Counselor Toolbox Podcast

Mood Disorders and PTSD Instructor: Dr. Dawn-Elise Snipes, PhD Executive Director: AllCEUs.com, Counselor Education and Training Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery Objectives ~ Bipolar 1 & 2 ~ Cyclothymic Disorder ~ Depressive Disorder ~ Persistent Depressive Disorder ~ Premenstrual Dysphoric Disorder ~ Circadian Rhythm Sleep Disorder ~ Generalized Anxiety ~ Social Anxiety ~ Panic Disorder ~ Agoraphobia ~ Acute Stress Disorder ~ PTSD Manic ~ A. (Often ego-syntonic) A distinct period of abnormally and persistently elevated, expansive, or irritable mood and increased activity or energy, lasting at least one week (or any duration if hospitalized). ~ Often the mood is irritable if due to the use of a substance or if the person’s wishes are denied ~ High mood liability is possible ~ In children, happiness, silliness inappropriate to context and developmental age ~ Depressive symptoms can occur during a manic episode lasting hours or a couple of days Manic ~ B. During the period of mood disturbance and increased energy or activity, 3+ of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior: ~ 1) Inflated self-esteem (uncritical self-confidence) or grandiosity. ~ Despite no prior experience, person may undertake a grandiose task like writing a novel ~ Delusions of grandeur are possible ~ Children overestimate abilities and may think themselves better at things than they are ~ 2) Decreased need for sleep (eg, feels rested after only three hours of sleep). Manic ~ 3) More talkative than usual or pressure to keep talking. ~ 4) Flight of ideas or subjective experience that thoughts are racing. ~ 5) Distractibility (ie, attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed. ~ Heightened sense of smell hearing or vision may be reported ~ 6) Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (ie, purposeless non-goal-directed activity). ~ Marked increase in sociability including talking to strangers is common ~ Dress may become markedly more seductive or flambouyant ~ Person may become aggressive or hostile Manic ~ 7) Excessive involvement in activities that have a high potential for painful consequences (eg, unrestrained buying sprees, sexual indiscretions, or foolish investments). ~ In children, developmentally inappropriate sexual preoccupations or taking on many tasks simultaneously ~ C. Causes marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. ~ D. The episode is not attributable to the physiological effects of a substance (eg, a drug of abuse, a medication, other treatment) or to another medical condition. ~ Cocaine, amphetamines; Medications: steroids, L-Dopa, antidepressants, stimulants (ADHD, weight, decongestants); Light therapy, ECT, MS, Stroke, lupus, AIDS, encephalitis Manic/Hypomania ~ Hypomania: ~ A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood increased activity or energy, lasting at least four consecutive days (4 days vs. 1 week) ~ The episode is not severe enough to cause marked impairment in social or occupational functioning ~ Do not confuse with euthymia —elevated mood that occurs for a couple days following remission of major depression Major Depressive Disorder ~ A. 5 (or more) (2 or more for PDD) of the following symptoms have been present during the same 2-week period (2 years for PDD (1 in children) and represent a change from pre

Communicating with the Cognitively Impaired Instructor: Dr. Dawn-Elise Snipes, PhD Executive Director: AllCEUs.com, Counselor Education and Training Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery   Objectives ~ Define cognitive impairment ~ Explore symptoms of cognitive impairment in ~ Alzheimer’s ~ Dementias ~ Fetal Alcohol Spectrum Disorders ~ Review APA Treatment Guidelines for counselors working with persons with Alzheimer’s ~ Identify methods for effective communication ~ Learn how to handle difficult behaviors ~ Identify specific issues and interventions for a person with a FASD Symptoms of Cognitive Impairment ~ The development of multiple cognitive deficits manifested by both ~ (1) memory impairment (impaired ability to learn new information or to recall previously learned information) ~ (2) one (or more) of the following cognitive disturbances: ~ (a) aphasia (language disturbance) ~ (b) apraxia (impaired ability to carry out motor activities despite intact motor function) ~ (c) agnosia (failure to recognize or identify objects despite intact sensory function) ~ (d) disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting) Symptoms of Cognitive Impairment ~ Other Symptoms ~ Attention ~ Perception ~ Insight and judgment ~ Organization ~ Orientation ~ Processing speed ~ Problem solving ~ Reasoning ~ Metacognition Causes of Cognitive Impairment ~ Wernike-Korsakoff’s Syndrome ~ Vascular Dementia ~ Stroke ~ Impeded blood flow to brain ~ Alzheimers ~ Fetal Alcohol Spectrum Disorders ~ Brain Injury (Car accident, football, fall, boxing) ~ (Temporarily) Hyper or Hypo-glycemia Screening for Cognitive Impairment ~ The AD8 (PDF, 1.2M) and Mini-Cog(PDF, 86K) are among many possible tools. ~ Patients should be screened for cognitive impairment if: ~ The person, family members, or others express concerns about changes in his or her memory or thinking ~ You observe problems/changes in the patient’s memory or thinking ~ The patient is age 80 or older(12) ~ Low education (IQ, FASD, stroke…) ~ History of type 2 diabetes ~ Stroke ~ Depression ~ Trouble managing money or medications ~ Episodes of delirium (confusion/disorientation) Important Aspects of Management ~ Important aspects of psychiatric management include ~ Educating patients and families about ~ the illness ~ treatment ~ sources of additional care and support (e.g.,support groups, respite care, nursing homes, and other long-term-care facilities) ~ the need for financial and legal planning due to the patient’s eventual incapacity (e.g., power of attorney for medical and financial decisions, an up-to-date will, and the cost of long-term care) Important Aspects of Management ~ Behavior oriented treatments ~ Identify the antecedents and consequences of problem behaviors ~ Reduce the frequency of behaviors by changing the environment to alter these antecedents and consequences. ~ Stimulation-oriented treatments ~ recreational activity, art therapy, music therapy, and pet therapy, along with other formal and informal means of maximizing pleasurable activities for patients ~ Emotion-oriented treatments ~ supportive psychotherapy can be employed to address issues of loss in the early stages of dementia ~ Reminiscence therapy has some modest research support for improvement of mood and behavior ~ Tolerate, Anticipate, Don’t Agitate Communication ~ Written, oral, body language/signs ~ Let the client write, draw or speak to communicate ~ Use real objects when possible. (i.e. an apple)

