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Summit Malibu
30765 Pacific Coast Hwy., #406
Malibu, CA 90265

Depression Disorder

Depression Disorder

Depression is a major psychiatric disorder that affects millions of Americans and their families, friends, and colleagues.  The National Institute of Mental Health reports that 18.8 million adults, or about 9.5 percent of the U.S. adult population, suffer from some form of depressive disorder.

The linkage between depression and physical illnesses makes it, in the words of the World Health Organization, "the world's second-most disabling disease after heart disease."

Symptoms of depression

• Ongoing sad, anxious or empty feelings
• Feelings of hopelessness
• Feelings of guilt, worthlessness, or helplessness
• Feeling irritable or restless
• Loss of interest in activities or hobbies that were once enjoyable, including sex
• Feeling tired all the time
• Difficulty concentrating, remembering details, or difficulty making decisions
• Not able to go to sleep or stay asleep (insomnia); may wake in the middle of the night, or sleep all the time
• Overeating or loss of appetite
• Thoughts of suicide or making suicide attempts
• Ongoing aches and pains, headaches, cramps or digestive problems that do not go away.

What is Depression?

The American Psychiatric Association's Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) lists nine symptoms for major depression, five or more which must be present over the same two-week period, including one of the first two:

• Feeling depressed most of the day, nearly every day.
• Markedly diminished pleasure.

The other seven symptoms include:

• Significant weight gain or loss.
• Insomnia or hypersomnia.
• Psychomotor agitation or retardation.
• Fatigue or loss of energy.
• Feelings of worthlessness or inappropriate guilt.
• Diminished ability to think or concentrate.
• Recurrent thoughts of death, suicidal thinking, and suicide attempts.

How is depression treated?

Medications and counseling are the cornerstones of depression therapy.  Reacting to depression as soon as it is noticed is important. With prompt treatment, a depressed person can return to a happier lifestyle and more balanced outlook on life.  There are effective treatments for depression, including antidepressants and talk therapy.  Most people do best by using both.

How long will the depression last?

This depends on how soon you get help. Left untreated, depression can last for weeks, months or even years. The main risk in not getting treatment is suicide. Treatment can help depression lift in 6 to 8 weeks, or less.

Reasons to get help for Depression

• Early treatment helps keep depression from getting worse or lasting a long time.
• Thoughts of suicide are common in people with depression.
• The risk of suicide is higher if you don't get treatment for your depression.
• When depression is successfully treated, the thoughts of suicide will go away.
• Treatment can help you return to your "normal" self, enjoying life.
• Treatment can help prevent depression from coming back.

Other Types of Depression

Dysthymia Depression

Dysthymia is chronic mild to moderate chronic depression, as opposed to major depression. The DSM-IV mandates the same symptoms as for major depression, except for suicidality, but requires only three symptoms in all, so long as they have persisted over two years. Mild to moderate is a misnomer, as dysthymia can make a person’s life as miserable as major depression.

Melancholic Depression

Melancholic depression is major depression with an emphasis on lack of pleasure or lack of reactivity to pleasure. Other characteristics include (three or more): Depressed mood, depression at worst in the morning, early morning awakening, psychomotor agitation or retardation, significant weight loss, and inappropriate guilt.

Atypical Depression

Atypical depression is a misnomer, as more outpatients suffer from atypical depression than from other forms of depression. Atypical depression is major depression that differs from melancholic depression in that patients react positively to external events, plus (two or more): Significant weight gain (as opposed to weight loss), hypersomnia (as opposed to insomnia), leaden paralysis, and sensitivity to personal rejection.

Bipolar Depression

Bipolar depression is a feature of bipolar disorder, also known as manic depression, an illness characterized by mood swings from depression to mania. The diagnostic criteria for bipolar depression are the same as for major depression, but bipolar patients tend to have atypical features. Bipolar patients who rapid cycle can be up and down in a matter of minutes, and in mixed states depression and mania are present at once.

Psychotic Depression

Psychotic depression is a rare form of depression characterized by delusions or hallucinations, such as believing you are someone you are not and hearing voices.

Catatonic Depression

Catatonic depression is a rare form of major depression characterized by (at least two): Stupor, excessive motor activity, extreme negativism, peculiarities in voluntary movement, and repetition of other people's words or actions.

Seasonal Affective Disorder (SAD)

Seasonal affective disorder is major depression that appears in the fall or winter and goes away in spring, thought to be caused by lack of sunlight.

