This presentation emphasizes the critical need for addiction counselors to recognize and adapt treatment approaches for diverse client populations, acknowledging that factors like age, gender, sexual orientation, co-occurring disorders, trauma, criminal justice involvement, and physical/cognitive disabilities significantly influence substance use, treatment response, and recovery.
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welcome to the addiction counselor exam review this presentation is part of the addiction
counselor certification training go to http /allceus.com/ certificate - tracks to learn more
about our specialty certificates starting at 149 dollars welcome everybody to today's presentation
of the addiction counselor exam review this is episode 20 today we're going to be talking
about working with specific populations and oh my gosh there are so many specific populations
that we can choose from and I can't possibly cover them all in an hour that we're going
to be talking today but we're gonna hit some of the highlights that are really identified in the
addiction counselor exam review guide that you can get from your state board or from IC NRC
so we're gonna look at some specific population considerations we need to recognize the aspects
of the clients identity may influence the clients substance using behavior their responsiveness to
treatment and the recovery process so if clients our are from a different race or
ethnicity or have cognitive difficulties that's going to influence their process we're also going
to find out later in this presentation that gender also has a significant impact on the
types of treatment that are effective how drugs affect the body etc so factors we're going to
talk about a little bit today include race and ethnicity but we're also going to talk
about age sexual orientation and the presence of co-occurring disorders including trauma it
is really important to recognize that from a trauma-informed perspective the expectation is
that most people have experienced trauma at some point in their lives which is currently probably
still impacting them so a trauma-informed approach is almost always a safe approach to use and it's
kind of better to be safe than sorry I would rather use a trauma-informed approach then you
know not use one and find out that I accidentally retraumatization placing a person and a in an
established treatment slot we're learning the importance of modifying and adapting services to
meet individual client needs and you know where I used to work it was a residential treatment
facility and we had different programs we had one for mothers and babies one for veterans one for
adolescent boys and one that was co-educational so those were all residential facility programs
and they all had different how shall I say approaches that were tailored to sort of meet
the needs of that particular population but just because somebody is in a population doesn't mean
that treatment for that population is actually appropriate for that person because all of us
have multiple specific considerations you know I may be a woman obviously and so that's going
to potentially impact my drug use history and things that are effective with me but if I'm also
a pregnant woman then that adds on a whole nother layer that we need to consider Samsa has produced
multiple publications called tips or treatment improvement protocol that adult in depth with
the treatment needs and recommended practices for specific types of disorders and populations
so I really recommend you go there and there's a link at the end of the presentation where you
can go and review these tips and download them for free as PDFs most of them right now are not
available for ordering as as hardcopy anymore but you can at least still get them as as PDFs
substance abuse treatment programs typically report fifty to seventy-five percent of our
clients have co-occurring disorders this is not a surprise when somebody is in early recovery
they're probably going to experience depression or anxiety and then that doesn't even count
for the people who have bipolar disorder or schizophrenia or something else whether the
person had their mental health disorder before they came into treatment or it developed during
the course of their addiction or during the course of their early recovery doesn't really matter we
have to address it it's going to be really hard for somebody to stay clean and sober if they're
anxious or depressed or you know having mood swings all over the place or in a florid psychotic
episode so we need to make sure to treat these things medical settings site proportions of 20
to 50 percent of their clients have co-occurring disorders so even in the hospital or in primary
care doctors are saying you know what yeah twenty to fifty percent of the people who
come in here not specialized addiction treatment just general medical have addictions in addition
to mental health and potentially physical health issues so co-occurring disorders dueled sorters
there's been a lot of terms out there now we call them co-occurring because dual implies two and
many times there are more than two diagnoses the persons dealing with so we use the term
co-occurring it means that multiple disorders are occurring at the same time co-occurring disorders
refers to co-occurring substance use and mental disorders so we're looking you know at the range
of mental health issues if they've got anxiety PTSD depression and addiction okay well that's
four disorders that you're looking at trying to treat they also you know people also have other
physical disorders that may be going on like hepatitis or HIV or or some of that stuff and
we want to make sure that we're encompassing that in the treatment plan but when we're when
we talk about a co-occurring capable treatment program we're talking about a treatment program