Using Research to Enhance Your Practice Instructor: Dr. Dawn-Elise Snipes, PhD Executive Director: AllCEUs.com, Counselor Education and Training Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery   Objectives ~ Review statistical terms and concepts ~ Explore the reasons to use research ~ Identify places to review research Reasons to Use Research ~ Identify new treatments that can benefit your clients ~ Evaluate the veracity of claims about treatment effectiveness ~ Example 1 ~ Ensure existing treatment approaches are effective with your client population ~ Use research methods to enhance the effectiveness and efficiency of your practice Terms ~ Validity ~ Reliability ~ Population ~ Sample size ~ Blind and double blind studies ~ A/B/A Design ~ Regression analysis ~ Strength of relationship between two or more variables ~ Meta Analyses Evaluating Programs and Instruments ~ Confidence Interval ~ “The confidence interval represents values for the population for which the difference between the parameter and the observed estimate is not statistically significant at the 5% level”. ~ Effect size ~ an effect size of 0.44 means that the score of the average person in the experimental group is 0.44 standard deviations above the average person in the control group, and hence exceeds the scores of 66% of the control group Where to Find Research ~ PubMed ~ Search ~ Filter ~ Directory of Open Source Journals ~ Buros Mental Measurements Yearbook ~ Tests In Print ~ Evidence Based and Promising Practices ~ Google Scholar (depression treatment) ~ Example 1 Where to Find Research ~ SAMHSA ~ Toolkits ~ RNAO ~ APA Practice Guidelines ~ [Approach] research review or meta analysis   Increasing the effectiveness and efficiency of your practice Conducting Your Own Research ~ Sample size (n=30+) ~ Defining your variables ~ Group vs. Individual ~ Self-help vs. Counseling ~ Medication vs. No-Medication ~ Match client profile with therapist ~ Eliminating confounds ~ Concurrent diagnoses ~ Additional significant bio-psycho-social variables ~ Age, Culture Conducting Your Own Research ~ Design your study ~ Who are your participants ~ How will you implement it ~ What instruments will you use ~ Consider the age/attention of the participants ~ How will you maintain participation ~ Consider having study design reviewed by an independent reviewer/review board ~ Ensure patients provide informed consent to participate Conducting Your Own Research ~ Measuring Variables ~ Objective tests ~ Urinalysis ~ Instruments ~ Likert scales / client self-report ~ Focus on symptom goals ~ Use anchors ~ Avoid odd numbers (“I feel energetic/happy…”) 1= lousy/rarely/20%/1 day/<3 hours per day 2= okay/sometimes/50%/3 days/3-8 hours per day 3=good/often/80%/5 days/8-12 hours per day 4=awesome/frequently/>80%/ More than 5 days /12-16 hours per day Conducting Your Own Research ~ Conduct the research ~ Gather the data ~ Analyze the data ~ http://statpages.info/ ~ http://www.quantitativeskills.com/sisa/ ~ SPSS Creating Your Own Instruments ~ Write the instrument ~ Test for: ~ Internal reliability ~ Test-retest reliability ~ Concurrent validity Summary ~ Research can be used to ~ Identify new treatments that can benefit your clients ~ Evaluate the veracity of claims about treatment effectiveness ~ Ensure existing treatment approaches are effective with your cl

Role of the Family & Community in Prevention & Treatment Opiate Commission Interim Report Recommendation #10 Instructor: Dr. Dawn-Elise Snipes, PhD Executive Director: AllCEUs.com, Counselor Education and Training Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery Objectives ~ Define family and community ~ Explore skills and strengths to help prevent medical, emotional and behavioral disorders Committee Recommendations ~ Evidence-based prevention programs for schools, and tools for teachers and parents to enhance youth knowledge of the dangers of drug use, as well as early intervention strategies for children with environmental and individual risk factors ~ Trauma ~ Foster care ~ Adverse childhood experiences (ACEs) ~ Developmental disorders What are Family and Community ~ Community ~ Neighborhood ~ School ~ Social service organizations ~ Business ~ Local media ~ National media ~ Internet ~ Politicians ~ Family ~ Biological mother ~ Biological family ~ Significant-others non-blood related Pregnancy, Infancy and Early Development ~ Preconception: Preventing High-Risk Pregnancies ~ Poor maternal nutrition and anemia ~ Maternal smoking and alcohol and drug use ~ Exposure to neurotoxic substances ~ Maternal depression (PPD correlated with lower child IQ) ~ Adrenal fatigue ~ Low birth weight ~ Low maternal weight ~ Multiple previous preterm deliveries ~ Periodontal diseases ~ Physical and emotional stress Pregnancy, Infancy and Early Development ~ Fetal Development and Infancy ~ Preterm births have increased from 8-12.5% ~ Improved nutrition ~ Prevention of exhaustion ~ Identify and control bacterial vaginosis (29.2% of women) ~ Natural lack of lactobacilli bacteria or using antibacterial soaps Pregnancy, Infancy and Early Development ~ Peri- and Post-partum Depression ~ Changes in sleep, appetite, weight, energy level, and physical comfort in women during pregnancy and postpartum can cause significant emotional strain. Pregnancy, Infancy and Early Development ~ Trust-Mistrust ~ Maternal Sensitivity and Infant Attachment ~ Mother–infant attachment is a well-established influence on infants’ successful development ~ Home Visiting ~ Home visiting is an intensive intervention that targets successful pregnancies and infant development. ~ Overview of Early Intervention ~ Florida Early Steps   Early Childhood and Childhood ~ Autonomy, Initiative ~ Aggressive social behavior, ~ Typically begins to emerge during childhood ~ A key risk factor for progression of externalizing disorders ~ Harsh and inconsistent parenting practices contribute to it ~ Positive involvement with children and positive reinforcement of desirable behavior contribute to cooperative and prosocial behavior ~ Child Maltreatment ~ Programs that target child maltreatment have the potential to prevent multiple MEB disorders and promote healthy development across several domains of functioning Early Childhood and Childhood ~ Family Poverty and Material Hardship ~ Family poverty is associated with ~ Increased parental depression ~ Increased spousal and parent–child conflict ~ Ineffective parenting Early Adolescence ~ Industry and Identity ~ Developmental period during which the prevalence of substance use, delinquency, and depression begins to rise ~ Psychological and behavioral problems tend to be interrelated ~ Risk Factors ~ Family conflict and poverty ~ Increase in the rates of teasing and harassment in middle school. ~ Significant physical changes ~ Socia

