Talking about complex substance use, chem sex, and serious mental - - PowerPoint PPT Presentation

Talking about complex substance use, “chem sex”, and serious mental health problems

Christian Hui Tim Guimond Wiplove Lamba Veeral Gandhi

Presenter disclosure – Tim Guimond

• Relationships with commercial interests
• Grants/Research support: I have no financial

connections to any pharmaceutical or medical device company

• Speaker Honoraria: none
• Consulting fees: none
• Other: I do own a vegan restaurant with a liquor

license (Cosmic Treats) and work as a psychiatrist in addictions – there’s some irony in that

Complexity

• Mental health care is rich in complexity
• It encompasses struggles that arise from different

etiological paths (different causative mechanisms)

• Highly stigmatized, similar to HIV
• Poorly understood
• Inadequately funded treatments and research and

treatments

• Many disorders have a chronic course
• Disagreement within the field on diagnosis and

treatment – various “orientations”

Perspectives of Psychiatry Paul R. McHugh & Phillip R. Slavney

• Experience
• PTSD
• Demoralization
• Do
• Substance use

disorders

• Sexual problems
• Are
• Intelligence
• Personality
• Have
• Schizophrenia
• Bipolar disorder

Disease Dimension Life Story Behaviour

Disease

• Have it or don’t have it
• “Broken part” is the etiology or cause
• A normal process in the body has been broken
• The ensuing dysfunction creates symptoms
• These symptom clusters are recognized in

diagnosis

• Example: cough, fever, wheezes and crackles is

recognized as pneumonia

• Several different agents could be the ‘cause’

Dimension

• Some characteristics of

people exist on a spectrum:

• Intelligence
• Personality traits:

Neuroticism, Extroversion/Introversion, Openness, Agreeableness, Conscientiousness

• These are typically normally

distributed

• Society accommodates the

middle of the distribution

• Being at an extreme makes us

vulnerable but not necessarily disordered

Behaviour

Antecedents (triggers)

• External
• people,

place, time

• Internal
• Thoughts,

emotions, sensations Behaviour

• What
• How often
• How much
• How long

Consequences

• Short term
• Positive or

negative

• Mirror

antecedents

• Long term
• Positive or

negative

• Domains

Life Story

• We all have a life story and it is personal and

unique

• The events in our lives craft our values, strengths,

and beliefs

• This is turn impacts the way we interpret new

events, drive our expectations and give our lives meaning

• Some stories are liberating and some confining so

it is wise to write our story carefully

• This story is continually written and can be

rewritten

Perspectives of Psychiatry So What? Why think this way?

• Counselling
• Psychotherapy
• Behavioural therapy
• Change triggers and

consequences

• Coaching to offset

vulnerability

• Avoid precipitating

situations

• Biological treatments
• Proper diagnosis

Disease Dimension Life Story Behaviour

Our cases

• Simple
• Newly diagnoses
• Complex
• PTSD, BPD, SUD, BAD

Disease Dimension Behaviour Life Story

Your cases

Disease Dimension Behaviour Life Story