 This episode was prerecorded as part of a live continuing education webinar. On-demand CEUs are still available for this presentation through all CEUs. Register at allceus.com slash counselor toolbox. I'd like to welcome everybody to today's presentation of the biopsychosocial impact of addiction on family and community. So you might be asking yourself, well, how does this apply? Well, even if your clients are not addicted to something, they may be related to someone who's addicted to something. And they're definitely living in a community where people are addicted. And so we want to look at the impact on the communities and how addiction can actually have negative impacts on the community and create a community that's more supportive of addictions and mental health disorders. And we're also going to look at what we can do as clinicians who may be treating people who are family members of someone with an addiction. So identify the biological and health consequences of addiction and mental health issues on the family and community. The psychological consequences of these things on the family and community, the social consequences, and then we're going to talk about interventions. So the family really functions to protect and sustain both the strong and the weak members of the family to help them deal with stress and pathology. The family doesn't say, well, we're going to keep the strong and the weaker on their own or vice versa. They're going to take care of the weak and the strong can fend for themselves. The family really brings everybody into the fold. So when there is a family member that is an identified patient, they're not going to be outcast or ostracized. They're going to still be part of that family. So we need to help the family figure out how to function or readjust their equilibrium with this new situation that has presented itself. The family serves as a mechanism for family members to interact with broader social and community groups. So it also influences who you interact with. My kids, especially since they can't really drive themselves yet, interact with groups and things that my husband and I interact with. They interact with their schoolmates. They interact with people where they take martial arts and things. But the family really serves as a launch pad and shapes where their interests may lie and with whom their interests may lie. The family also provides an important point of intervention. And this is for anything we're talking about, whether it's diabetes, depression or addiction. The family can help support the identified patient in making positive changes and in doing what they need to do and can encourage them when they're going gets tough. The family influences weaker members in harmful ways due to tension problems and pathology. So they're not ostracizing anybody. Everybody is, you know, brought into this family, this equilibrium, this unit. And ideally, it protects and sustains both the strong and the weak. But if the family unit has a lot of tension and problems and pathology and from clinical experience, we can see how this is true. Then the weaker members may tend to start suffering from that they may tend to experience more anxiety and depression and hopelessness. They're not observing healthy coping skills. They're not observing effective interpersonal skills. So the family can be, as I've said many, many times, the greatest buffer against stress or one of the biggest sources. So we really want to help create a healthy family system to prevent mental health issues in anyone who doesn't already have one to buffer against the effects of an identified patient that might have a presenting issue. And to help people live the highest quality life possible. So biological effects on the family includes stress and stress related illnesses and sleep disturbances. If you're worried about a family member, whether they're going to commit suicide, whether they are struggling and you're just worried about them, whether they are struggling with an addiction, any of these things, or even physical health issues, but that's ancillary. Any of these things can cause a parent to worry, can cause a sibling to worry, so it can increase stress within the family unit, which can cause stress related illnesses, as well as it impairs sleep. When people are under stress, they're not going to sleep as soundly. They're not going to have the quality sleep they need. And we know when quality sleep starts to go away, so does physical health, mental health, energy, all that other stuff. If the parent is the identified patient, then you may have issues where the parent fails to attend to the children's physical or psychological needs, not because they don't want to. You know, a lot of times they just, they're not able to get out of bed. They are not emotionally or mentally present, even though they may be physically present. And sometimes they're not even physically present because they're away in treatment or in jail or wherever they're at. So it's important to look at how does this impact the children and the family, and what can we do as clinicians and community members to make sure that children are still getting their needs met, to make sure that they have a safety net if their parent is incapacitated for some reason or another. Family members are also exposed to toxic substances. This is obviously in the case of substance abuse, cigarette smoke. We know that second hand cigarette smoke, second hand marijuana smoke can have extremely detrimental effects on the children and on anybody else in the family, but especially children and adolescents who still have a brain that's in the formative stages. And exposure to drugs, having drugs available in the household can predispose children to experiment to try it out. Another effect we see on families is the overuse of sedatives among parents for relaxation. You know, if they're anxious and stressed out. Sometimes parents may overuse the benzodiazepines, some sort of relaxation, something for relaxation, whether it's alcohol or prescribed medications, or even Benadryl to help them relax. But we also see, and people don't like to talk about it, but we also do see in parents who are just kind of at their wits end, they are out of gas, they are not able to attend to their kids' needs in a meaningful way. We see these parents may turn to using Benadryl and some other sedative type medications to get their kids to go to sleep. Just, I