Models of Treatment Instructor: Dr. Dawn-Elise Snipes Executive Director: AllCEUs.com, Counselor Education and Training Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery Objectives ~ Define the principles of effective treatment ~ Explore current trends and practices ~ Identify common approaches to treatment ~ Identify the main components of each approach ~ Compare and contrast each approach Principles of Effective Treatment ~ Addiction and mental health issues are complex but treatable conditions that affect: ~ Brain ~ Body ~ Behavior ~ No single treatment is appropriate for everyone ~ Treatment needs to be available to be effective ~ Effective treatment attends to multiple needs of the individual Current Trends and Practices ~ Focus on client competencies and strengths ~ Individualized, client-centered treatment ~ Shift away from labeling ~ Acceptance of new treatment goals (other than just abstinence) ~ Adoption of a recovery paradigm and away from the problem-focused, acute care model ~ Achieve a rich and meaningful life vs. eliminate depression Current Trends and Practices ~ Integration of addiction treatment in multiple disciplines esp. primary care, mental health and addiction ~ Use of evidence based practices ~ Use of medications ~ Telehealth technologies ~ Support groups (in the rooms, daily virtual support groups) ~ Chat support ~ Forums ~ Online video psychoeducation Question ~ How can we make treatment more available? Principles of Effective Treatment ~ Duration in treatment for at least 3 months is critical ~ Treatment plans must be assessed continually and modified to ensure that it meets the person’s changing needs ~ Treatment does not need to be voluntary to be effective Models of Treatment ~ Medical model ~ Chronic progressive disease ~ Often hospital or doctor office based ~ Uses a biopsychosocial approach with emphasis placed on: ~ Physical causes ~ Pharmacotherapy ~ Detoxification ~ Symptom reduction ~ Aversion ~ Medical maintenance Models of Treatment ~ Spiritual Model ~ Mood issues and addiction may be caused by spiritual emptiness which leads to character defects such as pride, resentment, anger ~ Less weight to causation and more emphasis on a spiritual path to recovery, development of values and a sense of meaning and purpose. ~ 12-Step Models (Mutual Help) ~ Emphasize that one cannot help oneself, and recovery requires surrender of one’s will to a higher power. ~ NA, AA, EA Question ~ How can you use a spiritual model with clients who do not believe in a higher power? Models of Treatment ~ Psychological (self-medication) Model ~ Addiction and mental health issues result from deficits in learning, thinking or emotion regulation ~ Treatments ~ Behavioral self-control ~ Individual and group counseling (Multiple EBPs) ~ Pharmacotherapy for mental health issues Psychological: Behavioral Self Control ~ Goals ~ Strengthen internal mechanisms (self-awareness) ~ Establish external controls ~ Coping skills ~ Goal setting ~ Behavioral contracting (What would you contract for?) ~ Trigger management (What are MH triggers) ~ Functional Analysis (of behaviors NOT diagnosis) ~ Relapse prevention (What are relapse prevention strategies for MH? Addiction?) Psychological: Psychotherapeutic ~ Dialectical Behavior Therapy ~ Why ~ Clients unintentionally rewarded ineffective treatment while punishing their therapists for effective therapy. ~ The sheer volume and severity of problems presented by clients made it impossible to

Mental Disorders Caused by Addiction Instructor: Dr. Dawn-Elise Snipes Executive Director: AllCEUs.com, Counselor Education and Training Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery Objectives ~ Define Alcohol Related Brain Damage ~ Explore how an awareness of ARBD is vital for mental health as well as addiction counselors ~ Learn about the symptoms of ARBDs including alcoholic dementia and vascular dementia ~ Learn about Fetal Alcohol Spectrum Disorders Alcohol Related Brain Damage ~ Damage directly caused to the person by exposure to alcohol or other drugs ~ Alcohol Related Dementia (Wernicke-Korsakoff’s syndrome) ~ Vascular Dementia ~ Fetal Alcohol Spectrum Disorders ~ According to the CDC ~ Most excessive drinkers do not meet the criteria for dependence (meaning they may present in mental health clinics for treatment of mood disorder) ~ About 17% of the adult population reported binge drinking, and 6% reported heavy drinking Alcohol Related Brain Disorders ~ Caused by regularly drinking too much alcohol over several years. ~ Covers several different conditions which are similar to, but not actually dementia, including: ~ Wernicke-Korsakoff syndrome ~ alcoholic dementia. ~ In contrast to dementia (i.e.Alzheimer's disease), most people with ARBD who receive good support and remain alcohol-free ~ Make a full or partial recovery ~ Will not experience a worsening of their condition Alcohol Related Brain Disorders ~ ARBD is greatly undiagnosed. ~ Post-mortem findings indicate it affects about 1 in 200 of the general adult population. ~ Among those with alcoholism, this figure rises to as high as one in three ~ People with ARBD tend to in their 40s or 50s ~ Alcohol-related brain damage is thought to cause more than 10% of ‘dementia' in people under 65. Alcohol Related Brain Disorders ~ Drinking more than the recommended limit for alcohol increases a person's risk of developing common types of dementia such as Alzheimer's disease and vascular dementia. ~ Recommended limits are now a maximum of 14 drinks each week, with a maximum of 2 per day ~ Repeated binge drinking – heavy drinking in one session is particularly harmful ~ Increased risk of dementia is greatest at higher levels of alcohol consumption ~ But you do not need to be an alcoholic or get drunk often to be at increased risk of developing dementia. ~ Regularly drinking even a little above recommended levels increases your risk ARBD ~ Alcohol-related brain damage causes a range of conditions ~ Alcoholic dementia/alcohol-related dementia ~ Korsakoff's syndrome/ Korsakoff's psychosis. ~ ARBD is defined as long-term decline in memory or thinking caused by excessive alcohol use and a lack of vitamin B1 (thiamine) ~ Regular heavy (>14/week) drinking over time can cause: ~ Damages nerve cells because alcohol ~ Causes chemical changes in the brain ~ Shrinkage of brain tissue ~ Intestinal damage  poor nutrient absorption ~ Poor handling of thiamine ~ Damaged blood vessels ~ High blood pressure ~ Increased risk of heart attacks and strokes Alcohol Related Dementia ~ Symptoms largely reflect the areas in the person's brain that are damaged. ~ Poor planning and organizational skills, and problems with decision-making, judgement and risk assessment ~ Problems with impulsivity (eg rash financial decisions) and difficulty controlling emotions (eg irritability or outbursts) ~ Problems with attention and slower reasoning ~ Lack of sensitivity to the feelings of other people ~ Behavior which is socially inappropriate. ~ Unlike Korsakoff's syndrome, however, not everyone with alcoholic dementia ha

