Assignment: Malingering and Addiction in the Treatment of Sleep Disorders

According to the National Sleep Foundation (2013), about 30–40% of the general population reports some level of insomnia during their lives, and 10–15% experience significant, chronic insomnia. For these individuals, medications to help induce and sustain sleep may be helpful. On the other hand, sleep aids pose potential concerns, namely abuse. Some people exceed recommended doses, and some continue taking medications even after symptoms are no longer present. Others obtain medications under false pretenses, which is one form of malingering. Malingering occurs when clients make up or exaggerate symptoms for some personal gain. Although mental health professionals may not be directly implicated in the client’s deceit, their unique position to receive more accurate and honest information thamalingering n other medical professionals presents ethical concerns. What is the mental health professional’s role in these instances? In which instances would it be appropriate to break confidentiality due to a concern of malingering? How could the potentiality be planned for and avoided?

For this Assignment, conduct an Internet search or a Walden Library search for at least one peer-reviewed journal article that addresses a counseling issue related to malingering and addiction in treating sleep disorders.

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BY DAY 7

In a 3- to 5-page, APA-formatted paper, include the following:

A description and explanation of the major types of drugs prescribed for sleep disorders
An explanation of the potential for addiction associated with these medicines
An explanation of the issues related to malingering in the treatment of sleep disorders
An explanation of the mental health professional’s role in mitigating the potentialities of malingering

Support your explanations with specific references to the Learning Resources and your peer-reviewed journal article

REQUIRED READINGS

Lichtblau, L. (2011). Psychopharmacology demystified. Clifton Park, NY: Delmar, Cengage Learning.

Chapter 6, “Anxiolytic-Sedative-Hypnotic Drug Pharmacotherapy” (previously read in Week 5)

Preston, J. D., O’Neal, J. H., & Talaga, M. C. (2017). Handbook of clinical psychopharmacology for therapists (8th ed.). Oakland, CA: New Harbinger.

Chapter 15, “Other Miscellaneous Disorders” (pp. 161-174)

Murdach, A. D. (2006). Social work and malingering. Health & Social Work, 31(2), 155-8. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1093/hsw/31.2.155

National Institute of Neurological Disorders and Stroke. (2014). Brain basics: Understanding sleep. Retrieved from http://www.ninds.nih.gov/disorders/brain_basics/understanding_sleep.htm#sleep_disorders
As you review this website, consider the types of sleep disorders associated with mental health treatment.

OPTIONAL RESOURCES

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Malingering and Addiction in the Treatment of Sleep Disorders

WALDEN UNIVERSITY

SOCW 6443

WEEK 7 ASSIGNMENT

Malingering and Addiction in the Treatment of Sleep Disorders

Sleep disorders are becoming increasingly common in modern society. Sleep disorders affect how a person operates since a human brain needs at least seven hours of sleep per day to function normally (Ninds 2019). The range of abnormal sleep patterns includes transient insomnia and sleep disruption that affect approximately 80% of the population, and chronic insomnia that manifests about 15% of sleep-related diagnoses (Bishop et al., 2020). A raft of therapeutic drugs exists for the treatment of sleep disorders with varying degrees of addictiveness and withdrawal symptoms. The different effects of the medicines place malingering in drug dosages, duration of use, and addiction among the most significant challenges facing mental health professionals today (Preston, O’Neal & Talaga, 2017). The paper seeks to address the various types of drugs used to treat sleep disorders, addiction, and the malingering potential of the drugs as well as the role of health professionals in dealing with the new drug-use challenges.

The Major Types of Drugs Prescribed for Sleep Disorders

A wide array of drugs with different levels of efficacy and contraindications exist for the treatment of sleep disorders. Sedative hypnotics, including zolpidem, zaleplon, and eszopiclone, come in handy for the treatment of insomnia by inhibiting activity in the central nervous system (Monti, 2017). The sedative drugs are useful in the improvement of sleep duration and sleep onset. Benzodiazepines are a class of drugs that work effectively in the treatment of mental health conditions and sleep disorders. Lorazepam and temazepam are benzodiazepines approved for the treatment of insomnia because of their shorter-acting characteristic.

Belsomra is a drug in the class of Dual Orexin Receptor Antagonists that promotes works against somnolence by inhibiting the Orexin receptor. As an antagonist drug, Belsomra enhances sleep onset by up ten minutes and extends the duration of sleep by about twenty-three minutes (Preston, O’Neal & Talaga, 2017). Before its introduction in 2014, Belsomra passed clinical tests by exhibiting remarkable efficacy in comparison to placebo drugs. Ramelteon is a short duration drug in the class of melatonin receptor agonists that enhances sleep onset in people struggling with insomnia. Also known as Rozerem, ramelteon also treats jet lag, which makes it one of the most commonly used drugs in the United States and other countries worldwide (Monti, 2017). Antidepressants such as doxepin also treat mild cases of insomnia by enhancing sleep duration though they are not as effective in improving sleep onset time.

