177  Systems Impact on Mood Disorders and Addictive Behaviors Live Addiction Counselor Certification

177 Systems Impact on Mood Disorders and Addictive Behaviors Live Addiction Counselor Certification

This episode was pre-recorded as part of
a live continuing education webinar. On demand CEUs are still available for this
presentation through ALLCEUs. Register at ALLCEUs.com/CounselorToolbox. I’d like to welcome everybody to today’s
presentation on the systems influences on mood and addictive disorders. This is
kind of a continuation of what we were talking about yesterday, with a little
bit of history thrown in to give it some depth if you will. We’re
going to examine the prevalence of mood and addictive disorders and learn about
the history of addictive behaviors in the US and then we’ll look at some
systems influences political-economic yada yada
some of those XO systems that we talked about we didn’t really get to you
yesterday in the development and maintenance of addictive and mood
behaviors or mood disorders so I will say for your test for your quiz I don’t
quiz on specific statistics so this thing like 32 percent lifetime
prevalence of anxiety it’s important to just kind of have that hit you and think
you know one out of every three people will experience a clinically diagnosed
alep asoto van’s aya T in their lifetime at any point in time any 12-month
snapshot roughly 1 out of every 5 people you know look around the room wherever
you’re at whether you’re in the grocery store or at church or in a staff meeting
roughly one out of every five of those people meets criteria for an anxiety
disorder and only 13% of those people who have one you know so one out of five
are experiencing it but only 13% of the people who need treatment are getting it
oh that just kills me depression has a lower prevalence and we’re really
looking at just major depressive disorder not persistent depression what
used to be called dysthymia in the dsm for but that’s 7% so that’s still a
relatively high number that means one out of every 13 people has is
experiencing a depressive experiences of episode at least one in a 12-month
period that’s that’s significant I mean we’re not talking just the Blues we’re
talking clinically diagnosed Abul major depressive disorder the prevalence among
people with depression is significantly higher among people of two or more races
so that goes you know from a clinician standpoint I’m gonna look at that and
I’m gonna say we are not doing well as a society as a culture maybe on being
culturally sensitive so we kind of want to look at that and there’s also the
process of acculturation and all that stuff we go over in in cultural cultural
diversity but it’s important to understand that people who are of
multiple races have a higher risk it appears of experience in clinical
depression in a any 12-month period now I have the resources over here if you
want to go look up the statistics you know you can certainly do that but again
you won’t be tested on the exact numbers alcoholism 6% 12-month prevalence and 6%
of that 6% receive treatment so we think of alcoholism as probably being a more
common addiction than it really is because 12-step programs are so
prevalent around but actually I mean we’re looking at alcoholism and
depression are roughly at the same rate now is that good of course not
sex and pornography addiction three to five percent of the population
struggle in a and in any year with compulsive sexual behaviors so that I
put sex and pornography together because they haven’t really split those out in
the literature and it’s a new field but it’s important to understand from a
clinician standpoint our clients that we’re seeing for mental health issues
may also have some alcohol issues maybe alcohol abuse maybe not quite dependence
yet or misuse and they may not recognized a pornography addiction sex
addiction is a little bit easier to recognize because you actually have to
go out and get it and or engage in other behaviors but pornography addiction
that’s sitting at home on your on your internet or at work on the internet in
the car driving on the internet yeah it can be it’s everywhere and it’s endless
so there’s a high rate of sex and pornography addiction and we’re gonna
you know if you think back to yesterday and we’ll talk a little bit about the
fact that the changes the brain changes that occur
during a addictive episode when somebody engages in some addictive pleasurable
behavior flooded with dopamine so then the brain says I can’t be this happy for
this long so I’m not gonna be quite as sensitive I am NOT going to let quite as
much dopamine go through so when the normal days the person is kind of
jonesing for a rush because they don’t even feel they don’t feel as happy after
a while because they need that extra push
you know if you’re somebody who’s consumed a lot of caffeine for a long
time you might be able to kind of relate where you get up and you’re just your
body doesn’t even hardly get started without having caffeine in your system
because it got so used to having that artificial energy and drug abuse 27% of
Americans reported using illicit drugs in their lifetime and 3% of Americans
over 12 reported in a 12 month period over the age of 12 reported non-medical
use of prescription drugs so I mean we’re talking we’re not just talking
opiates we’re talking sleep aids you know lunesta anyer benzos or barbituates
you know any of those things that you get prescribed by a doctor three percent
of Americans over the age of 12 ohmygosh report non-medical use in a
12-month period and it is really popular among unfortunately a lot of teenagers
and youth to go into their parents medicine cabinets and just kind of grab
whatever they can and they put it all into a bowl and just kind of guess and
take a handful of pills which is like playing Russian roulette but that’s a
whole different a whole different class so understanding that mental health
issues and substance abuse issues are really prevalent out there and there’s a
lot we can do to try to prevent them but there’s also a lot we need to do to
reach out and provide early intervention and bring people in and let them realize
that you know having a significant impact but a lot of
what we’re going to talk about today deals with prevention let’s look at some
