and you’re looking at them going yeah   I don’t blame you for feeling that way now let’s see what we can do to improve the next moment   so make sure that we understand that these things are going to go hand in hand and to be   on the lookout because like I said a lot of people aren’t forthcoming even about alcohol use which is   legal but if they’re using something illegally or using maybe their kid’s Ritalin or something   they’re pretty much almost guaranteed not to tell you so we want to be on the lookout for signs and   symptoms bipolar disorder can be triggered by drug use so we just know that we can the person could   get worn down mess with the neurotransmitters enough they’re not exactly sure how it happens   but we have seen the initial acute episode of bipolar disorder-triggered mania triggered by   drug use it is more common for people with bipolar to use stimulants when they’re depressed and just   about anything when they’re manic now if you’re working with somebody with bipolar you know   you’re probably already having these discussions about how you stay safe when you’re in a manic   episode people with ADHD may use to self-medicate and we’re talking cannabis is a big one for ADHD   to help people feel like they’ve got more focus and not feel like they’ve got so much coming in   and so much stimulation all the time which can be exhausting and after the use of any of the substances   of abuse the disruption and neurotransmitters can make people feel like they’ve got ADHD-type symptoms faculty concentrating difficulty following through with things etc so understanding   that even if things don’t meet the threshold for DSM-5 diagnosis we want to look at what symptoms   are there and how can we help people manage them so they’re getting adequate sleep nutrition pain   control social support and safety borderline and antisocial personality just kind of threw those   in there because we see those a lot when we’re working in dual diagnosis facilities more people   are more likely to use addictions to cope with a lack of sense of self and their emotional lability   if they’re borderline so I mean their world is so chaotic many people with borderline personality   disorder are likely to use to try to get some calm in the storm now I will put out my other soapbox   here with both of these personality disorders when you see somebody in active addiction or early recovery they probably have symptoms that would meet diagnosis you know their symptoms   are pervasive in multiple areas of life their symptoms would meet the diagnosis for one of these   two personality disorders during this period but it resolves as recovery becomes the norm   as the neurotransmitter stabilizes they develop interpersonal skills so you know giving people   a little bit of time before we say it’s borderline personality disorder versus borderline personality   characteristics if you will be helpful because both of these diagnoses can block people from   getting into certain treatment centers and getting some of the services they need okay so we’re going   to move on to some of our more common addictions alcoholism is associated with eating disorders   there’s a really strong Association and it usually flip-flops between bulimia and alcoholism so if   somebody’s symptomatic for bulimia they may not be drinking a lot of alcohol but they may during   periods of remission from the bulimia drink a lot more alcohol become alcohol dependent so there’s   a lot of research out there that shows there’s a strong correlation between these two things and   it’s also associated with binge eating disorder but especially bulimia nutritional deficiencies   from alcoholism can cause mood disorders so even if somebody is not and I use the term   I should have put alcohol instead of alcoholism because even the term heavy use without physical   dependence can cause nutritional deficiencies that can cause ulcers it can cause physical problems   physical exhaustion which can disrupt sleep alcohol impairs sleep quality alcohol makes   apnea worse so if you’ve got a client who has sleep apnea they’re drinking they’re probably   gonna sleep even worse than they normally do depression is the result of using well alcohol as a depressant so what do people expect well most people expect to relax they don’t think about the   rest of the stuff that’s going on in neurochemical imbalances because the alcohol exits our system a   lot faster than our brain can catch up and go okay it’s not in there anymore so I need to adjust the   temperature and in sleep disruption anxiety can also, be triggered as a result of use I’ve said   before say it again after that initial period where people feel the depressant or relaxing   effects of alcohol there is an upsurge in anxiety so a lot of people have another drink to kind of   quell that anxiety feeling but you know people with anxiety disorders are gonna feel it more   prominently and the neurochemical imbalances that alcohol use causes can worsen pre-existing   anxiety conditions or trigger anxiety conditions nicotine is another one that we see a lot even   in just straight-up mental health clinics not