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The Counseling Center

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Substance Use Disorders and Mental Health

Max Liles, Senior Director, The Counseling Center

The title alone says it, “and”; Substance Use Disorders AND Mental Health–two separate things. Personally and professionally, there is a distinct designation that people make between the two. Whether it be through their own lived experience, what they’ve been told by someone in the field, or what they have been taught in school–the division exists.

Fun fact: All these diagnoses come out of the same book – the Diagnostic and Statistical Manual of Mental Health Disorders (currently in its 5th edition) AKA the DSM5; a publication of the American Psychiatric Association.

So why the division? Is there a distinct division between substance use disorders and every other mental health disorder? Are some disorders acceptable and others aren’t? Are professionals more qualified to treat certain disorders than others?

First and foremost, the reference material, the DSM, does place substance use disorders in their own category. With that being said, the DSM also groups other similar disorders: Psychotic Disorders; Bipolar Disorders; and Sleep Disorders–to name a few.

The DSM makes no hesitation to acknowledge that substance use disorders, while similar in the way substances play a role, have much more to them than the substance itself. The DSM states (p. 483), “The essential feature of a substance use disorder is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems.”

Note: Before it even mentions the substance, the manual lists the cognitive, behavioral, and physiological implications of this group of disorders. 🤔 Sounds mental-health-ish…

Further, the DSM cites on the same page that “An important characteristic of substance use disorders is an underlying change in brain circuits that may persist beyond detoxification, particularly in individuals with severe disorders.”

Note: Wait–“underlying change in brain circuits”; is this a brain thing? Did they just call this a brain disorder?! And even if I dry out, like quit using, I am still going to have symptoms?!

While substance use disorders have a category based on the similarities they share as it pertains to the use and abuse of substances, are these disorders really such an anomaly that they need to be referenced independently of all other mental health disorders? And if so, or if not–how did that wind up happening?


Problem definition defines intervention.

By education, I am a Masters level Social Worker, an alumnus of Ohio University (OU? OH YEA!). During my time in grad school at the main campus, I learned a lesson that I think can shed some light on our topic: “Problem definition also defines the intervention.” (Shout out Dr. Sarah Garlington–I hope you read this).

With substance use disorders–people’s perceptions of the root of the problem can be various; is continuously using despite consequences in your life a choice? A disease? A moral failing? A criminal issue? Is the person possessed?

Based on your answer to that question, the way you address that problem will be different. If defined as a criminal issue, a judicial approach will be best suited. If the person is possessed, you’re going to need an exorcist. If the issue is of moral failing, the person may be perceived as weak – doomed to repeat a cycle of using and causing harm to themselves and others forever.

As the problem is inappropriately defined, the intervention does nothing to address the problem; further perpetuating the ideology “once an addict, always an addict”.

If the issue of substance use is defined as a medical issue–we can treat it like the disease it is.

The integration of primary health care can be implemented; medication utilized to help physically and mentally stabilize individuals with the disorder; integrated teams of counselors, social workers, and recovery support can develop treatment plans that implement evidence-based practices as an intervention–healing can happen.

While even the language used by professionals within the field can highlight this perceived division between mental health and substance use disorders–I think it is important to remember that, at the root of all of us within the social service and healthcare realm, we got into this to help people. While we may individually have a population that feels like our calling, it is the wellbeing of people, for humanity, that pulled us into this field.

This model–a medical model–that is comprehensive and empathetic in its approach is paramount in improving the mental health of people, regardless of their specific disorder. A model where disorders are not singled out or stigmatized, but people are treated as people experiencing an issue. A model that provides folks access to resources to get well, as an entire person.

I encourage you to follow us on Facebook and Instagram as we continue to share our thoughts and practices in the business of Mental Healthcare. If you or someone you love is in need of behavioral treatment of any kind–reach us at 740.354.6685.

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The Counseling Center is the region’s leader in behavioral healthcare. Our licensed behavioral and primary healthcare providers employ advanced treatments to help our patients achieve long-term mental and physical health goals. We are leading the way in shaping positive outcomes for mental health, substance use disorder, physical health, and recovery housing.

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