faith communities & mental illness: tools for … communities & mental illness: tools for...

Faith Communities & Mental Faith Communities & Mental Illness: Tools for Response Illness: Tools for Response

and Careand CareAddiction and Addiction and MentalMental IllnessIllness

Bill B. Burnett, M.Ed., MACBill B. Burnett, M.Ed., MACApril 27, 2012April 27, 2012

Bill B. Burnett, M.Ed., MACBill B. Burnett, M.Ed., MAC 22

ObjectivesObjectives

To understand the connection between substance To understand the connection between substance use, abuse and dependence with mental illness.use, abuse and dependence with mental illness.

To review some substance abuse facts and figures.To review some substance abuse facts and figures. To understand the importance of neurobiology in To understand the importance of neurobiology in

substance abuse.substance abuse. To review some information about alcohol and To review some information about alcohol and

marijuana.marijuana.

Outline of PresentationOutline of Presentation

Definitions of mental disorder, substance abuse and Definitions of mental disorder, substance abuse and dependence (addiction)dependence (addiction)Facts and figures about of substance use and abuseFacts and figures about of substance use and abuseNeurobiology simplifiedNeurobiology simplifiedAlcohol informationAlcohol informationMarijuana informationMarijuana information


WHAT IS A MENTAL WHAT IS A MENTAL DISORDER?DISORDER?

A mental disorderA mental disorder or or mental illnessmental illness is a is a diagnosable illness that:diagnosable illness that:

affects a personaffects a person’’s thinking, emotional state, s thinking, emotional state, behavior, and behavior, and

disrupts the persondisrupts the person’’s ability to:s ability to:–– work work –– carry out other daily activities, andcarry out other daily activities, and–– engage in satisfying relationships.engage in satisfying relationships.

44

What are the substances of abuse?What are the substances of abuse?

The DSM IV includes The DSM IV includes 11 classes of 11 classes of substancessubstances–– AlcoholAlcohol–– AmphetaminesAmphetamines–– CaffeineCaffeine–– CannabisCannabis–– CocaineCocaine

–– HallucinogensHallucinogens–– InhalantsInhalants–– NicotineNicotine–– OpioidsOpioids–– Phencyclidine (PCP)Phencyclidine (PCP)–– SedativesSedatives


Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition, American Psychiatric Association.


Substance AbuseSubstance Abuse

The essential feature of Substance Abuse is The essential feature of Substance Abuse is a a maladaptive pattern of substance use maladaptive pattern of substance use manifested by recurrent and significant adverse manifested by recurrent and significant adverse consequencesconsequences related to the repeated use of related to the repeated use of substances.substances.There may be There may be repeated failure to fulfill major role repeated failure to fulfill major role obligations, repeated recurrent social and obligations, repeated recurrent social and interpersonal problemsinterpersonal problems..




Substance DependenceSubstance DependenceThe essential feature of Substance Dependence The essential feature of Substance Dependence is a cluster of is a cluster of cognitive, behavioral and cognitive, behavioral and physiological symptomsphysiological symptoms indicating that the indicating that the individual continues use of the substance individual continues use of the substance despite significant substancedespite significant substance--related problems.related problems.There is a pattern of There is a pattern of repeated selfrepeated self--administrationadministration that usually results in that usually results in tolerance, tolerance, withdrawal, and compulsive drugwithdrawal, and compulsive drug--taking taking behaviorbehavior..




Mental Illness: FACTS and Mental Illness: FACTS and NumbersNumbers

One in four adults One in four adults –– approximately 57.7 approximately 57.7 million American experience a mental health million American experience a mental health disorder in a given year.disorder in a given year.One in 17 lives with a serious mental illness.One in 17 lives with a serious mental illness.Anxiety disorders affect 18.7% of adultsAnxiety disorders affect 18.7% of adultsAn estimated 5.2 million have coAn estimated 5.2 million have co--occuring occuring mental health and addiction disorders.mental health and addiction disorders.Suicide is the 11Suicide is the 11thth leading cause of death for leading cause of death for people ages 10people ages 10--24 years.24 years.

