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The LOSS Model Mental Illness and Substance Use Disorders
Amy L. Griffith, LPC
Director of Forensic Services
RHA Health Services, Inc
*LOSS models were develop by Paul Lilley, CIT Coordinator and consultant with the Criminal Justice
Coordinating Center of Excellence. For more info contact [email protected].
The LOSS Model
1. Loss of Reality
2. Loss of Hope
3. Loss Of Control
4. Loss of Perspective
1. Loss Of Reality
• Delusions
• Hallucinations
• Command Hallucinations
1. Diagnoses
• Schizophrenia
• Bipolar Disorder
• Schizoaffective Disorder
• Depression
1. Typical Medications
Antipsychotics
Abilify,
Risperdal,
Zyprexa,
Cogentin,
Ativan
Mood Stabilizers
Depakote,
Lithium,
Lamictal,
Tegretol
2. Loss Of Hope
• Depression
• Feelings of sadness,
helplessness, hopelessness
• Grief and loss
2. Diagnoses
• Depression
• Bipolar Disorder
• Bereavement
• Age-Related Cognitive
Decline
2. Typical Medications
•Antidepressants
Seroquel
Prozac
Celexa
Zoloft
3. Loss Of Control
• Anger
• Hostility
• Frustration
• Powerlessness
3. Diagnoses
• Bipolar Disorder
• Personality Disorders
• Intermittent Explosive
Disorder
3. Typical Medications
• Antipsychotics
• Mood Stabilizers
4. Loss Of Perspective
• Anxiety
• Excessive worry
• Nervousness
• Panic
4. Diagnoses
• Generalized Anxiety Disorder
• Panic Disorder
• PTSD
• Dementia
4. Typical Medications
• Anti-anxiolytics
Klonopin
Xanax
Ativan
Valium
Mood Stabilizers
Paxil
Zoloft
Prozac
Seroquel
Aricept
Xelon
Substance Use Disorders
Abuse: Failure to fulfill major roles
Use despite risk of
hazardous situations
Use despite legal
consequences
Use despite interpersonal
consequences
No history of Dependence
Dependence: Tolerance*
Withdrawal*
More use than intended
Failed attempts to stop
Excessive time spent
getting, using, recovering
Loss of functioning at
home, work, etc.
Use despite negative
consequences
DSM-V Mild 2-3 symptoms
Moderate 4-5 symptoms
Severe 6 + symptoms
More use than intended
Failed attempts to stop
Excessive time obtaining, using, recovering
Cravings
Failure to fulfill major roles
Use despite interpersonal consequences
Social, occupational, recreational activities are given up due to use
Use despite risk of physically hazardous situations
Use despite knowledge of secondary physical/psychological problems
Tolerance*
Withdrawal*
Loss of functioning at home, work, etc.
Substance Use & the LOSS Model LOSS of Reality
◦ Bath salts, hallucinogens, amphetamines, opiates,
benzos, withdrawal from alcohol…
LOSS of Hope
◦ Alcohol, opiates, withdrawal from amphetamines,
meth, cocaine…
LOSS of Control
◦ Methamphetamine, cocaine, alcohol, bath salts,
hallucinogens, benzos…
LOSS of Perspective
◦ K-2, marijuana, bath salts, alcohol, amphetamines,
meth, benzos, opiates, cocaine…
Intellectual & Developmental
Disorders (IDD)
• Autism spectrum disorders • LOSS of Control, LOSS of Reality
• Traumatic brain injuries • LOSS of Control, LOSS of Hope, LOSS of
Perspective, LOSS of Reality
• “Mental retardation” • LOSS of Control, LOSS of Perspective
Homelessness
39 % report mental health problems
20-25 % meet criteria for serious mental illness
66 % report either substance use &/or mental
health problems
46 % report chronic health conditions 1996 data from SAMHSA's National Mental Health Information Center.
On any given night, 200,000 veterans are
homeless. 2009 data from NOW on PBS.
Trauma
Typical Events:
Serious accidents
Assaults
Witnessing violence
Threats of violence
Natural disasters
Combat
Typical Reactions:
Sleeplessness
Reliving the experience
Startles easily
Irritability
Drug and alcohol use
Anxiousness
Sadness
Post Traumatic Stress Disorder
The person experienced the event.
The event involved actual or threat of
serious injury/death.
The person’s response involved fear,
helplessness, horror.
PTSD
Re-experiencing
Recollections
Dreams
Flashbacks
Triggers
Physical reactions
Avoiding & Numbing
Thoughts, feelings, conversations
Activities, places, people
Loss of recall
Loss of interest
Detachment
Decreased affect
Decreased sense of the future
PTSD
Increased Arousal
Sleeplessness
Irritability
Poor concentration
Hypervigilance
Startle response
Symptoms last for
more than 1 month
Significant
impairment in
functioning
Acute vs. Chronic
Delayed onset
Suicide
• LOSS of Reality
• Delusions and Hallucinations
• LOSS of Hope
• Hopelessness and Helplessness
• LOSS of Control
• Anger and Frustration
• LOSS of Perspective
• Anxiety and Worry
*addition of drugs and alcohol
