Linda J. Wilk, MAPC
Mental Health vs Addiction -- Finding Inner Peace
I'm a long term recovering addict and alcoholic. In my own life, this means total abstinence from alcohol and all drugs. This is a much more confusing conversation today than it was when I got sober in 1981. Back then if you were in a 12-step program and you took anything, even drugs requiring a prescription that would be seen as altering your mind, you were not seen as in recovery.
For someone like me, who had suffered a lifetime of depression (my first remembered deep down being 5 years old), this made sobriety a big challenge. I came to recover because none of the drugs or alcohol were working anymore. I'd already been in therapy for about 4 years, and that wasn't working either. I didn't want to live, but I didn't want to be unsuccessful at dying. I wasn't a successful addict or alcoholic because I simply could medicate myself enough to make the pain go away. Nothing was working anymore, and I was only 27 years old. I got to an AA meeting because a friend asked me to go along before we went out to do other things.
That night, I heard a woman talk about feelings like mine that brought tears to my eyes. In my mind, I asked myself, "You mean, alcohol might be the problem, not the answer?" I was incredulous. This idea had never occurred to me before that moment, and I didn't want to believe it. But something deep inside me told me this was right, and I never left AA from that moment. AA taught me things that my alcoholic family never could. I learned a new way of living. I was afraid if I didn't stay connected to something, I might get the courage to suicide. People extended a caring hand to me and helped me out of the darkness.
My sponsor said, "Just don't drink, don't drug and don't die, one day at a time, one second at a time if need be, and call me if you are in trouble." It was to me, a miracle. But it was not easy. Alcohol and drugs were not my only problem. I had a mental illness as well. Maybe several. And those kinds of problems do not go away just by taking the substances away. The substances were my medications for these other problems.
THE PARADOXES OF 12 STEP AND MENTAL HEALTH RECOVERY
The topic I'm taking up today is not theoretical. I have lived it, from the days of no medication to the days of lithium and serotonin reuptake-inhibitors and doctors thinking they dictated treatment, to the current days of beginning to advocate for myself and my body. This road is not an easy path. Whether doctors and psychotherapists want to believe it, we patients know that diagnoses suffer from the fads of doctors. Psychology is not a solid science yet though there are better ways to study the brain than there were 40 years ago. As a patient, it also takes years to beat our own denial of the diagnosis, whether that diagnosis is addiction or mental illness. These are two counts against gaining sanity.
Recovery in a 12-step recovery program is a strong basis for sanity. People with mental illness can't afford the experimentation that others can because the result can be permanent damage to the psyche. Twelve Step Recovery places a strong emphasis on honesty, open-mindedness, and willingness. This focus is equally applicable to the treatment of mental illness, where finding and accepting the diagnosis, and learning all there is to know, will bring the best results long term.
People with a mental health diagnosis may be dependent on medication to keep them balanced, to the same degree that an addict is dependent on abstinence. Self-honesty and the ability to ask for help become key in recovery. Yet, just like an addict, isolation and an ego tell the mentally ill person that they can handle things themselves and shouldn't divulge their problem to anyone, especially a boss, a lover or a therapist. These are the issues that plague people with mental illness and addiction at their most vulnerable moment. The same paradoxes exist in each illness.
ACCEPTANCE IS THE KEY TO ALL MY PROBLEMS
This is a well-worn statement in the twelve step programs. How ironic it is. We work so hard to apply this to ourselves but let someone come in the meeting room who has alcoholic dementia, or methamphetamine paranoia, or God forbid, schizophrenic hallucinations, and it is extremely difficult for us to avoid pointing the finger and wanting to gently hasten that person from the rooms. They make us so extremely uncomfortable. They make ME uncomfortable. I know why. They are me. It is easy to forget what I looked like when I came in. I don't want to remember that unkempt, smelly, shaky, self-conscious self, but I must or it may kill me. By helping others like me, I keep my own memory green, and I keep learning about myself through that newcomer.
I would rather look at where I am now than where I came from. It took me ten years to accept that despite what old-timers in AA were telling me, I would need to seek help from psychiatrists and take medication, or I would never cease being rolled up in a fetal position on the couch, unable to move for extended periods of time. Or maybe I would be stuck the other way and spend enormous quantities of money, feeling elated not to be depressed and wanting to redecorate our whole house in 3 days, before the next crash that I knew would come. Thank goodness I was not the only person in the AA program who also had mental health problems.
Acceptance is the key to all my problems if I am willing to look my problems square in the face. I can't rely on the advice of others if I am still feeling sick. I need a doctor for medical problems. Another paradox, because unfortunately, just like when I want to use or drink, the last thing I want to hear is that I need to follow the advice of someone I am convinced in my mental state, doesn't know what they are talking about. There is no underestimating denial!
MUCH IS KNOWN SCIENTIFICALLY ABOUT OUR MENTAL AND ADDICTED BRAINS
One of the most frustrating things for me, as I have worked as a family therapist and addiction counselor, is to hear people spouting age-old adages about people I know well, when there is good science these days that can help their family members or them. We know now that when people abuse drugs and alcohol, there are neuroreceptors of the brain that are affected, and it will take months, if not years for those centers to heal.
It is not lack of "willpower," it is damage to the brain that plagues us, and there is evidence that healing can occur. These same neuroreceptors can be activated by other events/actions that impact a person, including early childhood trauma, fetal abnormalities, trauma from an accident or brain injury, malnutrition, and other noteworthy events. To fail to take these issues into account when assessing an individual's mental health is to deny the full extent of their illness and what could be effective in treatment, yet this science is slow in being adapted in the public mental health system and the public in general. (Nutritional therapies for mental disorders - PMC (nih.gov)).
