1. IOP Part 2: Co-
Occurring Disorders,
Self-Medication and
Physiological Effects
of Addiction

2. Review of Last Week
0 We talked about the basics of addiction
0 How will life be different when you are sober
0 Review your journal and tell the group about 3 things
that made you feel
0 Angry/Frustrated/Irritated/Resentful
0 Happy/Grateful
0 Anxious/Stressed
0 Do the things that led to negative feelings have
anything in common? (Out of your control, Failure,
the Unknown, Rejection…)

3. Objectives
0 Define Co-Occurring Disorders
0 Identify the symptoms of the most common mental health
issues
0 Discuss how substances may be used to self-medicate
mental health issues
0 Discuss medical conditions and how they may mimic
mental health issues
0 Identify how certain medications can produce symptoms
of depression or anxiety
0 Understand why a bio-psycho-social approach to recovery
is so important

4. AD/HD
0 DSM-IV Diagnostic Criteria for ADHD Either (1) or (2):
0 Six (or more) symptoms of inattention have persisted for at
least six months to a degree that is maladaptive and
inconsistent with developmental level:
0 Often fails to pay attention to details or makes careless mistakes
0 Often has difficulty sustaining attention in tasks or play activities
0 Often does not seem to listen when spoken to directly
0 Often does not follow through on things
0 Often has difficulty organizing tasks and activities
0 Often avoids, dislikes or is reluctant to engage in tasks that require
sustained mental effort (such as schoolwork or homework)
0 Often loses things necessary for tasks
0 Is often easily distracted by extraneous stimuli
0 Is often forgetful in daily activities

5. 0 6 of the following symptoms of hyperactivity-
impulsivity have persisted for at least 6 months and
are inconsistent with developmental level:
Hyperactivity
0 Often fidgets with hands or feet or squirms in seat
0 Often leaves seat in classroom or in other situations in
which remaining seated is expected
0 Often runs about or climbs excessively in situations in
which it is inappropriate (in adolescents or adults, may be
feelings of restlessness)
0 Has difficulty playing or engaging in leisure activities
quietly
0 Is often "on the go" or often acts as if "driven by a motor"
0 Often talks excessively

6. 0Impulsivity
0Often blurts out answers before questions
have been completed
0Often has difficulty awaiting turn
0Often interrupts or intrudes on others
0 Some symptoms that caused impairment were present before age
7 years.
0 Impairment is present in two or more settings
0 Clinically significant impairment

7. Adult AD/HD
0 Adult symptoms
0 Hyperactivity and poor concentration
0 Affective
0 Lability/Hot temper
0 Inability to complete tasks and disorganization
0 Stress intolerance
0 Impulsivity

8. Axis I: Mood Disorders
Part A: Anxiety

9. Anxiety: Generalized
0 At least 6 months of "excessive anxiety and worry" about a variety of
events and situations.
0 There is significant difficulty in controlling the anxiety and worry.
0 The presence for most days over the previous six months of 3 or
more (only 1 for children) of the following symptoms:
0 1. Feeling wound-up, tense, or restless
0 2. Easily becoming fatigued or worn-out
0 3. Concentration problems
0 4. Irritability
0 5. Significant tension in muscles
0 6. Difficulty with sleep
0 The symptoms are not part of another mental disorder.
0 The symptoms cause "clinically significant distress“
0 The condition is not due to a substance or medical issue

10. Anxiety: Panic Disorder
0 Symptoms
0 A discrete period of intense fear/discomfort, in which 4 of the
following developed abruptly and peaked within 10 minutes:
0 palpitations, pounding heart, or accelerated heart rate
0 sweating
0 trembling or shaking
0 sensations of shortness of breath or smothering
0 chest pain or discomfort
0 nausea or abdominal distress
0 feeling dizzy, unsteady, lightheaded, or faint
0 derealization (feelings of unreality) or depersonalization (being
detached from oneself)
0 fear of losing control or going crazy
0 fear of dying
0 paresthesias (numbness or tingling sensations)
0 chills or hot flushes

11. Anxiety: PTSD
0 Symptoms
0 The person has been exposed to a traumatic that involved
actual or threatened death or serious injury, or a threat to
self or other and the person's response involved intense
fear, helplessness, or horror.
0 The traumatic event is persistently reexperienced in one
(or more) of the following ways:
0Dreams
0Flashbacks
0Intense distress at exposure to reminders of the event

