Dr. I will not only increase the original amount of anxiety the person is experiencing, but now there’s a compounding effect of the anxiety produced as a result of the substances. That’s why in the initial stages of the discontinuation of use, which a medical doctor can really help with that, that’s where the mental health subsides actually begin to increase. Because it’s been suppressed for so long. Dr. Yeah. And it’s a chronic disease model that should be of concern to a practitioner. Hey everybody, welcome back to the channel. This is Dr. B and the topic that will be considered today is the following.

 

Is addiction a mental health problem? And I said we because as usual, I am joined with Parham Amitola, a super therapist and I’m going to let him introduce himself. What’s up everyone? My name is Parham. I have a master’s degree in marriage and family therapy with an emphasis in child development. I’m a licensed advanced alcohol and drug counselor, so working with addictions and addictive processes is my specialty. I also teach community college at a local community college, coach high school basketball, and just really passionate about being in the helping space. So really grateful for the opportunity, Doc. school basketball and just really passionate about being in the helping space so really grateful for the opportunity. Is addiction a mental health problem? You go and give me your

 

take on that and we’ll generate a discussion hopefully it’ll be useful for you guys to get a better grasp on this for whatever road that you’re on let’s go. All right so mental health problems what are they and how do they manifest and how do they appear? So a mental health problem is anything that causes impairments with the way that we perceive the world, experience the world, with the way that our emotions work and fire and trigger. And addictions absolutely can cause mental health challenges. However, it’s important to know that oftentimes the mental health challenges and

 

conditions were already there prior to the development of addiction, most of the time. And so addiction for many people is actually a solution, a very short-term solution for a greater problem that they’re experiencing. For example, if somebody is experiencing some severe anxiety and they have a little drink or they take a little pill or they smoke something and their anxiety comes down, the addiction just helped the mental health condition. Now the problem with this is it works really well in the short term.

 

Works like magic in the short term. However, the continued use of any type of substance that has characteristics of tolerance, characteristics of dependence, is going to cause a secondary problem later on. So the solution for the anxiety, which was the drugs and alcohol, later on potentially is going to have a rebounding effect that will not only increase the original amount of anxiety the person was experiencing, but now there’s a compounding effect of the anxiety produced as a result of the substance use. That’s an amazing response.

 

Let me try to summarize that. Tell me if I’m wrong. So oftentimes what you’re saying is substances are used to alleviate what is originally a different mental health issue. Now that could be caused by anything from anxiety, coping mechanisms, PTSD, personality disorders, which we often miss. And once you go down that road, it itself becomes an additional mental health problem.

 

But I want to challenge, not challenge it, I want to bring on some nuances that I think create this issue. I think both at the theoretical level that we’re talking, but I don’t want to call the healthcare system a system, but the healthcare setup that we have and insurance claims and so forth in the clinical office, I don’t come from strictly a mental health background. I consider myself, I don’t know, body physician, but I also have had to deal with a lot of mental health in the

 

field that I have worked. And the way my office is set up, the way insurances actually take you in, this falls under behavioral or mental health within the insurance system, as you know, because you also deal with Buckeye Recovery. I actually have some problems with that. Now, one of the things, knee-jerk as well, you know, I get medication for this, so this is not mental health. Wrong, because we give medication for a lot of mental health. Nevertheless, I have this urge, this sort of thing where I’m always at odds with the way we are categorized as behavioral health or mental health.

 

I don’t, to this day, even though a lot of people look at me as a mental health kind of thing to go to, I don’t look at myself as that way as a medical doctor. I’m not a medical doctor that’s not traditionally a psychiatrist. I look at myself as really no different than any other specialty that is not mental health. One of the reasons may be because not only do I deal with medication, as you know, I’m an advocate of medication-assisted treatment, but I also deal with the patient’s other issues that are related in one way or another

 

with the substance abuse. For example, we take care of all of our abscesses. We take care of our own hepatitis C. We do a lot of clinical management that isn’t behavioral health, strictly. And I think that is where one of the issues arise. or pathophysiological model subscribe to and describe where it is utilized that creates this

 

space where we can call substance abuse a disease, you know, a disease of the brain. And if you know the description of this, you know, it’s a reward mechanism, God or I, you know. And even though mental health is described in that description, they just sort of leave it at that. In fact, it could be neurology. And a lot of family practice guys and internists may treat substance abuse.