Addiction and Mental IllnessAddiction and Mental Illness 88

http://www.nami.org/Template.cfm?Section=About_Mental_Illness&Template=/ContentManagement/ContentDisplay.cfm&ContentID=53155

http://www.nami.org/Template.cfm?Section=About_Mental_Illness&Template=/ContentManagement/ContentDisplay.cfm&ContentID=53155

2001 U.S. Drug Use in Past Month2001 U.S. Drug Use in Past Month

AlcoholAlcohol 48.3%48.3% 108.9 million108.9 million

CigarettesCigarettes 24.9%24.9% 60.4 million60.4 million

MarijuanaMarijuana 5.4%5.4% 12.2 million12.2 million

EcstasyEcstasy 3.6%3.6% 8.1 million8.1 million

CocaineCocaine 0.7%0.7% 1.7 million1.7 million

HeroinHeroin 0.1%0.1% 123 thousand123 thousand

Epidemiology of Substance Epidemiology of Substance AbuseAbuse Bill B. Burnett, M.Ed., MACBill B. Burnett, M.Ed., MAC 99


NSDUH Survey, 2002

05

1015202530354045

8th 10th 12th Grade

Perc

ent u

sing

in p

ast m

onth

AlcoholCigarettesMarijuana

Alcohol is the Most Commonly Alcohol is the Most Commonly Used Drug Among 12Used Drug Among 12--20 Year Olds20 Year Olds

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

48%26.9%

21.5%6.5%

5.5%3.3%

2.4%2.3%

2.3%1.5%1.4%

0.5%25.4%

0% 10% 20% 30% 40% 50%

Alcohol

Cigarettes

Marijuana

Smokeless tobacco

Amphetamines

Tranquilizers

MDMA

Hallucinogens

Cocaine

Inhalants

Steroids

Heroin

Any illicit drug


New UsersNew Users

AlcoholAlcohol–– 2009 2009 –– 4.6 million4.6 million

12,500 new users daily12,500 new users daily

Any Illicit DrugAny Illicit Drug–– 2009 2009 –– 3.1 million3.1 million


MarijuanaMarijuana–– 2009 2009 –– 2.4 million2.4 million


NonNon--prescribed prescribed Prescription drugsPrescription drugs–– 2009 2009 –– 2.6 million2.6 million


TobaccoTobacco–– 2009 2009 –– 2.5 million2.5 million


MethamphetamineMethamphetamine–– 2009 2009 –– 154,000154,000

422 new users daily422 new users daily


National Survey on Drug Use and Health (NSDUH) – 2009


Prevalence of Lifetime Use of Heroine, Cocaine, and Psychotherapeutics among Adults Aged 26 or Older, by Age

of Marijuana Initiation: 1999 and 2000

SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 1999 and 2000.

Additional Risks Related to Alcohol Additional Risks Related to Alcohol Use and AgingUse and Aging

Elderly individuals are more likely to be Elderly individuals are more likely to be affected by chronic illness and use of affected by chronic illness and use of medicationsmedicationsAlcohol and prescription drug problems Alcohol and prescription drug problems are frequently:are frequently:

UnderUnder--identifiedidentified UnderUnder--diagnoseddiagnosedUnderUnder--treatedtreated UnderUnder--estimatedestimated


Scope of Alcohol/Drug ProblemsScope of Alcohol/Drug Problems

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


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

Colleges Battle Colleges Battle Dangerous DrinkingDangerous Drinking

Alcohol abuse plagues universitiesAlcohol abuse plagues universities–– The death toll from alcohol has risen among The death toll from alcohol has risen among

US College students from 1,440 in 1998 to US College students from 1,440 in 1998 to 1,825 in 20051,825 in 2005

–– College responses have varied from denial College responses have varied from denial that the problem exists to a complete ban of that the problem exists to a complete ban of all alcohol on college property.all alcohol on college property.