The Potential for Addiction Associated with Drugs Used for Sleep Disorders

Sedative hypnotics pose a considerable risk of dependence and abuse through overdose and protracted usage beyond the prescribed timelines. Specific sedatives, including zaleplon, eszopiclone, and zolpidem, cause serious side effects such as vivid dreams and parasomnia manifestations (Lichtblau, 2011). Sedative hypnotics can also cause drowsiness, ataxia, and next-day hangovers, which impede tasks such as driving and machine operations. Longer-acting benzodiazepines increase the risk for fatal falls, especially in older patients, hence their classification as potentially inappropriate medication for patients in the geriatric category.

Patients using benzodiazepines also manifest next-day hangovers, though at a lower severity level compared to those using sedative-hypnotic drugs (Monti, 2017). Benzodiazepines also bind less-selectively to GABA receptors, which makes them more prone to abuse and dependency compared to sedative-hypnotics.

The use of Belsomra in inducing alertness manifests somnolence as one of the most notable side effects. Belsomra also poses a high abuse potential, especially when patients exceed the set dose limits. Ramelteon poses a high abuse potential because of its low levels of bioavailability and short duration of action (Lichtblau, 2011). Patients get prompted to use doses above the recommended amount to achieve the desired results, which could cause addiction. Antidepressants produce the most potent side effects and abuse potential compared to the other types of drugs as they act on serotonin or histamine receptors to elicit sedation in insomnia patients.

Issues Related to Malingering in the Treatment of Sleep Disorders

Malingering inhibits the effectiveness of mental health professionals in their quest to treat sleep disorders. Misrepresentation of symptoms or exaggeration of sleep disorders leads health experts to make wrong diagnoses and unwarranted drug prescriptions (Tracy & Rix, 2017). Prescription of drugs to treat non-existent or wrongly diagnosed sleep disorders poses a considerable risk to the patients’ health and the health professionals’ careers. Drugs such as antidepressants, benzodiazepines, and sedatives are potentially addictive and can lead to detrimental side effects when misused. High doses of these drugs could exacerbate the existing conditions or introduce new mental disorders, including memory loss and parasomnias. Ethically, health professionals have a responsibility to take the utmost care of their patients through accurate diagnosis, and prescription of drugs and any bridges in their duty amounts to unethical practice (Monti, 2017). In extreme cases, healthcare experts face the full force of the law in jurisdictions with stringent punitive measures against medical negligence and malpractice.

The Role of Mental Health Professional in Mitigating the Potentialities of Malingering

Mental health professionals have a primary responsibility of ensuring accuracy in the diagnosis of sleep disorders and the provision of appropriate medication. To mitigate the potential instances of malingering among sleep disorder patients, mental health professionals need to device diagnostic mechanisms to complement patient verbal responses (Bishop et al., 2020). One of the effective ways to enhance diagnostic accuracy is the use of polysomnogram tests in addition to patient statements to ascertain sleep disorders. The mechanism would go a long way to seal loopholes for malingering, where patients receive higher drug doses or extend the drug-intake period to fulfill the demands of addiction. Establishing a non-confidentiality protocol for cases of drug abuse would also enhance mitigation efforts against malingering in the treatment of sleep disorders (Preston, O’Neal & Talaga, 2017). Such a disclosure clause should provide a reasonable threshold for mental health professionals to report patients exploiting the healthcare system by misrepresenting or withholding crucial information concerning existing or purported sleep disorders. Assignment: Malingering and Addiction in the Treatment of Sleep Disorders

References

Bishop, T. M., Walsh, P. G., Ashrafioun, L., Lavigne, J. E., & Pigeon, W. R. (2020). Sleep, suicide behaviors, and the protective role of sleep medicine. Sleep Medicine, 66, 264-270.

Lichtblau, L. (2011). Psychopharmacology demystified. Clifton Park, NY: Delmar, Cengage Learning.

Monti, J. M. (2017). General Principle of Treatment of Sleep Dysfunction and Pharmacology of Drugs Used in Sleep Disorders. In Sleep Disorders Medicine (pp. 1187-1207). Springer, New York, NY.

Ninds. (2019). Brain Basics: Understanding Sleep. Retrieved April 9, 2020, from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep#sleep_disorders

Preston, J. D., O’Neal, J. H., & Talaga, M. C. (2017). Handbook of clinical psychopharmacology for therapists (8th Ed.). Oakland, CA: New Harbinger.

Tracy, D. K., & Rix, K. J. (2017). Malingering mental disorders: clinical assessment. BJPsych Advances, 23(1), 27-35.