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. Today’s
presentation of the biopsychosocial impact of addiction on family and
community so you might be asking yourself well how does this apply well
even if your clients are not addicted to something they may be related to someone
who’s addicted to something and they’re definitely living in a community where
people are addicted and so we want to look at the impact on the communities
and how addiction can actually have negative impacts on the community and
create a community that’s more supportive of addictions and mental
health disorders and we’re also going to look at what we can do as clinicians who
may be treating people who are family members of someone with an addiction
so we’ll identify the biological and health consequences of addiction and
mental health issues on the family and community the psychological consequences
of these things on the family and community the social consequences and
then we’re going to talk about interventions so the family really
functions to protect and sustain both the strong and the weak members of the
family to help them deal with stress and pathology the family he doesn’t say well
we’re gonna keep the strong and the weaker on their own or vice-versa
they’re gonna take care of the weak and the strong can fend for themselves the
family really brings everybody into the fold so when there is a family member
that is an identified patient they’re not going to be outcast or ostracized
they’re going to still be part of that family so we need to help the family
figure out how to function or readjust their equilibrium with this new
situation that has presented itself the family serves as a mechanism for family
members to interact with broader social and community groups so it also
influences who you interact with you know my kids especially since they can’t
really drive themselves yet interact with groups and and things that my
husband and I interact with they interact with their their school mates
they interact with people at their where they
martial arts and things but the family really serves as a launchpad and shapes
where their interests may lie and with whom their interests may lie the family
also provides an important point of intervention and this is for you know
anything we’re talking about whether it’s you know diabetes depression or
addiction the family can help support the identified patient in making
positive changes and in doing what they need to do and can encourage them when
their going gets tough the family influences weaker members in harmful
ways due to tension problems and pathology so they’re not ostracizing
anybody everybody is you know brought into this family this equilibrium this
unit and ideally it protects and sustains both the strong and the weak
but if the family unit has a lot of tension and problems and pathology and
from clinical experience we can see how this is true then the weaker members may
tend to start suffering from that they may tend to experience more anxiety and
depression and hopelessness they’re not observing healthy coping skills they’re
not observing effective interpersonal skills so the family can be as I’ve said
many many times the greatest buffer against stress or one of the biggest
sources so we really want to help create a healthy family system to prevent
mental health issues and anyone who doesn’t already have one to buffer
against the effects of an identified patient that might have a presenting
issue and just to help people live the highest quality life possible
so biological effects on the family include stress and stress-related
illnesses and sleep disturbances if you’re worried about a family member
whether they’re going to commit suicide whether they are struggling and you’re
just worried about them whether they are struggling with an addiction any of
these things or even physical health issues but
ancillary any of these things can cause a parent to worry can cause a sibling to
worry so it can increase stress within the family unit which can cause
stress-related illnesses as well as it impairs sleep when people are under
stress they’re not going to sleep as soundly they’re not going to have the
quality sleep they need and we know when quality sleep starts to go away so does
physical health mental health energy all that other stuff if the parent is the
identified patient then you may have issues where the parent fails to attend
to the children’s physical or psychological needs not because they
don’t want to you know a lot of times they just they’re not able to get out of
bed they are not emotionally or mentally present even though they may be
physically present and sometimes they’re not even physically present because
they’re away in treatment or in jail or wherever they’re at so it’s important to
look at how does this impact the children and the family and what can we
do as clinicians and community members to make sure that children are still
getting their needs met to make sure that they have a safety net if their
parent is incapacitated for some reason or another family members are also
exposed to toxic substances this is obviously in the case of substance abuse
cigarette smoke we know that secondhand cigarette smoke secondhand marijuana
smoke can have extremely detrimental effects on the children and on anybody
else in the family but especially children and adolescents who still have
a brain that’s in the formative stages and exposure to drugs having drugs
available in the household can predispose children to experiment to try
it out another effect we see on families is the overuse of sedatives among
parents for relaxation you know if they’re anxious and stressed out
sometimes parents may overuse the benzodiazepines some sort of relaxation
something for relaxation whether it’s alcohol or
prescribed medications or even benadryl to help them relax but we also see and
people don’t like to talk about it but we also do see in parents who are just
kind of at their wit’s end they are at a gas they are not able to attend to their
kids needs in a meaningful way we see these parents may turn to using benadryl
and some other sedative type medications to get their kids to go to sleep just I
can’t deal with you right now you know take a pill go to sleep and you know
I’ll see you when you wake up so we want to make sure that parents have the tools