co-occurring so what effect does nicotine have   well anxiety and depression are 70% more likely in smokers so that’s one of those statistics we want   to look at nicotine triggers dopamine release okay so nicotine is one of the most addictive drugs on   the planet and you’re thinking I thought that was opiates well opiates are in there but nicotine   not only is nicotine legal but it’s also one of the most addictive drugs on the planet so that’s   another important point to think about people are using their trigger and dopamine release their   brain gets used to being flooded with dopamine so their receptors on the other end start sensitizing   so we’re creating an artificial environment basically when people are smoking blood vessel   changes when people smoke it causes blood vessel changes that can cause high blood pressure as well   as depression and fatigue and confusion in the blood vessels narrow and get stiffer so the oxygenated   blood has a harder time getting to where it needs to be so people start feeling blah and that can   cause them to think that they’re starting to feel depressed can also cause those cause loss of   energy people with severe and persistent mental illnesses are two to three times more likely than   the general population to use nicotine so that’s just an interesting little fact to have out there   if you work with people with SP MI and people with ADHD may smoke because it increases their   concentration and attention for about five minutes literally, for about five minutes but during that   five minutes they’re like oh my gosh it’s a relief I can like focus for half a second so we   want to look at what else is going on whether the a person has adult ADHD for example physical health   mental nicotine is linked with COPD and emphysema and lung cancer so you know all kinds of lung   and cardiopulmonary stuff well when that happens you know we have less oxygenated blood efficient   efficiently getting through the system we’re going to have increased fatigue increased confusion some   grief that may go along with that especially if people are starting to have to carry an oxygen   tank around with them or something you know we may have to help them deal with disability acceptance   and depression and stroke because smoking like I said increases blood pressure and reduces   circulation so cutting off or greatly reducing circulation to the brain they have shown that   people who smoke especially heavy smokers are at a much greater risk of stroke and addiction nicotine   is strongly correlated with other addictions a a lot of people when they’re in the bar well not   so much anymore since smoking is not allowed in public places but used to be when they were in   the bar they would also be smoking but a lot of people associate alcohol and nicotine or nicotine   and other drugs so if somebody is using other drugs likely they’re smoking now it doesn’t work   the other way around just because they’re smoking doesn’t mean they’re likely using other drugs the   reason this is more important is that people who continue to smoke after they have gone into   recovery for their drug of choice have a relapse rates as high as 68 percent higher than for people   who quit smoking so we start thinking about that and we say well why is that well because nicotine is a mood-altering substance you know we don’t think of it as such because it’s not a   woohoo it’s Marva hey okay it’s not as prominent of interaction as maybe cocaine or something   but it does change the balance and people still do use smoking to cope with life when things get   stressful they smoke well if things get stressful and you know they’re too stressed for smoking to   handle then they may start going back to what else can I take use or do that will make this   feeling go away right now we know also that was smoking and that repeated release of dopamine   they’re messing with the neurochemical balances in their brain, so it makes sense that eventually   just like tolerance to other drugs happens it may not be enough at a certain point and they may fall   back into other habits nicotine has been known to suppress appetite and but whether it keeps weight   off or not they haven’t shown alcohol and nicotine both are appetite suppressants which   is another reason people with bulimia tend to drink and one of the reasons why people quit   smoking they tend to be hungrier so helping them get through that period now whether it   helps them keep weight off the party that deals with the reason that they eat it’s not really that it’s   suppressing their or increasing their metabolism so much its nicotine suppresses the anxiety   and sometimes the desire the hunger but if people are still eating out of anxiety if they’re still   eating under stress eating then you know when they stop smoking and they don’t have a cigarette to put   in their mouth when they’re stressed they tend to go for other things and so we need to help people   figure out when they stop smoking are you eating because you’re hungry or are you eating   because you’re stressed if they’re eating because they’re hungry and they’re getting heavier   than