of these systems and see where we might be able to you know step in themes to
look for when we talk about history and I’m gonna go through history really
quick there’s just a little brief history lesson but I want you to look
for the fact that a lot of times the problems with substances initiated from
the medical medical community trying to treat something and the more people that
were treated the more available the drug became the more available the drug
became the more was out there for diversion so I mean think about 15 20
years ago when you used to go have your wisdom teeth out or something a minor
procedure you might get two weeks worth of opiates in for pain management now
the doctor is probably going to give you three days if it gives you any but so
people were getting this and they were having opiates left over if they weren’t
taking them the whole time so they could sell them or they were more available or
they took them and they’re like ooh this produces an awesome feeling
oh they’ll keep taking these as long as I can get them and suddenly they’re
calling their doctor back and going I need more economic motivations we want
to look at what in the economy might be contributing to the increased
availability of drugs and alcohol the increased positive promotion in media
you know why is this problem there we want to look for giving in to political
pressures to repeal and one thing you’ll find is pretty much every time they put
a law into place to prohibit something it doesn’t work people who want it will
get it if they want it bad enough they’re going to get it it doesn’t cease
use for anything and people who you know don’t want to go through all the trouble
just find something else so a lot of times the drug prohibition laws don’t
work and politicians who want to get elected
think back to you know the recent elections when we did a lot of voting on
legalizing marijuana a lot of politicians will go with whatever their
constituency is wanting because they want to get reelected where there’s a
will there’s a way or an alternative so you know when one is less available or
too expensive they’ll find something else and that’s just human nature if
we’re using it for relief if we’re using it for relaxation and and we want to
look at cheaper alternatives because most of these drugs end up becoming
available in cheaper forms or cheaper alternatives come up so cannabis
marijuana was first introduced to the u.s. in 1545 so a long long time ago in
1775 the hemp culture was introduced into Kentucky and large hemp plantations
flourished in many states until well into the 1800s so this was an economic
business peep for murrs were making money from it consumers were buying it
everybody was happy until the late 1800s tobacco alcohol and opium could be
purchased readily free from government controls and were quite fashionable to
use so again you’ve got social pressures as well or social thoughts that this is
an okay thing to take there’s no government controls making it difficult
to get and in many cases it was relatively affordable during the Civil
War black AIDS on southern ports curtailed the imports of tea and coffee
so people switched over to a drink made from the cassia leaf which has
psychogenic properties and this drink became a viable alternative to coffee
and tea so we had people becoming addicted to a different drug because
they couldn’t get the caffeine morphine was used commonly as a painkiller during
the Civil War so a lot of soldiers became addicted like I said yesterday
three to five days people start building up a tolerance to opiate drugs and
morphine’s are pretty powerful opiate so you had a lot of people and they didn’t
that Opie opiate drugs were addictive back then so you had a lot of soldiers
that were in the hospital for a week two weeks or more and they were getting
addicted to opiates in the late 1800s to add insult to injury
morphine an opiate was prescribed as a substitute for alcohol addiction so
people who were addicted to alcohol were actually given opiates to help them get
off of it so we’ve got another reason that opiates are starting to come into
the market and yeah I’m sure the people who were addicted to alcohol we’re
feeling better we know that when people are detoxing from alcohol their blood
pressure goes up that’s one of the primary side effects and opiates are
depressants they’re going to lower respiration lower heart rate so there’s
a relationship we can see here where it probably did help I mean right now we
look at more at benzos during the detox period but opiates were used in the
1800’s because benzos didn’t exist yet in 1844 cocaine was first isolated from
the cocoa leaves woohoo and this doctor in in Germany issued a supply of pure
cocaine to soldiers to increase their endurance and alertness and it worked
and they said this is really good so it became a common practice to give
soldiers cocaine to help them stay alert in 1885 a guy named John Steve Pemberton
of Atlanta Georgia came up with coca-cola so he combined cocaine which
is a stimulant with caffeine which is a stimulant and you know we one plus one
is like six and they came up with you know this drink of coca cola that a lot
of people really liked and unfortunately because of the well because of the
cocaine but also a little bit because of the caffeine was highly addictive from
1850 until 1942 marijuana was recognized as a legitimate medicine under the name
of a strict ‘m cannabis so we still see even from 1500 all the way through 1942
cannabis is relatively legal has some uses so we see that there are
medicinal properties to it and we’re going to look as we go through why
suddenly suddenly society decided it was this scourge in night in 1898 the Bayer
corporation you know Bayer Aspirin found heroin as the newest opium derivative
and it was widely advertised as being at least ten times as potent a painkiller
as morphine with none of the addicting properties Oh Polly so now we have this
new more powerful thing coming on and in the people who found relief in morphine
found a lot more relief in heroin in 1920 the Prohibition Act was passed
this is for alcohol and was repealed in 1933 again politics it was not a popular
thing people wanted their alcohol it didn’t prevent anything there were
