Tag: co-occurring disorders

  • Double or Nothing: The Two Diseases That Want Me Dead

    My depression didn’t entirely cause my alcoholism, but it certainly played a key role.

    I have two diseases that want me dead.

    One is addiction, a progressive, incurable and potentially fatal disease that presents as a physical compulsion and mental obsession. I am addicted to alcohol and, as an alcoholic, can never successfully drink again.

    There is no cure, only ways of arresting the vicious cycle of binge, remorse and repeat that leads to ever-deeper bottoms. My alcoholism took me not only to unemployment but unemployability; not only selfishness but self-destruction; not only deteriorating health and heartache but abject desperation and insanity.

    My other deadly illness is depression. By this, I mean clinical depression – a necessary distinction considering the widespread, ill-informed use of the phrase “I’m depressed” to describe mere sadness. The difference is that sadness is rational while depression decidedly is not. Depression is not an emotion; it is a chemical imbalance that leads to hopelessness and self-loathing and, for that reason, is the leading cause of suicide.

    Mourning a loved one is understandable and altogether appropriate; that is sadness. Climbing to the roof of a six-story building and nearly jumping because I considered myself toxic and worthless, as I did in my mid-20s, is not normal and certainly not healthy; that is depression.

    I will be an alcoholic and depressive for as long as I am alive. But while neither is curable, both are certainly treatable. And increasingly, I’m finding that my progress in recovering from one disease is paying substantial dividends in combatting the other.

    Weller Than Well

    I took my final drink on October 10, 2011, the last in a long line of cheap beer cans littering my car. Wherever I was going, I never got there; instead, I crashed into a taxi and kept driving. Police frown upon that. I spent the night in jail and the next six months sans license. I was in trouble physically, spiritually, and now legally, and I had finally experienced enough pain to seek salvation.

    I got sober through Alcoholics Anonymous. There are several programs effective in arresting addiction; AA just happens to be the most prolific, and embodied the sort of group-centric empathy I needed during the precarious early stages of recovery. There are few things more alienating than being unable to stop doing something that you damn well know is destroying your life. Meeting consistently with others who’ve experienced this tragic uniqueness made me realize I wasn’t alone, and provided a glimmer of something that had long been extinguished: hope.

    Unlike traditional ailments, addiction is largely a “takes one to help one” disease. I needed to know that others had drank like me and gone on to recover by following certain suggestions. AA provided both the road to recovery and, through those that had walked the path before me, the trail guides. 

    It isn’t rocket science. AA and other forms of group-centric recovery thrive on a few basic tenets. I admitted I had a problem, and saw that others had solved that problem by adhering to certain instructions. I accepted that my addiction had been driven by certain personality flaws, and that active addiction had only exacerbated these shortcomings. I made concerted efforts to begin not only amending my actions through face-to-face apologies, but also diminishing the underlying character defects that had fueled my alcoholism.

    In the process, I did not recover so much as reinvent myself. Nine years into my recovery, I am not the same person I was before becoming an alcoholic. I am better than that catastrophically damaged person.

    Like no other illnesses, recovery from addiction can make sufferers weller than well. I am not 2005 Chris – pre-problem drinker Chris. I am Chris 2.0. Stronger, smarter, wiser.

    And that brings me to my other incurable illness.

    So Low I Might Get High

    My battle with depression predates my alcoholism. In fact, the aforementioned rooftop suicidal gesture came before I was a heavy drinker. Like many people with concurrent diseases that impact mental health, one malady helped lead to another. My depression didn’t entirely cause my alcoholism, but it certainly played a key role.

    For me, bouts of depression descend like a dense, befuddling fog. At its worst, I have been struck suddenly dumb, unable to complete coherent sentences or comprehend dialogue. My wife once likened my slow, confused aura to talking with an astronaut on the moon; there was a five-second delay in transmission, and my response was garbled even when it finally arrived.

    My depression is clinical, meaning it is officially diagnosed. I am medicated for it and see a psychiatrist regularly. Upon getting sober, the first cross-disease benefit was that the anti-depressants I took daily were no longer being drowned in a sea of booze. The result of this newfound “as directed” prescription regimen was the depression tamping down from chronic to episodic. For the first time in nearly a decade, there were significant stretches where I was depression-free.

    Still, come the depression did, in random waves that enveloped me out of nowhere, zapping the hopeful vibes and purposeful momentum of early recovery. The sudden shift in mood and motivation was stark, striking and scary. Above all else, I was frightened that an episode of depression would trigger a relapse of alcoholism.

