Treatment Models for mental health and addiction

May 2, 2014

Treatment Models for mental health and addiction-Current Models discussed

when both treatment for addiction and mental health problems are administered well you will surely get your life back.

Every day mental health and alcohol and other drugs (AOD) abuse treatment fields have become increasingly aware of the existence of patients with dual disorders, attempts are being made to adapt treatment to the special needs of these patients. The attempts have reflected philosophical differences about the nature of dual disorders, as well as differing opinions regarding the best way to treat them. These attempts also reflect the limitations of available resources, as well as differences in treatment responses for different types and severities of dual disorders. Three approaches have been taken to treatment.

Treatment Models for mental health and addiction-Sequential Treatment

The first and historically most common model of dual disorder treatment is sequential treatment. In this model of treatment, the patient is treated by one system (addiction or mental health) and then by the other. Indeed, some clinicians believe that addiction treatment must always be initiated first, and that the individual must be in a stage of abstinent recovery from addiction before treatment for the psychiatric disorder can begin. On the other hand, other clinicians believe that treatment for the psychiatric disorder should begin prior to the initiation of abstinence and addiction treatment. Still other clinicians believe that symptom severity at the time of entry to treatment should dictate whether the individual is treated in a mental health setting or an addiction treatment setting or that the disorder that emerged first should be treated first.

The term sequential treatment describes the serial or non-simultaneous participation in both mental health and addiction treatment settings. For example, a person with dual disorders may receive treatment at a community mental health center program during occasional periods of depression and attend a local AOD treatment program following infrequent alcoholic binges. Systems that have developed serial treatment approaches generally incorporate one of the above orientations toward the treatment of patients with dual disorders.

Treatment Models for mental health and addiction-Parallel Treatment

A related approach involves parallel treatment: the simultaneous involvement of the patient in both mental health and addiction treatment settings. For example, an individual may participate in AOD education and drug refusal classes at an addiction treatment program, participate in a 12-step group such as AA, and attend group therapy and medication education classes at a mental health center. Both parallel and sequential treatments involve the utilization of existing treatment programs and settings. Thus, mental health treatment is provided by mental health clinicians, and addiction treatment is provided by addiction treatment clinicians. Coordination between settings is quite variable.

Treatment Models for mental health and addiction-Integrated Treatment

A third model, called integrated treatment, is an approach that combines elements of both mental health and addiction treatment into a unified and comprehensive treatment program for patients with dual disorders. Ideally, integrated treatment involves clinicians cross-trained in both mental health and addiction, as well as a unified case management approach, making it possible to monitor and treat patients through various psychiatric and AOD crises.

There are advantages and disadvantages in sequential, parallel, and integrated treatment approaches. Differences in dual disorder combinations, symptom severity, and degree of impairment greatly affect the appropriateness of a treatment model for a specific individual. For example, sequential and parallel treatment may be most appropriate for patients who have a very severe problem with one disorder, but a mild problem with the other. However, patients with dual disorders who obtain treatment from two separate systems frequently receive conflicting therapeutic messages; in addition, financial coverage and even confidentiality laws vary between the two systems.

Treatment Models for mental health and addiction-Treatment Models

Sequential: The patient participates in one system, then the other.
Parallel: The patient participates in two systems simultaneously.
Integrated: The patient participates in a single unified and comprehensive treatment program for dual disorders.

In contrast, integrated treatment places the burden of treatment continuity on a case manager who is expert in both psychiatric and AOD use disorders. Further, integrated treatment involves simultaneous treatment of both disorders in a setting designed to accommodate both problems.

