I have worked in the area of addiction as a clinician and researcher for the past 30 years and I am still amazed at how it continues to be portrayed as somehow separate from other ‘legitimate’ mental health diagnoses like depression or PTSD. When it comes to alcohol in particular, even though it is the most widely used drug in Canada it is also linked with violence, suicide, and accidental death. So, it enters a sort of legal-medical category which is generally not the case for issues like depression, anxiety, or PTSD. This despite numerous studies showing high levels of overlap between substance misuse and most other mental health issues. We are not sure where to position addiction – as a behavioural problem stemming from flawed character or as a self-management strategy to cope with other mental health struggles.
Most commentators will agree publicly that addiction is a kind of self-medication (people use various substances to manage emotional control) but when it comes to traditional treatments the reality is quite different. Within nearly all organizations, there are two competing views – addiction is seen as a sort of disease on the one hand but on the other it is also viewed as a performance or discipline problem similar to a self-inflicted wound – the person brought it on themselves. Again, this is decidedly not how we view depression or PTSD which are considered to be legitimate operational injuries affecting members. Instead, these patients are seen as victims of specific external events.
When it comes to offering help, clinicians will state that they treat addiction and other co-occurring mental health problems at the same time under a unified approach. However, the fact is that most institutions seem to treat issues sequentially – do this first and do that next. Often, this requires people to stop drinking, have a period of abstinence, and then deal with other issues. A common view in addiction treatment is that in order to get, well patients have to become honest, face their denials, and stop their rationalizations and manipulations – they are viewed skeptically. If these same patients are also diagnosed officially as experiencing workplace or operational mental injuries, however, they are usually seen as victim sufferers. Efforts are made to support them and to treat them carefully and incrementally to help them resolve their problems. How can an employee make sense out of these polar opposite reactions to their problems?
We know that problems with emotional management and trauma of all types drive nearly all mental health issues, including addiction. Instead of compartmentalizing problems, we really need to develop coherent interventions for all mental health issues as shared problems of social disconnection and emotional dysregulation. We need to answer the fundamental question of ‘why’ when it comes to helping people come to terms with their over-reliance on substances and medications.
John J. Whelan
John J. Whelan, Ph.D., is the author of Going Crazy in the Green Machine, available now on FriesenPress.