Dear Therapist:

Without getting into the gory details, my daughter is currently being treated for a substance abuse addiction. My husband and I are trying to be supportive of her while understanding that it is going to take time. We are being told that we are supposed to view this as an “illness” just like any other mental health or physical illness, such as depression or heart disease. I can’t for the life of me understand how one can compare the two. How will not taking responsibility for her behaviors and blaming an “illness” help her long term? Why is our acceptance such an integral part of her treatment? As sad as it is, she made some terrible choices and is now suffering the consequences. I know it sounds harsh, but like my mother used to say, “You made your bed, you sleep in it.” Thank you for your time.

Response:

Many diseases that are high up on the list of leading causes of death have a large degree of self-infliction. For example, if people ate healthfully and exercised regularly there would be an extreme reduction in deaths caused by diabetes and heart disease. According to many credible studies, at least 90% of all cancers are caused by diet, lifestyle, and environmental factors. When putting things into perspective, the age-old “you did it to yourself” criticism is almost no different for addiction than for cancer.

Although we tend to view mental illness as just that, mental without any physical symptoms, this is not the case. Mental illness causes physical changes to the brain’s function. Addiction and substance abuse change brain structure and the way in which the brain functions. 

In addition, addiction is in many cases a result of another underlying issue. Many addicts suffer from emotional distress and other mental illnesses.  They often turn to drugs as a means of silencing or suppressing emotions with which they do not know how to cope. In many cases, people become addicted due to opioid use that was originally prescribed for physical pain. 

Some people have a greater propensity to become addicts than others. While we don’t have a full understanding of the causes, there are a number of factors that influence the risk of addiction.  One important factor is genetics. Some people are born with a predisposition for addiction. The second factor is environment. This includes friends and family relationships, economic factors, stress, abuse, and peer pressure. Development can also play an integral role. Since teenagers are still developing their self-control and decision-making skills they are more likely to try something risky such as drugs. That can lead to changes in their brain function, making it more likely for them to become addicts. 

As with many diseases, there is no cure for addiction; however, it is treatable. Recovery is the key word. Recovery is generally different for every person but there are a few common factors. In order for an addict to start on the road to recovery, it is imperative that she recognize that she cannot simply control the disease any more than someone can simply control her diabetes. Just as diabetics need to acknowledge that they can’t psychically wish their diabetes away, addicts have to recognize that they also require specific tools with which to fight their disease. 

It is naturally easier for a diabetic to change his eating habits when he has the support of his family and friends. This is all the more so for someone with a mental disorder, and often essential for an addict. In addition, if your daughter recognizes that you do not consider her addiction a disease, this might affect her ability to take her first step toward recovery: acceptance. With your understanding and support, your daughter will likely have a much increased chance of success in her recovery.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

 Brooklyn, NY

 author of Self-Esteem: A Primer

 www.ylcsw.com / 718-258-5317

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