12. PTSD cont…
0Avoiding reminders of the trauma and
numbing of general responsiveness (not
present before the trauma):
0efforts to avoid thoughts, feelings, or conversations
associated with the trauma
0efforts to avoid activities, places, or people that arouse
recollections of the trauma
0inability to recall an important aspect of the trauma
0markedly diminished interest or participation in
significant activities
0feeling of detachment or estrangement from others
0restricted range of affect (e.g., unable to have loving
feelings)

13. PTSD cont…
0 Persistent symptoms of increased arousal
(not present before the trauma)
0difficulty falling or staying asleep
0irritability or outbursts of anger
0difficulty concentrating
0hypervigilance
0exaggerated startle response

14. Axis I: Mood Disorders
Part B: Depression

15. Depression and Dysthymia
0 Major Depressive Episode
0 A. Five (or more) of the following have been present nearly every day
during the same 2-week period
0 depressed mood most of the day
0 markedly diminished interest or pleasure in all, or almost all,
activities
0 significant changes in eating patterns.
0 insomnia or hypersomnia
0 psychomotor agitation or retardation nearly every day
0 fatigue or loss of energy
0 feelings of worthlessness or excessive or inappropriate guilt
0 diminished ability to think or concentrate, or indecisiveness,
0 recurrent thoughts of death (not just fear of dying), recurrent
suicidal ideation

16. Depression cont…
0 The symptoms are not due to
0 the direct physiological effects of a substance
0 a general medical condition (e.g., hypothyroidism).
0 Bereavement, i.e., after the loss of a loved one, the symptoms
persist for longer than 2 months or are characterized by
marked functional impairment, morbid preoccupation with
worthlessness, suicidal ideation, psychotic symptoms, or
psychomotor retardation
0 Dysthymia is a constant, low-grade depression that lasts for
months or years.

17. Bipolar
0 Disorder in which the person experiences both manic
and depressive type symptoms
0 Symptoms can alternate, co-occur(mixed) or be
present to a greater or lesser degree
(hypomania/dysthymia)

18. Mania
0 Abnormally and persistently elevated, expansive, or
irritable mood, lasting at least 1 week
0 inflated self-esteem or grandiosity
0 decreased need for sleep more talkative than usual or
pressure to keep talking
0 flight of ideas or subjective experience that thoughts are
racing
0 distractibility
0 increase in goal-directed activity (either socially, at work
or school, or sexually) or psychomotor agitation
0 excessive involvement in pleasurable activities that have a
high potential for painful consequences (e.g., engaging in
unrestrained buying sprees, sexual indiscretions, or
foolish business investments)

19. Hypomania
0 Criteria for Hypomanic Episode (DSM-IV, p.
338)
0 The manic episode is not severe enough to cause
marked impairment in social or occupational
functioning, or to necessitate hospitalization, and
there are no psychotic features.

20. Medical Disorders
0 Depressive-Like Symptoms
0 Diabetes
0 Hypothyroid
0 Fibromyalgia
0 Chronic Fatigue
0 Manic-Like Symptoms
0 Hyperthyroid

21. Summary
Depressive & Bipolar Disorders
0 Depression
0 Dysthymia
0 Mania
0 Hypomania
0 Bipolar I
0 Bipolar II
0 Cyclothymia
0 Differential Diagnosis

22. Physical Issues
0 Physical conditions can mimic intoxication or
withdrawal
0 Physical conditions can worsen during use or
withdrawal
0 People use to self-medicate physical (and emotional)
conditions
0 Effective treatment involves addressing physical AND
emotional conditions AND treatment side effects
which are unplesant.

23. Substances and Medications
0 Depression
0 Opiates
0 Anxianxiety/Benzodiazepines
0 Depressants/Barbiturates
0 Inhalants
0 GHB
0 Mania
0 Ecstasy/MDMA
0 Methamphetamine
0 Cocaine
0 Steroids

24. Medications
0 Pain killers (opiates) and antianxiety medications
(benzodiazepines) can produce feelings of tiredness,
sluggishness and general apathy.
0 Stimulants (decongestants, ADD/ADHD medications)
can cause nervousness, shakiness and anxiety-like
symptoms. Excessive use can cause depression-like
symptoms when not using
0 Steroids can cause irritability, depression and
dramatic mood swings