    In recovery from addiction we are taught, for good reason, that sobriety is the most important thing in our lives, because we are patently unable to do anything truly worthwhile without it. If we drink or drug, the blessings of recovery will disappear, and fast.

    Ironically, and perhaps tragicomically, by far the most formidable threat to my sobriety was my depression. One of the diseases trying to kill me was persistently attempting to get its partner in crime back. Inject some hopelessness and self-loathing into a recently sober addict’s tenuous optimism and self-esteem, and there’s a good chance he’ll piss away the best shot he’s ever had at a happy, content existence.

    For months and even years into recovery, my only defense against depression episodes was intentional inactivity. Upon recognizing the syrupy sludge of depression draining my energy – a quicksand that made everything more strenuous and, mentally, seem not worth the extra effort – I would do my best to detach from as much as possible. My routine would dwindle to a questionably effective workday and, if any energy was left, what little exercise I could muster, an attempt to dislodge some depression with some natural dopamine – a stopgap measure that rarely bought more than half an hour of relief.

    Most alarmingly, during bouts of depression I would disconnect from my recovery from alcoholism, often going weeks without attending meetings or reaching out to sober companions. In depressive episodes, the hopeful messages of group-centric recovery rang hollow, and at times even felt offensive. How dare these people be joyous, grateful and free while I was miserable, bitter and stuck.

    Over an extended timeline, though, life had improved dramatically. As a direct result of sobriety and its teachings, my status as a husband and an executive improved drastically. In rapid succession I bought a house, rescued a dog and became a father. My depressive episodes grew fewer and further between.

    But when they came, I was playing a dangerous game. I now had a lot more to lose than my physical sobriety and, despite being rarer, my depressive episodes were almost more intimidating for what they represented: irrational hopelessness amid a life that, when compared to many others, was fortunate and blessed. So when depression descended, I did the only thing that seemed logical: I whittled life down to its barest minimum, and waited the disease out. I put life on pause while the blackness slowly receded to varying shades of gray and, finally, clearheaded lucidity returned.

    Essentially, I became depression’s willing hostage. I didn’t want it to derail me, and didn’t have a healthier means of dealing with it.

    And then suddenly, I did.

    Beating Back a Bully

    For the second time in my life, I have hope against an incurable disease where before there was hopelessness. And though I can’t place into precise words exactly how it happened, I’m hoping my experience can benefit others. For the countless battling mental illness while recovering from addiction, my hope is to give you hope.

    Last fall, just as I was celebrating eight years sober, I hit a wall of depression the likes of which I hadn’t encountered in a while. Like most depressive episodes, its origin was indistinct. It had indeed been a tough year – I had lost a close relative and had an unrelated health scare, among other challenges – but trying to pinpoint depression triggers is generally guesswork.

    Anyway, there it was. A big, fat funk, deeper and darker than I’d experienced in years. But for whatever reason, this time my reaction was different. Always, my routine was to place mental roadblocks in front of my depression. I justified this by telling myself, understandably, that depression’s feelings were irrational and, therefore, not worth confronting.

    This time, for whatever reason, I took a different tack. For the first time, I leaned in rather than leaning out. I stood there and felt the harsh feelings brought on by depression rather than running from them. Whether it was sober muscle memory or simple fed-upedness, I had had enough of cowering in a corner while depression pressed pause on my life.

    The result? It hurt. A lot. But if battling depression is a prize fight, I won by majority decision. And having stood up to my most menacing bully, I fear the inevitable rematch far less.

    This would not have been possible – and is not recommended – earlier in recovery. In hindsight, I’m realizing that at least part of the reason I finally confronted my depression was that, after eight years of recovery work and a vastly improved life, I had placed enough positives around me that depression’s irrational pessimism couldn’t fully penetrate them. I had built up just enough self-esteem through just enough estimable acts that the self-loathing pull of depression couldn’t drag me down as far. I stumbled and wobbled, but I did not fall.

    Depression also prompted a highly unexpected reaction: gratitude. Its wistful sadness made me pause, sigh, even tear up. It made me look around longingly and grasp the blessings that, during my typically time-impoverished existence, I often take for granted. It made me feel guilty for not fully appreciating the positives in my life… but this guilt was laced with vows to cherish life more once depression invariably lifted, as it always did. There’s a difference between hopeless shame and hopeful guilt; the former yields self-hatred, the latter self-improvement.

    In this way, the tools acquired in recovery from addiction were wielded effectively against depression. There is a retail recovery element at play here: Though not as simple as a “buy one get one free” scenario, I’ve learned that fully buying into continued recovery from alcoholism can lead to significant savings on the pain depression can cause me. I have a craziness-combating coupon, and it’s not expiring anytime soon.

