Impact of Addiction And Mental Disorders on the Individual

This episode was pre recorded as part of a live continuing education webinar on demand. CEUs are still available for this presentation through all CEUs. Register@allceus.com Counselortoolbox you I'd like to welcome everybody to today's presentation on the biopsychosocial impact of addiction and mental health disorders on the individual. I am Dr. Donnellice Snipes and I will be your host. We're going to examine the biological or physical impact of addiction and mental health issues on the individual, the psychological impact and the social impact. And we're going to talk about interventions and interactions in each area. Let's start out with the biological impact of mood disorders. Well, mood disorders can be caused by an imbalance in any of a number of neurotransmitters. Your serotonin and your GABA tend to be your calming neurotransmitters. But too much serotonin is also associated with anxiety. So it's, it's a matter of having the right level. Not too hot, not too cold. Glutamate is your excitatory neurotransmitter. It's your main excitatory neurotransmitter. And GABA is actually made from glutamate. So if you don't have enough glutamate, you can't have enough gaba. If you've got enough glutamate but not enough gaba, it could mean there's a problem in that system. Norepinephrine is another excitatory neurochemical and that's released when the HPA axis is kicked off along with glutamate and dopamine. Dopamine is, we typically think of it as our pleasure chemical, but that's kind of a misnomer. Dopamine is your secret chemical, dopamine. When we have that, we are driven to try to achieve that reward again, which is when we achieve that reward, we're provided with endogenous opioids. And that's where the pleasure actually comes from. They're kind of, they kind of go hand in hand. You can think of them as a dynamic duo. So dopamine is around when pleasure is around, but dopamine is responsible for energy levels. You see a lot of people who are on antipsychotics and atypical antipsychotics whose energy is just really low. They're tired all the time. Well, those medications reduce dopamine levels, so I wouldn't be surprised that they're feeling tired all the time. And that's one of Those fine lines or balances you've got to figure out. And encourage clients to advocate with their psychiatrist or their physician about how tired is just unacceptable and how tired can I be, how much medication can I take and have an unacceptable quality of life? Because that's not what we want anyhow. We've talked before about these neurotransmitters and how they have to be in a balance. When you increase one, it will cause increases or increased availability of others and decreased availability of yet others. So, for example, when glutamate, norepinephrine go up, serotonin is going to go down. The other one that's not on here is acetylcholine. But the take home is that when our mood, and I use that term really broadly, when our mood is dysphoric, there's likely some imbalance somewhere in that neurotransmitter system. And your body is saying you need more sleep, you don't have the energy to be excited, whatever it is. And we remember, or hopefully you remember, that there are a lot of lifestyle factors that impact neurotransmitter levels, especially lifestyle factors that lead to high cortisol or sex hormone imbalances. When people have a disruption in their neurotransmitters, it's not just affecting mood. And when we talk about depression, you know, I've always found it a little bit interesting that depression, when you look at the DSM 5, you have apathy and anhedonia. Okay, that's what we would expect. But you also have sleep changes, eating changes, fatigue and lethargy. Now, fatigue is feeling tired, lethargy is having no energy. And there is a semantic. But there is a notable difference between the two of them. Fatigue is more like you want to go to sleep. Lethargy, you just, your arms feel like they weigh 100 pounds, your legs feel like they weigh a hundred pounds, and you just can't move. So there is a fine difference between the two of those. But when we think about that, you know, that's not really a mood. Those are physical symptoms of depression, but they're also physical symptoms of a lot of other things. But the neurotransmitters can cause those, or imbalances in them can cause those physical as well as emotional symptoms. So the physical symptoms of mood disorders can include disrupted sleep. Sleep, when your neurotransmitters are out of whack, almost every one of them in there is either responsible for helping you stay awake or helping you go to sleep. So if they're out of balance, your sleep schedule is probably going to be off if your serotonin system is not working efficiently. And I'm stopping short of saying if you don't have enough serotonin, because remember, if you have too much serotonin, you can have anxiety when. Which will also disrupt your sleep. If your serotonin system is not working as like it should, you may have disrupted sleep. If you, your dopamine system. If you don't have enough dopamine and you're tired all the time, then you might disrupt your circadian rhythms. So you're getting adequate sleep. You're sleeping, you know, 15 hours a day. That's more than adequate. But you're actually sleeping too much. And that sleep that you're getting is not quite sleep. These are all things that we want to look at. When people are depressed, they tend to not have or anxious, they tend to not have good quality of sleep. When people are on antipsychotics, if they have some sort of psychotic disorder, they tend to not have good quality of sleep and tend to have a lot more sleep disturbances, which tends to exacerbate the mental health conditions, fatigue and irritability. And irritability can be crankiness. It can be, I just don't want to deal with anybody. And it can also be sort of psychomotor irritability where you're just, you're agitated, you don't, you don't have energy to do anything, but you don't want to sit still. I think we've all had those times. Hopefully, maybe it's just me. Nutritional changes. When people have mood disorders, they typically will either not have an appetite