that addresses mental health and addiction a diagnosis of a co-occurring disorder occurs
when at least one disorder of each type can be established independent of the other what does
that mean that means if the person is experiencing depression right now we can diagnose the the issue
as independent from the substance use it's not a side effect of withdrawal from the substance
it's not a side effect of intoxication from the substance it's actually something else over here
entirely so that's when we have co-occurring issues so we want to rule out any depressive
or anxiety symptoms or mood symptoms that are the result of intoxication or withdrawal review Samsa
tip 42 for more information on co-occurring disorders and you know I'm getting ready
to do a nine part series on Samsa tip 42 so stay tuned for that if you know co-occurring
disorders is something that you feel like you're weakened in preparing for your exam
okay one special population that is near and dear to my heart is the criminal justice population I
worked with in this was my first job out of college and a lot of times people who are in
the criminal justice system have addictions you know that's not a surprise but a lot of
times they have addictions that have never been treated either because they haven't sought help
for them or because they couldn't afford it or you know there's a whole myriad of reasons
but now they're in the system and one thing that can be good if you want to put it that way about
people who are in the criminal justice system is they have access to services and service providers
often have teeth if you want to put it that way to encourage people to participate in treatment
we can offer them reduce you know if you work with the courts a lot of times the courts will
offer them reduced sentences for participating in treatment they can get they may have to go
through treatment to get off probation so there's a lot of different ways we can use contingencies
when people are involved in the criminal justice system for many people in need of substance abuse
treatment contact with the criminal justice system is the first acknowledgment of a need
for treatment or an opportunity to receive services long-standing patterns of poor coping
skills criminal values and beliefs which we call criminogenic thinking in other courses that we do
on working with the criminal justice population often a lack of education and minimal job skills
may require an intensive treatment approach particularly among offenders with a prolonged
history of substance abuse and crime when you're working with criminal justice offenders you have
your offenders who have you know one DUI that's generally not who we're talking about here a lot
of times when you're working with people in the criminal justice system especially people who
have a long history of incarceration they have become institutionalized they have adopted the
values and the beliefs if you will of a criminal justice setting those criminal genic values that
are contrary to recovery many times they may not have the skills or tools or not know how
to survive in the outside world because they've spent so much of their adolescence and adulthood
incarcerated that you know that's normal for them they feel safe there so these are things
that we may need to look at addressing we can't assume that you know every person who comes out
of jail has the skills tools and abilities to function like you or I do because they've had
very different experiences and and remember that's not for everybody in the criminal justice system
but that applies especially true for people who have been in jail or or prison for a significant
period of their life addiction professionals must be able to communicate effectively with judges who
you know sometimes you'll have a sympathetic judge sometimes you'll have a real hard-nosed
but you need to be able to hear the judges point of view and effectively communicate to them what
you think this person needs and what programs are available to help them get it because we
don't want the judge thinking oh we're just trying to get this person you know a lighter sentence or
exempt from charges or something no that's not what we're trying to do but for example we had a
program that was called no wrong door where people who were incarcerated were released early on what
was called extended limits of confinement up to six months before their term ended they stayed
at our residential facility and they went through treatment we also had other programs
where offenders would get out or a month before they get out they would be on extended limits
of confinement in our co-ed program the benefit to that was we were able to help them ease that
transition you know they have a lot of clean time theoretically under their belt but they probably
hadn't built up the skills and tools and they certainly hadn't started addressing the criminal
genic thinking while incarcerated we're able to start changing some of the thought patterns and
behaviors when they got out sometimes judges would want to sentence somebody to treatment
at the beginning of their sentence and we would have to help the judge understand that that's
counterproductive because if they go in at the beginning we're gonna help this person make these
wonderful changes but they're not sustainable in a prison or jail environment so it's really really
important that we're able to get this person at the end of their sentence we need to be able to
communicate with probation officers if you've got clients who are on probation and they suddenly
test positive once you know yes the probation officer may have to put in a violation order but
we do need to communicate we need to be able to communicate with probation officers what clients
are going through most of the probation officers I worked with were really empathetic you know they