    To be clear: This is by no means a “totally solved” happy ending. Confronting my depression meant facing some demons that have been stalking me for decades. You don’t slay dragons that large in one sitting. I have, however, made a promising start. I have discovered that progress against complicated chronic afflictions is indeed possible, and can sometimes flow unexpectedly from sources one wouldn’t expect.

    View the original article at thefix.com

  • Can 12-Step Programs Treat Dual Diagnoses?

    Can 12-Step Programs Treat Dual Diagnoses?

    Effective treatment needs to include both the substance use disorder and the co-occurring disorder in an integrated approach because the two conditions build on each other.

    Thirty-three percent of people with mental illness also have a substance use disorder (SUD); that number rises to 50 percent for severe mental illness. Fifty-one percent of people with SUD have a co-occurring mental health disorder. Effective treatment needs to include both the SUD and the co-occurring disorder in an integrated approach because the two conditions build on each other. People with mental illness may turn to substances to alleviate symptoms and severe substance misuse can cause lasting psychological and physiological damage.

    12-step programs are free, prolific, and available throughout the world. These mutual-help organizations are designed to facilitate recovery from addiction, but are they suitable for treating the large segment of people with addiction who also have other mental health conditions or psychiatric diagnoses?

    A 2018 meta-analysis  undertook a literature review on 14 years of studies related to dual diagnosis and Alcoholics Anonymous (AA). This extensive quantitative look into the effiicacy of AA for people with dual diagnosis found that participation in AA and abstinence “were associated significantly and positively.” The research supports the clinically-backed notion that an integrated mental health approach that encourages participation in mutual help programs is the best approach for treating patients with comorbid SUD and mental illness.

    Does it Depend on the Dual Diagnosis?

    There is enormous variation in mental illnesses, so does the potential effectiveness of 12-step programs change based on the type of disorder or diagnosis? The co-founder of AA, William Wilson (known as Bill W.), was afflicted with a co-occurring disorder. Wilson struggled with “very severe depression symptoms” and today his mental health issue may have been diagnosed as major depressive disorder.

    A study published in the Journal of Substance Abuse Treatment followed 300 alcohol-dependent people with and without social anxiety disorder who went through hospital-assisted detox followed by participation in AA. Social anxiety disorder is characterized by an intense fear of being rejected or disliked by other people. This study found that there was no significant difference in relapse or abstinence rates between the two groups and concluded that social anxiety disorder was “not a significant risk factor for alcohol use relapse or for nonadherence to AA or psychotherapy.”

    Do Sponsors Matter?

    People with dual diagnoses tend to participate in 12-step programs like AA as much as people with just SUD and receive the same benefits in recovery. Those people with co-occurring conditions may actually benefit more from “high levels of active involvement, particularly having a 12-step sponsor.”

    In many 12-step mutual help organizations, people enter into an informal agreement with another recovering person who will support their recovery efforts and hold them accountable for continued sobriety. This one-on-one relationship of sponsor and sponsee has been compared to the “therapeutic alliance” that is formed between patients and their clinicians. The therapeutic alliance is positively correlated with treatment outcomes and abstinence.

    The therapeutic alliance is one of the most important aspects of effective psychotherapy, as it helps the therapist and the patient to work together. The relationship is based on a strong level of trust. Patients need to feel fully supported, and know that that their therapist is always working towards the best possible outcome for the patient. In the sponsor-sponsee relationship, a similar level of trust and belief is essential if sponsorship is going to be beneficial. 

    As with therapy, it may take many tries with many different people to find the right fit. Not all people are suitable to be sponsors and not all sponsorships go well. A sponsor is generally expected to be very accessible to their sponsee, and available at any time, day or night. They are supposed to help with completing the 12-steps, and they often provide advice and suggestions from their own experiences. It’s a lot of responsibility.

    A strong therapeutic alliance has been found to be an excellent predictor for treatment outcomes. Does that mean a failed therapeutic alliance could derail treatment? In short, the answer is yes. Trust is critical to healing from any mental illness.

    Trauma and the Therapeutic Alliance

    Traumatic events have a serious impact on mental health. People with mental illness are at a higher risk of being further traumatized and people who are traumatized are at a higher risk of developing mental illness than the general population. Childhood trauma “doubles risk of mental health conditions.”

    Recovery from trauma is based on empowering the survivor and developing new connections to life, including re-establishing trust. Judith Herman, a leading psychiatrist specializing in trauma is adamant that recovery is not a solitary process. This may be why 12-step programs have been successful in helping some people recovery from trauma. 