at all, because when your circadian rhythms out of whack, your ghrelin and leptin, which are your hunger and satiation hormones, as well as your circadian rhythms which tell you when to eat and when to not eat. Those are all wonky. So people tend to really, they either don't have an appetite, so they don't eat, or they're trying to feed better, so they eat foods that are more likely to increase serotonin and dopamine, like high fat, high carbohydrate foods. We see increased muscle tension in anxiety. You know, people can grind their teeth, they can hold their tension in their neck, they can even hold their tension in their lower back. But you can also see increased muscle tension internally. You know, the internal organs. When people are anxious, your body tends to be on a faster, whatever speed, if you will. So GI stuff may start getting upset because those GI muscles The peristalsis is going even faster to accommodate that fight or flight reaction. Nutritional changes also happen because that fight or flight reaction, when the neurotransmitters are out of balance, then, and you have a fight or flight thing going on, you've got some stress, then the body is getting rid of food faster so it doesn't have to worry about digesting it. But if it gets rid of food faster, then it absorbs fewer nutrients. So even if you're eating the same thing, you may have nutritional changes. There's a lot of stuff that goes into mood disorders. Who knew? And if you're not getting. How many times have you heard this from me? The building blocks to make the neurotransmitters and the hormones you need to feel happy, healthy and content, then you're not going to be able to. So all of these things are sort of bi directional. Mood can impact people physically and the physical changes can impact mood. There's a reduced pain tolerance. Serotonin has been implicated in our perception of pain. When serotonin goes down, our pain tolerance tends to go down. We when people's dopamine and endogenous opioids go down, their pain tolerance tends to go down. And gastrointestinal disturbances, we kind of already hit on that. On top of just things moving faster, sometimes people will have upset stomachs, indigestion, inability to tolerate certain foods when they're under, especially if they've got anxiety and they're under a lot of stress. So we do see a lot of biological. And think about Maslow's pyramid, those nutritional, medical, biological needs, they're not getting met. You're gonna have a hard time reaching self actualization and accomplishing all the other tasks that theoretically we need to accomplish to feel happy and healthy. In addictions we can have neurotransmitter imbalances. When people start engaging in addictive behavior, whether this is online gaming or porn or substances or smoking, it causes changes in the neurotransmitters. And I'm going to give you an analogy for that in a minute. But it can cause tolerance, which means over time your body gets used to having that high level or having that artificial amount of whatever it is put into your body so it accommodates for that. Because it says, you know, we're not supposed to be running that hot or we're not supposed to be quite that relaxed. Your body adjusts, it doesn't want to die. It likes its normal homeostasis. So it will kind of back things off to keep you alive and safe. Unfortunately, that means tolerance. That means if you started out taking a certain amount and let's just use alcohol because everybody's familiar with that. If you started out in two beers would give you a buzz, and then you started drinking more frequently and more often and whatever, eventually two beers wouldn't give you a buzz anymore. Your body would be tolerant to it and go, oh, that's just nothing. That's a drop in the bucket. But also, if you don't have that substance in your body, then your neurotransmitters may be a little bit out of kilter because it's used to having that alcohol in your system. Now, obviously, two beers a night is not going to develop tolerance, but if you're drinking, you know, maybe I should have used a bigger quantity, you know, a 12 pack twice a day or something. When your brain is exposed to toxins, which is what substances are, or higher levels of neurotransmitters, then it's going to protect itself when you quit taking that, you know, I said your body gets used to having that artificial additive in there. And so it adjusts. It says, okay, I'm going to get half of what I need from the cocaine. This person's doing. So I only need to produce half of these neurotransmitters and we're going to be good. This is overly simplistic. But then when you quit taking whatever that drug or engaging in that behavior, the body's not making enough of what it needs to make in order to help you feel good. So the person starts to feel withdrawal symptoms. Okay, makes a little bit more sense if you use an analogy. Think about Black Friday. On a normal day, say, the store capacity is about 750 people. The store needs a constant 500 people to stay open. It has eight doors. That allows for people to easily enter and exit without getting bunched. So think about one of your. Well, I don't want to name any stores, but any of the stores that you go to, you know, there's lots of doors. You go in and out, and there's a free flow of traffic. On Black Friday, everybody lines up out front and 1500 people push through the store. As soon as it opens, the store is destroyed, the staff is exhausted, and it takes time to restock and refresh the staff. I mean, you got to clean up and get back to normal. That's not something that happens like that. So management says, all right, let's close all but two doors and add security guards to manage the flow. This is Kind of what happens with neurotransmitters and addiction. We have a normal amount of neurotransmitters that go in and out. And in order to feel happy, we need those levels to stay pretty constant. So we have receptors, which we'll refer to as doors here, that the neurochemicals use to get through. When somebody engages in an addictive behavior. All of a sudden, instead of having 500 little dopamine people trying to get through the doors, you've got 1500 little dopamine people trying to get