Embark on a profound journey with us as we unravel the complexities of co-occurring disorders alongside our insightful co-host, Stacy Frost. Together, we illuminate the often-misunderstood intersection where mental health meets substance use, unpacking the critical signs and tailoring treatment to individual needs. Discover how bipolar disorder intertwines with alcohol, how PTSD merges with a bottle, and the shadowy dance between depression and opioids. Through our conversation, we promise insights that will deepen your understanding of these dual battles waged within the mind and body, equipping you with the knowledge to recognize and address the nuanced symptoms that often go unnoticed.
With an ear to the ground and an eye on the latest clinical tools, we guide you through the maze of diagnostic techniques that are reshaping our approach to dual diagnosis. The Structured Clinical Interview for DSM Disorders and the Mini International Neuropsychiatric Interview emerge as our compasses in this terrain, helping clinicians navigate the nuanced presentations of co-occurring disorders. As we share these insights, remember that a well-informed perspective is your best ally in supporting those facing the silent struggles of intertwined mental health and substance challenges. Join us for an engaging session that not only prepares you for clinical practice but also offers a beacon of understanding for anyone touched by these complex conditions.
If you need to study for your national licensing exam, try the free samplers at: LicensureExams
This podcast is not associated with the NBCC, AMFTRB, ASW, ANCC, NASP, NAADAC, CCMC, NCPG, CRCC, or any state or governmental agency responsible for licensure.
Embark on a profound journey with us as we unravel the complexities of co-occurring disorders alongside our insightful co-host, Stacy Frost. Together, we illuminate the often-misunderstood intersection where mental health meets substance use, unpacking the critical signs and tailoring treatment to individual needs. Discover how bipolar disorder intertwines with alcohol, how PTSD merges with a bottle, and the shadowy dance between depression and opioids. Through our conversation, we promise insights that will deepen your understanding of these dual battles waged within the mind and body, equipping you with the knowledge to recognize and address the nuanced symptoms that often go unnoticed.
With an ear to the ground and an eye on the latest clinical tools, we guide you through the maze of diagnostic techniques that are reshaping our approach to dual diagnosis. The Structured Clinical Interview for DSM Disorders and the Mini International Neuropsychiatric Interview emerge as our compasses in this terrain, helping clinicians navigate the nuanced presentations of co-occurring disorders. As we share these insights, remember that a well-informed perspective is your best ally in supporting those facing the silent struggles of intertwined mental health and substance challenges. Join us for an engaging session that not only prepares you for clinical practice but also offers a beacon of understanding for anyone touched by these complex conditions.
If you need to study for your national licensing exam, try the free samplers at: LicensureExams
This podcast is not associated with the NBCC, AMFTRB, ASW, ANCC, NASP, NAADAC, CCMC, NCPG, CRCC, or any state or governmental agency responsible for licensure.
Linton:
Welcome back to another episode of our licensure exam podcast. I'm Dr Linton Hutchinson and I'm here with my co-host, Stacey Frost. This episode, part of our demystifying disorders series, is all about co-occurring disorders, also called dual diagnoses, which is a topic that you'll need to know for the exam. We'll be looking at the signs and symptoms for co-occurring disorders, as well as the screening and assessment process. So, Stacey, why don't you start us off with the basics? What the heck is a co-occurring disorder?
Stacy:
So, linton, this is when your client has both a substance use disorder and a mental health disorder. Now, if your client has a substance use disorder, it's very possible that they also have an anxiety disorder, post-traumatic stress disorder, a depressive disorder, bipolar, a personality disorder, borderline and antisocial, for example, have a really high comorbidity with substance abuse. They could also have an eating disorder or a psychotic disorder like schizophrenia. So you need to be familiar with the symptoms of these disorders so that you can determine which intervention strategies will be most effective for your client in their recovery process.
Linton:
Yes, especially for the exam. So what combinations are therapists most likely to encounter in practice and on the exam?
Stacy:
Okay, so one of the most common pairings that you see is bipolar one and alcohol use or stimulant use. So a client with bipolar might use alcohol to cope with depressive episodes or use stimulants to prolong their manic or those really high energy phases.
Linton:
Mm-hmm, and there's also a strong link between PTSD and alcohol addiction. The numbing effects of alcohol provide temporary relief from PTSD symptoms like flashbacks and hypervigilance, but the alcohol use ultimately makes the PTSD worse. For your exam, if your client is given a provisional diagnosis of PTSD, you should also be on the outlook for a possible co-occurring disorder. Mm-hmm.
Stacy:
And there's also another common combination that you might see is major depressive disorder and opioid use disorder. So you could have a client who started off by using prescription opioids to manage a pain condition and then, after long-term, use their brain chemistry, mainly those feel-good neurotransmitters, dopamine and serotonin well, they get off balance, kind of out of whack and now they're dealing with depression too. Or you might have a client who starts off using heroin to self-medicate their depressive symptoms and their emotional pain Wow. But eventually this heroin use spirals into full-blown addiction and ultimately deepens their depression.
Linton:
Got it Now, the age-old question which came first, the chicken or the egg?
Stacy:
I know, you were going to say that.
Linton:
Oh, with you having chickens, what else could I say?
Stacy:
I appreciate a good chicken joke. Thank you, Linda Okay.
Linton:
So seriously? Which came first, the addiction or the mental illness?
Stacy:
Well, just like which came first, the chicken or the egg, this is different for everyone. So some clients might have started off to experience symptoms of a mental illness when they were young, and maybe around that time they also started to experiment with drugs and developed an addiction.
