Addictions and Mental Health Division Essay

Assessing the outcomes of a treatment is essential to develop a better understanding of psychological treatment options for substance abuse. Therapists need to create a welcoming and supportive environment, however, before changing methods, they need to obtain proof that the participants are ready to communicate and cooperate. In the below literature review and SSRS outline study I am going to provide a scope for future research and evaluation structures.

Do Counselor Spiritual Attitudes Effect Substance Abuse Treatment Outcome?

The selected treatment I am going to examine is the one used by  Alcoholics Anonymous (AA). Galanter et al. (2006) developed a 6-step self-rating scale, and this will form the base of my research. The scale does not only determine the measures, but it also provides us with a global measure of life and spiritual orientation. Deady (2009) also uses a global assessment, and emphasized the importance of social and emotional well-being, being used as an empowerment tool and recovery instrument. Addictions and Mental Health Division Essay.

Without successfully assessing the healing process step-by-step (STORI) using the methods described by Andersen (Andresen, Caputi, & Oades, 2006)  and outcomes, it is impossible to measure the different outcomes based on the substance the patient used, the length of abuse and attitudes. It is evident from studies reviewed below that patients who had a higher rating on the 6-item scale were two times more likely to recover and stay abstinent for five years. (Avants et al.) The details of the survey and studies are found in the literature review below.

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HYPOTHESIS

When planning the research I will attempt to determine the validity of the hypothesis that spirituality and counselor attitude has a positive effect on the speed and quality of healing. As I am intending to use widely known and accessible research models, the data gained during the research will be easily comparable with previous studies, concluded in traditional substance abuse clinics and rehabilitation centers.

LITERATURE REVIEW

 A recent study concluded by the Department of Human Services shows the performance measures for treating substance abuse patients. (AMH 2007) It is a good example of measuring performance across different states and institutions. The social aspects are measured in the study, and it also provides us data with the outcomes of treatments between 2000 and 2005. To create a similar framework, we need to also analyze studies created by Galanter. (Galanter et al. 2007)

In their special article, Galanter et al. (2007) looks at the treatments from a different perspective, and tries to capture the links between the involvement level in spirituality and recovery rate. Using a Spirituality Self-rating Scale (SSRS), and they also find that more attention should be paid to the role of spirituality regarding addiction recovery. (Galanter et al. 2007. pp. 257) The study shows a higher self rating among DD patients, TC patients and Methadone patients than students. Galanter combined all users into one group to compare their views about spirituality with students and faculty members.Addictions and Mental Health Division Essay.  Students were asked to provide their own views as well as attempt to reflect on patients’ attitudes to spirituality. The data collected by Galanter will provide us with enough resources to create a relevant hypothesis.

Reviewing the Faith Matters study created by Wallace ( M et al. In 2010), published in Canada, it is evident that there is a difference between instruments used in the spiritual mental healing process of substance abuse patients. The authors review some of the most promising programs currently used, including the Victory Fellowship and Victory Home. The ministry solely works with patients suffering from long term substance abuse problems. The program owners, a couple called Garcia created a 90-day plan and they have over 65 fellowships around North, Central and South America. The program does not only provide spiritual guidance for participants, but also offers free advice and help on housing and education.

Among all the practices reviewed in the study, I will choose to test my hypothesis based on one particular group and spiritual healing community. There are many charismatic groups I could contact to obtain information about the methods, instruments and techniques used, as well as statistical results. The below programs identified by the Faith Matters study are:

– Celebrate Recovery in California, using eight principles (Beatitudes) instead of the traditional 12-step program.

– Faith Partners in Texas uses a seven step system to establish a team and build a supportive community sharing beliefs and the faith.

DATA

 My intention is to use a procedure Descriptive Statistics model by using SPSS. The associates of the above detailed two organizations will be approached to seek cooperation. I am going to seek consent from patients to take part in the project, and based on the research framework concluded by Galanter, I will identify the current, method-specific measures of the different spiritual healing programs.

The sample size will be 20 patients from each organization, out of which I am looking to get data from at least five people from each sample to be fully abstinent for at least a year. This will allow us to not only measure the spiritual involvement and motivations (Galanter et al. 2007) but also the results of the treatment. I am also looking to evaluate the methods used  in the two centers, interviewing two of the therapists from each, to be able to create measurements for comparison. Addictions and Mental Health Division Essay.