through the doors. And they go through and it just exhausts your energy. It takes a while for your body to recover from that rush, that euphoria that it experienced and to rebalance itself. So what does the body do? It says, well, I can't handle that. We can't have Black Friday every single day. So Instead of letting 1500 people in, we're going to shut down some of those receptors, close some of those doors, basically, in order to prevent the overload. It isn't until the person, the body, the person's body realizes that, okay, we're not going to get flooded anymore, that the body starts gradually opening one or two doors a day to let those neurotransmitters back in. So the biological impact of addiction. Well, we are putting a lot of stress on our body when we engage in addictive behaviors. So there's reduced immunity. A lot of times people who are engaging in addictions aren't getting good sleep, which also reduces immunity. More rapid aging, Even if you're using sedatives and depressants, it is tough on your body, and you often see the aging process increase more rapidly. Sleep difficulties, nutritional deficits, reduced pain tolerance and increased pain. When you start monkeying with those neurotransmitters, you can throw your serotonin system out of whack, which can reduce pain tolerance, leading to an increased perception of pain. If you're taking opioids, then the body very quickly adapts to having that assault, as a colleague of mine called it, from the high levels of opioids coming in. So it protects itself when you stop taking those opioids. Think of somebody who started to develop tolerance to opioids, which happens really quickly when they stop taking them. If they don't titrate, they stop cold turkey for a short period of time. They may feel more achy, they may feel more pain. When I was working in Florida, we had a medication assisted therapy clinic, and I also had a pregnancy and postpartum unit. The women when they would be pregnant, it's very, very dangerous to the fetus to discontinue somebody from opioids or methadone when they are pregnant. So they would be allowed to stay on methadone while they were in treatment until they gave birth. Once they gave birth, which I thought was a little cruel, but that was our attending's decision, he would cut people off cold turkey. He's like, okay, you gave birth and in order to breastfeed, you can't be on methadone, so we're just going to take you off. Oh, my goodness, those poor women. The hormone changes, the lack of sleep, plus the opioid withdrawal, I mean, that was pretty horrific for a lot of them, but they felt a lot more pain. I mean, those of us who've had babies, we know that after you have a baby, the first week or so, you're still pretty achy. Your body's been through a trauma. So when you don't have your natural opioids in there, you can feel more pain. It's important for people to recognize that, that if they have been using opioids for a while, even if they're not what we would call addicted, they're not having significant problems in one or more areas of their functioning, yada, yada, yada. But maybe they had a car accident and they've been on some sort of opioid medication for a couple of months because of spinal surgery or something. I don't know. It would be rare to see somebody on opioids for months. But just for the sake of this, when they stop taking it, if they don't titrate, if they don't slowly reduce their dosage, then the body is going to go, where? Where did that go? And it's not going to start producing the endogenous opioids again right away. It's going to take a little time for the body to get back online. People also have increased pain with addictions because of things that they do and falls that they take. And, you know, health problems that they may have. And increased risk of diseases such as hepatitis, hiv, tuberculosa, and MRSA are also seen in people with addictions, especially those with compulsive sexual behaviors or substance addictions. So the brain under stress. We've talked about cortisol a lot, but there's a little graphic here. The brain tells the body when it's under stress to release cortisol and adrenaline. It says we need to fight or flee. Not sure what we need to do yet, but we're gonna have to have energy for it. So the immediate thing the body does is release, well, send out a chemical reaction that causes the release of glucose. Then that cortisol and adrenaline also tells the body, now is not the time to procreate. So we're going to reduce libido. So testosterone, interestingly enough, tends to go down, and it also suppresses serotonin. Part of that is because the sex hormones change in their balance, but part of that is because the body says now is not the time to calm and relax, because serotonin tends to be one of our chemicals that helps us calm down. So it suppresses the receptors that are responsible for calming in terms of serotonin. Well, what are the effects of that? Initially, that's great if that's a brief period. You know, high glucose, low libido, lots of energy to fight or flee. You know, know we've got laser focus here. But if it goes on for a while, you're going to have reduced melatonin, because the body makes melatonin from serotonin. And often you'll see increases in anxiety and anger because too little serotonin, as well as too much serotonin can cause symptoms of anxiety and anger. But also you're seeing increased levels of norepinephrine because of the increased cortisol or along with the increased cortisol, which can also increase anxiety and anger. And you're sort of revved up dysphoria. Both of those things contribute to an impaired quality of sleep. When you're not getting enough sleep, the body goes, ooh, we are at risk. We're the weak link in the herd. So we're the first that's going to be eaten by the lion. So we need to tell the person or tell the person's body to wake up. So we need to send out more cortisol, because cortisol helps us get up and going. It's kind of like our internal caffeine, if you will. And this cycle starts over and over and over again. It's important for us to help people figure out what they're doing that may be contributing lifestyle factors they may be engaging in that may be