even if they’re depressed even if they’re anxious even if they are
struggling with addiction that they have the tools to cope with the children and
the family unit and or they have a respite they have somebody they can call
in they have an alternative so we’re not exposing children to unhealthy coping
skills as much as possible psychological effects on the family physical or verbal
abuse can happen when you have someone who has anxiety they can be much more
irritable and snippy and can be sometimes hateful in in their words you
can see some more physical abuse you also see more physical and verbal abuse
when there is especially when there’s alcohol involved in a picture
more so than some of the other drugs but we know that when substances or mood
disorders get into a family and they’re uncontrolled that we can see an increase
in physical and verbal abuse the family’s behavior becomes really erratic
around the identified patient because they’re walking on eggshells they don’t
want to set the person off they don’t want to make the depression worse they
don’t want to make the anxiety worse they don’t want to make the addiction
worse whatever’s going on with that person they want the identified patient
mom dad brother whoever it is to be okay to be there so they start walking on
eggshells to try to keep calm if if it’s a sibling for example when the sibling
relapses or has a episode mood or addictive or otherwise
parents are probably going to experience extreme stress so other siblings may not
feel like they’re getting the attention they need so you can see where there’s a
constant power shifting going on which would motivate people to maintain the
status quo motivate people to walk on eggshells because when the identified
patient has an episode it causes a cascade of negative effects child
neglect can happen and this is like I said even if there’s it’s the parent who
is experiencing the issue may not be able to attend to the child’s needs in
an effective way but even if it’s a sibling who is constantly relapsing or
having you know self-injuring and having to go to the hospital so the parents are
constantly focused on this sibling then other siblings may not get the attention
that they need they may not be able to access some of the resources they need
you know Mom and Dad may be so busy running older sibling to the emergency
room and stuff that they forget to you know stock the refrigerator that doesn’t
happen a lot you see this more with addictions when somebody is completely
consumed with their addiction but sometimes when you’ve got a parent
especially who is clinically depressed and they just can’t get up to go to the
grocery store or something and if children aren’t old enough to say you
know we need to call out for pizza or something you can start to see some
child neglect there may develop an attitude of don’t talk don’t trust don’t
feel in the family and this is again one of those things that’s more prominent in
families with a person with an addiction but sometimes with some with a mental
health issue thought is if we don’t talk about it if
we pretend it’s not there then it’s not going to be as big of a problem we can’t
trust that everything’s gonna be okay from minute to minute which is why we’re
walking on eggshells and we just need to numb up our feelings because this stress
is overwhelming and we can’t keep feeling it all the time and the
resentment and the anger it does no good because we don’t have an outlet for it
so it creates a situation in the family where we have a lot of people with a lot
of pent up feelings a lot of them negative who don’t trust themselves who
don’t trust other people and who don’t feel like they can actually affect any
sort of change so as clinicians as helpers we can start helping people look
at being more genuine and authentic shame and guilt can be present in the
identified patient having shame and guilt about being depressed and not
being able to meet needs about having an addiction and you know making choices
that they later regret or not being able to or not having been present for
people’s graduations or ballgames or whatever but shame and guilt can also be
present in the non-identified patient so the other family members who think what
did I do to bring this on how could I have prevented it what did I miss
and being ashamed of having a parent or a sibling maybe of who’s experiencing an
addiction or a mental health issue these are things we can do stigmatize so we
need to get in there and say you know what for the PERT for the identified
patient we can work with this shame and guilt that’s energy tied up in the past
you can’t change it how can you you know make amends move on from here not do it
again whatever the case is for the non-identified patient for the rest of
the family members who may be experiencing shame and guilt we want to
make sure to educate about how common these issues are to be stigmatize it and
to address any guilt issues and help them understand that you know whatever
is going on with that person going on with that person and it’s not
your fault depression can also be very prevalent among the non identified
patient if the patient has depression or anxiety or the rest of the family
members members may feel exhausted may feel resentful may feel anxious because
of this person’s current issues and they may get exhausted I mean it’s really
tiring sometimes when you have someone who is in an acute episode taking care
of them and worrying about them for you know days or weeks on end so we started
to see caregiving burnout we start to see parents who are at their wit’s end
and you know they want to help junior feel better and they just don’t know how
and they feel like they’ve done everything and nothing’s working and
they feel like they’re spinning their wheels we want to make sure that parents
have and ever anybody who’s involved in care caregiving for someone with a
mental health or addictive issue that they have outlets that they have other
resources that they have support preferably from other people who are
also caregivers who get it sometimes will seem role-reversal where the parent
is the identified patient and they can’t take care of themselves or the family so
the child steps up and you know I’ve seen this in clinical depression I’ve
seen it in addiction where the parent just can’t do it and even in anxiety
