The National Institute on Drug Abuse (NIDA) defines addiction as a brain disorder as well as mental illness. The Diagnostic Statistical Manual, 5th Edition (DSM-V) of mental disorders published by the American Psychiatric Association, categorizes substance use disorders as mild, moderate, and severe. The American Society of Addiction Medicine (ASAM) defines addiction as a chronic medical disease. The National Institute of Mental Health (NIH) states that addiction is a mental disorder that affects a person’s brain and behavior.
Many different organizations have different definitions as to what constitutes addiction. In addition to not agreeing on a definition, no organization can explain with detailed accuracy, outside of symptoms and a general or broad explanation, what a mental disorder is or its origins. The American Psychiatric Association (APA) defines a mental disorder as:
Any condition characterized by cognitive and emotional disturbances, abnormal behaviors, impaired functioning, or any combination of these. Such disorders cannot be accounted for solely by environmental circumstances and may involve physiological, genetic, chemical, social, and other factors.
The DSM-V states that Mental Disorders are usually associated with significant distress or disability in social, occupational, or other important activities (American Psychiatric Association, 2013, p.20).
The World Health Organization (WHO) defines a Mental Disorder as follows:
A mental disorder is characterized by a clinically significant disturbance in an individual’s cognition, emotional regulation, or behavior. It is usually associated with distress or impairment in important areas of functioning.
The APA contains language such as “cannot be accounted for,” and it “may” involve certain factors. The WHO vaguely states that a mental health disorder “is usually associated with” certain factors, implicitly admitting this is not an exact science. This recalls similar wording regarding mental disorder medications such as SSRIs (selective serotonin reuptake inhibitors), where the description of the medications includes “it is thought to work by.” The point is this: no psychiatrist or mental health professional can affirm with precision exactly what a mental disorder is, its origin, what caused it, and what specific medications or therapies will effectively treat it. It all comes down to a hypothesis, which is to say, an educated guess. There are so many different disorders with overlapping symptoms and no real known cause that it is difficult to get a proper, accurate diagnosis. Some will disagree with the statements above. This disagreement will be from those whose treatment team was able to match the symptoms to a diagnosis and get the medications right the first time. It is rare when this happens, but it is possible.
Many people with mental illness or who have witnessed a loved one with a mental disorder recognize the inability of professionals to treat mental health disorders accurately. Some are still battling doctors and medications after years of trials and errors, hoping and praying for a magical formula.
Among the biggest challenges we face are families and their loved ones who insist the problem is a primary mental health disorder. Although there may be an underlying mental health disorder, there may also be other underlying causes. Claims of mental health disorders often surface when the client is diagnosed while in an untreated or active addiction. Because substance use disorders, as well as mental health disorders, are partly behavioral in nature, the symptoms of both disorders do not simply go away because someone stops using alcohol or drugs.
For those who insist that a diagnosis is correct if it was made long prior to any substance use, its accuracy is still not proven. Psychiatrists and mental health professionals frequently make quick diagnoses. The person being assessed may not have been completely open and honest during the assessment process. More importantly, most mental health disorder drugs are prescribed by family doctors with no training or experience in the treatment of such conditions. For those diagnosed early on by a psychiatrist or mental health professional, many of these diagnoses occur at a time of crisis. The point is the best way to achieve an accurate assessment is to first stabilize the patient under the care of an integrated treatment team.
In summary, if mental health professionals are challenged when diagnosing mental health disorders, then why should a family and their loved one think they can?
A Personal Experience with a Family Member Misdiagnosed Early on with Multiple Mental Disorders
A child in our extended family was struggling with a rare genetic disorder. As a result, the other child in the family suffered from a lack of attention and the stress brought on by her sibling. The other child who did not have the disorder was a straight-A student and was involved in many activities and sports. The child’s mother called us to speak about the situation. She stated that the child who was struggling with her sibling’s problem was herself diagnosed with four different disorders, including ADHD. Keep in mind she was a great student and did not struggle academically, as some do with ADD or ADHD. As the conversation progressed, the person at our house said to the distressed mother, “Mike is here, and he has the same credentials as the therapist who diagnosed her,” and then asked me, “What do you think?” Knowing the girl personally and in complete disagreement with her diagnosis, I asked the mother if her daughter had insurance or was on state Medicaid; she replied yes. I gave her the following suggestion. Tell your daughter’s therapist you no longer want to use the insurance and will pay for the appointments. That way, your daughter’s therapist will not need billable mental disorder codes in order to be reimbursed for the sessions. I also stated, “tell the therapist what I said.” A week later, we received a call from the mother saying the therapist became extremely angry (remember, anger is driven by fear) and told the child’s mom to tell us to mind our own business. The therapist then put the credit card on file, and the four mental disorders were never brought up again.
What if we had not intervened, and this girl turned to substances later in life? The diagnosis she received at age 11 would have followed her in and out of treatment centers and mental hospitals. Would diagnoses twenty years later be accurate when the ones twenty years earlier were not? Her family would be on the phone with us today, pleading the case of the daughter’s mental disorder struggles.