contributing to high cortisol levels and high adrenaline levels. And that can be you use of stimulants that can be stressing the body out in some way. That can be mood, it can be lack of sleep, poor nutrition, the list goes on. But we need to help people look at it from a biopsychosocial perspective. The biological impact of alcohol and we're going to go through several substances here real quick. Heart damage, high blood pressure, fatty liver, hepatitis, cirrhosis, pancreatitis, cancers of the mouth, throat, liver, breast and actually kidneys. Reduced immunity and brittle bones. Let me see if it can also cause brain damage through the toxic effects of alcohol on brain cells, that actually kills brain cells and the biological stress of repeated intoxication and withdrawal. Alcohol related cerebrovascular disease, head injuries from falls sustained when inebriated. So that's just to the person. It also contributes to. Okay, I'm going to get to that. Another factor is alcohol related birth defects, which we refer to as fetal alcohol spectrum disorders. Now we don't know how much alcohol can cause an fasd. We don't know if there is a safe level of alcohol. But we do know that alcohol use, especially in the first trimester, but alcohol use during pregnancy puts people at a much higher risk for FASDs. Nutrient deficiencies caused by alcohol, vitamins A, e, D, K, B12, folic acid and thiamine. Okay, well let's talk about that for a second here. And I don't have that up. I don't think I put that picture in here. But in order to make serotonin we need to back up. The body needs tryptophan, which you've got to eat. You can't make it, synthesize it internally. You eat tryptophan, which is a protein. It's found in a lot of foods. You don't need to go out of your way to do it. You're probably getting plenty of. But in order for the body to break down tryptophan to make serotonin, it has to have most of these vitamins and a few more on top of that like magnesium and iron. If it doesn't have all of those nutrients, then it can't efficiently or maybe even at all break down tryptophan to make 5 HTP to make serotonin. In order for serotonin to be broken down to make melatonin, it has to have a whole nother litany of vitamins and minerals to aid in that process. It would be kind of like making bread and just using flour and putting it in the bread machine or in the, in the oven and looking at the flour going, waiting for it to rise. That's what you're doing. If you're just taking in tryptophan and you don't have all the other ingredients necessary for the chemical reaction with bread. If you don't have the liquid of Some sort. And the yeast or the baking soda and baking powder, you're not going to have a rise. It also contributes to nutrient deficiencies in calcium. It can cause the body to leach calcium from the bones, which contributes to brittle bones. People can lose iron from intestinal bleeding. We know you've probably worked with people before who have anemia, which is often caused by lack of iron in the blood. When the blood doesn't have enough iron, it doesn't have enough hemoglobin, which means your body is not getting the oxygen it needs. So people feel tired and apathetic. What's one of those symptoms of depression, fatigue and dehydration? Alcohol is a diuretic, so when people drink, they tend to get dehydrated. 1% dehydration, which is not even something most of us notice, can lead to difficulty solving problems and concentration. 2% dehydration, which is when you really start feeling thirsty. They show that it has significant impacts on our memory and cognition. Who knew, by the way, just kind of off topic. Caffeine is also a diuretic, so definitely drink a lot of water if you drink a lot of caffeine. Oh, there we go, there's caffeine. Biological impact of caffeine. It can give you the jitters, increased blood pressure, heart palpitations, heartburn, diarrhea, disturbed sleep, cause dehydration. It can cause miscarriage and, or osteoporosis. And yes, again, caffeine may cause your body to not be able to absorb calcium correctly. Now, is there a positive side? Because, you know, we hear some stories about caffeine. Coffee can be good for you. Some studies have shown that there's a lower risk of Alzheimer's and dementia in people who moderately drink caffeine. That's like two cups a day or one cup of Starbucks. And the small one, not the big one, not a pot of coffee. A decreased suicide risk. I thought that one was interesting. Increased endurance and decreased risk of oral cancers. That one I found surprising too. So caffeine in and of itself is not the enemy necessarily. It's if you use it, just like anything else in excess. The other thing I want to mention about caffeine and mood is the fact that caffeine, if you've got anxiety, can increase anxiety in a lot of people. It can impair sleep in a lot of people because it has anywhere from a 6 to a 12 hour half life and it's usually closer to 6 for most people. But if you are also drinking, if you're also consuming Alcohol and have impaired liver function. It will take longer for your body to clear the caffeine. So what you're drinking at noon may still be impacting you at 10 or 11 when you're trying to go to sleep. Nicotine. Including gums and vapors, nicotine takes approximately two hours to exit the body. It has. So it's important to encourage clients to not smoke right at bedtime, if possible. It's highly addictive. It does activate multiple neurotransmitters. It's been associated with pain and anxiety relief, which when people stop smoking or using nicotine products, they often have an increase in anxiety. And that's not just that they can't have their cigarette. It's because that artificial bump that they've been getting from the nicotine, the tolerance they've developed to the nicotine, hasn't been replaced by their natural neurochemicals yet when they first stop smoking. Reduced appetite, which is a big reason that some people smoke. Respiratory irritation, increased heart rate and blood pressure, hyperglycemia. So too much blood sugar, decreased immune response, increased oxidative stress, and increased risk of diabetes and a variety of different cancers. Nicotine doesn't really have any upsides