they want to be they need to talk with their doctor about you know thyroid tests and also let   their doctor educate them on biological setpoint theory of you know not everybody’s going to be   a zero so you know that may be something we can help them deal with body acceptance issues if   you know maybe they’re programmed genetically to be you know a size X whatever that is and they’re   not happy because they want to be a zero which our culture does tell us to do as clinicians   we can help them look at you know the costs and benefits of continuing to smoke and what being   you know a size zero means for them to opiate abuse there’s a lot of physical stuff and we’re   just gonna run through it real quick because you’re not as concerned with it the physical   stuff the doctors are gonna see but we need to be aware of from a clinical point because it can keep   people from getting their basic needs met blood and injection site infections you know that’s   probably going to lay them up for a while but if they have repeated infections and are repeatedly   out of work they can lose their job they can lose their housing they can you know get some sort   of MRSA or something else which can be really expensive it can be life-threatening ya-ya   collapsed veins and this is more common obviously this is only for injection drug users but   collapsed veins just as you would expect keep the oxygenated blood from getting where it needs to be   so people are more likely to experience strokes and may have certain forms of vascular dementia   because of the strokes dementia we’re familiar with endocarditis is the inflammation around   the heart so again this is only for needle drug users but if you’ve got a client who is using   needles to inject any kind of drug be aware of that and what they get and what they inject is   rarely pure so knowing what else they’re injecting into their system if they’re you know crushing   pills from the pharmacy you’re a little bit more sure about what they’re getting as opposed to if   it’s from the corner dealer and sometimes they’re cut with really nasty things like   you know comic bathroom cleaner and stuff HIV if people get HIV from injection or some other risky   behavior they’re probably going to experience some depression and a lot of times HIV from   opiate abuse they’re gonna experience depression remorse regret all that kind of stuff anxiety   about how long they’re going to live what’s going to happen and oh those medication side   effects those the antiretroviral medications that they have to take are doozies I’ve seen people go   through the induction weeks on their medications and it is a rough time so helping people   get through it so they are medication compliance so they can continue to live we need to help them   maintain hope and self-efficacy and all that kind of stuff to maintain that forward movement to get   through the induction period liver damage from acetaminophen can set people up for you know   physical pain among other things and it decreased pain tolerance now this generally the decreased   pain tolerance goes away after the the body starts producing its endorphins and   natural painkillers again but that initial period if somebody quits using and maybe you know you are seeing them as a mental health client and they had an accident or had surgery or something   they started using pills they got a couple of refills then the doctor said no I’m cutting you   off and now they’re going through a detox period detox from opiates is unpleasant but it is rarely   life-threatening unless somebody becomes their electrolytes get imbalanced because of the flu   symptoms but we still may see this in private practice in mental health practice because   of the scenario I just told you people can start taking painkillers as prescribed for something   they may get addicted you know take them for a month or so then when they get off of them   not only do they feel like you know really bad but their pain is also back and it may be they   had their wisdom teeth out that pain may be gone but other aches and pains and everything you feel is probably going to be intensified until the body kicks back in so educating clients about   this is what happens you know it’s not uncommon if you think it’s too bad go see your   doctor helping them make sure they’re getting good nutrition you know it’s hard if you’ve got   flu symptoms to feel like you want to eat or hold anything down so what can you do to make   sure your body has the building blocks to make the stuff that it needs to help you feel better what   can you do to improve your sleep and a lot of our clients and you know where I used to work we   had a methadone clinic and we also had a mother baby unit and as soon as the mothers would give   birth then the doctor would start them on their detox from methadone and he didn’t believe   in the kinder gentler taper he was just like okay baby’s gone threats gone because you can’t detox   from somebody from opiates when they are pregnant because it can cause the baby to die anyway   so as soon as they would stop or as soon as they weren’t pregnant anymore he would