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What's so 'Special' about Special Populations?

New Programs for Women and Youth with Concurrent Disorders

Dr. Shimi Kang

Reprinted from "Concurrent Disorders" issue of Visions Journal, 2004, 2 (1), p. 56

For the first time, mental health and addictions services are being merged in BC and there is an opportunity to develop integrated services that address the specific and complex needs of people with concurrent disorders.

Dr. Shimi Kang is an addiction psychiatrist who hopes to develop a unique treatment model for women and youth with concurrent disorders. She is a consulting psychiatrist to both BC Children’s and Women’s Hospitals, where she has established BC’s first Youth Addiction Psychiatry Clinic, and has been specially contracted to develop a concurrent disorders program for women.

Both programs are supported in partnership with the respective hospitals and the Provincial Health Services Authority (PHSA) under the direction of Leslie Arnold, President of Mental Health for the PHSA. Through these programs, Dr. Kang hopes to provide women and youth specific diagnostic assessment, management and treatment recommendations which reflect the highly entangled relationship between substance use problems and mental health issues.

“It is clear that concurrent disorders require a specific management approach. Not only is there significant overlap between substance use and mental health problems, they affect each other’s development, course, and prognosis. Concurrent disorders increase the risk of misdiagnosis, treatment delay and result in the inefficient use of already scarce services,” states Dr. Kang.

Youth Addiction Psychiatry Clinic

In response to this need, the Youth Addiction Psychiatry Clinic at Children’s Hospital offers outpatient consultation for adolescents (age 12-17) with problems of substance use who may have additional co-occurring mental health issues. Specifically, services include a comprehensive psychiatry consultation with special attention to the role of substances in the diagnostic assessment, education regarding the acute and long-term medical and psychiatric effects of problem substance use, and liaison work with family, school and community resources.

“One of our goals is to increase the connection between the teen and his or her community. Studies show that youth who feel connected with home, school, sports or with community or religious groups are less likely to use substances, especially illicit drugs,” says Kang.

Youth addiction is a very real problem in BC, with the average age of first use being 12 for alcohol, 13 for marijuana, and 15 for ecstasy, methamphetamine and cocaine. Treatment requires a unique approach. As Dr. Kang explains, “Management of concurrent disorders in youth must include consideration of the negative impact of drugs on brain development, the binge pattern of use, and the increased involvement in high-risk behaviors such as driving, physical fights, and unsafe sex. The ideal clinic referral would be a youth with some period of abstinence who is willing to connect with primary drug and alcohol therapy in their community. Of course, this is difficult at times given the unpredictable nature of addictive behaviour; however, we hope to provide the maximum benefit to a highly underserved and large population.”

Developing a Program for Women

At Women’s Hospital, Dr. Kang has joined the Reproductive Mental Health Program where she works with women who are pregnant or post-partum and experiencing concurrent disorders. “Gender specific factors are seen in the entire range of issues related to problem substance use and addictive behaviours. Women differ from men in prevalence rates, drug of choice and the influence of trauma. Mental illness, infectious disease, victimization, and issues such as child care and the guilt, shame and societal stigmatization of addicted mothers and pregnant women are all gender specific features.

Although many are greatly affected by the ravages of drugs and alcohol, each population presents unique and explicit considerations and challenges for the prevention, assessment and management of their problem. It is only by recognizing and responding to these considerations, that a system of care can be equipped to provide optimal support and treatment. Programs being established at BC Children’s and Women’s Health Centres are leading the way.

 
About the Author

Dr. Kang, BSc, MD, FRCPC completer psychiatry training at the University of British Columbia and a Fellowship in Addiction Psychiatry at Harvard University in Boston, USA. She also gained front-line experience with substance use problems while working as a family physician in Greater Vancouver prior to completing speciality training in psychiatry and addiction psychiatry. She has a special interest in youth, women, trauma and the cross cultural aspects of addictions and mental health. Along with her role as consulting psychiatrist to BC Children's and Women's Health Centre, Dr. Kang is affiliated with the Orchard Recovery Centre and is a Research Associate with the Mental Health Evaluation and Community Consultation Unit (Mheccu), within UBC's Department of Psychiatry. As a result of her endeavours, Dr. Kang has received five national awards in the United States in the field of addictions and mental health, including the American Academy of Addiction Psychiatry Research Award

Notes

The following article is a result of an "e-interview" that Visions carried out with Dr. Shimi Kang, who told is about her work at the Children's and Women's Health Centre of British Columbia, establishing new programs for women and youth with concurrent disorders

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