Navigating the Path of Recovery: Empathy, Education, and Collaboration

A Collaborative Ecosystem of Healing and Therapeutic Techniques for Recovery:

In the diverse tapestry of human experience, the intersection of mental health and substance use challenges is an intricate and often misunderstood aspect. At Skyland Trail’s Dual Diagnosis program, clients from varied backgrounds and experiences find common ground in their shared struggles. Dual diagnosis treatment– in other words, treating an individual’s co-occurring mental illness(es) and substance use disorder(s) concurrently– is shown to be more effective than treating them subsequently, or one at a time. Having a mental illness increases the risk of developing a substance use disorder, and vice versa; other risk factors include a trauma history and a family history of addiction. A typical client may look like someone who has been using or was introduced to substances as a way to cope with the untreated symptoms of their mood, thought, or anxiety disorder; then became reliant on that substance; and then their substance use began to make their symptoms worse and significantly interfere with their health and their lives. Our Dual Diagnosis program has also supported clients who have a history of substance abuse that has contributed to the development or worsening of mental health symptoms. Finding the right treatment can be difficult and it is important to treat clients holistically. Without concurrent treatment, clients are at risk of making significant improvements in their mental health and then resuming unmanageable substance use post-discharge; or, gaining relapse prevention skills and not treating underlying mental illnesses contributing to the need to self-soothe with substances. 

Without psychiatric treatment, people often rely on behaviors that help them feel better or avoid pain or discomfort for even a short period of time. Those behaviors may include substance use, gambling, shopping, gaming, sexual behaviors, self-harm, etc. Part of Dual Diagnosis treatment is helping clients explore the link between mental health, substance use, and other addictive behaviors while providing psychoeducation about the long-term impacts of these coping strategies on their mood, health, and life. We aim to equip clients with tools that they can use post-discharge to respond to challenging emotions or urges in healthier, more sustainable ways. We really emphasize an individualized approach: What makes sense for them? How will they use these resources and tools independently in order to reach their goals and build a more fulfilling life?

One important strategy is to connect clients to recovery communities such as 12-step or sober living programs. An essential aspect of recovery from a dual diagnosis sense, and for mental health overall, is developing a community where clients can feel a sense of kinship and that other people can relate to their experiences. Having a space to share their stories and receive appropriate and positive feedback is critical for combating stigma and isolation as well as having connections with others who are building a life that does not center on substance use. 

After graduation from Skyland Trail, connection to a recovery community is crucial for clients to have ongoing support in early recovery. For some individuals, based on their substance of choice and dosage, post-acute withdrawal symptoms may last anywhere from 6 to 18 months. These symptoms can closely resemble those of mental health, including restlessness, irritability, mood ability, and anxiety. Our psychoeducation aims to establish a connection with each unique client, guiding them to discover the links between addiction and mental health. We foster engagement with recovery communities and discourage silent suffering. We help clients adopt skills to address substance-induced psychosis, impulsivity, or depression. Our flexible approach recognizes the diverse spectrum of client needs and aims to broaden their perspectives beyond dependence on temporary relief. 

Stigma, Myths, and Techniques to Overcoming Them:

One of the biggest culturally relevant myths that we see with our population is that it is not possible to be addicted to cannabis; we hear a lot of “it’s not a drug, it’s just a plant.” However, dependence on cannabis to manage mood, development of tolerance, and escalating, unmanageable use with negative consequences to mental and physical health, relationships, and other areas of life is a reality for many. Cannabis impacts the brain and body like other psychoactive substances and for some can increase risk and severity of depression, anxiety, psychosis, and mania, and withdrawal can be uncomfortable and prolonged. As cannabis becomes more normalized in society and legalized in a lot of states, individuals with a cannabis use disorder can struggle with feeling invalidated for needing support. 

Substance use is often shrouded in stigma and misconceptions, which hinder understanding and support for individuals facing these challenges. Some prevalent myths and stigmas include:

Moral Weakness: Many people believe substance use is solely a result of moral failure or lack of willpower. This oversimplification overlooks the complex interplay of genetic, environmental, and psychological factors.

Criminality: Substance users are sometimes unfairly labeled as criminals, perpetuating the idea that addiction is a choice rather than a medical condition. This view ignores the underlying neurobiological changes that occur with prolonged substance use.

Lack of Self-Control: People often perceive substance users as having no control over their actions. However, addiction rewires the brain’s reward system, making it challenging to quit without proper intervention and support.

One-Size-Fits-All: Stigma assumes that all substance users fit a single stereotype. In reality, individuals from various backgrounds and walks of life can struggle with substance use disorders.

Permanent State: Another myth is that addiction is a permanent state with no chance of recovery. Many individuals successfully enter remission with the right treatment and support.

Choice to Quit: The idea that someone can simply choose to quit overlooks the physical and psychological dependency that develops over time. It’s not as easy as just deciding to stop.

Lack of Treatment Efficacy: People might believe that treatment for substance use disorders is ineffective, but evidence-based therapies have proven to be successful in helping individuals achieve and maintain recovery.

Blame on the Individual: Often, blame is directed solely at the individual using substances, ignoring the societal factors that contribute to addiction, such as trauma, poverty, and lack of access to healthcare.

Isolation and Shame: Stigma can cause individuals to hide their struggles due to fear of judgment, which further isolates them and prevents them from seeking help.

Permanent Damage: While substance misuse can have serious health consequences, the belief that it’s irreversibly damaging ignores the body’s remarkable capacity to heal with the right interventions and support.

Stigma comes from a lack of knowing, either the facts and information or knowing somebody in recovery directly. In the U.S. specifically, mental health stigma and substance use stigma are still common, even while the rates of diagnosed mental illnesses and substance use are increasing. I have seen people gain new perspectives about substance use by listening to others’ stories, reading literature, watching movies, watching documentaries, or hearing interviews with people in recovery. Recovery is possible for everyone, and people are not disposable. Stigma can facilitate this ideology that other people can be dismissed or forgotten about. Everybody knows somebody with a substance use disorder, even if they are not aware. We have all been affected by addiction.

The Future of Dual-Diagnosis Care:

For a really long time, mental health and substance use disorders were treated separately from one another or sequentially, one after another. We know through research that dual diagnosis treatment – treating both simultaneously – is the most effective treatment for long-term recovery. 

Looking forward, there’s reason to be optimistic about the future of dual diagnosis care in society at large. As the field continues to evolve, evidence-based treatment is becoming more accessible and comprehensive, better meeting the multifaceted needs of individuals with co-occurring disorders. The vision is a landscape where integrated care takes center stage, addressing not only the symptoms but the underlying complexities that contribute to mental health and substance use challenges.

National Recovery Month is more than just a calendar event; it’s a reminder of the strength of the human spirit, the transformative power of compassion and evidence-based treatment, and the possibilities that arise when we come together. Skyland Trail’s Dual Diagnosis program exemplifies the unwavering dedication to providing individuals with the tools to rewrite their stories. As we reflect on the past and look ahead to the future, let’s stand united in our commitment to fostering understanding, embracing hope, and nurturing a culture of recovery.

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Sarah Overton, LCSW, is the Assistant Director of the Dual Diagnosis program at the Skyland Trail Adult Residential Treatment Program in Atlanta. With passion and experience in the field of complex trauma and recovery, Sarah is excited to continue the work of dual-diagnosis treatment.