HIPAA
Many Americans have had some personal experience with the Federal Government's Health Insurance Portability and Accountability Act (HIPAA). To ensure privacy, for example, they may have been asked to stand farther away from a customer in line to pick up prescriptions at the pharmacy counter. Or, they've been asked by their physician's office staff to read a "Notice of Privacy Practices" and to sign an acknowledgment of receipt of that information.
"While these may be small day-to-day changes, they reflect larger changes taking place behind the scenes that will benefit everyone," says Sarah A. Wattenberg, L.C.S.W.-C, a public health advisor at SAMHSA's Center for Substance Abuse Treatment (CSAT) and the SAMHSA HIPAA Coordinator.
HIPAA can be complex at times, but the U.S. Department of Health and Human Services (HHS) is working hard to develop resources that can help people better understand the requirements, and SAMHSA is contributing to these efforts.
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Streamlining the System
HIPAA was born out of frustration with the inefficiency—and spiraling costs—of the Nation's health care system. As a result of the Act, passed in 1996, HHS was required to create regulations for the electronic exchange of certain kinds of health information and for the security and privacy of that information. Some of the regulations, promulgated over several years, include the following:
Standards for Electronic Transactions and Code Sets Rule and its Modifications Rule, which had a compliance date of October 16, 2002 (the Administrative Simplification Compliance Act extended this rule for an additional year if covered entities submitted HIPAA compliance plans).
Privacy Rule and its Modifications Rule, with a compliance date of April 14, 2003.
Employer Identifier Rule, with a compliance date of July 30, 2004.
Security Rule, with a compliance date of April 21, 2005. (The additional year for small health plans for Transactions and Code Sets and its Modifications ended October 16, 2003.)
Three types of "covered entities" are subject to HIPAA: health plans, health care clearinghouses that health care providers
and plans can use to process and submit their transaction data in a HIPAA-approved manner, and health care providers who electronically exchange health information for which HIPAA has adopted a particular standard. Covered entities must comply with all HIPAA standards, not just one or two.
In addition, business associates of covered entities who have contact with a patient's health information are required
to sign contracts agreeing to protect that information. Business associates could include an attorney reviewing a patient's file, or an organization that collects information to evaluate patient care, among others.
What kind of information does HIPAA cover? HIPAA protects any patient information that is created or received by a covered entity and that identifies the individual or could be used to identify an individual, whether the information is in oral, written, or electronic format.
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Electronic Transactions Standards
Until now, every health care organization had its own codes
for billing and other types of transactions. The result was babel, with health insurers and providers unable to use the same language to "talk to each other." To create a common language, HIPAA's electronic transaction regulations require covered entities to use a standardized content and format when transmitting certain health care information electronically. Standards have been adopted so far for the exchange of information related to plan eligibility, health plan enrollment and disenrollment, premium payments, referral certification and authorization, claims and encounter information, claim status, payment and remittance advice, and benefit coordination.
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A National Code
Standard code sets for diagnosis and treatment have not existed up to this point. States have typically used "home-grown" codes for treatment procedures. Now, HIPAA requires that national, uniform codes be used. Certain code sets have been adopted by the HHS Secretary as national standards: the International Classification of Diseases, 9th Edition, Clinical Modification (Volumes 1, 2, and 3); the Current Procedural Terminology; the Centers for Medicare & Medicaid Services (CMS) Healthcare Common Procedure Coding System (HCPCS); the Code on Dental Procedures and Nomenclature; and the National Drug Codes.
Unfortunately, says Ronald W. Manderscheid, Ph.D., Chief of the Survey and Analysis Branch of the Division of State and Communities Systems Development within SAMHSA's Center for Mental Health Services (CMHS), these code sets did not originally include codes for many of the services offered by mental health and substance abuse treatment providers.
For the past 2 years, CSAT, the CMHS Decision Support 2000+ Initiative, and other groups worked to solve the problem by creating a more complete code set for behavioral health services and proposing them for inclusion into the CMS HCPCS code set. The large majority of these codes were adopted by the CMS and are now posted on the CMS Web site.
Also, while some providers may be able to adapt existing systems to comply with HIPAA's electronic transactions provision, most will need outside help, Dr. Manderscheid says. Providers can use health care clearinghouses to translate their transaction data into acceptable formats or purchase software to do the job.
Either way, Dr. Manderscheid's advice is the same: caveat emptor (buyer beware). "The burden of proof concerning the accuracy of the data ultimately lies with the provider or plan," he explains. Providers who go the software route should consult SAMHSA's handbooks for each of the eight electronic transactions to ensure that they're meeting the standards. (See "Resources")
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Protecting Privacy
"Before HIPAA, patients were very concerned about how the general health care system was handling information about them," says Ms. Wattenberg. "In fact, in 1999, the California HealthCare Foundation conducted a survey and found that one out of seven Americans reported evasive actions to avoid inappropriate use of their health care information. For example, someone wouldn't tell the truth to their primary care physician about a chronic physical condition for fear the information might get back to their employer," says Ms. Wattenberg. "That's a pretty upsetting statistic. It means that patients may not be giving their doctors important health information that's needed for appropriate and effective treatment," she added.
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Before HIPAA, patients were very concerned about how the general health care system was handling information about them.
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For this reason, HIPAA requires that covered entities obtain authorization from patients before they use or disclose information. This applies unless otherwise allowed by the Privacy Rule, such as, for example, information can be shared without authorization for treatment (so that your physician can discuss your x-rays with another provider, like a radiologist); for payment (e.g., so that information can be used to process claims); or for operations (e.g., so that information can be used or disclosed to oversee the quality of the health care you are receiving).
Among other requirements, covered entities also need to establish privacy policies, put privacy safeguards in place, train staff, designate a privacy officer, and establish a grievance process.
Consumers of health care services also have new rights under HIPAA and they need to be informed of these rights. For example, patients can review their medical records, make a copy of the records, and request changes.
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While some providers may be able to adapt existing systems to comply with HIPAA's electronic transactions provision, most will need outside help.
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"Mental health and substance abuse treatment providers should not have a hard time complying with HIPAA's privacy rule," says Ms. Wattenberg. "For mental health providers, state laws and professional ethics have always dictated high standards for protecting the sensitive information treatment providers create or receive about their clients."
"For substance abuse providers, most treatment programs have been required for decades to comply with the Federal Confidentiality of Alcohol and Drug Abuse Patient Records regulation, 42 C.F.R. Part 2," says senior program management officer Captain Ann G. Mahony, M.P.H., of CSAT's Division of Systems Improvement. "Covered entities should read both laws together," she advises. When HIPAA conflicts with the "Part 2" regulations or with state laws, the more stringent rule applies.
Patients will enjoy even more protection when HIPAA's security standard goes into effect. The standard will require covered entities to assign a security officer who will be responsible for conducting risk assessments and other measures to assure the integrity, confidentiality, and availability of identifiable health information that covered entities store, maintain, or transmit
November 03, 2010
November 02, 2010
Prescription Drug Dependence, Abuse, and Treatment
Prescription Drug Dependence, Abuse, and TreatmentThis chapter presents information on dependence on and abuse of prescription-type psychotherapeutic drugs that were used nonmedically. Estimates are based on data from the 2002, 2003, and 2004 National Surveys on Drug Use and Health (NSDUHs). The chapter also provides estimates of the prevalence and patterns of the receipt of treatment for problems related to substance use and discusses the need for and receipt of treatment at specialty facilities for problems associated with substance use.
6.1. Background
NSDUH includes a series of questions to assess the prevalence of substance use disorders (i.e., dependence on or abuse of a substance) in the past 12 months. These questions are used to classify persons as dependent on or abusing specific substances based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) (American Psychiatric Association [APA], 1994). The questions on dependence ask about continued use despite health or emotional problems associated with substance use, unsuccessful attempts to cut down on use, tolerance (e.g., requiring larger amounts of a substance to get desired effects), withdrawal symptoms, reducing other activities in order to use substances, spending a lot of time engaging in activities related to substance use, or using the substance in greater quantities or for a longer time than intended. The questions on abuse ask about problems at work, home, and school; problems with family or friends; physical danger; and trouble with the law due to substance use.
Dependence is considered to be a more severe substance use problem than abuse. Although individuals may meet the criteria specified for both dependence and abuse, persons are classified with abuse of a particular substance only if they are not classified as dependent on that substance. In this chapter, persons meeting the criteria for either dependence or abuse are counted together. It should be noted that the NSDUH questionnaire does not include specific dependence and abuse questions for methamphetamine because the DSM-IV criteria pertain to stimulants as a whole.
6.2. Trends in Dependence or Abuse
The estimated numbers and rates of past year prescription drug dependence or abuse for any psychotherapeutic drug and the specific drug classes did not change significantly from 2002 to 2004 among persons aged 12 or older (Figure 6.1 and Table 6.1). In 2004, approximately 2.0 million persons aged 12 or older met the criteria for dependence or abuse involving any prescription psychotherapeutic drug that was used nonmedically, including 1.4 million for pain relievers, 573,000 for tranquilizers, 470,000 for stimulants, and 128,000 for sedatives.
Figure 6.1 Substance Dependence or Abuse for Nonmedical Use of Prescription Psychotherapeutic Drugs in the Past Year for Persons Aged 12 or Older, by Drug Type: Numbers (in Thousands), 2002-2004
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a Difference between this estimate and the 2004 estimate is statistically significant at the .05 level.
b Difference between this estimate and the 2004 estimate is statistically significant at the .01 level.
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.
Within separate age groups, few year-to-year changes in the rates of dependence or abuse reached statistical significance. Among youths aged 12 to 17, the rate of pain reliever dependence or abuse increased from 1.0 percent in 2002 to 1.2 percent in 2004 (Figure 6.2). Among young adults aged 18 to 25, dependence or abuse involving this class of drugs increased from 1.1 percent in 2003 to 1.4 percent in 2004, but this change simply restored the rate observed in 2002 (1.4 percent). The apparent decline in the rate of pain reliever dependence or abuse among adults aged 26 or older was not statistically significant. There were no statistically significant changes in the rates of abuse or dependence for specific age groups for other classes of psychotherapeutic drugs that were used nonmedically.
Figure 6.2 Substance Dependence or Abuse for Nonmedical Use of Prescription Pain Relievers in the Past Year, by Age Group: Percentages, 2002-2004
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a Difference between this estimate and the 2004 estimate is statistically significant at the .05 level.
b Difference between this estimate and the 2004 estimate is statistically significant at the .01 level.
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.
6.3. Demographic Differences in Dependence or Abuse
Data aggregated for 2002, 2003, and 2004 provide sufficient numbers of respondents to permit reliable examination of differences in past year dependence or abuse for any prescription psychotherapeutic drug and the four therapeutic classes of psychotherapeutic drugs according to age, gender, race/ethnicity, and other covariates (Table 6.2). Consistent with the single-year trend data, combined data from the 2002 through 2004 surveys yielded an annual average of 2.0 million persons aged 12 or older who met the criteria for prescription psychotherapeutic drug dependence or abuse in the past year. Annual average numbers of people aged 12 or older who met dependence or abuse criteria for specific classes of psychotherapeutic drugs were 1.4 million for pain relievers, 505,000 for tranquilizers, 424,000 for stimulants, and 147,000 for sedatives.
As shown in Figure 6.3, young adults aged 18 to 25 had the highest rates of past year dependence or abuse involving pain relievers, tranquilizers, and stimulants, the three most frequently reported classes of nonmedically used prescription psychotherapeutic drugs. Youths aged 12 to 17 had the second highest rates of dependence or abuse involving these drugs. Rates of dependence or abuse among adults aged 50 or older were lowest for each of these drug classes.