I’ve seen children calming their parents and going it’s okay you know I’ll take
care of it mom it’s important to make sure that the boundaries and the roles
are clear in the family so help the child regain that role of the child and
help the parent regain the role of parent and so they both understand what
their roles are and how to accomplish them children could lack a sense of
well-being and safety if their parent is regularly unpredictable about whether
they’re going to be emotionally or physically present which creates a lot
of anxiety even in older children who have object permanence
that if they don’t know whether mom’s gonna remember to pick them up from
school if they don’t know whether mom’s gonna have a good day or a bad day or
dad or whomever it can create a lot of angst within them and children in
families with a parent with a mental health or substance use disorder often
see in appropriate coping models or no coping models the parent is just kind of
incapacitated so they don’t learn how to cope with life on life’s terms socially
a lot of times regardless of the diagnosis the family tries to put on
this facade for everybody else nobody else’s business or you know I don’t need
everybody else’s intervention or whatever for whatever reason they put on
this facade like everything’s fine how are things going fine you know they may
not say great glorious wonderful and make up a lie but they’re not going to
reach out to other people and go we’re really struggling right now part of that
is maybe because the shame and part of it may just be from exhaustion from
caregiving for an impaired member so people even if they’re not ashamed of
what’s going on they may stop going to support group meetings they may not go
to their normal activities because they’re just so tired and if those
activities provided a good buffer a good stress buffer for them then they lose
that on top of you know not getting a recreational respite or whatever so it’s
really important that we emphasize to people that they are no good to the
identified patient if they are not able to function they need to take care of
themselves or they are no good to anybody else families can experience
financial problems due to lost employment and/or overspending lost
employment can happen because of mental health issues you know being on long
term disability losing your job because you
into many days sick being having poor work productivity and we’re going to
talk about presenteeism when we get down to the community impacts and these
financial problems cause stress within the family it can cause homelessness it
can cause all kinds of other reciprocal problems when you don’t have enough
money to meet your basic needs so we want to look at how can we help people
sometimes referring them to financial counsellors making sure they know about
social services that are available if they have too many financial problems
they may lose their health insurance you know if they have children then they can
probably qualify for Medicaid but we want to make sure that they can access
all of those things on the bottom tier of Maslow’s hierarchy overspending is
more in the case of addiction people shopping buying drugs
spending money on things to make themselves feel better can also cause
financial problems other family social effects childhood trauma depression and
anxiety you see the kids in the family start to struggle and children start are
having poor relationships with adults if the identified patient is an adult is
a parental unit then they start not trusting other adults they start you
know don’t talk don’t trust don’t feel you know it’s not safe to go to your
homeroom teacher and go you know what mom needs really need some help and a
lot of kids wouldn’t do that anyway they wouldn’t go to the school counselor they
wouldn’t go and ask for help for it they tend to withdraw and adults often
interpret withdrawing as resistant or anti-social type behavior instead of
going what’s going on and a lot of times children are not going to answer
truthfully the first time because they’re trying to protect their family
so they’re not just gonna spill it so it’s important that we have places where
children feel safe to talk and ask for help let people know what’s going on lack of social competence may also occur
if there’s you know you’re not going out you’re not interacting you’re not going
to church or whatever you do for recreation you’re not interacting with
other people because the identified patient needs to stay home then children
especially in the family don’t develop that sense of social competence they
don’t have those experiences it can create distant chaotic or unsupportive
family relationships where people just start going you know what I’ve done
everything I know how to do I can’t do anymore so they start pushing away which
is not helpful to the identified patient and and they’re both everybody start
struggling it can also cause inconsistent parenting if the identified
patient is the parent or taking care of a sibling who has a problem the parent
may not always be focused you know if the identified patient is older brother
Tom and he’s having an episode right now then the other kids learn that they can
probably get away with a lot because parents attention is diverted over here
likewise the children who aren’t getting the attention may act out in order to
garner attention so inconsistent parenting has some reverberations more
common in addictions than in mental health we also see homelessness and
placing the family in high-risk situations so it’s important to look at
what are the effects you know this patient we’re dealing with if it’s a
person with with an addiction or with a mental health issue how is it impacting
their support system and what can we do to sort of shore up that support system
and make sure it stays there and is really strong if the person you’re
working with is not the identified patient we still want to look at the
family system the identified patient may not be ready for treatment you know what
regardless of the diagnosis but what can we do with the person that’s in our
office to help them manage this family environment
right now is kind of rocking I’ll stop short of saying dysfunctional some
things that we can do include improving communication within the family help
