Systems Influences on Mood and Addictive Disorders
Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director: AllCEUs Counseling CEUs and Specialty Certificates
Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery
A direct link to the CEU course is https://www.allceus.com/member/cart/index/search?q=systems+impact
~ Examine the prevalence of mood and addictive disorders
~ Learn about the history of addictive behaviors in the US
~ 32% lifetime prevalence
~ 18% 12-month prevalence
~ 13% of those with the disorder are receiving treatment
~ 7% 12-month prevalence
~ Prevalence is higher among people of 2 or more races
~ 6% 12-month prevalence
~ 6% of that 6% receive treatment
~ Sex/Pornography Addiction 3%-5%
~ Drug Abuse
~ 27% of Americans reported using illicit drugs
~ 3% of Americans over 12 reported nonmedical use of prescription drugs.
Themes to look for…
~ Initiation from the medical community to treat something—more people treated greater availability for diversion
~ Economic motivations for producers, government
~ Giving in to political pressures to repeal
~ Where there is a will there is a way (or an alternative)
~ Cheaper alternatives being produced (crack, fentanyl)
History of Substance Use
~ Cannabis was introduced to the US in 1545
~ In 1775, hemp culture was introduced into Kentucky and large hemp plantations flourished many states until well into the 1800s.
~ Until the late 1800s, tobacco, alcohol and opium could be purchased readily, free from government controls and was fashionable.
~ Civil War blockades on southern ports curtailed imports of tea and coffee, so cassia leaf drinks became a viable alternative
~ Morphine was used commonly as a pain killer during the Civil War. So large a number of soldiers became addicted
~ Late in the 1800s, morphine was prescribed as a substitute for “alcohol addiction’
~ In 1844, cocaine was first isolated from coca leaves. Dr. Theodor Aschenbrandt issued a supply of pure cocaine to soldiers to increase endurance and alertness
~ In 1885, John Styth Pemberton of Atlanta, Georgia introduced coca-cola. A combination of cocaine and caffeine from the Kola nut (caffeine).
History of Substance Use
~ From 1850 until 1942, marijuana was recognized as a legitimate medicine, under the name “Extractum Cannabis.“
~ Heroin, the newest opium derivative, was first produced commercially by Germany's Bayer Company in 1898. “It was widely advertised as being at least ten times as potent a painkiller as morphine with none of the addicting properties
~ 1920 Prohibition Act was passed and repealed in 1933. (politics, economics and unenforcability)
~ It was not until 1925 that import of opium for the manufacture of heroin finally was banned in this country.
~ Throughout the nineteenth century, opium and marijuana users enjoyed their diversion with little harassment.
~ The federal Harrison Narcotic Act was passed in 1914. in order to “provide for register and impose a special tax upon all persons who produce, import, manufacture, compound, deal in, dispense, sell, distribute, or give away opium or coca leaves, their salts, derivatives or preparations.”
History of Substance Use
~ In 1918, just three years after the Harrison Act went into effect, a study by a Congressional committee (which members included Dr. A. G. Du Mez, Secretary of the United States Public Health Service) released these findings:
~ Opium and other narcotic drugs [including cocaine] … were being used by about a million people.
~ The “underground” traffic in narcotic drugs was about equal to the legitimate medical traffic.
~ The “dope peddlers” appeared to have established a national organization, smuggling the drugs in through seaports or across the Canadian or Mexican borders …
~ The wrongful use of narcotic drugs had increased since passage of the Harrison Act.
~ By 1937, the District of Columbia and 46 states had adopted some form of legislation against marijuana
~ Treasury Department officials submitted to Congress a proposal which was eventually passed as the Marijuana Tax Act of 1937.
~ The Act did not actually ban marijuana but, like the Harrison Narcotic Act of 1914, did recognize the potential medical uses of the substance, while imposing a tax on those involved in distribution
~ LSD was discovered in 1938.
~ Use of cocaine declined in the 1940s due to lack of availability (and as the LSD craze was increasing)
~ From 1938-1958 LSD was used to treat a variety of medical and psychological issues including psychosis, pain management, and anxiety (neuroses)
~ 1960 Fentanyl first synthesized by Janssen Pharmaceuticals
~ Prior to 1962, LSD could be purchased, legally, by physicians, psychiatrists, psychologists, and other mental-health professionals who could certify legitimate use for the substances.
