What is a co-occurring disorder? According to Michael Fox, M.A., PCC, CCDCIII, a research associate with the Center for Innovative Practices at the Begun Center for Violence Prevention Research and Prevention at Case Western Reserve University, ‘It is simply when a mental health disorder and a substance use disorder occur at the same time.’ Fox has fifteen years’ experience in the addictions and mental health field, providing therapy in outpatient and home-based settings. Fox spoke at the recent NASW-Ohio social work conference, ‘Empowering Others, Empowering Ourselves’, which Pomegranate Health Systems co-sponsored and exhibited at.
He explained that according to CSAT, the Center for Substance Abuse Treatment under SAMHSA, a co-occurring disorder is, ‘When at least one disorder of each type can be established independent of the other and is not simply a cluster of symptoms resulting from [a single] disorder.“ For instance, ‘Jane Doe’ is clinically depressed and drinking. We ask, ‘Does the one diagnosis lead to the other? Which came first?’ For example, did ‘Jane’ drink to self-medicate, or become depressed after drinking? There were several categories of potential diagnostic combinations: mentally ill chemically addicted (MICA), chemically abusing mentally ill (CAMI), mentally ill substance abusing (MISA), mentally ill chemically dependent (MICD), dually disorders, dual diagnosis, co-occurring addictive and mental disorders (COAMD), addiction and co-occurring disordered (ACD) and substance abusing mentally ill (SAMI).
Fox defined diagnostic inclusions for ”Substance Use Disorders” which included: alcohol, amphetamine, caffeine, cocaine, hallucinogens, inhalants, nicotine, opioids, phencyclidine (PCP), and sedative/hypnotic/anxiolytics. Under “Mental Health Categories”, he included: Schizophrenia/psychotic, mood disorders, anxiety disorders, somatoform disorders, factitious disorders, dissociative disorders, sexual/gender identity, eating and sleep disorders, adjustment disorders, personality disorders, and infancy/childhood/adolescence. Impulse control, a Mental Health Disorder, could be included under the Substance Abuse column because it mimics a substance use disorder in the brain.
Fox cited three major federally funded national surveys about adolescent drug use: 1) Monitoring the Future (MTF) sponsored by NIDA; 2) Youth Risk Behavior Survey (YRBS) sponsored by CDC; and 3) National Survey on Drug Use and Health (NSDUH)-sponsored by SAMHSA. The MTF survey ‘Predicts that about 50% of teens have tried an illicit drug at least once in their lifetime’. In the case of Cannabis (marijuana) ‘the concentration is 4x stronger than in 1978; about 36.4% reported use in the last year. About 11.4% reported using synthetic cannabinoids (K2, Spice) in the last year’. There are 5 synthetic chemicals involved. See the link on increase in emergency room visits due to synthetic abuse: http://www.samhsa.gov/data/2k12/DAWN105/SR105-synthetic-marijuana.pdf Synthetic chemicals used to make bath salts rewire the neural pathways. Psychotic symptoms often occur. This can lead to Parkinson’s-like permanent brain damage. Inhalants can permanently kill brain cells he explained, and teens think they are invincible.
Another issue is binge drinking, or the ‘consumption of at least 5 alcoholic drinks over a single period of use for the purpose of intoxication.’ (That’s the .08 limit –or higher- in a single occasion.) Fox then outlined prescription drug abuse statistics. According to the YRBS survey, ‘25.6% of all HS Seniors reported non-prescribed use of an Rx drug at least once’. He outlined other substances used for the purpose of getting high, some known, and many new on the scene.
When looking at adolescent mental health research, “49.5% met criteria from some level of disorder and of this, 22.2% had difficulty functioning”. These statistics came from the American Academy of Child & Adolescent psychiatry National Comorbidity Study (NCS-A) supported by NIMH. Of the study population of 10,000 teens age 13-18, 22.7% suffered a major depressive disorder, 31.9% anxiety disorder, 8.7% ADHD, ODD 12.6%; CD 6.89%, and in the substance abuse disorder category, 6.4% alcohol abuse and 8.9% drug abuse. There are additional statistics for severe impairment versus overall. While 58% suffer one mental health disorder, 24% suffer two, 11% three and 7% four disorders according to the presentation.
Fox reviewed developmental considerations such as a teens’ challenge to control impulsive behavior because the pre-frontal cortex is not yet fully developed. He stressed that adolescents are not ‘little adults’, as many assume. Because the combination of mental illness and substance abuse is so common, clinicians expect to find it (or should expect to find it) according to NAMI. He agreed with this. An integrated approach is advised for screening, and treatment. Fox concluded his presentation with an overview of screening tools, assessment recommendations and resources for the social work clinicians present.
[Photo credit: Head in Hands by Anita Patterson Peppers/ Dreamstime.com 30279]