economics of it because the government was losing money on taxation and you
know people who sold alcohol were losing money on it unless they were making
stills in moonshine and it was relatively at that point in time just
unenforceable they found that it was just overwhelming to try to win for
enforce it so they just said you know what we’re gonna scrap it in 1925 the
import of opium for the manufacture of heroin was finally banned in this
country so alcohol is is banned in 1920 opium is banned in 1925 alcohol comes
back in 1933 but there’s still some restrictions on opium throughout the
19th century opium and marijuana users enjoy their diversion with little
harassment so it wasn’t until the 1900s that they started saying well this might
be a problem the federal Harrison narcotic Act was passed in 1914 in order
to provide for a register and impose a special tax upon all persons who
produced imported manufactured compounded dealt dispensed and sold
distributed or gaiba way opium or cocoa leaves their salt
derivatives or preparations the government now wanted their chunk of
change in 1918 three years after the Harrison Act went into effect a study by
a congressional committee released the findings that opium and other narcotics
including cocaine were being used by about a million people still so where
there’s a will there’s a way the underground traffic and narcotic
drugs was about equal to the legitimate medical traffic so even if it had
legitimate medicinal uses there was also also this whole
underground community and economy that was flourishing off of it the dope
peddlers appeared to have established national organizations smuggling the
drugs in through seaports or across the Canadian or Mexican borders so these
aren’t ones that were makin or growing in the u.s. right now or back then and
and I guess even now but they were getting into the country the wrongful
use of necrotic drugs had increased since the passage of the Harrison Act so
they passed this act for taxation and so people just went underground and there
was even less ability to kind of control it because it wasn’t being prescribed
anymore it was you know black market stuff by 1913 the District of Columbia
and 46 states had adopted some form of legislation against marijuana so you
know we have people starting to get really concerned about drugs and
alcohols back so there’s not as much of a need for marijuana you know it’s
really unclear as to why people got so fired up about marijuana when these
other drugs were still legal or being or readily available the Treasury
Department officials submitted to Congress a proposal which was eventually
passed as the marijuana Tax Act again government going if you’re going to use
it we get paid the Act didn’t actually ban marijuana at all but like the
Harrison Act it recognized the potential medical uses of the substance okay we’ll
give them the benefit there but imposed a tax on those involved in the
distribution so we’ve got marijuana’s that’s still being used
medicinally at this point in 1938 LSD was discovered they’re like aha score
this is a new one the use of cocaine declined in the 1940s due to the lack of
availability so there was some cracking down it wasn’t nope no pun intended on
the cocaine coming across the borders but the LSD this was something that was
available in the u.s. from 1938 to 1958 LSD was used to treat a variety of
medical and psychological issues including psychosis pain management and
anxiety what they called neuroses back then so again the doctors are going this
is a cool new drug let’s throw it at everything and see what sticks in 1960
fentanyl was first synthesized by Janssen pharmaceuticals and obviously
I’m going chronologically not by drug because I kind of want to see I want you
to see the ebb and flow of different drugs that are available in 1962 LSD
could be purchased legally by physicians psychiatrists psychologists and other
mental health professionals who could certify a legitimate use for the
substances well you can see a issue there you can see people you know
finding legitimate uses creating an economy for themselves in 1965
regulations were passed that outlawed LSD but the formula to make it could
still be purchased from the patent office for 50 Cent’s and the ingredients
were easily acquired so just like what we’re going to end up talking about with
bathtub methamphetamine people learned that they could make it pretty easily
and cheaply in the United States at home they didn’t have to worry about
importing so they’re like well I’m gonna keep doing this
doctors Timothy Leary and Richard Alpert instructors at Harvard spread the word
about LSD to anyone who would listen there was a revolution about to start
the mind would at last be freed from the bondage of proletarian concerns so you
know this is we’re in the 60s here you know you know what the culture was like
back then so people are really lack – this cocaine regained popularity in
the 1970s and 80s though glamorized by the media as a non-addictive
recreational drug so they don’t realize the addictive potential of cocaine in
the 70s and 80s the media glamorizes it if you look at movies from the 80s and
you know I grew up in the in the 70s and 80s people were that there was a lot of
media portrayal of people at parties doing lines of cocaine so it was sort of
the thing to do back then so it gained more popularity but it was still
expensive because they were having to import it so in 1985 crack emerged as an
affordable alternative to pure powder cocaine crack is cocaine plus baking
soda basically the increase in opiate prescriptions in 1980 so crack is
emerging this is you know they still have to get the cocaine still have to
make it but it it’s pretty readily available and crack is relatively easily
manufactured once you get the cocaine in the United States then we start with the
problem of opiates and opiates really didn’t flare up again you know there was
the initial flare back when they were using it in the war and everything but
it started to flare again in 1980 when an 11 line letter 11 lines printed in
the New England Journal of Medicine in January of 1980 pushed back on the
popular thought that using opioids to treat chronic pain was risky this letter
