ERIC ED372333: Facts on Mentally Ill Chemical Abusers. Clearinghouse Fact Sheet.

4 Pages·1992·0.12 MB·English

by  ERIC

DOCUMENT RESUME
ED 372 333
CG 025 635
AUTHOR
Fiorentino, Nancy; Reilly, Phyllis
TITLE
Facts on Mentally Ill Chemical Abusers. Clearinghouse
Fact Sheet.
INSTITUTION
Rutgers, The State Univ., Piscataway, NJ. Center of
Alcohol Studies.
PUB DATE
92
NOTE
The New Jersey Alcohol/Drug Abuse Resource
4p.
Center and Clearinghouse serves institutions of
higher education, state agencies, communities, and
school districts throughout the state of New Jersey
by providing technical assistance, training, and
resources in alcohol and other drug abuse education
and prevention. Clearinghouse fact sheets may be
reproduced for educational use.
PUB TYPE
Information Analyses (070)
EDRS PRICE
MF01/PC01 Plus Postage.
DESCRIPTORS
*Drug Abuse; Drug Addiction; Mental Disorders;
Psychiatric Services; Psychopathology; *Psychois;
Psychotherapy; *Substance Abuse; Therapy
ABSTRACT
Individuals are considered mentally ill chemical
abusers (MICAs) when they exhibit psychotic behaviors and are
actively abusing alcohol and/or drugs; are actively psychotic with a
history of alcohol or drug abuse; and/er are actively abusing alcohol
or other drugs and have a history of severe psychiatric diagnoses.
Although some practitioners use different diagnostic labels, MICAs
present a clear constellation of behaviors, symptoms, and risk
factors, and require specific treatment technologies. Mental health
and chemical dependency practitioners noted a rise in the number of
MICA clients during the last ten years due to a number of
contributing factors, such as the exodus of persons from state
hospitals to community care. In the past, treatment for these
individuals was hampered by conflicting or uncoordinated treatment
programs, misdiagnosis, damaging myths about MICAs, and failure to
distinguish between psychiatric disability and chemical dependency.
Today, a treatment protocol for the MICA client is emerging and
practitioners now agree on a number of treatment strategies: (1) both
illnesses must be treated concomitantly;
(2) the illness given
priority is the one most florid at the time of admission; (3) the
psychiatric illness must be controlled to deal with the active
chemical dependency; and (4) chemical dependency must be stabilized
to treat the psychiatric illness. (RJM)
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Reproductions supplied by EDRS are the best that can be made
*
from the original document.
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FACTS ON MENTALLY ILL CHEMICAL ABUSERS
by Nancy Fiorentino & Phyllis Reilly
REST COPY AVAILABLE
U.S. DEPARTMENT OF EDUCATION
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Office of Educational Research and Irnorovement
MATERIAL HAS BEEN GRANTED BY
EDUCATIONAL RESOURCES INFORMATION
CENTER (ERIC)
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0 This document nes been reproduced as
received from the person Or organization
onginatrng it
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reprOduCtiOn Qua 1dy
Points of view or opirons stated in this docu-
TO THE EDUCATIONAL RESOURCES
ment do not neCeSSarily represent official
OERI position or policy
INFORMATION CENTER (ERIC).-
New Jersey Alcohol / Drug
EN
NEE
EN
RESOURCE CENTER AND CLEARINGHOUSE
NE
Center of Alcohol Studies, Rutgers University
I
I
FACTS ON MENTALLY ILL CHEMICAL ABUSERS
Nancy Fiorentino, M.S.W. & Phyllis Reilly, M.A., CADC
difficulty of distinguishing between psy-
coholics have a second diagnosis corn-
The New Jersey Division of Mental Health
chiatric disability and chemical depen-
pared with 44% of male alcoholics. Of 1.4
and Hospitals defines mentally ill chemi-
dency in a client. This occurs mainly be-
million persons treated for alcoholism in
cal abusets (MICAs) as persons with diag-
cause clinicians tend to be trained in one
1987, two-thirds had a current psychiatric
noses of severe mental illness and chemi-
specialty or the other and symptoms mimic
disorder in addition to substance abuse.
cal dependence. Specifically, an individual
and mask one another. For instance,
is considered MICA when psychotic and
chemical dependency may produce tem-
In 1989 MICA clients in New Jersey corn-
actively abt,...,ing alcohol and/or drugs,
porary psychoses, hallucinations, para-
prised approximately 30% of state and
actively psychotic with a history of alcohol
noia, even suicidal tendencies.
county hospital admissions and 17% of
or drug abuse, and/or actively abusing
community program admissions. Of these
alcohol or other drugs with a history of
Similarly, psychiatric disability frequently
admissions, about 20% of all mental health
severe psychiatric diagnoses. MICAs are
resembles addiction, particularly when the
service clients had alcohol problems; about
most likely to be unemployed young adult
psychotic episode takes place during a
9% had problems with drugs. In contrast,
males between the ages of 18 and 35. How-
period of intoxication. Chemically depen-
about 5% of mental health service clients
ever, persons of other ages and either gen-
in the general population have alcohol
dent people frequently experience depres-
der may be MICA.