25. Medical Issues
0 Chronic Fatigue 0 Dry mouth
0 Being dizzy when standing up, or
0 Fatigue having problems with balance and
0 Sore Throat fainting
0 Loss memory and loss of 0 Irregular heartbeats
concentration 0 Ear aches
0 Enlarged lymph nodes in the neck 0 Morning stiffness
0 Muscle pain that is unexplained 0 Pain in your jaw
0 Joint pain that can move from joint 0 Nausea
to joint without any signs or
swelling. 0 Having night sweats and chills
0 Sleep that is unrefreshing and 0 Depression, anxiety, irritability,
waking up as tired panic
0 Headaches 0 Being short of breath
0 Exhaustion 0 Tingling Sensations in your
extremities
0 Pain in the abdominal region
0 Vision blurring, eye pain,
0 Having allergies or other sensitivity to light or dry eyes.
sensitivities
0 Gaining or losing weight.
0 Chest pains
0 Bloating/Diarrhea

26. Medical: Diabetes
0 Diabetes
0 Type 1 Diabetes
0 Frequent urination
0 Unusual thirst
0 Extreme hunger
0 Unusual weight loss
0 Extreme fatigue and Irritability
0 Mimics depression

27. Medical: Diabetes
0 Hypoglycemia
0 nervousness
0 sweating
0 intense hunger
0 Trembling
0 weakness
0 Palpitations
0 Trouble speaking/Word Slurring
0 Mimics anxiety disorders

28. Medical: Fibromyalgia
0 Chronic muscle pain, muscle spasms or tightness
0 Moderate or severe fatigue and decreased energy
0 Insomnia or waking up feeling just as tired
0 Difficulty remembering, concentrating
0 Tension or migraine headaches
0 Jaw and facial tenderness
0 Sensitivity to one or more of the following: odors, noise, bright
lights, medications, certain foods, and cold
0 Feeling anxious or depressed
0 Numbness or tingling in the face, arms, hands, legs, or feet
0 A feeling of swelling (without actual swelling) in the hands and
feet

29. Medical: Hypertension
0 Hypertension
0 Severe headache
0 Fatigue or confusion
0 Vision problems
0 Chest pain
0 Difficulty breathing
0 Irregular heartbeat
0 Blood in the urine
0 Pounding in your chest, neck, or ears
If you have any of these symptoms, see a doctor immediately.
You could be having a hypertensive crisis that could lead to a
heart attack or stroke.

30. Medical Arrhythmias
Symptoms of Arrhythmias
0 Palpitations (a feeling of skipped heart beats, fluttering
or "flip-flops," or feeling that your heart is "running
away").
0 Pounding in your chest.
0 Dizziness or feeling light-headed.
0 Fainting.
0 Shortness of breath.
0 Chest discomfort.
0 Weakness or fatigue (feeling very tired).

31. Medical: Heart Disease
0 Shortness of breath
0 Palpitations
0 A faster heartbeat
0 Weakness or dizziness
0 Nausea
0 Sweating

32. Polycystic Ovarian Syndrome
0 Infrequent, absent, and/or irregular menstrual periods
0 Increased hair on the face, chest, torso, thumbs, or toes
0 Cysts on the ovaries
0 Acne, oily skin, or dandruff
0 Weight gain or obesity, usually around the waist
0 Male-pattern baldness or very thin hair
0 Patches of skin on the neck, arms, breasts, or thighs that
are thick and dark brown or black
0 Pelvic pain
0 Anxiety or depression

33. Medical:Thyroid
Hyperthyroid HypoThyroid
0 Palpitations 0 Fatigue
0 Heat intolerance 0 Weakness
0 Nervousness 0 Weight gain
0 Insomnia 0 Coarse, dry hair
0 Breathlessness 0 Dry, rough pale skin
0 Increased bowel movements 0 Hair loss
0 Light or absent menstrual periods 0 Cold intolerance (you can't
0 Fatigue tolerate cold temperatures like
0 Fast heart rate those around you)
0 Trembling hands 0 Muscle cramps/muscle aches
0 Weight loss 0 Constipation
0 Muscle weakness 0 Depression
0 Warm moist skin 0 Irritability
0 Hair loss 0 Memory loss
0 Staring gaze 0 Abnormal menstrual cycles
0 Decreased libido

34. Axis III: Medical Issues---
Summary
0 Many medical conditions have symptoms that mimic
substance abuse or mood disorders
0 Side effects of medications can also mimic substance
abuse
0 Some people self medicate physical and/or emotional
issues with substances

35. Homework
0 Family History:
0 Identify each person in your family from your
grandparents and great aunts and uncles to your
parents and siblings.
0 List any medical or mental health problems they had, or
you suspect they had
0 Identify 2 simple things that you can do each day to
help you feel better
0 Example:
0 I watch the birds that come to my feeder and play with my
pets. Sometimes I garden.
0 I get better rest if I am on a schedule and go to bed at the
same time each night.