We work with people who either have a propensity to mental illness, which is triggered, or already have a mental illness, which is worsened, by drug use. With today’s drugs, we see such powerful changes of brain chemistry that mental illness results, even without other risk factors. It’s discouraging in many respects, because, although we create better treatments for the mental illnesses themselves, people bring them on and make them treatment-resistant by substance abuse.
One of our colleagues in the Addiction world, Chana (pronounced “Hana,” like the road to Hana, Hawaii) Carro is a licensed independent Substance Abuse Counselor, with over 24 years’ experience. She says, “This is an enormous tragedy. We made a very large advance when we decided that we should treat mental illness and active addiction as co-occurring disorders, that we weren’t going to give preference to one over the other.” In reality, it’s very challenging to make the correct diagnoses because patients aren’t going to tell us about their addiction issues.
Chana described a recent case where information was sought about a patient admitted to the mental health hospital on a court-ordered evaluation. Collateral information she received indicated that this person had a longstanding history of methamphetamine abuse, with no prior family history of mental illness, but with a very long, inter-generational history of drug and alcohol use. When she spoke to the professional in charge of this patient about why the diagnosis of schizophrenia might not be accurate in the face of such active addiction, she was told, “Well, I just want you to know that four or five people have seen this person over the last 15 years and every single one of them has agreed that this is the diagnosis.” As Chana says, “Well, you can call a giraffe an elephant for 15 years and get a whole lot of people to say that that’s what it is, but if a giraffe is a giraffe it’s not going to be an elephant, no matter how many people call it that!” Some of the challenges of drug abuse are that it’s so prevalent; it’s glamorized in social media; and many people don’t see it as a reportable component of their medical complaints. It’s difficult to treat if it’s not known. There are ways to improve treatment outcomes when we do know. We’ll discuss the involvement of a “Higher Power” next time.
Vernon and Louise Barksdale