Common Co-Occurring Issues: Exploring the interaction between mental health, physical health and addiction Instructor: Dr. Dawn-Elise Snipes Executive Director: AllCEUs.com, Counselor Education and Training Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery Objectives ~ Review what a healthy person needs ~ Review how different addictions may cause or be caused by ~ Mood disorders ~ Physical health issues What Does a Healthy Person Need ~ Nutrition ~ Sleep ~ Pain control ~ Access to regular medical care ~ Prevention ~ Early intervention ~ Social Support ~ Safe housing Why do I care about co-occurring issues? ~ 35% of people with anxiety disorders have abused opiates ~ Of opiate or alcohol dependent patients, 20% have major depressive disorder ~ Depression in opioid dependent patients (including pain management) has been associated with poorer physical health, decreased quality of life, increased risk-taking behaviors and suicidality ~ Prevalence and severity of depression tend to decline within the first few weeks after treatment initiation ~ Withdrawal from depressants (including alcohol), opioids, and stimulants invariably includes potent anxiety symptoms. ~ Many people with substance use disorders may exhibit symptoms of depression that fade over time and that are related to acute withdrawal. Mental Health: Chicken or Egg ~ Depression & Anxiety ~ Associated with addiction because… ~ Stimulant withdrawal/recovery / depression ~ Stimulant use ~ “Medicate” depression ~ Causes anxiety ~ Alcohol/opiate use ~ Numb/forget: Deal with physical pain ~ Detox from opiates /depression ~ Detox from alcohol /anxiety ~ Life circumstances as the result of addiction Mental Health: Chicken or Egg ~ Bipolar disorder ~ Triggered by drug use ~ More common for people with bipolar to use: ~ Stimulants when depressed ~ Anything when manic ~ ADHD ~ Self medication ~ Disrupted neurotransmitters after use Mental Health: Chicken or Egg ~ Borderline Personality ~ More likely to use addictions to cope with lack of a sense of self and emotional lability ~ Antisocial Personality ~ May use addictions for the high or stimulation Alcoholism ~ Eating disorders (especially bulimia and binge eating disorder) ~ Nutritional deficiencies which can cause mood issues ~ Physical exhaustion which can disrupt sleep ~ Depression as a result of use ~ Depressant effects ~ Neurochemical imbalances ~ Sleep disruption ~ Anxiety ~ As a result of use ~ Neurochemical imbalances Nicotine ~ Mental Health ~ Anxiety and Depression ~ 70% more likely in smokers ~ Nicotine triggers dopamine release ~ Blood vessel changes can mimic depression related fatigue/confusion ~ SPMI 2-3 times more likely than the general population to use nicotine ~ ADHD (increases in concentration and attention—short lived) ~ Physical Health ~ COPD /Emphysema ~ Lung cancer ~ Stroke (smoking narrows blood vessels increasing BP and reducing circulation) Opiate Abuse ~ Physical ~ Blood and injection site infections ~ Collapsed veins (stroke, dementia) ~ Endocarditis ~ Hepatitis (pain, disability) ~ HIV (depression, anxiety, medication side effects) ~ Liver damage from acetaminophen ~ Decreased pain tolerance (depression, disrupted sleep) ~ Mental Health ~ Depression & Anxiety ~ Used in some trials to treat depression ~ Can cause depressive symptoms due to pharmacological properties ~ Serves to reduce anxiety and increase energy in some Eating Disorders ~ Commonly co-oc

Opiate Commission Preliminary Report Dr. Dawn-Elise Snipes Executive Director: AllCEUs Counseling Education https://www.whitehouse.gov/sites/whitehouse.gov/files/ondcp/commission-interim-report.pdf Training on basic addiction counselor competencies  or Addiction Counselor Certification Training Intro ~ In 2015, 27 million people reported current use of illegal drugs or abuse of prescription drugs. ~ Only 10 percent of the nearly 21 million citizens with a substance use disorder (SUD) receive any type of specialty treatment ~ With approximately 142 Americans dying every day, America is enduring a death toll equal to September 11th every three weeks. Recommendations ~ Rapidly increase treatment capacity. Grant waiver approvals for all 50 states to quickly eliminate barriers to treatment resulting from the federal Institutes for Mental Diseases exclusion within the Medicaid program. ~ This exclusion prohibits federal Medicaid funds from reimbursing services provided in an inpatient facility treating “mental diseases” (including SUDs) that have more than 16 beds. ~ Right now, states entirely responsible for Medicaid-eligible patients in inpatient treatment facilities, including patients undergoing withdrawal management in addiction treatment facilities rather than hospitals. ~ This will immediately open treatment to thousands of Americans in existing facilities in all 50 states…Or will it? ~ Require extensive provider enrollment procedures ~ Requires extensive staff training ~ Requires extensive modifications to the HER and P&P Training—Wish List (Basic Medicaid Training Requirements can be found here: https://www.allceus.com/member/cart/index/product/id/765/c/ ) ~ Require all persons from technicians to clinicians and managers to receive specialty training in Addiction Counseling ~ In FL a bachelors level practitioner with specialized training in treatment of behavioral health disorders, human growth and development, evaluations, assessments, treatment planning, basic counseling and behavior management interventions, case management, clinical record documentation, psychopharmacology, abuse regulations, and recipient rights ~ Biopsychosocial evaluations ~ Group therapy services ~ Certified recovery peer specialist • Certified recovery support specialist • Certified behavioral health technicians can also provide ~ Group counseling in Day Treatment Programs ~ Community support and Rehabilitative services ~ Clubhouse services ~ Therapeutic behavioral on-site support services with persons under 21 Prescriber Education ~ Fewer than 20% of the over one million prescribers licensed to prescribe controlled substances to patients have training on ~ How to prescribe opioids safely. ~ How to screen for addiction ~ What to do if a patient has become dependent on substances or presents with an SUD ~ Mandate prescriber education initiatives with the assistance of medical and dental schools ~ Require all Drug Enforcement Administration (DEA) registrants to take a course in proper treatment of pain. ~ Work with partners to ensure additional training opportunities, including continuing education courses for professionals. ~ Promote expanded implementation of the CDC Guideline for Prescribing Opioids for Chronic Pain ~ 4 of 5 new heroin users begin with nonmedical use of prescription opioids ~ Not necessarily their own…. Medication Assisted Treatment ~ MAT has proven to reduce overdose deaths, retain persons in treatment, decrease use of heroin, reduce relapse, and prevent spread of infectious disease. ~ Only 10 p