    Being a sponsor to someone who has been traumatized requires a fine balance between listening and giving space. Herman explains that survivors need to know they’re being heard when telling their story. At the same time, “trauma impels people both to withdraw from close relationships and to seek them desperately.” Meaning that when the sponsor does not go away, their motives may seem suspect in the eyes of the survivor. Yet, if the sponsor doesn’t stay, it can reinforce negative self-appraisal and stoke a fear of abandonment.

    Individuals with psychological trauma can struggle to modulate intense emotions, such as anger. A sponsor or therapist has to have healthy boundaries with a sponsee/patient if the relationship is going to work. Providing good sponsorship is a huge undertaking that requires a firm commitment.

    The good thing about the 12 steps is that they are considered a long-term program which encourages revisiting the steps many times to sustain successful recovery. This is useful in terms of trauma recovery because most trauma is never fully resolved. A traumatized person will likely experience reappearance of symptoms; traumatic memories can surface in different stages of life. Stress is a major cause of these recurrences and having a place to process these events as they come up is important.

    Do 12-Step Programs Have a Role in Treating Dual Diagnoses?

    Integrated holistic treatment that addresses how the two conditions interact and affect each other will provide the best outcomes. Ultimately, what we want is to improve quality of life and to return to ordinary life with an open door to future support when necessary. The research shows that when the principles of 12-step programs are integrated with other treatments, we see improvements in self-esteem, positive affect, reduced anxiety, and improved health.

    Further research is necessary to compare 12-step programs with other emerging mutual and self-help organizations, as they have been around for less time and there are fewer published studies on their efficacy. 

    View the original article at thefix.com

  • Guide to Finding Multiplan Coverage for Mental Health and Addiction Treatment

    Guide to Finding Multiplan Coverage for Mental Health and Addiction Treatment

    If you are dealing with addiction alongside other mental health issues, this helpful guide can help

    1. What counts as addiction?
    2. Does Multiplan cover mental health treatment?
    3. Multiplan PPO
    4. Why should you consult with Multiplan psychiatrists?
    5. What is the Multiplan substance abuse criteria?
    6. How can you find the best substance abuse coverage?
    7. Does Multiplan offer aftercare services?
    8. Multiplan mental health coverage
    9. Find the best treatment for addiction and mental illness

    Addiction acts as a monster that can get its claws deeply embedded into your mind and body, and getting that monster off you can be quite a daunting task. However, it’s not impossible and is often made easier with the help of the right professionals and the right health networks. Addiction treatment usually includes all types of addictions, though primarily drugs and alcohol.

    When you check into the right rehab, you’re taking the first step towards taking care of yourself and being in charge of your lifestyle choices. Checking into a rehab facility can create an ideal environment for anyone who is suffering from addiction because can leave them with a long-term focus and good knowledge of self-care. Multiplan Mental Health, Addiction Treatment, and Drug Rehab Coverage is an excellent option for anyone who is considering rehab and wants to start their journey towards sobriety. Under this coverage, you can undergo rehab in complete privacy, which can minimize it from affecting your professional or social life. 

    What counts as addiction?

    Addiction takes over someone when they engage with a substance or behavior that grants them instant gratification. This condition usually has a lasting effect on a person, and it can encourage them to pursue the substance or behavior repeatedly, while ignoring the severe consequences. Addiction can come from different sources, including drugs like cocaine, heroin, opioids, nicotine, and alcohol, and with behaviors like gambling. 

    When you engage in substance abuse, mental health disorders can be triggered. Some of the prominent mental issues associated with addition include depression and anxiety. Addiction is a behavioral health disorder that can be characterized as overdoing the use of drugs and alcohol. While getting addicted to a substance is not a choice, using them, however, is most often a conscious decision. To overcome this disease, it can be beneficial to seek professional help from the medical field. 

    Does Multiplan cover mental health treatment?

    Mental health is a fragile thing, and if affected by drugs or alcohol, it needs to be dealt with in a delicate manner. The degree to which insurance can cover an individual plan varies, but overall, but some people use Multiplan mental health care. The mental health treatments usually depend on the condition of the patients who are treated for addiction and substance abuse. 

    Multiplan also offers its insurance holders essential addiction and mental health resources. They have a comprehensive guide and an education series that is great for giving the reader information that will help them recognize the signs of addiction and also provide helpful tips for the patients and their families. The Multiplan mental healthcare program encourages your friends and family to come forward and participate in their family and group counseling session, so that everyone around you understands the importance of mental health and can extend their support to you or anyone else who might be suffering. 

