When mental health and addiction collide

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Which comes first, a mental health issue or an addiction?

There’s no one answer; it depends on the individual’s circumstances. Here’s an example to illustrate: Jack became depressed after he lost his job and his partner, and after several weeks he turned to alcohol as a means to cope.

Regardless of what comes first, when a person like Jack develops a mental health disorder and an addiction at the same time, it’s called comorbidity or concurrent disorders. A specific behaviour or the use of a substance becomes a problem when it impacts negatively on a person’s health, relationships, and performance at work. The frequency, duration and intensity of the behaviour or use – and its consequences – determines whether the addictive behaviours meet the criteria set for a subtype of mental health disorders called substance-related and addictive disorders.
Awareness
A person with a mental health disorder is twice as likely to have a co-occurring substance use problem as the average person. Different drugs have different chemical molecules that influence how effectively the brain works regarding making decisions, self-control and compulsion.
If you’re concerned about your mental health or that you may be at risk for an addiction to alcohol, drugs or gambling, complete the Drugs-Alcohol-Gambling (DAGS) self-screening tool for some insights on your current risk and recommendations for action. The Centre for Addiction and Mental Health (CAMH), Canada’s largest mental health and addiction teaching hospital, has endorsed self-screening tools to Check Your Drinking or Check Your Gambling. Of course, the purpose of these kinds of self-screening tools is not to self-diagnose; rather, to increase your own self-awareness and decide if some form of action is warranted.
Obtaining information about alcohol and drug services available to you may be the first step. Health Canada has a website available with a number of resources listed by province. In Ontario, there is a provincial Alcohol and Drug Information Linewith Canada-wide resources and a free confidential information line that is available 24/7, which provides more options specific to your needs and location. Both websites provide links to specific outpatient and inpatient/residential programs that can be contacted directly, such as the Centre for Addiction and Mental Health (CAMH) and Edgewood Health Network (EHN) – Bellwood, as well as other options.
Accountability
We all own our mental health, whether it’s good or bad. There’s no magic pill or instant solution to mental health and addiction problems. The first step is admitting to yourself that you have an issue and that your current coping strategy is not working. Denial, shame and fear are normal responses that can make it hard for some to ask for or seek help for themselves.
If you do need help, understand that professionals who work in addictions are experienced dealing with people thinking and feeling the way you do. Know that you are not alone. Each year, millions of people with comorbidity issues seek help and, with some work, dedication and collaboration, are able to get their mental health back on track.
Action
If you may be at risk for a comorbidity issue, it is important for you to decide to ask for, and accept, help.
Never self-diagnose – The mind is powerful, and self-talk can fool us, especially when an addiction, or a risk for one, is involved. If you’re concerned, that’s enough to move from an internal conversation to having a real open and honest talk with an addictions or mental health professional or your family doctor.
Accepting help is a sign of strength – If you are driving to work and your car breaks down, calling a mechanic to help get you back on the road is a smart plan. No one is judged for calling a mechanic, but stigma can paralyze some people from ever asking or accepting help for their addiction and mental health issues. They remain stuck and at increased risk of both their addiction and mental health issues worsening, as well as increased risk for those issues having a negative impact on their health, career, and relationships.
Asking for help and accepting it is a sign of strength and bravery. Typically, you’re not the only person who is suffering because of comorbidity. By being responsible to yourself, you are often also being responsible to your loved ones as well.

Deal with one thing at a time – Set realistic expectations, and understand that regaining your health will take time. It’s common for a person who struggles with a mental health issue and addiction to expect things to get on track fast, once they get the addiction under control. Health and change will come step by step, one day at a time. How many days it takes is not as important as following your recovery plan daily. What you do today and the choices you make, no matter how small, help create a forward momentum towards your future. Yes, day 143 typically is easier than day five.

Few people can correct an addiction and mental health issue overnight, but small moment-to-moment choices can lead to big changes in the long run. Allow yourself time to heal, grieve and grow – and with time, you will. Many people have made this challenging and worthwhile journey; it’s not easy, but it is possible.

Bill Howatt is the chief research and development officer of work force productivity with Morneau Shepell in Toronto.

Hester Dunlap is a Clinical Psychologist at Edgewood Health Network (EHN) – Bellwood in Toronto.

Lisa Couperthwaite is a Clinical Psychologist at the Centre for Addiction and Mental Health (CAMH) Work, Stress & Health Program in Toronto.

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