Grant Proposal – Peer Reviews
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StudentE-51.docxANXIETY DISORDERS 16
Anxiety Disorders and Substance Abuse Prevention, Treatment, and Maintenance
PSY 625-Biological Bases of Behavior
Instructor Roxanne Beharie
March 20, 2017
Running head: ANXIETY DISORDERS 1
MATCHMAKING A SOCIAL PSYCHOLOGICAL VIEW 17
Anxiety Disorders and Substance Abuse Prevention, Treatment, and Maintenance
Specific Aims
Malfunctions in the brain through failed neurotransmitters and non-respondent receptors of the brain chemicals, dopamine, serotonin, and epinephrine, due to mental health disorders have been shown to be a high correlate of substance abuse. The association whether the mental disorders come before the substance abuse, during, or after has been debated for quite some time by researchers. Undiagnosed and untreated mental conditions, some of which include depression, bipolar disorder, schizophrenia, and anxiety disorders show to have high correlations to the start and continuation of substance abuse due to self-medicating and developed coping mechanisms, creating artificial chemicals in the brain to feel “normal”. Undiagnosed mental disorders have been debated to be primarily due to lack of insurance, and medical care coverage for lower income individuals (specifically teenagers and young adults), high caseloads in state funded facilities, and lack of knowledge of resources available to communities. Undiagnosed substance abuse and undiagnosed mental disorders lead to many debilitating consequences, among these, substance abuse is one of the most prevalent debilitating consequences. While several undiagnosed mental disorders can be associated with substance abuse, anxiety disorders are one of the top mental disorders associated with substance abuse. Several studies, research articles, multi-faceted research investigations have been done to explain the connection as well as treatment options of psychiatric disorders and substance abuse. These studies include Cross sectional analysis and many other types of research. These studies observe the processes that anxiety disorders and other mental health disorders include based on processes that have the same underlying principles, known as transdiagnostic processes. These processes are the fear of fearful or stressful situations, how an individual can handle high emotional situations, and whether they respond to negative situations on impulse, which are all common features in both anxiety and substance abuse problems. (Wolitzky-Taylor, et. al, 2016) Several disorders are included in this spectrum of anxiety disorders, including, social anxiety, generalized anxiety, OCD/PTSD, and other panic disorders. These disorders are associated with alcohol and cannabis use. These disorders have been assessed using several methods such as self-reported questionnaires and therapy sessions, and treatment observations. The specific aim of this research is to determine whether undiagnosed or untreated anxiety disorders come before substance abuse during or after and how these factors can predict rehabilitation success outcomes. Determining the dual diagnosis is key to create a program that can prevent substance abuse disorders, treat dual diagnosis of psychiatric conditions and substance abuse, and to maintain the treatment outcomes. Studies done concerning alcohol and drug treatment have shown that the severity of the different psychiatric disorders can predict the specific outcome, so if it can predict the outcome, a program can be created to develop better treatment techniques combining methods. (Polcin & Korcha, 2017) The goal is to understand the connection between anxiety disorders and other mood and mental health disorders combined with substance abuse and eventually create a program that targets the root of the problems leading to substance abuse and rehabilitation, and use this information to prevent and create a successful treatment program available to communities in high risk areas
Background Information
In recent studies “it is estimated that one in five Americans suffer from a chronic mental health and substance abuse (MHSA) issue” (Sanjil, et al., 2017). Many studies have shown the there is a brain related connection between that of substance abuse and psychiatric disorders. Though these studies are many, they are not very specific in their relation factors. During research, one of the articles reviews shows a number of twenty-six articles that focused on describing different associations between somatic nervous systems and cells, brain neuropathways, different anxiety disorders, and substance abuse disorders. The review was done to gain clarity of the associations that exist between these specific neurological disorders. There is a small amount of knowledge or research in this area that is not confounded and specific. (Hassan & Ali, 2011) One study used “secondary analysis of data from 43,093 non-institutionalized US adults in the first wave (2001–2002) of the National Epidemiological Survey on Alcohol and Related Conditions” (Martins & Gorelick, 2011). This analysis was followed by an interview that includes diagnostic procedures using the criteria of the DSM-IV to identify psychiatric disorders that are associated with psychoactive substance abuse, mood related disorders, and anxiety disorders. Substance use is associated with each of the disorders as well as the transition from use to abuse of substances. (Martins & Gorelick, 2011) The neurobiological results in this particular study reveal that the pathways and transmitters in the brain are revolving around the areas and transmitters that create pleasure. Rewards, motivations, and emotional memory, which are all leading pathways to substance abuse. Substance abuse is very likely to be simultaneous with several health problems like depression disorders, bipolar disorder, personality disorders, PTSD, OCD, and anxiety disorders. The genetic and biological factors that also play a part in the vulnerability include many factors such as social, psychological, and environmental factors. Individuals that use drugs do it in the beginning to “feel good”, to “feel better”, to “do better”, and for peer pressure. Though high-risk factors and low protective factors play a major part in these decisions. Those with mental health problems and disorders are at a greater risk for formation of substance abuse disorders, and less success in treatment. One study showed that biological markers that specifically target the reward system such as dopamine and opioids, play a role in both depression and anxiety disorders. Neurotransmitters such as serotonin (5-HT) run the goal directed behaviors by dopamine self-stimulators. Norepinephrine is known to be connected to the emotional memory, and regulate the social defeat vulnerability that are controlled in these specific neuron systems. The serotonin receptors are shown to be high in anxiety responses and explain the anxiety disorders and longer lasting neural changes that can lead to substance abuse. (Bandelow, et. al, 2017) Aside from neurobiological causes, behavioral economics plays a great deal of apart in substance abuse. Developmental periods in adolescents are critical and are the beginning of substance abuse and while the neurological system is still developing, the behavioral conditioning responses are also developing. Social, educational, and health-related components are affected by substance use. (Murphy & Dennhardt, 2016)
Treatment and Maintenance
One study based on previous research used a little over 500 adult participants in clinical trials of people that were using methamphetamines. During this study, mental health factors were examined and substance abuse and the outcomes of how individuals with anxiety disorders were able to live, their quality of life, etc, was examined after their 3-year treatment mark in association with alcohol and drugs. Anxiety disorders and mental health issues were shown to have decreased and levels of psychiatric symptoms had increased. This article explained how Anxiety disorders gives insight into creating and redeveloping treatment outcomes for substance abuse. This article showed that anxiety and high stress factors are some of the highest, most common symptoms that is reported in initial substance abuse counseling. This study explains that addressing the anxiety symptoms that are associated with lower treatment success rates, higher suicide rates, and substance abuse, can help to optimize the treatment availability and success among those presenting with dual diagnoses. (Glassner-Edwards, et. al, 2010)
Studies show that the responses for relapse come in different forms, such as emotional responses, life stress, cognitive factors, socialization processes, and environmental factors and perception is the key to success. In one experiment using adolescents, an experiment observed “Fourteen focus groups with 118 youth (78.3% male; 66.1% Latino) were enrolled in participating substance abuse treatment programs (4 young adult and 10 adolescent) throughout Los Angeles County” (Gonzales, et. al, 2012). These individual session reports were examined and themes were developed among these youths to determine successful or unsuccessful treatment. How an individual views treatment helps clinicians to create and shape the programs for youth substance abuse. In this study recovery barriers for adolescents, the highest relapse rating is 90 percent due to emotional responses, 85 percent for life stress, and 75 percent cognitive factors. (Gonzales, et. al, 2012) Based on these numbers the psychiatric factors have a strong significance in that of treatment purposes, as well as initial use and transition to abuse.