NIAAA

Percent of Prisoners with Percent of Prisoners with Alcohol or Drug ProblemsAlcohol or Drug Problems

Between 50 and 85 of percent of prisoners are Between 50 and 85 of percent of prisoners are incarcerated because of problems related to incarcerated because of problems related to drug and alcohol abuse.drug and alcohol abuse.TwoTwo--thirds of adult and onethirds of adult and one--half of juvenile half of juvenile arrestees tested positive for at least one illicit arrestees tested positive for at least one illicit drug.drug.Nearly one in five state inmates said that had Nearly one in five state inmates said that had committed the offense to obtain money to buy committed the offense to obtain money to buy drugs.drugs.


National Assembly: Drugs, Alcohol Abuse and the Criminal Offender - ONDCP, 2000.

7.1xAntisocial Personality Disorder

Odds

36.9xDrug Dependence

3.1xGeneralized AnxietyMood Disorders

5.2xHypomania5.7xMania2.8xDysthymia

Anxiety Disorders

2.5xSocial phobia

3.7xMajor depression

2.2xSpecific

3.4xPanic disorder without agoraphobia3.6xPanic disorder with agoraphobia

7.1xAntisocial Personality Disorder

Odds

36.9xDrug Dependence

3.1xGeneralized AnxietyMood Disorders

5.2xHypomania5.7xMania2.8xDysthymia

Anxiety Disorders

2.5xSocial phobia

3.7xMajor depression

2.2xSpecific

3.4xPanic disorder without agoraphobia3.6xPanic disorder with agoraphobia

Odds of an Alcohol-Dependent Individual Having a Co-occurring Disorder (General Population)

DSM-IV 12-month Prevalence

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

Possible CausesPossible CausesCauses of Alcohol Causes of Alcohol AddictionAddiction

Genetic Genetic –– family history of family history of addictionaddictionEmotional Makeup Emotional Makeup –– may use may use alcohol to block pain in lifealcohol to block pain in lifePsychological Psychological –– persons with persons with low self esteem or depressionlow self esteem or depressionSocial Social –– availability, peer availability, peer pressurepressureFrequency Frequency –– drinking regularlydrinking regularlyAge Age –– young people are at great young people are at great riskriskGender Gender –– men are more likely to men are more likely to become addictedbecome addicted

Causes of Mental IllnessCauses of Mental Illness

GeneticsGeneticsInfectionsInfectionsBrain defects or injuryBrain defects or injuryPrenatal damagePrenatal damageSubstance abuseSubstance abuseOther Other –– nutrition, exposure to toxinsnutrition, exposure to toxinsPsychologicalPsychologicalEnvironmental Environmental –– death, death, dysfunctional family, changing jobs dysfunctional family, changing jobs or schools, social expectations, or schools, social expectations, parental substance abuseparental substance abuse


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

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 IllnessAddiction and Mental IllnessAt least 60% of persons battling one are battling At least 60% of persons battling one are battling both disordersboth disordersWhen there is a genetic or biological vulnerability When there is a genetic or biological vulnerability to any type of mental health problem substance to any type of mental health problem substance may trigger the onset of that problemmay trigger the onset of that problem–– Substance use is not the cause, but can be a Substance use is not the cause, but can be a

precipitating factor that causes the condition to precipitating factor that causes the condition to manifestmanifest

Some researchers are now saying that certain Some researchers are now saying that certain forms of mental illness and addictions may be a forms of mental illness and addictions may be a single disease single disease –– not a dual diagnosisnot a dual diagnosis


http://www.webmd.com/bipolar-disorder/features/bipolar-disporder-and-substance-abuse

http://www.webmd.com/bipolar-disorder/features/bipolar-disporder-and-substance-abuse

Neurobiology SimplifiedNeurobiology Simplified Bill B. Burnett, M.Ed., MACBill B. Burnett, M.Ed., MAC 2121

