Addiction and Mental Illness: Making the Best Treatment Decisions
Robert is a twenty-seven year old living at home with his parents in Ft. Lauderdale, Florida. At 21 he graduated from the University of Maryland with good grades and a bachelor's degree in marketing. Growing up in South Florida, Robert enjoyed the benefits of an upper-middle class family that emotionally nourished him and his two younger sisters.
In high school Robert did well academically and took more than a passing interest in playing sports and after school clubs. His favorite extracurricular activity was the theatre group that performed a musical every year in the Spring and in which Robert always received a coveted speaking role.
As far his parents and siblings knew Robert didn’t drink regularly or experiment with drugs nor did he seem to suffer from depression or anxiety with the exception of some temporary bouts of melancholy following a breakup with a girl or Sunday night blues.
Robert’s first year in college was nothing abnormal except for adjusting to increased academic expectations and struggling to learn time management. Things started changing beginning in the spring semester of his sophomore year when Robert’s family heard from him less frequently and when they did, he was distant and preoccupied.
According to Active Minds whos mission it is to normalize the conversation about mental illness on college campuses: suicide is the second leading cause of death among college students, and 39% of students in college experience mental health issues; 50% of mental health issues begin by age 14; 75% begin by age 24, and two-thirds (60%) of students with anxiety don’t seek treatment.
Robert’s mother routinely checked-in with him over text to make sure he was okay. His texts back to her consisted of terse responses, such as, “fine” and “good” or no response at all. After graduation is when the family started becoming increasingly more concerned as Robert started spending a lot of time isolating and stopped communicating with his friends.
His parents had him evaluated by a psychiatrist who diagnosed Robet with depression and attention deficit disorder and prescribed a combination of Celexa and Wellbutrin. With medication Robert appeared to improve and become more social. Sadly, his improvement was short-lived as his depression returned and continued getting worse.
According to the National Alliance of Mental Health (NAMI) a staggering nineteen-percent or 47.6 million American adults experienced mental illness in 2018, and seventeen-percent of younger Americans, ages 6 to 17 years old has experienced some form of mental disorder.
Over the next six years, Robert was hired and fired from several jobs, ranging from good career opportunities consistent with his interests to menial jobs with basic responsibilities. To cope with his persistent state of disappointment and underemployment he started drinking and smoking marajuana everyday. At first he made efforts to hide his drinking and smoking pot from his family but then quit keeping up appearances.
Tetrahydrocannabinol more commonly known as THC, the psychoactive ingredient in marajuana is associated with an altered reward system, increasing the likelihood that research subjects will engage in other drugs (e.g., heroin). In the 1990’s the amount of THC found in confiscated drugs was approximately 4%, in 2018 it was 15%. The average marijuana extract contains more than 50% THC, with some samples exceeding 80% - According to the National Institute on Drug Abuse.
Soon Robert started hinting about suicide and expressing feelings hopelessness which gravely concerned his parents and sisters. They decided he needed more help than weekly or twice-weekly therapy would provide and began looking into residential treatment options.
Sensing his parents were moving in this direction he threatened them with “if you send me to treatment, I am going to kill myself” causing his parents to immediately give up on the idea of sending him to treatment.
While threats of suicide or self-harm should always be taken seriously they are not a reason to stop pursuing treatment solutions for your son or daughter. Often threats of suicide are a manipulation tactic used to by young people to avoid treatment and continue using drugs and other substances without being hassled by their concerned parents.
NOTE: If someone is talking about committing suicide or hurting themselves mmediately seek professional assistance of a licensed clinician or bring them to the emergency room. The telephone number for National Suicide Prevention Hotline is 800-273-8255.
For the next eight months Robert continued being depressed and continued drinking and smoking marajuana while his parents continued not sleeping and walking on eggshells in fear he would hurt himself or stop coming home. Everytime the phone rang Robert’s mother’s heart raced with fear, and anxiety kept her from going back to sleep or concentrating on her work.
Reaching their breaking point after Robert was arrested for possession of narcotics and subsequently being ordered into the hospital for a psychiatric evaluation, his parents decided they could no longer be in denial and began researching treatment centers. After speaking with a few treatment providers, his parents began to question if their son’s problems aresymptomatic of drug & alcohol addiction or mental illness. Recognizing the differences between these two illnesses confused the situation even more.
According to Sarah Gentry, a licensed therapist in Palm Beach, Florida, who has extensive experience in the areas of codependency and addiction recovery, a client can only be accurately diagnosed through proper screening. If a client has an existing substance use disorder it’s difficult to properly evaluate them until they have been detoxed and stabilized. The most important thing as a clinician is to make sure each client receives the appropriate level of care; no treatment center is a good fit for everybody.
