Mental ill health and psychiatric problems of one kind or another are often implicated in the onset of addiction. They can also result from an addiction. It frequently emerges that addiction has developed as a result of a person self-medicating an undiagnosed mental condition, such as depression, severe anxiety, bipolar disorder or even schizophrenia.
Addiction may be the presenting problem and the immediate reason for admission to an exclusive luxury addiction rehab like Clinic Les Alpes. However, the experienced medical team, including the expertise of the addiction psychiatrist, will be alert to the possibility of such co-existing disorders and offer psychiatric care. It is all part of making sure to look at the person as a whole, not just from the perspective of one condition. Only this way can a treatment plan be devised that is appropriately tailored to the individual’s needs.
The treatment plan will take into account not only the information received prior to arrival but also that of the thorough psychiatric assessment conducted on admission. Mindful of the anxious, demoralized or possibly, defensive state in which patients often arrive at the Clinic, the psychiatric assessment will sensitively explore the person’s life history, including that of the family of origin, as well as current circumstances that may be having a harmful impact.
Any previous experience with mental ill health and psychiatric treatment will be discussed, as will the course of the addiction to date and any previous attempts at recovery, with or without the help of treatment. It is vital to obtain information that helps build a comprehensive picture with which to inform treatment planning. While much of the work of assessment is to reveal the nature, extent and severity of problems in order to guide treatment decisions, it is also a good time to identify strengths that can help provide the foundations of recovery.
The treatment plan is iterative rather than fixed. It is continually reviewed and always subject to change as the person progresses through treatment. It is not uncommon for a provisional diagnosis to be enhanced or, indeed, rendered obsolete as the person’s profile can change quickly once abstinence from the addictive substances or behaviours has been established through detoxification. A previously identified mental illness may no longer be evident when the person is free from the effects of the substances. Conversely, underlying indications of mental ill health may emerge or become more apparent, even florid.
Psychiatric care will include maintaining a watchful eye over ongoing risks to health and even life. Addiction is a potentially fatal, self-harming condition with relapse during or soon after treatment a particular danger. It is not uncommon for there to be a risk of suicide. There may have been previous attempts, which will need to be considered.
Addiction may have brought someone to such a low state that they see fewer and fewer options in life and, having become clinically depressed, may temporarily require appropriate medication to alleviate more severe symptoms. Other self-harming behaviours such as cutting parts of their body or those related to disordered eating will be assessed, treated and monitored.
The treatment team will also be aware of the possibility of other conditions. Attention Deficit Hyperactivity Disorder (ADHD) is now thought to play a part in the onset of addiction in many people. Some people with Autism have developed addictions through turning to substances to help them manage everyday life, dealing with a sense of not fitting in and sensory hypersensitivity.
Some people with what are called personality disorders — not classified as mental illnesses as such — may develop addictions as a result of turning to substances as part of their attempt to cope with the challenges of life. They may be impulsive, highly anxious, struggle with relationships and self-harm in other ways besides addiction. Post Traumatic Stress Disorder (PTSD) may also feature. This may have links to trauma earlier in life. A careful judgment will need to be reached about the person’s current capacity, coherence and degree of resilience before addressing such damaging experiences head-on.
Some addictions directly affect brain function and can do so permanently. Alcohol, for instance, is known to be neurotoxic. Of most concern is that it kills off brain cells. Thus a consequence of chronic alcohol dependence may be a cognitive deficit, whereby the person’s ability to think efficiently is reduced, or memory may be impaired. This is one reason why clinical psychologists work alongside psychiatrists in addiction treatment. Psychological tests may have to be taken to assess the degree and type of damage to the brain.
An important feature of the treatment model adopted by exclusive rehab centres like Clinic les Alpes is the multi-disciplinary treatment and care team. This enables a range of expertise and diverse skills to be combined in the delivery of treatment.
It also reflects the fact that addiction is not exclusively a psychiatric disorder. It is a condition affecting the mind, body and spirit. It has social dimensions. The team approach also acknowledges that recovery will not be achieved solely by psychiatric treatment.
While the psychiatrist leads on any psychiatric diagnosis or intervention such as the prescription of medication for mental health conditions, he/she will call upon, even defer to colleagues with different expertise in shaping and developing the overall treatment plan.
In fact, it is as well as soon as possible to change the focus from a treatment plan, which involves interventions to address immediate health problems and certain chronic ailments, to a recovery plan. While the psychiatrist will remain available at all times, helping the person work towards achieving the goal of sustainable recovery becomes increasingly the province of the psycho-social and physio-therapeutic teams, supported by nutritionists and others; not forgetting the patient’s peers.
Treatment and recovery planning is not limited to the treatment episode and the stay in a luxury addiction treatment centre like Clinic Les Alpes. The information gathered before and during treatment helps the team to plan with the patient how their recovery will be sustained in the long term through our aftercare program.
The psychiatrist will, as necessary, have input into such planning, especially if mental ill health continues with an ongoing need for psychotropic medication. Stability is important to recovery and such medication may for some be essential to providing it.
This has been a description of psychiatric care in the context of addiction treatment. While the word “psychiatric” refers to a vital element of the help provided, it is important to recognise that “care” is of equal importance. The two work hand in hand.