    Patients who are under Multiplan providers need to find out if the treatment they want is covered by the insurance policy that they chose. It’s important that every person admitted into rehab knows the treatment they have chosen and if it’s viable with their insurance policy. They need to know the requirements and if they will have to take on any additional costs that may not be covered by the insurance company. 

    Multiplan PPO

    PPOs are a hot topic, but not many people know what they are. PPO stands for Preferred Provider Organization. With a PPO you can see providers without a prior referral from your primary physician and your plan will pay for all or part of it as long as the provider is in the network. If your provider is outside the network, you will have to pay more. A PPO is quite flexible, and it gives you more variety and a good selection of care. With a PPO, you can choose the doctor you want without any repercussions; the only issue is you will have to shell out a bit more cash if you wish to access that privilege. Additionally, you need to ensure that you meet the monthly premiums so that you get uninterrupted treatment that you have paid for. 

    Multiplan PPO and insurance work hard and consistently to help ensure that the policyholders are always treated well and that the cost of their services is accessible to everyone. 

    Why should you consult with Multiplan psychiatrists?

    An addiction psychiatrist is a doctor who focuses on treating patients that have any addictive or mental health disorder. They usually suggest medications like antidepressants and antipsychotics to help them cope with withdrawal and anxiety episodes. While many psychiatrists suggest that you take meds without really listening intently to your problems, the Multiplan psychiatrists are meant to ensure that your issues are heard and to listen to everything you have to say, which can better the treatment options. They often suggest a lifestyle change that can help you overcome your addiction as well as prescribe you with the right medication that will serve to improve your mental health with minimal side effects. 

    What is the Multiplan substance abuse criteria?

    There are many substance abuse hurdles one must climb over before they attain sobriety. If you contact any of Multiplan’s Mental Health and Addiction Treatment services, you will need to meet the following substance criteria:

    • Inpatient treatment 
    • Detoxification
    • Long-term residential programs 
    • Outpatient treatment and care

    When you contact Multiplan’s treatment referral center, you will be directed to professionals who can help you choose the best plan for you based on your needs. They will help you along with an insurance benefits review and then suggest rehab treatment facilities as well as what procedure you must follow. 

    How can you find the best substance abuse coverage?

    While you can opt for Multiplan substance abuse providers and the coverage they offer, you should ask yourself if this is the best option for you and if it’s vital in the long run for your treatment at the rehab center. Patients who are looking for rehab insurance must first contact the network providers that work with the insurance company and look for the plan and facility of their choice. The patients should ensure that they get a center that has professional psychiatrists, the best facilities, and the right type of care that they will need. 

    The treatment that you receive as a patient is important, especially if you’re admitted because of mental health and addiction. The care that a patient receives can have an impact on them in the long run. So, it would help if you put in much thought before making the decision; each patient should select the treatment plan that will suit them the best and the one they are most comfortable with. The Multiplan substance abuse providers will help you choose a plan that will meet your needs and help sustain your sobriety in the long run. 

    Does Multiplan offer aftercare services?

    Multiplan substance abuse counseling is one of the many highlights that come with applying for an insurance policy, but aftercare is also a part of the healing process and should not be avoided; therefore, insurance companies like Multiplan cover most aftercare services. For patients who seek residential treatment, their aftercare sessions will include staying at the center for a month or visiting the rehab center under strict supervision and daily medication. For people who don’t have a safe place to get better and are surrounded by potential elements that can trigger their addiction, they are recommended to go for inpatient treatment. 

    Both the treatments offer one-on-one therapy, where you learn to live without the addiction to alcohol or drugs. If you go for residential treatment, you will get more benefits, like having access to medical care and a choice between alternative therapies, along with family and group therapies. When you go for residential treatment, you will receive loads of benefits from a team of professionals whose sole purpose is to help you get better. 

    Multiplan mental health coverage

    When you go for substance abuse and addiction coverage, mental health is usually covered within that. This is a good aspect, because when a patient is suffering from addiction, their mental health can take a serious toll. Substance abuse can lead to withdrawal and depression, along with bouts of anxiety. Rehab centers acknowledge these issues, and the best treatments are often the ones that identify and recognize the connection between addiction and mental illnesses. Before you start your journey towards sobriety, you need to know your diagnoses, which has to be given to you by professionals. It is not a good idea to diagnose yourself. Once you’re diagnosed, you can choose the treatment that can best suit your situation and the one that can offer you the most effective results too. 

