severe substance abuse disorder Less severe mental disorder

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severe substance abuse disorder Less severe mental disorder
Mental Health &
Substance Use
A Non-Clinical, Harm Reduction Based
Perspective
Braunz Courtney, Programs Manager
Michael Snow, Screening Coordinator
HIV EDUCATION AND PREVENTION PROJECT OF ALAMEDA COUNTY
PRESENTATION GOALS
To understand
Substance use as a self medicating benefit
 The intersection of trauma, substance use and increased
HIV and hepatitis infection
Basic harm reduction based strategies to increase self
prioritization of health
TRAUMA & HEALTH RISKS
As the number of traumatic events experiences from childhood into
adulthood increase, the risk for the following health problems increases:
• Depression
• Suicide attempts
• Inability to manage minor (peer relations, time
pressures) and major (death, family separation,
divorce) stressors
• High stress
• Uncontrollable anger
AFRICAN AMERICAN SPECIFIC TRAUMA
• Some trauma-focused theories note the effects of racism and discrimination as
having an emotionally injurious effect.
• Afro-centric theories define white racism as a traumatic threat , particularly
those that are lower-income, urban, because white racism threatens their
collective survival.
• The concentration of community poverty leading to rising crime rates, domestic
violence, increased substance use.
• These issues in other populations might be addressed through public services.
however, in our community they (police, social services, etc.) were often
corrupt, abusive, and discriminatory and therefore historically distrusted.
• African American women are underdiagnosed with depression as symptoms
manifest differently (often due to coping through hard work and determination
over physical and mental well-being = “Wonder Woman Complex”)
HEPPAC PARTICIPANTS & TRAUMA
 In 2015, 54% of HEPPACs syringe exchange survey participants self
reported to have received a PTSD diagnosis in their lifetime
Of the 54%, over half (36%) self reported to have been placed on a
legal hold (5150) at least once within the past two years
Of the sample size of 100 active users, 92% self reported to
engage in substance use at least twice per day
Common reason for substance use; “to deal with all my shit”
Shit = homelessness, chronic physical pain, re-occurring PTSD
triggers, lack of family connection/support, lack of basic needs,
etc.
SYSTEMIC BARRIERS/CHALLENGES
• Discriminatory drug laws ; cocaine vs. crack; same substance
different penalties; ethnically specific
• Non - Intersectional funding resources ; public health
department operate in isolation; lack of collaborative efforts to
address mental health and substance use
• Warped public and civic substance use lense;rooted in
criminalization, not viewed as an illness
• THE WAR ON DRUG APPROACH
The Four Quadrant Framework for
Co-Occurring Disorders
Less severe
mental disorder/
more severe
substance
abuse disorder
Less severe
mental disorder/
less severe
substance
abuse disorder
More severe
mental disorder/
more severe
substance
abuse disorder
More severe
mental disorder/
less severe
substance
abuse disorder
LEVEL I
•
•
•
•
•
•
•
EXPERIENCED PARENTS DIVORCE DURING EARLY ADOLESCENCE
PARTICIPATED IN FORMAL COUNSELING/THERAPY/NO PSYCH MEDS
WORKING INDIVIDUAL
HAS FAMILY
SOCIAL ALCOHOLIC
MANAGES DAILY/MINOR STRESSORS WITH NICOTINE HABIT
INCREASED ALCOHOL CONSUMPTION DURING MAJOR STRESS
EVENTS
LEVEL II
• FORMALLY DIAGNOSED WITH PTSD, POST LONG-TERM FAMILY
SEXUAL TRAUMA EXPERIENCED DURING YOUTH
• STRONG FAMILY, PEER SUPPORT
• COLLEGE STUDENT
• CONSISTENT COUNSELING/THERAPY/NO PSYCH MEDS
• RECREATIONAL MARIJUANA AND ALCOHOL USE
• ENGAGES IN UNPROTECTED SEX WITH VARIOUS PARTNERS TO
INCREASE PERSONAL PERCEPTION OF SELF-WORTH
• CONSISTENT STI INFECTION /INCREASED HIV RISK
LEVEL III
SINGLE MOTHER
LACK OF FAMILY SUPPORT
MINIMAL WORK EXPERIENCE / CHALLENGES FINDING STABLE WORK
EXPRESSES INABILITY TO SLEEP TO PRIMARY PHYSICIAN/PRESCRIBES
XANAX
• BEGINS OVERUSING TO DEAL WITH LATE NIGHT ANXIETY (RACING
THOUGHTS OF INABILITY TO COPE)/ PHYSICIAN STOPS REFILLS AND
PROVIDES REFERRAL FOR COUNSELING/THERAPY
• DOESN’T SEEK COUNSELING/THERAPY AND BUYS BENZOS FROM STREET
DEALERS TO MAINTAIN SUBSTANCE USE
•
•
•
•
LEVEL IV
HARM REDUCTION BASED STRATEGY
PROVIDE IMMEDIATE SENSE OF SAFETY
 Provide HEPPAC participants who are “Level IVs” with a safe place
 No threshold to access safe place
 Provide basic needs (food, confidentiality, temporary shelter from the streets
 Provide space for “Level IVs” to socialize with peers; consistent access to peers
creates a social network that extends beyond, safe space
 Consistent utilization of safe space will address basic needs, which can lead to
participant wanting to deal with other issues (pre-contemplation to contemplatation)

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