Mental Health Issues in the

Context of Substance Use

Marie Grace A. Gomez, Ph.D., RGC
Professor
College of Education
University of the Philippines
Diliman, Quezon
 Objectives
1. Identify stereotypes and the surrounding social
context of a substance user that contribute to
psychosocial and mental health issues
2. Describe the myths of substance use/addictions
3. Be acquainted with the substance use disorders
(SUDs), risk factors and comorbidities
4. Identify protective factors and prevention
mechanisms to combat SUDs 2
 The substance user
and the surrounding
1 social context and its
contribution to
psychosocial and
mental health issues
How would
you describe a
substance
user? 4
5
Common images that
we know that describe
a substance user
6
How would they be described? What
adjectives do we use to describe them?

7
 Without
Adik Magulo Basagulero
change

Walang
Pasaway Salot Peste
kuwenta

Mamamatay Dirty
Kriminal Magnanakaw
tao

8
Condemned Judged

Not given a
Ridiculed second chance
in life

9
 What really goes on in the life of a
typical substance user
Problems
Self-esteem issues • Loss of
hope
Fathers who want to put food on the table • Painful life
Broken relationships • Desire to
not exist
Abandonment
Discouragement 10
Substance users are people like you and me

11
 “
It is not always that they want to be
“cool or be in.” They want to belong.
Some of them just want to survive life’s
blows.

12
 Understanding the
2 myths of substance
use/addictions
Myths in Understanding Substance Use
(Yale University Substance Use Disorder Training Program, 2020)

⊳Moral model
⊳Addiction is solely physiological
dependence
⊳Addiction is solely a brain disease
14
Myth: Moral Model

⊳ Substance use is sign of failure a and resulting

from moral weakness, bad choices or deficits of
the individual self
⊳ Addiction is likened to being dirty, while
sobriety is often referred to as clean.

15
Myth: Moral Model …(con’t)

⊳The moralistic approach can become a

barrier to treatment because it poses
barriers to intervention (Example: fear of
disclosing substance use because of being
fired from a job)
16
Myth: Addiction is Solely Physiological
Dependence

⊳ This model seeks to take the burden off choice and

highlights the body's natural reward mechanism.
⊳ While it is true that continued use leads to
dependence even despite harmful effects, this is not
the whole story.

17
Myth: Addiction is Solely Physiological
Dependence (…con’t)

⊳ If addiction was just a matter of dependence,

then once the person has detoxed, he/she
would be free from addiction, but that's not
the case.
⊳ Role of personal choice is omitted in this
model
18
Myth: addiction is solely a brain disease.

⊳ Focuses that substance dependence’s view

of addiction is solely on the biology of the
brain.
⊳ It neglects the environmental and social
forces apply.
19
Addictions are ….

not only a not only a

physiological
matter of choice
dependence

not only a
disease
20
 “
Biological, psychological, socio-
economic and spiritual dimensions of
the disease are at play. (Yale University Substance
Use Training Program, 2020)

21
Let us remember that …

⊳ A disease that should not be seen as

inevitable or without an element of personal
choice.
⊳ We can't understand the disease without the
complex context or contributing factors.

(Yale University Substance Use Training

Program, 2020)
22
 What are Substance
3 Use Disorders
(SUDs)
Understanding Substance Related
Disorders

⊳ a cluster of cognitive, behavioral, and

physiological symptoms indicating that
the individual continues using the
substance despite significant substance-
related problems.
⊳ important characteristic of substance use
disorders is an underlying change in
brain circuits that may persist beyond
detoxification, particularly in individuals
with severe disorders 24
Diagnostic Criteria Groupings of
DSM-5

⊳impaired control
⊳ social impairment
⊳ risky use
⊳pharmacological criteria
25
Impaired Control

⊳ The individual may take the substance

in larger amounts or over a longer
period than was originally intended

26
Impaired Control

⊳ Expression of a persistent desire to cut

down or regulate substance use and
may report multiple unsuccessful
efforts to decrease or discontinue us

27
Impaired Control

⊳ The individual may spend a great

deal of time obtaining the
substance, using the substance, or
recovering from its effects

28
Impaired Control

⊳ Craving is manifested by an intense

desire or urge for the drug that may
occur at any time but is more likely when
in an environment where the drug
previously was obtained or used.

29
Social Impairment

⊳Recurrent substance use may result

in a failure to fulfill major role
obligations at work, school, or
home
30
Social Impairment

⊳Important social, occupational, or

recreational activities may be given
up or reduced because of substance
use
31
Social Impairment

⊳The individual may withdraw from

family activities and hobbies in
order to use the substance

32
Risky use of the substance

⊳Recurrent substance use in

situations in which it is
physically hazardous

33
 Risky use of the substance

⊳ The individual may continue substance use

despite knowledge of having a persistent or
recurrent physical or psychological problem
that is likely to have been caused or
exacerbated by the substance

34
Pharmacological criteria

⊳ Tolerance - requiring a markedly

increased dose of the substance to
achieve the desired effect or a markedly
reduced effect when the usual dose is
consumed.