Early detection and treatment assessments are important for critical periods of substance abuse and it determines the transition from recreational use to dependency and at what period in an individual’s life this is the most prevalent. Behavioral economics play a major part in beginning use and continuation of use, with the use of conditioning. In adolescence development of risk taking traits for survival is a very sensitive period which in turn can manifest to use of drugs as coping mechanisms, or a means to survival. Their levels of impulsivity, novelty-seeking, and hyperactivity are at an all-time high and they are hyperactive to the specific environmental cues, and hypo active to the concepts of stress. This is where self-medicating is most prevalent. Because individuals begin using substance early, their developmental periods are disrupted and changed to allow them to depend on the substance to feel normal. One article studies the etiology of addiction and gives specific insight into what risk factors are present in addiction, such as, “immature PFC combined with hyper-reactivity of reward salience, habit, and stress systems” (Jordan & Andersen, 2017). One study showed that mental health conditions are associated with types of drug use and abuse. PTSD is associated with opioid and cocaine use, Anxiety, is associated with methamphetamine use and cannabis use, and Depressions is associated with alcohol use. Provided with the information for the neurotransmitters as well as the functions of these neurotransmitters in relation to the mental health disorders., treatment options to be based upon the specific disorders targeting both the psychiatric disorders and substance abuse disorders simultaneously can create a more successful treatment option. The treatment option that is most successful and newly used is integrated treatments of Cognitive Behavioral Therapies along with Pharmacological therapies, results have been assessed by quasi experimental studies that reported better outcomes. These therapies target both the chemicals in the brain as well as the conditioned behavioral responses. The drawback is the lack of number of trained providers as well as financial resources available to obtain these trained providers, especially for high risk, lower income areas, lacking proper insurance coverages. (McHugh, 2015)
Significance
The purpose of the proposal is to gain this specific knowledge lacking. Using epidemiological and clinical studies in examining the frequency and impact of both anxiety and alcohol use how they are related, what their impact in a clinical setting is, how they are developed and maintained over a long period of time, treatments are considered utilizing factors to treat both disorders, and how common this is among individuals. One article used research on studies done over decades and created an overview of connections between the two that are unique to other mental disorders. These studies have shown that this association is multifaceted and complex, and that treatment is complicated. (Smith & Randall, 2012) The importance of the research in the area of substance abuse and mental health disorders is describing, explaining, and creating treatment options for the connections between the two disorders. This current research can help create self-reporting questionnaires that tailor to the association and needs of those suffering from dual diagnoses to determine the direction of treatment among young adults.
One article explains how individuals that are incarcerated join a reentry program that targets both mental health and substance abuse while teaching life stills and allows these individuals to gain the insight and information needed to create successful reentry and life outside of prison, while this is a topic for specific reentry, it touches on very important topics that can help to transform the way treatment programs operate outside of prison walls. The combination of life skills, mental health rehabilitation, and substance abuse, identification, treatment, and follow up, create a pathway to successful individuals becoming upstanding members of society, and able to contribute. (Gunnison & Helfgott, 2017) If the specific aims are met, this could create revolutionary change, not only for those addicted to substances, those denied of mental health care, and substance abuse treatments due to costs, society, economic growth, and lastly for those recovering addicts to give them purpose. The idea of a combined research approach, combines cognitive behavioral therapy, to reshape the way the person perceives things, with life and educational courses, reward and motivation systems, for passed drug screens and incentives, motivation questions and comments, and follow up. The combination approach has been shown to give a well-rounded approach to different causes, and types of substance abuse, especially when diagnosed with a dual diagnosis. (Sharma & Bennet, 2015)
In recent studies substance abuse clinical create a substantial cost to both individuals and society financially. Many programs designed to help individuals are relatively lowly funded, and lack positive treatment outcomes due to lack of insurance, and lack of funds to cover the costs of the necessary treatments. (Olsson & Fridell, 2018) Creating a center in an environment that the high risk areas with lower income ratio and higher uninsured individuals reside, with high success rates would increase the level of working individuals essentially adding to the community’s economic growth, as well as creating volunteering positions at these centers for those recovering and adhering to giving back.
Proposed Study
Participants
100 clients recruited from an advertisement that offers a $10 sign up incentive, and free help to individuals with mental health and substance abuse issues, waving health care costs. There will be 50 clients, 25 male and 25 female, ranging between the ages of 17-30, presenting with mental health conditions seeking treatment and 50 clients ranging between the ages of 18-30 equal male and female diversified and gathered by willingness to participate, presenting with substance abuse conditions seeking treatment. This will take place in a community based setting such as The therapy center in Shreveport Louisiana. Each client that presents with substance abuse will be given an initial drug test for validation and determination of the type of drugs in their system.