Overall, rates of past year dependence and abuse were comparable for males and females for any misused prescription psychotherapeutic drug and each of the therapeutic drug classes (Table 6.2). When gender differences are considered for different age groups, however, a different pattern emerges. Among youths aged 12 to 17, the rate of dependence or abuse was higher among females than males for any prescription psychotherapeutic drug (1.8 vs. 1.1 percent, respectively), pain relievers (1.4 vs. 0.8 percent), tranquilizers (0.4 vs. 0.3 percent), and stimulants (0.5 vs. 0.3 percent) (Figure 6.4). For young adults aged 18 to 25, however, males were more likely than females to meet the criteria for past year pain reliever dependence or abuse (1.4 vs. 1.1 percent).
Figure 6.3 Substance Dependence or Abuse for Nonmedical Use of Pain Relievers, Tranquilizers, and Stimulants in the Past Year, by Age Group: Annual Averages Based on 2002-2004
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Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.
Figure 6.4 Substance Dependence or Abuse for Nonmedical Use of Pain Relievers in the Past Year, by Age Group and Gender: Annual Averages Based on 2002-2004
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Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.
Considered by race/ethnicity, the rate of past year dependence or abuse involving any nonmedically used prescription psychotherapeutic drug was higher for American Indians or Alaska Natives (2.0 percent) and whites (0.9 percent) than for blacks (0.5 percent) or Asians (0.5 percent) (Figure 6.5 and Table 6.2). However, whites and Hispanics had similar rates (0.8 percent for Hispanics). Rates also were not significantly different between whites and American Indians or Alaska Natives. Although the rate of dependence or abuse appeared to be high for Native Hawaiians or Other Pacific Islanders, it was not significantly different from other rates shown in Figure 6.5.
A similar pattern of differences held for pain relievers (0.6 percent for whites and Hispanics, 0.4 percent for blacks, and 0.3 percent for Asians). For pain relievers, the rate of dependence or abuse also was higher among American Indians or Alaska Natives (1.2 percent) than blacks or Asians. Past year dependence or abuse involving tranquilizers was higher among American Indian or Alaska Natives (0.9 percent) than among whites (0.2 percent) or blacks (0.1 percent); the rates for whites and Hispanics (0.2 percent) also were higher than that for blacks.
Figure 6.5 Substance Dependence or Abuse for Nonmedical Use of Any Prescription Psychotherapeutic Drug in the Past Year, by Race/Ethnicity: Annual Averages Based on 2002-2004
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Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.
6.4. Geographic Differences in Dependence or Abuse
Small but statistically significant regional differences were observed in rates of past year dependence or abuse involving some prescription-type psychotherapeutic drugs that were used nonmedically (Table 6.3).1 The rate for past year dependence or abuse involving any prescription psychotherapeutic drug was higher in the West (1.0 percent) and South (0.9 percent) than in the Northeast (0.7 percent) and Midwest (0.7 percent). Regional differences also were found in the rates of dependence on or abuse of pain relievers and tranquilizers. For pain relievers, the rate of past year dependence or abuse was higher in the South (0.7 percent) and West (0.6 percent) than in the Midwest (0.5 percent). For tranquilizers, dependence or abuse was more prevalent in the South (0.3 percent) than in the West (0.2 percent) or Midwest (0.2 percent).
Differences in the rate of past year dependence or abuse were found by census division for any prescription psychotherapeutic drug, pain relievers, tranquilizers, and stimulants (Table 6.3). For any psychotherapeutic drug, the rate of dependence or abuse was lower in the Middle Atlantic (0.6 percent) and West North Central (0.6 percent) Divisions than in the East South Central (1.2 percent), Pacific (1.0 percent), West South Central (1.0 percent), Mountain (0.9 percent), and South Atlantic (0.8 percent) Divisions (Figure 6.6). The rate in the East North Central Division (0.7 percent) was lower than that in the East South Central, West South Central, Mountain, and Pacific Divisions. Although the New England Division appeared to have a high prevalence of dependence or abuse for any psychotherapeutic drug (1.1 percent), only the West North Central Division had a significantly lower rate than that for New England.
Figure 6.6 Substance Dependence or Abuse for Nonmedical Use of Any Prescription Psychotherapeutic Drug in the Past Year, by Census Division: Annual Averages Based on 2002-2004
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Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.
The rank ordering of the census divisions by the rate of past year pain reliever dependence or abuse generally was similar to that for any prescription psychotherapeutic drug. One exception for pain relievers was that the West North Central Division had the lowest rate (0.3 percent), followed by the Middle Atlantic Division (0.4 percent). The rates in those census divisions were lower than those in the East South Central (1.0 percent), New England (0.9 percent), West South Central (0.7 percent), Pacific (0.7 percent), and Mountain (0.6 percent) Divisions.
Past year dependence and abuse varied by county type for any prescription psychotherapeutic drug, pain relievers, and stimulants. For any psychotherapeutic drug, the highest rate of past year dependence or abuse occurred in counties in small metropolitan areas with fewer than 250,000 population (1.2 percent); the lowest rate was found in completely rural counties (0.6 percent). This same pattern held for pain relievers (0.9 and 0.4 percent, respectively). For stimulants, the rate of dependence or abuse was somewhat lower in large metropolitan areas (0.1 percent) than in small metropolitan areas with fewer than 1 million population (0.2 percent) and less urbanized nonmetropolitan counties (0.3 percent).
Further information on geographic differences can be found in Chapter 7, which presents estimates by State.
6.5. Dependence or Abuse among Past Year Users
To some extent, variations in the rates of past year dependence or abuse are driven by differences in the rates of past year use. In this section, the rate of dependence or abuse involving prescription drugs is examined among users of the respective drugs to address questions of the relative propensity of persons in a particular demographic group or users of a particular drug to exhibit dependence or abuse once they have used the drug. The statistics discussed here sometimes are referred to as "conditional rates" because they refer to the rate of dependence or abuse, given use in the same time period.
Overall, aggregate data for 2002, 2003, and 2004 indicate that 13.5 percent of past year nonmedical users of any prescription-type psychotherapeutic drug met the criteria for dependence on or abuse of any such drug (Table 6.4). For the four therapeutic drug classes, the conditional rates of dependence or abuse were 12.7 percent for pain relievers, 10.1 percent for tranquilizers, 14.4 percent for stimulants, and 17.3 percent for sedatives.
Nonmedical users aged 12 to 17 had higher rates of dependence or abuse than those aged 18 to 25 regardless of the drug class (Figure 6.7). For any psychotherapeutic drug, 15.9 percent of youths aged 12 to 17 and 12.7 percent of young adults aged 18 to 25 who were past year users met the criteria for dependence or abuse. For pain relievers, adults aged 26 or older had higher conditional rates of dependence or abuse than young adults (13.3 vs. 10.9 percent). For tranquilizers, the rate for youths (15.3 percent) was higher than that for either young adults (9.2 percent) or adults aged 26 or older (9.7 percent).
Male and female past year nonmedical users of prescription drugs did not differ significantly in the rate of past year dependence on or abuse of those drugs, either overall or for the respective therapeutic drug classes. For example, the conditional rates of pain reliever dependence or abuse were 12.4 percent for males and a comparable 13.2 percent for females.
Figure 6.7 Substance Dependence or Abuse for Nonmedical Use of Prescription Psychotherapeutic Drugs in the Past Year among Past Year Nonmedical Users of Those Drugs, by Drug Type and Age Group: Annual Averages Based on 2002-2004
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Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.
6.6. Dependence or Abuse as a Function of Age at First Use
Table 6.5 presents information on the rates of past year dependence on or abuse of prescription drugs among lifetime nonmedical users aged 18 or older according to the age at which they first used those drugs. Except for sedatives, the risk of dependence or abuse was higher among persons who initiated nonmedical use before age 16 compared with those who were age 16 or older when they first used the respective drugs (Figure 6.8). This same pattern held for lifetime nonmedical users aged 18 to 25 and for those aged 26 or older. For example, 6.6 percent of persons aged 26 or older who were lifetime misusers of pain relievers and who initiated use before age 16 met the criteria for pain reliever dependence or abuse. Among lifetime pain reliever misusers in this age group who initiated use after age 16, only 3.3 percent met the criteria for dependence or abuse. Although this general pattern also was observed for sedatives, the rates of dependence or abuse were not significantly different between persons who initiated nonmedical sedative use before age 16 and those who initiated use at age 16 or older.
Figure 6.8 Past Year Substance Dependence or Abuse for Nonmedical Use of Prescription Psychotherapeutic Drugs among Lifetime Users Aged 18 or Older, by Drug Type and Age at First Use: Annual Averages Based on 2002-2004
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Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.
6.7. Treatment for Any Illicit Drug Use
This section presents findings on treatment received in the past year to stop or reduce the use of any illicit drug or for medical problems associated with misusing these drugs among persons who met the criteria for dependence on or abuse of prescription drugs in the past year. This measure includes treatment received in the past year at any location, such as a hospital (inpatient), rehabilitation facility (outpatient or inpatient), mental health center, emergency room, private doctor's office, prison or jail, or a self-help group, such as Alcoholics Anonymous or Narcotics Anonymous. Treatment at a specialty facility in the past year includes only treatment at a hospital (inpatient), a rehabilitation facility (inpatient or outpatient), or a mental health center. Findings for these analyses are shown in Table s 6.6 and 6.7.
In 2002, 2003, and 2004, an annual average of 290,000 persons received treatment for illicit drug use in the past year and met the criteria for dependence on or abuse of prescription psychotherapeutic drugs in the past year. This number includes treatment at any type of facility, both specialty and nonspecialty. Among the therapeutic classes of prescription drugs, those treated included an annual average of 210,000 persons who were dependent on or abusing pain relievers, 106,000 who were dependent on or abusing tranquilizers, 104,000 who were dependent on or abusing stimulants, and 39,000 who were dependent on or abusing sedatives (Table 6.6).2 The percentages receiving treatment for illicit drug use in the past year constituted 14.5 percent of those dependent on or abusing any prescription drug, 14.6 percent for pain relievers, 21.1 percent for tranquilizers, and 24.2 percent for stimulants. Too few persons met the criteria for dependence on or abuse of sedatives to produce estimates with adequate precision (see Appendix B for a discussion of precision requirements).
Rates of past year specialty treatment for any illicit drug among those dependent on or abusing prescription psychotherapeutic drugs in the past year were 12.5 percent for any psychotherapeutic drug, 12.9 percent for pain relievers, 19.3 percent for tranquilizers, and 20.4 percent for stimulants (Table 6.7). Viewing these findings from a different perspective, an estimated 87.5 percent of those meeting the criteria for dependence on or abuse of a prescription psychotherapeutic drug in the past year did not receive specialty treatment for any illicit drug use in that period, and 85.5 percent did not receive any treatment in the past year, either at a specialty or nonspecialty facility.
Receipt of past year specialty treatment among persons dependent on or abusing prescription psychotherapeutic drugs in the past year varied by drug category and age. The rate of treatment for an illicit drug problem was lower for persons aged 12 to 17 who were dependent on or abusing any psychotherapeutic drug (7.9 percent) than for their counterparts who were aged 18 to 25 (12.7 percent) or aged 26 or older (13.9 percent).
6.8. Treatment for Problems Related to Nonmedical Prescription Drug Use
For a subset of persons who received treatment for illicit drugs in the past year, it is possible to identify those whose treatment was specifically for problems resulting from nonmedical use of prescription psychotherapeutic drugs. These data are presented in Table 6.8 and pertain to persons whose last or current treatment in the past year was for one or more prescription psychotherapeutic drugs. Treatment at any type of facility—not necessarily specialty facilities—is included. An annual average of 209,000 persons treated in the past year met the criteria for dependence on or abuse of any prescription psychotherapeutic drug and received their last or current treatment for problems with any psychotherapeutic drug. Similarly, 135,000 persons met the dependence or abuse criteria and received their last or current treatment for pain relievers, 50,000 did so for tranquilizers, 64,000 did so for stimulants, and 34,000 did so for sedatives. Further estimates are not available for those treated for problems with sedatives due to small numbers.