can't deal with you right now, you know, take a pill, go to sleep, and you know, I'll see you when you wake up. So we want to make sure that parents have the tools, even if they're depressed, even if they're anxious, even if they are struggling with addiction, that they have the tools to cope with the children in the family unit. And or they have a respite, they have somebody they can call in, they have an alternative, so we're not exposing children to unhealthy coping skills as much as possible. Psychological effects on the family, physical or verbal abuse can happen when you have someone who has anxiety, they can be much more irritable and snippy and can be sometimes hateful. In their words, you can see some more physical abuse, you also see more physical and verbal abuse when there is, especially when there's alcohol involved in the picture, more so than some of the other drugs. But we know that when substances or mood disorders get into a family and they're uncontrolled, that we can see an increase in physical and verbal abuse. The family's behavior becomes really erratic around the identified patient because they're walking on eggshells, they don't want to set the person off. They don't want to make the depression worse, they don't want to make the anxiety worse. They don't want to make the addiction worse, whatever's going on with that person. They want the identified patient, mom, dad, brother, whoever it is to be okay to be there. So they start walking on eggshells to try to keep calm. If it's a sibling, for example, when the sibling relapses or has an episode, mood or addictive or otherwise, parents are probably going to experience extreme stress. So other siblings may not feel like they're getting the attention they need. So you can see where there's a constant power shifting going on, which would motivate people to maintain a status quo. Motivate people to walk on eggshells because when the identified patient has an episode, it causes a cascade of negative effects. Child neglect can happen, and this is, like I said, even if there's, it's the parent who is experiencing the issue may not be able to attend to the child's needs in an effective way. But even if it's a sibling who is constantly relapsing or having, you know, self-injuring and having to go to the hospital. So the parents are constantly focused on the sibling than other siblings may not get the attention that they need. They may not be able to access some of the resources they need. You know, mom and dad may be so busy running older sibling to the emergency room and stuff that they forget to, you know, stock the refrigerator. That doesn't happen a lot. You see this more with addictions when somebody is completely consumed with their addiction. But sometimes when you've got a parent, especially who is clinically depressed and they just can't get up to go to the grocery store or something. And if children aren't old enough to say, you know, we need to call out for pizza or something, you can start to see some child neglect. There may develop an attitude of don't talk, don't trust, don't feel in the family. And this is, again, one of those things that's more prominent in families with a person with an addiction. But sometimes with a mental health issue, the thought is if we don't talk about it, if we pretend it's not there, then it's not going to be as big of a problem. We can't trust that everything's going to be okay from minute to minute, which is why we're walking on eggshells. And we just need to numb up our feelings because the stress is overwhelming and we can't keep feeling it all the time and the resentment and the anger. It does no good because we don't have an outlet for it. So it creates a situation in the family where we have a lot of people with a lot of pent up feelings, a lot of them negative. Who don't trust themselves, who don't trust other people and who don't feel like they can actually affect any sort of change. So as clinicians, as helpers, we can start helping people look at being more genuine and authentic. Shame and guilt can be present in the identified patient, having shame and guilt about being depressed and not being able to meet needs about having an addiction and, you know, making choices that they later regret, or not being able to or not having been present for people's graduations or ball games or whatever. But shame and guilt can also be present in the non identified patient. So the other family members who think what did I do to bring this on? How could I have prevented it? What did I miss? And being ashamed of having a parent or a sibling maybe of who is experiencing an addiction or a mental health issue. These are things we can destigmatize. So we need to get in there and say, you know what, for the, for the identified patient, we can work with this shame and guilt. That's energy tied up in the past. You can't change it. How can you, you know, make amends, move on from here, not do it again, whatever the case is for the non identified patient for the rest of the family members who may be experiencing shame and guilt. We want to make sure to educate about how common these issues are to destigmatize it and to address any guilt issues and help them understand that, you know, whatever is going on with that person is going on with that person and it's not your fault. Depression can also be very prevalent among the non identified patient. If the patient has depression or anxiety or the rest of the family members may feel exhausted, may feel resentful, may feel anxious because of this person's current issues, and they may get exhausted. I mean, it's really tiring sometimes when you have someone who is an acute episode, taking care of them and worrying about them for, you know, days or weeks on end. So we start to see caregiving burnout. We start to see parents who are at their wits end, and, you know, they want to help junior feel better and they just don't know how. And they feel like they've done everything and nothing's working and they feel like they're spinning their wheels. So we want to make sure that parents have an anybody who's involved in care caregiving for someone with a mental health or addictive issue that they have outlets that they have other resources that they have support, preferably from other people who are also caregivers who get it. Sometimes we'll see role reversal, where the parent is the identified patient and they can't take care of themselves