MENTALMENTAL DISORDERSDISORDERS

InIn thethe U.S.,U.S., mentalmental disordersdisorders areare diagnoseddiagnosed basedbased onon thethe DiagnosticDiagnostic andand StatisticalStatistical ManualManual ofof MentalMental Disorders,Disorders, fourthfourth editionedition (DSM(DSM--IV)IV).. MENTALMENTAL DISORDERSDISORDERS

„ MentalMental disordersdisorders areare commoncommon inin thethe UnitedUnited StatesStates andand internationally.internationally. „ AnAn estimatedestimated 22.122.1 percentpercent ofof AmericansAmericans agesages 1818 andand olderolder——aboutabout 11 inin 55 adultsadults—— suffersuffer fromfrom aa diagnosablediagnosable mentalmental disorderdisorder inin aa givengiven year.year. „ WhenWhen appliedapplied toto thethe 19981998 U.S.U.S. CensusCensus residentialresidential populationpopulation estimate,estimate, thisthis figurefigure translatestranslates toto 44.344.3 millionmillion people.people. MENTALMENTAL DISORDERSDISORDERS

„ ManyMany peoplepeople suffersuffer fromfrom moremore thanthan oneone mentalmental disorderdisorder atat aa givengiven time.time. „ 44 ofof thethe 1010 leadingleading causescauses ofof disabilitydisability inin thethe U.S.U.S. andand otherother developeddeveloped countriescountries areare mentalmental disordersdisorders „ majormajor depressiondepression „ bipolarbipolar disorderdisorder „ schizophreniaschizophrenia „ obsessiveobsessive--compulsivecompulsive disorderdisorder MENTALMENTAL DISORDERSDISORDERS MOODMOOD DISORDERSDISORDERS

„ Depressive disorders encompass major depressive disorder, dysthymic disorder, and bipolar disorder. „ Approximately 18.8 million American adults, or about 9.5 percent of the U.S. population age 18 and older in a given year, have a depressive disorder. „ Nearly twice as many women (12.0 percent) as men (6.6 percent) are affected by a depressive disorder each year. These figures translate to 12.4 million women and 6.4 million men in the U.S. „ Depressive disorders may be appearing earlier in life in people born in recent decades compared to the past. „ Depressive disorders often co-occur with anxiety disorders and substance abuse. MENTALMENTAL DISORDERSDISORDERS MOODMOOD DISORDERSDISORDERS

Major Depressive Disorder „ Major depressive disorder is the leading cause of disability in the U.S. and established market economies worldwide. „ Major depressive disorder affects approximately 9.9 million American adults, or about 5.0 percent of the U.S. population age 18 and older in a given year. „ Nearly twice as many women (6.5 percent) as men (3.3 percent) suffer from major depressive disorder each year. These figures translate to 6.7 million women and 3.2 million men. „ While major depressive disorder can develop at any age, the average age at onset is the mid-twenties. MENTALMENTAL DISORDERSDISORDERS MOODMOOD DISORDERSDISORDERS

„ Major Depressive Disorder „ five or more of the following symptoms have been present during the same 2-week period; at least one is depressed mood or loss of interest or pleasure „ depressed mood „ markedly diminished interest in pleasure „ significant weight loss or weight gain „ insomnia or hypersomnia „ psychomotor agitation or retardation „ fatigue „ feelings of worthlessness or excessive or inappropriate guilt „ diminished ability to think or concentrate, indecisiveness „ recurrent thoughts of death, recurrent suicidal ideation without a specific plan MENTALMENTAL DISORDERSDISORDERS MOODMOOD DISORDERSDISORDERS BipolarBipolar DisorderDisorder „ BipolarBipolar disorderdisorder affectsaffects approximatelyapproximately 2.32.3 millionmillion AmericanAmerican adults,adults, oror aboutabout 1.21.2 percentpercent ofof thethe U.S.U.S. populationpopulation ageage 1818 andand olderolder inin aa givengiven year.year. „ MenMen andand womenwomen areare equallyequally likelylikely toto developdevelop bipolarbipolar disorder.disorder. „ TheThe averageaverage ageage atat onsetonset forfor aa firstfirst manicmanic episodeepisode isis thethe earlyearly twenties.twenties. MENTALMENTAL DISORDERSDISORDERS MOODMOOD DISORDERSDISORDERS