didn't want to have to violate somebody because you know that was a lot of work for them and a lot
of paperwork and it's just not what they got in it for you know that wasn't their goal in life so we
were able to work with the probation officers to say what is it this person needs in order to stay
clean and sober and get off probation successfully how can we work together so we can facilitate this
process probation officers were generally more than happy to accommodate whether that meant doing
more home visits and urine screens or whatever it was I never had a probation officer you know get
all bristly and go no you know if he can't do it then tuft Italy winks you know they were really
compassionate people in many cases and we also need to be able to communicate with other criminal
justice system personnel who are functioning as part of the community treatment team this means
law enforcement officers help them understand and identify early signs of addictive behaviors
help them you know provide early intervention and referrals when they go out on these calls
and there's obviously a substance abuse problem help officers have resources to hand out spend
30 minutes doing case management I'm not saying that but we can help them be aware of resources
and have a handout for people to make sure we're trying to get people early intervention services
before they actually do something that puts him in jail or lands them in the hospital or
something else leaders in both criminal justice and treatment systems need to develop shared goals
and clearer systems of care for addicted offenders both while they're incarcerated and after their
release with the big problem with opiates right now and this was a big issue back in the day when
I was working with it at the clinic because we would have people in our methadone clinic who
would get arrested and as soon as they would get arrested the Sheriff's Office or who ran the jail
at that point would discontinue their methadone and they would go through a hardcore detox and
it was it was pretty awful and then they would send them out you know after their time was up
and they would be not stabilized on any sort of psychotropic or medication assisted therapy when
they got out which set them up for relapse so it was important that we had shared goals what do we
want to do I mean ideally we need cost containment you know I get that but we also need to make sure
that we're providing the services these people need in order to not recidivate you know we want
to make sure they get out and hopefully don't come back another special population that we will work
with a lot are people with HIV and AIDS HIV is most efficiently transmitted through the exposure
of contaminated blood like sharing needles and you know certain sexual practices injection drug
users represent the largest HIV infected substance abusing population in the u.s. sexual contact like
I said is another route of HIV transmission but substance use treatment can play an important role
in helping individuals reduce risk-taking behavior so let's think about it when somebody is in active
addiction if they're using needles if they're sharing needles that's a risk so if they're
not using if we're providing treatment then we're keeping them from exposing themselves to potential
needle transmission additionally when people are an active addiction they may engage in other
behaviors in order to get the drugs they need or they may engage in other behaviors while they're
under the influence that put them at high risk for HIV and AIDS so again substance use treatment
keeps them from being in those situations so it's preventative HIV and AIDS substance use disorders
and mental disorders interact in a complex fashion each acting is a potential catalyst or obstacle
in the treatment of the other two so let's talk about catalysts first HIV and AIDS as it
progresses can contribute to HIV related dementia which is a mental health disorder people who are
experiencing grief loss dementia associated with HIV may tend to self-medicate more with
substances so they can catalyze themselves people who are abusing substances are putting a drain a
significant drain on their immune system which is going to speed up the rate that the HIV infection
progresses the same thing with mental disorders a lot of times when people have significant mental
health issues they're not taking good care of themself and they may even self-medicate with
substances but even if they're not if they're not taking good care of themselves because of their
depression or their anxiety again that stress as well as well as poor health habits are going to
speed up the rate of the HIV infection so they can catalyze each other this way and when people are
on HIV and AIDS medication they often don't feel well which can contribute to a sense of depression
and anxiety now they can also act as obstacles and how is that some treatment programs are not
set up to handle certain mental health issues they're only set up to handle substance use some
mental health programs are not set up to handle substance use issues so if somebody has both which
we already learned is sort of the expectation then they're going to have a harder time finding
a an appropriate placement and if they're HIV or AIDS condition is advanced enough where they're
requiring significant medical care that also may block them from access to certain treatment
because a lot of residential level 3 facilities just don't have the medical staff to be equipped
to handle that when you're working with people who have HIV or AIDS treatment goals include
living sips met living substance free let's take away that stressor on the immune system let's
take away that those risk factors for spreading HIV or getting something else that's going to
contribute to HIV progression let's slow or halt the progression of the disease by ensuring the