Among those dependent on or abusing any prescription-type psychotherapeutic in the past year, 10.5 percent received treatment in the past year specifically for one or more psychotherapeutic drugs. Comparable rates for other psychotherapeutic drug categories were 9.4 percent for pain relievers, 9.8 percent for tranquilizers, and 15.0 percent for stimulants. As was the case for treatment for any illicit drug in the past year, the percentage of persons who were dependent on or abusing any psychotherapeutic drug and who last received treatment for one or more of these drugs was lower for persons aged 12 to 17 than for those aged 18 to 25 (6.5 vs. 11.6 percent). Persons aged 12 to 17 who were dependent on or abusing stimulants also were less likely than their counterparts aged 18 to 25 to have received treatment for their problems with stimulants during their last or current treatment episode (10.0 vs. 19.0 percent). There were no significant differences by gender.
6.9. Summary
This chapter presented findings for substance dependence, abuse, and treatment in the past year related to the nonmedical use of prescription psychotherapeutic drugs. The chapter also presented data on selected correlates of dependence or abuse, based on combined data from the 2002 through 2004 surveys. In addition, findings were presented for treatment for nonmedical psychotherapeutic drug use based on the combined data.
Trend data indicated that rates of dependence or abuse for nonmedical use of psychotherapeutic drugs among persons aged 12 or older did not change significantly from 2002 to 2004. In 2004, approximately 2.0 million persons aged 12 or older met the criteria for dependence or abuse involving any prescription psychotherapeutic drug that was used nonmedically, including 1.4 million for pain relievers, 573,000 for tranquilizers, 470,000 for stimulants, and 128,000 for sedatives.
The prevalence of dependence or abuse was higher among young adults aged 18 to 25 for pain relievers, tranquilizers, and stimulant compared with the rates in other age groups; these findings were based on combined data from the 2002 through 2004 surveys. Males and females aged 12 or older had comparable rates of dependence or abuse, but gender differences occurred within specific age groups. Among youths aged 12 to 17, females had higher rates of dependence or abuse involving any psychotherapeutic drug, pain relievers, tranquilizers, and stimulants than did males. For young adults aged 18 to 25, however, males were more likely than females to meet the criteria for dependence or abuse involving pain relievers. The rate of dependence or abuse for any prescription psychotherapeutic drug was higher for American Indians or Alaska Natives and whites than for blacks or Asians. Regional differences in rates of dependence or abuse for psychotherapeutic drugs were small, although some differences were significant.
Among persons who used psychotherapeutic drugs nonmedically in the past year, 13.5 percent met the criteria for dependence on or abuse of at least one prescription psychotherapeutic drug. The prevalence of dependence or abuse among past year misusers of any psychotherapeutic drug was higher for youths aged 12 to 17 than for young adults aged 18 to 25.
For any psychotherapeutic drug, pain relievers, tranquilizers, and stimulants, the risk of dependence or abuse for psychotherapeutic drugs was greater for persons aged 18 or older who initiated nonmedical use before age 16 compared with those who initiated use at age 16 or older. For sedatives there was no significant difference in rates of dependence or abuse by age at first use.
An estimated 290,000 persons who met the criteria for past year dependence or abuse for psychotherapeutic drugs received treatment in the past year for use of any illicit drug, and 209,000 received their last or most current past year treatment specifically for a psychotherapeutic drug they were dependent on or abusing. Thus, the large majority of persons aged 12 or older who were dependent on or abusing prescription psychotherapeutic drugs in the past year did not receive illicit drug use treatment in the past year.
6.1. Background
NSDUH includes a series of questions to assess the prevalence of substance use disorders (i.e., dependence on or abuse of a substance) in the past 12 months. These questions are used to classify persons as dependent on or abusing specific substances based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) (American Psychiatric Association [APA], 1994). The questions on dependence ask about continued use despite health or emotional problems associated with substance use, unsuccessful attempts to cut down on use, tolerance (e.g., requiring larger amounts of a substance to get desired effects), withdrawal symptoms, reducing other activities in order to use substances, spending a lot of time engaging in activities related to substance use, or using the substance in greater quantities or for a longer time than intended. The questions on abuse ask about problems at work, home, and school; problems with family or friends; physical danger; and trouble with the law due to substance use.
Dependence is considered to be a more severe substance use problem than abuse. Although individuals may meet the criteria specified for both dependence and abuse, persons are classified with abuse of a particular substance only if they are not classified as dependent on that substance. In this chapter, persons meeting the criteria for either dependence or abuse are counted together. It should be noted that the NSDUH questionnaire does not include specific dependence and abuse questions for methamphetamine because the DSM-IV criteria pertain to stimulants as a whole.
6.2. Trends in Dependence or Abuse
The estimated numbers and rates of past year prescription drug dependence or abuse for any psychotherapeutic drug and the specific drug classes did not change significantly from 2002 to 2004 among persons aged 12 or older (Figure 6.1 and Table 6.1). In 2004, approximately 2.0 million persons aged 12 or older met the criteria for dependence or abuse involving any prescription psychotherapeutic drug that was used nonmedically, including 1.4 million for pain relievers, 573,000 for tranquilizers, 470,000 for stimulants, and 128,000 for sedatives.
Figure 6.1 Substance Dependence or Abuse for Nonmedical Use of Prescription Psychotherapeutic Drugs in the Past Year for Persons Aged 12 or Older, by Drug Type: Numbers (in Thousands), 2002-2004
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a Difference between this estimate and the 2004 estimate is statistically significant at the .05 level.
b Difference between this estimate and the 2004 estimate is statistically significant at the .01 level.
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.
Within separate age groups, few year-to-year changes in the rates of dependence or abuse reached statistical significance. Among youths aged 12 to 17, the rate of pain reliever dependence or abuse increased from 1.0 percent in 2002 to 1.2 percent in 2004 (Figure 6.2). Among young adults aged 18 to 25, dependence or abuse involving this class of drugs increased from 1.1 percent in 2003 to 1.4 percent in 2004, but this change simply restored the rate observed in 2002 (1.4 percent). The apparent decline in the rate of pain reliever dependence or abuse among adults aged 26 or older was not statistically significant. There were no statistically significant changes in the rates of abuse or dependence for specific age groups for other classes of psychotherapeutic drugs that were used nonmedically.
Figure 6.2 Substance Dependence or Abuse for Nonmedical Use of Prescription Pain Relievers in the Past Year, by Age Group: Percentages, 2002-2004
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a Difference between this estimate and the 2004 estimate is statistically significant at the .05 level.
b Difference between this estimate and the 2004 estimate is statistically significant at the .01 level.
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.
6.3. Demographic Differences in Dependence or Abuse
Data aggregated for 2002, 2003, and 2004 provide sufficient numbers of respondents to permit reliable examination of differences in past year dependence or abuse for any prescription psychotherapeutic drug and the four therapeutic classes of psychotherapeutic drugs according to age, gender, race/ethnicity, and other covariates (Table 6.2). Consistent with the single-year trend data, combined data from the 2002 through 2004 surveys yielded an annual average of 2.0 million persons aged 12 or older who met the criteria for prescription psychotherapeutic drug dependence or abuse in the past year. Annual average numbers of people aged 12 or older who met dependence or abuse criteria for specific classes of psychotherapeutic drugs were 1.4 million for pain relievers, 505,000 for tranquilizers, 424,000 for stimulants, and 147,000 for sedatives.
As shown in Figure 6.3, young adults aged 18 to 25 had the highest rates of past year dependence or abuse involving pain relievers, tranquilizers, and stimulants, the three most frequently reported classes of nonmedically used prescription psychotherapeutic drugs. Youths aged 12 to 17 had the second highest rates of dependence or abuse involving these drugs. Rates of dependence or abuse among adults aged 50 or older were lowest for each of these drug classes.
Overall, rates of past year dependence and abuse were comparable for males and females for any misused prescription psychotherapeutic drug and each of the therapeutic drug classes (Table 6.2). When gender differences are considered for different age groups, however, a different pattern emerges. Among youths aged 12 to 17, the rate of dependence or abuse was higher among females than males for any prescription psychotherapeutic drug (1.8 vs. 1.1 percent, respectively), pain relievers (1.4 vs. 0.8 percent), tranquilizers (0.4 vs. 0.3 percent), and stimulants (0.5 vs. 0.3 percent) (Figure 6.4). For young adults aged 18 to 25, however, males were more likely than females to meet the criteria for past year pain reliever dependence or abuse (1.4 vs. 1.1 percent).
Figure 6.3 Substance Dependence or Abuse for Nonmedical Use of Pain Relievers, Tranquilizers, and Stimulants in the Past Year, by Age Group: Annual Averages Based on 2002-2004
D
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.
Figure 6.4 Substance Dependence or Abuse for Nonmedical Use of Pain Relievers in the Past Year, by Age Group and Gender: Annual Averages Based on 2002-2004
D
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.
Considered by race/ethnicity, the rate of past year dependence or abuse involving any nonmedically used prescription psychotherapeutic drug was higher for American Indians or Alaska Natives (2.0 percent) and whites (0.9 percent) than for blacks (0.5 percent) or Asians (0.5 percent) (Figure 6.5 and Table 6.2). However, whites and Hispanics had similar rates (0.8 percent for Hispanics). Rates also were not significantly different between whites and American Indians or Alaska Natives. Although the rate of dependence or abuse appeared to be high for Native Hawaiians or Other Pacific Islanders, it was not significantly different from other rates shown in Figure 6.5.
A similar pattern of differences held for pain relievers (0.6 percent for whites and Hispanics, 0.4 percent for blacks, and 0.3 percent for Asians). For pain relievers, the rate of dependence or abuse also was higher among American Indians or Alaska Natives (1.2 percent) than blacks or Asians. Past year dependence or abuse involving tranquilizers was higher among American Indian or Alaska Natives (0.9 percent) than among whites (0.2 percent) or blacks (0.1 percent); the rates for whites and Hispanics (0.2 percent) also were higher than that for blacks.
Figure 6.5 Substance Dependence or Abuse for Nonmedical Use of Any Prescription Psychotherapeutic Drug in the Past Year, by Race/Ethnicity: Annual Averages Based on 2002-2004
D
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.
6.4. Geographic Differences in Dependence or Abuse
Small but statistically significant regional differences were observed in rates of past year dependence or abuse involving some prescription-type psychotherapeutic drugs that were used nonmedically (Table 6.3).1 The rate for past year dependence or abuse involving any prescription psychotherapeutic drug was higher in the West (1.0 percent) and South (0.9 percent) than in the Northeast (0.7 percent) and Midwest (0.7 percent). Regional differences also were found in the rates of dependence on or abuse of pain relievers and tranquilizers. For pain relievers, the rate of past year dependence or abuse was higher in the South (0.7 percent) and West (0.6 percent) than in the Midwest (0.5 percent). For tranquilizers, dependence or abuse was more prevalent in the South (0.3 percent) than in the West (0.2 percent) or Midwest (0.2 percent).
Differences in the rate of past year dependence or abuse were found by census division for any prescription psychotherapeutic drug, pain relievers, tranquilizers, and stimulants (Table 6.3). For any psychotherapeutic drug, the rate of dependence or abuse was lower in the Middle Atlantic (0.6 percent) and West North Central (0.6 percent) Divisions than in the East South Central (1.2 percent), Pacific (1.0 percent), West South Central (1.0 percent), Mountain (0.9 percent), and South Atlantic (0.8 percent) Divisions (Figure 6.6). The rate in the East North Central Division (0.7 percent) was lower than that in the East South Central, West South Central, Mountain, and Pacific Divisions. Although the New England Division appeared to have a high prevalence of dependence or abuse for any psychotherapeutic drug (1.1 percent), only the West North Central Division had a significantly lower rate than that for New England.
