Substance abuse disorders are now classified as mental disorders according to the DSM-5. Addiction changes the brain in fundamental ways and causes compulsive drug-seeking behaviors that override the ability to control impulses. Approximately 21.5 million Americans had a substance use disorder in the past year, including alcohol and illicit drugs. Co-occurring mental health and substance use disorders are common, with 7.9 million people having both in the past year. Integrated treatment that addresses both disorders together is most effective for those with co-occurring disorders.

1. SubstanceAbuse
&MentalHealthDisorders
Angela Penny, Cirque Lodge, 4/13/2016

2. SubstanceAbuseisaMentalDisorder
● Addiction changes the brain in fundamental ways,
disturbing a person's normal hierarchy of needs and
desires and substituting new priorities connected with
procuring and using the drug. The resulting
compulsive behaviors override the ability to control
impulses despite the consequences.
● Substance use disorders occur when the recurrent
use of alcohol and/or drugs causes clinically and
functionally significant impairment, such as health
problems, disability, and failure to meet major
responsibilities at work, school, or home. According
to the (DSM5) a diagnosis of substance use disorder
is based on evidence of impaired control, social
impairment, risky use, and pharmacological criteria.

3. SubstanceUseDisorders(SUDs)
Approximately 21.5 million people aged 12 or
older in 2014 had SUDs in the past year,
including 17.0 million people with an alcohol
use disorder and 7.1 million people with an
illicit drug use disorder
An estimated 2.6 million people aged 12 or
older had both an alcohol use disorder and
an illicit drug use disorder in the past year.

4. 1.3 Million of people with an SUD in the last year were aged 12 - 17

5. AnyMentalIllness(AMI)
● Mental illnesses are common in the
United States.
● AMIs include mental, behavioral, or
emotional disorders (excluding
developmental and substance use
disorders);
● In 2014, there were an estimated
43.6 million adults aged 18 or older
in the United States with an AMI in
the past year. This number
represented 18.1% of all U.S. adults.

6. SeriousMentalIllness(SMI)
● In 2014, there were an
estimated 9.8 million adults
aged 18 or older in the United
States with SMI. This number
represented 4.2% of all U.S.
adults.

7. CoOccuringDisorders
● The coexistence of both a mental
health disorder and a substance use
disorder is referred to as co
occurring disorders. This used to be
referred to as dual diagnosis.
● In 2014, an estimated 43.6
million (18.1%) Americans ages
18 and up experienced some
form of mental illness. In the past
year, 20.2 million adults (8.4%)
had a substance use disorder. Of
these, 7.9 million people had both a
mental disorder and substance use
disorder.

8. ComplicatedtoDiagnose
● People with mental health disorders are more likely than people without mental health disorders to
experience an alcohol or substance use disorder.
● Co occurring disorders can be difficult to diagnose due to the complexity of symptoms, as both may
vary in severity. Are people depressed because they are alcoholic or are they using alcohol to self
medicate depression?
● When someone is treated primarily for a substance abuse disorder they need to be clean of all
substances for 30 days before they can receive a secondary diagnosis. Many psychiatrists won’t do
it before 60 days.
● People with co occurring disorders are best served through integrated treatment. Addressing each
of the disorders separately and together.

9. MostCommoncooccuringdisorders
Anxiety Disorders
Anxiety can be a symptom of a substance abuse
problem, including alcohol and caffeine. It is also caused
by withdrawal from certain drugs. It often co occurs with
depression and bipolar disorder.
A person may find that they have problems making daily
decisions and remembering commitments as a result of
lack of concentration/preoccupation with worry.
The term anxiety covers four aspects of experiences
that an individual may have: mental apprehension,
physical tension, physical symptoms and dissociative
anxiety. The emotions present in anxiety disorders
range from simple nervousness to bouts of terror.
Mood Disorders
Mood disorders represent a category of mental
disorders in which the underlying problem primarily
affects the persistent emotional state of an individual.
Major depression is one of the most common mental
disorders in the United States.
In 2014, an estimated 15.7 million adults aged 18 or
older in the United States. had at least one major
depressive episode in the past year. This number
represented 6.7% of all U.S. adults.
Women are 50% more likely to experience depression
than men.

10. AnxietyDisorders
★ Anxiety is the most common mental disorder
experienced by Americans. 28.8% of all adults
will experience excessive anxiety in their lifetime.
Women are 60% more likely to experience
anxiety disorders than men.
★ It is a normal reaction to stress and is beneficial
in some situations. For some people, however,
anxiety can become excessive, and while the
person suffering may realize this, they still may
also have difficulty controlling it and it may
negatively affect their daily life.
★ Common treatment options include lifestyle
changes, therapy, and medications. Medications
are typically recommended only if other measures
are not effective.