    Multiplan mental health coverage includes the diagnosis of your mental illness from a professional psychiatrist and a prescribed treatment plan. Patients who have been properly diagnosed are entitled to a mental health coverage plan that deems appropriate care. Just like addiction treatment, mental health coverage can demand residential treatment if needed or even outpatient therapy (if needed).

    Find the best treatment for addiction and mental illness

    While Multiplan approved substance abuse facilities are available, you probably want to plan your treatment according to the diagnosis, and the plan that you choose has to be important. As mentioned before, it’s best to contact the in-network providers and look for a facility that has experience and will provide you with the appropriate care that you need. 

    The facility and treatment that you choose can be vital for your well-being and recovery, and it is often best a decision that is well thought out and not spontaneous.

    View the original article at thefix.com

  • Addiction or Mental Illness: Which Should You Treat First?

    Addiction or Mental Illness: Which Should You Treat First?

    Substance use can alter behaviors, moods, and personalities so severely for people with addiction that without specialized knowledge and experience, it’s difficult to determine underlying causes such as mental illness or trauma.

    I credit psychological intervention for pushing me into recovery from alcoholism.

    Addiction is a mental illness, but is it one that needs to be treated before anything else? Or should we be stopping people from hitting their addiction bottom and helping them recover from their comorbid conditions concurrently?

    What Is Addiction?

    Before we can discuss treatment, we need to understand what addiction is and how it is defined. The two major guidelines for diagnosing mental health conditions around the world are the DSM and the ICD. The DSM (Diagnostic and Statistical Manual of Mental Disorders) is the standard diagnostic tool for mental health conditions in the United States and often used in North America. The ICD (International Classification of Diseases) is endorsed by the World Health Organization and often used in Europe.

    In the DSM-5, substance abuse and substance dependence are combined under the same name of substance use disorder, which is diagnosed on a continuum. Each substance has its own sub-category, but behavioral addiction is also in the DSM-5, with gambling disorder listed as a diagnosable condition. Other similar entries, such as internet gaming disorder, are listed as needing further research before being formally added as a diagnosis. In the ICD-11 there is a subset of mood disorders called “substance-induced mood disorders,” which are conditions caused by substance use. To qualify for this category, one must not have experienced the mood disorder symptoms prior to substance use.

    Hypothetically, a person who has alcohol-induced mood disorder might find health with abstinence alone, but substance use disorders do not occur in a vacuum and no one can go through the experience of addiction without it altering their mind and body, sometimes irreversibly. With enough time, substance-induced disorders change the function of the brain and alter emotion regulation. That doesn’t mean that addiction will cause another mental disorder; addiction is a mental disorder.

    Not everyone with an addiction is concurrently experiencing another mental disorder. Substance use can alter behaviors, moods, and personalities so severely for people who are addicted that without specialized knowledge and experience, it’s difficult to determine what, if any, underlying cause is responsible for the changes. Drugs, even those that are prescribed and used as directed, can have side effects that seem to mimic the symptoms of other diagnosable conditions. These effects can also appear if a person is in withdrawal. Because of this inability to isolate co-occurring conditions, there was a time when it was popular for doctors and clinicians to first treat substance use disorders before exploring the possibility of other mental illnesses. That is no longer considered the best approach to care.

    My Story: Therapy Helped Me Recognize My Alcoholism

    I started therapy before I could realize my excessive drinking was actually alcoholism. I was riddled with anxiety and constantly on edge. I lied compulsively about the most unnecessary and mundane things. My partner helped me start therapy, calling the first point of contact for me and taking me to my first two appointments, and then patiently waiting outside for me. He wasn’t enabling me by keeping me from hitting bottom, he was supporting me and protecting me in a loving way; in a way that worked.

    In the early days of therapy, my psychologist gently guided me towards recognizing my alcohol use as problematic. My therapist convinced me to go to a psychiatrist who started me on antidepressants and gave me anti-anxiety medication to use when needed. My treatment was moving forward, but I was still drinking. I spent most therapy sessions crying, but my ability to live day to day was slowly changing.

    I was Googling local 12-step meetings while hungover and then deleting my search history while drinking. I was taking my medications but still getting drunk on the regular. I had to do some work on my crippling anxiety and debilitating depression to get to the point that I could even fathom walking into a new space with new people. I drank because alcohol made it easier to have fun and to talk to people. I was living with undiagnosed post-traumatic stress disorder (PTSD) and alcohol worked to calm symptoms like hyperarousal and insomnia. I was using alcohol to cope with issues that my shame wanted to keep buried and my therapy wanted to draw forth. It took nearly nine months of therapy before I quit drinking.

