What Mental Health Treatment Gets Right and What Addiction Treatment Gets Wrong Pt. 1

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What Mental Health Treatment Gets Right and What Addiction Treatment Gets Wrong Pt. 1

By Kathie Kane-Willis 06/09/16

We, as a society, are way more terrified of drugs than we are of other mental health disorders and because we’re scared we need to vilify these substances. 

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What Mental Health Treatment Gets Right and What Addiction Treatment Gets Wrong Pt. 1
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As a former heroin user, a harm reduction advocate, and a drug policy researcher, I have spent quite a bit of time thinking about how to effectively communicate “recovery” or “getting better,” as I like to call it.  

Recently, I was part of a group working on defining addiction stigma and as a frame of reference we looked at mental health stigma. This project made me think hard about the ways we “do” mental health and addiction treatment. Addiction is a mental health disorder, at least according to the DSM. But the way that we approach mental health disorders and the way that we approach addiction are radically different.  

One of the first things that I noticed is that we don’t really have prevention programs for mental health but we do have health promotion programs. Let that sink in for one minute. We don’t talk about how important it is to avoid depression, anxiety or schizophrenia. We do have programs that teach kids life skills and coping and have programs to intervene early with kids who seem to be suffering from mental health issues. And these programs work. Because early intervention works.  

Now let’s look at drug and alcohol prevention. We have myriad programs for teaching kids that drugs and alcohol are bad. I understand that delaying drug and alcohol use is likely going to result in fewer substance use disorders. The research tells us that. But so does health promotion, so does early intervention, mental health first aid and life skills training. All of these provide good outcomes and reduce substance use disorders.

We, as a society, are way more terrified of drugs than we are of other mental health disorders and because we’re scared we need to vilify these substances. Because let’s face it, we think drugs are going to come and steal our kids. We don’t talk about how “bad” depression or bipolar disorder or schizophrenia is, because we don’t view mental health disorders in the same way as we view the use of drugs, especially illegal drugs.  

We don’t think that other mental health disorders are going to steal our kids, even though other mental health disorders are more common than addiction. We worry when they are sad or unhappy or anxious and we might seek out care for them. But mental health disorders are not the personified bogeyman that addiction is. Addiction lurks, it is ever-waiting. Drugs creep, they invade, they overtake, they hide behind doors, they devour families, cities, towns, states, countries. They envelop. They come to get you.

But really drugs don’t come to get you. Let’s be real here. Drugs don’t fall out of the sky. They are not behind every door. They are inanimate objects, so logically all they can do is exist. If we choose to use them it is because we look for them. Drugs don’t look for you because they can’t look. They don’t have eyes.

Open any article about addiction and I guarantee that you will find those verbs. Because we infuse drugs and alcohol with a living power that they do not have. Drugs and alcohol have captured all of our collective fears and we use them as a place to deposit these fears. The problem with this approach is that scapegoating drugs and alcohol, means that we scapegoat the people who use drugs and alcohol. We are trash: junkies, addicts, crackheads, drunks, etc. Pick your pejorative.

Read an article about mental health disorders or even suicide clusters, I’m betting you won’t find that language. Other mental health disorders are not subject to same kinds of personification or name-calling. Or at least less so. Calling someone psycho is not really acceptable. Calling someone a drunk or junkie or stoner is.

The language we use around drug and alcohol use can be pretty stigmatizing. We talk about drug abuse. This language is grammatically incorrect since we cannot “abuse” drugs. Unless you are taking your alcohol down to the basement and beating it, you are not abusing it. You might be drinking too much. You might be misusing alcohol. You might even have an alcohol use disorder. But you cannot abuse it. Because alcohol, like other drugs, isn’t a person or an animal or even alive. It’s an inanimate object. Can someone misuse it? Heck, yeah. Can you abuse it? No, you cannot.

The reason why I bring up the abuse issue and the language issue is pretty simple. When we call someone a “drug abuser,” research shows that the person is treated with less compassion and less effectively than when we say “a person with a substance use disorder.”  

We don’t use the word abuse when it comes to mental health disorders. We don’t say that a person who is dealing with depression is a “mood abuser.” 

I think mental health does a better job with person first language and the reduction of labeling. Addiction treatment often requires the attachment of a label and internalization of that label, e.g., “alcoholic” or “addict.” In mental health treatment, there are labels attached to clusters of specific behaviors and thought patterns, but mental health practitioners don’t require their patients to call themselves “depressives” in order to receive care. Generally, mental health diagnoses come with person first language, e.g., a person who suffers/deals with depression, a person living with schizophrenia or simply my favorite “a person with lived experience.” But the patient is not required to take on the label in order to receive care.  