person has access to their inche antiretroviral medications and let's reduce risk-taking behavior
so again they are not spreading it and they're not contracting something else that could catalyze the
disease treating HIV and AIDS is extremely complex and that I mean we have courses on that at all
CEUs com we're not going into that right now but it's important to recognize that individuals with
substance use disorders whether or not they're HIV infected are subject to higher rates of
mental disorders than the rest of the population so we have somebody with a substance use disorder
we know that is likely they also have another mental health issue and they are at a higher
risk of having HIV infection so counseling is an important part of treatment and I mean medical
science has come so far and we're able to do so much in terms of prevention and taking care of
the disease and slowing the progression of HIV that as counseling is becoming even more import
to provide hope for people who are diagnosed that they can live a pretty normal life and they're not
doomed to you know two or three years you know it could be twenty or thirty years that they
live with this disease risk reduction allows for a comprehensive approach to HIV and AIDS prevention
which promotes changing the substance-related and other such behaviors so we do want to engage in
Risk Reduction if we're working with people who have substance use disorders we want to ideally
you know have avenues where they can engage in harm reduction practices such as clean needle
programs so we're not promoting the issue I mean do we want to just hand out needles so
people can inject well no but I would rather them if they're going to inject if they're determined
they're going to inject I would rather them inject with a clean needle and not also contract AIDS
then inject with a dirty needle and then have an opiate disorder as well as HIV or ACE that is the
harm reduction philosophy not everybody embraces it but it is a major part of risk reduction we
also want to encourage risk reduction in terms of making sure condoms and other things are
available for people who may engage in higher risk behaviors such as use treatment programs
can help reduce the spread of other blood-borne infections including hepatitis B and C viruses
you know all these blood-borne pathogens kind of start building on each other so you know when
we're providing substance use treatment we're also preventing the contraction and spread of hepatitis
counselors need to be familiar with federal and state laws protecting information about clients
substance use treatment as well as their HIV and AIDS related information one thing that you'll
find when you're going through the medical record is the HIV AIDS information is kept in a set
place from the assessment information because that is highly protected personal health information
your assessment is going to be in another section and your progress notes are going to be in yet
another section because when there is a subpoena for the records the HIV and medical information
as well as the progress notes are generally not covered unless the attorney or the judge puts
that in the order and CFR 42 part 2 talks a lot about special requirements for confidentiality
another thing to realize before I move on to this next slide in some states it is a felony to notify
even if you have an identical identifiable person with whom the HIV infected client is
engaging in high-risk behaviors even if you know that they're you know having unprotected sex
with their significant other or somebody and you have an identifiable victim in many states it's a
felony to notify that person so you need to check with your attorneys as well as you know stay up
to date on changes in state law about what you're allowed to report and who you have to report any
HIV infection to alright so physical and cognitive disabilities this is our next special population
now remember I said people with HIV can develop HIV related dementia so they may have cognitive
difficulties you can have a female who is pregnant with HIV and HIV related dementia that you're
treating so she's like for different special populations all wrapped into one and I point that
out to help you understand the different layers that make it imperative that we individualize
treatment and not just say okay this is a female program or this is a pregnant program or whatever
okay so physical and cognitive disabilities people with physical and cognitive disabilities are more
likely to have a substance use disorder and less likely to get effective treatment we're going to
talk about why that is in just a minute 20% of persons with disabilities have a substance use
disorder these individuals are less likely to compete complete treatment because their
physical attitudinal or communication barriers limit their treatment options or render their
treatment experience unsatisfactory okay so let's talk about examples I worked with one
client who had a tic disorder and when he would get stressed his tics would get really bad when
he was in group his he was stressed so his tics were always really bad and he couldn't
participate in group I had another client who was minimally literate so any of the activities that
we participated in that involved a lot of reading you know he couldn't do without assistance and he
didn't want to ask for assistance so we needed to be able to modify treatment to meet his needs
people who have dementia cognitive issues some physical issues or who are who are younger may
not be able to sustain attention for the hour that group is going on people who just came
out of detox are not going to be able to sustain attention for the hour that group goes on so we
do need to be aware of specific issues related to people's physical and cognitive state the
Americans with Disabilities Act states that both public and private facilities must be equally