and a couple of studies not a bunch created after a discussion in the 1990s
making pain treatment a priority for all patients so now they’re saying opiates
really are not addictive for people with chronic pain there’s not a great risk of
problems from it and people’s quality of life because of chronic pain is poor so
we really need to look at pain treatment in 1998 Purdue Pharma created a video
promotion called I got my life back it followed six people with chronic pain
who took oxycontin and basically looked at how much there
it improved since they had started using oxycontin regularly this was promoted
you know it was a video it was also on commercials you know people were
starting to see it on TV in 2001 the Joint Commission for the
accreditation of health care organizations or Jayco may pain
assessment of all patients a requirement I remember when this happened we had to
change all our manuals so now and one person in the articles I was reading
said asking people about pain or pain management became as common as checking
people’s vital signs because we had to check it at assessment and we had to
check it at every reassessment so Jayco is having us kind of ask people do you
have pain let’s see what we can do to help you with your pain to increase your
quality of life so there’s a real push here and if you’re conspiracy minded you
might think that there’s some underlying support from the drug companies going we
need to start asking people about chronic pain in order to make sure that
we were really kind of pushing this issue they started to realize it was a
problem though they started to realize there was some abuse issues in you know
2005 up to 2010 so oxycontin was blended with an abuse deterrent which is tylenol
um so what did the users do they switch Tobias they’re like no okay fine I’m not
going to take that one I will take one that won’t ruin my liver
they just ruin my life in 2015 trials began to treat resistant depression with
opiates so we’re still even though we realized that there is a significant
problem with opiates there’s a significant opiate epidemic right now we
haven’t learned our lesson it seems we’re still throwing it or trying it
with new to treat new new disorders if you will try it trying it to treat in
novel ways and I think a lot of that is spurred on editorial I think a lot of
that is spurred on by the pharmaceutical companies wanting to continue to
make money however fentanyl patches this is I found this terribly interesting and
concerning fentanyl patches are in the World Health Organization’s list of
essential medicines out the list of the most effective and safe medications that
every country needs to have I was just like wow that is kind of scary because
fentanyl is like 50 times more powerful than heroin so we’re looking at things
that are really intense and they come in patches and lollipops and other things
but so you can see that you know there’s an ebb and flow when people can’t get if
people couldn’t get opiates you know because they’re trying to do a lot of
legislation to keep doctors from prescribing it yadda yadda well you know
what until we figure out what’s causing people to want to use opiates and what
the benefit is and provide them a different alternative they’re gonna find
something else unfortunately it’s it’s not as simple as
just removing it the history of cigarettes now I put this in a little
bit you know differently there was an explosive increase in cigarette smoking
after 1910 which can be attributed in part to the public health campaigns of
that era against chewing tobacco they were telling people that a sputum of
tobacco chewers spreads tuberculosis and other diseases so people were like oh
well I’m not gonna I’m not gon dip I’ll smoke instead by 1921 the year after
alcohol prohibition 14 states had laws prohibiting cigarettes and a bunch of
anti cigarette bills were under consideration but people continued to
smoke and the last statewide cigarette prohibition law was repealed in 1927 I
watched The Beverly Hillbillies and regularly there are if you watch the old
ones they’ll have the ads that are attached still attached to the to the
episode and Winston cigarettes was a prominent sponsor of the Beverly
Hillbillies so you see that periodically and it just kind of makes me cringe now
the government currently earns around 15 billion that’s 15 billion with a B
dollars in revenue from cigarette taxes each year so you do the math and figure
out where the motivations lie so looking at the history we can see
that there’s a long history of drugs being used we don’t have data to show
back to you know I was trying to look for back to the date Great Depression
when there might have been a lot of mood disorders what was the frequency of mood
disorders during the Great Depression what was the frequency of alcoholism and
there’s just really there’s no data at least not that I could find that’s
available to tell it so we could compare you know back then to now and see if
anything’s changed so we could start trying to intervene there so my question
is what current social and cultural influences do you see that you think
contribute to the development of mood disorders you know depression anxiety
and/or addiction and I kept it kind of close with mood disorders instead of
saying any mental health issues because we know there’s a large genetic
component if you will or a biological component with schizophrenia and some
other disorders like that so we’re really looking at anxiety depression things that are less tied to genes so let’s you know start looking and if
you think of some more feel free to chime in social systems influence on
mental health and substance abuse mhm is mental health and si is substance abuse
coping methods that we model you know as Americans how do we model coping to our
children how do we model coping to each other right now think about the media
think about how people deal with adversity deal with conflict is this a
model that is going to promote mental health and compassion and you know
everybody holding hands and singing Kumbaya or is it going to promote
anxiety anger and depression I tend to lead towards we’ve got a lot of
ineffective coping mechanisms right now substance use aggression those
seemed to be pretty prominent also just ignoring it avoiding it burying your