I find the labeling of people with substance use disorders pretty problematic. For me, the idea of living my life as an “addict” didn’t empower me. It really doesn’t sum up who I am. Sure, I had a problem with heroin and definitely had a heroin use disorder. But refuse to live my life with that label because I am more than my condition. I am a person first. That is why I don’t use the words "recovery" or "addict" when I talk about myself. I call myself a former user. I feel that is a more apt description for me. But I have never been a fan of labeling, because labeling can create stigma. 

Another concept I have learned from mental health is that hitting bottom is not a good thing and it makes getting better more, not less, difficult. With other mental health disorders no one would argue that letting someone fall deeper into depression is good for them. More depression begets more depression. This is something that addiction treatment needs to let go of, the idea that hitting bottom is essential towards getting better. Because that is not true. The more severe the substance use disorder the harder it is to get well.

Being homeless does not make substance use disorders better – it makes them worse. Losing social support through tough love does not help people with substance use disorders, it isolates them. Isolation is deadly. Instead we can take a play from mental health and talk about setting appropriate boundaries, providing social support and help for the family who is dealing with the person with the substance use disorder. Boundaries are important to sanity and functioning.  

Speaking of functioning, in mental health, it’s all about functioning and improving functioning. Mental health recognizes small and big wins, any and all positive changes count. If you once suffered from debilitating depression that made it impossible for you to get out of bed every single day but now you still have one or two bad days a month that is a success. A success worth celebrating.

Would we say that about addiction? Would we say that a person struggling with substance use disorder who is not functioning 30 days out of the month, gets some help, changes their behavior and now has one or two dysfunctional days a month, are we willing to call that progress or recovery? I would. But the majority of people wouldn’t. Because we, as a culture don’t recognize any goal but abstinence. In fact, we have a term for it: "functioning addict” or “alcoholic.”

But we don’t use that term for people with depression who are functional. We don’t call them “functioning depressives” or “functioning manic depressives.” We call them functioning. Full stop. Period.

One of the differences between mental health and addiction advocacy is that there is a space in mental health treatment that recognizes that one might not be totally well. With substance use disorders, we tend only to focus on those who have achieved long term recovery. While harm reduction embraces active users, recovery movements really don’t (sadly, unfortunately).  

Here’s why this matters. If we only accept people who are abstinent or are willing to become abstinent or who can become abstinent we are leaving a whole lot of people behind. People who are making positive changes, people who are actively using and who are not interested in stopping, people who might be abstinent from a “drug of choice” but not from all drugs. That idea is important because there is no single organization or place that embraces folks on the substance use spectrum - that is, those who are using non-problematically, those who are addicted, and those who are in remission from their substance use disorder.

There needs to be a space for all of us. That is what I think the National Alliance on Mental Illness does better. There is more inclusivity. There are more people with “lived experience” who participate in advocacy days, and many of these people are still struggling. There are more consumer boards that include these folks with lived experience.  

I wish there were a place in addiction advocacy that was willing to embrace everyone. Because in order to really change our world and to destigmatize addiction and substance use disorder we need everyone. We need the people who are using drugs without issues, we need folks who are not interested in treatment but are willing to fight for different rights. We need folks in long term recovery. Come as you are. We need your voices. All of them. Every single one.

Kathie Kane-Willis is the co-founder and director of the Illinois Consortium on Drug Policy, a research and policy institute housed at Roosevelt University. Kathie, a former heroin user, has trended the demographic shifts in heroin use since 2004. Her work focuses on promoting health based solutions to drug use, ensuring that individuals with substance use disorders are restored to useful citizenship, including the removal of barriers related to employment, education, housing and healthcare. Kathie has worked extensively towards harm reduction policy solutions to the opioid crisis, including Good Samaritan immunity laws and naloxone access laws in Midwestern states. Kathie lives with her family in Humboldt Park, in Chicago.

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Kathie Kane-Willis is the co-founder and director of the Illinois Consortium on Drug Policy, a research and policy institute housed at Roosevelt University. Kathie, a former heroin user, has trended the demographic shifts in heroin use since 2004. Her work focuses on promoting health based solutions to drug use, ensuring that individuals with substance use disorders are restored to useful citizenship. Kathie has worked extensively towards harm reduction policy solutions to the opioid crisis, including Good Samaritan immunity laws and naloxone access laws in Midwestern states. Kathie lives with her family in Humboldt Park, in Chicago. You can find her on Linkedin or you can follow her on Twitter.

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