or the family. So the child steps up. And, you know, I've seen this in clinical depression, I've seen it in addiction, where the parent just can't do it and even in anxiety, I've seen children calming their parents and going it's okay, you know, I'll take care of it mom. It's important to make sure that the boundaries and the roles are clear in the family so help the child regain that role of the child and help the parent regain the role of parent. And so they both understand what their roles are and how to accomplish them. Children can lack a sense of well being and safety if their parent is regularly unpredictable about whether they're going to be emotionally or physically present, which creates a lot of anxiety, even in older children who have object permanence and all that. If they don't know whether mom's going to remember to pick them up from school. If they don't know whether mom's going to have a good day or a bad day or dad or whomever. It can create a lot of angst within them. And children in families with a parent with a mental health or substance use disorder often see inappropriate coping models or no coping models the parent is just kind of incapacitated. So they don't learn how to cope with life on life's terms. Socially, a lot of times, regardless of the diagnosis, the family tries to put on this facade for everybody else. Nobody else's business or you know, I don't need everybody else's intervention or whatever for whatever reason. They put on this facade like everything's fine. How are things going. You know, they may not say great, glorious, wonderful and make up a lie, but they're not going to reach out to other people and go, we're really struggling right now. Part of that is maybe because the shame. And part of it may just be from exhaustion from caregiving for an impaired member so people, even if they're not ashamed of what's going on they may stop going to support group meetings they may not go to their normal social activities because they're just so tired. And if those activities provided a good buffer, a good stress buffer for them, then they lose that on top of, you know, not getting a recreational respite or whatever. It's really important that we emphasize to people that they are no good to the identified patient, if they are not able to function, they need to take care of themselves or they're no good to anybody else. Families can experience financial problems due to lost employment and or overspending lost employment can happen because of mental health issues. Being on long term disability, losing your job because you called in too many days sick. Being having poor work productivity and we're going to talk about presenteeism when we get down to the community impacts. And these financial problems cause stress within the family it can cause homelessness it can cause all kinds of other reciprocal problems when you don't have enough money to meet your basic needs. So we want to look at how can we help people sometimes referring them to financial counselors, making sure they know about social services that are available. If they have too many financial problems they may lose their health insurance, you know, if they have children then they can probably qualify for Medicaid. But we want to make sure that they can access all of those things on the bottom tier of Maslow's hierarchy. Overspending is more in the case of addiction. People shopping, buying drugs, spending money on things to make themselves feel better can also cause financial problems. Other family social effects, childhood trauma, depression and anxiety you see the kids in the family start to struggle and children start having poor relationships with adults. If the identified patient is an adult is a parental unit, then they start not trusting other adults they start, you know, don't talk don't trust don't feel. You know it's not safe to go to your homeroom teacher and go you know what mom needs really needs some help, and a lot of kids wouldn't do that anyway, they wouldn't go to the school counselor they wouldn't go and ask for help for it. They tend to withdraw and adults often interpret withdrawing as resistant or anti social type behavior instead of going, what's going on. And a lot of times children are not going to answer truthfully the first time because they're trying to protect their family. So they're not just going to spill it. So it's important that we have places where children feel safe to talk and ask for help, let people know what's going on. Lack of social competence may also occur if there's you know you're not going out you're not interacting you're not going to church or whatever you do for recreation you're not interacting with other people, because the identified patient needs to stay home. And then children, especially in the family don't develop that sense of social competence. They don't have those experiences. It can create distant chaotic or unsupportive family relationships where people just start going you know what, I've done everything I know how to do. I can't do anymore. So they start pushing away, which is not helpful to the identified patient. And they're both everybody starts struggling can also cause inconsistent parenting if the identified patient is the parent or taking care of a sibling who has a problem. The parent may not always be focused. You know if the identified patient is older brother Tom, and he's having an episode right now, then the other kids learn that they can probably get away with a lot because parents attention is diverted over here. Likewise, the children who aren't getting the attention may act out in order to garner attention. So inconsistent parenting has some reverberations more common in addictions than in mental health. We also see homelessness and placing the family in high risk situations. So it's important to look at what are the effects you know this patient we're dealing with. If it's a person with with an addiction or with a mental health issue. How is it impacting their support system and what can we do to sort of shore up that support system and make sure it stays there and is really strong. If the person you're working with is not the identified patient, we still want to look at the family system. The identified patient may not be ready for treatment. You know what, regardless of the diagnosis, but what can we do with the person that's in our office to help them manage this family environment that right now