It was a wonderful surprise to see the Duchess of Cambridge’s unannounced engagement at Her Majesty’s Prison Send on September 25, 2015, where she met with inmates and ex-offenders who receive treatment for alcohol and drug addictions. This visit is part of the Duchess’ “autumn programme” which emphases her focus on “early intervention, mental health, and addiction” (@KensingtonRoyal, 9/26/15). The engagement was organized with the assistance of the Rehabilitation for Addicted Prisoners Trust (RAPt), a charity that provides case management, group intervention, and 12-step programming services in 25 prisons in England.
In light of Kate’s recent visit to HMP Send and the statement she released after the engagement in which she noted the role addiction plays in social issues, let’s look at the mental health aspects of addiction this month.
Fact: Addiction IS a mental health concern
Both the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), which is used by psychiatrists and psychologists to diagnose patients with mental health disorders, and the World Health Organization’s International Classification of Diseases, Tenth Edition (ICD-10), which is used by epidemiologists and other clinical specialists, diagnose the use and dependence of patients of drugs and alcohol as mental and behavioral disorders. Moreover, most of these substances have significant effects on the brain and behavior once consumed – causing alteration in mood, emotion, mental processing, and behavior regulation, among many other activities. In other words, drug and alcohol use and addiction is a mental health issue.
Further, not only is addiction in and of itself a mental health concern, but there is an extremely high rate of dual diagnosis – that is, there is a notable percentage of people with mental health disorders who ALSO have a substance use disorder. Additionally, some people with mental health concerns start, and then continue, to use substances as a way to self- medicate their mental health problem. For example: someone who has Social Anxiety Disorder starts drinking alcohol at social events in order to “loosen up” and feel less anxious in social situations. Rather than seeking treatment for the social anxiety (or effective behavior management strategies), he or she continues to use alcohol, and is thus self-medicating their social anxiety problem. Appropriate treatment in instances of dual diagnosis requires treating both the mental health disorder and the substance use disorder, and is infinitely more complex.
Fact: You can be addicted to things OTHER than drugs and/or alcohol
When speaking about addiction, most conversation or articles that you come across tends to speak about alcohol and drug addiction. Unfortunately, it is also possible to become addicted to things other than these substances, and these addictions are equally as devastating to those affected.
The most recent version of the DSM now includes a diagnosis for gambling addiction – and if you have spent any time in a Las Vegas casino recently, you may have seen pamphlets for hotlines on problem gambling (by Nevada Gambling Regulation, casinos are required to post or provide the hotline number and information on problem gambling near the cage or ATMs). Sexual addictions have also recently been in the news, thanks to Tiger Woods and other celebrities, but there are other addictions that are just as risky such as addiction to food, spending money, and excessive risk-taking. A notable addiction that hides behind the mask of “good health” is an exercise addiction – this can involve overexercising, refusing to skip a workout even when risking physical health (such as when you have a cold or risk possible injury), obsessing over how long you workout/how far you run, etc.
One of the sneakiest things about addictions is how easily one addiction can be traded for another. A typical story is often heard in rehab environments, in which patients with addictions to drugs or alcohol are working on their sobriety, and stop using their substances of choice, only to start smoking cigarettes and drinking A LOT of coffee – their new addictions being to nicotine and caffeine.
Fact: Alcohol is a socially acceptable drug and this fact can challenge recovery for addicts
One of the hardest things for those dealing with an alcohol addiction in our society is just how socially entrenched alcohol use is. After all, what is New Years’ Eve without champagne, Christmas without eggnog, or Sunday brunch without mimosas? What is Sex in the City without Cosmopolitans, James Bond without martinis, or Scandal without wine cardigans? What is football without beer, the Kentucky Derby without mint juleps, or rugby without mini white wine? What is a trip to Napa, California without a wine tasting, Ireland without Guinness, or sushi without sake? Alcohol is a part of our society, our rituals, our celebrations – it’s even a long-standing part of our history. Alcoholic beverages have existed since the Neolithic period (10,000 BCE), according to C. H. Patrick (1970).
Now imagine being unable to be a part of that, or imagine having to find a new way to be a part of that. That is what recovery is.
Fact: Treatment for addiction is long and complex, and is truly an individualized process
The most commonly known treatment route for those with substance use disorders are 12-step programs, such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), amazing nonprofit groups that work to help members stop substance use and find ways to live substance-free lives. Beyond AA and NA, the first and most important step on the road to treatment is the establishment of sobriety, and at times this requires the input of a medical professional or even hospitalization. Psychiatrists can be part of the treatment team for a recovering addict in providing psychotropic medication, especially in cases of dual diagnoses patients as mentioned above. Psychologists and group therapists often are part of the treatment of addiction by identifying and treating the root causes of the addictive behaviors. For example, what is the family dynamic that led to substance use? What were the interpersonal, financial, legal, and other stressors that the person was dealing with that led them to use substances? Are there anger or loss issues that need to be addressed in a healthier manner? Finally, depending on circumstances, case management or wraparound services are also needed for those suffering from addictions, and these can be provided by trained social workers, who can help with issues such as housing, finances, and unemployment.
Beyond the treatment of an addict him- or herself, there are even resources for family members of those with addictions. Family therapists can work with the entire family to explore the impact of the addiction on the family system, while groups such as Al-Anon and Alateen offer support and guidance for family and friends of those with substance use issues.
The Duchess of Cambridge’s patronage of Action on Addiction and her recent visit to the RAPt addiction treatment program at HMP Send bring much needed publicity to the problems of mental health and addiction in our society and within our prison systems. Let’s use this time to further educate ourselves, raise awareness, and increase compassion for those who battle with addiction.
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