Figure 6.6 Substance Dependence or Abuse for Nonmedical Use of Any Prescription Psychotherapeutic Drug in the Past Year, by Census Division: Annual Averages Based on 2002-2004
D
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.
The rank ordering of the census divisions by the rate of past year pain reliever dependence or abuse generally was similar to that for any prescription psychotherapeutic drug. One exception for pain relievers was that the West North Central Division had the lowest rate (0.3 percent), followed by the Middle Atlantic Division (0.4 percent). The rates in those census divisions were lower than those in the East South Central (1.0 percent), New England (0.9 percent), West South Central (0.7 percent), Pacific (0.7 percent), and Mountain (0.6 percent) Divisions.
Past year dependence and abuse varied by county type for any prescription psychotherapeutic drug, pain relievers, and stimulants. For any psychotherapeutic drug, the highest rate of past year dependence or abuse occurred in counties in small metropolitan areas with fewer than 250,000 population (1.2 percent); the lowest rate was found in completely rural counties (0.6 percent). This same pattern held for pain relievers (0.9 and 0.4 percent, respectively). For stimulants, the rate of dependence or abuse was somewhat lower in large metropolitan areas (0.1 percent) than in small metropolitan areas with fewer than 1 million population (0.2 percent) and less urbanized nonmetropolitan counties (0.3 percent).
Further information on geographic differences can be found in Chapter 7, which presents estimates by State.
6.5. Dependence or Abuse among Past Year Users
To some extent, variations in the rates of past year dependence or abuse are driven by differences in the rates of past year use. In this section, the rate of dependence or abuse involving prescription drugs is examined among users of the respective drugs to address questions of the relative propensity of persons in a particular demographic group or users of a particular drug to exhibit dependence or abuse once they have used the drug. The statistics discussed here sometimes are referred to as "conditional rates" because they refer to the rate of dependence or abuse, given use in the same time period.
Overall, aggregate data for 2002, 2003, and 2004 indicate that 13.5 percent of past year nonmedical users of any prescription-type psychotherapeutic drug met the criteria for dependence on or abuse of any such drug (Table 6.4). For the four therapeutic drug classes, the conditional rates of dependence or abuse were 12.7 percent for pain relievers, 10.1 percent for tranquilizers, 14.4 percent for stimulants, and 17.3 percent for sedatives.
Nonmedical users aged 12 to 17 had higher rates of dependence or abuse than those aged 18 to 25 regardless of the drug class (Figure 6.7). For any psychotherapeutic drug, 15.9 percent of youths aged 12 to 17 and 12.7 percent of young adults aged 18 to 25 who were past year users met the criteria for dependence or abuse. For pain relievers, adults aged 26 or older had higher conditional rates of dependence or abuse than young adults (13.3 vs. 10.9 percent). For tranquilizers, the rate for youths (15.3 percent) was higher than that for either young adults (9.2 percent) or adults aged 26 or older (9.7 percent).
Male and female past year nonmedical users of prescription drugs did not differ significantly in the rate of past year dependence on or abuse of those drugs, either overall or for the respective therapeutic drug classes. For example, the conditional rates of pain reliever dependence or abuse were 12.4 percent for males and a comparable 13.2 percent for females.
Figure 6.7 Substance Dependence or Abuse for Nonmedical Use of Prescription Psychotherapeutic Drugs in the Past Year among Past Year Nonmedical Users of Those Drugs, by Drug Type and Age Group: Annual Averages Based on 2002-2004
D
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.
6.6. Dependence or Abuse as a Function of Age at First Use
Table 6.5 presents information on the rates of past year dependence on or abuse of prescription drugs among lifetime nonmedical users aged 18 or older according to the age at which they first used those drugs. Except for sedatives, the risk of dependence or abuse was higher among persons who initiated nonmedical use before age 16 compared with those who were age 16 or older when they first used the respective drugs (Figure 6.8). This same pattern held for lifetime nonmedical users aged 18 to 25 and for those aged 26 or older. For example, 6.6 percent of persons aged 26 or older who were lifetime misusers of pain relievers and who initiated use before age 16 met the criteria for pain reliever dependence or abuse. Among lifetime pain reliever misusers in this age group who initiated use after age 16, only 3.3 percent met the criteria for dependence or abuse. Although this general pattern also was observed for sedatives, the rates of dependence or abuse were not significantly different between persons who initiated nonmedical sedative use before age 16 and those who initiated use at age 16 or older.
Figure 6.8 Past Year Substance Dependence or Abuse for Nonmedical Use of Prescription Psychotherapeutic Drugs among Lifetime Users Aged 18 or Older, by Drug Type and Age at First Use: Annual Averages Based on 2002-2004
D
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.
6.7. Treatment for Any Illicit Drug Use
This section presents findings on treatment received in the past year to stop or reduce the use of any illicit drug or for medical problems associated with misusing these drugs among persons who met the criteria for dependence on or abuse of prescription drugs in the past year. This measure includes treatment received in the past year at any location, such as a hospital (inpatient), rehabilitation facility (outpatient or inpatient), mental health center, emergency room, private doctor's office, prison or jail, or a self-help group, such as Alcoholics Anonymous or Narcotics Anonymous. Treatment at a specialty facility in the past year includes only treatment at a hospital (inpatient), a rehabilitation facility (inpatient or outpatient), or a mental health center. Findings for these analyses are shown in Table s 6.6 and 6.7.
In 2002, 2003, and 2004, an annual average of 290,000 persons received treatment for illicit drug use in the past year and met the criteria for dependence on or abuse of prescription psychotherapeutic drugs in the past year. This number includes treatment at any type of facility, both specialty and nonspecialty. Among the therapeutic classes of prescription drugs, those treated included an annual average of 210,000 persons who were dependent on or abusing pain relievers, 106,000 who were dependent on or abusing tranquilizers, 104,000 who were dependent on or abusing stimulants, and 39,000 who were dependent on or abusing sedatives (Table 6.6).2 The percentages receiving treatment for illicit drug use in the past year constituted 14.5 percent of those dependent on or abusing any prescription drug, 14.6 percent for pain relievers, 21.1 percent for tranquilizers, and 24.2 percent for stimulants. Too few persons met the criteria for dependence on or abuse of sedatives to produce estimates with adequate precision (see Appendix B for a discussion of precision requirements).
Rates of past year specialty treatment for any illicit drug among those dependent on or abusing prescription psychotherapeutic drugs in the past year were 12.5 percent for any psychotherapeutic drug, 12.9 percent for pain relievers, 19.3 percent for tranquilizers, and 20.4 percent for stimulants (Table 6.7). Viewing these findings from a different perspective, an estimated 87.5 percent of those meeting the criteria for dependence on or abuse of a prescription psychotherapeutic drug in the past year did not receive specialty treatment for any illicit drug use in that period, and 85.5 percent did not receive any treatment in the past year, either at a specialty or nonspecialty facility.
Receipt of past year specialty treatment among persons dependent on or abusing prescription psychotherapeutic drugs in the past year varied by drug category and age. The rate of treatment for an illicit drug problem was lower for persons aged 12 to 17 who were dependent on or abusing any psychotherapeutic drug (7.9 percent) than for their counterparts who were aged 18 to 25 (12.7 percent) or aged 26 or older (13.9 percent).
6.8. Treatment for Problems Related to Nonmedical Prescription Drug Use
For a subset of persons who received treatment for illicit drugs in the past year, it is possible to identify those whose treatment was specifically for problems resulting from nonmedical use of prescription psychotherapeutic drugs. These data are presented in Table 6.8 and pertain to persons whose last or current treatment in the past year was for one or more prescription psychotherapeutic drugs. Treatment at any type of facility—not necessarily specialty facilities—is included. An annual average of 209,000 persons treated in the past year met the criteria for dependence on or abuse of any prescription psychotherapeutic drug and received their last or current treatment for problems with any psychotherapeutic drug. Similarly, 135,000 persons met the dependence or abuse criteria and received their last or current treatment for pain relievers, 50,000 did so for tranquilizers, 64,000 did so for stimulants, and 34,000 did so for sedatives. Further estimates are not available for those treated for problems with sedatives due to small numbers.
Among those dependent on or abusing any prescription-type psychotherapeutic in the past year, 10.5 percent received treatment in the past year specifically for one or more psychotherapeutic drugs. Comparable rates for other psychotherapeutic drug categories were 9.4 percent for pain relievers, 9.8 percent for tranquilizers, and 15.0 percent for stimulants. As was the case for treatment for any illicit drug in the past year, the percentage of persons who were dependent on or abusing any psychotherapeutic drug and who last received treatment for one or more of these drugs was lower for persons aged 12 to 17 than for those aged 18 to 25 (6.5 vs. 11.6 percent). Persons aged 12 to 17 who were dependent on or abusing stimulants also were less likely than their counterparts aged 18 to 25 to have received treatment for their problems with stimulants during their last or current treatment episode (10.0 vs. 19.0 percent). There were no significant differences by gender.
6.9. Summary
This chapter presented findings for substance dependence, abuse, and treatment in the past year related to the nonmedical use of prescription psychotherapeutic drugs. The chapter also presented data on selected correlates of dependence or abuse, based on combined data from the 2002 through 2004 surveys. In addition, findings were presented for treatment for nonmedical psychotherapeutic drug use based on the combined data.
Trend data indicated that rates of dependence or abuse for nonmedical use of psychotherapeutic drugs among persons aged 12 or older did not change significantly from 2002 to 2004. In 2004, approximately 2.0 million persons aged 12 or older met the criteria for dependence or abuse involving any prescription psychotherapeutic drug that was used nonmedically, including 1.4 million for pain relievers, 573,000 for tranquilizers, 470,000 for stimulants, and 128,000 for sedatives.
The prevalence of dependence or abuse was higher among young adults aged 18 to 25 for pain relievers, tranquilizers, and stimulant compared with the rates in other age groups; these findings were based on combined data from the 2002 through 2004 surveys. Males and females aged 12 or older had comparable rates of dependence or abuse, but gender differences occurred within specific age groups. Among youths aged 12 to 17, females had higher rates of dependence or abuse involving any psychotherapeutic drug, pain relievers, tranquilizers, and stimulants than did males. For young adults aged 18 to 25, however, males were more likely than females to meet the criteria for dependence or abuse involving pain relievers. The rate of dependence or abuse for any prescription psychotherapeutic drug was higher for American Indians or Alaska Natives and whites than for blacks or Asians. Regional differences in rates of dependence or abuse for psychotherapeutic drugs were small, although some differences were significant.
Among persons who used psychotherapeutic drugs nonmedically in the past year, 13.5 percent met the criteria for dependence on or abuse of at least one prescription psychotherapeutic drug. The prevalence of dependence or abuse among past year misusers of any psychotherapeutic drug was higher for youths aged 12 to 17 than for young adults aged 18 to 25.
For any psychotherapeutic drug, pain relievers, tranquilizers, and stimulants, the risk of dependence or abuse for psychotherapeutic drugs was greater for persons aged 18 or older who initiated nonmedical use before age 16 compared with those who initiated use at age 16 or older. For sedatives there was no significant difference in rates of dependence or abuse by age at first use.
An estimated 290,000 persons who met the criteria for past year dependence or abuse for psychotherapeutic drugs received treatment in the past year for use of any illicit drug, and 209,000 received their last or most current past year treatment specifically for a psychotherapeutic drug they were dependent on or abusing. Thus, the large majority of persons aged 12 or older who were dependent on or abusing prescription psychotherapeutic drugs in the past year did not receive illicit drug use treatment in the past year.