Treatment Models for mental health and addiction-Critical Treatment Issues for Dual Disorders

Mental health and addiction treatment programs that are being designed to accommodate patients with dual disorders should be modified to address the specific needs of these patients. Although there are different dual disorder treatment models, all such programs must address several key issues that are critical for successful treatment. These issues include:

Treatment engagement
Treatment continuity and comprehensiveness
Treatment phases
Continual reassessment and re-diagnosis

Treatment Engagement

In general, treatment engagement refers to the process of initiating and sustaining the patient’s participation in the ongoing treatment process. Engagement can involve such enticements as providing help with the procurement of social services, such as food, shelter, and medical services. Engagement can also involve removing barriers to treatment and making treatment more accessible and acceptable, for example, by providing day and evening treatment services. Engagement can be enhanced by providing adjunctive services that may appear to be indirectly related to the disorders, such as child care services, job skills counseling, and recreational activities. It may also be coercive, such as through involuntary commitment or a designated payee.

Engagement begins with efforts that are designed to enlist people into treatment, but it is a long-term process with the goals of keeping patients in treatment and helping them manage ongoing problems and crises. Essential to the engagement process is:

A personalized relationship with the individual
Over an extended period of time
A focus on the stated needs of the individual

For patients with dual disorders, engagement in the treatment process is essential, although the techniques used will depend upon the nature, severity, and disability caused by an individual’s dual disorders. An employed person with panic disorder and episodic alcohol abuse will require a different type of engagement than a homeless person with schizophrenia and poly-substance dependence. With respect to severe conditions such as psychosis and violent behaviors, therapeutic coercive engagement techniques may include involuntary detoxification, involuntary psychiatric treatment, or court-mandated acute treatment.

Treatment Continuity

To treat patients with dual disorders, it is critical to develop continuity between treatment programs and treatment components, as well as treatment continuity over time. In practice, many patients participate in treatment at different sites. Even in integrated treatment programs, many patients require different treatment services during different phases of treatment. For this reason, treatment should include an integrated dual disorder case management program, which can be located within a mental health setting, an addiction treatment setting, or a collaborative program.

Treatment Comprehensiveness

An overall system for treating dual disorders includes mental health and addiction treatment programs, as well as collaborative integrated programs. Programs should be designed to:

Engage clients
Accommodate various levels of severity and disability
Accommodate various levels of motivation and compliance
Accommodate patients in different phases of treatment.

There should be access to abstinence-mandated programs and abstinence-oriented programs, as well as to drug maintenance programs. Different levels of care, ranging from more to less intense treatment, should be available.

Phases of Treatment

In general, the medical term acute describes phenomena that begin quickly and require rapid response. Acute problems are contrasted with chronic problems. Most commonly, acute stabilization of patients with dual disorders refers to the management of physical, psychiatric, or drug toxicity crises. These include injury, illness, AOD-induced toxic or withdrawal states, and behavior which are suicidal, violent, impulsive, or psychotic.

The acute stabilization of AOD use disorders typically begins with detoxification, such as inpatient detoxification for patients with significant withdrawal or outpatient detoxification for mild to moderate withdrawal, as well as nonmedical withdrawal, such as occurs in social-model detoxification programs. Also, initiation of methadone maintenance can provide outpatient acute stabilization for patients addicted to opioids.

Acute stabilization of psychiatric symptoms more frequently occurs within a mental health or emergency medical setting, but involves a range of treatment intensity. Patients with severe symptoms, especially psychotic, violent, or impulsive behaviors, usually require acute psychiatric inpatient treatment and psychiatric medications, while patients with less severe symptoms can be treated in outpatient or day treatment settings. It is important that dual disorder programs that provide stabilization to patients with acute needs should have the capability to:

Identify medical, psychiatric, and AOD use disorders
Treat a range of illness severity
Provide drug detoxification, psychiatric medications, and other bio-psychosocial levels of treatment
Provide a range of intensities of service.

These programs should be capable of promoting the patient’s engagement with the treatment system. They should be able to aggressively provide linkages to other programs that will provide ongoing treatment and engagement.

Sub-acute Stabilization

The medical term sub-acute describes the status of a medical disorder at points between the acute condition and either resolution or chronic state. The sub-acute phase of a medical problem occurs as the acute course of the problem begins to diminish, or when symptoms emerge or reemerge but are not yet severe enough to be described as acute.