Differential Diagnosis Exploring the Framing Bias Instructor: Dr. Dawn-Elise Snipes Executive Director: AllCEUs.com, Counselor Education and Training Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery Counseling CEUs are available at https://www.allceus.com/member/cart/index/search?q=framing+bias Objectives ~ Define the framing bias ~ Explore medial, substance and mood symptoms which may overlap ~ Identify how many “problem” behaviors are semi-functional adaptations to help the person survive ~ Develop an understanding for how a positive change in any one area can lead to positive changes throughout the system   Framing Bias ~ Tendency to react to a particular set of symptoms in different ways depending on how or where it is presented ~ Medical practitioners: Depression, Anxiety, Physical ~ May miss bipolar, substance intoxication or withdrawal, normal reactions to psychosocial stressors ~ Mental health clinicians: Mental health, normal reactions to psychosocial stressors ~ May miss medical, substance ~ Substance abuse clinicians: Substance, normal reactions ~ May miss mental health and medical Framing Bias ~ Problem (Finding the cause of the symptoms) ~ If it is caused by medical, psychosocial issues, psychotropics will (likely) not help much ~ If it is caused by substances, psychotropics may help “bridge the gap” ~ If symptoms are caused by a mental health issue which exists independently of substance use, recovery needs to address both Framing Bias ~ Find the cause of low water pressure ~ Leaks: ~ Water pressure coming into the house is fine, but doesn’t make it to where it needs to be ~ Dripping faucets, running toilet, poor fittings ~ Crack in the line ~ Pressure reducing valve malfunctioning Anxiety: Generalized ~ Symptoms ~ At least 6 months of “excessive anxiety and worry” about a variety of events and situations. ~ The presence for most days over the previous six months of 3 or more (only 1 for children) of the following symptoms: ~ Feeling wound-up, tense, or restless ~ Easily becoming fatigued or worn-out ~ Concentration problems ~ Irritability ~ Significant muscle tension ~ Difficulty with sleep   Anxiety: Panic Disorder ~ Symptoms ~ Palpitations, pounding heart, or accelerated heart rate ~ Sweating ~ Trembling or shaking ~ Sensations of shortness of breath or smothering ~ Feeling of choking ~ Nausea or abdominal distress ~ Feeling dizzy, unsteady, lightheaded, or faint ~ Derealization (feelings of unreality) or depersonalization (being detached from oneself) ~ Fear of losing control or going crazy or dying ~ Paresthesias (numbness or tingling sensations) ~ Chills or hot flushes   Depression and Dysthymia ~ Major Depressive Episode ~ A. Five (or more) of the following have been present nearly every day during the same 2-week period ~ depressed mood most of the day ~ markedly diminished interest or pleasure in all, or almost all, activities ~ significant changes in eating patterns. ~ insomnia or hypersomnia ~ psychomotor agitation or retardation nearly every day ~ fatigue or loss of energy ~ feelings of worthlessness or excessive or inappropriate guilt ~ diminished ability to think or concentrate, or indecisiveness, ~ recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation Mania/Hypomania ~ Symptoms ~ A distinct period of abnormally and persistently elevated, or irritable mood, lasting at least 1 week ~ Inflated self-esteem or grandiosity

