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Which Comes First: Mental Health or Addiction?


The broad and ever-changing landscape of mental health and addictions programs can be overwhelming. When considering treatment options, even concepts as basic as “dual diagnosis treatment” can leave one wondering, “Which one do I deal with first?” By the time we seek help, the two seem hopelessly convoluted.

The relationship between mental health and addiction is intimate. No one has ever been just addicted. For the overwhelming majority of us, mental health problems existed long before we took our first drink or drug. For all of us, the impact of substance abuse and addiction on our mental health is harmful at best and most often devastating.

Sobriety is the Priority

As a general rule, attaining and maintaining sobriety should be the first and greatest priority. As long as we continue to misuse substances, we endanger every part of our lives, including our physical and mental health. Further, gains made in improving clarity and coping through mental health treatment tend to be diminished or even lost when we continue to abuse drugs or alcohol.

First things first. Addiction arrests growth, learning, and healing. Increasing stability in our daily lives and tending to our physical health is more foundational than considering why we’re depressed and/or anxious. In the context of active addiction or early recovery, these states should be seen as natural consequences to the lives we’ve lived. The prospect of rebuilding our lives is anxiety producing and everything we’ve lost causes feelings of depression. These tend to diminish as we learn how to make life manageable.

Make Life Manageable

Clearing out the wreckage of our past and learning to live one day at a time is part and parcel with addiction counseling. The good news is that everything we experience in addiction recovery and treatment will improve our overall health (including mental and emotional well being). It’s all connected and it’s part of our journey to become whole.

Substance abuse treatment offers opportunities to learn how to:

  • Be grounded in the here and now
  • Control impulses and urges (as well as dealing with cravings)
  • Respond to situations without being reactive
  • Identify and cope with negative emotions
  • Effectively manage stress
  • Communicate effectively
  • Prevent escalation and resolve conflicts (internally and externally)

One Dragon at a Time

There’s an important distinction between “counseling” and “therapy.” Counseling is about our lives from today forward. Therapy is about how our past continues to negatively impact our present. Digging around in the past when life is less than stable today doesn’t make sense. There will be time for this in the future. Therapy can be viewed the same way folks in recovery tend to look at AA’s 4th Step. It’s best to put our efforts into developing support systems before exploring our pasts.

Our Drug of Choice & Implications for Mental Health

Identifying what we sought from our drug of choice and what the long-term effects became can reveal a lot about our mental health.

Depression has a very complex relationship with alcohol abuse and alcoholism. Alcohol is a depressant and yet many of us experienced a respite from depression when we drank. At some point, alcohol turned on us and the true effects of the drug manifest in higher levels of depression.

For many of us, opioids and benzodiazepines provided a false sense of security and safety. Living with anxiety disorders takes a progressive toll on body, mind, and spirit. Opioid drugs will generally provide an initial sense of peace before they begin to destroy our lives.

For those of us who live with Attention Deficit Disorder (A.D.D.), stimulants including cocaine and amphetamines helped us make sense of the world before they wrecked havoc with the compulsion to do more.

Bottom Line

Folks in the halls of AA and NA will tell you that:

“The good thing about being clean/sober is that you feel more and the bad thing about being clean/sober is that you feel more.”

Any addict will tell you that the progression goes from feeling liberated, to chasing the dragon, to tolerance, to a gradually reduced effect. By the end, we’re using not to feel good, but to feel nothing. “Thawing” emotionally is a rough and ongoing process. Give yourself time to grow and discuss what you expect of yourself with healthy people.

jim-lapierreJim LaPierre LCSW, CCS, is a recovery ally, clinical therapist, and addictions counselor. He publishes weekly for the Recovery Rocks section for the Bangor Daily News and welcomes your questions and concerns via

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