people start talking about their wants and their needs and being able to be
open about what’s going on and being honest sometimes parents think keeping
things from children shields them when in actuality kids know a lot more than
we give them credit for so opening up within the family D stigmatizing it
being willing to talk and encouraging family members to and you may need to do
this in family therapy to effectively communicate their feelings and thoughts
about the current situation it’s rare not going to say it doesn’t happen but I
haven’t ever experienced it working with a family where there is an identified
patient who is highly symptomatic for you know depression or anxiety or
addiction they’re highly symptomatic it’s rare if that goes on for very long
for the children and the family and the other people not to develop some
frustrations resentments irritability we can help people with that we can
intervene we can help them look at the resentments address their feelings you
know even if the identified patient isn’t willing or ready or able to deal
with their issue we want to help the client figure out alright this is my
situation right now how can I improve it for me how can I make the next moment
better for me if this over here can’t change and I can’t change it how can I
deal with it we want to help restore roles and boundaries within the family
if they’ve been disrupted and a lot of times they have so you know going back
and looking at who’s responsible for feeding the family getting the kids to
to their lessons into school and all those sorts of things
make sure to educate the family in the community about the disorder about the
issue this is what it looks like this is what can trigger it and we want to talk
about you know not just specifically for the identified
patient if we know what triggers it for him or her but we want to talk about in
general and make sure people understand how to prevent vulnerabilities by
getting good sleep eating eating well getting some exercise making sure to
keep their circadian rhythms kind of set involve the whole family when it’s
clinically appropriate in the treatment plan so and this presents an interesting
op opportunity if the person you’re working with is not the identified
patient so to speak you know it may be it’s mom and dad is the person that has
clinical depression mom comes in she’s like I’m at my wit’s end we can still
bring the family in and go you know what we need to involve everybody in helping
mom feel better there are some treatment plan issues that we can work on but
making sure to bring dad into so he can see and be involved in helping mom feel
better generally if we’re modeling good skills
and trying to help one person feel better everybody is going to be doing
more healthful behaviors so we can indirectly start impacting dads behavior
the identified patient’s behavior by working getting the whole family working
together to help whoever it is that’s in your office address anger guilt and
resentment in family members because it’s going to happen is gonna be there
so help them figure out and understand that anger represents a response to some
sort of a threat you know and in many cases like this its loss of control you
know you can’t make the person feel better it feels like your environment is
completely chaotic so yeah it makes sense to be kind of frustrated or
downright ticked off so fine that makes sense now what are you gonna do about it
so helping people move from feeling the feeling to choosing to improve the next
moment but what that looks like for each person is going to differ
what they have control over in each situation is going to differ
ensure that all family members have a respite not just you know we’ll stick
with the you know mom is the caregiver dad is the identified patient mom needs
a respite true but so do the kids the kids need to be able to get into an
environment where there’s happiness and joy and laughter and loudness and all
that stuff that may not be happening in the household where there is a depressed
identified patient so we want to make sure that kids can get out and
experience life and joy we want to encourage healthy behaviors in the
family nutrition sleep and exercise these are things that we can encourage
them to work with their the rest of their care team ostensibly to help
whoever’s in your office but it’s going to improve the life of not only the
identified patient but everybody in the family and they can also encourage
bonding and communication if they start cooking together or going out on walks
after dinner together or you know whatever it is that they do and we want
to encourage the development of social supports especially via support groups
so people are interacting with others who have similar experiences similar
needs right now caregiving is unique someone who is
caregiving for a person with Alzheimer’s is going to have unique experiences
compared to somebody who’s caregiving for somebody who’s in recovery from
addiction so ideally we want to get them into some specified kind of support
groups so they can you know reach out and understand I know when my son was in
the NICU that’s a whole different world you know there’s beeping and buzzing and
noises and tubes and everything constantly and you also have to figure
out how to work with the NICU nurses which I found a little bit challenging
sometimes we had one nurse who was really awesome and but then there was
another one it I had kind of power struggles with
sometimes so being able to communicate with other people who made it through
NICU life to figure out how to survive one of the things that I was doing was
staying in the NICU all day long you know I’d get there in the morning and I
would be in this room which is dark it’s dim almost all day long and then I’d go
out I’d go down to the cafeteria I’d eat I’d come back and sit in the darkness that through my circadian rhythms off in
addition to being you know under stress because you know my little dude was was
in an incubator it was important for me to be able to give myself permission to
go outside and take a walk and you know not necessarily be there all the time
but it took somebody else saying you know what he’s really not going to know
if you’re gone for 30 minutes and it’s going to be a lot more productive and
you’re going to be able to be better for him if you are happy healthy and
