Mental Health and Recovery

Which came first the fried chicken or the omelette? There has been a debate through the years regarding addiction and mental health issues like depression or anxiety — which came first, the addiction or the mental health issues? Doe addiction cause mental health problems? Do mental health problems cause addiction? Can mental health problems and addiction co-exist? Most people will say that alcohol and drug problems are caused by underlying mental and emotional problems. I hear this over and over — he drinks like this because his wife died — she uses heroin because her mother beat her when she was young, and she never dealt with it.

There are therapists who believe that addiction is a symptom of mental health problems. I think in the professional world of therapists it’s a matter of focus, and I think the language used is often imprecise. Research on addiction is pretty solid, and addiction is shown to have several possible causes. There’s also the misunderstanding when substance abuse and addiction are used interchangeably, when in fact they have different meanings. Addiction is a chronic brain disease, while substance abuse is the misuse of drugs. Substance abuse is usually situational, like during a divorce or after the loss of a loved one.

It’s hard to tell in the early stages of addiction whether the person is simply misusing alcohol or some other drug or whether they are in the early stages of addiction. I’ve written about this before. Although this is a good debate among healthcare professionals, it can have serious ramifications in treatment if faulty conclusions are drawn.

Logically, if I believe that alcohol and drug problems are caused by underlying emotional and mental problems, then I have to conclude that once the mental health concerns are dealt with effectively the person should be able to drink or use some other drug without experiencing the problems of addiction. This can certainly be the case with substance abuse. If a person misuses alcohol or some other drug to deal with anxiety, depression, stress, trauma, etc., then, if the person seeks help and deals with the underlying problems and becomes emotionally stable and mentally healthy, misusing drugs shouldn’t be a problem after mental health treatment.

However, I think it is malpractice to tell an alcoholic that she can successfully drink without the problems associated with addiction because she’s been sober for 6 months, she’s received therapy to deal with the loss of her mother and is now on an anti-anxiety medication. So, if we wouldn’t tell this women she can successfully drink again after receiving mental health treatment, this means that addiction is a problem of it’s own. If the woman would go back to addictive drinking after successfully receiving mental health treatment, then addiction is a disease state along side the mental health issues. Addiction has to be treated as the chronic brain disease it is, even if mental health problems co-exist — both should receive treatment to ensure success. If someone has scientific proof that mental health treatment allows an alcoholic to drink socially after effective treatment, then I want to change my model, quickly

If treating mental health issues “cured” the chronic addiction problem, then all addicts who receive quality mental health treatment should have the capacity to drink or use some drug socially or recreationally with no complications. This is not what I’ve witnessed and it’s not what the research shows. Again, though, we have to distinguish addiction from substance abuse. This is where language matters in treatment. It’s dangerous to lead an addict to think they can one day successfully drink or use some drug. If it’s someone who was misusing alcohol or some drug situationally, then, yes, they should have the capacity to socially drink or use a drug without major complications (legality issues aside).