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Complex cycle of substance abuse and mental health and why it’s so hard to unravel
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“It was almost manualized,” said Avita Chief Clinical Officer Lori Holbrook as she explained mental health treatment from 40 years ago.

It didn’t matter what the mental health disorder was; the way to treat clients was formulaic.

Not anymore.

Due to the increasing abuse of substances as a way to self-medicate, medical professionals, counselors and law enforcement have had to go back to the drawing board to navigate the complex issue of substance abuse and mental health treatment.

“You almost cannot have a substance abuse diagnosis without a mental health diagnosis,” said Holbrook.

Treatment centers like Avita Community Partners constantly have to modify their treatment approaches to keep up with the rapidly advancing addictions facing communities.

“It is so multilayered how it affects us,” said Holbrook. “As providers it affects us because we modified our assessments even, so that we’re not neglecting.”

Mental health and substance abuse treatments used to be differentiated, but in recent years the umbrella term “behavioral health” has been adopted due to the increasing overlap in diagnoses.

Most of Avita’s clients are co-diagnosed and providers can’t afford to treat each diagnosis separately because it’s a cycle where one affects the other, according to Holbrook.

Counselor Joe Stapp of Blue Ridge Counseling also sees a strong correlation between mental health and substance abuse when he sits down with clients.

“More often than not… I’m thinking ‘what drug,’” said Stapp.

When talking with clients battling depression, anxiety and other mental health disorders, Stapp will often ask what drug they use to self-medicate, he said.

Self-medicating is a way to escape, and with illegal substances readily available in the community it’s become even easier for those needing treatment to find a remedy for the pain they are escaping.

Dawson County Treatment Court Coordinator Suzanne Stanley believes many addictions stem from past traumas and the inability to cope with them in a healthy way.

Most treatment court participants are also co-diagnosed and seek treatment for both their substance addiction and their mental health disorders in the two and a half year long mandated treatment program.

“A lot of it is environmental so if you go through a traumatic event as a small child then, you know, you’re not taught how to cope with that event or maybe your parents didn’t educate you on how to have healthy coping mechanisms, so then as a teenager you’re introduced into alcohol or drugs,” said Stanley. “You think ‘Oh wow, this feels good,’ ‘I don’t have to think about this event that happened to me,’ or, ‘I can numb out the pain I feel from this event,’ so then you start using drugs and alcohol and it just kind of snowballs out of control.”

Eventually, the suppression of feelings and self-medicating with substances to deal with past traumas like physical, mental, and sexual abuse and sudden, tragic deaths or accidents, will come bubbling up to the surface, Stanley said.

“It’s not something to be ashamed of. Everybody has something. You wouldn’t be ashamed if you had diabetes or cancer… with addiction you don’t hear that or see that. It’s not something to be ashamed of. It’s an illness,” said Stanley. “No one knows how they would handle a situation until they’re put in that and yes, maybe at first it is a choice. They choose to take that first drink, to smoke that first joint, but then they’re no longer in the driver’s seat. They’re a passenger on the train of addiction and it’s out of control.”

It’s not any easier to deal with on the law enforcement side of it as the Dawson County Sheriff’s Office comes into contact with self-medicating individuals on a daily basis.

“It’s not as clear and defined as black and white,” said Dawson County Sheriff Jeff Johnson. “A lot of people self-medicate. They’re looking for something to help with the issues they’re having, so that drives them to look for different remedies, so to speak, escapes, so it’s very complex.”

Johnson realizes that his department will be in contact with individuals in the community who are facing a two-pronged battle that has had an effect on adapting policies and training to deal with individuals who might be struggling. Individuals with mental health disorders coupled with self-medicating on illicit substances can lead to dangerous situations for both themselves and officers.

“It’d be real easy to look at it from a law enforcement perspective and say, ‘Let’s put them in jail and throw away the key,’ but it’s not that simple. It’s far more complex,” Johnson said. “At the end of the day, I think anything we can do to help our brothers and sisters, so to speak, and realize that whether it’s jail, whether it’s treatment, whatever the case may be, trying to provide some form of relief.”


Editor’s note: This is the third article in the Dawson County News’ continuing series on the Dawson County Substance Abuse Coalition.