functional especially when it comes home so it’s really important to have people
that understand what you’re going through and you know clinicians we can
educate that that’s true you know just because we haven’t had a family member
with Alzheimer’s doesn’t mean we can’t be supportive but if we’re encouraging
people to reach out to people a people in the community you know it does help
to encourage them to interface with people who share similar experiences
because then they don’t have to try to educate what else do you think you could
do with people with families to help intervene and prevent or prevent the
disorder from kind of spreading through the family or having secondary
implications you you
you okay well move on to community mental
health no substance abuse and mental health don’t just impact the family it
actually impacts the community if you think back to Brock from Brenner’s model
the the individual is at the center the bullseye then you have the family and
the in the work and and school and then you have the larger community when a
person is has a mental health or substance use disorder it affects their
work it affects their performance at school it affects whether they are
attending their recreational activities church or volunteerism or whatever so it
does have an effect on the community people with poor coping skills this is
kind of general and negative thinking styles tend to model these behaviors
spreading them so in a community if children are exposed to people who have
poor coping skills they’re probably if they’re not provided
with other models that have good coping skills they may learn those and not
anything else so we want to make sure that the people that are serving as role
models our teachers our our coaches our pastors our community leaders and our
parents have knowledge of what good coping skills look like and preferably
can implement them and model them the National Bureau of Economic Research
reports that there’s a definite connection between mental illness and
addictive behaviors so by intervening early in families where there is
potentially some mental health stuff going on we can prevent the development
of that as well as the development of addictive behaviors people who’ve been
diagnosed with a mental health disorder at some point in their lives are
responsible for the consumption of 69 percent of the alcohol 84 percent of the
cocaine and 68% of the cigarettes and the reference for that is at the end of
the presentation but what I really want you to see is we’re creating a healthier
community if we intervene early to make sure that not
only you know we talked about prevention has multiple approaches the identified
patient we don’t want them to get worse and we don’t want them to experience
fallout from their issue from their condition but for everybody else in the
family and the community we don’t want them to develop it at all if possible we
want to prevent it so we want to intervene as many different ways as
possible the total economic burden of depression in the year 2000 so a while
ago was 83 billion dollars so depression is expensive
52 billion was due to lost workplace productivity so as 131 billion was due
to other costs but 52 billion dollars was due to lost productivity anxiety
costs roughly 47 billion dollars a year so we’re talking over a hundred billion
dollars a year is costs the u.s. each year over a hundred billion dollars
because of depression and anxiety issues and that’s not including any of your
other mental health issues we’re just talking about depression and anxiety
here other costs it’s not just like medicine and health care include
absenteeism and turnover annually employers lose twenty-seven workdays per
worker with depression so two-thirds is due to presenteeism which means the
person is there but they’re barely functional you know they kind of show up
and they stagger in and they do the bare minimum but they did the statistical
monkeying or whatever to figure out how many workdays how much productivity was
actually lost twenty-seven days is a lot that’s you know five times that’s like
five weeks worth of work in addition to time off days which you know so you’re
looking at losing seven to twelve weeks out of every fifty-two
when you’re working with a employee who has clinical depression the cost of
depression to employers is greater than the cost of many other common medical
conditions including heart disease diabetes and even back problems so
depression has a significant impact the leading cause of medical disability for
people aged 14 to 44 or 14 oh that broke my heart more when I read that stat the
leading cause of medical disability for this age group is depression and anxiety
this you know they’re on disability they may have reduced spending they may
experience more poverty less upward mobility because they’re not getting
promotions and that kind of thing they also may experience less connection and
community involvement if they’re not going to work if they don’t have that
sort of connection and if they are not financially able to go out and do a
bunch of other things so it’s important as advocates if we can to encourage
communities to make sure there are places people can go to engage in
basically free recreation parks we have here movies on the lawn once a week
every summer activities at the library there’s generally things that can be
done it’s important that we make sure that people who need to know about these
things know about them when I had very young children at home I very much look
forward to library activities where I could pack them both up and we could go
do something just to get out of the house and kind of regain my sanity for
you know an hour more than 1 in 10 Americans age 12 and older report taking
an antidepressant and remember antidepressants are effective for only
about 41 percent of the people who take them but to think about that for a
second 1 in 10 Americans over the age of 12 is taking an antidepressant what does
that say about what we’re communicating how are the health of our
community right now the health of our culture right now if 10% of people are
over the age of 12 are on antidepressants effective treatment
outreach in many instances is often stymied by a combination of
stigmatization of mental illness so we reach out and we say you know if you’re
