A Call to Action: Addressing the Mental Health and Substance ...
A CALL TO ACTION: ADDRESSING THE MENTAL HEALTH AND SUBSTANCE ABUSE CRISIS ON CAMPUS M A R I S A A . G I G G I E , M D , M P A F F A D A M B . D O W N S , P H . D , L M F T B L A K E S C H N E I D E R OVERVIEW Statement of Need (Giggie) Current Services (Downs) Student Perspective (Schneider)
GOALS Review of substance use problem on college campuses Review psychiatric problems common in emerging adults Discuss co-morbidity between substance use and psychiatric illness Discuss importance of addressing BOTH substance use and other psychiatric disorders OVERVIEW OF PROBLEM
Amanda 20 year old sophomore who overdosed on heroin found dead by sorority sister in her apartment OVERVIEW OF PROBLEM Michael 19 year old freshman
admitted to local hospital for alcohol poisoning after fraternity party RITE OF PASSAGE SUBSTANCE USE IN COLLEGE 18-25 y.o. enrolled in college more likely to drink ETOH, binge & drink heavily
2011 70% drank ETOH, 14% drank heavily, 22% use illicit drugs (SAMSA) 50% full-time students 18-22 y.o. binged or abused drugs monthly SUBSTANCE USE DISORDERS IN EMERGING ADULTS 30% met criteria for substance use d/o (2011 SAMSA)
23% of full-time college students have SUD vs 8.5% in general population In 2011, 13.2 million high school students in US. 1.6 million have SUD Only 6% receive treatment for addiction Thousands of substance abuse prevention & treatment programs exist in US. Only handful exist for collegiate students CONSEQUENCES OF SUBSTANCE USE
Legal Offenses Health Problems Academic Problems Unintentional Injury or Death Intentional Injury or Death Co-occur with psychological disorders
CO-OCCURRENCE OF SUBSTANCE USE AND OTHER PSYCHIATRIC DISORDERS Selfmedication hypothesis High-risk hypothesis Both REWARD PATHWAY Mesolimbic Pathway
Ventral Tegmental Area (VTA) Nucleus Accumbens (NAcc)Dopamine (DA) Stimulants stimulate NAcc directly Nicotine & ETOH stimulate VTA Opiates & THC work at VTA & some effects on NAcc PATHWAYS
ADDICTION & THE REST OF PSYCHIATRIC ILLNESS DA release in the NAcc highjacks the reward pathway Is this separate or related to other psychiatric illnesses? Addiction is BOTH separate and related to OTHER psychiatric illness RATES OF MENTAL ILLNESS IN EMERGING ADULTS IN COLLEGE
2011, 17.5 million students More than 1,100 suicides 2012, ACHA survey, 45% hopeless, 85% overwhelmed, 80%exhausted, 30%-depressed, 7%-suicidal thoughts, 6%SIB, 1.2%-attempted suicide 24% of students seen by counselors get rx MENTAL ILLNESS IN COLLEGE STUDENTS 88% - counseling center directors report more severe psychological problems In 2012, directors report an increased % of:
Emergency Crises (73%) Psychiatric Medication Issues (67%) Illicit Drug Use Problems (48%)
ODS Issues (59%) Sexual Abuse Issues (30%) Eating Disorders (26%) SIB (40%) Severe Psychological Problems (39%) MENTAL ILLNESS IN EMERGING ADULTS IN COLLEGE Problems are diverse & complex Developmental issues (identity formation, separation crises, transition problems) Trauma & violence
Onset of severe mental illness occurs in young adulthood Schizophrenia, Bipolar Disorder, MDD Stressor of college can trigger psychotic/manic/depressive episode CO-MORBIDITY SUD co-occur with psychological disorders 18-25 year olds with any mental illness 30% meet criteria for SUD (SAMHSA, 2011) Co-morbidity is highest in this age group Rates of mental illness among those with SUD vary from 40-80%
Treatment BOTH SUD and other mental illness is low in young adults 7% 2011 8 million adults older than 18 had diagnosable mental illness AND SUD 33% received mental health care only 4% received SUD treatment only 7% received treatment for both SUD and MI 57% received NO TREATMENT AT ALL CASE: MALLORY
21 year old junior with OCD, Trichotillomania, MDD, and severe Cannabis Dependence Failed sophomore year; skipped class; smoking MJ all day most days, drinking ETOH socially & experimenting with other drugs Rx by psychiatrist at home (3 hours away) Paxil 30 mg, Xanax XR 2 mg daily. Judicial Affairs involved in Back-on-Track program then referred for psychiatric evaluation Adjusted Paxil (50 mg), Added Wellbutrin and Buspar, tapering to less Xanax XR Worked with substance abuse counselor & family
JASON 35 year old non-traditional student. Bipolar d/o. Extensive drug/ETOH use abuse hx crack, opiates, MJ, ETOH Involved in CRC and referred for psychiatric eval Treated for 4 years sober off and on but compliant with medications Relapsed to crack use and left school Most successful in sobriety when compliant with psychiatric treatment
COLLEGIATE RECOVERY COMMUNITY (CRC) CRC CRCs provide environment for students in recovery to remain sober Safe Haven promoting Abstinence Positive Reinforcement for Sobriety
40 + programs in the Country UA CRC CO-MORBIDITY Rates of Co-Morbidity unknown in CRC population Substance Use CANNOT be considered separate from other mental health issues
Mental Health can interfere with recovery Students in Recovery must have mental health support & psychiatric treatment, if necessary SUBSTANCE ABUSE SERVICES designed for students whose excessive use of substances has created serious consequences holds substance-abusing students to a high level of accountability while providing, holistic
treatment and rigorous compliance monitoring for both short and long term programs unites campus leaders, student conduct personnel, and programming professionals SUBSTANCE ABUSE SERVICES Students referred by Office of Student Conduct, Dean of Students Office: Student Care & Wellness, Student Health Center etc. Meet with Dr. Adam Downs for evaluation Placed into appropriate program based on interview and collaboration with referral source.