November 01, 2010
Mood Disorders
MOOD DISORDERS CEUs
How much of the population is affected by mood disorders?
Each year, almost 44 million Americans experience a mental disorder. In fact, mental illnesses are among the most common conditions affecting health today.
What causes mood disorders / mental illness?
Researchers believe most serious mental illnesses are caused by complex imbalances in the brain's chemical activity. They also believe environmental factors can play a part in triggering, or cushioning against, the onset of mental illness.
Are mood disorders treatable?
Like other diseases, mental illnesses can be treated. The good news is that most people who have mental illnesses, even serious ones, can lead productive lives with proper treatment. Mood disorders are one form of serious mental illness.
What are some common mood disorders?
Two of the most common mood disorders are depression and bipolar disorder, also known as manic-depressive illness.
Bipolar Disorder
Description: Extreme mood swings punctuated by periods of generally even-keeled behavior characterize this disorder. Bipolar disorder tends to run in families. This disorder typically begins in the mid-twenties and continues throughout life. Without treatment, people who have bipolar disorder often go through devastating life events such as marital breakups, job loss, substance abuse, and suicide.
Symptoms: Mania-expansive or irritable mood, inflated self-esteem, decreased need for sleep; increased energy; racing thoughts; feelings of invulnerability; poor judgment; heightened sex drive; and denial that anything is wrong. Depression-feelings of hopelessness, guilt, worthlessness, or melancholy; fatigue; loss of appetite for food or sex; sleep disturbances, thoughts of death or suicide; and suicide attempts. Mania and depression may vary in both duration and degree of intensity.
Formal Diagnosis: Although scientific evidence indicates bipolar disorder is caused by chemical imbalances in the brain, no lab test exists to diagnose the disorder. In fact, this mental illness often goes unrecognized by the person who has it, relatives, friends, or even physicians. The first step of diagnosis is to receive a complete medical evaluation to rule out any other mental or physical disorders. Anyone who has this mental illness should be under the care of a psychiatrist skilled in the diagnosis and treatment of bipolar disorder.
Treatment: Eighty to ninety percent of people who have bipolar disorder can be treated effectively with medication and psychotherapy. Self-help groups can offer emotional support and assistance in recognizing signs of relapse to avert a full-blown episode of bipolar disorder. The most commonly prescribed medications to treat bipolar disorder are three mood stabilizers: lithium carbonate, carbamazepine, and valproate.
Depression
Description: When a person's feelings of sadness persist beyond a few weeks, he or she may have depression. According to the National Institute for Mental Health, three to four million men are affected by depression; it affects twice as many women. Researchers do not know the exact mechanisms that trigger depression. Two neurotransmitters-natural substances that allow brain cells to communicate with one another-are implicated in depression: serotonin and norepinephrine.
Symptoms: Changes in appetite and sleeping patterns; feelings of worthlessness, hopelessness, and inappropriate guilt; loss of interest or pleasure in formerly important activities; fatigue; inability to concentrate; overwhelming sadness; disturbed thinking; physical symptoms such as headaches or stomachaches; and suicidal thoughts or behaviors.
Formal Diagnosis: Four or more of the previous symptoms have been present continually, or most of the time, for more than 2 weeks. The term clinical depression merely means the episode of depression is serious enough to require treatment. Major depression is marked by far more severe symptoms, such as literally being unable to drag oneself out of bed. Another form of depression, known as seasonal affective disorder, is associated with seasonal changes in the amount of available daylight.
Treatment: Some types of cognitive/behavioral therapy and interpersonal therapy may be as effective as medications for some people who have depression. Special bright light helps many people who have seasonal affective disorder.
Three major types of medication are used to treat depression: tricyclics; the newer selective serotonin re-uptake inhibitors (SSRIs), and monoamine oxidase inhibitors (MAO inhibitors). Electroconvulsive therapy uses small amounts of electricity applied to the scalp to affect neurotransmitters in the brain. Usually referred to as ECT, this highly controversial and potentially life-saving technique is considered only when other therapies have failed, when a person is seriously medically ill and/or unable to take medication, or when a person is very likely to commit suicide. Substantial improvements in the equipment, dosing guidelines and anesthesia have significantly reduced the possibility of side effects.
For more information and referrals to specialists and self-help groups in your State, contact:
Depression and Bipolar Support Alliance (DBSA) (formerly the National Depressive and Manic-Depressive Association)
730 N. Franklin Street, Suite 501
Chicago, IL 60601-3526
Telephone: 800-826-3632
Fax: 312-642-7243
www.dbsalliance.org
How much of the population is affected by mood disorders?
Each year, almost 44 million Americans experience a mental disorder. In fact, mental illnesses are among the most common conditions affecting health today.
What causes mood disorders / mental illness?
Researchers believe most serious mental illnesses are caused by complex imbalances in the brain's chemical activity. They also believe environmental factors can play a part in triggering, or cushioning against, the onset of mental illness.
Are mood disorders treatable?
Like other diseases, mental illnesses can be treated. The good news is that most people who have mental illnesses, even serious ones, can lead productive lives with proper treatment. Mood disorders are one form of serious mental illness.
What are some common mood disorders?
Two of the most common mood disorders are depression and bipolar disorder, also known as manic-depressive illness.
Bipolar Disorder
Description: Extreme mood swings punctuated by periods of generally even-keeled behavior characterize this disorder. Bipolar disorder tends to run in families. This disorder typically begins in the mid-twenties and continues throughout life. Without treatment, people who have bipolar disorder often go through devastating life events such as marital breakups, job loss, substance abuse, and suicide.
Symptoms: Mania-expansive or irritable mood, inflated self-esteem, decreased need for sleep; increased energy; racing thoughts; feelings of invulnerability; poor judgment; heightened sex drive; and denial that anything is wrong. Depression-feelings of hopelessness, guilt, worthlessness, or melancholy; fatigue; loss of appetite for food or sex; sleep disturbances, thoughts of death or suicide; and suicide attempts. Mania and depression may vary in both duration and degree of intensity.
Formal Diagnosis: Although scientific evidence indicates bipolar disorder is caused by chemical imbalances in the brain, no lab test exists to diagnose the disorder. In fact, this mental illness often goes unrecognized by the person who has it, relatives, friends, or even physicians. The first step of diagnosis is to receive a complete medical evaluation to rule out any other mental or physical disorders. Anyone who has this mental illness should be under the care of a psychiatrist skilled in the diagnosis and treatment of bipolar disorder.
Treatment: Eighty to ninety percent of people who have bipolar disorder can be treated effectively with medication and psychotherapy. Self-help groups can offer emotional support and assistance in recognizing signs of relapse to avert a full-blown episode of bipolar disorder. The most commonly prescribed medications to treat bipolar disorder are three mood stabilizers: lithium carbonate, carbamazepine, and valproate.
Depression
Description: When a person's feelings of sadness persist beyond a few weeks, he or she may have depression. According to the National Institute for Mental Health, three to four million men are affected by depression; it affects twice as many women. Researchers do not know the exact mechanisms that trigger depression. Two neurotransmitters-natural substances that allow brain cells to communicate with one another-are implicated in depression: serotonin and norepinephrine.
Symptoms: Changes in appetite and sleeping patterns; feelings of worthlessness, hopelessness, and inappropriate guilt; loss of interest or pleasure in formerly important activities; fatigue; inability to concentrate; overwhelming sadness; disturbed thinking; physical symptoms such as headaches or stomachaches; and suicidal thoughts or behaviors.
Formal Diagnosis: Four or more of the previous symptoms have been present continually, or most of the time, for more than 2 weeks. The term clinical depression merely means the episode of depression is serious enough to require treatment. Major depression is marked by far more severe symptoms, such as literally being unable to drag oneself out of bed. Another form of depression, known as seasonal affective disorder, is associated with seasonal changes in the amount of available daylight.
Treatment: Some types of cognitive/behavioral therapy and interpersonal therapy may be as effective as medications for some people who have depression. Special bright light helps many people who have seasonal affective disorder.
Three major types of medication are used to treat depression: tricyclics; the newer selective serotonin re-uptake inhibitors (SSRIs), and monoamine oxidase inhibitors (MAO inhibitors). Electroconvulsive therapy uses small amounts of electricity applied to the scalp to affect neurotransmitters in the brain. Usually referred to as ECT, this highly controversial and potentially life-saving technique is considered only when other therapies have failed, when a person is seriously medically ill and/or unable to take medication, or when a person is very likely to commit suicide. Substantial improvements in the equipment, dosing guidelines and anesthesia have significantly reduced the possibility of side effects.
For more information and referrals to specialists and self-help groups in your State, contact:
Depression and Bipolar Support Alliance (DBSA) (formerly the National Depressive and Manic-Depressive Association)
730 N. Franklin Street, Suite 501
Chicago, IL 60601-3526
Telephone: 800-826-3632
Fax: 312-642-7243
www.dbsalliance.org
Continuing Education for Marriage and Family Therapists, Social Workers, & Licensed Professional Counselors
Continuing Education for Marriage and Family Therapists, Social Workers, Licensed Professional Counselors, and other Human Service Providers nationwide
Aspira Continuing Education Offers
Refer a Colleague and get Free CEUs!
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Private Practice Tools
The Counselor Connection is a comprehensive and simple service that connects clients with a therapist who can best meet their specific needs, circumstances and values.
Aspira Continuing Education Offers
Refer a Colleague and get Free CEUs!
When you refer a colleague to Aspira, simply ask them to enter a code of "REFERRAL" when they check out. In order for you to get the credit, though, they will need to know the email address you signed up with and enter it when prompted.
--------------------------------------------------------------------------------
Save Money when you buy an Annual Subscription
When you purchase an annual subscription, you can bring the cost of your continuing education to less than $4.00 an hour. To take advantage of this money-saving offer, visit our purchase page.
--------------------------------------------------------------------------------
Holiday Discount for November and December
Enter the code “HolidaySpecial” on our purchase page in the text box at the top of the page next to "Enter offer code", click on the submit button immediately to the right of this text box, and receive 10% off all purchases for the months of November and December! (Submit the code prior to entering any other information on the rest of the purchase page. This code is valid for all purchases made during the two months of November and December of 2010. Offer expires on December 31, 2010).
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Private Practice Tools
The Counselor Connection is a comprehensive and simple service that connects clients with a therapist who can best meet their specific needs, circumstances and values.
Mental Health Screenings and Trauma-Related Counseling in Substance Abuse Treatment Facilities
Mental Health Screenings and Trauma-Related Counseling in Substance Abuse Treatment FacilitiesIn Brief •In 2009, more than half (62 percent) of all substance abuse treatment facilities provided brief mental health screenings that could be used to identify clients in need of trauma services; less than half (42 percent) provided full diagnostic mental health assessments
•Facilities that primarily focused on a mix of mental health and substance abuse treatment services were more likely than facilities with other primary focuses to report using trauma counseling "always or often" (30 vs. 16 to 26 percent)
•Facilities that were operated by tribal governments (55 percent) were more likely than facilities that were operated by the Federal Government (37 percent), private for-profit organizations (36 percent), private non-profit organizations (35 percent), or State or local, county, or community governments (32 percent each) to offer domestic violence services
Research shows that the experience of traumatic events and the possible sequelae of posttraumatic stress disorder (PTSD) often co-occur with a substance abuse disorder1 and are present among many substance abuse treatment clients.2 Common types of trauma include being exposed to a natural disaster or violence in combat or noncombat situations and experiencing physical assault or domestic violence. Because of the relationship between substance use and trauma-related mental health problems, it is recommended that substance abuse treatment facilities offer mental health screenings and assessments to determine whether or not a client is suffering from a trauma-related illness3 and/or has been involved in domestic violence.4
This report explores the extent to which mental health screenings, mental health assessments, trauma-related counseling, and domestic violence services are provided in substance abuse treatment facilities. The provision of these services in treatment facilities is captured by the 2009 National Survey of Substance Abuse Treatment Services (N-SSATS).
