Naloxone Prescription Co Occurring Disorder Discussion

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Naloxone Prescription Co Occurring Disorder DiscussionNaloxone Prescription Co Occurring Disorder DiscussionORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Part of treating co-occurring disorders is being familiar with different community treatment options, and knowing when to refer a client to community resources. One controversial treatment stirring up much debate among emergency medical professionals, community mental health providers, and government agency officials is the use and availability of a drug called Naloxone.Naloxone is now available over the counter without prescription in over 15 countries as of 2016. Naloxone Prescription Co Occurring Disorder DiscussionYour task is to watch What is Naloxone? (Links to an external site.), review the literature related to non-prescription Naloxone, and answer the questions posed. You may use the internet, library, peer reviewed literature, brochures, or use other resources.Respond to the following prompts:What are two arguments for non-prescription Naloxone?What are two arguments against non-prescription Naloxone?After looking at both sides of the issue, what is your biggest concern?What, if anything, would you support?You must cite your sources and indicate where you got the information that helped formulate your view. If your discussion does not include a reference as to where you found the information, credit will not be awarded 1 attachmentsSlide 1 of 1attachment_1attachment_1Co-Occurring Disorders Integrated Assessment and Treatment of Substance Use and Mental Disorders By Charles Atkins, MD 2 “This book is wonderful. I plan to adopt it as a textbook for my MSW CoOccurring Disorder Program.” — Jaak Rakfeldt, Ph.D., Co-Occurring Disorder Cohort Program, MSW Coordinator, Southern Connecticut State Unviersity Professor “So much valuable information in a user friendly manner, clinicians as well as others will find this book useful in their practice. This resource is a powerful tool and I am especially proud of the way he connects issues related to gender and trauma.” — Colette Anderson, LCSW, CEO The Connecticut Women’s Consortium “A clear, concise and straightforward and up to date text on co-occurring disorders has been glaringly lacking in the Behavioral Health Field. CoOccurring Disorders: The Integrated Assessment and Treatment of Substance Use and Mental Disorders offers students and clinicians at all levels a comprehensive view of the challenges of treating those with a cooccurring mental health and substance use disorder. Written in plain language, Atkins provides a clinical road map beginning with an outline of key issues and ending with treatment planning. Atkins also does what most don’t and that is to stress the importance of peer support, natural supports and self-help. Co-Occurring Disorders: The Integrated Assessment and Treatment of Substance Use and Mental Disorders is an important addition to any educator’s and clinician’s bookshelf.” –Eileen M. Russo, MA, LADC, Assistant Professor, Drug and Alcohol Recovery Counselor Program, Gateway Community College, New Haven, CT 3 Copyright © 2014 by Charles Atkins, MD Published by PESI Publishing & Media PESI, Inc 3839 White Ave Eau Claire, WI 54703 Cover: Amy Rubenzer Layout: Bookmasters Edited by: Bookmasters ISBN: 978-1-936128-54-9 All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, recording, or by any information storage and retrieval system without the written permission from the author (except for the inclusion of brief quotations in a review). Printed in the United States of America Library of Congress Cataloging-in-Publication Data Atkins, Charles, author. Co-occurring disorders : integrated assessment and treatment of substance use and mental disorders / by Charles Atkins. p. ; cm. Includes bibliographical references and index. ISBN 978-1-936128-54-9 (pbk. : alk. paper) — ISBN 1-936128-54-3 (pbk. : alk. paper) I. Title. [DNLM: 1. Substance-Related Disorders—complications. 2. SubstanceRelated Disorders—therapy. 3. Mental Disorders—complications. 4. Mental Disorders—therapy. 5. Psychotherapy—methods. WM 270] RC564 616.86—dc23 2014036016 All rights reserved. 4 5 Books by Charles Atkins NON-FICTION The Bipolar Disorder Answer Book The Alzheimer’s Answer Book FICTION The Portrait Risk Factor Cadaver’s Ball The Prodigy Ashes Ashes Mother’s Milk Go to Hell Vultures at Twilight Best Place to Die Done to Death YOUNG ADULTS FICTION WRITING AS CALEB JAMES Haffling 6 To librarians extraordinaire Linda Spadaccini and Lynn Sabol 7 Table of Contents Acknowledgments About the Author Introduction Section I: Getting Started 1. The Co-occurring Basics: Overview, Terms, and Key Concepts 2. The Comprehensive Assessment Part One: Personal, Psychiatric, Family, and Social Histories, and the Mental Status Examination 3. The Comprehensive Assessment Part Two: Substance Use, Medical Histories, and Collateral Sources of Information 4. The Comprehensive Assessment Part Three: Stage of Change and Level of Motivation for Change 5. Creating a Problem/Need List and Setting Goals and Objectives 6. Treatment and Recovery Plans 7. Levels of Care 8. Key Psychotherapies, Mutual Self-Help, and Natural and Peer Supports Section II: Mental Disorders, Their Presentation(s), and Treatment Approaches with Co-Occurring Substance Use Disorders 9. Naloxone