„ Bipolar Disorder „ manic episodes with or without periods of depression „ manic episode characterized as a distinct period of abnormally and persistently elevated, expansive or irritable mood, lasting at least 1 week; including three or more of the following: „ grandiosity, inflated self-esteem „ decreased need for sleep „ more talkative than usual „ flight of ideas, racing thoughts „ distractibility „ increase in goal-oriented activity „ excessive involvement in pleasurable activities that have a high potential for painful consequences, unrestrained buying, sexual indiscretions or foolish business investments MENTALMENTAL DISORDERS:DISORDERS: DELIRIUM,DELIRIUM, DEMENTIA,DEMENTIA, AMNESTICAMNESTIC ANDAND OTHEROTHER COGNITIVECOGNITIVE DISORDERSDISORDERS

DeliriumDelirium „ disturbancedisturbance ofof consciousnessconsciousness (reduced(reduced clarityclarity ofof awarenessawareness ofof thethe environment)environment) „ reducedreduced abilityability toto focus,focus, sustain,sustain, oror shiftshift attentionattention „ changechange inin cognitioncognition (memory(memory deficit,deficit, disorientation,disorientation, languagelanguage disturbance)disturbance) MENTALMENTAL DISORDERS:DISORDERS: DEMENTIADEMENTIA

„ development of multiple cognitive deficits manifested by both memory impairment (inability to recall information or learn new information) with one or more of the following: aphasia (language disturbance) apraxia ( impaired ability to carry out motor activities despite intact motor function) agnosia (failure to recognize or identify objects despite intact sensory function) disturbance in executive functioning (planning, organizing, sequencing, abstracting) „ Dementia of the Alzheimer’s Type with Early Onset „ Dementia of the Alzheimer’s Type with Late Onset „ Vascular Dementia „ Dementia due to other causes MENTALMENTAL DISORDERS:DISORDERS:

Alzheimer'sAlzheimer's DiseaseDisease „ Alzheimer'sAlzheimer's disease,disease, thethe mostmost commoncommon causecause ofof dementiadementia amongamong peoplepeople ageage 6565 andand older,older, affectsaffects anan estimatedestimated 44 millionmillion Americans.Americans. „ AsAs moremore andand moremore AmericansAmericans livelive longer,longer, thethe numbernumber affectedaffected byby Alzheimer'sAlzheimer's diseasedisease willwill continuecontinue toto growgrow unlessunless aa curecure oror effectiveeffective preventionprevention isis discovered.discovered. „ TheThe durationduration ofof illness,illness, fromfrom onsetonset ofof symptomssymptoms toto death,death, averagesaverages 88 toto 1010 years.years. MENTALMENTAL DISORDERS:DISORDERS: SCHIZOPHRENIASCHIZOPHRENIA ANDAND OTHEROTHER PSYCHOTICPSYCHOTIC DISORDERSDISORDERS

„ Schizophrenia „ two or more of the following, each present for a significant portion of time during a 1-month period „ delusions „ hallucinations „ disorganized speech „ grossly disorganized or catatonic behavior „ negative symptoms, i.e. affective flattening, alogia, or avolition „ social/occupational dysfunction „ signs of disturbance persist for at least six months MENTALMENTAL DISORDERS:DISORDERS: SCHIZOPHRENIASCHIZOPHRENIA ANDAND OTHEROTHER PSYCHOTICPSYCHOTIC DISORDERSDISORDERS „ SchizophreniformSchizophreniform DisorderDisorder „ SchizoaffectiveSchizoaffective disorderdisorder „ DelusionalDelusional DisorderDisorder „ BriefBrief PsychoticPsychotic DisorderDisorder „ SharedShared PsychoticPsychotic DisorderDisorder „ PsychoticPsychotic DisorderDisorder NOSNOS MENTALMENTAL DISORDERS:DISORDERS: SCHIZOPHRENIASCHIZOPHRENIA

„ ApproximatelyApproximately 2.22.2 millionmillion AmericanAmerican adults,adults, oror aboutabout 1.11.1 percentpercent ofof thethe populationpopulation ageage 1818 andand olderolder inin aa givengiven year,year, havehave schizophrenia.schizophrenia. „ SchizophreniaSchizophrenia affectsaffects menmen andand womenwomen withwith equalequal frequency.frequency. „ SchizophreniaSchizophrenia oftenoften firstfirst appearsappears earlierearlier inin men,men, usuallyusually inin theirtheir latelate teensteens oror earlyearly twenties,twenties, thanthan inin women,women, whowho areare generallygenerally affectedaffected inin theirtheir twentiestwenties oror earlyearly thirties.thirties. MENTALMENTAL DISORDERSDISORDERS ANXIETYANXIETY DISORDERSDISORDERS

VirtuallyVirtually everyoneeveryone hashas oneone thingthing oror situationsituation thatthat isis aa sourcesource ofof fearfear andand subsequentsubsequent avoidance.avoidance. ItIt isis onlyonly whenwhen thethe fearfear isis excessiveexcessive oror unreasonableunreasonable andand isis clinicallyclinically significantsignificant thatthat aa diagnosisdiagnosis ofof aa phobicphobic disorderdisorder isis warranted.warranted. ExamplesExamples includeinclude fearfear ofof height,height, flying,flying, animals,animals, injections,injections, blood,blood, storms,storms, elevators,elevators, enclosedenclosed places,places, etc.etc.