head in the sand and going you know lalalalala
not helpful it doesn’t solve the problem it just gets you away from it for a
moment or maybe changes it patterns of use that are modeled so when we’re
looking at the social systems influence on substance abuse and you know I want
to say addiction in general whether it’s gambling internet porn sex addiction you
know any of those things what’s being used you know what are the common
popular things right now you remember right after Tiger Woods went in for sex
addiction treatment you know all of a sudden other people started following
suit so there was some social pressure maybe to acknowledge and identify it or
maybe it was the in thing to have you know I don’t know what the celebrities
motivations were but we want to look at you know what types of substances or
activities does our culture does their social system say this will help you
feel better when is it used you know if you think about food for example in
American culture we eat all the time we eat when we’re hungry we eat you know we
go out to meetings we’ll take clients to lunch or dinner we eat during
celebrations we during holidays we eat during funerals we eat so then think
about drinking alcohol you drink at those dinners with clients you drink at
celebrations you drink at parties you drink while you’re watching football on
the television and you know obviously that’s not true for everybody but these
are common times when people engage in alcoholic behavior you can say the same
thing about smoking and other legally or socially sanctioned drugs that we’re
talking about and why is it used what’s the benefit are people using to escape
are they using to fit in with a peer group are they using just because it’s
what they’ve always done peer pressure and acceptance of health-related
behaviors or treatment seeking also influences mental health
and substance abuse back in my grandmother’s day you know going to a
therapist for depression treatment was a no-no you you know you didn’t air your
dirty laundry you dealt with it you sucked it up when I was younger I think
it was still a little bit taboo sometime in the 90s I think it became the
fashionable thing to do was to have a therapist so people were more accepting
I guess of seeking treatment for mental health issues and substance use
disorders and health related behaviors you know when in the 60s when everybody
was taking all kinds of drugs you know that there wasn’t a problem with it
people didn’t see a problem with it when in the 80s when people were doing lines
of cocaine you know it that was one of those socially sanctioned things now
people seem to have gone a little bit more it seems to be a larger proportion
of the population that tends to be in thinking about health related behaviors
and exercising and eating well and getting rid of gluten and all that other
kind of stuff so we want to look at how do social systems influence whether
people take care of themselves and get treatment when needed and the
availability and engagement in health positive or health and negative
behaviors so what options are there you know when I lived in Virginia a couple
years ago the town I lived and had one gym and it was a relatively big town it
just exercised didn’t seem to be a real priority right there so it was a little
bit harder to find you know places to go work out and people who enjoyed working
out like I did finding places where there are people the social systems that
promote health positive behaviors healthy eating healthy exercise
relaxation you know not just you know kind of working at it all the time but
actually letting your hair down and having fun
versus places where there’s a lot of negative health behaviors there’s a
proliferation of drug use and OB city and people you know kind of sitting
on the couch think about and places where it gets wicked wicked cult and you
know for me wicked cold as anything below about thirty-five you know the
social systems there’s not a lot of people that like to go out and go hiking
or engage in a lot of activities when it is really cold outside so and a lot of
people aren’t going to do it by themselves so there could be more health
negative behaviors in during certain times of the year where people are just
like now I think I’m gonna sit inside drink cocoa and just cover everything up
with a big sweater so social systems have a big influence who we hang out
with what they do because we tend to want to be affiliated and we tend to
want to spend time with people political systems also influence both mental
health and substance abuse laws regulation regulating medication and
treatment availability it takes so many years for drugs to get through the FDA
that you know there are a lot of antidepressants anti-anxiety medications
that may be in the works that won’t come out for another five or ten years right
now so that can have an influence if there
is a good drug now on the other side it keeps harmful drugs fewer harmful
drugs from actually making it through all the trials another law if you will
when I worked in Florida for counselors we couldn’t bill for case management for
a lot of things and I’m sorry we do a lot of or at least where I was and I
still do a lot of case management making referrals following up doing all that
stuff and they weren’t billable hours so it was harder for us to spend a lot of
time making sure that our clients had all the wraparound services they needed
to deal with their depression and anxiety or addiction access to social
service programs for health care medicine and food think of Maslow you
know that bottom tier you have to have the building blocks to make the
neurotransmitters safe housing and you have to be relatively
healthy if you are sick or in chronic pain it’s gonna be hard to work on
having a really good mood or you know dealing improving your self-esteem
changes in the political system can also enhance a feeling of disempowerment and
oppression enough said that’s obvious and laws regulating access to addictive
substances and behaviors such as gambling and pornography can also have
an effect just like we talked about when things become more difficult to get you
know when opium became more difficult to get people kind of switch to something
else fentanyl as a side note I didn’t mention