Participants will be measured by spiritual involvement level, length of substance abuse, gender and program. Taking samples from both groups will allow us to compare the results and efficiency of the two programs and determine the right approach to spiritual healing.

The data will be collected by appointed coordinators at the organizations, preferably counselors or pastors of both congregations. The data will be collected preserving confidentiality and no names will be required to be provided. I will also set up a personal consultation with the coordinators of both congregation leaders to provide them with an outline of the purpose and outcome of the study.

MEASURES

When setting up measures, it is important to refer back to the Maudsley Addiction Profile (MAP) measurement method, created by Mandersen ((Marsden et al., 1998) to identify the outcomes. This outcome measurement method can be easily used together with self-report methods or interviews as well. It is important to provide support for substance abuse patients with low qualification and/or reading and writing skills.

The reliability of the data will be checked through a Brief Psychiatric Rating Scale (BPRS) prior to being selected for the survey. The pastors and support workers will check the validity of data, and patients who do not fit the initial screening group requirements will be excluded from the study. Data will be validated manually and placed into charts and tables to provide an easy overview and comparison opportunity.

ANALYSES

The above research provides me with numerous opportunities to assess outcomes of spiritual healing methods. Addictions and Mental Health Division Essay. Data will be collected and analyzed to create quantitative measurement. There are many framework models I can use as a sample, and I have selected the following measures to quantify and analyze:

– the connection between the spiritual involvement and progress of healing process. The latter will be assessed using the Camberwell Assessment of Need (CAN) which is widely used and approved in Australia. This model will allow us to compare outcomes of the two patient groups. Self-report will be used for sample.

– I am also intending to use the Maudsley Addiction Profile (MAP)  to assess and measure outcomes. This is again an Australian appraisal model, which has a high reliability rate and it is one of the most complex assessments available for various cultural groups.

RESULTS

The expected result of the study is to determine the validity of the hypothesis. I will attempt to exploit the differences between the two models used by the spiritual centers to reason the difference (if any) in the survey outcomes. It is important to differentiate between groups and try to create homogenous samples. For instance, data will not be comparable if we take 20 female patients from a safe family as a sample group from Celebrate Recovery and 20 male teenagers who have been living on the street since they were 10 year old.

Limitations

The limitations of the study can be identified by the fact that the demographics and location of the two groups will be different. Although we conclude the survey in the same country, there might be some social aspects that will influence healing, approach and attitude. Corrections might be needed, if we identify this influence to create a data manipulation of more than 2 percent and proof can be obtained.

Within this Independent study drug induced psychosis will be looked at. Within the first two pages a definition will be given as well as a brief history. Addictions and Mental Health Division Essay. This will be followed by a discussion on drug induced psychosis how individual is a affected and what is the cause. The author will then look at the drugs and how they affect people mentally and physically as well as how they affect the brain. When the final few pages it the author will look at the evidence and literature available for drug induced psychosis before then commenting on personal recommendations and the conclusion of all findings. The rationale behind choosing this topic was simply that more and more people through subculture and their own vulnerabilities are accepting of drug however through their own naiveté and lack of understanding are consequences he consequences and consequences

Definition

According to Mosby (2009), drug induced psychosis is a psychotic state caused by an excessive dose of both illegal and therapeutic drugs. This is supported by the West Australian Department of Health [WADOH](2009) who defines stimulant-induced psychosis, as an episode where the use of a legal or illicit drug has caused a psychiatric illness where the reality of the patient is impaired. The impairment of the patient can also include hallucinations or delusions, which can cause additional communication problems or social interaction difficulties. The drug induced psychosis according to WADOH (2009) may also be as a result of the overuse or abuse of prescription medication, or the outcome of a history of illicit drug abuse. Addictions and Mental Health Division Essay.

