This is the introductory installation of a series concerning substance addiction and mental health. It stems from my personal recovery and ongoing experiences interacting with people looking for support, our peers in recovery, and professional care providers.

I struggled with untreated mental health and substance addiction issues for many years until seeking assistance in January of 2009. Today I serve on the Mental Health Board of San Francisco as well as on the Board of Directors of LifeRing Secular Recovery, a non-profit, addiction support organization. I’ve been an active convenor (facilitator) of LifeRing’s peer support meetings for several years. I’m also active in multiple online groups both for people in recovery and for industry professionals. I’m a frequent contributor to several social media platforms which publish articles on recovery.

In these forums, I find that the most compelling topic that demands my input is the lack of diversity in both the methodologies and infrastructures of treatment and ongoing support systems. I am a strong proponent of choice in recovery. By this, I mean retiring the established, one-size-fits-all legacy path laid out by recovery communities, the industry, and society, and embracing a client-centric model that customizes the treatment practice to the individual.

The last century has seen enormous advances in defining and successfully treating the contributors to the cycles of addiction and their relations to various mental disorders. Current opinion clearly defines addiction as a common, self-perpetuating symptom of an individual’s self-medication of one or more primary stressors, disorders, injuries or diseases. These primary catalysts include among others, anxiety, depression, chronic pain, schizophrenia, bipolar disorder, PTSD, physical trauma. The patterns of addiction generally begin with incremental increases in the quantity and/or frequency of the use of substances that either dull pain or anxiety, or facilitate a temporary sense of escape from pain or discomfort, to the point of physiological or psychological dependence. The brain quickly learns that substances often used recreationally, can disrupt or postpone pain and discomfort. Naturally, the brain subconsciously craves more in order to guard against the unpleasant.

I am confidant that most scientists, physicians and psychologists would agree that substance addiction does not meet the criteria to be considered a standalone disease, but clearly qualifies those of being a disorder. Most would also concur that that the first steps in treating a disorder that is triggered by an altogether different stimulus is isolating and beginning treatment of the primary cause of instability. It goes without saying that continued substance use generally interferes with this process and that abstinence or significantly decreased consumption of “mind-altering” drugs is almost always recommended. A case can often be made for a supplement of medically-monitored pharmaceutical replacement or assistance in the initial treatment phase.

The hard questions

Given this increased awareness, why do the folkloric and outdated definitions and practices surrounding addiction, mental illness, and recovery continue to prevail within the medical, clinical and law enforcement communities?

· Despite the paradigm shift in the way science and medicine view evidence-based treatment, the majority of the clinicians and service providers that I interface with, remain evangelists of either the treatment modality that they were taught in school (sometimes decades ago), or in other cases, the formula that they believe helped them to overcome their personal issues with mental illness or addiction. What causes providers to ignore the current ideology and not include a range of proven, modern practices in their treatment plans?

· Our society still tends to treat addicts and people with mental illnesses as morally deficient or as criminals, as opposed to having a need for medical and psychological intervention. How is it that so many lawmakers and enforcement agencies have been left behind; literally dismissing the ever-increasing systemic and empirical knowledge that we now have on these subjects?

· Most treatment providers and support organization still offer only single, linear paths to recovery. The onus of success is placed on the individuals’ ability to comply with a belief system and/or practice that may not be appropriate to their need. Why does the recovery community perpetuate the dogmatic and antiquated practices that continue to inflict collateral damage on all but a small subset of the population in need?

· I am personally an influencer on several levels within non-profit and civic organizations, but my voice is only one among many in a minority of concerned advocates. What can I do as an individual and paraprofessional, to influence an impactful change and promote awareness in these and other areas that demand my attention?

These are some of the questions I hope to examine on a deeper level and the reason for initiating this dialog. I hope that my thoughts will inspire a respectful discussion on these subjects and that they may perhaps elicit conversation and participation in advancing our potential to serve those in need.