„ MENTALMENTAL DISORDERSDISORDERS ANXIETYANXIETY DISORDERSDISORDERS AnxietyAnxiety DisordersDisorders „ AnxietyAnxiety disordersdisorders includeinclude panicpanic disorder,disorder, obsessiveobsessive--compulsivecompulsive disorder,disorder, postpost-- traumatictraumatic stressstress disorder,disorder, generalizedgeneralized anxietyanxiety disorder,disorder, andand phobiasphobias (social(social phobia,phobia, agoraphobia,agoraphobia, andand specificspecific phobia).phobia). MENTALMENTAL DISORDERSDISORDERS ANXIETYANXIETY DISORDERSDISORDERS

„ Panic Disorder with Agorophobia „ Panic disorder without Agorophobia „ Agorophobia without Panic Disorder „ Social Phobia „ Obsessive-Compulsive Disorder „ Posttraumatic Stress Disorder „ Acute Stress Disorder „ Generalized Anxiety Disorder „ Anxiety Disorder NOS „ Specific Phobias (fear of an animal, heights, closed spaces, weather phenomena, etc.) MENTALMENTAL DISORDERSDISORDERS ANXIETYANXIETY DISORDERSDISORDERS

„ Approximately 19.1 million American adults ages 18 to 54, or about 13.3 percent of people in this age group in a given year, have an anxiety disorder. „ Anxiety disorders frequently co-occur with depressive disorders, eating disorders, or substance abuse. „ Many people have more than one anxiety disorder. „ Women are more likely than men to have an anxiety disorder. Approximately twice as many women as men suffer from panic disorder, post-traumatic stress disorder, generalized anxiety disorder, agoraphobia, and specific phobia, though about equal numbers of women and men have obsessive-compulsive disorder and social phobia. MENTALMENTAL DISORDERSDISORDERS ANXIETYANXIETY DISORDERSDISORDERS PanicPanic DisorderDisorder „ ApproximatelyApproximately 2.42.4 millionmillion AmericanAmerican adultsadults agesages 1818 toto 54,54, oror aboutabout 1.71.7 percentpercent ofof peoplepeople inin thisthis ageage groupgroup inin aa givengiven year,year, havehave panicpanic disorder.disorder. „ PanicPanic disorderdisorder typicallytypically developsdevelops inin latelate adolescenceadolescence oror earlyearly adulthood.adulthood. „ AboutAbout oneone inin threethree peoplepeople withwith panicpanic disorderdisorder developdevelop agoraphobiaagoraphobia,, aa conditioncondition inin whichwhich theythey becomebecome afraidafraid ofof beingbeing inin anyany placeplace oror situationsituation wherewhere escapeescape mightmight bebe difficultdifficult oror helphelp unavailableunavailable inin thethe eventevent ofof aa panicpanic attack.attack. MENTALMENTAL HEALTH:HEALTH: EatingEating DisordersDisorders

„ TheThe threethree mainmain typestypes ofof eatingeating disordersdisorders areare anorexiaanorexia nervosa,nervosa, bulimiabulimia nervosa,nervosa, andand bingebinge--eatingeating disorder.disorder. MENTALMENTAL HEALTH:HEALTH: EatingEating DisordersDisorders

„ Between 2 percent and 5 percent of Americans experience binge-eating disorder in a 6-month period „ Females are more likely than males to develop an eating disorder „ 5 to 15 percent of people with anorexia or bulimia and 35 percent of those with binge-eating disorder are male „ In their lifetime, an estimated 0.5 percent to 3.7 percent of females suffer from anorexia and an estimated 1.1 percent to 4.2 percent suffer from bulimia „ The mortality rate among people with anorexia has been estimated at 0.56 percent per year, or approximately 5.6 percent per decade, which is about 12 times higher than the annual death rate due to all causes of death among females ages 15-24 in the general population. MENTALMENTAL HEALTH:HEALTH: EatingEating DisordersDisorders

