Unorthodox approach to mental-health care pays off

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Sydney Morning Herald

Dr Siva Bala, a regional psychiatrist with the Kimberley mental-health and drug service, says he has to dispense with some conventions of traditional psychiatry to forge ties with remote indigenous communities.

Adopting an overly formal approach to consultation or relying on office or hospital-based environments can be detrimental, he has found. It is often more appropriate to see patients on their own terms, Bala says.

‘‘Seeing them in their homes with their family members can be very helpful and advantageous, and very secure for Aboriginal people…’’

… Bala attained his fellowship with the Royal Australian and New Zealand College of Psychiatry in 2007, 14 years after he began medical training. During his postgraduate training in psychiatry, he travelled to the Kimberley region for a mandatory six-month rural placement.

‘‘I did that and fell in love with the place and have essentially stayed on,’’ he says.

Read the full story by Josh Jennings: here

Behavioural Addictions

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Behavioural addictions have the same symptoms as drug addiction and alcholism. Process addictions alter mood by creating a euphoric feeling or a “high”. This feeling is caused by the serotonin or adrenalin released in the brain when a person uses drugs or alcohol or engages in an addictive activity. The brain then seeks to recreate this experience despite any negative consequences related to it. The need to repeatedly go through the experience, to get the chemical high, results in the individual being trapped in a compulsive process.

Causes of Behavioural Addiction
Just as in drug addiction, the withdrawal developed in a behavioural addiction refers to the negative physical and emotional reactions felt by the addict when the behaviour is stopped. And the relapse syndrome indicates the addict’s inability to reduce or stop indulging in the activity despite negative consequences.

Types of Behavioural Addictions

Behavioral addiction may include participating in pathological gambling, shopping, sex, internet, television or food.

All these activities are a natural part of many people’s lives and do not have any negative impact.

Symptoms of Behavioral Addiction -  The following criteria were printed in the American Journal of Preventive Psychiatry & Neurology in 1989. The criteria are listed similarly to the Diagnostic and Statistical Manual used by psychiatrists and other psychotherapists to diagnose mental disorders.

The criteria are:

1. Frequent engaging in the behavior to a greater extent or over a longer period than intended.

2. Persistent desire for the behavior or one or more unsuccessful efforts to reduce or control the behavior.

3. Much time spent in activities necessary for the behavior, engaging in the behavior, or recovering from its effects.

4. Frequent preoccupation with the behavior or preparatory activities.

5. Frequent engaging in the behavior when expected to fulfill occupational, academic, domestic, or social obligations.

6. Giving up or limiting important social, occupational, or recreational activities because of the behavior.

7. Continuation of the behavior despite knowledge of having a persistent or recurrent social, financial, psychological, or physical problem that is caused or exacerbated by the behavior.

8. Need to increase the intensity or frequency of the behavior to achieve the desired effect, or diminished effect with continued behavior of the same intensity.

9. Restlessness or irritability if unable to engage in the behavior.

At least three criteria must be met for diagnosis, and some symptoms of the disturbance must have persisted for at least 1 month or have occurred repeatedly over a longer period.
Treatment for Behavioural Addiction

Many treatment centers include individual therapy and support groups  for people with similar additions to break the sense of isolation and shame and to learn new coping skills.

The Australian and New Zealand Addiction 2015 Conference will address the treatment and recovery of alcohol, other drug and behavioural addictions. This National conference will feature case studies from around Australia, practical clinical experience in Addiction treatment and insights into Behavioural Addictions.

The focus of the Addiction 2015 conference will be on different types of addiction, assessment, prevention, treatment and recovery. The Addiction 2015 Conference is for Addiction treatment professionals, mental health, social workers, Drug an Alcohol Workers, health-care clinicians and researchers and academics.

Is Marijuana Addictive?

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Can recreational pot smokers become addicted? A realistic concern for recreational users of marijuana is whether or not they will become addicted.

There are no easy answers to this question. In my opinion, the most unbiased book on this and other related topics is The Science of Marijuana (2008).

The Science of Marijuana is written by Leslie L. Iverson, a professor of pharmacology at the University of Cambridge in England. In the book, he reviews decades of international research on marijuana, both laboratory research and survey research. Based on his review of the scientific literature, between 10 to 30% of regular users will develop dependency. Only about 9% will have a serious addiction.

