Mental Health Disorders:

Mental health disorders in large part reflect a breakdown of emotional hygiene. One in five adults meets criteria for a diagnosable mental disorder during the course of a year, with the most common problems being mood and anxiety disorders. Unfortunately, for many the issues remain untreated. Numerous studies also indicate that both mood and anxiety disorders are on the rise. The National Institute of Health published a study showing the lifetime incidence of depression in adults tripling from the 1980's to the 1990's (explained in part by the dramatic increase in antidepressant medication use). The prevalence of mental health disorders with substance use disorders (called dual diagnosis or co-occurring disorders) ranges from 55-85%. Successful long-term addiction management hinges on appropriately dealing with mental health problems.

Development Deficits & Constrictions:

World-renowned developmental psychiatrist  Stanley I. Greenspan has outlined six developmental stages that are critical to achieving mental health. These stages include: the ability to self-regulate attention and emotion, engage with others, show intention and purpose, make use of images, ideas and symbols, and ultimately think emotionally. In one of his most recent books, The Irreducible Needs of Children, he outlines seven needs that support the development of the six stages. The needs include 1) ongoing nurturing relationships 2) physical protection, safety and regulation 3) experiences tailored to individual differences 4) developmentally appropriate exercises 5) limit setting 6) stable, supportive communities and cultural continuity and 7) a future protected. Too often the roots of addictive behavior can be found in the unmet needs of children and teens. Developmental deficits and constrictions are among the most significant core issues that remain untreated. Are you able to refrain from alcohol or shooting drugs, but struggle to form healthy intimate relationships with others? Do you know how to read the nuances of emotional facial expressions and body language, or translate strong emotions in the body like anger/rage into thoughts that can rationally direct behavior? If not, the key to long-term addiction management and mental health is addressing the developmental deficits and constrictions.

Relationships:

Core issues are very much related to the ability to initiate, develop and maintain healthy intimate relationships (see previous section). According to the foremost authority on marriage in the world, Dr. John Gottman, 67% of first-time marriages will end in divorce over a forty-year period, and 43% will end in divorce over a fifteen-year period. These statistics, which have increased over the past few decades, simply reveal what we all know: maintaining a healthy intimate relationship is a lot of work. But the work of maintaining an intimate relationship is also the work of dealing with core issues, because in the end it is the "core issues" that end the relationship. Divorce trends tell only part of the story. As a society we are becoming more disconnected despite the advent of computer technology. Face to face relationships and interactions are being replaced by e-mail and web cams. Chatting is done on-line instead of at the park or grocery store. The gap between the "haves" and the "have-nots" has been increasing for years, leading to more gated communities and high-profile security systems. Following the events of September 11th there is evidence that instead of people coming together in more intimate ways, the patterns of disconnect and isolation continue. Those who struggle with addiction usually find themselves isolated, alone and disconnected from society. Therefore, successful long-term management of addictive behavior necessitates learning to be in relationship with others.

Overweight & Obesity:

We are in the midst of an epidemic, with about 55% of the adult American population being overweight or obese. In fact, in the last twenty years the prevalence of obesity has more than doubled. What does this have to do with core issues? In the book Calm Energy Dr. Robert Thayer reviews the research on mood disorders, obesity and exercise and convincingly documents how moods are very often the trigger for overeating. In a review of over 50 scientific studies done by Richard Ganley he concluded that much of obesity is based on emotional eating. The most common moods preceding overeating include depression, anxiety, anger, boredom and loneliness - in other words, negative moods (also primary relapse triggers).  In many cases these negative moods meet criteria for a mental health disorder. Although weight gain and obesity can often be linked to underlying core issues, there are some who now believe that people can be directly addicted to food. Evidence of a food-addiction link has recently been found by Brookhaven National Laboratory. It is also quite common for people struggling with one addiction to develop a "cross" addiction to food. This frequently occurs with sex addicts. Of course, not all weight problems are the result of unresolved core issues either.

Trauma:

Although trauma is classified as a mental health disorder it really deserves its own place when considering core issues related to addictions. About 50% of all those who seek treatment for substance use disorders have a lifetime prevalence of Post Traumatic Stress Disorder (PTSD), and 25-33% meet criteria for current PTSD. For women it could be even higher. Also, it is not uncommon for people to suffer from multiple types of trauma that include sexual, physical and emotional abuse, as well as physical and emotional neglect. Unfortunately, trauma is often missed in assessments and screenings, and when it is found, rarely is it addressed in any significant way. Currently, there exist no practice guidelines for treating trauma in the context of addiction treatment. Following the trauma of September 11th, nearly half the nation reported an increase in the demand for alcohol and drug treatment. Successful long-term management of addictive behavior requires underlying trauma(s) be resolved.

Grief & Loss:

Giving up a relationship to a substance or a behavior can feel like losing a best friend. The loss, if it is to be sustained, often must be grieved appropriately. Even more powerful than grief from addiction can be the loss of a loved one: an innocent child taken suddenly from the world, a parent who dies unexpectedly without the opportunity to say goodbye, or the end of an intimate relationship. Often, core issues related to grief and loss are among the most painful and long-standing. If you are serious about successfully dealing with an addiction and have grief and loss issues, it is absolutely critical that they be addressed appropriately.