Neurobiology: Dopamine, GABA, Serotonin, Acetylcholine Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs.com Counseling CEUs for this podcast can be found at https://www.allceus.com/member/cart/index/product/id/752/c/ Objectives ~ Define Neurobiology ~ For the following neurotransmitters, Dopamine, GABA, Serotonin, Acetylcholine, identify ~ Their mechanism of action/purpose ~ Where they are found ~ Symptoms of excess & insufficiency ~ Nutritional building blocks ~ Medications ~ Neurological changes over the lifespan What is Neurobiology ~ Neurobiology is the study of the brain and nervous system which generate sensation, perception, movement, learning, emotion, and many of the functions that make us human Dopamine ~ Mechanism of action/purpose ~ Movement ~ Memory ~ Pleasurable reward ~ Behavior and cognition ~ Attention ~ Sleep ~ Mood ~ Learning Dopamine ~ Mechanisms of Action ~ Precursor, L-DOPA is synthesized in brain and kidneys ~ Dopamine functions in several parts of the peripheral nervous system ~ In blood vessels, it inhibits norepinephrine release and acts as a vasodilator (relaxation) ~ In the pancreas, it reduces insulin production ~ In the digestive system, it reduces gastrointestinal motility and protects intestinal mucosa ~ In the immune system, it reduces lymphocyte activity. Dopamine ~ Symptoms of excess ~ Unnecessary movements, repetitive tics ~ Psychosis ~ Hypersexuality ~ Nausea ~ Most antipsychotic drugs are dopamine antagonists ~ Dopamine antagonist drugs are also some of the most effective anti-nausea agents Dopamine ~ Symptoms of insufficiency ~ Insufficient dopamine ~ Negative symptoms of schizophrenia ~ Pain ~ Parkinson’s Disease ~ Restless legs syndrome ~ Attention deficit hyperactivity disorder (ADHD) ~ Neurological symptoms that increase in frequency with age, such as decreased arm swing and increased rigidity. ~ Changes in dopamine levels may also cause age-related changes in cognitive flexibility. Dopamine ~ Symptoms of excess & insufficiency ~ Insufficient dopamine ~ Lack of motivation ~ Fatigue ~ Apathy, Inability to feel pleasure ~ Procrastination ~ Low libido ~ Sleep problems ~ Mood swings ~ Hopelessness ~ Memory loss ~ Inability to concentrate Dopamine: Age Related Changes ~ Dopamine levels decline by around 10% per decade from early adulthood and have been associated with declines in cognitive and motor performance ~ Dopamine levels are also impacted by availability of estrogen Dopamine ~ Nutritional building blocks ~ Eating a diet high in magnesium and tyrosine rich foods will ensure you’ve got the basic building blocks needed for dopamine production. ~ Here’s a list of foods known to increase dopamine: Dopamine ~ Medications ~ Most common dopamine antagonists (positive symptoms) ~ Risperdone, Haldol, Zyprexa ~ Metoclopramide (Reglan) is an antiemetic and antipsychotic ~ Most common dopamine AGONISTs (Parkinson’s, Restless Legs) (negative symptoms) ~ Mirapex & Requip Glutamate ~ Is an amino acid (present in most high protein foods) ~ Most prevalent excitatory neurotransmitter ~ Used to make GABA (teeter-totter) ~ Facilitates learning and memory ~ Excess glutamate is associated with ~ Panic attacks / anxiety ~ Impulsivity ~ OCD ~ Depression Glutamate ~ Availability declines with age ~ Affected by serotonin availability ~ Insufficient ~ Agitation

Human Development Part 2 Adulthood through Old Age 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 Counseling CEUs can be found at AllCEUs Counseling Continuing Education Objectives ~ Review stages of Adult Development (Erickson, Valliant, Levinson) ~ Identify biological, psychological and social issues which must be dealt with at each stage ~ Explore where stuck-points can occur and how to help people successfully resolve those issues to prevent/address depression, anxiety and/or addiction Early Adulthood Ages 20-40 ~ Physical functioning peaks at age 30, but can be maintained ~ Body shape changes with increases in fat and loss of muscle mass ~ Bodily systems begin to diminish in functioning at about 1% per year ~ Thinking becomes more practical and dialectical to adapt to inconsistencies and complexities of daily experience ~ Short term memory peaks ~ Knowledge continues to grow ~ Issues of identity and intimacy peak around age 30 ~ Continued need for affiliation ~ Friendships take on more importance for those who are single Early Adulthood Psychosocial Tasks ~ Early Adult Transition (Age 17-22). ~ Developing an Identity that allows a separation from parents ~ Choosing to go to college or enter the workforce ~ Family not supportive ~ Lack of direction ~ Difficulty with chosen task ~ Choosing to leave home ~ Difficulty with self-regulation ~ No idea how to fend for self Early Adulthood Psychosocial Tasks ~ Early Adult Transition (Age 17-22) Passion ~ Development of Intimacy ~ Choosing to develop reciprocal relationships with another person. ~ Developing and embracing sexual identity ~ Develop effective interpersonal skills to develop healthy relationships ~ Expanding one's sense of self to include another person ~ Develop a solid identity ~ Develop healthy both/and boundaries Early Adulthood Psychosocial Tasks ~ Entering the Adult World (Age 22-28) Enterprise ~ May start having children ~ Graduate from college / complete training ~ More concrete decisions regarding occupation, friendships, values, and lifestyles. ~ Career Consolidation. A job turns into a career once one has contentment, compensation, competence, and commitment (Valliant). ~ Includes stay at home parent or spouse (stay-at-home dad)   Early Adulthood Psychosocial Tasks ~ Age 30 Transitions (Age 28-33). ~ Significant lifestyle changes i.e. marriage or having children, promotions, “adulting” ~ Deal with grief/loss issues ~ All your friends are married ~ You are married with kids and can’t live the single life anymore (time and money ain’t yours) ~ Deal with anxiety/anticipation ~ What if I can’t do it? ~ What if I am alone forever?   Early Adulthood Psychosocial Tasks ~ Settling Down (Age 33-40) Contemplation ~ Establish a routine (can feel oppressive to some) ~ Makes progress on goals for the future ~ Reflect on a deeper meaning and purpose for their lives Middle Adulthood 40-65 ~ Bodily changes continue (wrinkles, gray hair and menopause) ~ Many people need reading glasses ~ Increased vulnerability to health and disease ~ Fluid intelligence may decline ~ Reaction time and mental processing speed slow ~ Short and long term memory remain stable ~ Cognitive abilities ~ Dependent on speed and adapting to novelty decrease ~ About the world increase and related to experience flourish (expertise) ~ Marital satisfaction

