Category Archives: Mental Health

Defining Recovery: Reconciling Mental Illness and Positive Mental Health

mental health
A curious and dynamic dance revolves around the definition of recovery from mental health disorders in the 21st century. On the one hand, consumers of mental health services tend to define recovery as the presence of positive behaviors and mental states – known as the salutogenic model – while members of the scientific and medical communities tend to define recovery as the absence of disease and negative mental states – known as the pathogenic model. In order to reconcile and synthesize these two disparate points of view into a workable, useful, and inclusive definition, a group of researchers, spearheaded by Helene Provencher of Laval University (Quebec City, Quebec, Canada) and Corey L.M. Keyes of Emory University (Atlanta, Georgia, USA) propose a comprehensive definition of recovery under the label complete mental health.

First explored in the 2005 article “Mental illness and/or mental health? Investigating Axioms of the Complete State Model of Health” and expanded over the course of the past decade in close to a dozen related, follow-up studies, the idea of complete mental health – and its relationship to recovery from mental health disorders – is novel in that it recognizes the following:

  1. The absence of the symptoms mental illness does not automatically mean positive mental health.
  2. Positive mental health does not require the total absence of the symptoms of mental illness.

Instead of viewing positive mental health and mental illness as mutually exclusive states of being, Provencher and Keyes consider them as “two separate continua rather than the opposite ends of a separate continuum.” It’s important to note that while these initial studies focus on mental health disorders such as depression, schizophrenia, PTSD, and mood disorders, the value of the complete mental health model applies with equal validity to recovery from addiction and substance abuse disorders. Professor James Jackson (University of Michigan) elucidates the transfer of this Provencher/Keyes model to include recovery from addiction and substance abuse disorders in the 2016 publication Measuring Recovery from Substance Use or Mental Disorders:

“…one commonality between substance abuse and mental disorders…is that people with substance abuse problems often have cravings that could be described as conceptually similar to symptoms. In both cases, such a craving may be fine as long as the person is not acting on it.”

Both professional substance abuse counselors and individuals in active recovery from substance abuse disorders know cravings are not the only persistent symptom-like phenomenon challenging successful recovery. Counter-productive psychological coping mechanisms such as denial, anger, and rationalizing not only contribute to continued substance abuse prior to recovery, but also follow the recovering addict throughout life and often lead to relapse. Recovery does not mean the total absence of these life-interrupting coping mechanisms; rather, recovery means having the awareness, self-efficacy, and practical tools to identify and counter these mechanisms as they recur over time.

Substance Abuse Recovery: Process and Outcome

Recovery from addiction and substance abuse disorders is complex. It’s tempting to measure recovery with a single, yes/no criterion wherein abstinence signifies recovery and indulgence in intoxicants signifies non-recovery or abuse. However, substance abuse counselors and individuals in recovery alike identify this black-and-white approach as a reductive oversimplification that ignores the subtleties and nuanced challenges involved in creating a life free of substance abuse.

Relapse is a reality, yet relapse does not always mean a total collapse of the recovery effort. Nor does it mean a return to square one. The functional truth is that recovery is a non-linear process filled with advances, setbacks, successes, and failures. It includes in-between periods that are neither highs nor lows. The lifelong process of recovery happens on a dynamic continuum, and the precise location of an individual in recovery on that continuum rarely remains fixed. A recovering individual responds to the stresses and gifts of daily life with relative degrees of efficiency. Hard days are as much a part of recovery of good days. Navigating the extremes while maintaining a commitment to the process is the hallmark of a sustainable approach, as opposed to a static mindset that relegates an individual to a restrictive binary with sobriety on one side and substance abuse on the other.

An Multi-Faceted, Inclusive Model of Recovery

The complete mental health model advocated by Provencher and Keyes allows for the non-linear nature of recovery from addiction and substance abuse, and accommodates the formation of an analog for the two features of complete mental health previously described:

  1. Abstinence alone does not automatically mean complete recovery.
  2. Recovery does not require the absence of addiction-related symptoms.

Abstinence is, of course, the ultimate measure of sobriety, yet for individuals struggling with addiction, recovery means more than abstinence. It means the restoration – or in some instances, the discovery – of a way of life that supports happiness, health, and well-being. The model designed by Provencher and Keyes integrates a pre-existing model of mental illness described by Liberman and Koplewicz with their own model of positive mental health. The combination of these two models results in a multi-dimensional rubric containing six states of relative and interconnected positive mental health and disruptive mental illness, ranging from an initial state of being non-recovered from mental illness and languishing to a final state of being recovered from mental illness and flourishing:

  1. Non-recovered and languishing. This phase is characterized by severe impairments in mental health and extreme symptoms of mental illness.
  2. Non-recovered and moderately mentally healthy. This phase is characterized by fewer symptoms of mental illness combined with moderate levels of positive mental health.
  3. Non-recovered from mental illness and flourishing. This phase is characterized by the significantly reduced presence of the symptoms of mental illness, combined with concrete and identifiable attributes associated with positive mental health and flourishing.
  4. Recovered from mental illness and languishing. This phase is characterized by the absence of the symptoms of mental illness, combined with an absence of the attributes of positive mental health.
  5. Recovered from mental illness and moderately mentally healthy. This phase is characterized by the absence of the symptoms of mental illness, combined with moderate levels of positive mental health.
  6. Recovered from mental illness and flourishing. This phase is characterized by the absence of the symptoms of mental illness, combined with high levels of positive mental health.