Prescription Co Occurring Disorder Discussion Co-Occurring Attention Deficit Hyperactivity Disorder and Related Disorders 10. Depressive Disorders and Co-Occurring Substance Use Disorders 11. Bipolar Disorder and Co-Occurring Substance Use Disorders 12. Anxiety Disorders and Co-Occurring Substance Use Disorders 13. Posttraumatic Stress Disorder and Co-Occurring Substance Use Disorders 14. Schizophrenia, Other Psychotic Disorders, and Co-Occurring 8 Substance Use Disorders 15. Personality Disorders and Co-Occurring Substance Use Disorders Section III: Substance-Specific Topics and Treatments 16. Alcohol 17. Tobacco 18. Opioids 19. Selected Topics for Other Substances Appendix: State-by-state Guide to Mental Health and Substance Abuse Agencies and Prescription Monitoring Programs Resources and References Index 9 Acknowledgments I wish to express my gratitude for all of those who helped me develop this book. In particular Eileen Russo, Colette Anderson, Aili Arisco, Steve Jayson, Karen Kangas, Steven Southwick, Lauren Doninger, Martha Schmitz, Lynn Zinno, Carol Genova, Marie Johnston, Lori Sobel, Thomas Reinhardt, Doreen Elnitsky, Laura Nesta, Cheryl Planten, Sheila Zimmerman, Jason Schwarz, Pam Kieras, Karen Savage, Diane Passander, Bob Taylor, Susan Hayward, Elizabeth Fitzgerald, Linda Jackson, and Michael Olson. So much of this book originates in work I did with my wonderful colleagues and clients at Waterbury Hospital’s West Main Behavioral Health and Community Mental Health Affiliates (CMHA) in New Britain, CT. We learn so much from each other, and experience is our greatest teacher. 10 About the Author Charles Atkins, MD is a board-certified psychiatrist, published author, clinical trainer, and the Chief Medical Officer for Community Mental Health Affiliates, LLC (CMHA) in New Britain, Connecticut. He has written both non-fiction and fiction, including books on Bipolar Disorder, and Alzheimer’s Disease. His recent novels include the Barrett 11 Conyors forensic thriller series and The Strauss and Campbell Connecticut cozies. His first young adult novel—HAFFLING—was published in 2013 under the pen name, Caleb James. Dr. Atkins has written hundreds of articles, columns, and shorts stories for professional and popular magazines, newspapers, and journals. He is a member of the Yale volunteer clinical faculty. He’s been a regular contributor to the American Medical Association’s American Medical News, a consultant to the Reader’s Digest Medical Breakthrough series, and his work has appeared in publications ranging from The Journal of the American Medical Association (JAMA) to Writer’s Digest Magazine. He’s been twice featured in the New York Times, as well as many other publications. 12 Introduction More than 8 million Americans meet the criteria for having at least one cooccurring substance use and mental disorder. This represents a large and diverse group of people, from a top executive with obsessive-compulsive disorder, who drinks more than a pint of hard liquor a day to a homeless woman who smokes cannabis heavily and has been in and out of psychiatric hospitals with a diagnosis of schizophrenia. With this vast spectrum of people affected with co-occurring disorders, and the almost endless number of diagnostic combinations, it is easy to see how the assessment and overall treatment must be custom fit to the person and their real-life circumstances. Strategies to help the homeless woman with schizophrenia will totally miss the mark with the germ phobic executive who drinks heavily to quiet his intrusive obsessive thoughts, and vice versa. Studies that look at particular pieces of this co-occurring matrix are still in their infancy. But on balance, the research shows that integrated treatment (i.e., treatment that addresses both the substance use and mental disorders) leads to better outcomes for both. For this reason, I’ve undertaken to write this book to give clinicians an overview on how to both assess co-occurring disorders and to develop effective treatment with their specific clients. Naloxone Prescription Co Occurring Disorder Discussion The how and why someone develops co-occurring substance use and mental health disorders makes sense. We are the sum of our experiences and upbringing, genetics, epigenetics, family history, lifestyle, and temperament. Perhaps someone got into trouble with drugs as a way of medicating crippling anxiety and depression. For a person with attention deficit disorder, perhaps they began to abuse their prescribed stimulants (Ritalin, Adderall, etc.) or discovered cocaine helped them calm down and focus. Maybe someone got hooked on prescription pain pills following a 13 medical problem, or maybe they just liked the high, or perhaps they were part of a social group where substance use was the norm and things got out of hand. For some, the drugs came first and serious psychiatric symptoms followed. New research has shown that for certain people, taking drugs can be like pressing the ON button to serious mental illnesses, such as schizophrenia. In other cases, things got bad following a traumatic event. For many with no history of mental illness, trauma—experiencing or witnessing life-threatening circumstances (war, sexual assault, prison, natural or human-made disasters, such as 9/11)—can leave us changed. There is no more frightening an experience than to find that one day your mind, which you thought was under your control, is