NeurobiologyNeurobiologySimplifiedSimplified

The Cellular BatteryThe Cellular Battery

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


Dendrites and AxonsDendrites and Axons

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


Axon Axon -- Synapse Synapse -- DendriteDendrite

How Drugs WorkHow Drugs Work

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


NeurotransmittersNeurotransmitters

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


Neurotransmitter, Impact and Neurotransmitter, Impact and Drug MimicDrug Mimic

Some NeurotransmittersSome Neurotransmitters

Dopamine (DA)Dopamine (DA)Serotonin (SER)Serotonin (SER)Endorphins (END)Endorphins (END)GammaGamma--Amniobutyric Acid (GABA)Amniobutyric Acid (GABA)Glutamate (GLU)Glutamate (GLU)


SerotoninSerotonin

Normal Functions Normal Functions –– mood stability, appetite, sleep control, sexual mood stability, appetite, sleep control, sexual

activity, aggression, self esteemactivity, aggression, self esteem


SerotoninSerotonin

NonNon--pharmaceutical Drugs That Disrupt pharmaceutical Drugs That Disrupt SerotoninSerotonin–– Alcohol, nicotine, amphetamine, cocaine, Alcohol, nicotine, amphetamine, cocaine,

PCP, LSD, MDMA, EcstasyPCP, LSD, MDMA, Ecstasy


SerotoninSerotonin

Mental Illnesses associated with the Mental Illnesses associated with the disruption of Serotonindisruption of Serotonin–– Anxiety, depression, bipolar disorder, Anxiety, depression, bipolar disorder,

obsessiveobsessive--compulsive disordercompulsive disorder


SerotoninSerotonin

Medications Used To Rebalance Medications Used To Rebalance SerotoninSerotonin–– BuSpar, tricyclic antidepressants, Prozac, BuSpar, tricyclic antidepressants, Prozac,

Zoloft, tryptophan, Ritanserin, Anafranil, PaxilZoloft, tryptophan, Ritanserin, Anafranil, Paxil


DopamineDopamine

Normal FunctionsNormal Functions–– Muscle tone/control, motor behavior, energy, Muscle tone/control, motor behavior, energy,

reward mechanism, attention span, pleasure, reward mechanism, attention span, pleasure, emotional stability, hunger/thirst/sexual emotional stability, hunger/thirst/sexual satiation.satiation.


DopamineDopamine

NonNon--pharmaceutical Drugs That Disrupt pharmaceutical Drugs That Disrupt DopamineDopamine–– Cocaine, nicotine, PCP, amphetamine, Cocaine, nicotine, PCP, amphetamine,

caffeine, LSD, marijuana, alcohol, opioidcaffeine, LSD, marijuana, alcohol, opioid


DopamineDopamine

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

Deficit DisorderDeficit Disorder


DopamineDopamine

Medications Used To Rebalance Medications Used To Rebalance DopamineDopamine–– MAO Inhibitors, Ritalin, phenothiazine MAO Inhibitors, Ritalin, phenothiazine

antipsychotics, thiazone antipsychotics, antipsychotics, thiazone antipsychotics, tyrpsone, taurine, bromocryphine, tyrpsone, taurine, bromocryphine, amantadine, Lamantadine, L--dopadopa


ALCOHOLALCOHOL

Age at Onset of DSM-IV Alcohol Dependence

0.0%

0.2%

0.4%

0.6%

0.8%

1.0%

1.2%

1.4%

1.6%

1.8%

5 10 15 18 21 25 30 35 40 45 50 55 60 65 70 75

Age

Perc

enta

ge in

eac

h ag

e gr

oup

who

dev

elop

fir

st-ti

me

alco

hol d

epen

denc

e

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

SourceSource

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


Neurotransmitters DepletedNeurotransmitters Depleted

Gamma amino butyric acid (GABA).Gamma amino butyric acid (GABA).


Brain Sites AffectedBrain Sites Affected

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


Initial Mood AlterationInitial Mood Alteration

Mild euphoria, relaxation and sedation.Mild euphoria, relaxation and sedation.