In addition the National Alliance Mental Health (NAMI) website lists these early signs of mental illness which includes drug and alcohol addiction; other symptoms can be:
- Excessive worrying or fear
- Feeling excessively sad or low
- Confused thinking or problems concentrating and learning
- Extreme mood changes, including uncontrollable “highs” or feelings of euphoria
- Prolonged or strong feelings of irritability or anger
- Avoiding friends and social activities
- Difficulties understanding or relating to other people
- Changes in sleeping habits or feeling tired and low energy
- Changes in eating habits such as increased hunger or lack of appetite
- Changes in sex drive
- Difficulty perceiving reality (delusions or hallucinations, in which a person experiences and senses things that don't exist in objective reality)
- Inability to perceive changes in one’s own feelings, behavior or personality (”lack of insight” or anosognosia)
- Multiple physical ailments without obvious causes (such as headaches, stomach aches, vague and ongoing “aches and pains”)
- Thinking about suicide
- Inability to carry out daily activities or handle daily problems and stress
- An intense fear of weight gain or concern with appearance, and
- Abuse of substances like alcohol or drugs.
Often the confusing part for family members is addiction and mental illness look the same. For instance, it’s not uncommon for people with a drug addiction or alcoholism to experience fear, sadness, extreme mood changes, changes in sleep and eating habits, thinking about suicide or inability to carry out activities or handle day-to-day challenges.
Prior to getting sober in 2004, I regularly experienced most of these symptoms, and some of them I endured for a while after getting sober. It takes approximately one year for the brain to recover from addiction.
A common question I get from people attempting sobriety is: “do I drink because I am depressed (unhappy, anxious, always angry, etc.) or am I depressed because I drink”. The answer I give them is simply, “yes,” because I don’t want the person to become bogged down in the mechanics of their addiction; the important thing is for them to stop drinking or using drugs.
Understanding what drove somebody’s addiction or alcoholism could take years of self-exploration, and even then, it’s a lifelong journey. If we waited for addicts to figure themselves out before quitting - nobody would ever get sober.
Therefore the first step is to remove the addictive substances because once the person stops getting high or drinking alcoholically their depression and anxiety may look very different or disappear all together.
Addiction can result in depressive symptoms that will improve with abstinence and recovery, and in this case, depression is considered a "secondary disorder." Addiction is always a primary disorder; it is not the result of another disease, according to Stephen M. Lange, Pd.D as reported in The Sober World magazine.
I get similar questions from parents when they contact me about doing an intervention. They want to know if their addicted family member, usually a child or adult child, is possibly suffering from depression and not an addict, or if I think the problem is environmental such as a bad marriage or money issues.
In a sense, these parents want to disqualify their son or daughter from being an addict and want to blame something else or someone else. On more than one occasion I have heard mothers blame their daughters-in-law for their son’s alcoholism or drug addiction. In all these cases the sons had a prior history of drug use or had been to treatment before meeting his wife.
Download Free Guide: How To Do An Intervention
Alcoholics will do anything to preserve their right to continue drinking and avoid going to treatment - even accept an ill-fitting psychiatric diagnosis. Nobody I know with long term sobriety regrets being sober or has a lesser quality of life as a result of it.
Addiction is tangible and therefore may be easier to solve than depression or a lifelong anxiety problem dating back to childhood. I worked with a man in New York City a couple of years ago who lost his family and career to his addictions and affairs. He became so convinced his problems were financial and not chemical.
After spending several months in treatment in New Jersey the man was eventually informed by his treatment team they would be transitioning him out when the month ended. In his explanation of the events “he wasn’t buying what they were selling”. He went on to defend his position by explaining he's not an addict or depressed and his circumstances were the result of bad choices.
Upon hearing this, I asked, “if you’re not an addict and you’re not depressed - what are you”? Knowing this person wasn’t suffering from a mental illness I wasn’t quite sure how I could help him. Ultimately he continued “bumping along the bottom” for quite some time.
With proper treatment, people can realize their full potential, cope with the stresses of life, work productively and meaningfully contribute to the world. Without mental health we cannot be fully healthy - NAMI.
As for Robert, he ultimately agreed to accept treatment following an intervention and was admitted into a ninety day, dual-diagnosis program in Utah specializing in men, ages 18 to 30 years old. Robert struggled for the first couple of weeks because the program pushed him to share feelings which had long been suppressed by his drug and alcohol use.
He furthermore didn’t want his parents and sisters coming out to Utah for family week because he would have to hear how they felt or how his actions hurt them. Robert felt shameful about hurting the people he loved most and doing things under the influence he would not have done sober. He learned communication and relationship skills are like muscles, if they aren’t exercised they become weak.
After completing the ninety-day program Robert moved into a sober house and attended twelve-step meetings everyday. Another revelation for him was learning sobriety had more to offer him then smoking weed ever did.
The last time I spoke to Robert or his family they were all doing well. Robert was still in sober living where he was planning to stay at least until his first sober anniversary. His parents and sisters are also moving forward quite well. His mom has taken to attending Al-anon meetings and focusing on her own recovery. Robert's father is also pursuing recovery with one-on-one therapy. His twin sisters are doing well and applying to colleges and enjoying their last year in high school.
Marc Kantor is an interventionist based in South Florida who works with families struggling with drug & alcohol addiction; he can be reached at 202-390-2273 or by e-mail at firstname.lastname@example.org.