Sadly, this experience is all too familiar for many of our clients. Diagnoses are made quickly and for billing purposes. This is not to say there are no mental health disorders. It is to say, however, that clinicians and psychiatrists should do a much better job of accurately assessing the situation.
What is a Mental Health Disorder Intervention?
Many are of the mindset that an intervention is a gathering of friends and family in an attempt to address a problem. Others believe an intervention is what they have seen on television. These types of perceptions are not completely off base, and they are one way to look at what an intervention consists of. An intervention is a clinical tool or strategy used by clinicians as well as mental and substance use disorder professionals. Interventions use specific strategies to address a problem or behavior in order to meet a specific goal. Interventions for any purpose can change from minute to minute, as can the strategies. Whether a substance use disorder or a mental health disorder, interventions require a professional interventionist to facilitate the process effectively.
It is not uncommon for people to seek information about our services and find many references to addiction while doing so. Some believe that we are not equipped to help them or their loved ones with a possible mental health disorder. In our experience, it is quite rare to have a person with substance use or a mental health disorder who is not experiencing a dual diagnosis. Mental Health Interventions are very similar to other interventions, such as substance use and process addictions (e.g., gambling, sex, eating disorder, etc.). Given that the protocol of an intervention includes having it conducted by a trained professional, then the format is similar. What can be different are the goals and the approach, depending on the particulars of the situation. The goal of a mental health disorder intervention, as with an intervention for addiction intervention, is to avoid coercive approaches and deliver the patient safely to a treatment facility to begin stabilization. While being stabilized, the goal of the integrated treatment team is to bring the patient to baseline, while the role of the interventionist’s team is to guide the family through the significant changes that have occurred. Mental Health Disorder interventions are just that and are not intended to treat the person’s disorder.
Mental Health Interventionists almost always encounter a dual diagnosis client. The question is and always will be what is the driver behind the behavior? Many families insist it is only a mental health disorder. In our experience, it is rare while conducting an intervention to encounter a mental health disorder only. In the great majority of cases, the situation involves substance use. Until it can be determined otherwise, the interventionist must assume the behavior is a result of substance use. This is why it is so important to escort the loved one to a facility that can bring the client to a baseline and then build a treatment plan from there. Far too often, doctors, psychiatrists, mental health professionals, and the intended patient’s family make mental health disorder diagnoses too quickly and under less than desirable conditions. These conditions can be anything from a diagnosis made during a crisis or when the person is under the influence of drugs or alcohol.
What are Different Mental Health Intervention Strategies?
Two models are commonly used by the patient’s treatment team in determining a dual diagnosis. When substance use or mental health disorder symptoms are present, clinicians may use the Super Sensitivity Model or the Antisocial Personality Disorder (ASPD) Common Factor Model.
Intervention strategies most effective for Mental Health Disorders consist of increasing client motivation and instilling hope within the client. Intervention strategies for substance use only, mental health disorder only, or dual diagnosis intervention strategies can and will benefit all involved if motivation and hope are the primary focus. While a mental health interventionist needs to use motivational strategies, there must be a family’s willingness to change, too. Many times, motivation to change comes by way of consequences and accountability. Although it is much harder for a family to hold their loved one accountable for a mental health disorder, it is still an essential strategy in the intervention process. Coercion tactics are always the last resort in mental health disorder interventions, but they may be necessary in order to prevent harm to the loved one.
Families often make the mistake of seeing no difference between coercion and ultimatums and accountability and boundaries. They are not the same. Coercion and ultimatums are often used with involuntary commitment strategies, whereas boundaries and accountability offer a voluntary choice for the loved one. In other words, your loved one has the right to do it their way, and the family has the right not to agree with, enable, or support that decision. A person with a mental disorder, substance use disorder, or a dual diagnosis has to have some level of accountability in order to advocate for their own care. Even in strategies of Close Monitoring, i.e., intensive supervision of a person with a mental health disorder, consequences should exist for negative actions or behavior. As tough as it is, no illness gives anyone the right to make another person miserable. Enabling can and does take place with mental health disorders. The impact of enabling a mental health disorder is equivalent to the negative effects of enabling a substance use disorder.
The strategies employed in an intervention can and will change as the situation evolves. It is highly encouraged that the family retains a professional substance use and mental health disorder interventionist when attempting to provide help for their loved one. It is important to remember that the interventionist is not a clinician but rather is there to help your loved one accept help. The aftercare team is part of the intervention process and provides the family with education, support, and assistance after the intervention. The interventionists’ aftercare team can and will work with your loved one’s treatment team in collaboration with the family to provide the best opportunity for a successful recovery for both the family and their loved one.
What are co-occurring disorders?
Co-Occurring Disorder – refers to two mental health disorders taking place simultaneously. This can also include two mental disorders or a substance use disorder with a mental disorder.