Procedures
The first 30 days of the study will be the initial intake and assessment term. During this time each participant will be informed of the reason for the study as well as the protocols they will be participating in, such as group sessions, and self-reporting surveys. They will be informed of confidentially practices and asked if they have any questions and asked to sign an informed consent. The individuals that seek treatment for substance abuse disorders will be given self-reported questionnaires and a background history report in relation to psychiatric symptoms and diagnoses. For this study individuals will not be charged the full price of psychological treatment, but they will be charged based on what they are able to afford using a sliding scale. They will be asked for a comprehensive history, based on family, social, educational, and mental health history. They will also be asked to describe the drugs they have experimented with and utilized as well as the one or ones they are abusing. Obtaining this information will help to tailor the program to target dual diagnoses and categorize the specific disorder, treatment, and management of the disorder. Lastly, brain imaging will be used to determine the areas of the brain affected to target pharmacological and cognitive intervention. Individuals seeking mental health treatment will also be asked for their history with substance use in the same manner. Lastly everyone will be asked to take a questionnaire to determine their individual perceptions of treatment and maintenance. After initial intake, individuals will then be split into groups based on their results provided pharmacological and cognitive behavioral therapy and other behavioral interventions with a trained psychologist and monitored through a treatment program of six months, then a year, and be moved to maintenance if they have successfully completed a year. Each participant will be asked to fill out self-reporting questionnaires that will be assessed using 7-point Likert scales as well as one on one interviews to determine dual diagnoses as well as treatment perspectives. Upon completion of the intake term, participants will begin in tailored treatment programs attending one group session a month, that includes life skills, and personal skills, as well as coping mechanisms education. The participants will also attend Cognitive Behavioral Therapy once a month for 5 months along with the group educational sessions, and lastly the maintenance time, the last 6 months will be focused on building education and support systems and assessing the probability of relapse. The stages of relapse will be discussed and steps to take should this happen, will be revealed. At the end of the program, another round of self-reporting questionnaires will be given to determine if both the psychological and substance abuse disorders have improved and in what areas.
Hypothesis & Analysis
The hypothesis is that this integrated program will combine efforts to simultaneously treat, maintain, and prevent future disorders in both anxiety disorders and substance abuse by combining education, Cognitive Behavioral Therapy, Support systems and Pharmacology.
The hypothesis is that the anxiety group will reveal substance use but not abuse and the program minus the drug tests, will assist them in a similar fashion. The substance use group will reveal underlying psychiatric problems that will simultaneously be treated once in treatment.
To analyze this information Likert scales as well as other scales will be used, and face to face interviews will be calculated. Each of these taken at the start of treatment and the end of treatment will be analyzed and compared to determine effectiveness of treatment and prediction of relapse.
Budget Justification
Funding is requested for a half time Licensed Mental health counselor for intake assessment and to oversee group sessions, $15,000. Part time Cognitive Behavioral Therapist to assist in cognitive behavioral therapy in substance abuse clients once a month in the first 6 months of treatment, $6,250. Graduate Study associate that will be responsible for overseeing the entire study the entire year. Entering calculations, taking notes, assessing scales, and converting information into representable data, $15,000. Group session incentives for each month $10 a month for each client for their time, $12,000. Participation costs per person $10 sign up incentive, $1,000. The rest of the funds will be for $1000 for a data analyzing computer, $500 for office supplies, $500 for Survey scales, and $3000 for drug tests for a test every other month for all substance abuse clients. The final numbers come out to be $59,744.
REFERENCES
Bandelow, B., Baldwin, D., Abelli, M., Bolea-Alamanac, B., Bourin, M., Chamberlain, S. R., … Riederer, P. (2017). Biological markers for anxiety disorders, OCD and PTSD: A consensus statement. Part II: Neurochemistry, neurophysiology and neurocognition. The World Journal of Biological Psychiatry: The Official Journal of the World Federation of Societies of Biological Psychiatry, 18(3), 162–214. http://doi.org/10.1080/15622975.2016.1190867
Glasner-Edwards, S., Mooney, L. J., Marinelli-Casey, P., Hillhouse, M., Ang, A., Rawson, R., & the Methamphetamine Treatment Project Corporate Authors. (2010). Anxiety disorders among methamphetamine dependent adults: Association with posttreatment functioning. The American Journal on Addictions / American Academy of Psychiatrists in Alcoholism and Addictions, 19(5), 385–390. http://doi.org/10.1111/j.1521-0391.2010.00061.x
Gonzales, R., Anglin, M. D., Beattie, R., Ong, C. A., & Glik, D. C. (2012). Understanding Recovery Barriers: Youth Perceptions About Substance Use Relapse. American Journal of Health Behavior, 36(5), 602–614. http://doi.org/10.5993/AJHB.36.5 .3
Gunnison, E., & Helfgott, J. B. (2017). Critical keys to successful offender reentry: Getting a handle on substance abuse and mental health problems. The Qualitative Report, (8), 2152.