35
Pharmacological criteria

⊳ Withdrawal is a syndrome that occurs when

blood or tissue concentrations of a substance
decline in an individual who had maintained
prolonged heavy use of the substance. After
developing withdrawal symptoms, the
individual is likely to consume the substance to
relieve the symptoms
36
The Different SUDs
⊳ Alcohol-related disorders
⊳ Caffeine-related disorders
⊳ Cannabis-related disorders
⊳ Hallucinnogen-related disorders
⊳ Inhalant-related disorders
⊳ Sedative, Hypnotic, or Anxiolytic –related Use
Disorder
⊳ Tobacco-related disorders
⊳ Other (or Unknown) Substance Use Disorder
37
Alcohol-Related Disorders

⊳ Alcohol Use Disorder

⊳ Alcohol Intoxication
⊳ Alcohol Withdrawal
⊳ Other Alcohol-induced Disorders
⊳ Unspecified Alcohol-Related Disorder
38
Caffeine-Related Disorders

⊳ Caffeine Intoxication
⊳ Caffeine Withdrawal
⊳ Other Caffeine-Induced Disorders
⊳ Unspecified Caffeine-Related
Disorder
39
Cannabis-Related Disorders

⊳ Cannabis Use Disorder

⊳ Cannabis Intoxication
⊳ Cannabis Withdrawal
⊳ Other Cannabis-Induced Disorders
⊳ Unspecified Cannabis-Related Disorder
40
Hallucinogen-related disorders

⊳ Phencyclidine Use Disorder

⊳ Other Hallucinogen Use Disorder
⊳ Phencyclidine Intoxication
⊳ Other Hallucinogen Intoxication
⊳ Hallucinogen Persisting Perception Disorder
⊳ Other Phencyclidine-induced Disorders
⊳ Other Hallucinogen-induced Disorders
⊳ Unspecified Phencyclidine-Related Disorder
⊳ Unspecified Hallucinogen-Related Disorder 41
Inhalant-related Disorders

⊳ Inhalant Use Disorder

⊳ Inhalant Intoxication
⊳ Other Inhalant-Induced Disorders
⊳ Unspecified Inhalant-Related
Disorder
42
Sedative, Hypnotic, or Anxiolytic –
related Use Disorder

⊳ Sedative, Hypnotic, or Anxiolytic Use Disorder

⊳ Sedative, Hypnotic, or Anxiolytic Intoxication
⊳ Sedative, Hypnotic, or Anxiolytic Withdrawal
⊳ Other Sedative ・ , Hypnotic-, or Anxiolytic-Induced
Disorders
⊳ Unspecified Sedative-, Hypnotic-, or Anxiolytic-Related
Disorder

43
Tobacco-related Disorders

⊳ Tobacco Use Disorder

⊳ Tobacco Withdrawal
⊳ Other Tobacco-Induced Disorders
⊳ Unspecified Tobacco-Related
Disorder
44
Other (or Unknown) Substance Use
Disorder

⊳ Other (or Unknown) Substance Use Disorder

⊳ Other (or Unknown) Substance Intoxication
⊳ Other (or Unknown) Substance Withdrawal
⊳ Other (or Unknown) Substance-Induced Disorders
⊳ Unspecified Other (or Unknown) Substance-Related
Disorder
45
General Risk Factors

⊳ Prenatal exposure to substances

⊳ Exposure to community violence during childhood
⊳ Females- unstable home environment
⊳ Having a psychiatric condition
⊳ Associating with dealers of substances
46
 General Comorbidities Associated with
SUDs

⊳ Conduct disorder Psyhosocial Issues:

⊳ Antisocial personality disorder • Poorer life
⊳ Bipolar disorder satisfaction
• Suicide attempts
⊳ Depression
⊳ Anxiety disorder

47
4 What can be
done?
The Transtheoretical Model or the Stages of Change Model

49
PREVENTION
Identify and strengthen Protective Factors

50
Protective Factors

⊳ Contribute to mental health

⊳ Allow a person to be resilient in the face of challenges
⊳ You can use these when things go out of control (genetics,
disability, environment where you live)
⊳ Can be a mechanism to choose the people in your life, cope
and solve problems and how you still spend each day.

51
Different Protective Factors (Therapist Aid CBT Worksheets)

⊳ Social Support
⊳ Coping Skills
⊳ Physical Health
⊳ Sense of Purpose
⊳ Self-Esteem
⊳ Healthy Thinking 52
Enhancing Social Support

⊳ Increase ability to talk about problems

to other people
⊳ Asking people for help
⊳ Experiencing feelings of love, intimacy
and friendship
53
Enhancing Coping Skills

⊳ Awareness of own emotions and

recognition on how they affect behavior
⊳ Increasing ability to manage unhelpful
emotions

54
Evidenced-Based Ways of Developing Coping Skills
(Laurie Santos of Yale University, 2020, The Happiness Lab)

⊳ Exercise (at least 30 mins of exercise)

⊳ Gratitude (3-5 things I am thankful for each day)
⊳ Sleep (getting rid of gadgets before sleeping)
⊳ Getting Social (bonding with friends and family)
⊳ Being with emotions (recognizing emotions)

55
 Enhancing Physical Health

⊳Adequate exercise or physical

activity
⊳A balanced and healthy diet
⊳Medical compliance 56
Enhancing Sense of Purpose

⊳ Meaningful involvement in work,

education and other roles
⊳ Understanding of personal values and
living in accordance with these values

57
Enhancing Self-Esteem

⊳Belief that one’s self has value

⊳Acceptance of personal flaws, mistakes
and weaknesses
⊳Belief in ability to overcome challenges
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Thank you
very much!

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