now playing horrible and frightening tricks that can include vivid flashbacks and reexperiencing horrific events. When people are in pain, physical or emotional, they want relief, even if temporary. When someone with overwhelming anxiety and panic attacks discovers the calming effects of alcohol, it’s easy to see how returning to the bottle becomes a daily habit. Likewise, the soothing and euphoric effects of opioids—from pain pills to heroin—can quickly change from an occasional indulgence to an enslaving addiction, where going even a few hours or a day without a pill or the next hit of dope leads to unbearable symptoms of withdrawal. I sometimes use the metaphor that treating co-occurring disorders is like assembling a Thanksgiving meal, where you’re firing—literally—on all burners. Some things must be carefully watched lest they get ruined, while other dishes can simmer on the back of the stove. The front burner items must be immediately tended to, including active withdrawal syndromes, suicidality, homelessness, serious legal issues, child-safety concerns, and dangerous behaviors. Once those issues are safely managed, or at least not about to boil over, the focus shifts to less pressing, but still serious, issues, such as an untreated or inadequately treated depression or anxiety disorder. The goals of this book are to give you, the reader, both the framework for constructing treatment and the tools with which to do it. It is written for the clinician but is also accessible for people in recovery, their families, and their loved ones. • The first part of the book explores key topics in working with people with co-occurring mental illness and substance use disorders. This section includes how to conduct a comprehensive and ongoing 14 assessment, clarify diagnoses, and establish and understand the person’s goals and level of motivation (both to change the substance use behavior and to work on mental health problems). The first several chapters lay down a step-by-step process of constructing the problem/need list, establishing goals, and mapping out treatment. • The second portion of this book goes through the major classes of mental disorders. Each chapter utilizes case studies to demonstrate the tight connections between particular disorders and the ways substance use problems develop and co-occur. Each chapter includes specific therapeutic approaches, as well as the importance of wellness regimens (attention to health, diet, exercise, relationships, meaningful activities, spirituality, etc.), and the use of medications, when indicated. Naloxone Prescription Co Occurring Disorder Discussion • The final section covers topics related to specific substances, such as alcohol withdrawal, opioid replacement therapies, misuse of over-thecounter medications, substances obtained through the Internet, and so forth. Therapies approved by the Food and Drug Administration (FDA) for particular drugs will be reviewed, along with other “off label” and alternative treatments and the evidence—or lack thereof—to support their efficacy. • References and resources specific to each chapter, and appendix for state drug monitoring programs and state agencies, are included at the back of the book. For myself, I find working with people who have co-occurring mental and substance use disorders to be highly gratifying. People can, and do, transform their lives, and it’s a wonderful thing to be a part of that transformation. 15 SECTION I Getting Started 16 CHAPTER 1 The Co-Occurring Basics: Overview, Terms, and Key Concepts Overview Historical Perspective Key Concepts and Definitions Recovery Co-Occurring Disorders (COD) “No Wrong Door” Policy Person-Centered Cultural Competence Trauma Informed Gender- and Sexual-Orientation Sensitivity The Quadrants of Care Stages of Treatment Sequential, Parallel, and Integrated Treatment Integration of Behavioral Health and Substance Use Services with Primary Care: The Patient-Centered Medical Home (PCMH) Understanding Behavioral Health Diagnoses and the DSM-5 OVERVIEW The 2012 National Survey on Drug Use and Health (NSDUH) reports that 43.7 million Americans older than 18 have at least one mental illness 17 (18.6% of the population), 17 million (6.5%) people are heavy alcohol users, and 23.7 million (9.2%) have used illicit drugs in the past month. Among those 43.7 million people with mental illness, roughly 8.4 million (19.7%) also have problems with drugs or alcohol. Among those with more serious mental illness this percentage is higher (27.3%). These numbers contrast starkly with the 6.4 percent of the general population reported to have a substance use disorder. Finally, for those individuals with co-occurring substance use and mental disorders, nearly 50 percent (46.3%) will receive some substance use and/or mental health treatment within the year. For behavioral health clinicians, the question has become not, “Did you use drugs?” but “What drugs did you use? And why?” For the substance abuse counselor, the question is, “Did you use drugs to get high, to be social, or was it—at least in part—to medicate away painful emotions, memories, or others symptoms of mental health problems?” The scope and magnitude of co-occurring disorders (COD) include the following: • More than 8 million Americans have COD in any given year. • Mental illness rates in people seeking substance abuse treatment range from 50% to 75%. • Substance use disorders