The large majority of people who try marijuana do it experimentally and never become addicted. Unlike other substances, pot has very few severe withdrawal symptoms and most people can quit rather easily. When present, withdrawal symptoms might include: anxiety, depression, nausea, sleep disturbances and GI problems.

Compared to other substances, marijuana is not very addicting. It is estimated that 32% of tobacco users will become addicted, 23% of heroin users, 17% of cocaine users, and 15% of alcohol users. Cocaine and heroin are more physically harmful and nicotine is much more addictive. It is much harder to quit

About 10% of recreational users will develop problems serve enough to impair their work and relationships.

Read More: on this article published on December 5, 2010 by Jann Gumbiner, Ph.D. in The Teenage Mind

Marijuana and other Drug Addictions will be addressed at The Australian & New Zealand Addiction Conference . ADDICTION 2015  is an initiative of the Australian & New Zealand Mental Health Association. The Call for Abstracts is now open for more information about the conference email the secretariat@addictionuaustralia.org.au or visit our website www.addictionaustralia.org.au.

Will unemployment surge put additional pressure on Rural Mental Health Services

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THE latest unemployment rates in the Launceston and North-East regions compare with the South Australian outback as some of the worst in the country. Full-time jobs fell to 152 600 with regional data showing a bleak future for the North of Tasmania.

Georgie Burgess from The Examiner (Friday 8th August 2014) stated:

Launceston and the North-East are in the top six highest unemployment rates in the country, out of almost 100 regions. At 9.4 per cent, the North joins the South Australian outback, Geelong and New England in rural New South Wales as some of the worst in the country.

It is acknowledged that there are mental health consequences of being unemployed and those who’ve been seeking work for over 6 months are more than three times as likely to be suffering depression, anxiety and other mental health issues.

Yunda Thomas said in the Atlantic that

“unemployment often exacts a toll that goes beyond economic concerns to psychological ones. Humans, after all, are not robots, and the loss of a job is not merely the loss of a paycheck but the loss of a routine, security, and connection to other people.

There is a great concern in rural communities of Australia that the unemployment rate will increase these mental health concerns.  Three quarters of Queensland is now drought declared with farmers actively looking for work which simply isn’t available in their local area.  The rural and remote community faces a greater challenge than its urban counterparts with limited job opportunities and less access to mental health services and support.

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The 6th Australian Rural and Remote Mental Health Symposium theme, The Practitioner’s Voice, seeks to give voice to practitioners who are faced with these challenges on a regular basis.  Be a part of the discussion by registering for the symposium to be held 12-14 November 2014 at the Commercial Club Albury.

Related stories:

Effect of Rural Residence on Use of VHA Mental Health Care Among OEF/OIF Veterans (America)

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Abstract

Objective  The Veterans Health Administration (VHA) has worked to increase availability of mental health treatment for rural veterans. The objective was to understand the impact of rural residence on screening for, diagnosis of, and treatment for depression and posttraumatic stress disorder (PTSD) among veterans of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) using VHA care.

Methods  A cohort of veterans from a five-state region was identified whose first VHA clinic visit occurred between January 1, 2008, and March 17, 2009. The cohort was retrospectively followed for three months to identify a cohort who used VHA care at least twice.

Results  The sample included 4,782 OEF/OIF veterans known to be using VHA care; mean age was 31 years (range 18–64); most were male (88%). Screening rates were 85% for depression and 84% for PTSD. Compared with veterans in small or isolated rural towns, those in urban areas were less likely to be diagnosed as having PTSD (odds ratio [OR]=.79, 95% confidence interval [CI]=.66–.95, p<.05) and less likely to receive psychotropic medications (OR=.52, CI=.33–.79, p<.01) or psychotherapy (OR=.61, CI=.40–.94, p<.05) for PTSD. Veterans living in urban areas were also less likely to receive antidepressants (OR=.56, CI=.32–.98, p<.05) or psychotherapy (OR=.61, CI=.40–.93, p<.05) for treatment of depression.

Conclusions  Among veterans who used VHA care at least twice, those living in urban areas were less likely than those living in rural areas to receive diagnoses of and treatment for PTSD and depression.

Dr. Hudson, Dr. Fortney, Mr. Williams, Mr. Austen, and Dr. Pope are with the Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock (e-mail: teresa.hudson@va.gov). Dr. Hudson, Dr. Fortney, and Dr. Pope are also with the Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock. When this work was done, Dr. Hayes was a student at the Colleges of Pharmacy and Public Health, University of Arkansas for Medical Sciences, Little Rock. He is now with Baptist Health in Little Rock. These findings were presented in a poster session at the national meeting of the Veterans Health Administration Health Services Research and Development program, National Harbor, Maryland, February 16–18, 2011.