just   D see them and they would feel really bad I mean not only did they just push an 8-pound something   out of their body but they also are experiencing a decreased pain tolerance because they’re not   on the opiates anymore and all they want to do is sleep it’s just like please so understanding that   is important in helping people get through that period even though they may want to sleep   all the time helping them understand that it’s important to maintain their circadian rhythms   if they have to take two or three ten-minute power naps throughout the day to get through   the day you know more power to them but if they can practice good sleep hygiene they’re gonna   be way better off in the long run OPD opiate abuse is also or opiate use is also associated   with the treatment of depression but it can cause depressive symptoms due to its pharmacological   properties I mean it slows everything down from you’re gastrointestinal to your heart rate to your   respiration you’re not breathing as much you’re not getting as much oxygen in you’re gonna have   more fatigue you’re gonna have more confusion you’re going to have more of those symptoms of   depression for some people they find it is and certain opiates they find it is a powerful way   to reduce anxiety it makes them feel like they’ve got a ton of energy because they’re not stressed   out anymore and this last one is one of the The main reason that I find people don’t want to give   up opiates is that they finally feel better when they’re on the eating disorders commonly a coat   co-occur with depression and anxiety which can be caused by nutritional deficiencies you know   you’re not giving your body the building blocks so it can’t make the neurotransmitters it needs   and it also probably disrupts your sleep some and depression anxiety can cause or trigger or   whatever you want to say eating disorders because people with eating disorders may fear becoming fat   have low self-esteem have a sense of lack of self-control or have body dysmorphic disorder   so we also want to be aware that there are mental health stuff that can trigger dysfunctional eating   patterns there’s about a 24% prevalence of PTSD among people with eating disorders so if you’ve   got a client with eating disorders especially bulimia be on the lookout for depression anxiety   body dysmorphic disorder alcoholism and PTSD they maybe smoking too but of the things, I just listed   that’s probably the least of their worries it’s all eating disorders are also associated with   alcoholism and smoking I said physical health issues now you’re seeing somebody with an eating   disorder it’s a mild eating disorder you’re seeing them once a week outpatient so you’re not and you   have you know you have training and working with eating disorders or maybe it’s   mild enough that you’re just getting supervision on treating this issue whatever being aware that   people with eating disorders anorexia or bulimia can have irregular heartbeats and cardiac arrest   due to potassium imbalances and electrolyte imbalances so if they’re not eating or if   they are binging and purging in some way shape or form and that includes excessive exercise which can   trigger a lot of heart problems they may have loss of bone mass and osteoporosis so they may   break bones a little bit easier going back up to the heartbeat not to belabor the point but again   heart problems mean a lack of available oxygen mean confusion fatigue potential difficulty   sleeping depressive symptoms and you know cardiac arrest in and of itself is bad kidney damage from   Doretta caboose and low potassium can also potentially drain damaged the adrenals which   are on the kidneys and so it’s important to be aware of what people are using a lot of people   with eating disorders are going to creatively use stimulants to suppress their appetite think   about any of your diet drugs your enter mean I think it’s one of them the ones they give to help   people lose weight they’re stimulants they’re intense stimulants so people who are   struggling with eating disorders are likely to go towards abusing stimulants or at least using them   which can drain the adrenals it can in some cases have been linked to the development of   Addison’s disease liver damage from not eating or binging and purging causing toxin buildup   and possibly pain we can help people deal with it as much as we can anemia which can cause symptoms   of depression in and of itself so goes back to that nutrition making sure they’re getting enough infertility which in and of itself can be devastating for young women if they can’t   have children anymore or can’t have children ever that may be a grief issue that we need to   help them deal with cathartic: and this is an important one to be aware of because you   don’t have to have somebody who uses laxatives all the time but people who regularly use or   abuse laxatives can become dependent on them so when they don’t use them they have a feeling of   bloating feeling full and abdominal pain which especially in people with eating disorders or   body morphic disorders surrounding just general body fit bad back