 

I think that is where the problem comes about. Any thoughts on that? I think what I’m trying to say is, you know, I’ve always felt uncomfortable with it being looked at as behavioral health. Even to this day, even though I do an incredible amount of counseling, that would be mental health counseling. I don’t think of my practice would be mental health counseling i don’t think of my practice as a mental health practice uh any thoughts yeah i think going on from your scope of practice and this is uh it’s kind of interesting because addiction when it gets to those stages

 

that they have to come see a doctor like you or come see you know a therapist like me it’s not just impacting the mind and the mental health component. There’s a significant amount of physical impairments and physical ailments and physical stresses and challenges that happen. Even to what draws, right? Especially with sedative hypnotics, you know, you come see me, you could have seizures or die from that. Yeah. So, I mean, there’s impacts to the various organs of the body. There’s impacts to various mechanisms and systems of the body. And a medical doctor needs to stabilize all that first. If you look at the priorities of needs of

 

an individual to recover, the physical healing component is significant. But what happens is a lot of people think, well, as long as I stop using the drugs and alcohol, then my life is going to get better. That’s not really true because the only thing that gets better when you stop the use of drugs and alcohol is the problems related to your drugs and alcohol go away. Everything else that was underneath there, which is the mental health component, all that stuff starts to resurface. It starts to actually come up and be extremely sensitive and you can touch it, you can feel it, you can experience it. And now you’re no longer using the solution you were using to cope with it all. So that’s why in the initial stages of the discontinuation of use, which a medical doctor could really help with that,

 

that’s where the mental health stuff starts to actually significantly increase because it’s been suppressed for so long. And that’s kind of – so it is a two-problem approach. I don’t think it’s either or. I think it’s both. Yeah, and I agree. And I think we would agree on this. And it’s something I go back to over and over where I try to teach kind of a formal thinking approach to these issues to the audience is it’s not either or. And this is when I use the term holistic, I don’t mean it in a new age sense. I mean it in a really formal sense.

 

It doesn’t matter what you call it. There is a model, a disease model. That model, utilizing it gives me a few tools. I can assess the severity of your disease and I can plan out your treatment with medications and have some degree of predictability and long-term clinical sequela. Now, my practice, although we always advise people to see a therapist, and many do, but many don’t.

 

They simply use us as their mental health folks and as their medication folks. And I think a better concern for the audience, don’t worry about if the number, the question of whether it’s a disease or not is not what we’re talking about here. The particular question is, is it a mental health thing or is it something like diabetes? That’s number one. And what we’re getting to is, well, it doesn’t matter which you call it. It’s very complex.

 

I think what we’re getting to is a bigger issue that you should all be concerned with. It’s a chronic disease. And it’s a chronic disease model that should be of concern to a practitioner. Now, whether you use just a medical doctor or someone like Parham, you know, both those expertise need to be, I think, employed in the long run of approaching this chronic issue, which I am very, as many of you

 

know, I’m very big on sort of medication as the cornerstone of treatment for you to get all of your other treatments. And that needs to be followed over a long period of time because as any chronic disease and data shows that relapses and exacerbations are just as right there in terms of their numbers with any other chronic disease and so the practitioner needs to approach it that way i think we both agree about that don’t worry about if it’s mental health or physiological

 

otherwise but it is a complex thing and the more important issue is the chronicity of it and it has a large amount of mental health issues that are sort of woven into this whether proceeding the initial issue or not. Yeah and you know the chronic part it’s also that it’s progressive and progressive meaning that potentially the different stages of it can get worse and when left untreated and that’s one of the parts of the disease model when left untreated it one of the outcomes could be fatal you know so that’s kind of the the whole approach to the

 

disease model has nothing to do with what your thoughts are opinions are disease what the primary um objection people have is they say well you know that’s a disease that’s a disease because people didn’t really choose to get them and all that kind of stuff it’s a stigma type thing around but when you just remove it and just look at the reason why it’s classified as one is because there’s signs there’s symptoms there’s treatment there’s best practices there’s outcomes there is um relapse there’s education uh and if all of these are kind of taken care of you actually can minimize

 

reduce sometimes even eliminate some of the symptomology of it absolutely okay i think we gained something out of that we both agree that worrying about whether it’s behavioral mental health or physiological disease doesn’t matter the more important issues the fact that it is chronic you need good solid stable continued long-term care and it should be approached in a holistic way to get the best outcomes and the utility of considering it as a disease which really wasn’t the topic here

 

gives us all of those factors signs signs, symptoms, predictability that Param just discussed so we can have better outcomes for your health. Is that right? That’s right. Okay, guys. Thank you very much. Don’t forget to like and subscribe and maybe consider our Patreon. See you guys next time. Peace.