Mental Health Screenings and Assessments
Mental health screenings and assessments can be used in treatment facilities to identify clients who have been exposed to one or more traumatic events and who have problematic symptoms associated with such exposure. The Center for Substance Abuse Treatment (CSAT) guidelines for best practice with substance abuse treatment clients differentiate between mental health screenings and mental health assessments. Screenings assist in identifying substance abuse clients that show signs of mental health problems by asking questions that elicit a yes or no response; assessments define the nature of the mental health problem and gather more detailed information that may be used to develop treatment plans for clients with co-occurring mental health and substance abuse problems.5
More than half (62 percent) of the 13,513 treatment facilities that responded to N-SSATS provided brief mental health screenings for clients, but less than half (42 percent) provided full diagnostic mental health assessments. Facilities with a primary focus on mental health services, a mix of mental health and substance abuse treatment services, or general health care were more likely than facilities that primarily focused only on substance abuse treatment services to provide mental health screenings or mental health assessments (Figure 1).
Figure 1. Facilities Providing Mental Health Screenings or Assessments, by Primary Focus of Treatment Facility: 2009
Source: 2009 SAMHSA National Survey of Substance Abuse Treatment Services (N-SSATS).
Figure 1 Table. Facilities Providing Mental Health Screenings or Assessments, by Primary Focus of Treatment Facility: 2009 Primary Focus Mental Health Screenings Mental Health Assessments
Substance Abuse Treatment Services 45% 20%
Mental Health Services 94% 89%
Mix of Mental Health and Substance Abuse Treatment Services 90% 76%
General Health Care 85% 75%
Other/Unknown 53% 21%
Source: 2009 SAMHSA National Survey of Substance Abuse Treatment Services (N-SSATS).
Treatment facilities that were operated by the Federal Government (68 percent) were more likely than facilities operated by State governments (52 percent); local, county, or community governments (50 percent); private non-profit organizations (43 percent); tribal governments (40 percent); or private for-profit organizations (36 percent) to provide mental health assessments (Figure 2). Additionally, facilities that were operated by the Federal Government (79 percent) were more likely than those operated by other types of governments or organizations to provide mental health screenings.
It is recommended that substance abuse treatment providers screen all clients in substance abuse treatment for exposure to domestic violence in order to identify batterers and survivors. After substance abuse treatment providers identify those clients who have been involved in domestic violence, the provider may then determine what services the clients may need.4 Domestic violence services may include, for example, specialized counseling, medical services, or legal services.
N-SSATS provides information regarding whether or not treatment facilities offer domestic violence services. In 2009, less than half (35 percent) of treatment facilities offered domestic violence services. Facilities that primarily focused on a mix of mental health and substance abuse treatment services (46 percent) or general health care (44 percent) were more likely than those that focused on mental health services (37 percent) or substance abuse treatment services (30 percent) to offer domestic violence services.
Discussion
Mental health problems, specifically those related to trauma and/or domestic violence, often co-occur with substance abuse. Mental health screenings Mental health problems, specifically those related to trauma and/or domestic violence, often co-occur with substance abuse. Mental health screenings and assessments may be used by substance abuse treatment facilities to identify clients who are suffering from mental health problems related to trauma. By first identifying these clients, treatment providers may then develop a comprehensive treatment plan and assist clients with gaining access to trauma-related services. Treatment plans for clients with these co-occurring problems should address their substance abuse and incorporate evidenced-based interventions that aim to reduce the biological, psychological, and behavioral symptoms associated with trauma.6
The data in this report provide a snapshot of the extent to which the treatment system is identifying and providing certain services to clients suffering from co-occurring substance abuse and trauma-related mental health problems. This information may be used to increase public health awareness about substance abuse and trauma-related mental health problems, and inform behavioral health care reform initiatives that increase the treatment system’s capacity to provide needed trauma-related services to substance abuse clients.
End Notes
1 Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048-1060.
2 Nanjavits, L. M. (2002). Clinicians’ views on treating posttraumatic stress disorder and substance use disorder. Journal of Substance Abuse Treatment, 22, 79-85.
3 Center for Substance Abuse Treatment. (1995). Anxiety disorders. In Assessment and treatment of patients with coexisting mental illness and alcohol and other drug abuse (Treatment Improvement Protocol [TIP] Series 9, DHHS Publication No. SMA 95-3061). Rockville, MD: Substance Abuse and Mental Health Services. (Original work published 1994) Retrieved from http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hssamhsatip&part=A30236
4 Fazzone, P. A., Holton, J. K., & Reed, B. G. (Consensus Panel Co-Chairs); Center for Substance Abuse Treatment. (1997). Substance abuse treatment and domestic violence (Treatment Improvement Protocol [TIP] Series 25, DHHS Publication No. SMA 97-3163). Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hssamhsatip&part=A46712
5Sacks, S., & Ries, R. K. (Consensus Panel Co-Chairs); Center for Substance Abuse Treatment. (2005). Substance abuse treatment for persons with co-occurring disorders (Treatment Improvement Protocol [TIP] Series 42, DHHS Publication No. SMA 05-3922). Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hssamhsatip&part=A74073
6 Shalev, A., Bonne, O., & Eth, S. (1996). Treatment of post traumatic stress disorder: A review. Psychosomatic Medicine, 58, 165-182.
•Facilities that primarily focused on a mix of mental health and substance abuse treatment services were more likely than facilities with other primary focuses to report using trauma counseling "always or often" (30 vs. 16 to 26 percent)
•Facilities that were operated by tribal governments (55 percent) were more likely than facilities that were operated by the Federal Government (37 percent), private for-profit organizations (36 percent), private non-profit organizations (35 percent), or State or local, county, or community governments (32 percent each) to offer domestic violence services
Research shows that the experience of traumatic events and the possible sequelae of posttraumatic stress disorder (PTSD) often co-occur with a substance abuse disorder1 and are present among many substance abuse treatment clients.2 Common types of trauma include being exposed to a natural disaster or violence in combat or noncombat situations and experiencing physical assault or domestic violence. Because of the relationship between substance use and trauma-related mental health problems, it is recommended that substance abuse treatment facilities offer mental health screenings and assessments to determine whether or not a client is suffering from a trauma-related illness3 and/or has been involved in domestic violence.4
This report explores the extent to which mental health screenings, mental health assessments, trauma-related counseling, and domestic violence services are provided in substance abuse treatment facilities. The provision of these services in treatment facilities is captured by the 2009 National Survey of Substance Abuse Treatment Services (N-SSATS).
Mental Health Screenings and Assessments
Mental health screenings and assessments can be used in treatment facilities to identify clients who have been exposed to one or more traumatic events and who have problematic symptoms associated with such exposure. The Center for Substance Abuse Treatment (CSAT) guidelines for best practice with substance abuse treatment clients differentiate between mental health screenings and mental health assessments. Screenings assist in identifying substance abuse clients that show signs of mental health problems by asking questions that elicit a yes or no response; assessments define the nature of the mental health problem and gather more detailed information that may be used to develop treatment plans for clients with co-occurring mental health and substance abuse problems.5
More than half (62 percent) of the 13,513 treatment facilities that responded to N-SSATS provided brief mental health screenings for clients, but less than half (42 percent) provided full diagnostic mental health assessments. Facilities with a primary focus on mental health services, a mix of mental health and substance abuse treatment services, or general health care were more likely than facilities that primarily focused only on substance abuse treatment services to provide mental health screenings or mental health assessments (Figure 1).
Figure 1. Facilities Providing Mental Health Screenings or Assessments, by Primary Focus of Treatment Facility: 2009
Source: 2009 SAMHSA National Survey of Substance Abuse Treatment Services (N-SSATS).
Figure 1 Table. Facilities Providing Mental Health Screenings or Assessments, by Primary Focus of Treatment Facility: 2009 Primary Focus Mental Health Screenings Mental Health Assessments
Substance Abuse Treatment Services 45% 20%
Mental Health Services 94% 89%
Mix of Mental Health and Substance Abuse Treatment Services 90% 76%
General Health Care 85% 75%
Other/Unknown 53% 21%
Source: 2009 SAMHSA National Survey of Substance Abuse Treatment Services (N-SSATS).
Treatment facilities that were operated by the Federal Government (68 percent) were more likely than facilities operated by State governments (52 percent); local, county, or community governments (50 percent); private non-profit organizations (43 percent); tribal governments (40 percent); or private for-profit organizations (36 percent) to provide mental health assessments (Figure 2). Additionally, facilities that were operated by the Federal Government (79 percent) were more likely than those operated by other types of governments or organizations to provide mental health screenings.
It is recommended that substance abuse treatment providers screen all clients in substance abuse treatment for exposure to domestic violence in order to identify batterers and survivors. After substance abuse treatment providers identify those clients who have been involved in domestic violence, the provider may then determine what services the clients may need.4 Domestic violence services may include, for example, specialized counseling, medical services, or legal services.
N-SSATS provides information regarding whether or not treatment facilities offer domestic violence services. In 2009, less than half (35 percent) of treatment facilities offered domestic violence services. Facilities that primarily focused on a mix of mental health and substance abuse treatment services (46 percent) or general health care (44 percent) were more likely than those that focused on mental health services (37 percent) or substance abuse treatment services (30 percent) to offer domestic violence services.
Discussion
Mental health problems, specifically those related to trauma and/or domestic violence, often co-occur with substance abuse. Mental health screenings Mental health problems, specifically those related to trauma and/or domestic violence, often co-occur with substance abuse. Mental health screenings and assessments may be used by substance abuse treatment facilities to identify clients who are suffering from mental health problems related to trauma. By first identifying these clients, treatment providers may then develop a comprehensive treatment plan and assist clients with gaining access to trauma-related services. Treatment plans for clients with these co-occurring problems should address their substance abuse and incorporate evidenced-based interventions that aim to reduce the biological, psychological, and behavioral symptoms associated with trauma.6
The data in this report provide a snapshot of the extent to which the treatment system is identifying and providing certain services to clients suffering from co-occurring substance abuse and trauma-related mental health problems. This information may be used to increase public health awareness about substance abuse and trauma-related mental health problems, and inform behavioral health care reform initiatives that increase the treatment system’s capacity to provide needed trauma-related services to substance abuse clients.
End Notes
1 Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048-1060.
2 Nanjavits, L. M. (2002). Clinicians’ views on treating posttraumatic stress disorder and substance use disorder. Journal of Substance Abuse Treatment, 22, 79-85.
3 Center for Substance Abuse Treatment. (1995). Anxiety disorders. In Assessment and treatment of patients with coexisting mental illness and alcohol and other drug abuse (Treatment Improvement Protocol [TIP] Series 9, DHHS Publication No. SMA 95-3061). Rockville, MD: Substance Abuse and Mental Health Services. (Original work published 1994) Retrieved from http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hssamhsatip&part=A30236
4 Fazzone, P. A., Holton, J. K., & Reed, B. G. (Consensus Panel Co-Chairs); Center for Substance Abuse Treatment. (1997). Substance abuse treatment and domestic violence (Treatment Improvement Protocol [TIP] Series 25, DHHS Publication No. SMA 97-3163). Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hssamhsatip&part=A46712
5Sacks, S., & Ries, R. K. (Consensus Panel Co-Chairs); Center for Substance Abuse Treatment. (2005). Substance abuse treatment for persons with co-occurring disorders (Treatment Improvement Protocol [TIP] Series 42, DHHS Publication No. SMA 05-3922). Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hssamhsatip&part=A74073
6 Shalev, A., Bonne, O., & Eth, S. (1996). Treatment of post traumatic stress disorder: A review. Psychosomatic Medicine, 58, 165-182.