    Once I was able to cross that threshold, things really began to change for me. My medication was able to work as intended because I wasn’t combining it with other mood-altering substances, and my therapeutic work could go deeper because I wasn’t self-medicating with alcohol. I gained tools to manage my mental health challenges. My alcoholism treatment has gone so well because I have concurrently received care for my comorbid conditions.

    Integrated Treatment

    That’s just one personal story of recovery and successful treatment of co-occurring mental illnesses. But it turns out that’s actually the best treatment: individualized integrated care. In the book The Anatomy of Addiction, Dr. Akikur Mohammad writes that the “best approach to treating a dual diagnosis…is…integrating mental health and addiction treatment in a single, comprehensive program designed to meet the individual needs of the specific patient.” How do we determine a patient’s needs? According to Dr. Mohammad, “the best diagnostic instrument is the clinician’s experience in treating addiction.”

    How many times have you heard the adage: “You have to let an addict hit bottom”? If you take a seat in any 12-step recovery meeting, you’ll likely hear someone speaking about their own experience hitting bottom. The idea is that one must reach a point of complete and utter desperation before being able to start recovery. Being desperate enough to change because your life is wretchedly entwined with addiction makes for a good story, but waiting to fall into such desperation doesn’t make for a solid treatment plan. The evidence base supports this view, but people don’t necessarily believe it.

    Generally, public views about drug addiction are incongruent with current medical knowledge on the disease. A 2014 study that surveyed over 700 adults across the country found that the majority of Americans hold stigmatized views. Forty-three percent of those surveyed said they oppose giving people with drug addiction equivalent insurance benefits compared to 21 percent who believe the same about those with mental illness. Half of all respondents were against increased government spending for treatment of drug addiction, compared to 33 percent for mental illness. About a third of folks don’t believe recovery is even possible for someone with either a drug addiction or a mental illness. And the number of people who believe that treatment options are not effective? Fifty-nine percent for drug addiction and 41 percent for mental illness.

    Consequences of Discrimination Against People with SUD

    These public opinions have real world consequences. They translate into low support for policies that could provide equal insurance coverage and policies that could allocate government funds into public health programs to improve the success rate of (and access to) evidence-based treatment. Drug addiction or substance use disorder (SUD) is a mental illness, but in the United States it’s treated as distinct from mental illness as a whole.

    Did I hit bottom? In retrospect, I find solace in the narrative that I hit “my” bottom. That’s the problem with the notion of rock bottom, it is a storytelling plot point that can only be defined in hindsight. Not even the precepts of Alcoholics Anonymous (the original peer support program that all 12-step groups are derived from) says that a person needs to hit rock bottom. According to the 12 Traditions, which are the general guidelines for 12-step groups, “The only requirement for membership is a desire to stop [fill in behavior or addiction here].”

    One thing is undeniable: people with real or perceived substance use and/or mental disorders face discrimination and an uphill battle to a healthier life. Everyone is different, and different treatment plans will have different outcomes for different people. Relying on one method of recovery for all people is irresponsible, illogical, and ineffective.

    View the original article at thefix.com

  • Shame, Alcoholism, Stigma, and Suicide

    Shame, Alcoholism, Stigma, and Suicide

    In addiction treatment circles, conventional wisdom suggests we have to let people hit rock bottom before we can help them. But what happens if rock bottom is dying from suicide?

    Historical records as far back as ancient Athens have the underpinnings of the stigmatization of suicide. In 360 BCE, Plato wrote that those who died by suicide “shall be buried alone, and none shall be laid by their side; they shall be buried ingloriously in the borders of the twelve portions the land, in such places as are uncultivated and nameless, and no column or inscription shall mark the place of their interment.” Fast-forward a couple millennia and suicide is still criminalized in many places around the world. In the Western Judeo-Christian tradition, suicide has long been considered the ultimate sin, to such an extent that even the body of a person who died by suicide was legally brutalized and dehumanized. This long history of shaming and penalizing suicide has created deeply seated (mis)beliefs that are engrained in cultural norms. Suicidal ideation is stigmatized, and those who experience such thoughts often suffer in silence.

    Alcoholism (both alcohol use disorder and alcohol dependence) is also highly stigmatized. Past research has found that public attitudes are very poor towards people with substance use disorders (SUD). Across the globe, around 70% of the public believe alcoholics were likely to be violent to others. As recently as 2014, research has found 30% of people think recovery from SUDs is impossible and almost 80% of people would not want to work alongside someone who had or has a substance use disorder.

