Stigma: a mark of disgrace associated with a particular circumstance, quality, or person.
Stigma surrounds qualities that are shamed in our society. In our culture, people with mental illness and addiction wear one of the most prominent societal marks of shame.
But living with mental illness and/or addiction is not uncommon; According to the Canadian Association for Mental Health, one in five Canadians will have a mental health problem during his or her lifetime. And 40 to 60 per cent of people with a mental health problem will also have a substance use problem in their lifetime.
So with numbers so high, why is there still a sense of shame attached to having mental health problems and addiction?
Stigma surrounding addiction or mental illnesses comes from simple misunderstanding and lack of education. Years ago, people with mental illness would be locked away. People with addictions were considered hopeless. Over time, these attitudes and assumptions were supposed to have changed. But as someone who works in addiction and mental health, and as someone who has worn the same mark of shame, I can attest to the fact that the shame of having a co-occurring mental illness is alive and well.
Sensational stories in the press increase the degree of stigma attached to having a mental health issue and/or an addiction. We don’t have to look far to see this in action; someone with schizophrenia or psychosis hurting or even killing another person receives endless press. Unfortunately, the public understanding that the crime may have been a result of an illness is lacking. Who would want to admit that they live with depression, bipolar disorder or periodic episodes of psychosis when the societal view is that these conditions make people at best unreliable and at the worst dangerous.
What’s more is that even those who have to courage to seek help often face stigma from the hands of service providers or institutions who are supposed to help. As therapist Debbie Suian said,
“It takes an incredible amount of courage on the part of an already demoralized and suffering person to travel a path laden with the possibility of further rejection and disappointment. Along the way, even the most compassionate and caring therapist can forget the power of stigma until reminded firsthand of its sting.”
Bill Wilson, the co-founder of Alcoholics Anonymous lived with depression and faced the stigma attached to having both an addiction and mental health problem. The stigma of having a mental illness during his lifetime was already high but having both the illness of alcoholism and clinical depression was even worse. Both conditions were seen a s result of weakness, rather than illnesses with the possibility of recovery. Once he began participating in AA, the stigma of having an on-going mental illness was such that he still would not admit it. To have continuing difficulties beyond substance use meant you were not serious about recovery or the AA program. Instead, Bill kept his bouts of depression quiet and held a sense of shame about his inability to stop them.
As a person who has lived with both PTSD and addiction, I can attest to the need for greater understanding and compassion in both the recovery community and clinical fields of care. My recovery started with a doctor who demanded that I get treatment for my abuse of benzodiazepines, which I was taking to treat high levels of anxiety and panic disorder. Yes, it was true that I had become addicted. I knew that at the time, but I also realized that there wasn’t an available alternative to help me to cope and dull the constant fight or flight feelings that were ruling my life. The pill use at the beginning was a relief; I finally had a reprieve from my most troubling symptoms. But it was a case of double trouble. I now had to contend with a growing dependence on chemicals to get through each day, and still did not get much understanding or support for my mental health condition.
I did go to treatment. I went off all of my pills cold turkey. I will never forget being admitted to the 28-day program and thinking, as I was sitting in the waiting room, that I was having a psychotic break. Over the first few days and weeks, I watched other people seemingly get better physically and mentally. As far as I could tell, my recovery lagged far behind. As my abstinence progressed, my panic increased to the point where, after I completed treatment, I could barely get out the door to attend a meeting or get to a therapy session. And now had a depression settling in, which complicated the progression of my recovery. I did not feel understood either in addiction treatment, self help groups or by mental health professionals.
It took a year of clean time to start dealing with the underlying anxiety and get the right help. I was fortunate to connect with an addictions team that was working with a range of interventions: addiction counselling and therapy, 12-step work, mental health recovery and spirituality. I was diagnosed with PTSD and for the first time, understood the relationship between my mental health issue and my addiction: co-occurring disorders.
What behaviours contribute to stigma surrounding addictions and mental illness?
Stereotypes: Stereotypes perpetuate the view of people with mental illness and addiction as dangerous. They paint people as the hopeless addict alcoholic. They depict people with addiction and mental illness on the street, using needles and remaining oblivious to those trying to help them.
Assumptions: Assumptions that people with mental illness and addiction are not working hard enough to get better or are not motivated are very harmful. People may be seen as lazy, not committed or in denial about their addiction or mental illness. People who could be supportive don’t understand the connection between mental wellness and substance use and sometimes reinforce the idea that the addict is not working his or her program.
Lack of awareness in services: Services that treat both addictions and mental health issues may be inadvertently discriminatory or restrictive—if they exist at all. Service providers in the agencies may subconsciously carry those pervasive stereotypes and fail to help and support the people who most need it.
Social isolation: People living with mental illness and addiction are more likely to live in isolation or at the very least try to hide and conceal their struggles. The person may not even know that they have a co-occurring disorder, but simply feel that something is very wrong inside of them and choose to isolate themselves.
Antagonizing medication: I recently watched the Russell Brand video, From Addiction to Recovery, which I thought was very good. However, I was disappointed that Brand appeared to deem all medication potentially dangerous and addictive. This perspective, which can end up in the 12-step club room, says that all drugs are bad–even those that treat depression or anxiety. This attitude can further stigmatize those who need to take them. The attitude that all medication–prescribed or otherwise–is bad may also influence some people to be non-compliant with meds and then compromise both their abstinence and mental health stability.
Lack of information and resources: It can be difficult to find services that treat both an addiction and a co-occurring disorder simultaneously. As I pointed out earlier, I was very lucky to have a team that worked with me on both my addiction and anxiety disorder. I would have very likely relapsed without this kind of understanding and support.
Organizations and alternative support groups have developed in response to the particular needs of people living with co-occurring disorders. They provide information and a sense of community to those who may not get all of their recovery needs met in the more mainstream 12-step groups. Support groups like Double Trouble Recovery and Dual Recovery Anonymous, use the 12 steps as a main focus and help their members to stabilize and recover from the dual conditions involving mental health and addiction.
Treatment programs that address both mental health and addiction are critical. I have worked in systems for both mental health and addictions where only one condition was treated at a time. This presented people with a fragmented recovery process that left them struggling to stay afloat mentally, spiritually and physically. Drug and alcohol treatment programs must also treat mental health conditions and likewise mental health programs must be able to recognize and respond to addiction issues.
Aurora Recovery Centre does both. We have programs for people from all walks of life who live with both illnesses. Our staff are competent in both mental health and addiction, treating co-occurring disorders with the models of recovery that work. We are an organization that provides individualized treatment plans, which will emphasize either the mental illness or the addiction as primary. We provide evidence based interventions like DBT, CBT, EMDR and Mind Body Bridging that directly address trauma and mental health. These are treatments that will reduce the likelihood of relapse into a mental health crisis or substance use addiction.
I know from my own experience that mental health and addiction often operate hand in hand. I want those who are struggling with these to have the chance that I had, to not just be abstinent from drugs and alcohol and be stable, but to thrive and realize their dreams. This can happen when we have integrated supportive programs, but these are not enough. Let’s end the stigma attached to co-occurring disorders through education and compassion.
— Tracy Fehr, Addictions Counsellor