April 30, 2013 by Dr. Bob Weathers
Unfortunately, in the treatment of co-occurring disorders — where there are twin diagnoses of substance abuse and psychiatric disorders (e.g., depression or anxiety) — there has historically been little integration of treatment to address both elements. That is, an addict in recovery has found his/her addiction addressed more directly by substance abuse counselors; and his/her psychiatric difficulties (again, depression or anxiety, for example) addressed much more fully, even exclusively, by mental health professionals or therapists.
This separation between equally critical necessities of complete treatment has often ill-served the addicted population. The addicted individual has often found that substance abuse counselors focus on abstinence and continuing attendance in self-help support groups (e.g., the 12-step program); whereas, emotional and relational issues have been more the province of therapy; but without a similar advocacy for sobriety and/or support group participation.
This disconnect between services is all the more striking when we take into account the fact that over ½ of substance abuse clients also have some kind of co-occurring mental disorder; and nearly ½ of mental health clients have a co-occurring substance abuse disorder. In light of this obvious overlap, yet with a seeming separation far too often of sufficiently comprehensive services, what might be suggested?
First, professional education and training need to be beefed up. Models of diagnosis and treatment which address the whole client need to become standard in the field. As but one example, the holistic “integral recovery” model — one which addresses multiple sectors of the client’s life, including medical, behavioral, emotional, and spiritual domains — offers hope for a broad-ranging approach (see integralrecovery.org).
Second, it makes sound clinical sense for differently focused professionals, operating within different specializations and perspectives, to work hand-in-hand. The idea of a single expert (as in the now outmoded medical model, where physician is God) must give way to a collaborative integration of expertise and services rendered. I’m reminded here of the ancient tale of the 5 wise men and the elephant. Each man touched a different part of the elephant’s body and mistakenly over-generalized to assume that the elephant was nothing but a hoof, a tail, a trunk! Greek philosopher Plato referred to this as the part/whole error; where a single, even if important, part of a problem is again mistakenly taken to represent the whole. A strong dose of humility and respect is called for amongst both substance abuse counselors and mental health professionals.
Finally, we have all heard of the stigma associated in our culture to psychiatric diagnoses. Who after all wants to be diagnosed as borderline personality? Add to this cultural stigma already placed on mental health diagnoses yet another wrinkle: now, substance abuse disorder, or addiction. Our society is no less generous in its assessment or lack of moralizing about the plight of the addict; even as he/she seeks treatment, healing, and recovery.
Hence it is that substance abuse counselors must join forces with mental health professionals in committing to de-stigmatizing co-occurring disorders, which (as stated above) are clearly common in individuals seeking mental health counseling and/or substance abuse treatment. The “double whammy” of both diagnoses must be addressed sensitively (for the individual so suffering) and proactively in the field of treatment, as well as in balanced, compassionate presentations to the general public.