Child and Adolescent Development Child and Adolescent Development 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 CEUs are available for this presentation at allceus.com.  Learn more about our Addiction Counselor Certification Training Programs at https://allceus.com/certification Objectives~ Identify the major psycho-social milestones for each age group~ Learn about things that may thwart development~ Identify protective factors for healthy development~ Conceptualize behaviors as goal-driven in order to better understand their purpose and provide appropriate redirection Infancy Milestones~ Age 0-1 years~ Children master the use of their hands (0-6 months)~ Start crawling~ Respond to familiar words~ Discover their voices~ Rely on parents for comfort and to meet basic needs~ Cognitive (Piaget): Object permanence~ Develop Trust (Erickson)~ Secure attachment to caregiver~ In self to properly interpret signals and get needs met Infancy and Attachment ~ Attachment~ Attachment is the quality of the relationship with the caregiver characterized by trust, safety and security.~ The quality of the infant-parent attachment is a powerful predictor of a child’s later social and emotional outcome~ Determined by the caregiver’s response to the infant when the infant’s attachment system is ‘activated’ ~ Beginning at six months old, infants come to anticipate caregivers’ responses to their distress and shape their own behaviors accordingly (eg, developing strategies for dealing with distress when in the presence of that caregiver)~ Sensitive, Responsive, Loving = Secure~ Insensitive, Rejecting or Inconsistent = InsecureAttachment cont…~ Continues through childhood, but formative attachment relationships developed in infancy~ Effects of Secure Attachment~ Learn basic trust, which serves as a basis for all future emotional relationships~ Develop fulfilling intimate relationships~ Maintain emotional balance~ Feel confident and good about themselves~ Enjoy being with others~ Rebound from disappointment and loss~ Share their feelings and seek support Attachment Cont…~ Effects of Secure Attachment cont…~ Explore the environment with feelings of safety and security, which leads to healthy intellectual and social development~ Develop the ability to control behavior, which results in effective management of impulses and emotions~ Create a foundation for the development of identity, which includes a sense of capability, self-worth, and a balance between dependence and independence~ Establish a moral framework that leads to empathy, compassion, and conscience~ Generate a core set of beliefs~ Provide a defense against stress and trauma Infancy Developmental Stuck Points~ Interferences~ Child does not have basic food, shelter, safety, love needs met~ Manifestations~ Inability to trust self or others~ Reliance on others to tell them what they need~ Lack of a sense of worthiness for basics~ Discomfort with and craving of attention~ Irritability/anxiety~ Establishment/Re-Establishment of Trust and Attachment~ Consistency~ Care: Understanding and ensuring basic needs are met~ Compassion: Being calm and accepting of the child’s emotions and needs~ Providing compassionate redirection: Add.  Don’t just subtract Toddlers 2-3 Years~ Developmental Task: ~ Psychosocial: Autonomy vs. Shame & Doubt (Erickson)~ Personal control over physical skills and body (potty training and “no”)~ Cognitive: Preoperational (Through age 7)~ Think about things symbolically (Doll can “be” Mom) / Pretend play~ Begin to understand the concept of past and future~ Continue to develop secure attachmentsToddlers 2-3 Years Stuck Points~ Interferences~ Overly permissive or overly strict parents~ Lack of praise for exploration and experimentation~ Manifestations~ Low self-esteem/need for external validati

Continuum of Co-Occurring DisordersContinuum of Co-Occurring 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 CEUs can be earned for this podcast at AllCEUs.com.  Learn more about our addiction counselor training options at https://allceus.com/certification Objectives~ Explore a couple cross cutting issues~ Explore the varying courses of addiction and mental health disorders~ Explore the continuum of addictive behaviors from initiation, intoxication, harmful use, abuse, dependence, withdrawal, craving, relapse and recovery~ Explore the continuum of mental health disorders from mild to severe to recovery, and explore causes of relapse Mental Health Disorders—Why Do I Care?~ Treating someone with a mental health or personality disorder complicates the picture and increases risk of concurrent disorders~ Addictive~ Mood~ Personality~ People with more chronic or longer standing mental health issues are at a much greater risk for misusing substances or developing addictive disorders. Mood Disorders—General Information~ Effective differential diagnosis~ Both substance use and discontinuance may be associated with depressive symptoms.~ Acute manic or anxiety symptoms may be induced or mimicked by intoxication with stimulants, steroids, hallucinogens, or polydrug combinations.~ Withdrawal from depressants, opioids, and stimulants invariably includes potent anxiety symptoms. ~ Medical problems and medications can produce symptoms of anxiety and mood disorders. ~ Lookout for substance misuse~ Those with depression favor stimulation and those with anxieties favor sedation, but there appears to be considerable overlap. Mood Disorders Risk Factors~ Genetics: 30-40% of variability~ Environment– Especially multiple adverse childhood experiences, overprotective or disengaged parents ~ Temperamental- Neuroticism/negative affect ~ Moody and to experience such feelings as anxiety, worry, fear, anger, frustration, envy, jealousy, guilt, depressed mood, and loneliness~ Respond worse to stressors and are more likely to interpret ordinary situations as threatening and minor frustrations as hopelessly difficult. ~ Self-conscious and shy~ Have trouble controlling urges and delaying gratificationMood Disorders: Continuum~ Considerations~ Situational~ Episodic with no easily identifiable trigger~ Continuum~ Mild~ Moderate~ Severe~ RemissionMood Disorders Course~ Median Age of Onset~ 13 for social anxiety~ 30 for GAD~ Puberty (10-14) for Major depressive disorder~ Content of anxiety is age appropriate changing over the lifespan~ Depression diagnosis requires 5 of 9 symptoms resulting in 126 possible presentations~ In MDD, the first episode presentation is quite variable with…~ Some never achieving remission of 2 or more months~ Others going years between episodesMood Disorders Course~ Recovery begins within 3 months of onset for 2:5 and within 1 year for 4:5~ The longer the recovery period, the lower the chance of recurrence~ Early onset of persistent depressive disorder is correlated with a higher incidence of developing personality and addictive disorders. (DSM-V)~ Those with chronic episodes or long-standing symptoms have higher risk of developing concurrent mental health and addictive disorders Mood Disorders Course~ General Course ~ Mood symptoms~ Social problems due to mood symptoms (irritability, fatigue)~ Depression, anxiety, grief about mood symptoms~ Sleep disruption/Exhaustion~ Reduced involvement in important activities (work, family, recreation)~ Withdrawal from social relationships~ Increased mood symptoms Mood Disorders Course~ General Course (Recovery)~ Desire for help and hope that recovery is possible~ Begins proper self-care (including medical & psychiatric as needed)~ Appreciation of possibilities—What does happiness/recovery look like for you?

