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Is it Mental Health or Addiction?

Generally speaking, individuals who abuse drugs or alcohol will present with psychiatric symptoms also. These may include: sadness, irritability, mood swings, sudden or rapid shifts in personality, pressured speech, poor judgement, poor impulse control, difficulty reasoning, and sometimes difficulty with reality testing including hallucinations and delusions. Due to changes in personality functioning it is not uncommon to hear the term “borderline” used.

When investigating options for addiction treatment it is important to know what their licensed to treat.  Some facilities are only licensed to treat Mental Health disorders while others are licensed to treat only addiction. There are also others that are licensed to treat both mental health and addiction also known as co-occurring disorders or dual-diagnosis. A treatment center can identify themselves as being “dual-diagnosis” by virtue of having a psychiatrist on-staff. It does not mean that they are the best option for particular needs.

Determining which came first (the addiction or mental health) disorder is very important in order to guide treatment. Not necessarily challenge whether a problem exists. If you are reading this article chances are a problem exists. Some mental health disorders require a higher level of care (i.e., acute inpatient) treatment in a locked facility that has 24-hour nursing staff, psychiatric technicians, social workers, psychiatrists and essentially what is called a “multi-disciplinary treatment team”.  Addiction treatment centers also have “multi-disciplinary teams” but most are “free-standing” meaning they are not part of a hospital or medical facility. They may be licensed to offer detoxification services..Yet, not equipped to handle more serious cases of psychiatric illness. It is important to know what is giving the afflicted person the most trouble (addiction or mental health) concerns because a person with psychotic symptoms or hallucinations will have a very difficult time integrating with an addiction population that they are unable to connect with. For treatment to be effective there needs to be an establishment of trust, empathy, compassion, interpersonal connectedness, inter-dependence, and these are relational qualities that the afflicted individual needs to either possess already or be capable of developing as treatment progresses.  When inquiring about a specific facility ask specifically whether they have a psychiatrist on staff.  Is the psychiatrist certified by the American Society of Addiction Medicine?  Is the psychiatrist Board Certified in General Psychiatry or simply Board Eligible?  Some facilities because they deal with a forensic population meaning individuals with psychiatric conditions that are involved in the legal system. Sometimes they may need addiction services while undergoing assessment to determine whether their crime was committed as a result of substance use, abuse, or addiction. Then based upon the assessment it is determined whether the individual is competent to stand trial. The doctor will determine whether there are other factors that should be taken into consideration when sentencing an individual. This is a very specialized area. 

Many addiction treatment programs offer “tracks” that are specific to certain issues that co-occur with the addiction such as: trauma, eating disorders, personality disorders to name a few. These tracks usually involve specialty groups aimed at controlling emotional intensity, regulating mood, mindfulness, stress reduction, harm reduction (not totally eliminating the behavior; but reducing its impact). When inquiring about these programs ask about the credentials of the therapists working with this patient population. Professionally and ethically a treatment program and/or “counselor, therapist, behavioral health tech” should not be offering clinical advice, guidance, direction, analysis, interpretation of issues that fall outside the realm of their own professional training. Because someone has training in a certain area, does not mean they are “competent” to treat a particular issue. Inquire whether the person treating you has access to “clinical supervision”.  This will help you understand how strong of a clinical team there is at the facility. Professionals who practice in an ethical and professional manner are good at knowing their limits. They seek the input of their colleagues. Programs with specialty tracks usually have a primary therapist working in conjunction with a specialty therapist who has special expertise in other models of therapy commonly referred to as: Dialectic Behavioral Therapy, Somatic Experiencing, EMDR (Refer to Francine Shapiro) on Google to get specific information on EMDR. When working with an EMDR therapist inquire about where they received their training.  You may want to know what level practitioner they are? Those who offer these services frequently belong to professional associations. Inquire whether they are active in professional associations. Determine how they assess whether someone is ready for a specific therapy or service. EMDR is not recommended for some cases of complex trauma.  It is important to ensure that the person working with you has access to good clinical supervision.It is also important that the treatment is paced in such a way that you do not become re-traumatized.  Trauma work takes time.  There are no quick fixes.

Treatment facilities usually have to report to your insurance every 2-3 days or at set intervals determined by the insurance company when they want to be updated about your treatment in order to determine whether you meet their “medical necessity criteria” for the “level of care” the facility is requesting “authorization” or “pre-certification” for. Detox is the highest level of care, followed by inpatient or residential, followed by partial hospital that sometimes has housing connected to it. Insurance companies want to see that your treatment is progressing; the goals are realistic and that you need to be there. If a place is licensed to treat both mental health and substance abuse it is not uncommon to see them bill under mental health once benefits have been exhausted under substance abuse. Some policies only authorize 30 calendar days per year. Others authorize an unlimited number of days. It is again all based upon medical necessity. Check with the facility to determine whether you are responsible for “room/board” charges if the level of care gets dropped to “partial hospital” also known as “day programming”. Some ask the patient to pay the difference between what is billed and paid. When a facility is “in-network” with your insurance generally they are agreeing to accept whatever rate is negotiated between the insurance company and their business office staff. 

Be careful of or concerned when a center inquires within minutes for your insurance information. There are many treatment centers that out-source calls to third-party marketers that do not necessarily work for the treatment center directly. They are independent contractors whose goal is to ensure the beds are filled in that facility. The focus with these entities is not so much on whether you are going to get the right of help as much as meeting his/her commission or quota needs. 

You should also be careful of treatment centers that allude to your problem being resolved in 30-days.  Research is showing that the longer a person stays in treatment (not necessarily residential) but is some form of structured, supportive, monitored, phased type of treatment that their chances of achieving long-term success in recovery improves greatly. Do not be pressured into going to the specific provider the individual recommends. Many recommend only places they are affiliated with. If they are connected to a place financially and are profiting from your referral to a specific place this would be concerning.

In closing, do your homework, ask questions —–speak directly with clinical staff regarding clinically related questions. Do not commit to long-term stays, large down-payments (,000-10,000) and have them give you a bill to submit to your insurance because your treatment needs to be authorized “in advance” not after services are rendered. When it feels like the person your speaking to is more of a sales person chances are that’s all they are rather than someone who has an interest in ensuring your needs will be met. Do your research and if feels right then go with what feels right. If not ask questions. Remember, it’s your treatment, your recovery, your life, your happiness and you need to know your making the right choice in whatever you choose.

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