SUBSTANCE ABUSE SERVICES 3 Programs Alcohol & other Drug Awareness Program (AODA) 4-8 weeks Education w/ monitoring University Community Program 12-16 weeks Life & Coping skill development w/ monitoring Focus on academic success
Campus Drug Court 8-10 months Diversion program through OSC or SCW Life & Coping skill development w/monitoring Focus on academic success AODA PROGRAM
Program Contents: (4-8 weeks) 4 psycho-educational classes Random drug screens Color Code Center for Academic Success (CAS) Case management (weekly) Recovery meeting (weekly) Individual counseling (as needed) Psych/medical evaluations (as needed) AODA PROGRAM Psycho-Educational Groups: Alcohol and Other Drugs: The Mind Body
Connection Pleasure Unwoven Brain disease concept Strength Identification workshop Building character and changing behaviors UNIVERSITY COMMUNITY PROGRAM Phase 1: - Understanding the Problem (4 weeks) Individual Therapy & Group Case Management 1 individual 1 group Psychiatrist for medication management as needed
Extended Assessment Phase Personality Type Values Goals/Objectives Family Functioning Depression inventories Parent/Peer Attachment
Career Center Degree Works Strength finder Treatment plan development UNIVERSITY COMMUNITY PROGRAM Phase 2 Learning the Solution (8-10 weeks) Objective/Goals developed based on Treatment Plan Group Therapy 2x a week Life skill/coping skill development
Individual & Psychiatrist for medication Management as needed Case management Academics custom academic success plan Drug screens color change Weekly requirements Treatment plan compliance
Family Program Monthly updates Family Dynamic education and support Weekly recovery/support meetings UNIVERSITY COMMUNITY PROGRAM Phase 3 Applying the Solution (4-6 weeks) Group therapy 2x week Less case management Present their own case management to group
Mentorship Tutoring Assigned a junior group member Outreach Service project with group CAMPUS DRUG COURT All students have been found responsible for a dismissible violation of the Student Code of Conduct
Clinical Components are same as UCP Length of stay is longer (8-10 months) Involvement from Office of Student Conduct Open Case Review (drug court) Weekly team meetings: Representatives from OSC, UAPD, Law School Extern, Student Housing, Dean of Student office, Substance Abuse Services, Office of Counsel CAMPUS DRUG COURT Involvement from Office of Student Conduct Community service hours assigned (40hrs)
Open Case Review Judge (retired drug court judge) All students attend weekly Weekly updates Receive rewards/sanctions Closed Case Review
Present application to phase up If in noncompliance must go before the team for individual attention COLLEGIATE RECOVERY COMMUNITY (CRC) Mission The mission of the Collegiate Recovery Community is to support students in recovery and help them achieve their academic goals while participating in the collegiate experience without the use of drugs, alcohol, or other behavioral or process addictions. The program also
provides opportunities for families to engage in and support students in their recovery and education. CRC Goals Support lasting recovery for addiction
Aid in development of recovery & life skills Inform/educate student & community about addiction Provide service (ASAS) Raise awareness of recovery process CRC Stats Average Length of Sobriety for UA CRC : 5.4 years UA CRC Grade point average: 3.67 100% of UA CRC student graduates have obtained jobs in their field after graduation, or have been accepted to graduate schools. Job fields of UA CRC students include
engineering, finance, and marketing. A STUDENTS PERSPECTIVE
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