Hassan, I., & Ali, R. (2011). The Association Between Somatic Symptoms, Anxiety Disorders and Substance Use. A Literature Review. Psychiatric Quarterly, 82(4), 315-328. doi:10.1007/s11126-011-9174-2
Jordan, C. J., & Andersen, S. L. (2017). Sensitive periods of substance abuse: Early risk for the transition to dependence. Developmental Cognitive Neuroscience, 25, 29–44. http://doi.org/10.1016/j.dcn.2016.10.004
Martins, S. S., & Gorelick, D. A. (2011). Conditional substance abuse and dependence by diagnosis of mood or anxiety disorder or schizophrenia in the U.S. population. Drug and Alcohol Dependence, 119(1-2), 28–36. http://doi.org/10.1016/j.drugalcdep.2011.05.010
McHugh, R. K. (2015). Treatment of Co-occurring Anxiety Disorders and Substance Use Disorders. Harvard Review of Psychiatry, 23(2), 99–111. http://doi.org/10.1097/HRP.0000000000000058
Murphy, J. G., & Dennhardt, A. A. (2016). The Behavioral Economics of Young Adult Substance Abuse. Preventive Medicine, 92, 24–30. http://doi.org/10.1016/j.ypmed.2016.04.022
Olsson, T. M., & Fridell, M. (2018). The five-year costs and benefits of extended psychological and psychiatric assessment versus standard intake interview for women with comorbid substance use disorders treated in compulsory care in Sweden. BMC Health Services Research, 181-13. doi:10.1186/s12913-018-2854-y
Polcin, D. L., & Korcha, R. (2017). Social Support Influences on Substance Abuse Outcomes among Sober Living House Residents with Low and Moderate Psychiatric Severity. Journal Of Alcohol & Drug Education, 61(1), 51-70
Sangil, L., Herrin, J., Bobo, W. V., Johnson, R., Sangaralingham, L. R., & Campbell, R. L. (2017). Predictors of Return Visits Among Insured Emergency Department Mental Health and Substance Abuse Patients, 2005-2013. Western Journal Of Emergency Medicine: Integrating Emergency Care With Population Health, 18(5), 884-893. doi:10.5811/westjem.2017.6.33850
Sharma, M., & Bennett, R. (2015). Substance abuse and mental illness: Challenges for interventions. Journal Of Alcohol & Drug Education, 59(2), 3-6.
Smith, J. P., & Randall, C. L. (2012). Anxiety and Alcohol Use Disorders: Comorbidity and Treatment Considerations. Alcohol Research: Current Reviews, 34(4), 414–431.
Principal Investigator: Instructor B. Jones, PhDChristia Hockaday
Grant Title: Anxiety Disorders and Substance Abuse, prevention, treatment, & maintainence
Period of Performance: 9/1/15 - 8/31/1604/1/18-03/31/19
Funds Requested
Full Time Licensed Mental Health Counselor Annual Salary 30,000$
Percentage of effort 50%
Number of months 12
15,000$
Full Time Cognitive Behavioral Therapist 25,000$
Percentage of effort 25%
Number of months 12
6,250$
21,250$
Equipment -$
Group Sessions
Group sessions incentive 1,200$
Graduate salary 15,000$
Total Incentive and Salary Costs 16,200$
Participants
number of subjects:100
payment per subject: $10
Total Participant Cost 1,000$
Computer 1,000$
Survey Scales 500$
Office supplies (postage, paper, etc) 500$
Drug Tests 3,000$
5,000$
43,450$
37.5% 16,294
59,744$
Total Direct Costs
Indirect Costs*
Total Funds Requested
Full Time A/P (10% time 12 Mo)
Licensed Mental Health Counselor (50% time, 12 months)
Salaries
Total Salaries
Supplies
Total Supplies
