The co-occurring I chose is Schizophrenia and Alcohol Dependence, with the prevalence of Nicotine Dependence. Schizophrenia occurs in people from all cultures and all walks of life, and its characteristic symptoms are well recognized. Those symptoms include extreme oddities in perception, thinking, action, sense of self, and manner of relating to others. However, the hallmark of schizophrenia is a significant loss of contact with reality, referred to as psychosis. Taken from the DSM IV (Association, 2000), (pgs. 153-154) the criteria for schizophrenia are two or more of the following symptoms, present for a significant portion of time during a 1-month period, and lasting for six months are:
Grossly disorganized or catatonic behavior.
According to (Butcher & Mineka, 2010) (pg.458), “the vast majority of cases of schizophrenia begin in late adolescence and early childhood, although schizophrenia is sometimes found in children, such cases are rare. Schizophrenia tends to begin earlier in men than in women, usually between ages 20 and 24. The incidence of schizophrenia in women peaks during the same age period, but the peak is less marked than it is for men. Overall, the average age of onset of schizophrenia is around 25 years for men and around 29 years for women”.
Alcohol Dependence is a state, psychic and usually also physical, resulting from alcohol use, and is characterized by behavioral and other responses that always include a compulsion to take alcohol on a continuous or periodic basis in order to experience its psychic effects, and sometimes to avoid the discomfort of its absence, tolerance may or may not be present. According to the DSM IV (Association, 2000), the criteria for alcohol dependence are a tolerance as defined by: a need for markedly increased amounts of the substance to achieve intoxication or desired effect, and the markedly diminished effect with continued use of the same amount of the substance. The symptoms of alcohol dependence are; Withdrawal syndrome.
It is taken in larger amounts or over a longer period than was intended. Unsuccessful efforts to cut down or control substance use.
A great deal of time is spent in activities necessary to obtain the substance. Alcohol and nicotine dependence are extremely common among patients with schizophrenia (Drake, 2001), almost half of schizophrenic patients have a substance use disorder during their lifetime. The rate is probably even greater among high-risk groups, such as young men with a history of violence or homelessness, and among patients in acute care settings. Alcohol abuse is correlated with poor concurrent adjustment and predictive of adverse outcomes such as higher rates of homelessness, hospitalization, and incarceration. There is a huge prevalence of nicotine dependence with this co-occurring disorder. Nicotine is the most common form of substance abuse in people with schizophrenia.
According to the (National Institute of Health, 2013), people with schizophrenia are driven to smoke. They smoke at three times the rate of the general population. In the general adult population age 18 years or older, the reported rate of nicotine use is 25.9%, with a 12.8% increase within the past year. In people with schizophrenia there is a reported rate of use of nicotine of 60% – 90%, a 28.5% increase within the past year. In the general population the rate of use for alcohol in people age 18 years or older is 2.9% – 17.9%, a 5.1% increase within the past year. In schizophrenic patients alcohol use has gone up from 14 to 22 percent in the 1960’s and 1970’s, to 25 to 50 percent in the 1990’s. Within the past year the reported dependence for alcohol in schizophrenic patients has gone up from 43.1% to 65%. According to (Substance Abuse and Mental Health Services Administration, 2013) assessment issues for this co-occurring disorder are: People who are experiencing symptoms of schizophrenia may put up resistance to help because they do not know that something is wrong, when in reality this can be a manifestation of the negative symptoms of schizophrenia.
The symptoms of schizophrenia can be mistaken for an individual being intoxicated. Many individuals with symptoms of schizophrenia isolate themselves from family and friends, and many are homeless, so they are not surrounded by a support system to get them to needed help. If the professional doing the assessment doesn’t have the individual’s previous mental health background, or their family’s mental health background, they won’t be able to properly assess the disorder. The traditional treatment modality for schizophrenia has been strictly focused on psychiatry and psychotropic drugs. However today professionals should be aware that there is evidence of increasing use of alcohol and drugs by persons with schizophrenia, and a dual diagnosis should be expected. Therefore, an accurate understanding of the role of substance use disorders in the client’s psychosis requires a multiple contact, longitudinal assessment.