it back then is much much much much cheaper to manufacture than heroin
so fentanyl became an affordable alternative to pure heroin and it
actually can be manufactured it’s not easy but it can be manufactured in the
States so if there were laws regulating gambling you know it might control it a
little bit laws regulating child pornography are extremely strong and
that’s not all pornography just CP but it does reduce the number of people who
are thinking you know maybe I’ll just go here and check it out they don’t even
want to go there because they don’t want to risk the penalties so there are ways
to deter people it’s not going to prevent everything but it can deter
repeal of laws as the result of pitiful political pressure from constituents
also you know influences how people feel about things what substances are
available taxes on substance and you know when we talk about repeal of laws
think about the Affordable Care Act you know how is that going to affect
people’s ability to access mental health care when they need it especially if
their mental health issue is a pre-existing condition taxes on
substances obviously the government wants to keep itself going and it needs
to figure out how to fund itself because they’re always in debt so taxes
on these activities brings in a lot of money to the government so they’re
motivated to not make it go away just to try to control it a little bit laws
regulating marketing practices of addicted substances and mental health
medications also influence mental health and substance abuse I mean right now you
know there’s there’s not a lot of laws that prohibit advertising these things
on on TV especially like mental health medications
I have watched countless pharmaceutical company commercials and you hear that
hear about this drug and how wonderful it’ll make your life and everything and
when the commercials over I’m like well what was it supposed to treat but
there’s such a promotion about how much better life will be so there’s not a lot
of real strict laws on presenting the information about the actual
effectiveness in clinical trials of you know whether this worked you know we
know that it if it got through the FDA it probably didn’t hurt anybody but how
many people actually saw significant clinical improvement and enhanced
training and penalties for servers I mean this is an alcohol thing obviously
but it’s one of those laws that the government and political systems can put
down because you’ve got people who own bars they’re not going to sell their
bars there’s too much of an economic motivation so in order to control the
consumption without having to get rid of it because they like their taxes they
put more regulations on on the sale of alcohol economic systems availability of
addictive behaviors the internet if you are addicted to pornography if you are
addicted to shopping and I know people who have you know they’ll go online and
they can blow thirty thousand dollars without thinking twice about it and you
know and then they’re like that was how they were escaping there’s an endless
supply of places to shop online but in your community if there’s a huge
availability whether it’s street level drug dealers or corner stores or
there’s a lot of shopping where you live or whatever it happens to be people may
be more likely to engage in addictive behaviors if it’s easily easily accessed
remembering that addictive behaviors mucks up the neurotransmitters and can
cause depressive symptoms now does it is it intractable no you know once the
brain balance is out that the mood disorder generally goes away if it was
caused by the substance but it can cause depressive or anxiety related symptoms
affordability the up surges of fentanyl free porn and bathtub meth have all
increased the use of those things and you know now if you want just standard
porn evidently there are several sites that you can just access it for free
so people are accessing it and youth unfortunately are accessing it earlier
cigarette cost and taxes you know when we look at cigarette use cigarette use
has gone down because there has been I mean they’re really expensive now and
the cigarette taxes are really high so people are not using it quite as much
they’re turning to vaping and you know in some cases they may be turning to
marijuana I don’t know what the cost comparison is there but so people use is
reduced some but it’s not eliminated and the affordability of medication and this
can be your antidepressants or any of your medication that you’re prescribed
if people can’t afford it and they need it and it actually would help them feel
better and I can’t get it then they’re gonna continue to have you know suffer
with symptoms remember that most pharmaceutical companies have patient
assistance programs and there are formulary is at most grocery stores and
Walmart’s and stuff that had like the $5 prescriptions for a lot of the necessary
medications and a lot of times doctors can be cajoled by the patient to
prescribe a medication that’s on one of those lists instead of some you know
name-brand only education motivation a big pharma to
convince people to buy more drugs increases people’s presentation for
substances whether it’s opiates or antidepressants people are looking for
happiness in a pill and big pharma seems to promise that then when they take a
pill and they don’t automatically get happy then they can start feeling
depressed and anxious and like what’s wrong with me am I never going to get
better and actually sort of create a situation where they don’t feel well the
ability of taxation of a substance or activity to benefit the government is
another economic pressure so we want to look at what are what’s the government
getting out of it whether it’s you know xanax or something that’s like marijuana the availability of health and mental
health care and the availability of nutritious foods will just kind of put
those together people need to be able to afford the stuff that gets that bottom
level of Maslow’s hierarchy taken care of so is it available and affordable can
they you know with insurance deductibles that way the way they are right now I
know a lot of people who have insurance that can’t afford to go to the doctor
because they pay so much in deductibles their deductible is so big that they pay