As AOD-induced toxic or withdrawal symptoms resolve, constant reassessment and re-diagnosis is required. During this phase, a psycho-educational and behavioral approach should be used to educate patients about their disorders and symptomatology. During this phase, treatment providers should provide assessment and planning for dealing with long-term issues such as housing, long-term treatment, and financial stability.

Treatment Models for mental health and addiction-Current Models discussed

Addiction and Mental health

May 2, 2014

Addiction and Mental health-Treatment

Your mental health can be affected by addiction and substance abuse, but wait a minute, did you know that event like team building could help you overcome some of these problems?

For people with dual disorders also known as “dual diagnosis”, the attempt to obtain professional help can be frustrating and confusing. They may have problems arising within themselves as a result of their psychiatric and alcohol and other drug (AOD) use disorders as well as problems of external origin that derive from the conflicts, limitations, and clashing philosophies of the mental health and addiction treatment systems. For example, internal problems such as frustration, denial, or depression may hinder their ability to recognize the need for help and diminish their ability to ask for help. A typical external problem might be the confusion experienced when individuals need services but lack knowledge about the different goals and processes of various types of available services. Other problems of external origin may be very fundamental, such as the inability to pay for child care services or the lack of transportation to the only available outpatient program.

Historically, when patients in alcohol and other drug (AOD) treatment exhibited vivid and acute psychiatric symptoms, the symptoms were either unrecognized or observed but miss-described as toxicity or acting-out behavior or accurately identified, prompting the patients to be discharged or referred to a mental health program. Virtually the same process occurred for patients in mental health treatment who exhibited vivid and acute symptoms of AOD use disorders.

Mislabeling, rejecting, failing to recognize, or automatically transferring patients with dual disorders can result in inadequate treatment, with patients falling between the cracks of treatment systems. The symptoms of psychiatric and AOD use disorders often fluctuate in intensity and frequency. Current symptom presentation may reflect a short-term change in the course of long-term dual disorders. Thus, even when patients receive traditional professional help, treatment may address only selected aspects of their overall problem unless treatment is coordinated among services including AOD, mental health, social, and medical programs.

As a result, the treatment system itself may be a stumbling block for some people attempting to receive ongoing, appropriate, and comprehensive treatment for combined psychiatric and AOD use disorders. Thus, treatment services for patients with dual disorders must be sensitive to both the individual’s and the treatment system’s impediments to the initiation and continuation of treatment.

Addiction and Mental health-Treatment Systems

People with dual disorders who want to engage in the treatment process (or who need to do so) frequently encounter several treatment systems, each having its own strengths and weaknesses. These treatment systems have different clinical approaches.

Addiction and Mental health-The Mental Health System

Actually, there is no single mental health system, although most States have a set of public mental health centers. Rather, mental health services are provided by a variety of mental health professionals including psychiatrists; psychologists; clinical social workers; clinical nurse specialists; other therapists and counselors including marriage, family, and child counselors (MFCCs); and paraprofessionals.

These mental health personnel work in a variety of settings, using a variety of theories about the treatment of specific psychiatric disorders. Different types of mental health professionals for example, social workers and MFCCs have differing perspectives; moreover, practitioners within a given group often use different approaches.

A major strength of the mental health system is the comprehensive array of services offered, including counseling, case management, partial hospitalization, inpatient treatment, vocational rehabilitation, and a variety of residential programs. The mental health system has a relatively large variety of treatment settings. These settings are designed to provide treatment services for patients with acute, sub-acute, and long-term symptoms.

Acute services are provided by personnel in emergency rooms and hospital units of several types and by crisis-line personnel, outreach teams, and mental health law commitment specialists.
Sub-acute services are provided by hospitals, day treatment programs, mental health center programs, and several types of individual practitioners.
Long-term settings include mental health centers, residential units, and practitioners’ offices.
Clinicians vary with regard to academic degrees, styles, expertise, and training.
Strength of the mental health system is the growing recognition at all system levels of the role of case management as a means to individualize and coordinate services and secures entitlements.