October 29, 2010
Facts on Mental Health Disorders
Anxiety Disorders
Panic DisorderPanic disorder affects about 2.4 million adult Americans and is twice as common in women as in men. A panic attack is a feeling of sudden terror that often occurs with a pounding heart, sweating, nausea, chest pain or smothering sensations and feelings of faintness or dizziness. Panic disorder frequently occurs in addition to other serious conditions like depression, drug abuse, or alcoholism. If left untreated, it may lead to a pattern of avoidance of places or situations where panic attacks have occurred. In about a third of cases, the threat of a panic attack becomes so overwhelming that a person may become isolated or housebound—a condition known as agoraphobia. Panic disorder is one of the most treatable of the anxiety disorders through medications or psychotherapy. Early treatment of panic disorder can help prevent agoraphobia.
Obsessive-Compulsive Disorder (OCD)
OCD affects about 3.3 million adult Americans, and occurs equally in men and women. It usually appears in childhood. Persons with OCD suffer from persistent and unwelcome anxious thoughts, and the result is the need to perform rituals to maintain control. For instance, a person obsessed with germs or dirt may wash his hands constantly. Feelings of doubt can make another person check on things repeatedly. Others may touch or count things or see repeated images that disturb them. These thoughts are called obsessions, and the rituals that are performed to try to prevent or get rid of them are called compulsions. Severe OCD can consume so much of a person's time and concentration that it interferes with daily life. OCD responds to treatment with medications or psychotherapy.
Post-Traumatic Stress Disorder (PTSD)
PTSD affects about 5.2 million adult Americans, but women are more likely than men to develop it. PTSD occurs after an individual experiences a terrifying event such as an accident, an attack, military combat, or a natural disaster. With PTSD, individuals relive their trauma through nightmares or disturbing thoughts throughout the day that may make them feel detached, numb, irritable, or more aggressive. Ordinary events can begin to cause flashbacks or terrifying thoughts. Some people recover a few months after the event, but other people will suffer lasting or chronic PTSD. People with PTSD can be helped by medications and psychotherapy.
Generalized Anxiety Disorder (GAD)
GAD affects about 4 million adult Americans and twice as many women as men. GAD is more than day-to-day anxiety. It fills an individual with an overwhelming sense of worry and tension. A person with GAD might always expect disaster to occur or worry a lot about health, money, family, or work. These worries may bring physical symptoms, especially fatigue, headaches, muscle tension, muscle aches, trouble swallowing, trembling, twitching, irritability, sweating, and hot flashes. People with GAD may feel lightheaded, out of breath, or nauseous, or might have to go to the bathroom often. When people have mild GAD, they may be able to function normally in social settings or on the job. If GAD is severe, however, it can be very debilitating. GAD is commonly treated with medications.
Social Anxiety Disorder
Social phobia affects about 5.3 million adult Americans. Women and men are equally likely to develop social phobia, which is characterized by an intense feeling of anxiety and dread about social situations. These individuals suffer a persistent fear of being watched and judged by others and being humiliated or embarrassed by their own actions. Social phobia can be limited to only one type of situation—fear of speaking in formal or informal situations, eating, drinking, or writing in front of others—or a person may experience symptoms any time they are around people. It may even keep people from going to work or school on some days, as physical symptoms such as blushing, profuse sweating, trembling, nausea, and difficulty talking often accompany the intense anxiety. Social phobia can be treated successfully with medications or psychotherapy.
Attention-Deficit/Hyperactivity Disorder (ADHD)
ADHD affects as many as 2 million American children and is a diagnosis applied to children and adults who consistently display certain characteristic behaviors over a period of time. The most common behaviors fall into three categories: inattention, hyperactivity, and impulsivity. People who are inattentive have a hard time keeping their mind on any one thing and may get bored with a task after only a few minutes. People who are hyperactive always seem to be in motion. They can't sit still and may dash around or talk incessantly. People who are overly impulsive seem unable to curb their immediate reactions or think before they act. Not everyone who is overly hyperactive, inattentive, or impulsive has an attention disorder. While the cause of ADHD is unknown, in the last decade, scientists have learned much about the course of the disorder and are now able to identify and treat children, adolescents, and adults who have it. A variety of medications, behavior-changing therapies, and educational options are already available to help people with ADHD focus their attention, build self-esteem, and function in new ways.
Depressive Disorders
About 18.8 million American adults experience a depressive illness that involves the body, mood, and thoughts. Depression affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. People with a depressive illness cannot just "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years.
Depression can occur in three forms:
Major Depressive Disorder
Major depressive disorder involves a pervading sense of sadness and/or loss of interest or pleasure in most activities that interferes with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. This is a severe condition that can impact a person's thoughts, sense of self worth, sleep, appetite, energy, and concentration. The condition can occur as a single debilitating episode or as recurring episodes.
Dysthymia
Dysthymia involves a chronic disturbance of mood in which an individual often feels little satisfaction with activities of life most of the time. Many people with dysthymia also experience major depressive episodes in their lives leading to a recurrent depressive disorder. The average length of an episode of dysthymia is about four years.
Bipolar Disorder
Bipolar Disorder, or manic-depressive illness, is a type of mood disorder characterized by recurrent episodes of highs (mania) and lows (depression) in mood. These episodes involve extreme changes in mood, energy, and behavior. Manic symptoms include extreme irritable or elevated mood; a very inflated sense of self-importance, risk behaviors, distractibility, increased energy, and a decreased need for sleep.
The most important thing to do for people with depression is to help them get an appropriate diagnosis and treatment. Treatment, usually in the form of medication or psychotherapy, can help people who suffer from depression.
*Do not ignore remarks about suicide.
If someone tells you they are thinking about suicide, you should take their distress seriously, listen, and help them get to a professional for evaluation and treatment. If someone is in immediate danger of harming himself or herself, do not leave the person alone. Take emergency steps to get help, such as calling 911. You can also call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
Eating Disorders
Anorexia Nervosa
People with this disorder see themselves as overweight despite their actual body weight. With this disorder, a person works to maintain a weight lower than normal for their age and height. This is accompanied by an intense fear of weight gain or looking fat. At times, a person can even deny the seriousness of their low body weight. Eating becomes an obsession and habits develop, such as avoiding meals, picking out a few foods and eating these in small quantities, or carefully weighing and portioning food. People with anorexia may repeatedly check their body weight, and many engage in other techniques to control their weight, like compulsive exercise or purging by vomiting or using laxatives. Some people fully recover after a single episode; some have a pattern of weight gain and relapse; and others experience a deteriorating course of illness over many years.
Bulimia Nervosa
Bulimia is characterized by episodes of binge eating—eating an excessive amount of food at once with a sense of lack of control over eating during the episode—followed by behavior in order to prevent weight gain, such as self-induced purging by vomiting or misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise. Because purging or other compensatory behavior follows the binge-eating episodes, people with bulimia usually weigh within the normal range for their age and height. However, like individuals with anorexia, they may fear gaining weight, desire to lose weight, and feel dissatisfied with their bodies. People with bulimia often perform the behaviors in secrecy, feeling disgusted and ashamed when they binge, yet relieved once they purge.
Schizophrenia
More than 2 million Americans a year experience this disorder. It is equally common in men and women. Schizophrenia tends to appear earlier in men than in women, showing up in their late teens or early 20s as compared to their 20s or early 30s in women. Schizophrenia often begins with an episode of psychotic symptoms like hearing voices or believing that others are trying to control or harm you. The delusions— thoughts that are fragmented, bizarre, and have no basis in reality—may occur along with hallucinations and disorganized speech and behavior, leaving the individual frightened, anxious, and confused. There is no known single cause of schizophrenia. Treatment may include medications and psychosocial support like psychotherapy, self-help groups, and rehabilitation.
Panic DisorderPanic disorder affects about 2.4 million adult Americans and is twice as common in women as in men. A panic attack is a feeling of sudden terror that often occurs with a pounding heart, sweating, nausea, chest pain or smothering sensations and feelings of faintness or dizziness. Panic disorder frequently occurs in addition to other serious conditions like depression, drug abuse, or alcoholism. If left untreated, it may lead to a pattern of avoidance of places or situations where panic attacks have occurred. In about a third of cases, the threat of a panic attack becomes so overwhelming that a person may become isolated or housebound—a condition known as agoraphobia. Panic disorder is one of the most treatable of the anxiety disorders through medications or psychotherapy. Early treatment of panic disorder can help prevent agoraphobia.
Obsessive-Compulsive Disorder (OCD)
OCD affects about 3.3 million adult Americans, and occurs equally in men and women. It usually appears in childhood. Persons with OCD suffer from persistent and unwelcome anxious thoughts, and the result is the need to perform rituals to maintain control. For instance, a person obsessed with germs or dirt may wash his hands constantly. Feelings of doubt can make another person check on things repeatedly. Others may touch or count things or see repeated images that disturb them. These thoughts are called obsessions, and the rituals that are performed to try to prevent or get rid of them are called compulsions. Severe OCD can consume so much of a person's time and concentration that it interferes with daily life. OCD responds to treatment with medications or psychotherapy.
Post-Traumatic Stress Disorder (PTSD)
PTSD affects about 5.2 million adult Americans, but women are more likely than men to develop it. PTSD occurs after an individual experiences a terrifying event such as an accident, an attack, military combat, or a natural disaster. With PTSD, individuals relive their trauma through nightmares or disturbing thoughts throughout the day that may make them feel detached, numb, irritable, or more aggressive. Ordinary events can begin to cause flashbacks or terrifying thoughts. Some people recover a few months after the event, but other people will suffer lasting or chronic PTSD. People with PTSD can be helped by medications and psychotherapy.
Generalized Anxiety Disorder (GAD)
GAD affects about 4 million adult Americans and twice as many women as men. GAD is more than day-to-day anxiety. It fills an individual with an overwhelming sense of worry and tension. A person with GAD might always expect disaster to occur or worry a lot about health, money, family, or work. These worries may bring physical symptoms, especially fatigue, headaches, muscle tension, muscle aches, trouble swallowing, trembling, twitching, irritability, sweating, and hot flashes. People with GAD may feel lightheaded, out of breath, or nauseous, or might have to go to the bathroom often. When people have mild GAD, they may be able to function normally in social settings or on the job. If GAD is severe, however, it can be very debilitating. GAD is commonly treated with medications.
Social Anxiety Disorder
Social phobia affects about 5.3 million adult Americans. Women and men are equally likely to develop social phobia, which is characterized by an intense feeling of anxiety and dread about social situations. These individuals suffer a persistent fear of being watched and judged by others and being humiliated or embarrassed by their own actions. Social phobia can be limited to only one type of situation—fear of speaking in formal or informal situations, eating, drinking, or writing in front of others—or a person may experience symptoms any time they are around people. It may even keep people from going to work or school on some days, as physical symptoms such as blushing, profuse sweating, trembling, nausea, and difficulty talking often accompany the intense anxiety. Social phobia can be treated successfully with medications or psychotherapy.
Attention-Deficit/Hyperactivity Disorder (ADHD)
ADHD affects as many as 2 million American children and is a diagnosis applied to children and adults who consistently display certain characteristic behaviors over a period of time. The most common behaviors fall into three categories: inattention, hyperactivity, and impulsivity. People who are inattentive have a hard time keeping their mind on any one thing and may get bored with a task after only a few minutes. People who are hyperactive always seem to be in motion. They can't sit still and may dash around or talk incessantly. People who are overly impulsive seem unable to curb their immediate reactions or think before they act. Not everyone who is overly hyperactive, inattentive, or impulsive has an attention disorder. While the cause of ADHD is unknown, in the last decade, scientists have learned much about the course of the disorder and are now able to identify and treat children, adolescents, and adults who have it. A variety of medications, behavior-changing therapies, and educational options are already available to help people with ADHD focus their attention, build self-esteem, and function in new ways.