„ AnorexiaAnorexia NervosaNervosa refusalrefusal toto maintainmaintain bodybody weightweight atat oror aboveabove aa minimallyminimally normalnormal weightweight forfor ageage andand height;height; intenseintense fearfear ofof gaininggaining weightweight oror becomingbecoming fat,fat, eveneven thoughthough underweightunderweight „ BulimiaBulimia NervosaNervosa frequentfrequent bingebinge eatingeating accompaniedaccompanied byby inappropriateinappropriate compensatorycompensatory behaviorsbehaviors toto avoidavoid gaininggaining weightweight thoughthough usuallyusually normalnormal weightweight oror overweightoverweight MENTALMENTAL HEALTH:HEALTH: SOMATOFORMSOMATOFORM DISORDERSDISORDERS

„ Somatization Disorder (psychologically based physical complaints) „ Conversion Disorder (psychologically based neural complaints) „ Pain Disorder (pain in one or more anatomical sites; severity to warrant clinical attention; causes significant distress or impairment of social, occupation or other important areas of functioning; psychological factors an important role in the onset, etc. „ Hypochondriasis (preoccupation with fears of having a serious disease) „ Body Dysmorphic Disorder (preoccupation with an imagined defect in appearance) MENTALMENTAL DISORDERS:DISORDERS: DISSOCIATIVEDISSOCIATIVE DISORDERSDISORDERS

„ Dissociative Amnesia reversible inability to retrieve memories not due to a general medical condition or substance use; memories usually of a traumatic or stressful, personal nature „ Dissociative Fugue sudden, unexpected travel away from home or one's customary place of work with inability to recall one's past „ Dissociative Identity Disorder presence of two or more distinct identities or personality states „ Depersonalization Disorder individual feels as if he or she is watching his life go by as if in a dream or a movie MENTALMENTAL DISORDERS:DISORDERS: SEXUALSEXUAL ANDAND GENDERGENDER IDENTITYIDENTITY DISORDERSDISORDERS

„ Sexual Desire Disorders „ Sexual Arousal Disorders „ Orgasmic Disorders „ Sexual Pain Disorders „ Sexual Dysfunction Due to a General Medical Condition „ ... „ Paraphilias „ Exhibitionism „ Fetishism „ Frotteurism „ Pedophilia „ Sexual Masochism „ Sexual Sadism „ Transvestic Fetishism „ Voyeurism „ Paraphilia NOS MENTALMENTAL DISORDERS:DISORDERS: SEXUALSEXUAL ANDAND GENDERGENDER IDENTITYIDENTITY DISORDERSDISORDERS ParaphiliasParaphilias „ ExhibitionismExhibitionism „ FetishismFetishism „ FrotteurismFrotteurism „ PedophiliaPedophilia „ SexualSexual MasochismMasochism „ SexualSexual SadismSadism „ TransvesticTransvestic FetishismFetishism „ VoyeurismVoyeurism „ ParaphiliaParaphilia NOSNOS MENTALMENTAL DISORDERS:DISORDERS: SEXUALSEXUAL ANDAND GENDERGENDER IDENTITYIDENTITY DISORDERSDISORDERS GenderGender IdentityIdentity DisordersDisorders „ GenderGender IdentityIdentity DisorderDisorder inin ChildrenChildren „ GenderGender IdentityIdentity DisorderDisorder inin AdolescentsAdolescents oror AdultsAdults MENTALMENTAL DISORDERS:DISORDERS: SLEEPSLEEP DISORDERSDISORDERS

Primary Sleep Disorders: Dysomnia „ Primary Insomnia (difficulty falling asleep, waking intermittently, awakening with inability to go back to sleep) „ Primary Hypersomnia (excessive sleepiness for a month or more, sleep episodes during the daytime) „ Dysomnia NOS

Primary Sleep Disorders: Parasomnias „ Nightmare Disorder „ Sleep Terror Disorder „ Sleepwalking Disorder „ Parasomnia NOS MENTALMENTAL DISORDERS:DISORDERS: IMPULSEIMPULSE--CONTROLCONTROL DISORDERSDISORDERS NOTNOT ELSEWHEREELSEWHERE CLASSIFIEDCLASSIFIED

„ IntermittentIntermittent ExplosiveExplosive DisorderDisorder „ KleptomaniaKleptomania „ PyromaniaPyromania „ PathologicalPathological GamblingGambling „ TrichotillomaniaTrichotillomania „ ImpulseImpulse--ControlControl DisorderDisorder NOSNOS MENTALMENTAL HEALTH:HEALTH: PERSONALITYPERSONALITY DISORDERSDISORDERS