Medication is more often used in psychiatric treatment than in addiction treatment, especially for severe disorders. Medications used to treat psychiatric symptoms include psychoactive and non-psychoactive medications. Psychoactive medications cause an acute change in mood, thinking, or behavior, such as sedation, stimulation, or euphoria.

Psychoactive medications (such as benzodiazepines) prescribed to the average patient with psychiatric problems are generally taken in an appropriate fashion and pose little or no risk of abuse or addiction. In contrast, the use of psychoactive medications by patients with a personal or family history of an AOD use disorder is associated with a high risk of abuse or addiction.

Some medications used in psychiatry that have mild psychoactive effects (such as some tricyclic antidepressants with mild sedative effects) appear to be misused more by patients with an AOD disorder than by others. Thus, a potential pitfall is prescribing psychoactive medications to a patient with psychiatric problems without first determining whether the individual also has an AOD use disorder.

While most clinicians in the mental health system generally have expertise in a bio-psychosocial approach to the identification, diagnosis, and treatment of psychiatric disorders, some lack similar skills and knowledge about the specific drugs of abuse, the bio-psychosocial processes of abuse and addiction, and AOD treatment, recovery, and relapse. Similarly, AOD treatment professionals may have a thorough understanding of AOD abuse treatment but not psychiatric treatment.

Addiction and Mental health-The Addiction Treatment System

As with mental health treatment, no single addiction treatment system exists. Rather, there is a collection of different types of services such as social and medical model detoxification programs, short- and long-term treatment programs, methadone detoxification and maintenance programs, long-term therapeutic communities, and self-help adjuncts such as the 12-step programs. These programs can vary greatly with respect to treatment goals and philosophies. For example, abstinence is a prerequisite for entry into some programs, while it is a long-term goal in other programs. Some AOD treatment programs are not abstinence oriented. For example, some methadone maintenance programs have the overt goal of eventual abstinence for all patients, while others promote continued methadone use to encourage psychosocial stabilization.

As with mental health treatment, addiction treatment is provided by a diverse group of practitioners, including physicians, psychiatrists, psychologists, certified addiction counselors, MFCCs, and other therapists, counselors, and recovering paraprofessionals. There can be a wide difference in experience, expertise, and knowledge among these diverse providers. As with mental health treatment, most States have public and private AOD treatment systems.

The strengths of addiction treatment services include the multidisciplinary team approach with a bio-psychosocial emphasis, and an understanding of the addictive process combined with knowledge of the drugs of abuse and the 12-step programs. In typical addiction treatment, medications are used to treat the complications of addiction, such as overdose and withdrawal. However, few medications that directly treat or interrupt the addictive process, such as disulfiram and naltrexone, have been identified or regularly used. Maintenance medications such as methadone are crucial for certain patients. However, most addiction treatment professionals attempt to eliminate patients’ use of all drugs.

Addiction and Mental health-Similarities Treatment Systems

Variety of treatment settings and program types
Public and private settings
Multiple levels of care
Bio-psychosocial models
Increasing use of case and care management
Value of self-help adjuncts.

Many who work in the addiction treatment field have only a limited understanding of medications used for psychiatric disorders. Historically, some people have mistakenly assumed that all or most psychiatric medications are psychoactive or potentially addictive. Many addiction treatment staff tends to avoid the use of any medication with their patients, probably in reaction to those whose addiction included prescription medications such as diazepam. Many staff lack proper training and experience in the use of such medications. In the treatment of dual disorders, a balance must be made between behavioral interventions and the appropriate use of non-addicting psychiatric medications for those who need them to participate in the recovery process. Withholding medications from such individuals increases their chances of AOD relapse.

