After working with literally thousands of people who are seeking to overcome various “addictions” or as I prefer to call them, substance use or other behavioral problems, it is clear to me that the vast majority would not be classified as clinically mentally ill. And even those with legitimate moderate mental disorders such as some of the schizo disorders or bi-polar disorder, did demonstrate the capacity to change their lives and overcome their substance use problems as long as they believed they could change.
The pharmaceutical industry, the mental health industry and the drug treatment industry seemed to have teamed up and while less than 1/3 of people admitted to rehab were diagnosed with mental illness just a decade ago, more than 2/3 are today. Diagnoses from ADHD, depression and anxiety, to bi-polar disorder and schizophrenia are becoming more and more commonplace. Is this rapid increase indicative that these illnesses are actually on the rise within the substance using population, or is it a direct result of the complete failure of drug treatment, and diagnosing mental illness/disorder provides a convenient excuse for failure?
These are important questions that no one is asking; yet more and more people are being labeled, diagnosed and medicated and in many cases to their detriment. So how can a mental health or addiction professional identify the difference between a legitimate mental disorder that has the potential to hinder or deter someone on their path to sobriety, from poor behavior, judgment, actions and choices so commonly exhibited by most problem substance users? There is an interesting phenomenon that happens with individuals who have genuine moderate to severe mental illness; many of these people do not believe that they are mentally ill and will try desperately to prove to others that they are not. For people with delusions who are diagnosed with one of the schizo disorders, many of these people do not see their behaviors as wrong because they believe they are acting appropriately based on their version of reality. Not only will these people not use their mental illness/disorder as an excuse for poor or disruptive behavior, but they may actually exhibit anger and aggression at the suggestion of it.
Many people know that when individuals use substances heavily they can begin to exhibit many mental health symptoms such as extreme anxiety or bouts of depression and some will have extreme shifts in mood and emotion such as is exhibited in bi-polar disorder. Some heavier, long term alcohol and drug users may also have delusions, turn to self-harm, exhibit suicidal ideations and have violent outbursts making them dangerous to themselves and others. While these symptoms may be apparent to all parties involved with the substance user, it is impossible for a clinician to diagnose mental disorders in an individual who is actively using drugs and alcohol because the symptoms of substance use mimic those of the most common mental disorders. It becomes of a question of which came first, the chicken or the egg? And further pharmacotherapy is not recommended for people who are active alcohol and drug users as using substances with these medications can be quite dangerous and even deadly in some cases. Unfortunately clinicians diagnose mental disorders and prescribe psychiatric medications all the time to active substance users and these desperate people eat it up as it gives them yet another excuse for their bad behavior. Sadly, what these well-intentioned clinicians are actually doing is providing substance users with one more reason to believe that they are unable to change and are powerless to overcome their problems.
There is an ongoing debate within the mental health community about over-diagnosing and over-prescribing pharmacotherapy for patients. Many mental health professionals are becoming more and more vocal about the inherent problems with the medicalization of normal human development and emotions. Until now no one has tackled this issue specific to substance users and those with “addictions.” Now is the time to ask the question, are mental health professionals helping substance users by diagnosing and medicating them, or are they actually hurting them?
Walk into any AA or NA meeting and find out how many people are currently taking medication for depression, anxiety, bi-polar, ADD (ADHD), or even some of the schizo disorders, and I guarantee you will find that more than half are in counseling and/or on something. So what is the difference between self-medicating with alcohol and drugs and taking a prescription prescribed by a professional; both are tools people use to alter their mood artificially and neither works very well at all. And if they do work, the effects are temporary and often times an individual needs more and more to gain the same benefits. It is only through learning how to truly take control of your life and managing your moods through personal choice and action that true peace and mental health can be achieved.