Depressive Disorders
About 18.8 million American adults experience a depressive illness that involves the body, mood, and thoughts. Depression affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. People with a depressive illness cannot just "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years.
Depression can occur in three forms:
Major Depressive Disorder
Major depressive disorder involves a pervading sense of sadness and/or loss of interest or pleasure in most activities that interferes with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. This is a severe condition that can impact a person's thoughts, sense of self worth, sleep, appetite, energy, and concentration. The condition can occur as a single debilitating episode or as recurring episodes.
Dysthymia
Dysthymia involves a chronic disturbance of mood in which an individual often feels little satisfaction with activities of life most of the time. Many people with dysthymia also experience major depressive episodes in their lives leading to a recurrent depressive disorder. The average length of an episode of dysthymia is about four years.
Bipolar Disorder
Bipolar Disorder, or manic-depressive illness, is a type of mood disorder characterized by recurrent episodes of highs (mania) and lows (depression) in mood. These episodes involve extreme changes in mood, energy, and behavior. Manic symptoms include extreme irritable or elevated mood; a very inflated sense of self-importance, risk behaviors, distractibility, increased energy, and a decreased need for sleep.
The most important thing to do for people with depression is to help them get an appropriate diagnosis and treatment. Treatment, usually in the form of medication or psychotherapy, can help people who suffer from depression.
*Do not ignore remarks about suicide.
If someone tells you they are thinking about suicide, you should take their distress seriously, listen, and help them get to a professional for evaluation and treatment. If someone is in immediate danger of harming himself or herself, do not leave the person alone. Take emergency steps to get help, such as calling 911. You can also call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
Eating Disorders
Anorexia Nervosa
People with this disorder see themselves as overweight despite their actual body weight. With this disorder, a person works to maintain a weight lower than normal for their age and height. This is accompanied by an intense fear of weight gain or looking fat. At times, a person can even deny the seriousness of their low body weight. Eating becomes an obsession and habits develop, such as avoiding meals, picking out a few foods and eating these in small quantities, or carefully weighing and portioning food. People with anorexia may repeatedly check their body weight, and many engage in other techniques to control their weight, like compulsive exercise or purging by vomiting or using laxatives. Some people fully recover after a single episode; some have a pattern of weight gain and relapse; and others experience a deteriorating course of illness over many years.
Bulimia Nervosa
Bulimia is characterized by episodes of binge eating—eating an excessive amount of food at once with a sense of lack of control over eating during the episode—followed by behavior in order to prevent weight gain, such as self-induced purging by vomiting or misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise. Because purging or other compensatory behavior follows the binge-eating episodes, people with bulimia usually weigh within the normal range for their age and height. However, like individuals with anorexia, they may fear gaining weight, desire to lose weight, and feel dissatisfied with their bodies. People with bulimia often perform the behaviors in secrecy, feeling disgusted and ashamed when they binge, yet relieved once they purge.
Schizophrenia
More than 2 million Americans a year experience this disorder. It is equally common in men and women. Schizophrenia tends to appear earlier in men than in women, showing up in their late teens or early 20s as compared to their 20s or early 30s in women. Schizophrenia often begins with an episode of psychotic symptoms like hearing voices or believing that others are trying to control or harm you. The delusions— thoughts that are fragmented, bizarre, and have no basis in reality—may occur along with hallucinations and disorganized speech and behavior, leaving the individual frightened, anxious, and confused. There is no known single cause of schizophrenia. Treatment may include medications and psychosocial support like psychotherapy, self-help groups, and rehabilitation.
Genetic attribution for schizophrenia, depression, and skin cancer: impact on social distance.
Genetic attribution for schizophrenia, depression, and skin cancer: impact on social distance.
New Zealand Journal of Psychology| November 01, 2007 | Breheny, Mary | COPYRIGHT 1998New Zealand Psychological Society. This material is published under license from the publisher through the Gale Group, Farmington Hills, Michigan. All inquiries regarding rights should be directed to the Gale Group. (Hide copyright information)Copyright
Genetic explanations for mental and physical illness are increasingly common in both scientific research and in media reports generated from such research, however, the social impact of these explanations are less well understood. In this study it was predicted that both genetic attribution for illness and type of illness would be related to a desire for social distance. Participants were provided with a description of Jamie, who suffered from skin cancer, major depression, or schizophrenia. This illness was described as either having a strongly genetic basis, no genetic basis, or no causal explanation was provided. Participants then indicated their willingness to interact with Jamie using the Social Distance Scale. Type of illness described did significantly influence social distance score, with participants more willing to interact with Jamie when he was described as having skin cancer than schizophrenia or major depression. There was a significant interaction between illness type and genetic attribution for illness, with an increase in willingness to interact when schizophrenia was described as genetically caused and a decrease in willingness to interact when major depression was described as genetically caused. Genetic explanations may be suggested to reduce the stigma associated with mental illnesses, however, these explanations work in complex ways and may not uniformly reduce illness related stigma.
**********
The role o f genetics in determining health and wellbeing is increasingly discussed in scientific research (de Jong, 2000) and in media reports of such research (Conrad, 2001). The genetic component of complex traits is often investigated (de Jong, 2000), including the contribution of genetics to criminality (see Lowenstein, 2003; Martens, 2002; Retz, Retz-Junginger, Supprian, Thome & Rosler, 2004), and mental illness (see Thompson, Watson, Steinhauer, Goldstein & Pogue-Geile, 2005). Media representations contribute to lay explanations, and genetic factors are commonly identified as causing mental illness. Around two thirds of an Australian community sample attributed schizophrenia and depression to genetic causes (Jorm, Christensen & Griffiths, 2005). However, the impact of a claim of a genetic basis for complex psychological traits has received relatively little attention (Lemke, 2004), and may be a useful framework for understanding public attitudes towards those with mental illnesses (Zissi, 2006).
Genetic Attribution
Genetic explanations may influence understandings of human behaviour and the stigma associated with these behaviours (Phelan, 2005). Reframing mental illness as a brain disease with a genetic component has been suggested to reduce the stigma associated with mental illness; however, conversely, this may exacerbate experience of stigma (Bag, Yilmaz, Kirpinar, 2006; Corrigan & Watson, 2004). In support of this, Dietrich, Matschinger and Angermeyer (2006) found that biological or genetic causes of schizophrenia were associated with greater fear and reduced willingness to interact with people with schizophrenia. Phelan (2005) also found that genetic causes were associated with greater seriousness, persistence, and transmissibility of deviance. Research has found less blame attributed to those with genetically caused schizophrenia (Phelan, 2002), and less stigma associated with causes beyond the patients control, including genetic transmission (Martin, Pescosolido & Tuch, 2000; van't Veer, Kraan, Drosseart, & Modde, 2006). Phelan (2005) found some participants reported both reduced blame and increased associative stigma for genetically caused mental illnesses. Genetic causes for mental illness may have complex effects, ameliorating the blame associated with mental illness, bur increasing stigma.
Social Distance
Stigma is an attribute that discredits an individual, reducing them from a whole person to a discounted person in the eyes of others (Major & O'Brien, 2005). The evaluations of stigmatised others are widely shared, and are used as the basis for excluding or avoiding members of the discredited category (Major & O'Brien, 2005). Social distance is a way to assess attitudes towards those with a stigmatised identity, and is defined as the relative willingness to participate in relationships of varying intimacy with those who have a devalued social identity (Lauber, Nordt, Falcato & Rossler, 2004). Measures of social distance are widely used to assess attitudes to mental illness (Reinke, Corrigan, Leonhard, Lundin & Kubiak, 2004), by measuring participants' reported willingness to engage in relationships with a person described as having a particular illness (Lauber et al., 2004).
New Zealand Journal of Psychology| November 01, 2007 | Breheny, Mary | COPYRIGHT 1998New Zealand Psychological Society. This material is published under license from the publisher through the Gale Group, Farmington Hills, Michigan. All inquiries regarding rights should be directed to the Gale Group. (Hide copyright information)Copyright
Genetic explanations for mental and physical illness are increasingly common in both scientific research and in media reports generated from such research, however, the social impact of these explanations are less well understood. In this study it was predicted that both genetic attribution for illness and type of illness would be related to a desire for social distance. Participants were provided with a description of Jamie, who suffered from skin cancer, major depression, or schizophrenia. This illness was described as either having a strongly genetic basis, no genetic basis, or no causal explanation was provided. Participants then indicated their willingness to interact with Jamie using the Social Distance Scale. Type of illness described did significantly influence social distance score, with participants more willing to interact with Jamie when he was described as having skin cancer than schizophrenia or major depression. There was a significant interaction between illness type and genetic attribution for illness, with an increase in willingness to interact when schizophrenia was described as genetically caused and a decrease in willingness to interact when major depression was described as genetically caused. Genetic explanations may be suggested to reduce the stigma associated with mental illnesses, however, these explanations work in complex ways and may not uniformly reduce illness related stigma.
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The role o f genetics in determining health and wellbeing is increasingly discussed in scientific research (de Jong, 2000) and in media reports of such research (Conrad, 2001). The genetic component of complex traits is often investigated (de Jong, 2000), including the contribution of genetics to criminality (see Lowenstein, 2003; Martens, 2002; Retz, Retz-Junginger, Supprian, Thome & Rosler, 2004), and mental illness (see Thompson, Watson, Steinhauer, Goldstein & Pogue-Geile, 2005). Media representations contribute to lay explanations, and genetic factors are commonly identified as causing mental illness. Around two thirds of an Australian community sample attributed schizophrenia and depression to genetic causes (Jorm, Christensen & Griffiths, 2005). However, the impact of a claim of a genetic basis for complex psychological traits has received relatively little attention (Lemke, 2004), and may be a useful framework for understanding public attitudes towards those with mental illnesses (Zissi, 2006).
Genetic Attribution
Genetic explanations may influence understandings of human behaviour and the stigma associated with these behaviours (Phelan, 2005). Reframing mental illness as a brain disease with a genetic component has been suggested to reduce the stigma associated with mental illness; however, conversely, this may exacerbate experience of stigma (Bag, Yilmaz, Kirpinar, 2006; Corrigan & Watson, 2004). In support of this, Dietrich, Matschinger and Angermeyer (2006) found that biological or genetic causes of schizophrenia were associated with greater fear and reduced willingness to interact with people with schizophrenia. Phelan (2005) also found that genetic causes were associated with greater seriousness, persistence, and transmissibility of deviance. Research has found less blame attributed to those with genetically caused schizophrenia (Phelan, 2002), and less stigma associated with causes beyond the patients control, including genetic transmission (Martin, Pescosolido & Tuch, 2000; van't Veer, Kraan, Drosseart, & Modde, 2006). Phelan (2005) found some participants reported both reduced blame and increased associative stigma for genetically caused mental illnesses. Genetic causes for mental illness may have complex effects, ameliorating the blame associated with mental illness, bur increasing stigma.
Social Distance
Stigma is an attribute that discredits an individual, reducing them from a whole person to a discounted person in the eyes of others (Major & O'Brien, 2005). The evaluations of stigmatised others are widely shared, and are used as the basis for excluding or avoiding members of the discredited category (Major & O'Brien, 2005). Social distance is a way to assess attitudes towards those with a stigmatised identity, and is defined as the relative willingness to participate in relationships of varying intimacy with those who have a devalued social identity (Lauber, Nordt, Falcato & Rossler, 2004). Measures of social distance are widely used to assess attitudes to mental illness (Reinke, Corrigan, Leonhard, Lundin & Kubiak, 2004), by measuring participants' reported willingness to engage in relationships with a person described as having a particular illness (Lauber et al., 2004).
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