to it. Now, marijuana, and just kind of bear with me, because I'm hitting some of the highlights of the things that a lot of our clients probably use. So we want to recognize the impact it's having. Like, for example, nicotine, if you're working with a client who has anxiety. And my mother was a chain smoker, my father was a chain smoker. And, you know, you know, I've been around a lot of smokers my life, and a lot of them say they smoke to relax. And, you know, I look at the research and this doesn't seem like that supports that, but nicotine interacts in very interesting ways in the brain, and it actually does simultaneously help people wake up and relax at the same time. So there's a complex interaction that we need to be aware of. When those neurotransmitters are imbalanced, though, because of the nicotine, then people are going to keep going back to get another hit to balance out that that system, which can exacerbate mood disorders and other psychiatric problems. So marijuana, when we talk about marijuana, we are not talking about hemp, we are not talking about cbd, oil, marijuana. We're talking about the cannabis plant that has 3% or more of THC in it. And it's usually much more the positive aspects of marijuana. Some people say altered senses and altered Reality experience, hallucinations, nausea reduction, pain management with as little as three puffs a day and for some, improved sleep. That's what the research says. So I'm just, I'm putting it out there. The negative aspects of marijuana are dependent on the amount of THC in the marijuana. The lower levels of THC are not going to have the same effect as TH levels that are high, around the 15, 25% range, which can get really, really intense. Now other processes for taking in marijuana, the dabs and other things, may have a much higher concentration of thc. So they could be a lot more potent and a lot more powerful. Anyway, THC can cause neurochemical changes which cause short term problems with attention, memory and learning. It may cause permanent changes in the brain development of children, even secondhand smoke. So these brain changes and brain development, we're talking about the prefrontal cortex, where you've got learning as well as impulse control and, you know, other functions that are going on in, in the child or adolescent. There's an increased risk of testicular cancer, increased risk of heart, heart rate and blood pressure issues, significant increase in the risk of heart attack in the hours right after marijuana use. Because a lot of THC can raise the blood pressure, bronchitis, cough and phlegm production, and even delusions or psychosis. This is also true of your synthetic THC's, like spice. I remember we had a client who went to work. She was in work phase and this was, you know, spice was legal and it wasn't one of those things that we could test for anyway at this point in time, it's been a while. And so she went out and she smoked some spice while she was at work. And she came back to the treatment center and you know, we urine dropped her and everything and she turned up clean not 15 minutes later, 30 minutes later, she's laying in her room. Her heart rate, no joke, is almost 200 beats a minute. And she's like, I can't move my arms and legs, feel like they're glued to the bed. So we called EMS and they hauled her off. But marijuana can have really intense effects. And because it's a plant, or in the case of spice, it's. You don't know how much of the THC is being sprayed on the particular leaves that you're smoking. It can have very variable impacts on people, which can also impact their mood and impact their feelings. I had a friend of mine who was, you know, 420 friendly and she said that she hadn't smoked Marijuana since she was in high school and she smoked some and she's like, I have never had such a bad trip in my life. We didn't have stuff that potent back when I was smoking. It's important to help them recognize. She said her anxiety was through the root roof for, you know, hours on end. Biological impact of opioids so a lot of people end up taking opioids at some point in their life for oral surgery or something. Most of the time, one or two days worth is more than enough to get you over the hump where ibuprofen or something else will do the trick, but not with everybody. So the positive effect of opioids, pain relief and for many people, euphoria. They've started using opioids in emergency rooms and some other settings in order to treat treatment resistant depression and people who are at high risk of suicide. There is a new nasal spray that's out that uses opioids. It's only administered in the doctor's office. So theoretically there's low risk of diversion. But we are finding that some opioids do impact certain receptors and they're not exactly sure how that help people feel less depressed. The negative impact of opioids is that they're highly addictive and tolerance develops really, really quickly. Another thing with tolerance is that it develops really quickly. It goes away, you know, maybe not quite as quickly, but then when somebody starts using again, they can't start right where they left off. So if they were taking 10 oxies a day or 10 oxy's in a sitting, I had, I've known people who've done that, and then they detox. Their body is not used to that anymore. It started, its system is kicked back in and is producing its own opioids. So if they start out by taking 10 Oxy's, which is what they were taking when they went through detox, they very well may overdose. It's really important for clients to recognize that detox happens really quickly and you can't start back up where you stopped or you could kill yourself. It also causes constipation, fatigue and nausea. It slows everything down and the body quits producing its own natural painkillers. So what can we do to help clients who have engaged in addictive behaviors, who, who are in early recovery, experiencing post acute withdrawal syndrome, who have mood disorders. Any clients that we see basically improve sleep quality. When people are getting adequate sleep, that's one less thing that's gonna trigger that HPA axis. It also, when we're asleep, your Body's able to clear adenosine out of the