Postpartum Depression

Postpartum depression occurs within four weeks of a women giving childbirth. Most new mothers suffer from some form of the “baby blues.” Postpartum depression, by contrast, is major depression, thought to be triggered by changes in hormonal flows associated with childbirth.

Dual Diagnosis/Co-Occurring Disorder

Depression disorders often occurs together with substance abuse and substance dependence disorders.  Often the substance use is the result of an attempt to "self-medicate" but just as often substance dependence is the primary disorder with depression being secondary.  In either case, both disorders must be treated simultaneously to achieve an effective outcome.

Disclaimer: This assessment is not intended to diagnose or treat any medical or emotional condition. It is advised that you consult your physician with any concerns regarding this condition.

Dual Diagnosis/Co-Occurring Disorders

Dual Diagnosis/Co-Occuring Disorders

Dual diagnosis and co-occurring disorders are psychiatric disorders that are occurring along with substance abuse or substance dependence disorders.

More than half of people experiencing alcohol and drug abuse or dependence disorders are also suffering from a co-occurring mental disorder.

Diagnosing a dual diagnosis/co-occurring disorder condition in substance abusers can be difficult, as drug abuse itself often induces psychiatric symptoms.  In determining the correct dual diagnosis/co-occurring disorder diagnosis it is necessary to differentiate between substance induced and pre-existing mental illness.

Self Medication and Drug or Alcohol Abuse and Dependence

Often people suffering from mental disorders attempt to deal with the problem themselves by "self medicating."  It is common for people experiencing mental disorders to feel relief when drinking alcohol or taking drugs, so it is natural that they should start using these substances to alleviate or control their symptoms.

The problem with self medicating a mental disorder is that prolonged use of alcohol and recreational drugs will likely create a condition of pathological dependence.  In addition, use of certain substances may actually increase the symptoms or create new symptoms.

Treatment for Dual Diagnosis/Co-Occurring Disorders

Summit Malibu's world-class therapists have decades of experience treating the many dual diagnosis/co-occurring disorders that often accompany substance dependence.

Click on the links below to learns more about treatment of dual diagnosis/co-occurring disorders, such as:

• Anxiety Disorder
• Attention Deficit Hyperactivity Disorder (ADHD)
• Bi-Polar Disorder
• Borderline Personality Disorder (BPD)
• Depression
• Obsessive Compulsive Disorder (OCD)
• Panic Disorder
• Post Traumatic Stress Disorder (PTSD)
• Social Anxiety Disorder

OxyContin Abuse and Addiction

OxyContin is the brand name of a time-release formula of oxycodone, an opioid pain-relief medication synthesized from the opium-derived compound thebaine.  OxyContin is one of several semi-synthetic opioids created to replace morphine and codeine in medical practice.  OxyContin is currently the best-selling non-generic narcotic pain reliever in the United States.

OxyContin is classified as a Schedule II drug as it has a high potential for abuse that can lead to severe psychological and physical dependence.

According to several studies, hazardous abuse of opiates is increasing in general, but abuse of OxyContin is mentioned most frequently in the studies.  Several factors have contributed to rising hazardous use and diversion of OxyContin in the U.S.  First, the large amount of OxyContin available  compared with other types of oxycodone pills makes them more likely to be stolen or diverted.  Second, the rising trend of crushing OxyContin pills to rapidly release oxycodone despite warning, and then injecting or snorting the drug.  Last but not least, the ability to purchase OxyContin legitimately by prescription for a few dollars and then easily sell it illegally for as much as $20 per pill.

People who abuse OxyContin are at higher risk of severe withdrawal symptoms as they tend to use more than the standard prescribed doses.

The most common effects of OxyContin include euphoria, constipation, fatigue, dizziness, nausea, lightheadedness, headache, dry mouth, anxiety, itchy skin, and profuse sweating.  High doses can cause shallow breathing, bradycardia, apnea, hypotension, pupil constriction, and in some cases circulatory collapse, respiratory arrest, and death.

Severe withdrawal symptoms are likely if OxyContin use is discontinued abruptly.  Symptoms of OxyContin withdrawal, similar to other opioids, are anxiety, nausea, insomnia, muscle pain, muscle weakness, and fever.  Psychological dependence will continue after the physical withdrawal, and psychosocial treatment is recommended.