accessible so if you're running a facility or you're live working in a facility you're going
to work with people with disabilities and you need to be able to make reasonable accommodations
it's up to you working with your legal team and your directors to identify what is considered
a reasonable accommodation but interpreters definitely are you know certain structural
Asians definitely are certain modifications to the treatment program definitely are so you
really want to ask what does this patient need in terms of treatment what prevents him or her
from you know being able to plug in to our program as is and how can we make modifications that make
the most sense to make sure that he or she gets his needs met in our program and a lot of times
it's really not brain surgery it's not that hard for my client who is minimally literate instead of
having him write his autobiography which wasn't going to happen he recorded it on a cassette
tape recorder and then we transcribed it later so there are options barriers to communication
must be removed and discriminative policies and practices eliminated we need to look at these
things and really get input from the community if we need it if we can't see the forest for the
trees because it's our program bring people in who have disabilities and say what would be hard here
accommodating people with coexisting disabilities and treatment for substance use disorders includes
things such as adjusting counseling schedules if people are on heavy-duty medication they may not
be able to get up at 7:00 in the morning to be in group or they may need to take breaks
throughout the day because the medication they're on is very very sedating especially like atypical
antipsychotics and those sorts of things provide interpreters for people who are either deaf or
hard of hearing who are blind or who speak a different language suspend the no medication
rules some treatment centers are not okay with certain medications in ours it was opiates and
benzos however when we started the program with the veterans and they were being seen medically
by the VA we had to suspend that rule for that population and really look at our policies
because many of them were on benzodiazepines and opiate based pain medications and we need
to overcome people's fears and ignorant help them understand you know what's going on if you've got
somebody with Tourette's if you've got somebody with a tic disorder if you've got somebody with
dementia educate if it's a residential facility you may need to educate the other house members
about you know how they can help that particular client definitely need to educate the staff about
what that client will need in terms of additional supports but we want to overcome their ignorance
about what causes it if it's contagious you know anything that could bring stigma to that
person people with disabilities are more likely to use substances in part because they experience
unemployment lack of recreational options social isolation homelessness victimization and abuse
more frequently than the general population I have to say it again and and I will repeatedly say this
when you're talking about any group of people whether it's race ethnicity age gender whatever
there is nothing that applies to everybody in that group but the research has found that some people
with disabilities are more likely to experience these things especially if they have significant
disabilities or severe and persistent mental mental illness like schizophrenia so we need
to be aware of these issues because it's going to affect their treatment program if they are
socially isolated then you know do they have social anxiety or do they are they not able
to integrate or do they not want to integrate with the programs that are available if they
are homeless why are they homeless some people choose to be homeless some people are homeless
because of their mental illness or because of job loss or financial reasons or or whatever but
there is a subset of people who are homeless who are not mentally ill and they choose to
live on the street they don't want to have the responsibilities and weights of you know home
ownership and all that other stuff so we do need to be sensitive to why a person is experiencing
these things and if they need help with them then obviously we need to provide linkages to
help them people who are deaf and identify with deaf culture will usually prefer specialized
treatment programs people with intellectual disabilities may find it easier to understand
and participate in discussions with others with similar disabilities and may be more inclined to
ask questions people with dementia for example or people who are cognitively impaired in some way
may need group to go a little bit more slowly they may need a little bit more time for processing and
they may feel more comfortable opening up in a room full of peers who are you know processing
at the same rate so they don't feel like they're holding up the group or they don't sense a result
other disability conditions that may warrant some standalone services include traumatic brain
injury spinal cord injury or severe or multiple disabilities alright I brought up women multiple
times gender differences play a role in drug selection drug use and treatment patterns the
research is indicated that women and men tend to abuse different drugs and the effects of drugs
are different for women and men women often use significantly more prescription drugs than men
and are more vulnerable to certain drugs another issue and partly because of our body composition
and how it differs from men women advance more rapidly from initial use to regular use to the
first treatment episode and we had experienced an effect called telescoping you probably need
to know that for your tests telescoping is when we progress faster than men from initial use to