Brief history

Razool (1998) describes the historical evidence for substance abuse dating back thousands of years. Tobacco, alcohol and other psychoactive drugs have bee used by different societies for medical, religious, cultural and religious purposes and acts as a social lubricant. Today there is no lack of interest in the use of psychoactive substances and plants. Alcohol and drug use remain part of the social and psychological fabrics of our society and are now regarded as a public health problem. Attitudes towards drug use have changed during various stages historically and even with harsh laws, there still remains problems in society where drug education and drug treatment is required by society (Razool, 2008). Tea, coffee and tobacco have all been illegal in Britain at some stage (Whitaker, 1987 cited by Razzol, 2008). Alcohol and drug use can cause a host of physical, social, psychological and economic harm, not only to the individual, but also to the family and the wider community.Addictions and Mental Health Division Essay.  If the individual has previously had psychosis the use of drugs or alcohol can increase the likelihood of another psychotic event. This is due to the fact that the individual can become emotionally unstable, due to their drug use along with their loss of cognitive processing and therefore, inhibits the chemical balance of the brain (Royal Brisbane and Women’s Hospital, 2009).

Within this section use critical analysis and relevant referencing to show a lack of information provided and the difficulty clinical nurses face while battling this.

Drug induced psychosis

According to studies by REF, Psychosis can be induced by the misuse of drugs, such as Cocaine and Amphetamine and Cannabis, which according to Arendt (2005), has been linked with the development of early onset psychosis. However, these drugs can trigger psychosis, particularly in someone who is already an increased risk because they have “vulnerability”. This is then known as drug induced psychosis WADOH (2009); Royal Brisbane and Women’s Hospital,( 2009). National Health Service [NHS] (2009). This type of psychosis which is normally the result of long term or heavy drug use, generally lasts only a couple of days and is characterised by confusion, memory loss, delusions and hallucinations, that responds well to treatment (WADOH,2009). While the majority of drug induced psychosis responds well to treatment there are individuals who from their drug use develop persistent psychosis.

Early intervention program (Canada Health 2004)

The diagram above depicts how an individual with the vulnerability factors can combine, to cause psychosis. The full jar represents a person with psychosis. As the individual has a predisposition towards psychosis, the addition of environmental factors, increases the individual’s risk of developing psychosis to increase, and over time, this can lead to the development of full psychosis.

Early intervention program (Canada Health 2004)

When the individual reduces the environmental factors such as illegal drugs their jar of risk comes to a point where the individual is not affected by psychosis. Addictions and Mental Health Division Essay. Additionally, the second diagram indicates how the psychosis can be overcome and managed, using medication and coping strategies, thus enabling the individual to continue with their every day life in the community.

How drugs affects individual’s mental and physical health

Cannabinoids

Marijuana, weed, and dope, skunk (cannabis): people smoke cannabis to relax and get high, however the short term affects of this can make it difficult to remember things, even if they’ve only just happened. According to Barnes (2008), cannabis can cause anxiety attacks or feelings of paranoia, and using a lot of cannabis regularly, may be putting oneself at risk of suffering confusion or delusions. However, as a long term affect the individual who smokes cannabis might trigger long-term mental health problems, according to Barnes (2008; Nutt, 2007) including psychosis, schizophrenia and depression. Rounsaville’s (2007) research indicates that if the drug addiction is treated, the psychosis level will be reduced. The environmental factor of cannabis and its effects in relation to schizophrenia, needs further research according to Rounsaville (2007); as there appears to be some long term implications, indicating that use of high strength cannabis, triggers schizophrenia. Addictions and Mental Health Division Essay.

Methylenedioxymethamphetamine (MDMA, also known as Ecstasy)

MDMA (Ecstasy) in the short term can provide relaxation and energy to users but can also have the opposite effect where the individual will become paranoid, aggressive and anxious (Barnes, 2008). Nutt (1996; 2005) highlights that regular long term usage of MDMA can cause sleep imbalance problems, lethargy, and anxiety. However, there is some debate over whether MDMA causes depression. While Barnes (2008, Nutt, 1996 & 2005) states MDMA can cause depression, Gillette et al(2006) found that within their study, MDMA on its own, does not cause depression in male or female participants. Gillette et al (2006) found that MDMA may contribute to depression symptoms, if the individual was female and a heavy cannabis user.  Addictions and Mental Health Division Essay.They report, that dose specific connection between MDMA and depression was most likely due to women having lower body weights then men. Nutt (2005) advises that MDMA users with depression, once they discontinue taking MDMA, are likely to improve their mental state of mind.

Amphetamine and methamphetamines (Speed and crystal meth)

These drugs provide the user with initially an energetic feeling, along with confidence but, along with highs, there can be panic attacks, irritability and paranoia, according to Barnes (2008).