brain, which, which clears up some of that mental fog because adenosine builds up in the brain over the course of the day. Sleep is really essential to helping people rebalance their neurotransmitters and be happy and healthy. Ensure adequate nutrition. And I've said this before, say it again. It doesn't have to be crazy. You don't have to be measuring everything. Eat colorfully and there are a lot of books out there. Consult with a dietitian. Look on the health.gov website for guidelines for healthy eating. That's all we're asking is that you eat healthfully. A dietitian friend of mine said try to have three colors on your plate at every meal. That's pretty simple. There's no measuring involved in that. Three colors and different shades of white and brown don't count. That encourages people to get their vegetables and their fruits in and all of the nutrients that are found in those foods assist people in the development of non pharmacological pain management strategies. Obviously you're going to have to consult with the person's physician, physical therapist, etc. But you can encourage them to look into things like stretching, yoga, ergonomics, massage, hydrotherapy, hot tub, tens units, transcutaneous electronic nerve stimulation. You can buy them over the counter now. They're wonderful little gadgets. You put little electrodes on and turn it on. It's with has a little 9 volt battery attached to it. The feeling is like somebody's just tapping on you. It doesn't hurt at all unless you turn it way up and you make your muscle contract. But you wouldn't do that. What it does is it basically bombards the nerves so they can't send the nerves pain signals to the brain. So that's one method for helping people with pain. Also look at what's causing their pain. Look at the ergonomics of their sleeping as well as their workstation and maybe even their car. If they spend a lot of time in their car, are they sitting in a good position? Rule out and address physical causes of depression and anxiety, such as thyroid issues, hormone imbalances, adrenal insufficiency, diabetes and heart problems. With heart problems, your body is not getting enough oxygen to your brain. So people tend to feel more depressed, more foggy headed, more confused, etc. The psychological impact of mood disorders. Well, when you're depressed or anxious or you know, have schizophrenia, bipolar disorder, but especially depressed or anxious for a while, you can start feeling hopeless and Helpless. It's like, you know, I can't get this under control. I've been taking this med, and it's not helping me. We know that less than 50% of people experience significant relief from psychopharmacology alone. Okay, well, then what else do people need to do? We're going to talk about that. Mood disorders can also contribute to feelings of guilt. You may feel guilty that you're depressed and you don't have the energy to play with your kids, or energy to take the dog out on a walk or whatever it was, or you don't have the energy to keep the house clean like you used to. Whatever your guilt is, we have lots of reasons we can feel guilty. But mood disorders generally compound that guilt. People may have anger at their higher power, at themselves, at their body for not being normal. They may also have anger at other people for being, quote, normal. And what is normal anyway? Helping people normalize for themselves. There's that word again. Can't get away from it. The fact that, you know, a lot of people are struggling with depression and anxiety. So it's not that they're not normal. It's not that they're not their normal. It's not that they're how they feel like they should be. And they can get angry about that, or they may not be like they used to be. As I've gotten older, you know, I've tried to do the stuff that I did when I was 20, and my body really doesn't go with that very good. And I get frustrated. I'm like, I should still be able to do this. And my husband's like, yeah, no. Anxiety can occur in people thinking that things won't improve. I'm never going to feel better. I'm never going to be happy again. I'm never going to sleep again. We see a lot of anxiety in people, especially in people who can't sleep through the night if they can go to sleep, but then they wake up in the middle of the night and they can't get back to sleep, they're actually at higher risk of suicidality than others. Because in the middle of the night, you're bouncing around the house, there's nothing to do, and you feel anxious. You can get all of these feelings just kind of flooding in on you, and there may be grief over loss of prior functioning. If somebody is experiencing clinical depression, they may have to grieve the fact that that's something that's going on right now, or they. If they're diagnosed with bipolar disorder, they may have to grieve the fact that their life is not going to be quite the same as it used to be. Addictive behavior the psychological impact well, initially, euphoria and relaxation, depression, lack of pleasure and anxiety can also occur as a result of addictive behaviors because the addictions negatively impact serotonin, norepinephrine, gaba, glutamate and dopamine. Balances. Most addictions burn through dopamine like nobody's business. So you end up having, if you will, a shortage of dopamine. Indirect psychological impact of addictive behaviors can include depression or anxiety caused by a lack of sleep. If you're going out on three day bender on cocaine, then when you are detoxing, you're probably going to experience depression. If you are using or abusing opioids or other downers, then when you are detoxing, you are probably going to experience more anxiety. Malnutrition, which again keeps the body from being able to make the neurotransmitters to keep you happy. Guilt as we talked about being overwhelmed by the mess that you've caused. When people have addictive behaviors, at a certain point they sober up or they wake up and they look around and whatever was going on or going bad before hasn't been tended to. So it's gotten worse and they're just like, oh my Gosh, this is 10 times worse. I couldn't handle it before, definitely can't handle it now. Think about when you get a cut on your arm or