alcohol and drug related consequences because the same amount of alcohol that a woman drinks if a
man drink we can drink the same amount of alcohol but it will hit women harder or be more powerful
in the female body partly because we have more body fat and less muscle and they have more muscle
but there's a lot of reasons for it women are more likely than men to have co-occurring substance use
and mental health disorders including anxiety and major depression and women's substance use
problems are more stigmatized and less likely to be acknowledged than men's so let's think about
that we've got women who may have may be pregnant or may have children what does society say if they
are in active addiction while they have children or their pregnant Society can be very very
judgmental so it's important to understand that a lot of women may not acknowledge their problem or
may not seek help for a variety of stigma and fear related factors so issues impacting women
shame and stigma you know some women it's not even this from the community but it's personal
shame at being addicted physical and sexual abuse can keep them from seeking help if they have been
abused they may feel like they're broken already they may feel unworthy or they may be afraid that
to confront the traumas and they would prefer to stay numb for a while relationship issues
including fear of losing children fear of losing a partner or needing a partner's permission to
obtain treatment some cultures are very family centric where an individual doesn't make a big
decision like this on their own they need their partner or their family's permission
treatment issues include a lack of services for women especially specialized services there's a
lot of co-ed services but there's not a lot of in unique services for women there's not a lot
of unique meetings support meetings just for women although there are more now than there
used to be there are often long waiting lists and lack of childcare services so since women
are often the primary caregiver for children if you do an assessment on a woman and it turns out
that you know she would benefit from either IOP PHP or residential one of the factors that may
come up is what am I going to do with my kids I don't have anywhere for my kids to be if I'm
in treatment from 6:00 p.m. to 10:00 p.m. or if I'm residential one thing that you can do as a
treatment center is look at when school starts and you know generally school starts somewhere
between 7 and 9 a.m. depending on the grade level and have your IOP program start 30 minutes after
that that way the parents the mom can drop the child off at school if they need to or
get get them on the bus and then get to treatment participate in treatment while the child is in
school and then be home in the evenings systemic issues include lack of financial resources lack
of clean and sober housing lack of pregnancy and postpartum services poorly coordinated services so
I mean women have a lot of issues especially if they've got children to care for so it's
important to look at you know again what are the obstacles that are keeping any particular woman
from seeking treatment and how can we facilitate that three primary types of services exist for
women there's clinical treatment the IOP php' residential there's clinical support so that's
more once a week counseling and case management and then there's community support which includes
everything from child care and transportation to housing services family strengthening recovery
support services employment services vocational and academic services now we've started to
call this a recovery-oriented system of care those community support services are all those
ancillary or wraparound services that support the clinical progression so it's important to
identify what does this person need to engage in treatment succeed in treatment and stay in
recovery development of substance use disorders is often viewed as a disconnection for women
and I don't like this term but evidently you need to know it treatment stresses
the development and repair of connections to others oneself one's beliefs and one's culture
okay so connections to others and I'm not gonna tell people who they need to be connected to I
want them to tell me who's their family who do you want to be connected with because we all
need social support but that social support may be different in recovery than it was an
active addiction I do want them to reconnect with themself and figure out what they need and start
learning to like themselves I do want them to get in touch with their beliefs and figure out
what's important to me and what do I stand for and where do I stand on issues and then when
it comes to culture I mean people are generally have multiple cultures that they affiliate with
but it's important for the woman to identify you know what parts of called that culture of
each culture that she embraces pregnant women substance use often creates or is accompanied
by an array of social problems including violence child abuse neglect and family
dysfunction so if you're working with a pregnant woman who is also abusing substances we do need
to be aware of the fact that there's a higher rate of family violence abuse and neglect and
family dysfunction five point four about five and a half percent of babies are born to illicit drug
users substance abuse during pregnancy increases the risk of problems for both the mother and the
fetus alcohol use during pregnancy can be really detrimental to the fetus and cause fetal alcohol
spectrum disorders but other substances can also be detrimental to the fetus Samsa just
put out an entire publication on working with pregnant substance abusing women the March of
Dimes website has detailed information about risks by the drug used so you can you know get
a real quick overview pregnancy creates a window of opportunity to enter treatment become abstinent
