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Addictions Treatment Needs to Also Address Mental Health Issues – as seen in the Globe and Mail

According to Homewood Health Centre's Dr. Ben McCutchen, a majority of people with substance use disorders also have a mental health disorder.

After nearly two decades as a first responder in Vancouver, B.C., Brady Hoffman was suffering from work-related post-traumatic stress disorder, or PTSD. He had been using alcohol to cope with his symptoms and developed a dependency on alcohol.

In June 2021, Hoffman hit a low point and attempted to take his own life. That experience led him to seek support from another first responder who had sought treatment for substance use.

“By the end of that conversation, the word ‘treatment’ was drilled in my head as something that I needed to do,” Hoffman says.

Why do people need concurrent treatment?

Hoffman enrolled in a concurrent treatment program in Guelph, Ont. at the Homewood Health Centre where, for the first time in his life, he was able to address both his mental health issues and substance use at the same time. Homewood Health Centre offers programs that specialize in treating concurrent disorders, where a person is experiencing a substance use disorder and a mental health disorder at the same time.

“Concurrent treatment, in my scenario, really made sense,” Hoffman says. “Once I understood my PTSD and was getting treatment for my mental health, the alcohol side of things was easier for me to overcome.”

Hoffman is not alone in experiencing concurrent mental health and substance use issues. Based on survey data and his years of experience in the field, Dr. Ben McCutchen, the Chief of Psychiatry of the mood and anxiety program at Homewood Health, says the majority of people with substance use disorders also have a mental health disorder.

Brady Hoffman, a longtime first responder in Vancouver, once struggled with both PTSD and alcohol dependency but has benefited from concurrent treatment.
Brady Hoffman, a longtime first responder in Vancouver, once struggled with both PTSD and alcohol dependency but has benefited from concurrent treatment.

One reason that concurrent disorders develop is because people suffering from mental health issues such as trauma, depression or anxiety may experience temporary relief when they use substances. Over time, their reliance on substances to cope with their mental illness becomes its own problem. Likewise, if someone experiences a standalone substance issue disorder, the longer that disorder goes untreated, the higher the likelihood that they will develop a mental health issue as a result, McCutchen says.

“A substance use disorder — especially one that’s prolonged and severe — can contribute to a substance-induced mood disorder or anxiety disorder,” he says.

“There is a real need for treatment programs that tackle both mental health and substance use issues in order to better serve people,” says Kerry Manthenga, Homewood Health Centre’s Director of Clinical Operations and Programs – Addiction and Trauma Services.

How does concurrent treatment work?

At Homewood Health, staff were seeing many people come in for one issue, such as alcohol use disorder, but also presenting with an underlying mental health condition. This led to the development of concurrent services in various parts of the organization over the last several years that tackled both problems at the same time, rather than treating only one or the other. The newest concurrent program enhancement, IMAAC (Integrated Mood, Anxiety and Addictions Concurrent program) is specifically designed to help people experiencing these interconnected issues.

The nine-week inpatient program has two treatment phases: The first is focused on assessment, withdrawal management and stabilization under medical supervision. This is very important if someone has an alcohol or opioid use disorder, for example, and requires medically supervised withdrawal. It is also important to have a comprehensive assessment at the beginning of treatment to ensure all issues and mental health diagnoses are identified early on, in order to be able to incorporate this information into an individual’s treatment plan.

The second phase, active treatment, includes group-based and individual therapy in addition to optimizing medications and other treatment modalities. Therapeutic approaches including cognitive behavioural therapy (CBT) and psychotherapeutic recovery process groups help individuals to better understand their substance use and mental health issues and to learn strategies to make and maintain changes in their behavior.

“We also offer various additional adjunctive therapies that complement the core clinical work that we do,” says Vineeta Raman, Director of Clinical Operations and Programs at Homewood Health Centre and the IMAAC program lead. “Examples include music therapy, horticulture and creative arts, which are wonderful opportunities for patients to have access to therapeutic outlets outside of traditional talking therapy. Providing this range of therapeutic tools allows patients to improve expressive skills, manage stress and process difficult emotions.”

Homewood Health Centre’s program is different in that it acknowledges that mental health and substance use issues may present differently in people of different communities. For example, Indigenous peoples, first responders and health care providers might all have unique lived experiences and require a tailored treatment approach. In fact, cultural competency training is ongoing and offered to all Homewood Health Centre staff.

“For an Indigenous person, for example, entering inpatient treatment shouldn’t be a barrier to participating in culturally relevant practices,” Dr. McCutchen says. Homewood Health Centre creates a culturally-safe environment where Indigenous peoples can take part in traditional practices such as smudging or meet with an Indigenous patient navigator in partnership with Southwest Ontario Aboriginal Health Access Centre (SOAHAC).

The benefits of an integrated approach to care

In addition to tailored therapeutic approaches, the benefit of treating concurrent disorders at the same time is that it allows patients to better understand how their mental health and substance use intersect and influence each other. This concurrent approach is shown to improve patient outcomes, and gives patients a toolbox of coping strategies that best align with their needs.

In the past, it was common for someone seeking treatment for alcohol use disorder to only receive help for that singular issue — even if they also presented with symptoms of depression, for example. The same went for people seeking treatment for other mental health conditions.

“People would come in for mental health care, and treatment providers would say, ‘Until you’ve managed this substance use piece, we can’t really do anything,’” Manthenga says.

Raman says that with greater awareness of concurrent disorders today, treatment programs that address both mental health and substance use disorders provide patients with consistent care from the same team of healthcare providers, eliminating less effective patchwork approaches. Not only does this improve people’s treatment experience, but it helps set them up for greater success once they leave the program. According to Homewood Health Centre, 96 per cent of patients say the Mood, Anxiety and Concurrent programming met their needs.

“You’re coming out of the experience of care with a strong recovery plan that’s focused on both your substance use and your mental health, because they are interlinked,” Raman says.

For Hoffman, seeking concurrent treatment has allowed him to better cope with the stress of his job and manage his substance use in the real world. He is now in a place where he is supporting other first responders and is currently in the process of launching a wellness centre in his department. There is a need to dismantle stigma about mental health and substance use disorders so people don’t suffer in silence and miss out on getting help, he says.

“I still have bad days, and I think anyone going through something similar to me needs to understand that just because you get help doesn’t mean everything is suddenly rosy,” Hoffman says. “But treatment gives you the skills to not have to turn to other coping mechanisms and helps you be able to process your emotions properly.”

After nearly two decades as a first responder in Vancouver, B.C., Brady Hoffman was suffering from work-related post-traumatic stress disorder, or PTSD. He had been using alcohol to cope with his symptoms and developed a dependency on alcohol.

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Homewood Health Centre is a fully accredited, physician-led, medically-based inpatient treatment facility offering several specialized programs and extensive services to treat a wide range of mental health issues including trauma, addiction, anxiety, depression as well as co-occurring mental health and addiction issues.
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