~ In 1965 regulations were passed outlawing LSD, but the formula could be purchased from the patent office for $0.50 and the ingredients were easily acquired
~ Drs. Timothy Leary and Richard Alpert, instructors at Harvard University, spread the word of LSD to anyone who would listen: There was a revolution about to start. The mind would at last be freed from the bondage of proletarian concerns.
~ Cocaine regained popularity in the 1970s and 80s, glamorized by the media as a non-addictive recreational drug.
~ Crack emerged in 1985 as an affordable alternative to powder
~ Increase in opiate prescriptions in 1980 when an 11-line letter printed in the New England Journal of Medicine in January 1980 pushed back on the popular thought that using opioids to treat chronic pain was risky.
~ This letter and a couple studies after created a discussion in the '90s around making pain treatment a priority for all patients.
~ In 1998, Purdue Pharma created a video promotion called “I Got My Life Back.” It followed six people with chronic pain who took OxyContin.
~ In 2001 JCAHO made pain assessment of all patients a requirement
~ In 2010 oxycontin was blended with “an abuse deterrent” Users followed suit by switching opiates.
~ In 2015 trials began to treat “resistant depression” with opiates.
~ Fentanyl patches are on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed
~ The explosive increase in cigarette smoking after 1910 can be attributed in part to the public-health campaigns of that era against the chewing of tobacco. “The sputum of tobacco chewers, according to repeated public-health warnings, spreads tuberculosis and perhaps other diseases.”
~ By 1921, the year after alcohol prohibition, 14 states had laws prohibiting cigarettes, and 92 anti-cigarette bills were under consideration in 28 more state legislatures (Brecher, 1972). But people continued to smoke, and the last statewide cigarette prohibition law was repealed in 1927.
~ The government currently earns around 15 Billion dollars in revenue from cigarette taxes each year
~ What current social and cultural influences contribute to the development of mood disorders and/or addiction?
Social Systems Influence on MH & SA
~ Coping methods modeled
~ Patterns of use modeled
~ What is used
~ When it is used
~ Why it is used
~ Peer pressure/acceptance of health-related behaviors and/or treatment seeking
~ Availability of and engagement in health positive or health negative behaviors
Political Systems Influence on MH & SA
~ Laws regulating medication and treatment availability (FDA) (ex. Case management)
~ Access to social service programs for healthcare, medicine and food
~ Changes in the political system enhancing a feeling of disempowerment and oppression
~ Laws regulating access to addictive substances and behaviors (gambling, pornography)
~ Repeal of laws as a result of political pressure from constituents
~ Taxes on substances
~ Laws regulating marketing practices of addictive substance and mental health medications
~ Enhanced training and penalties for “servers”
Economic Systems Influence on MH & SA
~ Availability of addictive behaviors (internet, endless supply, many corner stores)
~ Upsurgence of fentanyl, free porn, bathtub meth
~ Cigarette cost and taxes
~ Motivation of big-pharma to convince people to buy more drugs
~ Ability of taxation of a substance or activity to benefit the government
~ Poverty/High Unemployment
~ Availability of health and mental health care
~ Affordability of nutritious foods
Cultural Systems Influence on MH & SA
~ Acceptability of via media portrayals
~ Use of potentially addictive behaviors
~ Liquor advertising expenditures rose more than 620% between 1995 and 1997 creating an environment that suggests that alcohol consumption and over-consumption are normal
~ Portrayal of people with mood disorders as “unstable”
~ Help seeking for mood and addictive disorders
~ Celebrities seeking help
~ Media portrayals of people seeking help (Monk, 28-Days)
Cultural Systems Influence on MH & SA
~ Culturally modeled methods of coping
~ Stressors in the culture which promote anger, anxiety, depression
~ Rejection of or nonconformance to dominant culture
Other Cultural Influences
~ Social media/never being offline
~ Social media disinhibition
~ Parents emotionally or physically unavailable
~ Fewer outlets for extracurricular activities
~ Transportation barriers
~ Age barriers
~ Simple lack of opportunities
~ There is a long history of substance use and mood disorders in the US.
~ Patterns of problem development are influenced by
~ Social environments (friends, co-workers, family)
~ Community norms
~ While we cannot directly control politics, economics or culture, we can provide people with resources to respond to negative influences
~ Self esteem
~ Coping skills
~ Interpersonal effectiveness skills
~ Problem solving skills