11. GeneralizedAnxietyDisorder(GAD)
● Generalized anxiety disorder (GAD) is characterized by excessive worry about a variety of everyday problems for at least
6 months. For example, people with GAD may excessively worry about and anticipate problems with their finances, health,
employment, and relationships. They typically have difficulty calming their concerns, even though they realize that their
anxiety is more intense than the situation warrants.
● Symptoms include: fatigue, fidgeting, headaches, nausea, numbness in hands and feet, muscle tension, muscle aches,
difficulty swallowing, excessive stomach acid buildup, stomach pain, vomiting, diarrhea, bouts of breathing difficulty,
difficulty concentrating, trembling, twitching, irritability, agitation, sweating, restlessness, insomnia, hot flashes, rashes,
and inability to fully control the anxiety
● GAD is also common in individuals with a history of substance abuse. Long term use of benzodiazepines can worsen
underlying anxiety, with evidence that reduction of benzodiazepines can lead to a lessening of anxiety symptoms.
Similarly, long term alcohol use is associated with anxiety disorders, with evidence that prolonged abstinence can result in
a disappearance of anxiety symptoms. However, it can take up to two years for anxiety symptoms to return to baseline in
about a quarter of people recovering from alcoholism.

12. GeneralizedAnxietyDisorderSTATS
● In a given year, approximately 3.1%
of American adults experience GAD.
● It is seen in women twice as much
as men.
● About a third of the variance for
generalized anxiety disorder has
been attributed to genes.
● It is the most common cause of
disability in the workplace.
● Once GAD develops. it may become
chronic, but can be managed or
eliminated with proper treatment.

13. OtherTypesofAnxietyDisorders
Social Phobia Among Adults | (6.8% in 2014) 12.1% lifetime prevalence
Social phobia is characterized by a persistent, intense, and chronic fear of being watched and judged by others and feeling
embarrassed or humiliated by their actions. This fear may be so severe that it interferes with work, school, and other
activities and may negatively affect their ability to form relationships.
Post Traumatic Stress Disorder (PTSD) | (3.5% of US Adults in 2014) 6.8% lifetime prevalence
(PTSD) is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which there was the potential for or
actual occurrence of grave physical harm. Traumatic events that may trigger PTSD include violent personal assaults, natural or human
caused disasters, accidents, and military combat. People with PTSD have persistent frightening thoughts and memories of their ordeal.
They may experience sleep problems, feel detached or numb, or be easily startled.
Obsessive Compulsive Disorder (OCD) | (1% of US pop, 1.6% in lifetime) 50% severe
Characterized by intrusive thoughts that produce anxiety (obsessions), repetitive behaviors that are engaged in to reduce anxiety
(compulsions), or a combination of both. While many are concerned about germs or leaving their stove on, people with OCD are
unable to control their anxiety producing thoughts and their need to engage in ritualized behaviors. As a result, OCD can have a
tremendous negative impact on daily functioning.

14. SocialAnxietyDisorder
Social Anxiety Disorder
People with social anxiety disorder (sometimes called “social phobia”) have a marked fear of social or performance
situations in which they expect to feel embarrassed, judged, rejected, or fearful of offending others. Social anxiety disorder
symptoms include:
● Feeling highly anxious about being with other people and having a hard time talking to them
● Feeling very self conscious in front of other people and worried about feeling humiliated,
embarrassed, or rejected, or fearful of offending others
● Being very afraid that other people will judge them
● Worrying for days or weeks before an event where other people will be
● Staying away from places where there are other people
● Having a hard time making friends and keeping friends
● Blushing, sweating, or trembling around other people
● Feeling nauseous or sick to your stomach when other people are around

15. PanicDisorders&ADHD
Panic Disorder (2.7 % of Adult Population, 44.8% severe, 4.7% in Lifetime)
People with panic disorder have recurrent unexpected panic attacks, which are sudden periods of intense fear that may
include: palpitations, pounding heart, an accelerated heart rate, sweating, trembling or shaking, shortness of breath,
smothering or choking sensations, or a feeling of impending doom.
Panic disorder symptoms include:
● Sudden and repeated attacks of intense fear
● Feelings of being out of control during a panic attack
● Intense worries about when the next attack will happen
● Fear or avoidance of places where panic attacks have occurred in the past
Attention Deficit Hyperactivity Disorder (4.1% in past 12 months, 8.1% in lifetime)
Attention deficit hyperactivity disorder (ADHD) is defined by a persistent pattern of inattention (for example, difficulty keeping focus)
and/or hyperactivity, impulsivity (for example, difficulty controlling behavior, excessive and inappropriate motor activity).

16. MoodDisorders
Mood disorders represent a
category of mental disorders in
which the underlying problem
primarily affects an emotional
state (their mood). The statistics
below, derived from the National
Comorbidity Survey –
Replication (NCSR), represent
people experiencing major
depressive disorder, dysthymic
disorder, and/or bipolar disorder.

17. DepressiveDisorders(IncludingMDD)
In 2014, an estimated 15.7 million adults aged 18 or older in the United States. had at least one
major depressive episode in the past year. This number represented 6.7% of all U.S. adults.

