The LOSS Model Mental Illness and Substance Use Disorders

Amy L. Griffith, LPC Director of Forensic Services RHA Health Services, Inc

*LOSS models were develop by Paul Lilley, CIT Coordinator and consultant with the Criminal Justice Coordinating Center of Excellence. For more info contact [email protected].

The LOSS Model

1. Loss of Reality

2. Loss of Hope

3. Loss Of Control

4. Loss of Perspective 1. Loss Of Reality • Delusions • Hallucinations • Command Hallucinations 1. Diagnoses • Schizophrenia • Bipolar Disorder • Schizoaffective Disorder • Depression 1. Typical Medications

 Antipsychotics  Mood Stabilizers

 Abilify,  Depakote,  Risperdal,  Lithium,  Zyprexa,  Lamictal,  Cogentin,  Tegretol  Ativan

2. Loss Of Hope

• Depression • Feelings of sadness, helplessness, hopelessness • Grief and loss 2. Diagnoses

• Depression • Bipolar Disorder • Bereavement • Age-Related Cognitive Decline 2. Typical Medications

•Antidepressants  Seroquel  Prozac  Celexa  Zoloft 3. Loss Of Control

• Anger • Hostility • Frustration • Powerlessness 3. Diagnoses

• Bipolar Disorder • Personality Disorders • Intermittent Explosive Disorder 3. Typical Medications

• Antipsychotics • Mood Stabilizers

4. Loss Of Perspective

• Anxiety • Excessive worry • Nervousness • Panic 4. Diagnoses • Generalized Anxiety Disorder • Panic Disorder • PTSD • Dementia 4. Typical Medications

• Anti-anxiolytics  Mood Stabilizers  Klonopin Paxil  Xanax Zoloft  Ativan Prozac  Valium Seroquel Aricept Xelon

Substance Use Disorders

Abuse: Dependence:  Failure to fulfill major roles  Tolerance*  Use despite risk of  Withdrawal* hazardous situations  More use than intended  Use despite legal  Failed attempts to stop consequences  Excessive time spent  Use despite interpersonal getting, using, recovering consequences  Loss of functioning at  No history of Dependence home, work, etc.  Use despite negative consequences

DSM-V Mild 2-3 symptoms Moderate 4-5 symptoms Severe 6 + symptoms

More use than intended Failed attempts to stop Excessive time obtaining, using, recovering Cravings Failure to fulfill major roles Use despite interpersonal consequences Social, occupational, recreational activities are given up due to use Use despite risk of physically hazardous situations Use despite knowledge of secondary physical/psychological problems Tolerance* Withdrawal* Loss of functioning at home, work, etc. Substance Use & the LOSS Model  LOSS of Reality ◦ Bath salts, hallucinogens, amphetamines, opiates, benzos, withdrawal from alcohol…  LOSS of Hope ◦ Alcohol, opiates, withdrawal from amphetamines, meth, cocaine…  LOSS of Control ◦ Methamphetamine, cocaine, alcohol, bath salts, hallucinogens, benzos…  LOSS of Perspective ◦ K-2, marijuana, bath salts, alcohol, amphetamines, meth, benzos, opiates, cocaine… Intellectual & Developmental Disorders (IDD)

• Autism spectrum disorders • LOSS of Control, LOSS of Reality • Traumatic brain injuries • LOSS of Control, LOSS of Hope, LOSS of Perspective, LOSS of Reality • “Mental retardation” • LOSS of Control, LOSS of Perspective

Homelessness

 39 % report mental health problems  20-25 % meet criteria for serious mental illness  66 % report either substance use &/or mental health problems  46 % report chronic health conditions 1996 data from SAMHSA's National Mental Health Information Center.

 On any given night, 200,000 veterans are homeless. 2009 data from NOW on PBS. Trauma

Typical Events: Typical Reactions:

Serious accidents Sleeplessness Assaults Reliving the experience Witnessing violence Startles easily Threats of violence Irritability Natural disasters Drug and alcohol use Combat Anxiousness Sadness

Post Traumatic Stress Disorder

 The person experienced the event.

 The event involved actual or threat of serious injury/death.

 The person’s response involved fear, helplessness, horror. PTSD

 Re-experiencing  Avoiding & Numbing  Thoughts, feelings,  Recollections conversations  Dreams  Activities, places, people  Flashbacks  Loss of recall  Triggers  Loss of interest  Physical reactions  Detachment  Decreased affect  Decreased sense of the future

PTSD

 Increased Arousal  Symptoms last for more than 1 month  Sleeplessness  Irritability  Significant  Poor concentration impairment in functioning  Hypervigilance

 Startle response Acute vs. Chronic Delayed onset Suicide

• LOSS of Reality • Delusions and Hallucinations • LOSS of Hope • Hopelessness and Helplessness • LOSS of Control • Anger and Frustration • LOSS of Perspective • Anxiety and Worry *addition of drugs and alcohol Resources

Contact: Amy L. Griffith 828-250-6296 [email protected]