Medically supervised OxyContin detoxification (detox) is recommended for cases of OxyContin abuse and OxyContin dependence.

Oxycontin Abuse & Treatment

Oxycontin Abuse & Treatment

OxyContin is the brand name of a time-release formula of oxycodone, an opioid pain-relief medication synthesized from the opium-derived compound thebaine. OxyContin is one of several semi-synthetic opioids created to replace morphine and codeine in medical practice. OxyContin is currently the best-selling non-generic narcotic pain reliever in the United States.

OxyContin is classified as a Schedule II drug as it has a high potential for abuse that can lead to severe psychological and physical dependence.

According to several studies, hazardous abuse of opiates is increasing in general, but abuse of OxyContin is mentioned most frequently in the studies. Several factors have contributed to rising hazardous use and diversion of OxyContin in the U.S. First, the large amount of OxyContin available compared with other types of oxycodone pills makes them more likely to be stolen or diverted. Second, the rising trend of crushing OxyContin pills to rapidly release oxycodone despite warning, and then injecting or snorting the drug. Last but not least, the ability to purchase OxyContin legitimately by prescription for a few dollars and then easily sell it illegally for as much as $20 per pill.

People who abuse OxyContin are at higher risk of severe withdrawal symptoms as they tend to use more than the standard prescribed doses.

The most common effects of OxyContin include euphoria, constipation, fatigue, dizziness, nausea, lightheadedness, headache, dry mouth, anxiety, itchy skin, and profuse sweating. High doses can cause shallow breathing, bradycardia, apnea, hypotension, pupil constriction, and in some cases circulatory collapse, respiratory arrest, and death.

Severe withdrawal symptoms are likely if OxyContin use is discontinued abruptly. Symptoms of OxyContin withdrawal, similar to other opioids, are anxiety, nausea, insomnia, muscle pain, muscle weakness, and fever. Psychological dependence will continue after the physical withdrawal, and psychosocial treatment is recommended.

Medically supervised OxyContin detoxification (detox) is recommended for cases of OxyContin abuse and OxyContin dependence.

Cocaine Abuse & Treatment

Cocaine Abuse & Treatment

Cocaine is a crystalline tropane alkaloid that is procured from coca plant leaves. The drug acts as both reuptake inhibitor for neurotransmitters serotonin, norepinephrine, epinephrine and dopamine by blocking their transporters. It is occasionally prescribed for genuine medical uses, particularly as local anesthesia for eye, ear and throat surgeries.

Cocaine stimulates the nervous system and increases alertness, feelings of well-being and euphoria, energy and motor activity, the perception of competence and sexuality and possible enhanced athletic performance. It can also generate anxiety, paranoia and restlessness.

Cocaine is listed at a Schedule II drug according to the Controlled Substances Act of 1970, which means that it has a high potential for abuse and dependence.

With excessive dosage, the onset of tremors, convulsions and increased body temperature are noticeable. Because of the way it affects the mesolimbic pathway, which modulates behavioral responses to stimuli that activate feelings of reward and reinforcement through the neurotransmitter dopamine, cocaine is addictive.

In the late 19th century, cocaine began to be used to treat morphine addition. It was also introduced in Germany around that time for clinical use as a local anesthetic and has historically been used in eye and nasal surgery. Cocaine wasn't officially considered a controlled substance until 1970 when it was listed as such in the Controlled Substances Act.

A problem with illegal cocaine use by long-time users is the risk of ill effects or damage caused by the compounds used in adulteration.

Cutting or "stamping on" the drug is common, using compounds which simulate ingestion effects, such as Novocain which produces temporary anesthaesia as many users believe a strong numbing effect is the result of strong and/or pure cocaine, ephedrine or similar stimulants that produce an increased heart rate.

Other symptoms of repeated use include insatiable hunger, aches, insomnia/oversleeping, lethargy, and persistent runny nose. Depression with suicidal thoughts may develop in very heavy users. Frequent usage also leads to a rise in tolerance thus requiring a larger dosage to achieve the same effect.

Treatment for cocaine abuse and addiction focuses on behavioral interventions.

Cognitive Behavioral Therapy and other interventions have been shown to be effective for decreasing cocaine use and preventing relapse. Treatment must be tailored to the individual patient’s needs in order to optimize outcomes—this often involves a combination of treatment, social supports, and other services.

