PUBH 3003 1st Edition Lecture 5Outline of Last Lecture I. Why do people do drugs?II. What Motivates PeopleIII. Addictiona. Why do some people become addicted and others do not?b. Risk factorsc. Reward/ Pleasure SystemIV. Genetics and Biology of Alcoholism a. Environment factorsb. What Heroin Addiction Tells us About changing bad habitsV. Risk Factorsa. Elementary Ageb. Adolescent c. Adults d. FamilyVI. Why does a person who is addicted to drugs continue to take thema. Slow delivery Current LectureI. Substance Abusea. Spectrumb. DisordersII. Mental Health and Mental Disorders a. Diagnosis and Treatmentb. Justice Systems III. Mental Health StudiesSubstance Use Disorders and Mental Health Spectrum of Psychoactive Substance Use- Casual Non Problematic Use- recreational, casual, or other use that has negliable health or social effects- Beneficial Use- Use that has health, spiritual or social impacts (prescribed medications)These notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.- Problematic Use- Use that begins to have negative consequences for individual friends/ family or society- Chronic Dependence- use that has become habitual and compulsive despite negative health and social effectsChanges in DSM – 5 (2013)- Combined categories of substance abuse and substance dependence into a single disorder – substance use disorder – and measured on a continuum from mild to severe- Eliminates legal problems as criterion- Ads craving as criterion for diagnosisSubstance Use Disorders:1. Recurrent substance use resulting in a failure to fulfill a major role – obligations at work, school or home (e.g. repeated absences and poor work performance related to substance abuse; substance related absences, suspensions or expulsions from school, neglect of children or household)2. Recurrent substance abuse in situations in which it is physically hazardous (e.g. drivinga car when impaired by a substance)3. Continued substance abuse despite having persistent or recurrent social or interpersonal problems caused by or exhaberated by the effects of the substance ( e.g. Arguments with spouse about substance use, etc)4. Tolerance- As defined by the following :a. A need for markedly increased amounts of the substance to achieve intoxication or desired affectsb. Markedly diminished effect with continued use of the same amount of substance. ( Note: tolerance is not counted for those taking medication under medical supervision)5. Withdrawal: As manifested by the following:a. The characteristic withdrawal syndrome for the substance b. The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms (Note: Withdrawal is not counted for those taking medication under medical supervision)6. Substance taken in lager amounts over longer period of time than intended 7. Persistence desire or unsuccessful efforts to cut down or control use 8. A great deal of time is spent in activities necessary to obtain the substance or recover from its effects9. Important social, occupational or recreational activities are given up or reduced because of use10. The substance is continued despite the knowledge of having a persistent, recurrent, physical or psychological problem that is likely to have been caused by or exacerbated by the substance 11. Craving or a strong urge to use a specific substanceDisorder categorized based on level of severity :Mild- 0-2Moderate 3-6Severe- 7-11Mental Health and Mental Disorders:- Mental Health: State of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to change and cope with challenges - Mental Disorders- Health conditions that are characterized by altered by thinking, mood and or behavior that are associated with distress and or impaired functioning - Mental Illness – The term that refers collectively to all diagnosable mental disordersMental Health, Illness and Drugs- Self Medication - Casual effects- Common or correlated reasonsCo- Morbidity of mental health- Drug addiction is a mental illness- Drug use/ abuse leads to drug induced changes to the brain structure and function- Changes often occur in the same areas of brain as other mental disorders - Overlapping makes diagnosis and treatment complexExposure to traumatic events  higher risk of substance abuse disorders Concern for returning Veterans- 1 in 5 military services members back from Iraq and Afghanistan have reported symptoms of PTSD or major depression- As many as 50% of veterans diagnosed with PTSD have co-occurring substance use disorderDiagnosis and Treatment- Patients entering treatment for psychiatric illness should be screened for substance use disorders and vice versa- Comorbid conditions should be treated concurrentlyo Many people needing treatment are in criminal justice system (45% of offenders in prison)US PRISON SYSTEM- 5% of the worlds citizen population- 25% of the worlds prison population- 1 of 108 adults are incarcerated - 1 of 50 on parole or probation- $74 billion spent each year on incarceration - Less than 1% of that goes to health care - 57-65 Million lost by incarcerated workers - 75% of prisoners will be rearrested within 5 years- 60% rearrested within the first year - 66% rearrested within the first 6 monthsSubstance Abuse: Released Prisoners at highest risk of premature death- Rate of death 3.5% higher- Risk highest during first two weeks- Drug overdose leading cause of death followed by suicide Mental Health (Federal, State and Local) - Approximately 1.26 Million inmates in the U.S are mentally Ill- 56% of state inmates- 64% of local inmatesMental Health Studies - A 2011 study (Castillo and Alarid) of recidivism (inmates who return to prison) showed:o 36.3% suffered from bipolar disorderedo 22.5% suffered depressiono 18% suffered from schizophrenia o 22.5% suffered more than one of the aboveMental Health Treatment- 33% of state correctional facilities - 24% of federal facilities - 17% of local facilitiesMental Health Other Concern1. Mental illness affects inmates of almost every age but most are under the age of 352. Prison wait time to receive health services can take as long as 12 months3. While waiting these mentally ill people are segregated and forced into isolationwhich often makes the problems worsePromising behavioral therapies for patients with comorbid