Copyright © 2014 by the American Psychiatric Association

Don’t get worked up: you can beat your porn addiction … if you want to

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By Gomathi Sitharthan, University of Sydney and Raj Sitharthan, University of Western Sydney

There are several myths regarding what constitutes “porn addiction”.

Some argue that, like alcohol problems, porn addiction is a disease. Once trapped, the consumer of porn will hit rock bottom with no recourse but to aim for abstinence and engage in treatment programs based on the 12-step model.

Others have simply substituted some prominent signs of severe alcohol dependence (e.g. having an alcoholic drink first thing in the morning, engaging in drinking despite knowledge of harmful consequences, etc), to porn addiction. They’ve opened shop and go on lecture tours armed with powerpoint presentations. Anecdotal reports are provided to support the notion of porn addiction of how someone’s life spiralled out of control.

On the other side, advocates from the porn industry, as one would expect, generally deny any negative consequence of excessive viewing.

It is essential we take a balanced view, supported by good evidence, rather than making assumptions.

For porn, the three main contributing factors are availability, anonymity, and affordability.

Gone are the days when you had to go to a shop, pay for the merchandise, and come out with brown paper bag.

You can now download anything onto your PC, laptop, iPad or mobile phone. You can do this in your bedroom, your car, your office or even a park thanks to superfast wireless broadband.

Let’s face it, porn is here to stay. Trying to ban it will not work (look what happened to prohibition in USA). Moral crusades and scaremongering will hardly leave a dent.

There is no doubt that for some people, excessive viewing of porn can lead to a series of negative consequences.

And yes, for some, viewing certain themes may lead them to act out their fantasies and land them in trouble with the law.

But not all viewers get hooked on porn to the extent that their viewing becomes detrimental to themselves and impacts others.

In our view, engaging in any “excessive” behaviour is a learned habit and can be unlearned. In other words, all bad habits can sometimes cause us grief, but we can change them.

We recently conducted a study of porn use in Australia.

Based on our preliminary findings from 722 participants, 85% of males and 15% of females view pornographic materials on the internet regularly.

The average age of the participants was 32.5 years, and over half of the participants were married or in de facto relationships.

71% were in paid employment and 43% were first introduced to porn between the ages of 11 and 13 years.

Parents often ask us what signs might be indicative of someone experiencing a problem with porn addiction.

Spending more and more time in front of the PC, getting defensive when questioned, absconding for long periods of time with the new laptop, marked reduction in other activities, being reasonably secretive about spending habits, skipping school or university, low mood, social isolation, sleep issues, looking tired, in extreme cases skipping meals can all point to this.

We can technically get “addicted” to anything: drinking excessive alcohol, gambling, playing video games, spending a lot of money on shoes, and so on.

For porn, we need more epidemiological and clinical data before we can have some confidence in how widespread porn is in Australia and its impact.

As the saying goes, in data we trust.

The Conversation

Gomathi Sitharthan has received funding from NHMRC. She is affiliated with the University of Sydney.

Prof Raj Sitharthan has received funding from NHMRC and ARC. He is affiliated with the University of Western Sydney and University of Sydney.

This article was originally published on The Conversation.
Read the original article.

Addictive Behaviours including Porn Addiction will be featured at the Australian and New Zealand Addiction Conference at the Gold Coast in March 2015,

please visit the website for more information about the conference

Chronic pain sufferers risk addiction

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Health groups are calling for greater oversight for prescription painkillers amid concern sufferers are at serious risk of addiction.

An increasing number of chronic pain sufferers are being prescribed pharmaceutical opioids, which can be highly addictive.

Rising trend of prescribing opioids for treatment

The supply of oxycodone has increased significantly in the past two decades.

According to research from the Victorian Department of Health’s Malcolm Dobbin, the drug’s supply has increased from less than 100 kilograms in 1991 to well over 2,000 kilograms in 2012.

Australian Pain Society president Dr Malcolm Hogg says doctors often rely on opioids when there is a lack of alternative treatment.