18. DepressiveDisorders(IncludingMDD)
● Depressive disorders are among the most common mental health disorders in the United States. They are
characterized by a sad, hopeless, empty, or irritable mood, and somatic and cognitive changes that significantly
interfere with daily life.
● Major depressive disorder (MDD) is defined as having a depressed mood for most of the day and a marked loss of
interest or pleasure in activities. Additional symptoms may include significant weight loss or gain, insomnia or
hypersomnia, feelings of restlessness, lethargy, feelings of worthlessness or excessive guilt, distractibility, and
recurrent thoughts of death, including suicidal ideation. Symptoms must be present for at least two weeks.
● NSDUH data also show that the prevalence of MDE among adolescents aged 12 to 17 was 11.4% in 2014, while
female youths were about three times as likely as male youths to experience a MDE.
● MDD is thought to have many possible causes, including genetic, biological, and environmental factors. Adverse
childhood experiences and stressful life experiences are known to contribute to risk for MDD. In addition, those with
closely related family members (for example, parents or siblings) who are diagnosed with the disorder are at
increased risk.
● Substance use: 27% of individuals with substance abuse disorders (both alcohol and other substances) experience
depression. (National Institute of Mental Health, 1999)

19. BipolarDisorder(2.6%ofPop)
Some bipolar disorder symptoms are similar to other illnesses, which can make it hard for a doctor to make a diagnosis. In addition,
many people have bipolar disorder along with another illness such as anxiety disorder, substance abuse, or an eating disorder. People
with bipolar disorder are also at higher risk for thyroid disease, migraine headaches, heart disease, diabetes, obesity, and other
physical illnesses.
Psychosis: Sometimes, a person with severe episodes of mania or depression also has psychotic symptoms, such as hallucinations
or delusions. The psychotic symptoms tend to match their extreme mood. For example:
● Someone having psychotic symptoms during a manic episode may believe she is famous, has a lot of money, or has special
powers.
● Someone having psychotic symptoms during a depressive episode may believe he is ruined and penniless, or that he has
committed a crime.
As a result, people with bipolar disorder who also have psychotic symptoms are sometimes misdiagnosed with schizophrenia.
Anxiety and ADHD: Anxiety disorders and attention deficit disorder (ADHD) are often diagnosed among people with bipolar disorder.
Substance Abuse: People with bipolar disorder may also misuse alcohol or drugs, have relationship problems, or perform poorly in
school or at work. Family, friends and people experiencing symptoms may not recognize these problems as signs of a major mental
illness such as bipolar disorder.

20. BorderlinePersonalityDisorder
1.6% of the Population had this in the year 2014
Borderline personality disorder (BPD) is characterized by pervasive instability in moods, interpersonal relationships, self-
image, and behavior. While a person with depression or bipolar disorder typically endures the same mood for weeks, a
person with BPD may experience intense bouts of anger, depression, and anxiety that may last for only a few hours to a
day. People with Borderline Personality Disorder often have trouble having insight to their disorder.

21. HistoryofTreatment
1750: Alcoholic mutual aid societies (sobriety "Circles") are formed within various Native American tribes.
Some are part of, or evolve into, abstinence based Native American cultural revitalization movements and
temperance organizations.
1849: The Swedish physician Magnus Huss describes a disease resulting from chronic alcohol consumption
and christens it Alcoholismus chronicus. This marks the introduction of the term alcoholism.
1864: The New York State Inebriate Asylum, the first in the country, is opened in Binghamton, NY. A
growing network of inebriate asylums will treat alcoholism and addiction to a growing list of other drugs:
opium, morphine, cocaine, chloral, ether, and chloroform.
1935: The opening of Shadel Sanatorium marks the introduction of aversive conditioning in an institutional
alcoholism treatment setting.
The first federal "narcotics farm" (U.S. Public Health Prison Hospital) opens in Lexington, Kentucky. The
second facility opens in Fort Worth, Texas in 1938. This marks the beginning of federal involvement in
addiction research and addiction treatment.

23. ChangefromDSM4toDSM5
● The Substance Abuse diagnosis was substantially simplified from the DSM 4 to the new DSM 5
version published in 2013.
● Now the Substance Abuse diagnosis is enough for most insurance companies to approve the
expenditure. You don’t need to have a co occurring disorder to get treatment.
● Stigmas attached to drug addiction and alcoholism are changing. There is more of an understanding
that people aren’t choosing to screw up their lives.
● It is important to understand that disorders overlap and impact each other. It is impossible to treat
the co occuring disorder if the substance abuse disorder is not addressed.
● It is important stay focused on treatment and a) stay as long as possible, b) be vigilant about health
& fitness, therapy and, c) not only treating the alcoholism/drug addiction but also any co occuring
mental disorders.

24. Advocateforthyselfasamental
healthconsumer
Informationispower