Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program
June 2013
ACKNOWLEDGEMENTS
To Community Connections Inc. (CC Inc.) SWOOPP
III project and the Salvation Army Bridge Program
for collaborating on this initiative to deliver
education to the wider community regarding
comorbidity. The Commonwealth Department of
Health and Ageing - Substance Misuse and Service
Delivery Grant Fund (SMSDGF) 2012-2015, NonGovernment Organisation Treatment Grants
Program (NGOTGP) 2012-2015.
Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program
June 2013
BACKGROUND
• The Australian Government under the National Illicit Drug Strategy,
allocated 9.7 million over 5 years to a National Comorbidity
Initiative to improve service coordination and treatment outcomes
for people with co-existing mental health and substance use
disorders. This resulted in the Commonwealth’s Department of
Health and Ageing – Improved Services Initiative 2008-2012
followed by the Substance Misuse and Service Delivery Grant Fund
(SMSDGF) 2012-2015. CC Inc. acquired funding through these
streams to deliver the SWOOPP project, which focusses on service
improvement and community education regarding comorbidity.
• Through collaborations with the North West Regional Comorbidity
Action Group a partnership between CC Inc. and The Salvation
Army Bridge program was formed to develop, implement and
deliver a ‘generically targeted’ comorbidity community education
session and manual.
Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program
June 2013
EVALUATION
• Pre Evaluation:
• There is a pre evaluation that is to be filled out
prior to the session commencing.
• The form will take approximately 5 minutes to
complete and are anonymous.
• Please keep both of the evaluation forms with
you until the end of the session.
• THERE ARE NO WRONG ANSWERS
Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program
June 2013
What is comorbidity?
When you hear the word ‘comorbidity’, what do you
think it means?
• The term ‘comorbidity’ is a clinical word, which is used
to describe the co-existence of more than one problem
or disorder. However, in Australia it is used to refer to
the co-existence of mental illness and substance
misuse. In other words, a person who is “comorbid”
has both a mental illness and a substance misuse
problem. The substance can be legal or illegal.
• You may also hear the term ‘dual diagnosis’, but this
can refer to many co-occurring problems. EG. A heart
attack and a broken leg.
Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program
June 2013
• Does that make sense? Do you have any
further questions?
Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program
June 2013
Is there a difference between mental
health and mental illness?
Mental illness may refer to a clinically diagnosed condition or “illness”. Common examples are
depression, anxiety, psychosis and eating disorders.
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A mental illness is a disturbance in the way people think, their mood or behaviours, which
affect how they function or causes distress to themselves or others. Mental illness has
varying levels of severity and impacts on a person’s life. However, whilst most people will
experience periods of stress, anger, sadness etc., if a mental illness is present this will have a
greater impact on a person’s day to day life.
It is a psychological or behaviour pattern that is not expected during normal development.
The person is unwell or experiencing distress and may need support.
Mental health is a positive concept and refers to being “well”. Generally we strive to be
mentally well.
Mental health also incorporates resilience, happiness and joy, effective coping strategies and
functioning well.
Mental health is not just the absence of mental illness. A person will still experience periods
of sadness and anger, yet they have effective coping strategies to remain mentally well.
It is possible for someone who experiences mental illness to also experience mental health.
For example, they may be well supported, have resilience and are able to experience
happiness.
Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program
June 2013
What types of mental illness exist?
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Can you name some types of mental illness?
Depression
Anxiety
Schizophrenia
Bipolar Mood Disorder type I and II (BPMD)
Borderline Personality Disorder (BPD)
Eating disorders: Anorexia, Bulimia, Overeating
Dissociative Identity Disorder (People may still call DID
Multiple Personalities Disorder)
Obsessive Compulsive Disorder (OCD)
Post-Traumatic Stress Disorder (PTSD)
Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program
June 2013
How is a mental illness diagnosed?
• Diagnosing mental illness is done by a trained
health professional i.e. Psychiatrist, Doctor,
Psychologist or an accredited Allied Health
Professional.
• If it is thought a person may have a mental illness,
the DSM-v (Diagnostic and Statistical Manual 5) is
used by the professional to assess a person’s
behaviour, feelings and thinking against criteria’s
for a mental illness. All diagnosable mental illness
is found in the DSM-v.
Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program
June 2013
What is a drug? And what types are
there?
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What do you think a drug is?
A drug is a chemical that changes the way your
brain works.
A drug impacts on the Central Nervous System.
There are three main drug types: Stimulants,
Depressants and Hallucinogens. Drugs are
classified into these categories by the effects they
have on the Central Nervous System.
Stimulants “rev you up” (speeds up your system),
Depressants slow down your system and
Hallucinogens distort your perception.
Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program
June 2013
What are some drugs that can you think
of?
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Ecstasy/ MDMA – E, pingers, eccies, disco
biscuits, M, pills
Active ingredient –
Methylenedioxymethamphetamine
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Coffee – Coca-Cola, Pepsi, Red Bull, Monster,
cuppa’
Active ingredient – Caffeine
Speed – Whiz, go-ee, whipper
Active ingredient – Amphetamine
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Cocaine/ free base –Coke, snow, blow, crack
Active ingredient –
Benzoylmethylecgonine
Ice – Meth, glass, crank
Active ingredient –
Methylamphetamine
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LSD – Acid, trips, dots, paper, liqqy
Active ingredient – Lysergic acid
diethylamide
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Licit Medications – Morphine, percocete,
oxycontin,
Diazepam (valium), tamazepam, oxazepam
Active ingredient – Opioid (Opium),
Benzodiazepine
Marijuana – Dope, pot, hash, weed, bud, Mary J
Active ingredient – Tetrahydrocannabinol
(THC)
Alcohol – Grog, booze, gas
Active ingredient - Ethanol
Tobacco – Ciggies, durries
Active ingredient – Nicotine
Heroin – Smack, gear, H, horse
Active ingredient –Diacetylmorphine
Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program
June 2013
How does a person become comorbid?
