Spotlight Series: Substance Use or Mental Illness?
Substance Use Disorder or mental illness, two separate categories, right? Eating Disorder or mental illness? What about Borderline Personality Disorder, Major Depressive Disorder, or mental illness? At IMF Counseling, we’ve been hearing this question more often since beginning The Intensive. Diagnoses often make the waters murky, and when assessing for appropriate services and placement, we often do not know where to start.
Our team at IMF does not differentiate between diagnoses when it comes to treatment planning. As we know, the answer to the questions outlined above is yes! Substance Use Disorder, eating and feeding disorders, and depressive and personality disorders are all included under the umbrella of mental illness. Societal and cultural stigma will try to separate depression and anxiety from a symptom of substance use and substance use from a coping mechanism for binge-eating disorder. This type of thinking and practicing leaves clients feeling split and leaves us as clinicians feeling confused. It doesn’t have to be this way.
We work with clients based on their presenting concern. We know additional concerns may surface as layers of awareness are peeled back and the original, reported levels of distress are given attention and soothed. Clients come to us for answers; we typically do not give answers. What we’re able and called upon to give is space – space for exploration of present-day symptoms, past experiences, and future anxieties. As we give that space, hold that flashlight to the beaten path for our clients, the next step often appears. We don’t need to tackle everything at once and in our experience, there’s really only one guideline to follow when deciding where to begin:
Safety first.
If a client comes to us expressing interest in outpatient services, we assess for safety, first, and client desire, second. Mental and physical diagnoses only serve to inform the treatment plan; they do not rule out care. If a client’s bio-psycho-social situation meets criteria for one to nine hours of therapy per week, we collaborate with them to determine appropriate services: individual, couple’s, or family therapy, group therapy, or intensive outpatient treatment. We then tailor that treatment to the client’s presenting concern. 9 times out of 10, the “treatment” looks the same: stabilize symptomology and get to work – this is called the bottom-up approach.
In our experience, clients are desperate for us to go to the places of pain with them so they’re not alone. In our work, important questions and areas of growth may include exploring attachment history, timeline of past events and emotional reactions to those events, maladaptive stress responses over time that have become ingrained and hard to see, and present hurdles to meeting basic needs of connection and comfort.
It is then from that place of safety they can begin to work toward behavioral changes. If we take the examples we started with, those changes can look like this:
- Substance Use Disorder: using less or less often as we evaluate whether sobriety or moderation is the goal
- Eating Disorders/Disordered Eating: less use of ED behaviors, evaluating restrictions and challenging them, and/or taking an honest look at exercise/movement behaviors to see what function they are serving.
- Borderline Personality Disorder: consider making changes in interactions with those around us to increase responsiveness and engagement rather than isolation and abandonment.
- Major Depressive Disorder: add some structure to the day so sleeping during the day happens only when necessary, not as an escape.
If your clients are seeking additional support, and The Intensive is not the best fit for them, we’d be happy to talk with you about other options and programs that may be more closely aligned with their needs and values. Send us an email or use this form to contact us.