body fat can greatly increase   anxiety depression hopelessness and in some cases of suicidality so again educating people   is the first step to helping them understand what’s going on and how dangerous laxatives can be but   also if somebody is trying to cut back on their use of laxatives or just recently stopped using   laxatives like when people stopped using opiates it takes the body a while to get back   online but for most people it eventually does people with eating disorders also have chronic   ulcers which are painful and can keep you up at night As you know gastric reflux and pancreatitis   which can flare up at a moment’s notice will is extraordinarily painful and can cause people to   lose time from school or work social activities feel bad about themselves and also   pancreatitis causes a lot of bloating which in eating disorders is a huge trigger   for anxiety and depression pathological gambling is associated with stimulant abuse especially   cocaine methamphetamine and Ritalin to stay focused disrupted sleep and rebound depression   when they quit taking that stuff they wake up and they’re like oh wow what did I just do alcoholism   is also associated with pathological gambling some people drink to calm their nerves some   people drink because it’s the culture if you go to any of the casinos you know their hand-and-out drinks, they’re trying to get you drunk so you keep gambling more and there’s as we spoke about   earlier rebound depression or anxiety smoking may help people increase their focus or make   them think they can increase their focus so if you can’t smoke in public places this is more of   an issue if you have somebody who does a lot of online gambling or they gamble at their friend’s   house or somebody’s house where there’s poker games and stuff smoking has some anti-anxiety   anti-anxiety properties and may be part of the the culture I know when my daddy used to have his   poker games everybody would smoke cigars and even the one woman who went there would be smoking a   cigar with everybody else and it was just the culture of being there so there are a lot of   different reasons that people may use substances in addition to gambling mental health issues from   gambling anxiety from the stimulant use or from the tension and release of am I going to you know   I’m down $20,000 am I going to make it back ADHD is also strongly associated with pathological   gambling bipolar disorder, especially during manic phases are associated with pathological gambling   generally you see them co-occurring it’s not like gambling causes it it’s you will see co-occur depression can occur due to losses and gambling can start because somebody’s depressed   because of their financial situation and their trying to figure out a way to you know borrow from   Peter to pay Paul and get ahead you also see pathological gambling is more strongly associated   with people who have obsessive-compulsive disorder if you’ve got clients with these   diagnoses just kind of you know be attentive to the fact that they are more likely to engage in   pathological gambling or if they start gambling it’s more likely to become a problem than for   people who don’t have these issues internet an addiction that is diagnoseable so   you know I’m not just making something up depending on your resource affects eight   point two percent to thirty-eight percent of the general population now obviously we were looking   at you know like games versus you know games plus Facebook plus shopping or something so depending   on the study you looked at their parameters were a little bit different but either way up   to 38 percent of the population has sacrificed significant personal recreational activities to engage in some sort of internet behavior Internet addiction can cause anxiety or   depression due to eyestrain and chronic headaches you know if you’re hurting all the time it can   make you feel wonky it can also interrupt your sleep can cause circadian rhythm disorder which   can trigger depression fatigue reduced stress tolerance this is a condition when your body   doesn’t know whether it’s supposed to be awake or asleep because a lot of people who engage in internet-addictive behaviors do so in the dark or you know they don’t pay attention to whether the   lights are on or not they may just sit there kind of in their cave carpal tunnel contributes to pain   and sleep disruption because carpal tunnel does wake you up at night back ache again may disrupt   your sleep and can cause chronic pain during the a day which can interrupt your daily activities poor   nutrition I know a lot of gamers that will sit there for an entire weekend and not get up to go   eat so if it’s not brought to them they don’t eat they’ll even wear adult diapers so they don’t have   to get up to go to the bathroom reduced immunity due to exhaustion from not sleeping and job or   relationship problems I know uh several people whose marriages ended over a world of warcraft’   so internet addiction is a real thing and it’s something that we need to be cognizant of because   it does cause a lot of problems and a lot of relationships and