wherever if you don't treat it and you just let it, the dirt stay in there and everything else and you pretend it's not there and you go about your day. It's kind of what life is like for somebody who has an addiction. They go about their addictive business, they don't pay attention to this other stuff that's a problem and they just don't know what to do with it. And the initial pain is usually there, the initial cut every time they sober up. Whatever caused them to start using heavily is probably still there. Psychological interventions enhance hope and empowerment. Help them see. One of my clients used to say, see colors again. He said when he was in his post acute withdrawal phase, there was no color, it was just all shades of gray. And you know, he'd been using for many, many years. So his neurotransmitters took a while longer to rebound. And everywhere he looked there was kind of stress, there was kind of this cloud looming. Help them find hope in recovery. Help them see and revel and celebrate the good days. Or even the good hours and help them feel empowered to take charge of their recovery. Whether it's their addiction or their mood disorder or both, There are things they can do. They can do the next right thing, as we say in addictions treatment. Help them develop resiliency skills. And this can include acceptance and commitment, therapy, addressing cognitive distortions, distress tolerance skills, you know, go with the DBT route. Anything that can help them bounce back from adversity. So when we talk about resilience, think about taking a ball, you know, one of those beach balls and pushing it underwater. That is stress. Stress pushes that ball underwater. Resiliency is what happens when you let go of that ball and it bounces right back up and straight out of the water. We want to help them get that, get their bounce back. Identify and address cognitive distortions because most people have them. Even more people who have addictions or mental health issues also have a lot of cognitive distortions. They may see the world through a very distorted lens, Enhance self esteem, teach distress tolerance, coping and problem solving skills, educate about the connection between behaviors, thoughts and feelings, address guilt and identify and address grief triggers such as their idea that they're quote, not normal. And I like what Kristin said, that normal is a setting on the washing machine. That's all it is. Normal is not. No one person is. There's no standard that we measure people by that's normal. Now you can have your own personal normal. I believe that we know what we feel like on a good day. You know, this is my normal, I'm good, or any loss of function they may be experiencing. Another area of loss of function that we really didn't talk about a lot is postpartum depression. And there can be a lot of guilt and grief surrounding postpartum depression. And we know that that depression is likely going to lift with some treatment. However, during those first crucial weeks, a lot of parents feel a lot of grief if they're not able to bond and interact with their baby like they feel they should, Quote unquote. And remember that postpartum depression affects men as well as women. It's not just a hormonal thing. It's a huge life change thing. Social impact of mood and addictive disorders Isolation and withdrawal. When people are not feeling good, when they are dysphoric, or when they are, when they've kind of given up and they're trying to protect their addiction because that's the one thing that's making them feel good, they may tend to isolate and withdraw. They may have a loss of supportive Healthy relationships because they pushed people away, either because those people kept nagging them about their use or those people just didn't understand and they said, oh, you just need to get over it. You know, let's go on a walk and it'll make you feel better. And the person's going, you have no idea what this is like. Or people may have chosen to leave because the person was so depressed or so addicted that it was toxic to them. So they may have chosen to back off and said, you know, I just, I can't have this in my life. Or they may hang out with friends that share the same dysfunctional thinking which in addictions we call stinkin thinkin', which is characterized by minimization, rationalization, denial and blaming, or cognitive distortions and encouraging people to look. Because a lot of times people look for others, not just people with addictions, but people in general. We often look for people who have like beliefs. And again, in addictions, we call it co signing on our own bs. We look for somebody who's gonna validate us and tell us, yeah, you're. But if you've got a negative outlook and you're holding on to these cognitive distortions and you're surrounding yourself with people who are validating that, you know, you're just going to get in a darker and darker place. Social interventions enhance social support and reduce isolation via support groups. And I'm not saying, Let me back up. I'm not saying that people don't experience negativity in their life. You know, what I'm saying is people need to figure out what they want to do when they experience unfairness or difficulties instead of just nurturing those cognitive distortions, because that's not going to do any good. You want to figure out how to empower them to improve the next moment. Part of that can be enhancing social support, improving interpersonal effectiveness skills, helping people become more adept at saying what they need and not expecting, mind reading and not trying to assume or not assuming they can read other people's minds or understand telepathically other people's intentions. Interpersonal effectiveness skills helps people learn not to assume and to actually ask and talk. Go figure. Educate them about healthy relationships and boundaries, both emotional and physical boundaries. What does that look like? And what qualities do you have in your current relationships that are healthy? Because most relationships have some healthy and some unhealthy characteristics. Hopefully few unhealthy, but there's probably a few in there. And examine and address characteristics of current