Substance Abuse: When (and How) to Intervene

R.* was in high school when, severely depressed, she was forced to withdraw from her classes. Rather than seek out counseling, R. says she “turned to drugs and alcohol. I nearly killed myself partying.”

The reason for foregoing professional help goes back to the environment in which she was raised, she explains. “Growing up religious, happiness was directly tied to righteousness.” As a result, not only did R. not recognize her depression for what it was, but those who should have been there for her, the ones whose responsibility it was to intervene, actively discouraged her from seeking the help she needed.

“I was always met with the same advice—don’t tell anyone, pray, avoid stigma.”

Without the support she needed, she sought comfort in the only place she could think of: drugs and alcohol.

R. attributes a five-month, court-ordered rehab program with saving her life.

Overcoming Shame and Stigma

According to Ashley Groesbeck, a licensed clinical social worker practicing in New York City, R.’s story is not uncommon.

“There is a tremendous amount of shame and stigma around mental illness and addiction,” she says, adding this is especially true for the latter, which is often “seen as people just not having enough self-control.”

And where there is stigma, there is fear—be it to suggest help or seek help.

Groesbeck, who has worked with veterans and traumatized youth and families for seven years, suggests “keeping that shame factor in mind” when approaching a loved one about addiction, realizing that it can lead people to hide their behaviors.

For this reason, Groesbeck said that as unorthodox as it may seem, ask loved ones what they enjoy about their addiction. In doing so, she says, you allow the person to acknowledge what they get out of it, leaving them more open to acknowledging the downsides, such as missing work or strained relationships and budgets.

After you allow them to explore the pros and cons on their own, Groesbeck says it’s a good idea to ask them if they have thought about getting help. “The odds are they have.”

Baltimore-based psychiatrist Dr. Mark Komrad notes that it is not your responsibility to diagnose your loved one. The author of the book You Need Help! A Step-by-Step Plan to Convince a Loved One to Get Counseling[1] explains his approach as such: “You know that something is wrong with your loved one’s thoughts, feelings, or behaviors. You aren’t sure how to understand it, what to call it. But you do know that the problem needs more help and more evaluation than you as a caring supporter can provide.”

According to Groesbeck, the most important thing is to make sure you are coming from a place of love. “If you watch the show Intervention, they’re all about cutting friends and family off and talking about all the ways the addiction has hurt them. That probably has a place, but that’s not the place you start. The place you start is ‘I’m really worried about you and here are the reasons why.’ Then, ‘I’m wondering if it’s because you’ve been drinking more, because you’ve been using drugs more.’”

Komrad agrees that beginning with a gentle approach is best, explaining that more drastic measures, such as putting the relationship on the line, are best saved as a last resort given addicts’ propensities to drive problematic behavior underground. The same goes for taking away the physical alcohol or drug during those initial stages, says Groesbeck. “And the more the behavior is hidden, the more pathological it becomes,” she says. “Healthy families don’t have secrets.”

Dual Diagnosis

The power of stigma in deterring treatment is not the only theme in R’s story that is common to addiction. While she admits the numbers are “nebulous,” Groesbeck says as many as 25 to 30 percent of people with addictions suffer from a co-occurring mental illness, be it depression, bipolar disorder, or schizophrenia.

Also unclear in most cases is which came first—the chemical addiction or the mental illness. “It’s completely chicken and egg,” she notes. Muddying the waters is the fact that the two share many symptoms depending on where a person is in his or her addiction-mental illness cycle.

As many as 25 to 30% of people with addictions suffer from a co-occurring mental illness, be it depression, bipolar disorder, or schizophrenia.

What is clear is that lasting recovery is far more likely when both issues are treated together. Doing so, Groesbeck says, is “enormously important,” as is helping a person to “understand the interplay between their addictions and mental health illnesses.”

In R.’s case, it took more than ten years after she left rehab before she was properly diagnosed with dysthymia, a form of chronic depression. She managed to avoid relapse, but it wasn’t easy. “I think if I’d known, I would have been a real adult sooner,” R. says. “I spent way too much time hiding from life in bed when I could have been advancing my career, developing relationships—that sort of thing.”

Groesbeck admits that finding a facility that treats both addiction and mental illness can be difficult. “Most places tend to treat just one or the other.” Still, she says, it might be worth the extra investigation. “In the end, all evidence suggests dual diagnosis is incredibly important.”


*Names have been changed to protect privacy

Written by Tamarra Kemsley

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