    Alcohol dependence and alcohol use disorder (AUD) are high on the list of risk factors for suicide. Mood disorders, such as depression, anxiety, and bipolar disorder, are even higher risk factors. What is particularly concerning is that mood disorders frequently go hand in hand with AUDs. Alcohol causes depression, and it can be hard to distinguish whether the alcohol or the depression came first because they feed each other. In his book Alcohol Explained, author William Porter explains, “hangovers cause depression whether you are mentally ill or not…the real cause of it is the chemical imbalance in the brain and body. ”

    People who have alcohol dependence are 60 to 120 times more likely to attempt suicide than people who are not intoxicated and individuals who die as a result of a suicide often have high BAC levels. Alcoholism is positively correlated with an increased risk of suicide and “is a factor in about 30% of all completed suicides.” A 2015 meta-analysis on AUD and suicide found that, across the board, “AUD significantly increases the risk [of] suicidal ideation, suicide attempt, and completed suicide.”

    Suicide attempts with self-inflicted gunshots have an 85% fatality rate. If someone does survive a suicide attempt, over 90 percent of the time they will not die from suicide. That margin of survival gets smaller with alcohol dependence. Being intoxicated increases the likelihood that someone will attempt suicide and use more lethal methods, such as a firearm.

    When a suicide attempt survivor encounters medical professionals, half of the time they will be interacting with someone who has “unfavorable attitudes towards patients presenting with self-harm.” (These statistics have cultural and regional variations.) When a patient with AUD encounters medical professionals, they are also likely to be met with negative perceptions. Myths about AUD and alcohol dependency are pervasive and not even nurses are immune to such prejudice.

    So what improves professional perceptions and treatment outcomes? Education. Training works to dispel myths and reinforce the fact that SUDs are diagnosable conditions that require as much care and attention as any other potentially fatal ailment. Perhaps increased understanding of these conditions and experiences could fuel progress for treating addictions and preventing suicide. Doctors are sometimes at a loss for what to do with alcoholic patients; interestingly, the physicians who had more confidence in their abilities in this area were associated with worse outcomes. Meanwhile, there has been little progress in treatment availability outside of basic peer support groups such as Alcoholics Anonymous.

    Peer support groups do help a lot of people get and stay sober and to live happier and healthier lives: 12-step proponents credit the steps and meetings for saving their lives; many say they were suicidal and that after getting sober they no longer had those thoughts. But while suicidal ideation may go away for some people who receive treatment, it doesn’t work like that for everyone.

    People who are abstinent from drugs and alcohol still die from suicide. In the case of post-traumatic stress disorder, quitting drinking can exacerbate feelings of hopelessness and despair. Continuing to drink may reduce the severity of the symptoms in the very short term, but ultimately “a diagnosis of co-occurring PTSD and alcohol use disorder [is] more detrimental than a diagnosis of PTSD or alcohol use disorder alone.”

    Suicide is a leading cause of death across the world and ranks as the 10th most common cause of death in the United States. For every completed suicide, there are an estimated 25 attempts.

    It’s clear that we must do something to reduce the number of lives lost by suicide. Raising awareness of the relationship between alcohol-dependence and suicide attempts is an important part of the equation. Medical professionals, social workers, law enforcement, employers, and others who are frequently the first point of contact need better training to improve attitudes and fine tune skill sets for taking appropriate action. The public also needs to be armed with information that they can use to help their family and friends who may be at risk for suicide, and in particular what to do if that person has a co-occurring SUD.

    Despite evidence to the contrary (particularly in the case of comorbidity with another mental illness) conventional wisdom in addiction treatment suggests that we have to let people fall to rock bottom before we can help them. But what happens if rock bottom is dying from suicide? It’s true that we can’t force health onto another person, but we also can’t help them if they’re no longer alive. For many people, prior trauma and mental health issues come before addiction. More evidence-based intervention and prevention programs are needed if we hope to make any headway in fighting this epidemic.

    Until that happens, opportunities do exist to help prevent suicide. After Logic released his Grammy winning song titled “1-800-273-8255” (the phone number for the National Suicide Prevention Lifeline), calls to the Lifeline increased exponentially. There is nothing quite like hearing another human voice offering support and comfort. There is also a growing number of online crisis support services which provide help through live chat and email. These, unlike many crisis phone numbers, are not limited by location. Texting a crisis hotline such as the US Crisis Text Line at 741741 is also an option and can be done with just basic SMS, no data needed.

    If you or someone you know is in immediate danger, call your local emergency number. Find your country’s equivalent to 911 on this wiki page or through The Lifeline Foundation. Find a list of additional suicide prevention resources worldwide on this page.

    View the original article at thefix.com