relationships that mitigate or exacerbate the problems. So looking at if you've got Jane and she's got clinical depression, let's take a look at that depression and her support system and her relationships. And let's say, okay, of those people in your support system, what things about them help you deal with your depression and help you feel happier and loved? And what things about those people or what things do they do that may make your depression worse? And let's start addressing those things so the total picture. Someone who's become physiologically less able to experience happiness or pleasure may have a desire to find that feeling again. Most of us, we don't want to be Eeyore the rest of our lives. I know me, I want to be Tigger. I think Tigger rocks. And people may want to keep that feeling at all costs. So they want to hold on to that feeling of euphoria, Even if that means doing something that you know logically you go, well, this is. Addictions are not good for me. But it's more rewarding than the alternative. And that's the person is trying to survive, you know, at a certain point, unbearable emotional and or physical pain that exists when they're not using and they don't have any other tools. So this is helping them survive. It's a bad solution to a problem, but. But it's a solution that's helping them survive until now. It's a creative solution. I try to help people look at it that way instead of getting caught up in the shoulda, coulda, wouldas. Mood disorders contribute to a host of other problems, including increased pain, reduced immunity, sleep problems, lost work time and productivity, and relationship issues. And problems in any one of those areas likely going to make the mood issues worse. So both of them feed on one another. Addiction and mood disorders have both direct and indirect consequences for the person, both biologically and physically, psychologically and socially or interpersonally. All aspects of the person in recovery must be addressed. It's hard to change your thinking when you don't feel feel well. Think about the last time you were really sick or you were in pain or you were just, well, sleep deprived. Way, way sleep deprived. How easy was it to start changing your cognitions and looking at the bright side of things and embracing those dialectics? I don't know about you, but when I'm not feeling good, I tend to not be real motivated to do those things. It's hard to change physical habits when you're depressed and unmotivated. Well, when people are depressed, that indicates that their norepinephrine Levels are probably low. Their glutamate levels are probably low. So their get up and go neurotransmitters are low. Dopamine is probably low, which leads to lack of motivation. So we do need to help people start figuring out what they need to do to get those levels up. And sometimes it's adding in the happy. And I know that sounds ridiculously Pollyanna ish, but encouraging people to do things each day that make them at least not unhappy can start having a positive effect. And it's hard to change thinking or health habits without social support, because social support is one of our greatest stress buffers and it can help us have more energy. I know when I have, when I go to the gym with a friend, I tend to be more energetic than if I'm dragging my happy butt there by myself at 4 in the morning. So encourage people to not just take on a simplistic view of, I'm depressed, I need to fix my emotions. Well, your emotions are caused by your brain chemicals, which are affected by the health of your body. The health of your body is affected by your thoughts as well as you know, your stress levels. Are there any questions? In answer to Kathryn's question? When a person's in complete denial that they have an addiction, you in Prochaska and Diclemente call this pre contemplation. And basically the best thing that you can do is provide them objective feedback about what's going on. Kind of open the door for them, but help them look at other areas. And when. I've had clients that have been involuntary before, and that's actually my favorite group to work with, I start out by saying, you know, if, if they say they don't have a problem. I have had a lot of clients who are drug dealers, and they said, I don't use my own product. I don't have a problem. I'm like, okay, well, be that as it may, you're stuck with me for the next 12 weeks, says the judge. What are we going to work on? What is it that you want to improve in your life? And sometimes you can work at it from, from that perspective. I had one client I worked with who fully admitted he used, but he said he didn't have a problem with it. He was on probation, he was on blood pressure medication, and his kid was struggling in school. And those were the three things that were of his concern. He didn't want to take blood pressure pressure medication, he wanted to get off probation, and he wanted to figure out what to do with his. With his kid. Ultimately, you know, one of the things that we talked about was the fact that, well, in order to get off probation, he had to pee clean so he couldn't use for the next 90 days. That was just the way it was. And he's like, yeah, okay, so you can't use for the next 90 days in order to get off paper. So let me help you achieve that goal after you finished with me. What you do is your business. And we approached it from that perspective instead of a lecturing perspective. That's one way to do it. If you go to Substance Abuse and Mental Health Services Administration or SAMHSA TIP 35, it's TIP Treatment Improvement Protocol 35 talks about motivational interviewing and different strategies that you can use for patients who are at different levels of change. And they talk about the reasons in that protocol. They talk about the reasons people may be in denial or unwilling to admit they've got a problem and ways that you might start working with them if you if they're involuntary. And you've actually got to figure out how to engage them. So I can actually probably. Okay, everybody, have an amazing 4th of July and I will see you on Tuesday when we are going to talk about the basics of what is autism. 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