is kind of rocky. I'll stop short of saying dysfunctional some things that we can do include improving communication within the family help people start talking about their wants and their needs and being able to be open about. What's going on and being honest, sometimes parents think keeping things from children shields them where when an actuality kids know a lot more than we give them credit for. So, opening up within the family destigmatizing it being willing to talk and encouraging family members to and you may need to do this and family therapy to effectively communicate their feelings and thoughts about the current situation. It's rare. Not going to say it doesn't happen, but I haven't ever experienced it working with a family where there is an identified patient who is highly symptomatic for, you know, depression or anxiety or addiction. They're highly symptomatic. It's rare if that goes on for very long for the children in the family and the other people not to develop some frustrations, resentments, irritability. We can help people with that we can intervene we can help them look at the resentments address their feelings. You know, even if the identified patient isn't willing or ready or able to deal with their issue. We want to help the client figure out. All right, this is my situation right now. How can I improve it for me? How can I make the next moment better for me if this over here can't change and I can't change it? How can I deal with it? We want to help restore roles and boundaries within the family if they've been disrupted and a lot of times they have. So, you know, going back and looking at who's responsible for feeding the family getting the kids to to their lessons and to school and all those sorts of things. Make sure to educate the family and the community about the disorder about the issue. This is what it looks like. This is what can trigger it. And we want to talk about, you know, not just specifically for the identified patient, if we know what triggers it for him or her. But we want to talk about in general and make sure people understand how to prevent vulnerabilities by getting good sleep eating eating well getting some exercise, making sure to keep their circadian rhythms kind of set. Involve the whole family when it's clinically appropriate in the treatment plan. So, and this presents an interesting opportunity. If the person you're working with is not the identified patient, so to speak, you know, maybe it's mom and dad is the person that has clinical depression. Mom comes in. She's like, I'm at my wit's end. We can still bring the family in and go, you know what, we need to involve everybody in helping mom feel better. There are some treatment plan issues that we can work on, but making sure to bring dad into so he can see and be involved in helping mom feel better. Generally, if we're modeling good skills and trying to help one person feel better, everybody is going to be doing more healthful behaviors. So we can indirectly start impacting dad's behavior, the identified patient's behavior by working, getting the whole family working together to help whoever it is that's in your office. Address anger, guilt and resentment in family members because it's going to happen. It's going to be there. So help them figure out and understand that anger represents a response to some sort of a threat. You know, and in many cases like this is loss of control. You know, you can't make the person feel better. It feels like your environment is completely chaotic. So yeah, it makes sense to be kind of frustrated or downright ticked off. So fine. That makes sense. Now, what are you going to do about it? So helping people move from feeling the feeling to choosing to improve the next moment. But what that looks like for each person is going to differ. What they have control over in each situation is going to differ. Ensure that all family members have a respite, not just, you know, we'll stick with the, you know, mom is the caregiver, dad is the identified patient. Mom needs a respite. True. But so do the kids. The kids need to be able to get into an environment where there's happiness and joy and laughter and loudness and all that stuff that may not be happening in the household where there is a depressed identified patient. So we want to make sure that kids can get out and experience life and joy. We want to encourage healthy behaviors in the family. Nutrition, sleep and exercise. These are things that we can encourage them to work with their, the rest of their care team. Ostensibly to help whoever's in your office, but it's going to improve the life of not only the identified patient, but everybody in the family. And they can also encourage bonding and communication if they start cooking together or going out on walks after dinner together or, you know, whatever it is that they do. And we want to encourage the development of social supports, especially via support groups. So people are interacting with others who have similar experiences, similar needs right now. Caregiving is unique. Someone who is caregiving for a person with Alzheimer's is going to have unique experiences compared to somebody who's caregiving for somebody who's in recovery from addiction. So ideally we want to get them into some specified kind of support groups so they can, you know, reach out and understand. I know when my son was in the NICU, that's a whole different world. You know, there's beeping and buzzing and noises and tubes and everything constantly. And you also have to figure out how to work with the NICU nurses, which I found a little bit challenging sometimes. We had one nurse who was really awesome. But then there was another one that I had kind of power struggles with sometimes. So being able to communicate with other people who made it through NICU life to figure out how to survive. One of the things that I was doing was staying in the NICU all day long. You know, I'd get there in the morning and I would be in this room, which is dark. It's dim almost all day long. And then I'd go out, I'd go down to the cafeteria, I'd eat, I'd come back and sit in the darkness. That threw my circadian rhythms off. In addition to being, you know, under stress because, you know, my little dude was in an incubator. It was important for me to be able to give myself permission to go outside and take a walk and, you know, not necessarily be there all the time. But it took somebody else