TREATMENT ALTERNATIVES FOR OPIATE USERS
More is known about utilizing this holistic treatment for drug and alcohol recovery and these protocols are being adopted slowly into treatment programs. Unfortunately, in my opinion, the federal government has chosen the route of drug substitution programs, rather than looking at the more natural route of healing the brain by utilizing amino acid replacement therapies. The substitution method is far less expensive, but less is known about the long-term impact of these drugs, known as suboxone or bupropion.
I know I will hear criticism about taking this stand, so I tell you, I am speaking from my opinion and my own observation when I tell you that I have seen how hard it is for addicts to give up this replacement drug, for distinct reasons. These include the false belief and fear many addicts hold, that this dependency means they will never be able to survive without 'something' despite knowing many others who are abstinent. The withdrawal from bupropion is far worse than from other opiates; I have witnessed this myself, working in a treatment center. Many addicts have cyclical patterns of addiction and this drug feeds that belief that they can't survive abstinent. Many treatment centers are content to maintain addicts on suboxone for extended periods (years) of time, and this feeds that same false feeling that abstinence is an impossibility.
There is also a negative pattern in the drug community of users being admitted to suboxone programs and being administered a higher dose than they feel is necessary. Being addicts, they have admitted to me that they will half their strips and sell the other half for a profit. Ultimately this keeps them connected to their drug community and can lead them back to active addiction. Suboxone treatment personnel I questioned seemed reluctant to admit that behaviors like this existed.
There is much current research about the use of amino acids in opiate withdrawal. Here are a couple: (Excitatory amino acids and morphine withdrawal: differential effects of central and peripheral kynurenic acid administration - PubMed (nih.gov),Early Intervention of Intravenous KB220IV- Neuroadaptagen Amino-Acid Therapy (NAAT)™ Improves Behavioral Outcomes in a Residential Addiction Treatment Program: A Pilot Study - PMC (nih.gov). This research is widely available, but it does not seem to have been well accepted by the treatment community. It is a good step toward abstinence and positive mental regard for the opiate user and we can hope for better acceptance in the future.
WHY THE ABSTINENCE MODEL WITH DUAL-DIAGNOSIS?
In my years of work as an outpatient therapist, there appeared a dance that most therapists in my agencies did in trying to work with dually diagnosed patients, or even in trying to tease out if that was what was happening.
Patients who are self-medicating a mental illness can appear to have symptoms of different mental illnesses on presentation, which may dissipate after a period of abstinence. The reverse may also be true; that symptoms may exacerbate on the removal of alcohol or drugs, as the symptoms rise to the surface. Good research has been done on Alcohol Use Disorder and the appearance of symptoms of Antisocial and Borderline Personality Disorder symptoms, for instance (Alcohol Use Disorder and Antisocial and Borderline Personality Disorders - PMC (nih.gov)).
A 2019 study by SAMHSA found that there was a huge correlation between people who abused drugs and alcohol and suicidal ideation, as well as mental illness (Key Substance Use and Mental Health Indicators in the United States: Results from the 2019 National Survey on Drug Use and Health (samhsa.).
It is beyond the scope of this blog to delve deeply into this matter but suffice it to say that teasing apart what is mental illness and what specific illness it is, is almost impossible without a person being clean of alcohol and drugs. In the best-case scenario, a person would have at least 3 months clean before we re-assessed any new mental illness, while helping to balance the brain with amino acid therapy prescribed by a doctor. In this way, along with a healthy, clean diet, simple exercise and a program of education and awareness, the person would have the time to heal and for their thinking to clear before any new psychiatric drugs were introduced. In this time, symptoms will change widely, even amazingly, as I observed.
The patients themselves are often amazed. On the other hand, at times psychiatric symptoms emerged, and the person might be referred to a higher level of care for evaluation and treatment as this happened. In a longer-term setting, this was a safe protocol, where the patient could be observed, moved to a higher level of safety when necessary, and sobriety or abstinence from substances preserved, while mental health issues were observed and treated as well. Notedly, there was much less risk of relapse or crisis if the trust of the patient was maintained, and the treatment milieu preserved.
STAYING CLEAN AND SOBER PLUS
If you'd like to read more about this, I refer you to the book Staying Clean and Sober, third ed.: Complementary and Natural Strategies for Healing the Addicted Brain, by Merlene and David Miller. Another useful resource is The Craving Cure, by Julia Ross. Ms. Ross's book will even help you look at your own amino imbalances which is a terrific way to understand the way the brain works. If you want a visual guide, I'd direct you to "Pleasure Unwoven," a video on YouTube. This video is aimed at teaching whether addiction is a disease, and it does so by explaining the science of amino acids and the brain.
These resources don't speak directly to dual diagnosis, and it was difficult for me to find good references in this area. It is important that someone dealing with both mental illness and addiction have people in their life that they can trust. The development of Peer Recovery Specialists in both fields is a good touchpoint for recovering people who are dually diagnosed, as these people have personal experience that they can lend to a situation, and it helps them build trust with their clients. They can accompany their clients to meetings. They can help you, the questioning person, to move in the direction of treatment if they are doubtful or resistant. Why? Because they have lived it, besides being trained to help.
Ask at mental health or drug treatment centers if they have such a Peer Recovery Specialist in dual diagnosis available to talk to. Also be aware that there are twelve step programs today, either online or in person, that are aimed directly at the dually diagnosis person. There you will find people like you, and it will make your passage to health much easier. Those programs may be called "Emotions Anonymous, Dual Recovery Anonymous, Double Trouble or Dual Diagnosis Anonymous." I suggest you google Dual Diagnosis twelve step programs and see what comes up. There are usually family programs available that correspond to the programs for the individual, or you can visit the Alanon.org page to find family support.
You can contact me at Linda@CoachingaPeacefullife.com if you need further support! I wish you well on your journey!