Currently, there are no FDA-approved medications for treating cocaine addiction. Researchers are trying to develop medications that help alleviate the severe craving associated with cocaine addiction, as well as medications that counteract cocaine-related relapse triggers, such as stress. Several compounds are currently being investigated for their safety and efficacy, including a vaccine that would sequester cocaine in the bloodstream and prevent it from reaching the brain.

Current research suggests that while medications are effective in treating addiction, combining them with a comprehensive behavioral therapy program is the most effective method to reduce drug use in the long term.

Heroin Abuse & Treatment

Heroin Abuse & Treatment

Heroin (diamorphine) is a semi-synthetic opoid drug synthesized from morphine, a derivative of the opium poppy.

Heroin is typically a white crystalline powder, although it is commonly adulterated with various additives and may appear off-white or even brown. Heroin is used as both a pain-killer and a recreational drug. It is listed as a controlled substance under Schedules I and IV of the Single Convention on Narcotic Drugs. Under the name diamorphine, it is a legally prescribed controlled drug in the United States.

The most common methods of illicit heroin use is intravenous injection, called "slamming" or "shooting up." Recreational users may also take the drug via snorting or smoking by inhaling its vapors when heated.

The withdrawal syndrome from heroin may begin within 6 to 24 hours of discontinuation of the drug. This time can fluctuate with the degree of tolerance as well as the amount of the last consumed dose. symptoms of withdrawal includes sweating, malaise, anxiety, depression, excessive yawning or sneezing, tears, insomnia, cold sweats, chills, severe muscle and bone aches, nausea, vomiting, diarrhea, cramps and fever.

Heroin addiction withdrawal can last several weeks to several months. Attempting heroin withdrawal or detoxification without professional assistance is not only dangerous, it is potentially lethal.

Heroin addiction withdrawal can cause serious physical and emotional trauma including stroke, heart attack and even death. Methadone is often used to ease heroin withdrawal, though this typically ends with the individual acquiring an addiction to another drug.

Recovery from heroin addiction involves detoxification as the initial step. Secondly, the individual needs to be willing to participate in a rehabilitation program. The highest documented success rates for heroin addiction recovery are through long-term drug rehabilitation treatment lasting at least 3 to 6 months.

Methamphetamine Abuse & Treatment

Methamphetamine Abuse & Treatment

Methamphetamine is a psychoactive stimulant that increases alertness and energy, and in high doses, can induce euphoria, enhance self-esteem and increase sexual pleasure. Methamphetamine is FDA approved in the United States for the treatment of ADHD and some forms of obesity, under the trademark name, Desoxyn.

Methamphetamine has a high potential for abuse, activating the psychological reward system by increasing levels of dopamine, norepinephrine and seratonin in the brain.

Methamphetamine is a potent central nervous system stimulant that affects neurochemical mechanisms responsible for regulating heart rate, body temperature, blood pressure, appetite, attention, mood and responses associated with alertness or alarm conditions. Users experience an increase in focus, increased mental alertness, and the elimination of fatigue, as well as a decrease in appetite.

Psychological effects can include euphoria, anxiety, increased libido, alertness, concentration, energy, self-esteem, self-confidence, sociability, irritability, aggression, psychosomatic disorders, hubris, excessive feeling of power and invincibility, repetitive and obsessive behaviors, paranoia, and with chronic and/or high doses, amphetamine psychosis.

Withdrawal is characterized by excessive sleeping, increased appetite and depression, often accompanied by anxiety and drug-craving.

Regular use can lead to amphetamine-induced psychosis, though for most patients these symptoms will stop within 7–10 days of discontinuing the drug. However, a small percentage of long-term or "heavy" users will continue experiencing intermittent psychotic episodes (experiencing hallucination, delusions, and/or paranoia) on an ongoing basis within the first year of abstinence. Although not common, these users offer some anecdotal evidence about the neurotoxicity of long-term amphetamine use, and the healing process that a user experiences when these neurotoxic effects are either partially or fully reversed.

Spontaneous and long-term recurrences (akin to "flashbacks") are hypothesized to be triggered (or exacerbated) by high stress and by sleep deprivation. In extremely rare cases, this condition is documented to persist beyond one year.

The key distinction between amphetamine psychosis and a psychotic disorder or schizophrenia is that the symptoms will eventually subside, but only with abstinence and proper treatment.