a hundred percent of the office visit pretty much unless they go to the
hospital so they can’t even afford medical care even though they have
insurance so we want to make look at it and see is this even working do people
have access to affordable healthcare and can they afford nutritious foods a lot
of the cheapest foods are some of the unhealthiest foods but that’s a whole
different soapbox for me to get on for us what can we do we can help patients
make sure that they know about how to access patient assistance programs for
medications we can educate patients about the effectiveness of medications
in treating their disorder help them make educated decisions we can
educate them about the effects of different addictive behaviors and help
them see the difference between a social or recreational use and an addiction
which is when it starts causing clinically significant problems and they
continue to do it anyway cultural systems you know this is you know really
looking at the big macro concepts or meta concepts the acceptability of media
portrayals we spent a lot of time watching videos and you know YouTube
videos and even our social media is filled with comments and little video
snippets and stuff from the media itself whether it’s the news or popular culture
so what does our culture say about the use of potentially addictive behaviors
for example liquor advertising expenditures rose more than six hundred
and twenty percent between 1995 and 1997 so in two years it it went up more than
six hundred and twenty percent creating an environment that suggests that
alcohol consumption and overconsumption are normal you know I watch a lot of
these shows still and I see people you know they have a liquor in their in
their desk drawer at the office and they’re pouring themselves a drink
before they go home or at the end of the day and I’m thinking how are you not DUI
but but that’s just me and the way my mind works but it does communicate that
going out for a drink after work is pretty normal so how do people how do we
perceive some of these behaviors and what is the media tell us about it is it
you know really scary or is it something everybody’s doing portrayal of people
with mood disorders is unstable and this drives me crazy because the majority of
violent crimes are not committed by people who are you know actively in
health episode you know people who are depressed are not violent people who
have anxiety are not violent even the majority of people with schizophrenia
especially if they’re taking their medication are not violent
so the portrayal of people with mood disorders is really important to looking
at do people seek help when they start having symptoms of problems and help
seeking for mood disorders do we have celebrities that are coming out and
seeking help and going yeah I had a problem feeling better now there were
those little bleeps that came on I think it was CBS yea CBS cares where they
would have celebrities come on who were struggling with depression or anxiety or
something and say you know what I had this I got treatment I’m feeling better
now and I think that went a long way to helping people see that I’m not the only
one and it’s okay to have this it doesn’t mean that there’s anything wrong
with me and media portrayals of people seeking help have actually improved you
know think back to one Flew Over the Cuckoo’s Nest and some of those
old-fashioned movies from the 50s or whatever and think about things today I
don’t know if you’ve ever watched the show monk it was about a police
detective who had obsessive-compulsive disorder but he went to see his
therapist all the time almost unhealthful II so but that’s a whole
different issue the movie 28 days that came out way back in the 90s that sort
of popularized or normalized I guess addiction treatment so it wasn’t so
scary to people so if the media portrays it portrays seeking help as okay if the
media portrays people who have mental health issues as you know just fine then
it’ll encourage more people to come come out to seek help and to kind of be real
and genuine culturally method culturally modeled methods of coping such as using
substances in acting violently to conflict or prayer you know obviously
different ends of the spectrum also affect mental health and how people
are reacting to what’s going on in life how are they coping with it are they
avoiding it are they lashing out or are they trying
to do something you know through prayer with their higher power we also want to
look at stressors in the culture that promote anger anxiety and depression
there’s always been stressors but there are times you can look over the past 200
years where there have been fewer stressors or different stressors so we
want to take a look at what stressors are promoting dysphoria for lack of a
better global term and what can we as clinicians do to help people have an
arsenal to defend against those stressors and deal with those stressors
when they come and then there’s also always an element of people who reject
or are non conforming to the dominant culture if the dominant culture is very
segregated if you will and somebody doesn’t adhere to the dominant cultures
values and ideals then that can promote depression anxiety a whole host of other
problems so it’s important to look when we’re working with clients to examine
what does the dominant culture say about you’re who you are how you feel your
lifestyle choices whatever it is and how is that impacting you and what can we do
as clinicians advocate educate and advocate other cultural influences that
may contribute to the development of depression and anxiety social media and
just never being offline always being connected is exhausting our brains were
not designed for that so it’s important to pay attention to are you getting
emails at 7 8 9 o’clock at night are you on social media engaging with people
when back back in the day before the internet you would have been relaxing
hanging with family petting your dog whatever there’s a lot more uptime and a
lot less downtime in current modern culture social media disinhibition kind
of goes along with that when people are on social media whether it’s an email or
text messages or Facebook they tend to say things or they are more likely to