[For the purposes of this article, the states are described here in sequence, whereas the rubric created by Provencher and Keyes situates them on an x/y axis, with the x axis representing the mental health continuum, and the y axis representing the mental illness continuum]

Substance abuse therapists and individuals struggling with substance abuse will immediately recognize the value of this expanded view of recovery. It asks both to understand that the process of recovery – the goal of which is complete mental health – is neither wholly salutogenic nor wholly pathogenic, but a combination of the two. It also asks those therapists and individuals to understand that recovery is neither solely a process nor solely an outcome, but again, a combination of the two. It gives therapists the tools to identify a client who’s abstinent, yet displaying mental health behaviors that may lead to relapse, and provides the vocabulary to discuss what they see with their client. It gives individuals in recovery the means to understand that it’s possible to be sober, abstinent, and diligently following a recovery program, yet still experience negative emotions and signs of poor mental health.

The Intersection of Theory and Practice

The Provencher/Keyes model gives treatment professionals the groundwork for situating traditional and complementary therapeutic modes side-by-side in pursuit of a greater whole: complete mental health. Awareness and application of the model particularly benefits individuals with co-occurring disorders, in that an array of therapies can be deployed – with the six states of recovery as a guide – to address both addiction and mental health disorders simultaneously. For many therapists and individuals in recovery, the Provencher/Keyes model verifies what they know already: recovery can be a messy process, filled with peaks and valleys. What works for one individual might not work for another, and what works one day for one individual might not work the next day for the same individual. The ability to bolster a recovery plan in one area, ease off in another, and stay steady in still another is something experienced practitioners and those in recovery have cultivated for decades. Until recently, however, these types of tweaks, and the insights that instigate them, have been a matter of instinct and the result of experiential knowledge – not the result of standard prescriptive practice. The introduction and adoption of a model that integrates the salutogenic and pathogenic theories of recovery into an adaptive, holistic, inclusive, and seamless whole unites theory and practice in a way that gives individuals in recovery a greater chance of therapeutic success, and ultimately, more options on the path to personal well-being and total mental health.

The Neurological Science Behind Substance Abuse Addiction

Substance use and abuse starts when an individual likes the way a particular substance makes them feel. For some of us, it’s possible to enjoy a drink or use a drug and never become hooked. Others cross a distinct threshold and transition into addiction.

A growing amount of research has shown that during this transitional phase into addiction, there are distinct changes that happen in the brain. Because of this evidence that clearly shows addiction is far more than just a character flaw, the science community now widely accepts that addiction should be categorized as a brain disease.

Dopamine And Addiction

Neurological Brain-Dopamine And AddictionThe human brain has evolved in such a way that we learn to survive based on a reward system. When we do things that support our survival, such as eat or exercise, our brain rewards this behavior by releasing a “feel good” chemical called dopamine. Because we enjoy the feeling when this chemical is released, we repeat these behaviors.

Along with the necessities of survival, there are also a variety of substances that affect the “reward center” of our brains. These include drugs and alcohol which release high levels of dopamine. In fact, the release of the chemical can be two to 10 times greater than what is normally released, producing a “high.” Users of these substances can develop a habit to sustain that positive feeling when dopamine is released. This can quickly turn into addiction.

This cycle is further propelled as the brain struggles to regain balance after the effect of a substance wears off. This struggle can produce symptoms of a hangover or withdrawal which can cause physical, mental and emotional pain. For the individual, the substance that is perpetuating the destructive cycle is many times used to combat this pain, further strengthening the addiction.

The Link Between Drug And Alcohol Abuse And Mental Illness

Of course, not everyone who drinks a glass of wine or takes a prescription painkiller will become an addict. Some individuals are more prone to developing an addiction than others. This further shows a connection between the brain and addiction. In those who have a mental health condition, such as anxiety or depression, the chance of developing an addiction is significantly higher. Often, drugs or alcohol are used to help numb the symptoms of mental illness.

According to the Journal of the American Medical Association, approximately 50 percent of individuals with severe mental disorders are also affected by substance abuse. And, 37 percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness. The link between addiction and mental illness is strong, and many who enter treatment discover they require treatment for both addiction and an underlying mental illness. This is why it’s so important to choose a recovery center that has expertise in dual diagnosis addiction treatment.

Are You Struggling With Addiction And Mental Illness?

