Before COVID even started, mental health professionals already knew that there was a high correlation between substance use and mental health issues. According to SAMHSA (the Substance Abuse & Mental Health
Services Administration), 83% of people with a substance use disorder also have a co-occurring mental health issue. Add COVID to the mix — not to mention a recession and societal tensions — and the number of individuals seeking treatment for depression and anxiety has risen considerably.
“Often, when a person has a mental health or substance use issue, there is a natural tendency to disconnect and withdraw from others,” says Chris Tuell, Ed.D., LPCC-S, LICDC-CS, Clinical Director of Addiction Services at Lindner Center of HOPE. “During COVID, people had to isolate, which resulted in cutting off a lot of important personal connections, and that lack of connection has become problematic.”
Jason Thompson, LIS W-S, LICDC-CS, Clinical Director, Intensive Outpatient Program, Therapist with Lindner Center of HOPE, has witnessed the same trend in the Intensive Out- patient Program (IOP) that he runs for co-occurring disorders (addiction and mental health).
“With addiction, there’s so much self-deception, denial and isolation,” says Thompson. “One of the remedies for that is connection with other people.”
During the early stages of the pandemic, in-person connections weren’t possible, including support groups. Although many of these groups shifted to an online forum, not everyone utilized them.
“As a whole, relapse, overdose and suicides increased,” says Thompson, who focuses on skill building in the 12-week, 36-session IOP that meets three times a week for three hours. (To be in IOP, the patient must complete at least nine hours weekly.) In addition, they must attend three mutual support group meetings a week and comply with their medication.
“The IOP is psychoeducation and group therapy,” says Thompson. “An IOP can serve as someone stepping out of residential treatment, or it could be someone’s primary course of treatment.”
Connection is also crucial in residential treatment. When disconnection happens in our general society, Tuell explains, what follows is indifference, a lack of empathy, and a lack of understanding of one another. Then fear sets in, followed by paranoia, anger and hatred.
“This dynamic in our society has grown in the last couple of years, and for people with mental illness, this is devastating,” says Tuell. “They become increasingly disconnected, and what they may experience in society strengthens some of that distortion, so they isolate even more.”
What is Addiction?
“No one is protected from addiction because of their age or position in life,” says William Hartmann, M.D., FAPA, Chief of Adult Psychiatry and Medical Director of Williams House.
People often use alcohol and substances to unwind, blow off steam or cope with a problem.
“Although the substance may provide temporary relief, it tends to set them up for much more pain, discomfort and suffering in the long run,” says Thompson. “For most there is nothing in life that a drink or drug can’t make worse.”
There are signs that indicate when a behavior is becoming problematic — namely, frequency and duration of use. Ask your- self the following questions: How often are you using? When are you using? Has your tolerance increased? Are you preoccupied with it? Are you putting yourself in physically hazardous situations?
“Often times, people initially use alcohol, in particular, to be social, but if you’re now drinking alone, that’s a red flag,” says Thompson.
Also, are you experiencing any physical withdrawal, such as anxiety, sleep disturbance/insomnia, or nausea? Are you lying about it, hiding it, or have you ever stolen for it?
“One of the major things we see with addiction is the continued use despite negative consequences,” says Tuell. “A person with an addiction may know they could lose their job, marriage, or freedom [jail], and they do it anyway. That’s the true essence of addiction.”
It’s a loss of insight. For instance, a person who gets a DUI may claim that a deer ran out in front of them. They find ways to rationalize their behavior. That’s some of the self-deception that goes into this disorder, which is precisely why open, honest communication is so critical.
“If someone is anxious or depressed and is willing to talk to a friend or family member, that’s huge,” Thompson says. “Get them help when they’re willing to talk. As treatment unfolds, other stuff will come out as long as somebody is connected. The patient may start to connect the dots to think, ‘Oh, maybe my use is a problem.’ But if they are not talking to anyone and not getting comfort and relief, they’re certainly getting it through the substance on the front end.”
Breaking the Stigma
Educating the family about addiction is also an essential piece of the puzzle.
“It can be a bit of a relief when families learn that [the addiction] is not their fault,” says Hartmann. “They can learn how to avoid enabling their loved one and be supportive.”
It’s good for families to understand that addiction is a disorder like any other biochemical disorder in the brain.
“Understanding helps break the stigma associated with this idea that the [person who is using] is weak,” says Margot Brandi, M.D., Medical Director of Sibcy House, a specialized short-term residential treatment program for adults. If a friend, colleague or loved one is experiencing an addiction, step one is to get an evaluation to determine the severity of the substance use and the comorbidity with other mental health issues to establish the needed level of care.
“That’s the key to success in avoiding relapse and frustration when people think, ‘I tried treatment, and it didn’t work,’” says Brandi.
Some patients may undergo psychotherapy or add an IOP, for example. Others may need to detox first and could benefit from an extended residential stay.
“We’re always thinking longer term when the severity is present,” says Brandi. “We say 90 days is the magic number be- cause it’s about what we can offer that’s going to put the patient in a place of success even though relapse is part of the journey in any recovery.”
The reality is, however, that with relapse comes regret, guilt, and shame, which can make it even more difficult to re-engage in treatment. That treatment is crucial, however, not only for the individual but also for the family members. Thompson speaks of an old commercial that the Alcoholism Council put out in which an entire family boards a rollercoaster. The first time on it, ev- eryone has a great time. The ride keeps looping, however, not allowing anyone to get off, and of course, the fun is lost.
“With addiction, the family is along for the ride, too,” says Thompson, who recommends that relatives seek therapy to un- pack issues and heal. “Living with people who struggle with addiction and severe substance use disorders causes massive destruction.”
Plus, if addiction has been in the picture for some time, it becomes normalized in a family system.
“Later in life, a family member may look back and see how unhealthy a family dynamic was,” says Tuell. “But when it’s some- thing they have lived with for years, they grow accustomed to it. Therefore, part of therapy is helping them with that awareness to address that unhealthiness.”
At Lindner Center of HOPE, professionals can help individuals along their treatment journey as they offer all levels of care, from intensive outpatient to intermediate to residential care.
“We want people to understand that it’s okay to take care of your mental wellness,” says Tuell. “That stigma surrounding get- ting help is improving, and more people are seeking treatment for their mental health.”
Do you or a loved one need help battling addiction? Visit lindnercenterofhope.org. Lindner Center of HOPE is located at 4075 Old Western Row Rd., Cincinnati, Ohio 45040.