Because of these variances in administering addiction medication you need to specifically take the lead role in offering addiction treatment. Dr. Dalal Akoury Founder of AWAREmed Health and Wellness Resource Center is the expert you need. She is offering her exclusive NER Recovery Treatment to other physicians and health care professionals through training, clinical apprenticeships, webinars and seminars. Contacting her would be the beginning of your journey to truly successful and fast addiction recovery treatment.

Addiction and Mental health-Treatment

Neurotransmitters dysfunction and obesity

February 11, 2014

Neurotransmitters are the naturally occurring chemicals inside your body that transmit messages between nerve cells. In the brain alone there are 183 different neurotransmitters. Two major neurotransmitters are…..

Neurotransmitters

Neurotransmitters are naturally occurring chemicals that “transmit” electrical messages between nerve cells, called “neurons” hence the name neurotransmitters. They are produced in the body by amino acids with the help of vitamins and minerals. We get these amino acids, vitamins and minerals from the food we eat. However, if we are not getting enough of these or in an imbalanced ratio a deficiency occurs and over time can lead to the development of diseases and illnesses associated with low levels of neurotransmitters.

What diseases are associated with neurotransmitter dysfunction?

According to Neuro-Research a list of diseases or illnesses are caused by or associated with neurotransmitter dysfunction. Neurotransmitter dysfunction leads to obesity and the diseases resulting from obesity, as well as other diseases not associated with obesity. Causes of neurotransmitter dysfunction There are four known primary causes of neurotransmitter dysfunction. 1: Nutritional Deficiency 2: Prescription drugs 3: Damage to the neurons of the brain 4: Excess excretion of neurotransmitters by the kidneys

Neurotransmitter dysfunction -Why is lab testing only used after starting amino acid therapy?

This is a common question. We are used to a medical community that runs tests first and then treats based on the test. However with neurotransmitters, hyper excretion is a common problem. Hyper excretion results when the kidneys are excreting excessive amounts of neurotransmitters so that the urinary values don’t match up with the systemic values. Once treatment starts with amino acids this problem doesn’t seem to occur. Therefore testing is NOT performed prior to supplementation with amino acids.

Neurotransmitter dysfunction -How many supplements are involved in treatment and what is each doing?

There are two different programs available for treatment. The first specifically treats neurotransmitter dysfunction resulting in the “conditions related to obesity and neurotransmitter deficiency” listed right. The second program treats neurotransmitter dysfunction as well as weight loss by incorporating an appetite suppressant in the formula. This will assist in controlling your appetite, however, calorie restriction is still necessary to accomplish long-term weight loss. This second program can also be used to treat symptoms associated with Parkinsonism. If only one neurotransmitter system is not functioning properly, why do I have to take supplements that affect both systems? The reason is simple, according to Neuro-Research’s extensive research, they have found that 5% of patients have only serotonin dysfunction, 5% of patients have only catecholamine dysfunction and 90% of patients are a mixture of both. Both systems must be functioning properly for the entire system to be healthy and free of neurotransmitter disease. After you have started the program we will monitor your symptoms and lab test results and adjust the supplements accordingly. So in the end you may take more of one supplement than another to achieve an appropriate “balance”. More about the Neurotransmitter Support Supplements available! Proteins, minerals, vitamins, carbohydrates, and fats are the essential nutrients that make up your body. Proteins are the essential components of muscle tissue, organs, blood, enzymes, antibodies, and neurotransmitters in the brain. Your brain needs the proper nutrients every day in order to manufacture proper levels of the neurotransmitters that regulate your mood. Neurotransmitter Effects:

Control the appetite center of the brain.
Stimulates Corticotrophin Releasing Factor, Adrenocorticotropic Hormone, & Cortisol.
Regulate male and female sex hormone.
Regulates sleep.
Modulate mood and thought processes.
Controls ability to focus, concentrate, and remember things.
The Mind Body Connection.
The chemistry of our bodies can alter, and be altered by our every thought and feeling. Our bodies and our minds are truly interconnected; the health of one depends on the health of the other.