„ PersonalityPersonality -- ourour ownown personalpersonal andand particularparticular patternpattern ofof experiencingexperiencing andand interactinginteracting withwith ourour environmentenvironment andand withwith otherother peoplepeople „ PersonalityPersonality DisordersDisorders areare abnormalabnormal personalitypersonality traitstraits MENTALMENTAL HEALTH:HEALTH: PERSONALITYPERSONALITY DISORDERSDISORDERS

„ Paranoid Personality Disorder (tendency to be suspicious, mistrustful, hypervigilant and preoccupied with being exploited or betrayed by others) „ Schizoid Personality Disorder (profound defect in the individual's ability to form personal relationships or to respond to others in an emotionally meaningful way „ Schizotypal Personality Disorder (encompasses a combination of odd or peculiar behavior, speech, thought and perception) „ Antisocial Personality Disorder (socially irresponsible, exploitative and guiltless behavior; person engages in the deception and manipulation of others for personal gain and fails to abide by the law, sustain consistent employment and develop stable relationships) „ Borderline Personality Disorder (intense and chaotic relationships with fluctuating and extreme attitudes toward others „ Histrionic Personality Disorder (attention seeking, self dramatizing, excessively gregarious, seductive , manipulative, exhibitionistic, shallow, labile, vain and demanding) MENTALMENTAL HEALTH:HEALTH: PERSONALITYPERSONALITY DISORDERSDISORDERS

„ Narcissistic Personality Disorder (egocentric, grandiose, entitled, shallow, exploitative, arrogant and preoccupied with fame, wealth and achievement; generally lacks empathy and consideration for the feelings of others; often exquisitely hypersensitive to evaluation or criticism) „ Avoidant Personality Disorder (inhibited, introverted, and anxious behavior with low self-esteem, hypersensitivity to rejection, social awkwa4dness, timidity, social discomfort and self-conscious fears of being embarrassed or acting foolish) „ Dependent Personality Disorder (excessive reliance on others that is reflected in the person's tendency to permit others to make important decisions, to feel helpless when alone, to subjugate his or her own needs to those of others to tolerate mistreatment and fail to be appropriately self-assertive; often living with controlling, domineering, overprotective and infantilizing person „ Obsessive-Compulsive Personality Disorder (perfectionist, constricted, and excessively disciplined; behavior is rigid, formal, emotionally cool, distant, intellectualizing and detailed) MENTALMENTAL HEALTH:HEALTH: SUBSTANCESUBSTANCE––RELATEDRELATED DISORDERSDISORDERS SubstanceSubstance Abuse:Abuse: „ personperson isis oftenoften intoxicatedintoxicated fromfrom substancesubstance throughoutthroughout thethe dayday and,and, despitedespite allall efforts,efforts, isis unableunable toto cutcut consumptionconsumption inin anyany consistentconsistent wayway „ statestate ofof intoxicationintoxication isis deepdeep enoughenough thatthat thethe personperson failsfails inin importantimportant obligationsobligations toto friendsfriends andand familyfamily andand atat workwork „ AtAt leastleast oneone month’smonth’s durationduration MENTALMENTAL HEALTH:HEALTH: SUBSTANCESUBSTANCE––RELATEDRELATED DISORDERSDISORDERS SubstanceSubstance Dependence:Dependence: „ PhysiologicalPhysiological DependenceDependence (addiction)(addiction) aa person’sperson’s bodybody needsneeds moremore andand moremore ofof thethe substancesubstance toto achieveachieve itsits effecteffect andand thethe personperson sufferssuffers withdrawalwithdrawal whenwhen thethe substance’ssubstance’s useuse isis cutcut backback oror eliminatedeliminated „ PsychologicalPsychological DependenceDependence isis nonnon--addictingaddicting reliancereliance onon aa substance;substance; thethe drugdrug isis takentaken toto makemake stressfulstressful oror anxietyanxiety provokingprovoking situationssituations moremore bearablebearable MENTALMENTAL HEALTH:HEALTH: SUBSTANCESUBSTANCE––RELATEDRELATED DISORDERSDISORDERS

AlcoholAlcohol--RelatedRelated DisordersDisorders

„ AlcoholAlcohol UseUse DisordersDisorders -- AlcoholAlcohol DependenceDependence -- AlcoholAlcohol AbuseAbuse „ AlcoholAlcohol--InducedInduced DisordersDisorders MENTALMENTAL HEALTH:HEALTH: SUBSTANCESUBSTANCE––RELATEDRELATED DISORDERSDISORDERS

Alcohol-Induced Disorders:

„ Alcohol Intoxication „ Alcohol-Induced Psychotic „ Alcohol Withdrawal Disorder „ Alcohol Intoxication „ Alcohol-Induced Mood Delirium Disorder „ Alcohol Withdrawal „ Alcohol-Induced Anxiety Delirium Disorder „ Alcohol-Induced „ Alcohol-Induced Sexual Persisting Dementia Dysfunction „ Alcohol-Induced „ Alcohol-Induced Sleep Persisting Amnestic Disorder Disorder „ Alcohol-Related Disorder NOS MENTALMENTAL HEALTH:HEALTH: SUBSTANCESUBSTANCE––RELATEDRELATED DISORDERSDISORDERS AmphetamineAmphetamine (or(or AmphetamineAmphetamine--Like)Like) RelatedRelated DisordersDisorders „ AmphetamineAmphetamine UseUse DisordersDisorders „ AmphetamineAmphetamine--InducedInduced DisordersDisorders CannabisCannabis--RelatedRelated DisordersDisorders „ CannabisCannabis UseUse disordersdisorders „ CannabisCannabis--InducedInduced DisordersDisorders CocaineCocaine--RelatedRelated DisordersDisorders „ CocaineCocaine UseUse DisordersDisorders „ CocaineCocaine--InducedInduced DisordersDisorders MENTALMENTAL HEALTH:HEALTH: SUBSTANCESUBSTANCE––RELATEDRELATED DISORDERSDISORDERS HallucinogenHallucinogen--RelatedRelated DisordersDisorders „ HallucinogenHallucinogen UseUse DisordersDisorders „ HallucinogenHallucinogen--InducedInduced DisordersDisorders InhalantInhalant--RelatedRelated DisordersDisorders „ InhalantInhalant useuse DisorderDisorder „ InhalantInhalant--InducedInduced DisordersDisorders OpioidOpioid--RelatedRelated DisordersDisorders „ OpioidOpioid UseUse disordersdisorders „ OpioidOpioid--InducedInduced DisordersDisorders MENTALMENTAL HEALTH:HEALTH: SUBSTANCESUBSTANCE––RELATEDRELATED DISORDERSDISORDERS PhencyclidinePhencyclidine (Or(Or PhencyclidinePhencyclidine--Like)Like) RelatedRelated DisordersDisorders „ PhencyclidinePhencyclidine UseUse DisordersDisorders „ PhencyclidinePhencyclidine--InducedInduced DisordersDisorders SedativeSedative--,, HypnoticHypnotic-- oror AnxiolyticAnxiolytic--RelatedRelated DisordersDisorders „ Sedative,Sedative, HypnoticHypnotic oror AnxiolyticAnxiolytic UseUse DisordersDisorders „ SedativeSedative--,, HypnoticHypnotic-- oror AnxiolyticAnxiolytic--InducedInduced DisordersDisorders PolysubstancePolysubstance--RelatedRelated DisorderDisorder OtherOther SubstanceSubstance--RelatedRelated DisordersDisorders MENTALMENTAL HEALTH:HEALTH: SUBSTANCESUBSTANCE––RELATEDRELATED DISORDERSDISORDERS CaffeineCaffeine--RelatedRelated DisordersDisorders „ CaffeineCaffeine--InducedInduced DisordersDisorders

NicotineNicotine--RelatedRelated DisordersDisorders „ NicotineNicotine UseUse DisorderDisorder „ NicotineNicotine--InducedInduced DisorderDisorder MENTALMENTAL HEALTH:HEALTH: SUBSTANCESUBSTANCE––RELATEDRELATED DISORDERSDISORDERS AlcoholAlcohol Use:Use: „ 121121 millionmillion (50.3(50.3 %)%) AmericansAmericans agedaged 1212 oror olderolder werewere currentcurrent drinkersdrinkers ofof alcoholalcohol inin 20042004 „ 5555 millionmillion (22.8(22.8 %)%) participatedparticipated inin bingebinge drinkingdrinking (defined(defined asas fivefive oror moremore drinksdrinks onon atat leastleast oneone occasionoccasion inin thethe 3030 daysdays priorprior toto thethe survey)survey) „ 16.716.7 millionmillion (6.9(6.9 %)%) werewere heavyheavy drinkers,drinkers, (defined(defined asas bingebinge drinkingdrinking onon 55 oror moremore daysdays inin thethe pastpast month)month) MENTALMENTAL HEALTH:HEALTH: SUBSTANCESUBSTANCE––RELATEDRELATED DISORDERSDISORDERS UnderageUnderage drinkingdrinking „ 10.810.8 millionmillion personspersons (28.7(28.7 %)%) agedaged 1212 toto 2020 reportedreported drinkingdrinking alcoholalcohol inin thethe monthmonth priorprior toto thethe surveysurvey interviewinterview inin 20042004 „ 7.47.4 millionmillion (19.6(19.6 %)%) werewere bingebinge drinkersdrinkers „ 2.42.4 millionmillion (6.3(6.3 %)%) werewere heavyheavy drinkersdrinkers MENTALMENTAL HEALTH:HEALTH: SUBSTANCESUBSTANCE––RELATEDRELATED DISORDERSDISORDERS AmongAmong personspersons agedaged 1212 toto 2020 inin 2004,2004, pastpast monthmonth alcoholalcohol useuse rates:rates: „ 16.416.4 %% amongamong AsiansAsians „ 19.119.1 %% amongamong blacksblacks „ 24.324.3 %% amongamong AmericanAmerican IndiansIndians oror AlaskaAlaska NativesNatives „ 26.426.4 %% amongamong thosethose reportingreporting twotwo oror moremore racesraces „ 26.626.6 %% amongamong HispanicsHispanics „ 32.632.6 %% amongamong whiteswhites MENTALMENTAL HEALTH:HEALTH: SUBSTANCESUBSTANCE––RELATEDRELATED DISORDERSDISORDERS