Alcohol Abuse & Treatment

Alcohol Abuse & Treatment

Alcohol abuse and alcoholism are among the most serious health problem we are facing today. More than 100,000 U.S. deaths are caused each year by excessive alcohol consumption each year. Direct and indirect causes of death include drunk driving, cirrhosis of the liver, accidents, cancer, and stroke.

The National Highway Traffic Safety Administration estimates that there are over 17,000 alcohol-related traffic fatalities every year.

50% of all U.S. homicides are alcohol related, and 40% of all assaults are alcohol related, particularly domestic assaults. About three-quarters of all prisoners were involved in alcohol or drug abuse in some way in the time leading up to their current offense.

Alcohol abuse and alcoholism is a family disease. Approximately 53% of adults in the United States have reported that one or more of their close relatives has a drinking problem.

Three-quarters of children aged 8 to 17 cite their parents as the primary influence in their decisions about whether they drink alcohol or not.

Use the navigation bar to the left, or click the links below to learn more about alcohol abuse and alcoholism, including:

• Alcohol Abuse
• Alcoholism
• Binge Drinking
• Periodic Drinking
• Problem Drinking

Relapse Prevention Program

Relapse Prevention Program

Relapse Prevention is the practice of proactively planning for the onset of a possible relapse and preparing a response that will prevent that relapse from occurring.  

A Relapse Prevention Plan is a written document created by the client with the help of a Relapse Prevention Counselor that contains specific, concrete practices that will help the client avoid relapse.

A Relapse Prevention Plans differs from an Aftercare Plan in many key ways.  An Aftercare Plan is very important, and might include such action items as seeing a therapist, attending 12-Step meetings, and improving physical health, etc.   A Relapse Prevention Plan is what saves the client if and when the Aftercare Plan breaks down.   Without effective Relapse Prevention Planning, the best Aftercare Plan in the world simply isn’t enough.

Summit Malibu Addiction Treatment Centers are committed to providing the best possible Relapse Prevention counseling and support to our clients, as well as to those people who will be supporting the client’s recovery on an ongoing basis.

Relapse Statistics

The statistics for relapse from drug and alcohol addiction are notoriously high.  Estimates range from 40% to 60% or more, depending on the study.  

These statistics are alarming and should be viewed as a warning to treat the subject seriously, but it is important to put these statistics in correct perspective.   The relapse rates for addiction should be compared to the relapse rates of other chronic illnesses.  

For example, the relapse rate for Type I diabetes is 30% to 50%.  The relapse rate for hypertension and asthma is 50% to 70%.   Drug and alcohol addiction should be treated like any other chronic illness, with relapse being an indication of the need for renewed intervention.

Having said that, these statistics also indicate that relapse does not occur in a large number of cases.  At Summit Malibu we believe that these successful cases are due in large part to effective Relapse Prevention Planning.

Relapse Prevention Planning

Clients at Summit Malibu receive several hours of Relapse Prevention Planning each week.   Guided by a Relapse Prevention Counselor, they must complete their own Relapse Prevention Workbook before being discharged.  

The workbook contains sections listing the client’s situational triggers, belief-system triggers, and emotional triggers, and includes specific plans for behavioral coping, mental and emotional coping, and information for people supporting their recovery about signs and symptoms of a relapse and what they can do to help.   By the time they leave Summit their workbook contains a concrete, personalized plan for managing the inevitable stresses that will occur during a reintegration into normal life.  

The Summit Relapse Prevention Counselor also provides post-discharge support by following up with each client on a weekly basis, referring to the client’s workbook and adjusting and refining the plan as needed.  The Relapse Prevention Counselor is also available to consult with other professionals that are supporting the client.

The Summit Malibu Relapse Prevention Program

Summit Malibu’s Relapse Prevention Program was created by Tim Worden, Ph.D., a practicing Clinical Neuropsychologist with over 20 years experience in addiction rehabilitation.   Drawing on the findings of leaders in the addiction recovery field including Marlatt, Gorsky, Daley, Hazelden, and Matrix Institute, Dr. Worden refined these methods through clinical practice and arrived at what he believes to be the best Relapse Prevention Methodology in the industry.

“I believe that relapse prevention is the key to a successful return to normal life for the recovering alcoholic and addict,” says Dr. Warden.  “I know from years of experience that recovering addicts and alcoholics will have a much better chance of staying sober if the people supporting them understand what relapse prevention is, and if they are familiar with the client’s own relapse prevention plan.”

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