quit smoking eliminate risk-taking behaviors and lead a healthier life if the woman is motivated to
do so not everybody finds out they're pregnant and is like overjoyed and says okay I need to
stop doing everything um you know we need to get empathize with the woman and understand where she
is at in terms of you know what does it mean if she becomes abstinent what does it mean if
she starts leading a healthier life you know she may be living on the street you know living with
her pimp and has nowhere to go doesn't have any family resources you know the idea of you know
I'm pregnant now I need to turn my life around may not even be something she can even conceptualize
how to make it happen so that's important for us to help provide options and if she wants to
embrace those options wonderful but we do need to understand that that's huge for some people
additional specialized treatment needs to include improving nutrition childcare financial support
and identification of and treatment of infectious diseases both in women and their infants another
population that we want to think about our older adults nearly one in five have mental health and
substance abuse conditions that's sad depressive disorders and dementia related behavioral and
psychiatric symptoms are the most prevalent but substance use is a significant problem as well so
you notice I said depressive and dementia related behavioral symptoms and psychiatric symptoms they
may not meet the full criteria for diagnosis of major depressive disorder or dementia but those
symptoms that go along with it may be prevalent and may be prevalent enough to be called to be
a reason for intervention age alters the way people metabolize alcohol and drugs and this
is something that I'm one of my soap boxes that I get on because as people aged it takes their
liver longer to clear some of these drugs so things like benzodiazepines can build up to
toxic levels really quickly opiates can build up to toxic levels really quickly you know not
only does age and I learned about this in a different presentation I was doing but this
city can also alter the metabolism of drugs but since we're talking about older adults
will stay with age right now so it's important to recognize that you know the amount that a 20
year old could drink or use and not experience significant problems may be very different than
the amount that a 70 year old could drink or use issues the trigger symptoms in older adults can
include losses that frequently occur in old age loss of a spouse loss of friends loss of
physical or mental capacities it can get really frustrating I know my stepfather right now just
recently had back surgery he used to play golf every single day and now he has to walk with a
walker and that's devastating to him so there are certain things that we do need to recognize that
happen that older adults may have to grieve and deal with it's important to differentiate between
major depression and grief and the person with significant losses but that's often difficult and
they've removed the bereavement exception in the dsm-5 for diagnosis of major depression so you can
have bereavement and depression at the same time but you treat them a little bit differently you
know obviously the we want to look at what's the underlying issue that is prompting these symptoms
cognitive functional and sensory impairments may complicate detection and diagnosis of
mental health and substance use issues as people get older they may not hear as well so we may
not know if they just didn't hear us or if they didn't understand us we may not know if they are
losing their balance because of sensory issues or because they're intoxicated oh and going back to
metabolism of drugs when people who are older take benzodiazepines they are at a much higher
risk of Falls so you know it's really important to be aware of specific prescribing guidelines
for the geriatric population because not all our adults go to geriatric specialists so you know
you may see something and you no need to refer to your in-house doc to talk to their doctor
whatever adolescence so let's go to the other end of the spectrum the National Institute on
Drug Abuse has recently published a version of the principles of adolescent substance abuse substance
use disorder treatment a research-based guide so you can look at that if you go to the NIDA
website which I'm going to give you in a minute and look at that publication you can learn a lot
about treating adolescents but we want to remember that adolescent brains are still developing up
until about the age of 25 our brains are still developing especially that impulse control area
exposure to neuro chemical changes and health consequences associated with addictive behaviors
appear to cause more significant and long-lasting brain changes for adolescents so everything's
kind of mushy in there if you want to think of it that way that's not actually how it happens
but you know for for lack of a better metaphor so when adolescents expose themselves to addictive
behaviors for example and their brain is flooded with dopamine or they expose themselves and their
brain is flooded with certain drugs it causes more lasting changes so you know think about
cement you know when you have cement it takes a while to set up and if you pour water on after
its set up you know it's gonna get wet but it'll eventually dry out if you pour water in the cement
before it has set up then you're gonna have very weak cement that kind of crumbles and the same
sort of thing can happen with adolescents we may see greater brain damage if you will from
addictive behaviors and you notice I keep saying addictive behaviors and not just substance use
they've found that pornography has a much more intense impact on the adolescent brain than then
on the adult brain so even addictive behaviors like pornography and gambling can be much more