• Much remains unknown about comorbidity
but there is increasing evidence to suggest
that simple causal hypotheses are not
sufficient to explain the association (Teesson &
Proudfoot 2004).
Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program
June 2013
CASE SCENARIO
• John sustained a back injury from an accident at work. He went through
months of rehabilitation, physio and rest. He was prescribed heavy
painkillers by doctors. He says he is always in pain, has trouble sleeping
and has nightmares. He has lost a lot of mobility and says he “always feels
moody and angry”. He has lost his job and has been unable to get another.
He doesn’t see his friends anymore and he cannot drive.
• John starts smoking marijuana joints. He said he “doesn’t like the way
painkillers make him feel”. John feels the marijuana helps ease pain, helps
him sleep and makes the day go quicker. John feels like he needs to smoke
marijuana throughout the day and says he “can’t go without it and doesn’t
cope”.
• Has lost his fulltime income and is now on a pension. John can’t repay his
mortgage and car loan, yet he is spending a lot of cash on marijuana.
• John’s family are becoming concerned. They decide to take him to a
doctor. John is then diagnosed with Post Traumatic Stress Disorder and a
Substance Misuse Disorder.
Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program/
June 2013
Discussion 7.
Chicken or the Egg
Was it helpful for John to be
taken to the doctor? What do
you think might happens next for
John to start feeling better?
7. Family become
concerned, take him to a
doctor where he is
diagnosed with Post
Traumatic Stress
Disorder and Substance
Misuse Disorder.
START HERE
JOHN DOE
Injured his back at work.
Comorbidity
As you can see by this
scenario, anyone can become
comorbid and it can affect
many areas of a person’s life.
Discussion 6.
6. Has lost his fulltime
income is now on a
pension. Can’t repay
mortgage and car loan, is
spending a lot of cash on
marijuana.
What stressors is John under
right now? What is the
possible worst case-scenario if
John continues to spend
money on marijuana and not
his bills?
Discussion 3.
How do you think John
feels about his
unemployment, not
seeing his friends and
not being able to drive?
What problems will this
cause in the long term
for John?
3. Has lost his job and
unable to get another,
doesn’t see his friends
anymore and cannot
drive.
Discussion 1.
This was a hard time for John,
what might he have been
thinking and feeling?
1. Went through
months of
rehabilitation, physio
and rest. Prescribed
heavy painkillers by his
doctor.
Discussion 2.
Why might John be having
nightmares and sleep
problems? Why might he
be feeling “moody”?
2. He is always in pain, has
trouble sleeping, has
nightmares, has lost partial
mobility, feeling moody and
angry.
Discussion 5.
It seems that John has
developed a dependency on
smoking marijuana.
What factors in John’s life have
contributed to an addiction? Is it
likely that he may have a mental
illness?
5. Needs to smoke
marijuana joints
throughout the day. Feels
like can’t go without it and
doesn’t cope.
4. Starts smoking
marijuana. He doesn’t
like the way painkillers
make him feel.
Marijuana helps ease
pain and with sleep. He
feels it makes the day go
quicker.
Discussion 4.
Why would John’s painkillers
make him feel unwell? (List types
of symptoms).
Do you think it is a good idea for
John to stop taking his painkillers
and use marijuana instead?
Types of treatment for comorbidity
When a person is comorbid, what types of treatment do
you think are available to assist in recovery?
• Pharmaceutical Treatments: prescription medications EG. Anti-depressants, Anti-anxiety.
• Behavioural Therapies: modifying behaviour and
thinking patterns to eliminate unhelpful thought
patterns and produce effective coping strategies. -EG.
Cognitive Behavioural Therapy, Exposure Therapy.
• A combination of Behavioural Therapies and
Medication is usually considered best practice.
• Natural Treatments: exercise, healthy diet, drinking
water and adequate sleep.
Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program/
June 2013
Where to go to for help?
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Doctor/General Practitioner
Hospital Emergency Department (For emergency situations only)
School Counsellors/ Workplace Counsellors
Drug and Alcohol Services
Mental Health Services
GP services are often the first port of call in Mental Health Services unless it is an
emergency. People needing urgent mental health assistance should call the Mental
Health Services Helpline or Emergency services on 000.
CONTACT 000 OR 112 FROM A MOBILE IF URGENT ASSISTANCE IS REQUIRED.
When contacting 000 for an emergency it is important to know that a police unit
will be present if:
Someone is behaving violently.
Harm has been sustained by someone acting violently.
Someone has become suicidal or has attempted suicide.
Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program/
June 2013
SESSION WRAP UP
• How did you find today’s Session?
• Was there anything new that you have learnt?
• Do you have any questions?
Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program/
June 2013
EVALUATION
• Post Evaluation:
• The post evaluation form is to be filled at the
end of the session.
• This will take approximately 5 minutes for
participants to complete.
• Please hand the forms forward once they are
completed.
• Thank you for your feedback.
Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program
June 2013
Thanks for coming!
Developed & prepared By Nancy Thomas - Community Connections Inc. & Sarah Costelloe - Salvation Army Bridge Program
June 2013