Module 5 - Co-Occurring Disorders: Integrating Tobacco Use Interventions into Chemical Dependence Services. Welcome. Add Trainer Name(s). This training was developed by the Professional Development Program, under a contract with the NYS Department of Health, Tobacco Control Program.
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This training was developed by the Professional Development Program, under a contract with the NYS Department of Health, Tobacco Control Program.
PDP developed five classroom-based curricula and seven online modules, which are available at www.tobaccorecovery.org
Module 1 - Foundations
Module 2 - Assessment, Diagnosis, and Pharmacotherapy
Module 3 - Behavioral Interventions
Module 4 - Treatment Planning
Module 5 - Co-occurring Disorders
E-Learning - All Modules
Please review page 10 in your manual
Learning points from prior modules
New knowledge or skills integrated into practice
How do you define co-occurring disorders?
Co-occurring disorders - when a person has a substance use disorder and mental health disorder at the same time.
How do you define co-morbidity?
Co-morbidity - two or more disorders are present at the same time and they interact in ways that affect the course and/or prognosis of each disorder.
Assess your current confidence, attitudes, and beliefs about tobacco use among people with MHD and SUD
Examining how attitudes and beliefs about tobacco, affect staff and patient behavior to examine and address tobacco use.
Produced by Clubhouse of Suffolk Ronkonkoma, NY
Vignette #1 Program, under a contract with the NYS Department of Health, Tobacco Control Program.
Vignette #2 Program, under a contract with the NYS Department of Health, Tobacco Control Program.
Vignette #3 Program, under a contract with the NYS Department of Health, Tobacco Control Program.
mentioned about stopping tobacco use?
Vignette #4 Program, under a contract with the NYS Department of Health, Tobacco Control Program.
Vignette #5 Program, under a contract with the NYS Department of Health, Tobacco Control Program.
Definition of co-occurring disorders and co- morbidity
Confidence, attitudes, and beliefs
Patient perspectives on tobacco use/dependence
Challenges and barriers to addressing tobacco use by people with SUDs and MHDs
What is the frequency of patients having a co-occurring mental health disorder and substance use disorder?
NYS Chemical Dependence Programs:
(Office of Alcoholism and Substance Abuse Services, 2008)
Tobacco and Co-occurring Disorders
PM 21 - 23
About 70% of people with a mental health disorder (MHD) and/or a substance use disorder (SUD), also smoke tobacco.
Studies vary as to each disorder and people with some disorders have smoking rates up to 80 - 90%.
About half of all
in the US are by
people with MHD
Results in significant illness, death, and health disparity for two vulnerable populations.
Primary cause of death is cardiovascular disease (CVD) and diabetes. #1 cause of CVD is tobacco smoke and tobacco is a key factor in onset of diabetes.
The average lifespan in US is 77.8 years.
For smokers with MHD or SUD, this life span is reduced by 32%.
Average percentage of monthly income spent on tobacco
Averages about $142 per month based upon 2000 - 2002 costs.
Increased suicide thinking and attempts even considering a prior history of depression, substance use disorder, and prior suicide attempts.
Increased risk of suicide for people with bipolar illness and schizophrenia.
Increased suicide completion rates for tobacco using adolescents and greater number of attempts, especially for females
Heavy tobacco smoking is highly associated with increased suicide completion
Nicotine is not a carcinogen and is not a major risk factor of cardiovascular disease (CVD).
Tobacco smoke is the disease-causing agent.
Nicotine does not affect the metabolism of medications.
Tobacco smoke induces the liver to increase the metabolism rate of some psychiatric and some non-psychiatric medications.
Many people can stop without changes in medication levels.
Some may require lower doses to avoid medication toxicity (i.e., clozapine, olanzepine) or to avoid increased side effects (i.e., amitriptyline, nortriptyline, and imipramine).
See Table 1 - Common Drugs Affected by Tobacco Smoke
Increased feelings of general anxiety from using tobacco.
Patients often confuse nicotine withdrawal symptoms with primary anxiety symptoms of MHD or SUD.
Many mistakenly assume using tobacco causes their general anxiety symptoms to stop.
Tobacco use is a significant risk factor for panic disorder, agoraphobia, and generalized anxiety disorder (GAD).
Also refer back to answer in Statement 10.
70% expressed an interest in stopping in the past year.
People with MHDs and/or SUDs express an interest in stopping tobacco use as often as smokers in the general population.
Many can stop and need more frequent treatment, more intense treatment, and more engagement.
No increased problems after stopping and recent research shows MH symptoms decrease after tobacco abstinence.
About 92% of Chantix is eliminated unchanged from body by kidneys.
Chantix has no drug-to-drug interactions.
Tobacco is a common “gateway drug” for AOD use
Smoking increases risk for mental illness and doubles the risk for major depression when used in adolescence.
Adolescent tobacco use associated with increased adult risk for panic disorder, anxiety disorder, agoraphobia, depression, suicidal behavior, SUD, and schizophrenia.
Active psychiatric disorders are associated with daily smoking and progression to dependence.
Risk of major depression in women who smoke is increased 93%.
How many of these answers did you already know?
Were there any surprises from what you just learned?
Biopsychosocial Approach to Substance Dependence medications
Tobacco dependence is a biopsychosocial disease
Neurobiological Factors and Neuro-chemical Effects of Tobacco/Nicotine
PM 32 - 33
Other Factors Affecting Tobacco Use Tobacco/Nicotine
PM 34 - 35
Other Substance Use Disorder
Substance Use Disorder
Mental Health Disorder
Interaction between Tobacco Dependence Mental Health Disorder and
Mental Health Disorder
Interaction between Tobacco Dependence, Mental Health Disorder, and Substance Use Disorder
Substance Use Disorder
Mental Health Disorder
What are the common factors between tobacco dependence, substance use disorders, and mental health disorders?
PM 40 - 41
All have common chemical pathways affecting the brain
All are chronic, biopsychosocial diseases
The disorders negatively interact and result in co-morbid conditions
Treatment using medication, behavioral, psychoeducation, and supportive therapies
Recovery is possible and requires lifestyle changes
PM 45 - 47
Case Studies Disorder, and Substance Use Disorder
PM 53 - 54
PM 55 - 56
Smoking/Drug Chart PM 57
PM 51 - 52
Tobacco dependence treatment for people with MHD or COD is not different from other populations
Often requires higher intensity and frequency of treatment episodes, and often more engagement
Tobacco treatment medications are important to use along with counseling, psychoeducation, and supportive therapies
Anticipate possible need to modify medication dosage
Revisit your confidence, attitudes, and beliefs from the questions posed earlier
The Tobacco Recovery Resource Exchange http://www.tobaccorecovery.org
E-Learning and Online Resources
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