damaging and highly addictive to the adolescent it's important to remember that adolescents are
often in a very tumultuous life stage I mean 1718 they are graduating high school they are
starting to be expected to be adults they're ending their childhood which some of them fight
tooth and nail others embrace wholeheartedly they're starting to develop their identity and
try to figure out who they are and what they want and what they think and a lot of them are leaving
home for the first time so they're having to be responsible and start adulting and this is you
know overwhelming adulting can be overwhelming for adults who've been doing it for 20 years
it's really overwhelming for the adolescent who's doing it for the first time so we do need to be
sensitive to some of the issues that they may be facing when they go off to college for example a
lot of adolescents leave home and go far away to college so they're leaving their entire support
system behind and they're having to make new friends at college which can be exciting but
again it can also be overwhelming other special needs that we didn't talk about we talked a little
bit about trauma-informed care do remember that the expectation is that people have been exposed
to trauma so approaching treatment whether you use cognitive behavioral or humanistic or
experiential or whatever it is but approaching treatment from a trauma-informed perspective
is definitely the best way to go about it so it's important to be aware of trauma-informed
practices and take a hard look at some of the practices that your agency currently uses that
maybe retry Mathai zhing to some people the other special needs issue that we didn't talk about are
non abstaining addictive behaviors shopping for example people can't say well I'm never
gonna shop again I mean you have to grocery shop you have to there are certain types of shopping
you have to do to be independent you people who have eating disorders or who've been on on foods
who have a food addiction if you want to put it that way even though it's not in the DSM there
are addictive properties to eating you can't say I'm never gonna eat again it is just not possible
and well you can say I will never have sex again because there are some people who take a vow of
abstinence most people choose not to do that so sex is another one of those addictive behaviors
that people may present for treatment that they can't completely abstain so it's important to
know how to tailor treatment programs to help people who have issues compulsive behaviors that
they can't completely abstain from just like it's vital to be aware of the special needs
of persons from different races and ethnicities it's also vital to recognize that there are other
factors that require specialized skills gender and age differences themselves produce a range
of special issues that need to be considered in prevention you know prevention preventing a
sixteen-year-old from using substances is going to probably be different than preventing a 46
year old from using substances they have different life issues that going on they're developmentally
different they've got a lot of different issues assessment will be different for different genders
and ages because like I said drugs impact women differently than men drugs impact adolescents
and older adults differently than middle-aged people engagement will be different is you'll
use a different approach when you're engaging and developing rapport with someone who is 65
versus someone who's 15 or 25 treatment setting recommendations are going to be unique based on
gender and age some people will prefer a gender specific treatment program some people you know
a pregnant woman may need to be in a pregnancy and postpartum program we need to consider this
we also need to consider like I brought up earlier that if the person who is often a
woman who has primary caregiving responsibilities is enrolling in treatment she may not be able to
participate in certain programs because of a lack of child care and we need to consider treatment
approaches not every approach is appropriate for every person if they've got cognitive issues then
they may have difficulty reading writing paying attention for an hour straight in group etc so
we do need to look at the approaches that we use and modify those approaches to meet the specific
needs of the individual okay as promised there are more resources if you heard some of this
and you're like oh I need to brush up on that you can go to our YouTube channel at all CEUs
comm slash YouTube and I have videos on there about working with adolescents about working
with older adults about working with pregnant and postpartum women in the perinatal period
as they call it and about cultural competence and Samsa has a wonderful tip on working with
cultural confidence that you can also download from store dot salsa gov and then to download
that publication on adolescents that I told you about from the National Institute of drug abuse
NIDA you go to drug abuse gov slash publications okay thank you for joining me today and I'll see
you next Wednesday for episode 21 elicit all CEUs wish you great success on your exam once
you're certified or licensed please remember to visit all CEUs for all of your continuing
education needs we offer unlimited CEUs for $59 for addiction and mental health counselors social
workers and marriage and family therapists if you're still thinking about becoming an addiction
counselor all CEUs offers the training you need in three formats online multimedia self-study
self-study Plus live webinars or face to face weekend intensives which meet one weekend per
month for 12 months we can even present a training series at your facility just email
support at all CEUs dot-com go to all CEUs comm /a sir that's all CEUs comm /a CER to learn more
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