„ TheThe highesthighest prevalenceprevalence ofof bingebinge andand heavyheavy drinkingdrinking inin 20042004 waswas forfor youngyoung adultsadults agedaged 1818 toto 2525 (41.2(41.2 andand 15.115.1 percent,percent, respectively).respectively). „ TheThe peakpeak raterate ofof bothboth measuresmeasures occurredoccurred atat ageage 2121 (48.2(48.2 andand 19.219.2 percent,percent, respectively).respectively). MENTALMENTAL HEALTH:HEALTH: SUBSTANCESUBSTANCE––RELATEDRELATED DISORDERSDISORDERS

Illicit Drug Use In 2004: „ 19.1 million Americans (7.9 %) aged 12 or older, were current illicit drug users. (used an illicit drug during the month prior to the survey interview) „ 12.3 million (75.2 %) of the 16.4 million illicit drug users aged 18 or older in 2004, were employed either full or part time „ 19.2 % of unemployed adults aged 18 or older were current illicit drug „ 8.0 % of those employed full time „ 10.3 % of those employed part time MENTALMENTAL HEALTH:HEALTH: SUBSTANCESUBSTANCE––RELATEDRELATED DISORDERSDISORDERS

Substance Abuse Statistics „ 70% of those who use drugs are employed „ 23% of those who use drugs admit to drug use on the job „ 44% of those who use drugs obtain their supply at their place of employment „ 18% of drug users steal from co-workers to support their addiction „ 47% of industrial accidents and 40% of industrial deaths can be linked to substance abuse taken from www.drugfreeworks.com MENTALMENTAL HEALTH:HEALTH: SUBSTANCESUBSTANCE––RELATEDRELATED DISORDERSDISORDERS

„ YoungYoung adultsadults agedaged 1818 toto 2222 enrolledenrolled fullfull timetime inin collegecollege werewere moremore likelylikely thanthan theirtheir peerspeers notnot enrolledenrolled fullfull timetime (this(this categorycategory includesincludes partpart-- timetime collegecollege studentsstudents andand personspersons notnot enrolledenrolled inin college)college) toto useuse alcohol,alcohol, bingebinge drink,drink, andand drinkdrink heavilyheavily inin 20042004 „ BingeBinge andand heavyheavy useuse ratesrates forfor collegecollege studentsstudents werewere 43.443.4 andand 18.618.6 percent,percent, respectively,respectively, comparedcompared withwith 39.439.4 andand 13.513.5 percent,percent, respectively,respectively, forfor otherother personspersons agedaged 1818 toto 22.22. MENTALMENTAL HEALTH:HEALTH: SUBSTANCESUBSTANCE––RELATEDRELATED DISORDERSDISORDERS

Substance abusers: „ file twice as many worker's compensation claims as non- abusers „ are 1/3 less productive „ are 2.2 times more likely to request early dismissal or time off „ are 2.5 times more likely to be late for work „ are 7 times more like to have wage garnishments „ Drug abusers have 300% higher medical costs & benefits — which increases health insurance premiums for all

Taken from www.drugfreeworks.com MENTALMENTAL HEALTH:HEALTH: SUBSTANCESUBSTANCE––RELATEDRELATED DISORDERSDISORDERS