!
problems -,nd 2% have drug problems.
sion and anxiety as a normal part of with-
drawal and adjustment to a life of recov-
Between 1984 and 1989, the proportion of
Persons suffering from concomitant ill-
ery. For some persons, psychiatric treat-
MICA clients rose by 7% in community
nesses of psychiatric disability and chemi-
ment will be necessary. For others, the
programs and 4% in hospitals.
cal dependency have been variously re-
depression will lift if given time to adjust
ferred to throughout the United States as
Mental health and chemical dependency
to the new abstinence lifestyle. Generally,
SAMI (Substance Abusing Mentally Ill),
these conditions improve with abstinence
practitioners have noted a rise in the num-
Dual Diagnosed, SECA (Seriously Emo-
ber of MICA clients during the last ten
and recovery.
tionally Impaired Chemical Abusers), and
years. Contributing factors are the exodus
PICA (Psychiatrically Impaired Chemical
Persons who demonstrate addiction have
Abusers). Whatever term is used to de-
cl persons from state hospitals to commu-
been discriminated against in the psychi-
nity care and unsupervised living, the in-
scribe persons who are suffering from a
creasing ranks of homeless and impover-
atric system, and persons who demonstrate
dual diagnosis, MICAs present a clear
psychiatric symptomatology have been
ished persons, and the collaboration be-
constellation of behaviors, symptoms, and
discriminated against in the addiction sys-
tween mental health and chemical depen-
risk factors and require specific treatment
tem. Now, enhanced assessment of clients
dency providers.
technologies.
who are recognized as suffering from dual
diagnosis has become a vailable.
How-
In the past, because chemical dependency
Psychiatric disability is more common
ever, past refusal of treatment and provi-
treatment and psychiatric disability treat-
among addicted persons than in the gen-
sion of inappropriate treatment to indi-
ment occurred in different settings with
eral population. Addiction is more com-
viduals and family members gave rise to
different technologies and specializations
mon among psychiatrically disabled per-
the Mentally Ill Chemical Abusers move-
of health care personnel, these treatments
sons than among the general population.
took place sequentially and frequently
ment.
Both illnesses may be in an acute stage
were contradictory. Therefore, a person
simultaneously, or one may be in remis-
who was dually-diagnosed could receive
Den ial of the concomitant illnesses contin-
sion while the other is active, or both may
ues in both systems. Problems are com-
treatment for both chemical dependence
be in remission.
pounded by misdiagnosis, mistreatment,
and addiction, but these treatments would
and myths surrounding the treatment of
not take place concurrently, nor be coordi-
In the general population, about 13% hi.ve
each disability. There are more relapses
nated. These practices of the two systems
experienced alcohol abuse or dependence
with MICA clients, more problems with
led to frequent client relapse and contra-
at some time during their lives, and about
dictory treatment instructions from the
medication and treatment compliance, and
half ot this group also has had a psychiat-
two systems to the client and family. His-
more resistance. Families report that they
ric diagnosis. Diagnosis of alcohol depen-
suffer from a double stigma and strong
torically, combined treatment did not sur-
dence is five times more prev.ilent among
denial.
face until the mid 1980's.
men than among women. However, the
association of alcoholism with other psy-
Another frequent problem (more preva-
chiatric diagnoses is more prevalent in
Individuals with a lifetime history of psy-
lent in the past but still ongoing) is the
chiatric disility and addiction have clic-
women. Sixty-five percent of female al-
CLEARINGHOUSE FACT SHEET, 7992
Family members have organized associa-
programs. This pamphlet paved the way
ited adverse public reaction due to
tions for mutual support and to advocate
for the establishment in New Jersey in
homelessness and perceived antisocial acts
on behalf of MICA relatives. Renewed at-
1985 of the first specialized self-help group
and bizarre behavior. Therefore, commu-
tention, funding, and demonstration
for persons with dual diagnoses.