saying, you know what, he's really not going to know if you're gone for 30 minutes and it's going to be a lot more productive. And you're going to be able to be better for him if you are happy, healthy and functional, especially when he comes home. So it's really important to have people that understand what you're going through. And, you know, clinicians, we can educate that that's true, you know, just because we haven't had a family member with Alzheimer's doesn't mean we can't be supportive. But if we're encouraging people to reach out to lay people in the community, you know, it does help to encourage them to interface with people who share similar experiences. Because then they don't have to try to educate. What else do you think you could do with people with families to help intervene and prevent or prevent the disorder from kind of spreading through the family or having secondary implications. Okay, we'll move on to community mental health. No, substance abuse and mental health don't just impact the family. It actually impacts the community. If you think back to Brock von Brenner's model, the individual is at the center, the bull's eye, then you have the family and the and the work and school, and then you have the larger community. When a person is has a mental health or substance use disorder, it affects their work. It affects their performance at school. It affects whether they are attending their recreational activities church or volunteerism or whatever. So it does have an effect on the community. People with poor coping skills. You know, this is kind of general and negative thinking styles tend to model these behaviors spreading them. So in a community, if children are exposed to people who have poor coping skills, they're probably if they're not provided with other models that have good coping skills, they may learn those and not anything else. So we want to make sure that the people that are serving as role models, our teachers are our coaches are pastors are community leaders and our parents have knowledge of what good coping skills look like and preferably can implement them and model them. The National Bureau of Economic Research reports that there's a definite connection between mental illness and addictive behaviors. So by intervening early in families where there is potentially some mental health stuff going on, we can prevent the development of that as well as the development of addictive behaviors. People who've been diagnosed with a mental health disorder at some point in their lives are responsible for the consumption of 69% of the alcohol, 84% of the cocaine and 68% of the cigarettes. And the reference for that is at the end of the presentation. But what I really want you to see is we're creating a healthier community. If we intervene early to make sure that not only, you know, we talked about prevention has multiple approaches. The identified patient, we don't want them to get worse and we don't want them to experience fallout from their issue from their condition. But for everybody else in the family and the community, we don't want them to develop it at all. If possible, we want to prevent it. So we want to intervene as many different ways as possible. The total economic burden of depression in the year 2000. So it was a while ago was $83 billion. So depression is expensive. $52 billion was due to lost workplace productivity. So that's $31 billion was due to other costs. But $52 billion was due to lost productivity. Anxiety costs roughly $47 billion a year. And we're talking over $100 billion a year is costs the US each year over $100 billion because of depression and anxiety issues. And that's not including any of your other mental health issues. We're just talking about depression and anxiety here. Other costs and not just like medicine and healthcare include absenteeism and turnover. Annually employers lose 27 work days per worker with depression. So two thirds is due to presenteeism, which means the person is there, but they're barely functional. You know, they kind of show up and they stagger in and they do the bare minimum. But they did the statistical monkeying or whatever to figure out how many work days, how much productivity was actually lost. 27 days is a lot. That's, you know, five times. That's like five weeks worth of work in addition to time off days, which, you know, so you're looking at losing seven to 12 weeks out of every 52 when you're working with an employee who has clinical depression. The cost of depression to employers is greater than the cost of many other common medical conditions, including heart disease, diabetes, and even back problems. So depression has a significant impact. The leading cause of medical disability for people aged 14 to 44, 14. Oh, that broke my heart when I read that stat. The leading cause of medical disability for this age group is depression and anxiety. This, you know, if they're on disability, they may have reduced spending, they may experience more poverty, less upward mobility, because they're not getting promotions and that kind of thing. They also may experience less connection and community involvement if they're not going to work, if they don't have that sort of connection, and if they are not financially able to go out and do a bunch of other things. So it's important as advocates, if we can, to encourage communities to make sure there are places people can go to engage in basically free recreation parks. We have here, movies on the lawn once a week every summer, activities at the library. There's generally things that can be done. It's important that we make sure that people who need to know about these things know about them. When I had very young children at home, I very much look forward to library activities where I could pack them both up and we could go do something just to get out of the house and kind of regain my sanity for, you know, an hour. More than one in 10 Americans age 12 and older report taking an antidepressant. And remember antidepressants are effective for only about 41% of the people who take them. But just think about that for a second. One in 10 Americans over the age of 12 is taking an antidepressant. What does that say about what we're communicating? How the health of our community right now, the health of our culture right now if 10% of people are over the age of 12 are on antidepressants. Effective treatment outreach in many instances is often stymied by