RatesRates ofof illicitillicit drugdrug amongamong youthsyouths agedaged 1212 toto 1717 „ 26.026.0 percentpercent AmericanAmerican IndianIndian oror AlaskaAlaska NativeNative youthsyouths „ 12.212.2 percentpercent forfor youthsyouths reportingreporting twotwo oror moremore racesraces „ 11.111.1 percentpercent forfor whitewhite youthsyouths „ 10.210.2 percentpercent forfor HispanicHispanic youthsyouths „ 9.39.3 percentpercent forfor blackblack youthsyouths „ 6.06.0 percentpercent forfor AsianAsian youths.youths. MENTALMENTAL HEALTH:HEALTH: SUBSTANCESUBSTANCE––RELATEDRELATED DISORDERSDISORDERS

„ 14.614.6 millionmillion (6.1(6.1 percentpercent )) currentcurrent usersusers ofof MarijuanaMarijuana „ 2.02.0 millionmillion currentcurrent CocaineCocaine usersusers (467,000(467,000 ofof whomwhom usedused Crack)Crack) „ 929,000929,000 currentcurrent usersusers ofof HallucinogensHallucinogens „ 166,000166,000 currentcurrent usersusers ofof HeroinHeroin MENTALMENTAL HEALTH:HEALTH: SUBSTANCESUBSTANCE––RELATEDRELATED DISORDERSDISORDERS

„ 6.06.0 millionmillion personspersons (2.5(2.5 percent)percent) werewere currentcurrent usersusers ofof psychotherapeuticpsychotherapeutic drugsdrugs takentaken nonmedicallynonmedically thesethese included:included: „ 4.44.4 millionmillion whowho usedused painpain relieversrelievers „ 1.61.6 millionmillion whowho usedused tranquilizerstranquilizers „ 1.21.2 millionmillion whowho usedused stimulantsstimulants „ 0.30.3 millionmillion whowho usedused sedativessedatives MENTALMENTAL HEALTH:HEALTH: SUBSTANCESUBSTANCE––RELATEDRELATED DISORDERSDISORDERS MostMost peoplepeople addictedaddicted toto aa substancesubstance suffersuffer fromfrom chronicchronic andand severesevere emotionalemotional distressdistress priorprior toto it’sit’s useuse characterizedcharacterized byby depressiondepression hopelessnesshopelessness distrustdistrust guiltguilt AngerAnger anxietyanxiety painpain interpersonalinterpersonal inhibitioninhibition MENTALMENTAL HEALTH:HEALTH: SUBSTANCESUBSTANCE––RELATEDRELATED DISORDERSDISORDERS

„ The main goal of therapy is to help the clients establish themselves in meaningful and supporting roles in society „ Recovery is based on self-help with the support and concern of others „ The therapist’s role is to direct he person’s interests toward activities that have a good chance of success „ Activity therapy provides a means to activate and re- socialize the withdrawn and isolated person and help them re-establish social relationships, „ Reduce fears of intimacy and tenderness „ Help develop self-confidence, new interests and new ways of self-expression MENTALMENTAL HEALTH:HEALTH: SUBSTANCESUBSTANCE––RELATEDRELATED DISORDERSDISORDERS RoleRole forfor horticulture:horticulture: „ WellWell--structuredstructured taskstasks „ ImmediateImmediate andand longlong--termterm gratificationgratification „ StimulateStimulate allall ofof thethe sensessenses „ EmphasisEmphasis onon biologicalbiological andand organicorganic processesprocesses inin contrastcontrast toto mechanicalmechanical processesprocesses andand goodsgoods „ ReduceReduce stressstress „ IncreaseIncrease selfself--confidenceconfidence andand selfself-- accomplishmentaccomplishment „ PutPut clientclient inin rolerole ofof aa carecare givergiver asas wellwell asas aa carecare receiverreceiver MENTALMENTAL HEALTH:HEALTH: SUBSTANCESUBSTANCE––RELATEDRELATED DISORDERSDISORDERS TypesTypes ofof horticulturalhorticultural projects:projects:

„ PlantingPlanting seedsseeds „ MowingMowing lawnlawn „ RootingRooting cuttingscuttings „ PlantingPlanting vegetablevegetable „ MakingMaking dishdish gardensgardens gardengarden „ GreetingGreeting cardscards withwith „ CaringCaring forfor landscapelandscape drieddried flowersflowers „ NatureNature walkwalk „ SeedSeed picturespictures „ VisitVisit wildflowerwildflower „ FloralFloral arrangementarrangement meadowmeadow „ HouseHouse plantplant I.D.I.D. „ MaintainMaintain officeoffice plantsplants