it may be one of many problems   but it’s something to look at sex addiction can cause hepatitis and a variety of different STDs   which if not treated can cause systemic problems it’s related to anxiety and depression because sex   addiction may begin in order because somebody wants to feel loved or connected maybe after   a breakup or because they never felt loved you’re connected and then they feel that rush and they’re   like oh I like that I want to do that again part of it could be engaging in that behavior which is   so thrilling you know depends on the person psychological withdrawal from sex addiction   people who have been engaging in sex addiction type behaviors and I include pornography addiction   in it for this presentation if they’re not able to access that may start feeling anxious or depressed   they can’t get to that they can’t get to the the thing that’s gonna cause the dopamine rush and   reflection on behaviors that they’ve engaged in as a part of their sex addiction can also prompt   anxiety about a spouse finding out you know am I going to develop an STD and am I you know how I feel about what I’ve been doing so as clinicians if we’re working with somebody who has compulsive   sexual behaviors even if you know anywhere about that the spectrum we need to be aware that these things may   exist and figure out or help them figure out how they feel about it and what they need to   do to make sure that they’re getting good sleep that they’re dealing with their depression and   their anxiety so that they can have a safe internal and external environment so back to that global   perspective how can we and why is it important to address chronic illness and disabilities   that result from or cause mood disorders or addictions how can we address depression anxiety   and hopelessness that results from or causes depression anxiety or physical problems how can   we address physical problems that are caused by mood or addictions and how can we address   guilt or regret which may accompany addiction recovery or the realization of a diagnosis of a   disease caused by the addiction so while you kind of ponder those there was a question that came in so question what about robbing Peter to pay Paul in association with trauma specifically childhood trauma so if you could clarify that for me a little bit I had mentioned robbing Peter   to pay Paul in terms of gambling so I’m just so mental health issues can be caused by or trigger   addictions or physical health issues addictions can cause or trigger mental health issues or   physical health issues that can be caused by addictions or mental health issues   so again chicken-or-egg we don’t necessarily know which one came first when you have any one of   these it’s probably going to or likely impact each other person or each other area common   issues are seen in all three changes in sleeping changes in nutrition fatigue and grief effective   treatment requires addressing the underlying causes as well as the ripple effects you know so yes after childhood trauma or trauma of any sort, some people may spend a lot   of time feeding the addiction as you put it or engaging in addictive behaviors to avoid some   of the PTSD symptoms to avoid thinking about it to deal with the grief to deal with the shame so   they may engage in something that makes them feel better or helps them forget to cope with the trauma that happened until they have other tools so they can come to   some sort of terms with it and you know as I say close that chapter in their book already   if there are no other questions tomorrow’s the presentation I learned a lot creating is   on alcohol-related dementia and vascular dementia and fetal alcohol spectrum disorders all three of   which are issues that are caused by substance use and specifically alcoholism and then I’ll   give you a hint about where an acute Korsakoff a a lot of clients who abuse alcohol but they’re not   alcohol dependent who decide to stop drinking can trigger where Nikki Korsakoff syndrome   and causes alcohol-related dementia-type symptoms so again in mental health, we need to be on the   lookout for it if we hear that our clients are trying to cut down on their alcohol use   alrighty everybody and so tomorrow is that presentation and then Thursday we’re going to   look at different models of new bottles of treatment if you enjoy this podcast please   like and subscribe either in your podcast player or on YouTube, you can attend and participate   in our live webinars with doctor Snipes by subscribing at all CEUs com VirtualBox this   episode has been brought to you in part by all CEUs calmly provide 24/7 multimedia continuing   education and pre-certification training to counselors therapists and nurses since 2006 used coupon code consular toolbox to get a 20% discount on your order this month As found on YouTube Animated Video Maker – Create Amazing Explainer Videos | VidToon #1 Top Video Animation Software To Make Explainer, Marketing, Animated Videos Online It’s EASIER, PRODUCTIVE, FASTER Get Commercial Rights INCLUDED when you act NOW Get Vidtoon

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