Biopsychosocial Impact of Addiction on Family and CommunityBiopsychosocial Impact of Addiction on Family and Community 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 CEU courses based on this project are at https://allceus.com OR Register for the live webinar-based addiction counselor certification track https://allceus.com/certification Objectives~ Identify the biological/health consequences of addiction and mental health issues on the family and community ~ Identify the psychological consequences of addiction and mental health issues on the family and community~ Identify the social consequences of addiction and mental health issues on the family and community~ Identify family and community interventions Functions of the Family~ Protects and sustains both strong and weak helping them to deal with stress and pathology ~ Serves as a mechanism for family members to interact with broader social and community groups (peer, schools, work, religious, social)~ Provides an important point of intervention~ Influences weaker members in harmful ways due to tension, problems and pathology Biological Effects on the Family~ Stress and stress related illnesses & sleep disturbances~ Failure to attend to children’s physical needs~ Exposure to toxic substances~ Cigarette smoke~ Drugs~ Overuse of sedatives~ Among parents for relaxation~ Among children for sleep/sedativePsychological Effects on the Family~ Physical or verbal abuse~ Erratic behavior leading to “walking on eggshells”~ Child neglect which can have a traumatic impact ~ Don’t Talk– Don’t Trust – Don’t Feel~ Shame and guilt in IP and non-IP~ Depression among non-identified patient~ Anxiety among non-identified patientPsychological Effects on the Family~ Caregiving burnout~ Role reversal ~ Children lack a sense of wellbeing and safety~ Inappropriate coping models Family Social~ Social Isolation~ Perfect façade~ Shame~ Exhaustion from caregiving for impaired member~ Financial problems due to lost employment and/or overspending~ Childhood trauma, depression, anxiety~ Children have poor relationships with adults (parents, teachers)Family Social~ Lack of social competence~ Distant, chaotic, unsupportive family relationships~ Inconsistent parenting~ More common in addictions~ Homelessness~ Placing family in high-risk situations Family Interventions~ Improve communication within the family~ Restore roles and boundaries within the family~ Educate the family about the disorder~ Involve the family in the treatment plan~ Address anger, guilt, resentment in family members~ Ensure all family members have a respite~ Encourage healthy behaviors in the family (nutrition, sleep, exercise)~ Encourage development of social supports especially via support groups Community Mental Health~ People with poor coping skills and negative thinking styles model these behaviors, spreading them~ National Bureau of Economic Research (NBER) reports that there is a definite connection between mental illness and addictive behaviors~ People who have been diagnosed with a mental health disorder at some point in their lives are responsible for the consumption of:~ 69 percent of alcohol~ 84 percent of cocaine~ 68 percent of cigarettes Community Health~ Impact of Depression and Anxiety~ The total economic burden of depression in 2000 was $83 billion ~ $52 billion was due to lost workplace productivity.~ Anxiety costs ~$47 billion per year~ Other costs include absenteeism, turnover, disability leave~ Every year, employers lose 27 work days per worker with depression, two-thirds of which is due to “presenteeism” ~ The cost of depression to employers greater than the cost of many other common medical conditions, including heart disease, diabetes, or back problemsCommunity Health~ Impact of Depression and Anxiety~ Lead

Biopsychosocial Impact of Addiction and Mental Disorders on the Individual 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 Counseling CEUs can be earned for this presentation at AllCEUs.com Objectives ~ Examine the biological (physical) impact of addiction and mental health issues on the individual ~ Examine the psychological impact of addiction and mental health issues on the individual ~ Examine the social impact of addiction and mental health issues on the individual ~ Identify interventions in each area. Biological Impact of Mood Disorders ~ Caused by an imbalance of: ~ Serotonin (calming) ~ GABA (Calming) ~ Glutamate (Excitatory) ~ Norepinepherine (Excitatory) ~ Dopamine (Pleasure) Biological Impact of Mood Disorders ~ Effects ~ Disrupted sleep ~ Fatigue ~ Irritability ~ Nutritional changes ~ Increased muscle tension ~ Reduced pain tolerance ~ Gastrointestinal disturbances The Brain Under Stress Biological Impact of Addictions ~ Direct (neurotransmitter imbalances) ~ Tolerance ~ Withdrawal   Neurotransmitters, Addiction & Black Friday ~ Normal day ~ Normal store capacity is 750 people. ~ The store needs a constant 500 to stay open ~ The store has 8 doors to allows for people to easily enter and exit without getting “bunched” ~ Black Friday ~ 1500 people push through the door as soon as it opens ~ Store is destroyed ~ Staff is exhausted ~ Takes time to restock and refresh staff ~ Management closes all but two doors and adds security guards to manage flow Biological Impact of Addictions ~ Indirect ~ Reduced Immunity ~ More rapid aging ~ Sleep difficulties ~ Nutritional deficits ~ Reduced pain tolerance & Increased pain ~ Disease (Hepatitis, HIV, TB, MRSA)   Biological Impact of Alcohol ~ Alcohol ~ Heart damage ~ High blood pressure ~ Fatty liver ~ Hepatitis ~ Cirrhosis ~ Pancreatitis ~ Cancers of the mouth, throat, liver and breast ~ Reduced immunity ~ Brittle bones Biological Impact ~ Alcohol ~ Brain damage through: ~ The toxic effects of alcohol on brain cells ~ The biological stress of repeated intoxication and withdrawal ~ Alcohol-related cerebrovascular disease ~ Head injuries from falls sustained when inebriated. ~ Alcohol related birth defects (FASD) Biological Impact ~ Alcohol ~ Nutrient deficiencies: ~ Vitamins: A, E, D, K,B12, folic acid, thiamine ~ Thiamine deficiencies, which cause severe neurological problems such as impaired movement and memory loss seen in Wernicke/Korsakoff syndrome (memory disorder often seen in Alzheimers) ~ Calcium ~ Iron (intestinal bleeding) ~ Dehydration Biological Impact of Caffeine ~ Negative ~ Stimulant/jitters ~ Increased blood pressure ~ Heart palpitations ~ Heartburn/Diarrhea ~ Disrupted sleep ~ Dehydration ~ Miscarriage ~ Osteoporosis ~ Positive (with moderate intake) ~ Lower risk of Alzheimer's and dementia ~ Decreased suicide risk ~ Increased endurance ~ Decreased risk of oral cancer Biological Impact of Nicotine ~ Nicotine (including gums and vapors) ~ Highly addictive ~ Activates neurotransmitters ~ Pain and anxiety relief ~ Reduced appetite ~ Respiratory irritation ~ Increased heart rate and blood pressure ~ Hyperglycemia ~ Decreased i