are found in 50% of people seeking mental 18 • • • • health services. People with COD are far more likely to require hospitalization than people with either just a mental illness or a substance use disorder. Across mental health diagnoses, people who have co-occurring substance use disorders have worse outcomes, including more hospitalizations, lower quality of life, more physical health problems and more psychiatric diagnoses. Higher rates of serious suicidal thinking, suicide plans, and suicide attempts are seen in people with co-occurring disorders. Rates of illicit substance use are higher, for all substances, among people with mental illness. HISTORICAL PERSPECTIVE The mid- to late-twentieth century saw a movement away from the longterm hospitalization of people with serious mental illnesses, such as schizophrenia, bipolar disorder, and severe depression. Many of these individuals had spent much of their lives in institutionalized settings. Naloxone Prescription Co Occurring Disorder Discussion Although efforts at deinstitutionalization were deemed humanitarian, and the emphasis was placed on “least-restrictive settings,” the transition into the community was not a smooth one. 19 As large state hospitals emptied and closed, their prior residents experienced high rates of homelessness, exposure to violence, increased rates of serious infections (HIV and hepatitis), arrests and legal problems, and use of drugs and alcohol. At the same time younger individuals with serious mental illness, for whom these long-term hospitalizations were no longer an option, came to the attention of researchers. In particular, a growing awareness focused on younger people with mental illness turning to drugs and alcohol. In the late 1980s the terms dual diagnosis and co-occurring emerged to describe individuals who had both serious mental illness and substance use disorders. What also became clear was that services for substance use disorders and mental illness were not linked and had exclusionary criteria that created barriers. The norm was for a substance abuse treatment program to exclude people with a history of significant mental illness, and mental health providers were reluctant to work with people who were actively using drugs or alcohol. By the 1990s, growing concern and clinical literature began linking the problems of substance use disorders and mental illness. Clearly, the risks 20 associated with co-occurring disorders were real and ranged from increased rates of hospitalization, homelessness, poverty, arrests, violence and traumatization, HIV and hepatitis infection, and poor overall psychosocial functioning. What emerged, initially in working with people with more serious mental illness and co-occurring substance use disorders, was the concept of integrated treatment. Early studies and efforts to integrate treatment showed improved outcomes, with decreased rates of relapse and hospitalization, and improved quality of life. In the past three decades, greater attention has surrounded the issues of co-occurring disorders (COD). In 2005 the Center for Substance Abuse Treatment (CSAT), a part of the Substance Abuse Mental Health Service Administration (SAMHSA) released a treatment improvement protocol (TIP 42) that both explored the scope of the issue and urged clinicians, programs, and mental health and substance abuse systems to move toward increasingly integrated approaches to working with people with cooccurring disorders. In TIP 42, as well as in other publications since, there is an acknowledgment that any discussion of co-occurring disorders involves a vast matrix of people and diagnoses. What has been carefully studied is only the tip of the iceberg. The overall field of integrated behavioral health and substance use treatment is still in its infancy. For researchers, the task is a daunting one. Co-occurring disorders by definition imply multiple variables, which make for challenging research questions such as whether a medication or therapy work with a certain group of people who have a certain psychiatric diagnosis and a particular substance use disorder. Because of this complexity, relatively few studies have looked at specific medications and therapies in people with cooccurring disorders. For instance, little is known about the specific benefits of any FDA-approved antipsychotic medication for people who have both schizophrenia and a cocaine or alcohol use disorder, or which medication might be the best choice for a person with a panic disorder who also has an alcohol use disorder. On the plus side, a growing body of research examines specific psychosocial and psychotherapeutic approaches for people with specific co-occurring disorders, such as treatments for trauma survivors who also have substance use disorders. So even though the research and empirical evidence are important, they lag behind what clinicians and people with co-occurring disorders need to construct effective and realistic recovery and treatment plans. It all comes down to the individual who wants to change, what they 21 present with, their strengths, and the challenges they face. Wh… Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10 Order NowjQuery(document).ready(function($) { $.post(‘’, {action: ‘wpt_view_count’, id: ‘61903’});});jQuery(document).ready(function($) { $.post(‘’, {action: ‘mts_view_count’, id: ‘61903’});});

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