Methamphetamine can provide an intensive and prolonged high, but also known for severe comedowns, where individuals may experience feelings of sadness or depression.

http://upload.wikimedia.org/wikipedia/commons/thumb/b/b4/Effects_of_metamphetamine.png/380px-Effects_of_metamphetamine.png

Vaughn 2001

Nutt (2003; Nutt, 1996) has indicated that there is some evidence of individuals who appear to be permanently depressed, due to the long term use of intravenous amphetamines. Addictions and Mental Health Division Essay.

Benzodiazepines

BNF (2008) states that benzodiazepines are routinely used within clinical care, as a sedative to calm patients down who are distressed. One of side effects of benzodiazepine usage is that, the body develops resistance, therefore an increased dosage may be needed, in order to experience the same effect. This medication is highly addictive, and withdrawal can be difficult to manage without medical supervision. Rapid withdrawal from high dosages according to the BNF (2008), can cause severe convulsions. Ashton (2005) advises, that benzodiazepines can cause cognitive impairments and have the paradoxical effect of aggression and inhabitation. The use of benzodiazepines, according to Ashton (2005), has been controversial, due to concerns about the adverse psychological and physical effects that they can cause, along with the tolerance. Once the individual has completed the withdrawal from benzodiazepines according to Ashton (2009) they generally have improved mental health. However, the elderly seem to have an increased risk of experiencing short term and long term adverse effects from this drug.

Cocaine

According to Barnes (2008), cocaine can have a tendency to make the individual feel elated in mood, over confident, as well as energetic. This however, according to Nutt (2005), can also create feelings of anxiety, paranoia and panic. Some of the side effects from cocaine usage include depression, lethargy and mood imbalances (Nutt, 2005; Barnes,2008). Addictions and Mental Health Division Essay.

Heroin

As a member of the opioid family, Barnes (2008) states that heroin provides the user with cessation of physical pain and provides emotional detachment. Murphy (2006) declares, that heroin is physically addictive and that overcoming this addiction is difficult. Maintaining sobriety for former heroin users, can be very difficult due to its high level dependence.

Figure 1: Dependence Levels of psychoactive drugs vs Physical Harm

http://upload.wikimedia.org/wikipedia/commons/7/77/20drugs.gif

(Nutt et al 2007)

Figure 1 above, demonstrates the scale of physical harm that each drug can inflict on the user with 0 indicating little or relatively no harm and 3 being serious harm including death. The addictive nature of the drug is also measured on the same scale where dependence is described as 0 for little or no dependence, to 3 as highly addictive.

How drugs affect the brain

The various drugs listed above have an effect on the brain chemistry. Psychotropic substances are substances which act upon the brain function to change perception, mood, consciousness and behaviour. Johnson (2009), believes that psychotropic drugs are often associated with addiction; these can be divided into two types; psychological and physical addiction.Addictions and Mental Health Division Essay.  Psychological addiction is where the user feels that they have to use the drug, although they may be aware of negative, physical or emotional consequences. Physical dependence, is where a user must use a drug to avoid physical, uncomfortable or medically harmful symptoms. However, not all drugs are physically addictive. Nevertheless, any activity that stimulates the brain’s dopaminergic system with a pleasurable activity, can lead to a psychological addition (Zhang, 2001).

http://www.drugabuse.gov/sciencefair/Drugs.gif

National Institute on Drug Abuse (2009)

Literature to evidence

In a mental health setting, 20 percent of the admissions of patients according to Thompson et al (2004), are as a result of psychosis. A further 1.7 percent of patients, are admitted to mental health facilities, as a result of substance misuse (Thompson et al, 2004), with this high number of patients who are experiencing psychosis, the nurse practitioner, needs to be aware of possible reasons for the psychosis. According to Shaner et al (1987), 74 percent of patients in his study, were difficult to characterise, due to diagnostic confusion. These patients had chronic psychosis and a history of substance abuse. The researchers had difficulty in determining a definitive diagnosis as to what was causing the patient’s psychosis. The most common factors that made the diagnosis unclear was that there was continued drug use (78%), reduced memory (24%), and conflicting reporting of symptoms (20%). This difficulty in diagnosis, transfers to difficulty in developing treatment plans and the management of patients on the ward. If the individual is only treated for their mental health without addressing the addiction, the treatment plan is not addressing the cause of the mental health imbalance. Rounsville (2007) identifies that the failure to consider the comorbidity of psychotic disorders and substance misuse, undermines the treatment of individuals with mental health needs.