“GPs are struggling with a patient complaining of pain. They have access to opioids through the PBS (Pharmaceutical Benefits Scheme) yet they don’t have appropriate access to alternative medications,” Dr Hogg said.[Painkillers are] very good and effective in short or medium-term situations, but become extremely problematic with prolonged usage. Victorian Alcohol and Drug Association chief executive Sam Biondo “So there is an escalation of both the number and the dosing of opioids in the community.”

Victorian Alcohol and Drug Association chief executive Sam Biondo says chronic pain sufferers are of particular concern because they are likely to use medication over a much longer period.

“They’re very good and effective in short or medium-term situations, but become extremely problematic with prolonged usage,” he said. He says those patients can be at risk of addiction, leading to abuse. “That has an impact not only on the individual, but on the family, their loved ones and the community more generally,” he said. “It knocks them out of the work environment as they go on a spiral of trying to manage their pain.”

In some cases, the misuse of prescription drugs can be lethal.

The Victorian Coroners Court found that in 2013, prescription drugs contributed to 310 overdose deaths across the state. Almost two-thirds of those involved opioids.

But Dr Hogg says the actual rate of misuse among patients is hard to quantify.

“We believe there’s a small amount of [abuse], but the significant amount is appropriate use for patients in pain,” he said.

Read more ABC By James Fettes Updated Mon 19 May 2014, 11:29a

Prescriptions Medicines, Pain Relief and Drug Addiction to be addressed at the Australian and New Zealand Addiction Conference.

Improving rural mental health support

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Abstracts closing soon – Rural & Remote Mental Health Symposium

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header14The number of Australians experiencing mental health problems in rural and remote areas is estimated to be comparable to major urban centres. However, the rural and remote community faces a greater challenge with limited access to mental health services and support.

The Symposium theme, The Practitioner’s Voice, seeks to give voice to those practitioners who are faced with these challenges on a regular basis. Abstracts are sort for the following streams:

  • The Practitioners Voice
  • Rural and Remote Challenges: resources, professional development, employment
  • Working in Partnerships: practitioners, consumers and carers
  • Recovery Oriented Practice
  • Cultural Engagement: working with Aboriginal people
  • Resilient Communities through Natural Disasters
  • Mental Health Youth Services
  • Suicide Prevention
  • e-Health, Technology and Social Media

Abstract submission closes on Friday August 1st.

submit abstractTo find out more about the conference, visit the website

Culturally responsive frameworks influencing practice and informing our health workforce

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Indigenous Allied Health Australia (IAHA), the national Aboriginal and Torres Strait Islander allied health peak body, leads the way in influencing innovative practice and integrative systems approached in their culturally responsive framework for Aboriginal & Torres Strait Islander communities, allied health professionals and all health professionals working with these communities.

Successful outcomes for Aboriginal & Torres Strait Islander healing practices have often been hindered by limited understanding of cultural worldviews. Particularly, in understanding and incorporating the Social and Emotional Wellbeing (SEWB) framework and holistic case formulation in professional practice.

These key elements are paramount if culturally responsive health care is to be provided. This framework allows mainstream practices to be improved, evaluated, and replicated using culturally responsive variations to existing or proposed programs attempting to address the complex and diverse health needs and outcomes of trauma experienced by individuals and their families.

The development of culturally responsive models of care, which demonstrate successful SEWB healing outcomes when dealing health outcomes for Aboriginal & Torres Strait Islander communities, will prove valuable. Such holistic models could influence development of best practice program design and incorporate culturally responsive and coherent guidelines for mental health practice and program development as well as providing beneficial planning data for funding distribution and effective healing outcomes for Aboriginal & Torres Strait Islander communities.

In addition, health professionals who are Aboriginal and Torres Strait Islander people, form a pathway or conduit between the knowledge system of their professions, the mainstream health system and Aboriginal and Torres Strait Islander knowledge systems. No single system is favoured above the other but are equal in their own right and importance, supporting strategies and understanding in providing practice on the ground that is effective and sustainable.

Ms Kelleigh Ryan, Psychologist and IAHA Board Member, Indigenous Allied Health Australia  will give practical examples around how a cultural responsive framework can guide mental health practice when working with the complex health and wellbeing needs of Australia’s first peoples at the 15th International Mental Health Conference will be held at the QT Hotel, Surfers Paradise from Monday 25th to Tuesday 26th August 2014.

15th International Mental Health Conference will be held at the QT Hotel, Surfers Paradise from Monday 25th to Tuesday 26th August 2014.  – See more at: http://anzmh.asn.au/conference/#sthash.xIfHko54.dpuf