a combination of stigmatization of mental illness. So we reach out and we say, you know, if you're depressed, you know, we can help you come to this clinic. A lot of times people won't go because they don't want to admit that they're they've got clinical depression or they don't want to admit that they postpartum depression is another big one. A lot of people are still afraid to talk about partly because the media has highlighted the couple of cases where there's been infanticide from postpartum depression, but they haven't focused on the millions of women each year who deal with postpartum depression. So educating the community about mental illness and about addiction so it's not such a stigma. Educating the community about how prevalent it is. So when they're sitting in a meeting at work or in church or even they're at Walmart and they're looking around, you know, standing in the Walmart parking lot someday and look around there's like, you know, I don't know 150 cars. Well, think about it, about half of those cars have somebody in them that is either experiencing addiction, depression, or anxiety. Wow. Okay, so maybe we're not as alone as we think we are. Some people also don't reach out for help and take advantage of treatment outreach and early intervention because they don't realize they need care. They think, oh, I'm just having a bad week. I'll get over it. But a bad week turns into a bad month turns into a bad six months. And then before they realize it, they are, you know, clinically depressed. A belief that treatment wouldn't work in their particular circumstance, either because they've been through treatment before and it didn't work, or because they have front family members who've been through treatment before and it didn't work. I really firmly believe in educating people about not only the fact that depression and anxiety and addiction are treatable, but also the fact that what worked for Jane may not work for John and there are a lot of different counseling approaches. So if you went to a humanist rogerian counselor before and it didn't work, you know, let's talk about what you think might work. Maybe we'll look at cognitive behavioral. Maybe we'll look at experiential EMDR if we're talking about trauma issues. So helping people see that it's not a one size fits all. And if this one thing doesn't work, then you're screwed is really important. We want to open that dialogue in the community so people who need to hear it can hear it because a lot of times they're not going to come and say, well, I tried it before and it didn't work. We need to actually reach out to them and go, Hey, guess what? There are multiple options out there. Some people don't reach out for help, even for community support groups and stuff because they believe a cure can be found in a pill. So they keep going to their doctor going, Well, that meds not working. Give me another one. And they before they know it, they end up on like six different medications and they're still not feeling what they call happy. And then they start getting depressed and feeling hopeless and helpless. Other people may not reach out because they're impatient with a slow pace of symptom relief. So they're like, Well, it's not working. It doesn't work for me. How long were you in treatment? Well, sometimes people will say I was in treatment for two weeks and I wasn't feeling any better. And I'm thinking to myself, well, you felt that way for 20 years, two weeks, probably not going to feel huge improvements. As clinicians, again, we can encourage people and educate people in the community about the fact that treatment, you know, effects generally take anywhere from six weeks to three months to really start feeling a good strong effect from it. So for educating the community, then the family members of the identified patient are also hearing this message and they can cheerlead and they can go, You know what? It's only been two weeks. You need to give it a little more time and they can get some hope and say, You know what? It's only been two weeks. I bet in a month or so things will start getting better as we improve hope. We improve treatment compliance. We improve a whole lot of the things. A lot of it is really about outreach and education, not just to the identified patient, but to the family members that support him or her and the community that serves as the larger safety net and provides the wraparound services that provides the child care. I've heard of some communities that where there's childcare agencies, childcare providers that will provide respite care, drop in respite care for people who are caregivers and maybe one of the parents has cancer or maybe they've got grandma living with them and grandma has cancer. And the caregivers need a break so they can drop the kids off in a safe place for free or for low cost. America's top medical problems can be linked directly to addiction. Tobacco contributes to 11 to 30% of cancer deaths. And by the way, on your exam, if you haven't already taken it, I do not test you on specific statistics. I just want you to kind of get a global picture of how big this problem is. The Society for the Advancement of Sexual Health estimates that 3 to 5% of the US suffers from some sexual compulsion disorder. So internet porn, sex addiction, something like that. So 5% is a pretty big number. That's one out of every 20 people. Again, when you go to the grocery store, you know, there's 80 people in there. So for the people that are in the grocery store when you are, probably struggle with some sort of sexual compulsive disorder. And this can have far-reaching effects. STDs are at a record high according to the CDC. This was a bulletin that they put out in 2016. So we're not doing a really good job with addressing STDs, which are spread through addictive behaviors, as well as they can be spread by people who are struggling with depression and anxiety and seeking comfort from another person that don't have high self-esteem. They are seeking comfort. There's a lot of reasons why people may engage in risky sexual behaviors, but wow, that was shocking. Heart disease is also correlated with the use of tobacco, cocaine, ecstasy, amphetamines, and steroids. So we've got a sick society, and cancer heart disease and COPD cost billions with a B each year in medical costs, lost wages, and unemployment. So things that arise from tobacco smoke, well, nicotine products in general, cost millions. Why