The Department of Health [DoH] (2006) states that clients/patients who endure more server and complex substances use will require specialist interventions such as opiate dependence, the management of severe cannabis dependence, for drug or alcohol use in the circumstances of more complex problems. In these situations, integrated, joint or coordinated working with substance misuse services, is to be expected. Addictions and Mental Health Division Essay.

Nevertheless the National Alliance for Mental Illness [NAMI] (2008) highlights that it can be very difficult to find appropriate treatment opportunities. Unfortunately many substance-abuse centres do not accept people with serious psychiatric conditions, and inversely many psychiatric centres do not have the required expertise with substance abuse.

What my recommendations would

The potential reasons for the individual’s mental health need to be addressed and thus both the mental illness and the substance misuse must be treated. A recommendation from the research is that services for substance misuse should be provided for mental health patients. Although the biggest substance misuse service within in the Merseyside region is the lighthouse project they are not officially on the wards and patients in secure environments have to be referred to them off the ward. This situation does not help those patients who have a substance misuse problem and who are unable to access the service since they are unable to leave the ward as they do not have Section 17 leave under the Mental Health Act [MHA] 1983 which was updated in 2007. If the substance misuses treatment program was sponsored and available on the ward this could potentially reduce the number of psychotic incidences and the revolving door admittance patterns of a number of patients. For some patients the ward environment is an opportunity for them to be removed from their substance and thus they are able to gain better mental health due to drug abstinence but as these individual patients do not have the coping strategies for dealing with their addiction they struggle when released from the ward. There are patients who routinely are admitted on a regular basis and it seem that sometimes the mental health support provided is just patching up the underlying problems and not dealing with it. By having services on the wards to address the substance misuse problem it would allow patients to identify their own weakness and develop coping strategies through the service. With coping strategies in place the patient would be enabled transition to an external service with support when they are discharged, so they can cope with the temptation and the addiction off the ward.

If there was more integration and multi-agency working the lives of many individuals would have the potential improvement as they hopefully could be less dependant on health and social services and thus have greater participation in the community.

With greater interagency working and access to substance misuse services while in the community some of the patients’ mental health would not have deteriorated to the point where they were sectioned. There appears to be a well known division between mental health services and substance abuse services. Addictions and Mental Health Division Essay. If there was more integration and interagency working within the community and on the wards the better potential long term outcomes for a large percentage of the patients who have a dual diagnosis of mental health and substance misuse.

Nursing and other medical staff members on the wards need to have a greater awareness of the reasons why their patients may have a secondary mental problem from substance misuse and thus be aware of the issues the issues patients are battling with on and off the wards. With more awareness about the impact of drug misuse on mental health better treatment plans can be developed. Another recommendation is that there needs to be further funding into the effects of drug misuse has on individual’s mental health along with research in developing treatment plans which are effective for patients with dual diagnosis. From the additional research further training and practice development could be implemented so that mental health practitioners are better tooled to support their patients. Addictions and Mental Health Division Essay.

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Conclusion

Throughout this independent study the conclusion reached was that drug induced psychosis is not caused by the misuse of substances alone but by many triggering factors such as environmental factors and vulnerabilities such as a family history of mental health. However during this study it was made clear to the author that drugs do play an important part of this psychosis because of there properties (stimulating the dopaminergic system) and side affects (needing due to physical discomforts) which causes the individual who may already have vulnerabilities to continue drug use therefore increasing there risk of psychosis. Nevertheless through this independent study it has been made clear to the author although drug induced psychosis is common within the mental health field due to the present culture there has still been little research into it. Most articles that where found where out dated, as there appears to be a gap of research interest and funding into substance misuse and long term mental health illnesses. As a result nurses often lack detailed understanding and knowledge of this type of patients’ needs and treatments they require such as psychologically and physical.

If there was any one recommendation that the author would be able to make happen it would be the integration of drug counselling and therapies within the mental health hospital setting therefore allowing those patients who do not have access to Section 17 (MHA, 1983&2007) leave a chance to also access these specialised services. This would be part of the treatment plan and patients as a must should be encouraged to engage with these services or run the risk of losing leave personally there are to many revolving door patients which to an extent shows how the current system is failing them rather than dealing with there mental health we also have to deal with there drug addiction. Addictions and Mental Health Division Essay.