depressed you know we can help you come to this clinic a lot of times people
won’t go because they don’t want to admit that there they’ve got clinical
depression or they don’t want to admit that they postpartum depression is
another big one a lot of people are still afraid to talk about partly
because the media has highlighted the couple of cases where there’s been
infanticide from postpartum depression but they haven’t focused on the millions
of women each year who deal with postpartum depression so educating the
community about mental illness and about addiction so it’s not such a stigma
educating the community about how prevalent it is so when they’re sitting
in a meeting at work or in church or even there at Walmart and they’re
looking around you know stand in the Walmart parking lot some day and look
around there’s like you know I don’t know 150 cars well think about it about
half of those cars have somebody in them that is either experiencing addiction
depression or anxiety Wow okay so maybe we’re not as alone as we
think we are some people also don’t reach out for help and take advantage of
treatment outreach and early intervention because they don’t realize
they need care they think oh I’m just having a bad week I’ll get over it but a
bad week turns into a bad month turns into a bad six months and then before
they realize that they are you know clinically depressed a belief that
treatment wouldn’t work in their particular circumstance either because
they’ve been through treatment before and it didn’t work or because they have
family members who’ve been through treatment before and it didn’t work
I really we believe in educating people about not
only the fact that depression and anxiety and addiction are treatable but
also the fact that what worked for Jane may not work for John and there are a
lot of different counseling approaches so if you went to a humanist Rogerian
counsellor before and it didn’t work you know let’s talk about what you think
might work maybe we’ll look at cognitive behavioral maybe we’ll look at
experiential EMDR if we’re talking about trauma issues so helping people see that
it’s not a one-size-fits-all and if this one thing doesn’t work then you’re
screwed is really important we want to open that dialogue in the community so
people who need to hear it can hear it because a lot of times they’re not going
to come and say well I tried it before and it didn’t work we need to actually
reach out to them and go hey guess what there are multiple options out there
some people don’t reach out for help even for community support groups and
stuff because they believe a cure can be found in a pill so they keep going to
their doctor going well that meds not work and give me another one and they
before they know it they end up on like six different medications and they’re
still not feeling what they call happy and then they start getting depressed
and feeling hopeless and hopeless other people may not reach out because they’re
impatient with the slow pace of symptom relief so they’re like well it’s not
working it doesn’t work for me how long were you
in treatment well sometimes people say I was in treatment for two weeks and I
wasn’t feeling any better and I’m thinking to myself well you felt that
way for twenty years so two weeks probably not gonna feel
huge improvements as clinicians again we can encourage people and educate people
in the community about the fact that treatment you know effects generally
take anywhere from six weeks to three months to really start feeling a good
strong effect from it so for educating the community then the
family members of the identified patient are also hearing this message and they
can cheerlead and they can go you know what it’s only been two weeks you need
to give it a little more time and they can get some hope and say you know what
it’s only been two weeks I bet in a month or so things will start getting
better as we improve hope we improve treatment compliance we improve a whole
lot of things a lot of it is really about outreach and education not just to
the identified patient but to the family members that support him or her and the
community that serves as the larger safety net and provides the wraparound
services that provides the child care I’ve heard of some communities that
where there’s child care agencies child care providers that will provide respite
care drop-in respite care for people who are caregivers and maybe one of the
parents has cancer or maybe they’ve got grandma living with them and grandma has
cancer and the caregivers need a break so they can drop the kids off in a safe
place for free or for low-cost America’s top medical problems can be linked
directly to addiction tobacco contributes to 11 to 30% of cancer death
deaths and by the way on your exam if you haven’t already taken it
I do not test you on specific statistics I just want you to kind of get a global
picture of how big this problem is the Society for the Advancement of sexual
health estimates that 3 to 5 percent of the u.s. suffers from some sexual
compulsion and disorder so internet internet porn sex addiction something
like that so 5% is a pretty big number that’s one out of every 20 people again
when you go to the grocery store you know there’s 80 people in there that
means for the people that are in the grocery store when you are probably
struggle with some sort of sexual compulsive disorder and this can have
far-reaching effects STDs are at a record high
according to the CDC this was a bulletin that they put out in 2016 so we’re not
doing a really good job with addressing STDs which are spread through addictive
behaviors as well as they can be spread by people who are struggling with
depression and anxiety and seeking comfort from another person that don’t
have high self esteem they are seeking comfort there’s a lot of reasons why
people may engage in risky sexual behaviors but wow that was shocking
heart disease is also correlated with the use of tobacco cocaine ecstasy and
feta means and steroids so we’ve got a sick society and cancer heart disease
and COPD cost billions with a B each year in medical costs lost wages and
unemployment so things that arise from tobacco smoke
well nicotine and nicotine products in general cost millions why do we care why
does that matter to the mental health counselor well as it costs our society