Acute Side EffectsAcute Side Effects

IntoxicationIntoxicationDiminished hearingDiminished hearingDiminished sense of responsibilityDiminished sense of responsibilityHangoverHangover


Chronic Side EffectsChronic Side Effects

AddictionAddictionCirrhosis of the liverCirrhosis of the liverMemory impairmentMemory impairmentReasoning impairmentReasoning impairmentFetal Alcohol SyndromeFetal Alcohol Syndrome



Drinking is involved in:Drinking is involved in:

40 %40 % of fatal car crashesof fatal car crashes50% 50% of all murdersof all murders2020--36%36% of all suicidesof all suicides50%50% of rapesof rapes2525--30%30% of admissions to hospitalsof admissions to hospitals

Alcohol: Social Health EffectsAlcohol: Social Health EffectsTotal U.S. Drinking Deaths: 130,000Total U.S. Drinking Deaths: 130,000

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

AnonymousAnonymous


Age at Onset of DSM-IV Cannabis Use Disorders

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

0.0%

0.2%

0.4%

0.6%

0.8%

1.0%

1.2%

1.4%

1.6%

5 10 15 18 25 30 35 40 45 50

Age

Perc

enta

ge in

eac

h ag

e gr

oup

who

dev

elop

fir

st-ti

me

Can

nabi

s U

se D

isor

ders

0.0%

0.2%

0.4%

0.6%

0.8%

1.0%

1.2%

1.4%

1.6%

5 10 15 18 25 30 35 40 45 50

Age

Perc

enta

ge in

eac

h ag

e gr

oup

who

dev

elop

fir

st-ti

me

Can

nabi

s U

se D

isor

ders

Neurotransmitters DepletedNeurotransmitters Depleted

Acetylcholine, serotonin, endorphins and GABA.Acetylcholine, serotonin, endorphins and GABA.

MarijuanaMarijuana Bill B. Burnett, M.Ed., MACBill B. Burnett, M.Ed., MAC 5050

THCTHC

Marijuana is the dried buds and leaves of the Marijuana is the dried buds and leaves of the Cannabis sativa plant.Cannabis sativa plant.This plant contains more than 400 chemicals, This plant contains more than 400 chemicals, including deltaincluding delta--99--tetrahydrocannabinol (THC), tetrahydrocannabinol (THC), the plantthe plant’’s main psychoactive chemical.s main psychoactive chemical.


Acute Side EffectsAcute Side Effects

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


Chronic side effects:Chronic side effects:

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


Marijuana PotencyMarijuana Potency

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


““Frequent marijuana use leads to more Frequent marijuana use leads to more tissue destruction and longtissue destruction and long--term term impairment of our highest intellectual impairment of our highest intellectual functions than almost any other drug of functions than almost any other drug of abuse.abuse.

Robert Gilkeson, DirectorRobert Gilkeson, DirectorBrain Research Institute, CaliforniaBrain Research Institute, California


The good news isThe good news is……

Drug abuse is a Drug abuse is a preventablepreventable behaviorbehavior

AndAnd

Drug addiction is a Drug addiction is a treatabletreatable diseasedisease


WEB SitesWEB SitesYRBSSYRBSShttp://www.cdc.gov/healthyyouth/yrbs/index.htmhttp://www.cdc.gov/healthyyouth/yrbs/index.htm

Institute of MedicineInstitute of Medicinehttp://www.iom.eduhttp://www.iom.edu

NIDANIDAhttp://www.nida.nih.govhttp://www.nida.nih.gov

NIAAANIAAAhttp://www.niaaa.nih.govhttp://www.niaaa.nih.gov

NIAAA NIAAA http://www.niaaa.nih.govhttp://www.niaaa.nih.gov


http://www.cdc.gov/healthyyouth/yrbs/index.htm

http://www.iom.edu

http://www.nida.nih.gov

http://www.niaaa.nih.gov

http://www.niaaa.nih.gov

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