Substance Use Disorder is a Mental Health Disorder
By Kevin Doyle, EdD
NOTE: This was published for the Hazelden Betty Ford Foundation’s monthly Recovery Advocacy Update. If you’d like to receive our advocacy emails, subscribe today.
For far too long, substance use disorders (SUDs) have been positioned as separate from mental health disorders. In fact, the term “behavioral health” has emerged to capture both mental health disorders and substance use disorders. While likely well-intentioned, the continued bifurcation of these terms risks holding back the legitimacy of treatment for SUDs and slowing progress on reimbursement and employment policies, among other important considerations.
We already refer to addiction (a severe substance use disorder) as a brain disease. And the diagnostic criteria for substance use disorders are already published in the Diagnostic and Statistical Manual of Mental Disorders, alongside all of the recognized mental health conditions. Yet, funding streams, the infrastructure of our professional institutions, and our common terminology continue to sustain distinctions that are often unnecessary at best and harmful at worst.
For example, in my career as an addiction counselor, counselor educator, and counselor licensing board member, I have experienced several instances in which students and employees working in substance use treatment settings were encouraged or even mandated to “broaden” their clinical experiences (i.e. practica and internships) under the rationale they were not prepared to treat a wide range of patients/clients without doing so. Such a directive would never be given, in my estimation, if an individual was working for a center that specialized in the treatment of depression or bipolar disorder.
The ugly double-standard persists: practitioners with preparation in the so-called mental health arena, with no experience working with people with SUDs, are permitted to do this challenging work without much question, while those who have worked extensively with people with SUDs are not afforded the same opportunities to work with patients/clients who have mental health conditions.
Ethical requirements, of course — whether for counselors, social workers, psychologists, or physicians — specify that a clinician should not work with diagnostic groups for which they are not prepared through combinations of education and experience. This is a noble, even critical, requirement or admonition, but it is also perhaps unrealistic in that there is no way any clinician will ever gain experience working with the unique characteristics of every possible patient/client. That’s one reason having adequate, professional supervision is so important in the mental health (inclusive of substance use disorder treatment) environment.
Unintentional consequences of this separation between mental health treatment and substance use disorder treatment, of course, also manifest themselves in even more damaging ways when access to treatment is restricted; “relapse” (or return to active use) is seen solely as voluntary, willful behavior (contrast that to how a return of depressive symptoms is viewed); or job applicants are held to an entirely different set of standards due to their history of SUD as compared to their mental health history (perhaps because we criminalize SUD but not MH!).
In actuality, substance use disorder IS a mental health disorder — and it is time we treated it as such, and not as something less, shuttled off to the stigma corner of willful behavior.
Kevin Doyle Ed.D., is the president and CEO of the Hazelden Betty Ford Graduate School of Addiction Studies in Center City, Minn.