There are many biochemical neurotransmitter imbalances that result in mental health symptoms such as:

Adrenal dysfunction
Blood sugar imbalance
Food and Chemical allergy
Heavy Metal Toxicity
Hormone imbalance
Nutritional Deficiency
Serotonin/Dopamine/Noradrenalin imbalance
Stimulant and drug intoxication
Under or overactive thyroid

Neurotransmitter Imbalances Disrupted communication between the brain and the body can have serious effects to one’s health both physically and mentally. Depression, anxiety and other mood disorders are thought to be directly related to imbalances with neurotransmitters. The four major neurotransmitters that regulate mood are Serotonin, Dopamine, GABA and Norepinephrine.

Neurotransmitter dysfunction -The Inhibitory System

Neurotransmitter system dysfunction may contribute to the borderline personality disorder traits of impulsive aggression and affective instability

This is the brains braking system, it prevents the signal from continuing. The inhibitory system slows things down. Serotonin and GABA are examples of inhibitory neurotransmitters. GABA (Gamma amino butyric acid) GABA is the major inhibitory neurotransmitter in the central nervous system. It helps the neurons recover after transmission, reduces anxiety and stress. It regulates norepinephrine, adrenaline, dopamine, and serotonin; it is a significant mood modulator. Serotonin imbalance This is one of the most common contributors to mood problems. Some feel it is a virtual epidemic in the United States. Serotonin is key to our feelings of happiness and very important for our emotions because it helps defend against both anxiety and depression. You may have a shortage of serotonin if you have a sad depressed mood, anxiety, panic attacks, low energy, migraines, sleeping problems, obsession or compulsions, feel tense and irritable, crave sweets, and have a reduced interest in sex. Additionally, your hormones and Estrogen levels can affect serotonin levels and this may explain why some women have pre-menstrual and menopausal mood problems. Moreover, daily stress can greatly reduce your serotonin supplies. The Excitatory Neurotransmitter System This can be related to your car’s accelerator. It allows the signal to go. When the excitatory neurotransmitter system is in drive your system gets all raved up for action. Without a functioning inhibitory system to put on the brakes, things (like your mood) can get out of control. Among other things, the following should be in place to restore neurotransmitters in attempt to achieve weight loss. Epinephrine It’s also known as adrenaline is a neurotransmitter and hormone essential to metabolism. It regulates attention, mental focus, arousal, and cognition. It also inhibits insulin excretion and raises the amounts of fatty acids in the blood. Epinephrine is made from norepinephrine and is released from the adrenal glands. Low levels have been can result in fatigue, lack of focus, and difficulty losing weight. High levels have been linked to sleep problems, anxiety and ADHD. Dopamine It’s responsible for motivation, interest, and drive. It is associated with positive stress states such as being in love, exercising, listening to music, and sex. When we don’t have enough of it we don’t feel alive, we have difficulty initiating or completing tasks, poor concentration, no energy, and lack of motivation. Dopamine also is involved in muscle control and function. Low Dopamine levels can drive us to use drugs (self-medicate), alcohol, smoke cigarettes, gamble, and/or overeat. High dopamine has been observed in patients with poor GI function, autism, mood swings, psychosis, and children with attention disorders. Glutamate It’s the major excitatory neurotransmitter in the brain. It is required for learning and memory. Low levels can lead to tiredness and poor brain activity. Increased levels of glutamate can cause death to the neurons (nerve cells) in the brain. Dysfunction in glutamate levels are involved in many neurodegenerative diseases such as Alzheimer’s disease, Parkinson’s, Huntington’s, and Tourette’s. High levels also contribute to Depression, OCD, and Autism. Neurotransmitter Levels Neurotransmitter levels can now be determined by a simple and convenient urine test collected at home. Knowing your neurotransmitter levels can help you correct a problem today or prevent problems from occurring in the future.

Tag Archives: Mental health