By Marvin Ross

With apologies to Frank Sinatra who sang that tune. I have no idea who decided that mental health (a euphemism for severe and persistent mental illness) and addictions needed to be considered together but it is as counterproductive as combining cancer and heart disease. Severe and persistent mental illness and addictions are two distinct groups with some overlap.

Severe and persistent mental illness involves a number of conditions like chronic depression, OCD, bipolar disorder and schizophrenia with symptoms and treatments that are mostly distinct for each. Addictions involve the compulsive use of various substances despite adverse consequences. Genetic makeup can predispose some to becoming addicted.

The overlap are those with severe and persistent mental illnesses who also use substances mainly, in many cases, to self medicate their symptoms as they are untreated by doctors. In other cases, they may use in an attempt to free themselves from the boredom and futility of their lives. We treat those with mental illnesses briefly in hospital and then discharge them with little or no regard for the adequacy of housing, community treatment and meaningful work let alone financial resources. Alcohol or drugs can help give them some pleasure until they take over and their lives then spiral down even further.

To illustrate that mental illness and addictions are unique conditions, the Pew Charitable Trust in the US recently looked at the arrest records for the general population, those with mental illness only, addictions only and mental illnesses and addictions combined. Those with neither a mental illness nor an addiction had an arrest rate of 1% from 2017 to 2019. The arrest rate for those with only a mental illness was 2% while 9% of those with addictions were arrested in that period. Combining mental illness and addictions, the arrest rate went up to 12%.

Imagine the impact on the individual with only a mental illness when thrown together with those with addictions. Sadly, I’ve seen that and as I mentioned in a previous blog on supportive housing, someone who had been free of drugs for a number of years was influenced by the addicts he was housed with to go back to using and died of an overdose.

Aside from that, people with treated schizophrenia tend to be the victims of aggression rather than being violent. If they are untreated, they can be and often are aggressive but otherwise they are not. If we use arrests as found by Pew as a proxy for violence then those with addictions and combined mental illness and addictions are much more violent than those with severe mental illness. Putting people who are aggressive together with those who are passive is a prescription for trouble. That is something that I have seen.

What Pew also found was that very few of those with co-morbidities (10%) received treatment for both although as Pew said  “research demonstrates that simultaneous, coordinated treatment for multiple diagnoses produces better outcomes compared with separate treatment for only mental illness or substance use disorder.”

Kicking an addiction is not an easy task but the best motivator is having a strong desire and reason to quit. Without that, it will likely not be successful. I gave up smoking two packs a day after failed attempts because of a wife with asthma and a newborn. I had referred a few people to the person who helped and he refused them as clients because he did not feel they were sufficiently motivated. Without that motivation, success would have been difficult.

Nicotine is as difficult to stop as heroin but many do quit and, as I’ve mentioned before, people can kick heroin and other drugs. During the Vietnam War, many US servicemen were addicted to all sorts of drugs and the US was concerned that they would return to the States and continue. Most quit easily because they were out of a war zone and returned to normal lives. The point is that the soldiers had the potential to stop that behaviour which they voluntarily entered into in the first place. No one voluntarily decides to embrace a severe and persistent mental illness and to then leave it.

People I know who have been successful only managed because they had families who had the financial resources to utilize very expensive private programs.

Addiction is a problem for the addicted, their families and society as is mental illness. The option that serves all best is to provide evidence based treatment specific to each and to end muddying the waters by talking about this amorphous creature mental health and addictions. Currently, treatment and adequate resources for the mentally ill is rare and even more rare for those addicted. Instead of sufficient programs to help people quit, we focus on harm reduction which means we encourage people not to overdose and die. That avoids the real issue of rehabilitation and recovery. A dead addict is not a good candidate for rehabilitation.

Mental illness and addictions are unique and require dedicated well resourced strategies to help those who suffer. What is known to help mental illness is inadequately funded. What can help addictions for those who want help according to some experts is this. “Treatment” is based on persuasion and social pressure to stop people from using and to stay clean. The most powerful and successful forms of this are very costly and is not provided through public health but should be if we want success: This involves removal from all bad influences and sources, fulfilling and supportive and friendly activities filling every day, life style change (diet/exercise/mindfulness), all lasting at least a month in a resort-like setting far from the city, with good counseling, group counseling, and medical follow up.