Linton:
Right.
Stacy:
Others might have tried to self-medicate and cope with a pre-existing mental illness by using drugs, and there are still some other clients who may have developed the addiction first and this acted kind of like a trigger for a mental illness like depression, anxiety or a psychotic disorder.
Linton:
Okay, Now let's shift over into talking about some of the signs and symptoms that a client may be experiencing with a dual diagnosis. What are some of the red flags to look out for in the case study or subsequent sessions with the client Stacey?
Stacy:
Okay. So we've got things like rapid mood swings. This could indicate a mental health issue like bipolar disorder, combined with substance use intended to self-medicate Mm-hmm, you could. If you see something like social withdrawal and isolation, this can happen with depression, anxiety or other disorders and really be exacerbated by drug or alcohol use. Then we've got difficulty concentrating or remembering things. So cognitive issues might signal psychiatric problems that are being compounded by substance use. Those are off the top of my head. Any other signs you'd like to add, Linton?
Linton:
Well, you've covered some of the big ones, but a few other signs that could suggest a dual diagnosis are repeated risky or dangerous behaviors. Being impulsive and poor judgment linked to mental illness can also be magnified by substance intoxication. Paranoia or hallucinations, symptoms of schizophrenia or other psychotic disorders may become worse with heavy substance use. Also, if your client exhibits poor self-care and hygiene or experiences dramatic changes in sleep patterns. That's a key, mm Gotcha. Thanks.
Stacy:
Linton, can you talk a little bit more about the screening process for co-occurring disorders?
Linton:
The components of the screening process depend on the treatment setting. Really, if you're working in a mental health settings, you'll want to one screen for past and present substance abuse. If there's any recent or current substance abuse, you'll also want to determine any safety risk associated with intoxication and withdrawal. If you're in a substance use treatment setting, then you'll be screening for safety risk associated with suicide, violence, ability to care for self, hiv, hepatitis and other risky behaviors, past and current mental health problems, cognitive and learning problems and any other dangers and trauma. That's good, that makes sense.
Stacy:
Okay, and once you've determined that your client likely has a co-occurring situation, so they've got that substance use issue combined with a mental health issue, then you're going to continue with a very detailed assessment to determine the exact nature of your client's problem so you can come up with treatment recommendations. So you're going to ask your client questions about their background, including family, community and other issues. So you're going to ask your client questions about their background, including family, cultural, gender, sexual orientation issues, trauma, marital status, legal financial health, education, housing status, strengths and resources and employment. Well, you're also going to ask your client questions about substance use, including the age of their first use, primary drugs they've used, any patterns of use and past or current treatment. You'll ask about psychiatric problems, including family and client history of psychiatric issues, current diagnoses or symptoms, medication and whether they are adhering to their medication and past successful treatment for mental disorders. And you'll conduct an integrated assessment, which means you're looking at the relationship between the mental disorder or disorders and the client's substance use.
Linton:
So basically everything in the kitchen sink.
Stacy:
You got it, yep.
Linton:
Okay On your exam. If you suspect that your client may have a co-occurring disorder, here are some assessment tools you might consider using to evaluate their situation further the structured clinical interview for the DSM disorders, or the SCID, which is a semi-structured interview guide used by clinicians and researchers to determine the presence of a DSM-5-TR diagnosis for mental health disorders. Different versions screen for mood disorders, substance use, anxiety and psychiatric disorders. Here's another the mini-international neuropsychiatric interview. Say that twice, stacy.
Stacy:
That's a mouthful Linton Boy. We'll just call it the mini for short.
Linton:
Really Okay, mini, which is a short, structured diagnostic interview that screens for mental health disorders commonly associated with substance use, disorders, including mood, anxiety, psychotic and eating disorders and, of course, one of your favorite, a biosocial assessment. This takes a comprehensive history, look at biological, psychological and social factors. This allows the clinician to assess for signs of multiple conditions rather than taking a more narrow focus. The interactive effects of disorders are considered, for example, depression symptoms exacerbated by alcohol abuse or psychosis aggravating PTSD. This helps determine primary versus secondary illnesses.
Stacy:
Good ones. And of course there is the mental status examination, which is a structured way of observing and describing a client's psychological functioning at any given point in time. So when you observe the client's appearance, behavior, speech, thought process, cognition, insight and judgment, this is going to allow you as a clinician to pick up on signs and symptoms of multiple conditions that might be present. So the MSC also helps differentiate symptoms that could be attributed to different disorders. For example, disorganized speech could indicate psychosis, mania or possibly a side effect of substances. So it gives you kind of a platform to explore more things in depth once you've identified kind of an umbrella of symptoms.
Linton:
That makes sense. Yeah, and all right. So this brings us to the end of this episode. How about giving us a quick summary before we sign off? Stacey, Sure.
Stacy:
Co-occurring disorders, also called dual diagnoses, is when a person has both a substance use disorder and a mental health disorder. Some common combinations include bipolar one disorder and alcohol use or stimulant use, ptsd and alcohol and depression and opioid use. Signs of co-occurring disorders can include mood swings, withdrawal, cognitive issues, risky behaviors, paranoia and hallucinations and poor self care, and there are a variety of assessment tools that can be used to screen for and comprehensively assess co-occurring disorders, including the structured clinical interview for DSM disorders and the mini international neuropsychiatric interview.
Linton:
Thanks, stacey, and until we meet again. Remember it's in there.