do we care? Why does that matter to the mental health counselor? Well, as it costs our society millions, as people lose productivity, the average per household income goes down, which reduces spending, which reduces the effluency, if you will, of the community that you live in, and you can start seeing deterioration. Bloodborne illnesses, one-third of AIDS cases, and most cases of hep C in the U.S., are associated with injection drug use. Alcohol causes cirrhosis of the liver, which is very, very painful. I've had some clients who have had advanced stages, and the water retention in their abdomen actually had to be relieved periodically because it got so painful. And many patients with chronic or terminal illnesses experience high rates of concurrent depression and or anxiety. So if a client has chronic pain, or even chronic depression, and we'll talk about that in a couple of classes from now, if they feel like they're never going to break from the bonds of whatever this condition is, even if they have periods of remission, they may have additional concurrent mental health symptoms, which can impact their ability to work, their ability to socialize, their ability to be supportive of their children. Addiction costs the U.S. over $484 billion annually, and mental illness costs the U.S. over $273 billion annually. And so we're spending a crap ton of money treating things instead of preventing them. And what do they say? An ounce of prevention is worth a pound of cure. We are losing money or spending money, if you will, on health care, on insurance, on people who need health care, they don't have health insurance, and they can't pay their bills, so they go to government funded institutions. We lose money to lost earnings. We lose money to crime that occurs as a result or concurrently with substance abuse, depression, anxiety. Child welfare, if there's child neglect or child abuse that results from the parent being emotionally unable to attend to the child's needs. Accidents, work related accidents, you know, slips and falls, etc., making mistakes at work and vehicular accidents, whether it's taking too much of your prescribed medication and falling asleep at the wheel, drinking, DUIs, or just not paying attention because you are emotionally kind of spaced out. And homelessness, 31% of homeless people have an addiction. So that's not even a third. So it's important to recognize that there are people out there who are homeless by choice. It's a culture choice. There's a proportion of people out there who are homeless due to addiction. But there's another proportion of people out there who are homeless because of the negative effects of mental health issues. So we want to make sure that we're reaching out and making sure they know how to get access to mental health care and medical care and prescription drugs in order to improve their situation if they don't want to be homeless, which the majority of homeless people don't. But like I said, there is a proportion who that's a nomadic lifestyle is one that they've chosen. U.S. social problems related to addiction include drug driving, fetal alcohol spectrum disorders, which cost over 4 billion annually, violence and crime, and child abuse. Domestic violence, PTSD and bullying and childhood suicide are also U.S. problems related to depression, anxiety and addiction. So we want to look at, you know, what's going on and where can we intervene when we've got people who are lashing out when we've got people who are angry and committing violence against one another or bullying one another. We've got people who are experiencing traumatic situations in their home where it's supposed to be safe. How do we help intervene? Prevention obviously is where we're going to start. What can we do? In the community, we're not going to, you know, unless you're an excellent fundraiser, you're not going to be able to raise the money to open a children's clinic or something. But as a clinician, what can you start doing today, tomorrow? Provide short actionable practical prevention messages. That's a bunch of stuff right there. In schools, you know, morning announcements where they can remind people to take a mindfulness minute. They can teach mindfulness and acceptance and commitment skills, distress tolerance skills in health and PE class. They can, you know, morning announcements is generally the best place because you can hit it every single day with something, just something for the child to ponder each day. Churches, synagogues, places where people typically voluntarily gather. And even I was thinking about this the other day, even sporting events where there's a circular something that gets handed out a program. They have a short wellness message in it. You know, we're not talking about teaching people how to live a completely healthy lifestyle in 50 words or less. We're talking about giving them one short actionable practical something they can do to improve their life. In churches at the end of the sermon is a good place to put the message because a lot of times, you know, most of the time, people don't leave church early, so the pastor can get that in right at the end of the sermon. And right before the weather broadcast, because most people tune into the news for weather, even if they don't stay for the different sections. So having a wellness minute again teaching one short thing this is what mindfulness is this is what distress tolerances and here's an acronym go to the website to print out a worksheet. We can also put stuff on our own websites and blogs and Facebook pages that can help people. It can be a word document saved as a PDF that they can just print out and have to review each day. Social media do one post a day on on your social media about something, whether it's a quote or tool people can use search engines can be encouraged to do it. I don't know that today we can necessarily make this happen. But if somebody could convince Google, for example, right where they you know how they change the little Google graphic each day, right underneath it, have some sort of wellness tip. When you go to stores, every store gives you a receipt. So have it printed on the receipt just like they print the coupons and everything else. Have a little wellness note printed there. That's another place where people aren't going and actually reaching out and saying I want to information about this, but it's being fed to them so they can see it. And