nities have demanded more careful scru-
projects for specialized treatment of this
tiny of both addiction and psychia tric agen-
population have resulted. Addressing the
Today a treatment protocol for the MICA
cies. However, service agencies are faced
service needs of the MICA has brought
client is emerging. Practitioners agree: (1)
with medical and legal conflicts. At times,
about an emerging partnership and con-
both illnesses must be treated concomi-
the treating professional knows that the
sensus between the mental health and
tantly; (2) the illness that will be given
dual illness is not under control, but, if the
chemical dependence fields. This is re-
priority is the one that is most florid at the
client has not done anything to require
flected in recent federal legislation (1991)
time of admission; (3) stabilization of the
commitment, treatment is unavailable.
which mandates nondiscrimination in ser-
psychiatric illness is necessary to deal with
Treatment technologies in both systems
vice provision to dually-diagnosed clients
the active chemical dependency; and (4)
are changing to accommodate MICA
in all federally-funded mental health, al-
stabilization of the chemical dependency
needs. The addiction system has become
cohol, and drug addiction agencies.
is advised to treat the psychiatric illness.
flexible about participation in formal lec-
tures and acceptance of prescribed medi-
cations. The mental health community has
become more open-mi nded about referral
REFERENCES
to self-help groups and the need for blood,
breath or urine testing.
The A.A. member, medications and other drugs: A report from a group ofphysicians in A.A.
Appropriate differential diagnosis and
(1984). New York, NY: Alcoholics Anonymous World Services, Inc.
cross-training of mental health end addic-
tion professionals are essential. At the
Daley, D.C., Moss, H., & Campbell, F. (1987). Dual disorders: Counseling clients with
present time, there are many gaps in the
chemical dependence and mental illness. Minneapolis, MN: Hazelden.
continuum of care. Many treatment ser-
vices remain inappropriate. MICA clients
continue to face discrimination. Agencies
Evans, K., & Sullivan, J.M. (1990). Dual diagnosis: Counseling the mentally ill substance
protect turf and territoriality depending
abuser. New York, NY: Guilford Press.
upon funding streams and technical skills.
The costs of mismanagement are enor-
Helzer, J., & Pryzbeck, T.R. (1988). The Co-occurrence of alcoholism with other
mous. Mental health emergency services
psychiatric disorder in the general population and its impact on treatment. Journal
see persons who are not in stable recovery
of Studies on Alcohol, 49, 219-224.
from the chemical dependency. Chemical
dependency programs experience more
National Institute on Alcohol Abuse and Alcoholism. (1990). Alcohol and health:
relapse because of unstabilized psychiat-
Seventh special report to the Congress from the Secretary of Health and Human Services.
ric disability. Treatment is driven by the
Washington, DC: U.S. Government Printing Office.
therapist's approach and the agency's
philosophy rather than client needs.
O'Connell, D.F. (Ed.). (1990). Managing the dually diagnosed patient: Current issues
and clinical approacheq. New York, NY: The Haworth Press, Inc.
Nearly ten years ago, a new publication
was developed by a team of recovering
Office for Treatment Improvement. (1990).Bibliography of abstracts in coexisting sub-
psychiatrists which addresses the issues
stance abuse and mental disorders. Rockville, MD.
of AA and medication. This pamphlet ar-
ticulates the problem of v.ychiatrically
Reilly, P. (1990). Assessment and treatment of the mentally ill chemical ;thuser and
disabled individuals attending Alcoholics
Anonymous and being admonished to
the family. Journal of Chemical Dependency Treatment, 4, 167-178.
cease taking psychotropic and other pre-
scribed medications. The authors empha-
Vine, P. (1982). Families in pain: Children, siblings, spouses and parents of the mentally
size that there is a subset of the MICA
ill speak out. New York, NY: Pantheon Books.
population for whom medication is a nec-
essary and helpful adjunct to treatment
and that this group should be supported
in their recovery process through 12-Step
The New lerseyAkohol/Drug Resource Center and Clearinghouse serves institutions of higher educ ation, state agencies, communities,
Nancy Fiorentino, M.S.W.
and school districts throughout the state of New jersey by providing technical assistance, training , and resources in alcohol and other
is a policy analyst in the Office of Ilealth Policy and
drug abase education and prevention. For more information on the Ckaringhouse, call or write to:
Research, NJ Department of Health and co-adjunct
New jersey Alcohol/Drug Resource Center & Clearinghouse
faculty at Rutgers University 's Graduate School of
Center of Alcohol Studies
Social Work.
Smithers HallBusch Campus
Rutgers University
Phyllis Reilly, M.A., CADC
Piscataway, NT 08855-0969
(908) 981 - 0964 FAX [phone]
is Director of Addiction Recovery Services, Commu-
1992
4
nity Mental Health Center, l'iscataway, NJ and Associ-
kutGERS
ate in Psy i. hia try, Robert Wood Johnson Medical School,
University of Medicine and Dentistry of New Jersey.
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