Women Overlooking Lake-Struggling With Addiction And Mental Illness

You’re not alone. In fact, many people who have a mental illness also abuse alcohol and/or drugs. Don’t take chances with getting the help you need. At Summit Estate, we specialize in treating individuals who have dual diagnosis by treating both the addiction and the mental illness with a personalized treatment plan. Call us to speak with an addiction specialist now.

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The Role Of Mental Health In Addiction

The challenges of mental illness often go hand-in-hand with drug or alcohol abuse. This makes both conditions difficult to diagnose and to treat.

Wildflower Closeup-The Role Of Mental Health In AddictionThe link between addiction and psychological problems is complex and not completely understood. What is known is that mental illness can increase the risk of drug abuse and alcoholism. Very often, the individual suffering from a mental illness will use a substance to self-medicate and cope with side effects that aren’t being properly managed.

The flip side of this common link is that drug and alcohol abuse can lead to depression, anxiety, and other mental conditions. Very often, untreated addiction and mental illness will propel each other, leading to a self-perpetuating cycle that is very difficult to treat.

Common Mental Conditions Connected With Addiction

Some of the most common mental conditions that are connected with drug or alcohol dependency include:

Anxiety – Alcohol is commonly abused by individuals who suffer from addiction. Often the addiction begins at a young age to deal with the challenges of being in social situations and to overcome feelings of shyness and being overwhelmed by everyday challenges.

Depression – Some individuals begin abusing drugs or alcohol to mask symptoms of depression. This is particularly common in females who have depression.

Bipolar Disorder – Alcohol is also frequently used by men and women who suffer from mood swings associated with bipolar disorder.

Post-Traumatic Stress Disorder – Substances are commonly used by those suffering from the very difficult symptoms of post-traumatic stress disorder that include flashbacks, sleep disturbances, regression, and anger.

Schizophrenia – Hallucinations, delusions, and other psychotic symptoms lead some to drug use to ease symptoms of distress and fear.

Other Connections Between Addiction And Mental Illness

There are also other proven links between addiction and mental illness. These include neuro-chemical and environmental factors. Genetics also play an important role. While the connection between mental illness and addiction is multi-faceted and not completely understood, it is necessary to proactively treat the conditions simultaneously.

What To Do If Your Loved One Is Struggling With Mental Illness And Addiction

A common question that people ask when they have a friend or family member who is struggling with depression, anxiety, or other mental illness and is self-medicating with drugs or alcohol, is “What do I do if my loved one is struggling with mental illness and addiction?” The first step is getting them evaluated to determine the best possible treatment program for them. A one-size-fits-all approach to overcoming addiction is not wise for someone who is suffering from co-occurring disorders.

For effective and individualized treatment for co-occurring disorders in Northern California, call Summit Estate now for immediate help. We’re here to answer your questions and to begin the admissions process.

Learn More About Our Co-Occurring Disorders Treatment

Is There A Link Between An Empty Nest And Depression?

Link Between An Empty Next And Depression-SummitEstate.comThe time when children leave home for college or careers can bring on feelings of sadness, loneliness, and grief in many parents. Coined “empty nest syndrome” by health professionals, this transition can lead some men and women to depression and even to turn to drugs or alcohol.

As a parent, the focus is on providing a loving, nurturing environment for children. When they begin to establish their independence, it can bring on a sense of loss and negative feelings that persist and lead to depression.

Although many “empty nesters” find freedom and a sense of relief in an empty house with more time for hobbies and interests, others find themselves emotionally vulnerable. Some even dwell on lost opportunities or begin to feel like they’re no longer needed.

Who Is At Risk Of Empty Nest Syndrome?

Those who have experienced depression in the past or who have a family history of the condition are more likely to develop empty nest syndrome. Major life changes such as a child leaving home can spawn negative feelings and the desire to self-medicate with alcohol, prescription pain medications, or other substances.

Factors That Can Cause Empty Nest Syndrome

There are often multiple contributing factors that cause this type of depression including:

Loss Of Identity – As a primary caregiver, it’s easy to become engrossed in the role of being a parent. When an adult child leaves home, there sometimes is a loss of an identity that has been present for 18 or more years.

Guilt – Many parents fear that they did not adequately do their job to prepare their children for the real world. This can spawn feelings of guilt and regret.

Financial Issues – Worries about college tuition and other college-related expenses can place many parents under a high level of stress.

Relationship Changes – Without the time-consuming task of raising children, many couples are unprepared for how to live life without having to manage the daily responsibilities of being a parent.

Getting Help For Depression And Addiction

For many parents struggling with empty nest syndrome, it’s wise to get help from an experienced mental health professional. If there is also a co-occurring addiction, a recovery program might be the right first step in recovery.

Summit Estate offers in-patient co-occurring disorders treatment in Los Gatos, CA for substance abuse and depression. If you need help for the feelings you’re experiencing since your children have left home, don’t delay in getting help.

You Don’t Need To Hurt Another Day – Call Us Now – We Are Here For You 24/7