millions as people lose productivity the average per household income goes down
which reduces spending which reduces the affluence e if you will of the community
that you live in and you can start seeing deterioration blood borne
illnesses one-third of AIDS cases and most cases of Hep C in the u.s. are
associated with injection drug use alcohol causes cirrhosis of the liver
which is very very painful I’ve had some clients who have had advanced stages and
the water retention in their abdomen actually had to be relieved periodically
because it got so painful and many patients with chronic or terminal
illnesses experience high rates of concurrent depression and/or anxiety so
if a client has chronic pain or even chronic depression and we’ll talk about
that in a couple of classes from now if they feel like they’re never going to
break from the bonds of whatever this condition is even if they have periods
of remission they may have additional concurrent mental health symptoms which
can impact their ability to work their ability to socialize their ability to be
supportive of their children addiction cost the US over four hundred four
hundred and eighty four billion dollars annually and mental illness costs the
u.s. over two hundred and seventy three billion annually and so we’re spending a
crap ton of money treating things instead of preventing them and what do
they say an ounce of prevention is worth a pound of cure we are losing money or
spending money if you will on health care on insurance on people who need
health care they don’t have health insurance and they can’t pay their bill
so they go to government-funded institutions we lose money – lost
earnings we lose money – crime that occurs as a result or concurrently with
substance abuse depression anxiety child welfare if there’s child neglect or
child abuse that results from the the parent being emotionally unable to
attend to the child’s needs accidents work-related accidents you
know slips and Falls etc making mistakes at work and and vehicular accidents
whether it’s taking too much of your prescribed medication and falling asleep
at the wheel drinking duis or just not paying
attention because you are emotionally kind of spaced out and homelessness 31
percent of homeless people have an addiction so that’s a lot not even a
third so it’s important to recognize that there are people out there who are
homeless by choice is a culture choice there’s a proportion of people out there
who are homeless due to addiction but there’s another proportion of people
out there our homeless because of the negative
effects of mental health issues so we want to make sure that we’re reaching
out and making sure they know how to get access to mental health care and medical
care and and prescription drugs in order to improve their situation if they don’t
want to be homeless which the majority of homeless people don’t but like I said
there is a proportion who that’s a nomadic lifestyle is one that they’ve
chosen us social problems related to addiction include drug driving fetal
alcohol spectrum disorders which cost over four billion annually violence and
crime and child abuse domestic violence PTSD and bullying and childhood suicide
are also us problems related to depression anxiety and addiction so we
want to look at you know what’s going on and where can we intervene when we’ve
got people who are lashing out when we’ve got people who are angry and
committing violence against one another or bullying one another when we’ve got
people who are experiencing traumatic situations in their home where it’s
supposed to be safe how do we help intervene prevention obviously is where
we’re going to start what can we do in the community we’re not going to you
know unless you’re an excellent fundraiser you’re not going to be able
to raise the money to open a children’s clinic or something but as a clinician
what can you start doing today tomorrow provide short actionable practical
prevention messages that’s a bunch of stuff right there in schools you know
morning announcements where they can remind people to take a mindfulness
minute they can teach mindfulness and acceptance and commitment skills
distress tolerance skills in health and PE class they can you know morning
announcements is generally the best place because you can hit it every
single day with something just something for the
child to ponder each day churches synagogues places where people typically
voluntarily gather and even I was thinking about this the other day even
sporting events where there’s a circular something that gets handed out a program
have a short wellness message in it you know we’re not talking about teaching
people how to live a completely healthy lifestyle in 50 words or less we’re
talking about giving them one short actionable practical something they can
do to improve their life in churches at the end of the sermon is a good place to
put put the message because a lot of times you know most of the time people
don’t leave church early so the the pastor can get that in right at the end
of the sermon and right before the weather broadcast because most people
turn tune into the news for weather even if they don’t stay for the different
sections having a wellness minute again teaching one short thing this is what
mindfulness is this is what distress tolerance is and here’s an acronym go to
the website to print out a worksheet we can also put stuff on our own websites
and blogs and Facebook pages that can help people it doesn’t have to be fancy
it can be a Word document saved as a PDF that they can just print out and have to
review each day social media do one post a day on on your social media about
something whether it’s a quote or tool people can use search engines can be
encouraged to do it I don’t know that today we can necessarily make this
happen but if somebody could convince Google for example right where they you
know how they change the little Google graphic each day right underneath it
have some sort of wellness tip when you go to stores every store gives you a
receipt so have it printed on the receipt just like they print the coupons
and everything else have a little wellness note printed there that’s
another place where people aren’t going and actually reaching out and saying I
want information about this but it’s being fed to them so they can see it and
if they want to read it they can and if they don’t want to read it they don’t