Both psychotic and substance use disorders tend to be chronic disorders with multiple relapses and remissions, supporting the need for long-term treatment. For clients with co-occurring disorders involving psychosis, a long-term integrative approach is imperative. Treatment practices that could be harmful or contradictive for individuals with co-occurring disorders are; Untrained or unqualified staff – (staff members, whether primarily from the substance abuse treatment or mental health fields, should be knowledgeable about both disorders and their treatments. Treating one disorder without treating the other – (mental health and addiction treatment systems often are separated.
This situation may result in patients’ being treated at one location for addiction and at another for mental health disorders. Some mental health care facilities do not accept patients in medication-assisted treatment, forcing these patients to choose which disorder to treat. Also co-occurring disorders require individualized treatment approaches. It is usually best to address all of a patient’s disorders simultaneously because each can influence the other. The treatment approach for this co-occurring disorder should be a multi-disciplinary team approach. Special considerations should include an integrated approach, (a team working closely together, social worker, counselor or therapist, psychiatrist or mental health professional, and a medical doctor). There should also be: Available resources for crisis intervention.
Treatment for schizophrenia and drug treatment.
Rehabilitation (social and vocational training to help people with schizophrenia function better in their communities). Family education (people with schizophrenia are often discharged from the hospital into the care of their families. So it is important that family members know as much as possible about the disorder. With the help of a counselor, family members can learn coping strategies and problem solving skills). CBT (it helps patients with symptoms that don’t go away even when they take medications). Self-help groups (group members comfort and support each other; they know that others are facing the same problems, which can help everyone feel less isolated). Two treatment or community supports that are available in central Ohio are:
Dublin Springs Treatment Center
7625 Hospital Drive
Dublin, Ohio (614) 717-1800 www.dublinsprings.com
Center for Innovative Practices
Kent State University
Kent, Ohio (330) 672-7917 www-dev.rags.kent.edu/cip
Two local service providers that provide treatment for people with this co-occurring disorder are: Southeast Inc.
16 W. Long Street
Columbus, Ohio (614) 225-0990 www.southeastinc.com
Columbus Area Integrated Health Services
1515 E. Broad Street
Columbus, Ohio (614) 252-0711 interventionamerica.org
The factors that will increase the likelihood that clients will participate in treatment are: Developing and using a therapeutic alliance to engage the client in treatment. Maintaining a recovery perspective.
Monitoring psychiatric symptoms.
Using supportive and empathic counseling.
Employing culturally appropriate methods.
Increasing structure and support.
Encouraging family support and providing counseling and education. Three potential barriers that could prevent a person from taking advantage of treatment and/or supports are: Inaccessibility or funding for treatment (some mental health centers do not offer integrated treatment. Because of the lack of insurance and Medicaid cutbacks some people do not have access to funding for treatment. Also Legislators need to re-appropriate funding for treatment. However, agencies that are funded by ADAMH provide 100% funding for treatment. Ex. Southeast Inc.). Homelessness (many individuals who suffer from this disorder isolate themselves from family and friends, so they don’t have a support system to get them to help when their symptoms are presenting.
Many are incarcerated and there is no mental health background for them, or they are jailed because the symptoms of schizophrenia are similar to intoxication). Staff who are undertrained in the symptoms of this co-occurring disorder. Involvement of family or significant others are very important in treatment and should be offered counseling to help them with coping strategies and problem-solving skills, they should also be offered education about the disorder. Additional information about this co-occurring disorder pertains to the use of nicotine; (smoking may make anti-psychotic drugs less effective, and quitting smoking is very difficult because nicotine withdrawal may cause these individuals psychotic symptoms to get worse for a while.
Association, A. P. (2000). DSM, IV. In Diagnostic Criteria (pp. 153-154). Arlington: American Psychiatric Association. Butcher, J. N., & Mineka, S. H. (2010). Abnormal Behavior. Boston: Pearson Publishing Co. Drake, R. E. (2001, August 17). Treating Substance Abuse Among Patients With Schizophrenia. Biological Psychiatry, pp. 71-83. National Institute of Health. (2013, October 12). Retrieved from National Institute of Mental Health: www.nimh.nih.gov Substance Abuse and Mental Health Services Administration. (2013, September 15). Retrieved from SAMHSA: www.samhsa.gov
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