Medical Treatment: More Legitimate than Mental Health and Substance Use Treatment?

Let me start off by saying that I believe medical, spiritual, and behavioral health are all linked. It is very naive to think that they are not.

One of my first questions when someone comes into my practice relates to medical issues, especially when nothing is indicated about their health. I think that, before you treat someone for mental health and substance abuse, you need to make sure nothing else is going on medically. Think about hypo or hyper thyroidism. That can affect your mood in a huge way. Diabetes, when not treated, can affect your judgement in a huge way. A traumatic brain injury can also appear to be many different mental health conditions. A physical is essential before treatment.

I also want to know about the length of their sobriety if someone has had substance use issues. A person who has been sober for less than 90 days is still dealing with the mental and physical readjustment of their body to this detoxification. You may be going through psychological withdrawal and, in my experience, the mourning phase of their sobriety. Saying goodbye to substances is a huge stress on you, especially emotionally and physically.
During these first sessions, some individuals are looking for "answers" and " a cure" to their emotional ailments. After all, medical doctors usually have a quick answer to what is wrong, usually in the form of medications. Why can't counseling do the same thing? That is usually when we have a discussion about how therapy is indeed not an exact science.

It is also at this time I discuss two points: first of all addiction and mental health has only been around for 150 years. It is, in many ways, in its infancy. It has come a long way during this time and does have lots of research that backs up certain treatments for several ailments, including CBT for mood disorders, EMDR for trauma, motivational interviewing for substance use, among many others. Psychophamacology, or meds, has also been well research and has proven beneficial for many mental health issues.

"But how do they (doctors) know what meds will help me? I've been told many names so which one is for me?" We usually than talk about how different body chemistry react differently to different medications. "So they don't know? That is why this psycho babble stuff doesn't work". I use to react negatively to these type of statements but I got to thinking about medical issues.

Is there only one treatment for diabetes? Is there only one cancer "cure"? What about heart conditions or cholesterol issues? Of course not. Medical professionals also explore different options, which includes behavior modifications for some of these ailments, including diet and exercise.  And we usually discuss at length these points and how behavioral changes may be the only thing needed to a combo of both pharmacological and behavioral change to even just a medication exploration only . I find that many individuals are moved by that argument and seem to understand why different medications and treatments can/should be explored before settling to only a few of them.

Is medical treatment better than mental health and substance use treatment? I believe that, once explained, they are more similar than one might think.

Extremes and how they are detrimental

I have been pondering my next blog for several weeks and thanks to recent sessions, I realized that this subject has been part of my counseling consistently.
When I started getting interested in counseling, my mother purchased a book that I continue to use to this day: "Feeling Good: The New Mood Therapy" by David Burns. It's pretty thick and kind of long to read but the 10 cognitive distortions that Burns discusses in this book have become my bread and butter for most of my counselling career.
One of the distortions that he discusses at length is "all or nothing" thinking.  I don't want to go thru the whole theory but the short version of this faulty thinking process is when an individual thinks in extremes, making statements with words such as "always", "never", "all the time", and such.
Why do we do this? I think that is a very complicated yet logical explanation.  In fact, I can think of 3 good explanations. The first one is that it simplifies our analysis of a situation. If you can classify it in two boxes, it makes it easy to remember, as well as simplify our emotional understanding of a situation. Think about the last time a misfortune happened to you at a restaurant. How did you react? It is so much easier to say it "always" happens to you instead of thinking of exceptions. This simplifies your emotional response instead of thinking of other factors happening such as a new staff, a busy night, shortage of certain ingredients, or even your own role in this situation. This last sentence complicates your emotional reaction and " gut instinct". No one likes to complicate their lives like that, do they?
Secondly, it can also be what I have nicknamed the "us versus the world" mentality. If "everyone" is against you and "no one" understands because it has "always" been that way, doesn't this type of thinking simplify things for you? I also have dubbed it the narcistic response. I am special, unique, one of a kind. Do you recognize other all or nothing statements there? And frankly, are we that special?
Finally, it distracts you from the true issues. When you think this way, you don't  have to look at yourself and you can blame others, faith, the world, the situation, your upbringing. And change will be "impossible".
How do you change this? It is both easy and hard. You must be able to accept to challenge yourself and your thoughts. And this is a lifetime challenge. You have to learn that black and white does not work. Life belongs in the middle, in shades of gray. If you learn to do this regularly, the extremes will fade. It will not disappear but it will get easier to reach.
In my practice, it is a common subject of treatment. But it is not always discussed...