have to strengthen community resources with peer support and trained volunteer
programs so encourage people to work with their with their churches work with
their community centers work with their libraries to provide support where I
came from in Alachua County they had it was wonderful they redid all the
libraries and they had a children’s section where it was designed like a
playroom I mean there were toys for them to play with and stuff and all the kids
books there were a bunch of kids books there but there was also a whole corner
that had books on parenting so parents could go educate themselves about how to
deal with their kids ADHD or how to parent a two-year-old or whatever the
case may be the kids could do something fun they were in a community center sort
of thing so they were learning that the library is kind of a cool place to go
and they were also having access or getting access to books which you know
in my mind is a good thing so that’s something that you can work with your
local library to do is just to set up a special shelf that is topical you know
maybe each month it switches so one month it’ll be new nutrition another
month it’ll be depression and encourage people to go to the library it doesn’t
cost them anything to check those things out those are places where you can get a
lot of bang for your buck the other thing you can do as a if you’re an
independent clinician is host workshops at community centers and libraries a lot
of times they’ll let you use the space for free if you don’t charge the
participants but then participants get to know you you provide them with some
good information one thing I have found in my experience at least is when
make the title for the workshop you want to make it something that’s not
stigmatizing you know not how to beat your depression because people may not
want to admit they’ve got depression so find something else cool to call it
preventing depression in the youth of tomorrow or something because what we’re
doing by helping the adults of today be happier healthier people we are
preventing depression in the youth of tomorrow so remember when we’re
providing any of these to the individual family or community we want to make sure
we use the frames approach provide feedback about the impact of thoughts
behavior and feelings on self and others so encourage people to remember how they
impact everybody else is not just them they impact their family they impact the
community encourage people to take responsibility for what’s within their
control and figure out how to deal with what’s not in their control because
there’s a lot provide advice on what they can do I mean theoretically we’re
the experts so we can provide some information but couching it with you’re
the expert on you so I’m providing you tools this works for some people but
we’re gonna have to figure out what works for you which is where the menu of
options comes in giving people multiple ways to access intervention and
prevention services podcast is another great way if you if you listen to
podcasts finding some that have really good information and recommending it to
your to your patients to your clients etc providing empathy just being there
going yeah I know this is really tough when when your child is struggling with
depression or whatever and providing the opportunity for self efficacy
encouraging people to recognize how effective they have been navigating this
issue whether they’re the identify patient or the supportive caregiver
encourage them to acknowledge how effective they’ve been and what they
can do not only to improve the situation but to improve their quality of life and
improve their life and help them really hone in on seeing how a healthy them is
going is necessary to do everything else that they want to so it’s important that
they take that time to make sure that they are healthy and happy addiction and
mental health issues can have a direct and indirect effect on the family and
community as clinicians we need to attend to the reciprocal impact of the
disorder on the individual their proximal environment which is their home
and kind of work and the community in which they live so their neighborhoods
school and work and vice versa if they are going to school in a place where
there’s a lot of bullying well then we need to look at intervening there
because that’s just going to send home stressed out depressed children if they
are if the neighborhood is unsafe so we need to look at the reciprocal
interaction and pay attention not just to the person but to where they spend
all 24 of their hours many people with addictions and mood disorders see their
issues is not hurting anyone but themselves so we can help educate them a
little bit so they can see the impact they may be having to increase
motivation the caveat is we have some people who recognize it and they feel so
guilty so we don’t want to encourage guilt we want to increase motivation
when it provided with objective evidence to the contrary the frames approach can
assist with increasing motivation for treatment so if people say they’re not
ready or they don’t want to or things are fine right now then we can say you
know you said these were your goals but this is how you’re living right now so
are things really fine remembering to elicit from the client
what can be done and not to lecture them if they’ve got a problem they’re
probably quite aware they’ve got a problem
so elicit from them what is it that could change that could help you feel
happier and healthier as far as podcasts that I found helpful
I cannot think of the names of some of my favorites right now I’m not a big
podcast listener but I will put that on the resources page all CEUs comm slash
resources and I’ll have that up by the end of the week so you can see some of
the podcasts I recommend generally the ones that I’ve listened to have been
like in the top 15 on any of the podcast players so if you go to pod bean or
stitcher or one of those and type in wellness or I tend to look for things
that are health inspiring not necessarily I haven’t looked at like
depression or anxiety but they’re podcasts out for everything so I will
get those up by the end of the week any other questions all righty everybody have a wonderful
day and I will see you tomorrow

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