Dual Diagnosis – describes when Co-Occurring Disorders are determined and diagnosed.
Comorbidity – occurs when medical complications exist with a substance use disorder, a mental health disorder, or both. Alcohol Use Disorder, along with Anxiety Disorder and a failing liver, would be an example of comorbidity.
The challenge for professionals is to uncover the cause of the problem. Is the mental health disorder being exacerbated by substance use? Is substance use causing the mental health disorder symptoms? Is the person using substances while taking prescribed mental disorder medications? When substance use is present, even in small amounts, it is not possible for the professional to make an accurate distinction between the substance use disorder symptoms and the mental disorder symptoms, even when there is a medical history of a past diagnosis. Someone who turned to substance use later in life after an earlier mental disorder diagnosis may now be medicating the unwanted feelings and thoughts. The symptoms of the mental disorder may be seen as the patient acting out maladaptive thoughts and coping skills before escaping with drugs or alcohol.
What is the difference between a mental health intervention vs. an addiction intervention?
The theory behind interventions for mental health disorders and alcohol as well as drug addiction is the same. What can separate the two are the different strategies and goals based on what is observed in real time during the intervention. Even with the information and background the family provides, it cannot be guaranteed the intervention will go as expected. Many people have advice and expectations in regard to the way they think the intervention should or will unfold. Volatility can occur, and because of it, strategies and goals can change, as can the outcome.
Interventionists mostly deal with a dual diagnosis of substance use and a mental health disorder. As a result, professional interventionists are not able to determine with accuracy the cause or diagnosis at the time of the intervention. The professionals at the treatment center need weeks to make an accurate diagnosis, and it follows that the interventionist cannot do it in a day. What the professional interventionist is able to determine are the most appropriate strategies to achieve the goal of bringing the person in need of help to a facility for stabilization and a much more thorough assessment.
The interventionist performs triage and is a bridge for both the family and the patient. The interventionist is neither the family’s therapist nor the patient’s treatment team. Interventionists are there to listen, build strategies, instill hope and willingness in your loved one, and to educate the family. In addition to this, they are ready to deliver your loved one safely to the facility (or to a representative from the facility) and prepare the handoff to the aftercare team. The interventionist acts as the nexus to everyone and everything at the intervention. Your interventionist’s aftercare team will help the family in its recovery as their loved one navigates the healing process and recovery.
What do you treat first, addiction or mental illness?
We have learned this about mental disorders and addiction: drug or alcohol use on any level can and will exacerbate mental disorder symptoms. The level of alcohol and drug use that can affect mental disorder symptoms does not have to be abusive in order to do this. The recommended and most effective way to rule out drug-induced psychosis influencing mental health disorder symptoms of any kind is to stabilize the patient or client in a controlled environment over the course of several weeks to bring them to a baseline. Once this baseline is achieved, an integrated treatment team can start the process of accurately determining the appropriate diagnoses, medications, and evidence-based treatments.
Is it better to treat an addiction or a mental illness?
Throughout our information, it is indicated that when a dual diagnosis of both a substance use disorder and mental health disorder exists, the clinician assumes the impairments are the result of the substance use until it can be proven otherwise. That said, a facility that employs three approaches, Sequential, Parallel, and Integrated, should receive preference.
Sequential Treatment Approach – Each problem is addressed one at a time. This makes it difficult, if not impossible to treat one disorder without having to address the other.
Parallel Treatment Approach – Both disorders are treated simultaneously but by different professionals at different facilities. The parallel approach is ineffective if a lack of communication or differences of opinion exists between the professionals and the other facility.
Integrated Treatment Approach – One treatment team, one facility. The integrated approach is the most common today for dual diagnosis clients. Integrated treatment approaches are far better suited to effectively address a dual diagnosis of both a substance use disorder and a mental disorder.
An intervention is not about how to control the substance user; it is about how to let go of believing you can.
Professional Mental Health Interventionists with Family First Intervention
One of the hardest parts for family members is acknowledging a loved one’s drug or alcohol use. Many families default to a mental health disorder as being the driving force behind the problems. Although that may be the case, far more is involved in determining the causes and conditions of the dual diagnosis. Even when mental health disorder symptoms are present before any substance use has taken place, there may still be discrepancies in the diagnosis.
At Family First Intervention, our goal is to help you through the uncertainty in determining the underlying problem. With the assistance of our interventionist and our family aftercare program, we can help families to let go and allow the professionals to help their loved ones. Substance use and mental disorders are very complex, as is the family system dysfunction that arises as the result of either disorder or both simultaneously. The treatment team will help your loved one, and we can help your family. By working collaboratively with the treatment center and with you, we can add an important layer to the integrated treatment team process. This layer, e.g., recognizing the family’s heartache and pain as a result of the addiction and mental disorder, is too often neglected and frequently falls by the wayside. The stronger and more educated a family becomes, the greater the opportunity for a successful outcome for both the family and their loved one.