if they want to read it, they can and if they don't want to read it, they don't have to strengthen community resources with peer support and train volunteer programs. So encourage people to work with their with their churches work with their community centers, work with their libraries to provide support where I came from in Alachua County they had. It was wonderful they read it all the libraries and they had a children's section where it was designed like a playroom. I mean there were toys for them to play with and stuff and all the kids books there were a bunch of kids books there. But there was also a whole corner that had books on parenting. So parents could go educate themselves about how to deal with their kids ADHD or how to parent a two year old or whatever the case may be. The kids could do something fun. They were in a community center sort of thing so they were learning that the library is kind of a cool place to go. And they were also having access or getting access to books which, you know, in my mind is a good thing. So that's something that you can work with your local library to do is just to set up a special shelf that is topical, you know, maybe each month that switches so one month it'll be new nutrition another month it'll be depression. And encourage people to go to the library. It doesn't cost them anything to check those things out. Those are places where you can get a lot of bang for your buck. The other thing you can do as a if you're an independent clinician is host workshops at community centers and libraries. A lot of times they'll let you use the space for free. If you don't charge the participants, but then participants get to know you, you provide them with some good information. One thing I have found in my experience at least is when you make the title for the workshop you want to make it something that's not stigmatizing, you know, not how to beat your depression, because people may not want to admit they've got depression. So find something else cool to call it preventing depression in the youth of tomorrow or something. Because what we're doing by helping the adults of today be happier healthier people we are preventing depression in the youth of tomorrow. So remember when we're providing any of these to the individual family or community. We want to make sure we use the frames approach. Provide feedback about the impact of thoughts behavior and feelings on self and others so encourage people to remember how they impact everybody else it's not just them they impact their family they impact the community. Encourage people to take responsibility for what's within their control and figure out how to deal with what's not in their control because there's a lot. Provide advice on what they can do. I mean, theoretically we're the experts. So we can provide some information, but couching it with. You're the expert on you so I'm providing you tools this works for some people, but we're going to have to figure out what works for you, which is where the menu of options comes in, giving people multiple ways to access intervention and prevention services. Podcast is another great way if you if you listen to podcasts, finding some that have really good information and recommending it to your to your patients to your clients, etc. Providing empathy, just being there and going yeah I know this is really tough when when your child is struggling with depression or whatever. And providing the opportunity for self efficacy, encouraging people to recognize how effective they have been at navigating this issue, whether they're the identified patient or the supportive caregiver. Encourage them to acknowledge how effective they've been and what they can do, not only to improve the situation, but to improve their quality of life and improve their life and help them really hone in on seeing how a healthy them is going is necessary to do everything else that they want to. So it's important that they take that time to make sure that they're healthy and happy. Addiction and mental health issues can have a direct and indirect effect on the family and community. As clinicians we need to attend to the reciprocal impact of the disorder on the individual, their proximal environment, which is their home and kind of work, and the community in which they live so their neighborhood school and work and vice versa. If they are going to school in a place where there's a lot of bullying, well then we need to look at intervening there because that's just going to send home stressed out depressed children, if they are if the neighborhood is unsafe. So we need to look at the reciprocal interaction and pay attention, not just to the person, but to where they spend all 24 of their hours. Many people with addictions and mood disorders see their issues as not hurting anyone but themselves. So we can help educate them a little bit so they can see the impact they may be having to increase motivation. The caveat is, we have some people who recognize it and they feel so guilty. So we don't want to encourage guilt. We want to increase motivation. When provided with objective evidence to the contrary, the frames approach can assist with increasing motivation for treatment. So if people say they're not ready or they don't want to or things are fine right now, then we can say, you know, you said these were your goals, but this is how you're living right now. So are things really fine. Remembering to elicit from the client what can be done and not to lecture them. If they've got a problem, they're probably quite aware they've got a problem. So elicit from them. What is it that could change that could help you feel happier and healthier. As far as podcasts that I've found helpful, I cannot think of the names of some of my favorites right now. I'm not a big podcast listener, but I will put that on the resources page all see us.com slash resources. And I'll have that up by the end of the week so you can see some of the podcasts I recommend generally the ones that I've listened to have been like in the top 15 on any of the podcast players so if you go to pod bean or Stitcher one of those and type in wellness or I tend to look for things that are health inspiring not necessarily I haven't looked at like depression or anxiety but their podcast out for everything. So I will get those up by the end of the week. Any other questions. Alrighty everybody have a wonderful day and I will see you tomorrow.