say things that they wouldn’t say to another person’s face because there’s
that distance so people tend to be a lot nastier on social media or a lot more
argumentative you know we have people who just go around and flame other
people’s posts which causes anxiety and angst and depression among the consumers
of those posts you know and we see this in internet bullying cyber bullying but
we also see it in even in our media where people tend to be a lot snippy ER
with each other when there’s not actually an interview going on when
they’re talking about somebody they tend to be a lot more disinhibited than they
would be if that person was sitting in the studio with them parents are
emotionally or physically unavailable a lot of parents are working two jobs now
there’s a lot of stuff going on even if you’re not working if both parents are
working just even one job and junior has football practice and you know somebody
else has martial arts practice or something you may be running six ways
till Sunday and kind of pass each other in the night and this can create
problems because the parents are less engaged with the children less able to
promote coping skills and and help with the developmental process during the
teen years which are so formative and fewer outlets for extracurricular
activities can also be a cultural influence some places have
transportation barriers so you can’t get to and a lot of small towns you know
there’s not a lot to do in that small town and unless you can get
transportation to the next big town you know that you can feel bored you can
feel depressed you can feel isolated age barriers even when we’re talking about
volunteering and maybe getting part-time jobs legally it’s hard for a lot of
youth under the age of 16 to get even get volunteer positions because there’s
so much regulation on it a lot of places at least around here won’t even touch
anybody under the age of 16 and just a simple lack of opportunities what is in
your community that where you can volunteer where you can get involved
where you can engage and I think meetup meetup calm I think it is has done a
good job with providing some some types of outlets for people so they can see
more things that are going on in their community Facebook to a certain extent
helps people connect it doesn’t seem to do that much around here but it may in
some areas there are I think as volunteer org is the website where it
has they have a lot of everybody puts their volunteer opportunities not
everybody but a lot of people do so people can find places to volunteer and
get involved so they have that connection they’re not feeling isolated
and they can feel a sense of accomplishment and purpose in their
community which helps buffer against stress and anxiety there’s a long
history of substance abuse and mood disorders in the u.s. patterns of
problem development are influenced not only by the individual but also by
social environments in which that individual exists their friends
co-workers and family we want to fit in we want to get along community norms you
know what does your community say is okay and you can even look within your
city and there are going to be communities are places where drug use is
common and there are going to be places where you don’t even let your dog go to
the bathroom and the in the grass without picking it up you know they’re
just completely different cultural norms in different places in the community
so we need to look at the person’s community norms and not just look at it
as a city or as a town but as their neighborhood economics influence I mean
when people are impoverished when they don’t know where their next meal is
coming from when they don’t know how they’re going to pay the rent it’s a lot
of stress it can contribute to anxiety and depression if they can’t access
medical care so we want to look at a lot of this stuff is since it’s the exo
system we have less ability to affect it so much but we can’t advocate and we
can’t provide people tools to buffer against some of these influences and
politics you know politics and you know what laws are currently in place and
what’s getting attention by the government is going to play a role in
you know which squeaky wheel gets the grease well we can’t directly control
politics economics or culture we could provide people with resources to respond
to negative influences by helping them bolster their self-esteem improve their
coping skills develop strong interpersonal effectiveness skills have
good problem-solving skills and have a sense of self efficacy if I do something
positive things are going to happen so just before we go beginning in the 1980s
mute media portrayals of the miracles of pain management with opiates combined
with Jake O’s 2001 mandate that pain be assessed and pain management made a
priority contributed to the development of the current opiate problem so that’s
an important point to remember cocaine has come and gone and calm again and it
would really regain popularity in the 70s and 80s when it was glamorized by
the media as non addictive so we got a lot of bad information so another thing
as clinicians we can do is help people make sure they know how to research
stuff to figure out what’s accurate initiation from the medical community to
treat something often leads to more people being treated and a greater
availability for divert back to that you know pain management
now we’re assessing pain just as much as we assess vital signs when substances
are outlawed use can be diminished but it is rarely eliminated and even if it
is diminished it’s going to be replaced by something else we’ve seen that over
and over and over again so the take-home message there is really looking at why
are people using what is the underlying cause or benefit of use and how can we
help them achieve that which I mean after you went through these slides you
see there’s a lot of stuff that that’s out there that can contribute to
depression anxiety and addiction that we need to see if we can do a better job of
giving the people tools giving people tools to deal with life on life’s terms
as life is at the moment okay are there any questions okay well I will see you all hopefully
tomorrow have a wonderful afternoon if you enjoy
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