Mental health and substance use treatments can complement each other in vital ways, says Peter Lindsayhall.
I am a dual-qualified mental health nurse and psychotherapist, and I’ve worked across NHS Scotland, NHS England and the private sector. My focus has been on primary care mental health providing broad access care for all, and my practice comes from a modern cognitive-behavioural approach recognising relational, attachment and systemic factors as well as intrapsychic processes.
In his 2004 article The origins of addiction, Vincent Felitti focused on adverse childhood experiences (ACEs) and the link with substance use. The results were as predictable as they are tragically painful – Felitti concluded that ‘…the basic cause of addiction is predominantly experience-dependent during childhood, and not substance-dependent’. In other words, what has happened to people in their life has a greater predictive power on the development of addiction than the psychoactive properties of the drugs themselves.
Further research highlights the links between addiction, mental health and ACEs. Traumatic effects disrupt our ability to regulate our emotions, feel safe, connect with others and understand ourselves. Whilst we are learning and developing through our lives, disruption has significant ripple effects. When all of this is coupled with Giano et al’s 2020 study showing that 57.8 per cent of people have at least one ACE, and 21.5 per cent have at least three, we can see that ACEs are not uncommon – but have powerful effects across social, emotional and physical health.
Interestingly, the research of neuroscientist Jaak Panksepp showed that infant bonding and intimacy triggered the opioid receptors in the brain – leading to further connections being identified between opiate addiction and deficits in experiencing close, nurturing and fulfilling relationships throughout our lives, particularly in early childhood. So, the need is clear – people who experience addictions are very likely to have experienced trauma, anxiety and depression, had difficulty with emotional regulation and struggled with interpersonal and intrapersonal relationships.
This means services that guide and support people in resolving their substance dependency are ideally suited to, and enhanced by, evidence-based mental health treatments and interventions to establish understanding, skills and alleviation of psychological and emotional suffering. The mental health strategy being implemented at Phoenix Futures is progressive, compassionate and exciting, and the organisation exudes a sense of care and responsibility to provide holistic support to everyone who is part of delivering or receiving help.
The work to further enhance the mental health support available begins by focussing on residentials, and the plan is to then roll out initiatives across all services provided by Phoenix. The Scottish Residential service provides treatment that is already adept at supporting the multifactorial nature of the people they work with, and the staff, peers, programme and environment combine to provide a safe space to understand the experiences of the residents and utilise their own sense of self-efficacy. The house has also been designed to be accessible for those with additional mobility support needs.
We plan to ensure that the core therapeutic community treatment processes remain strong, and are aided by the mental health treatments. Where additional support may be needed for a particular individual, we can respond proactively. For example, a resident may present with issues around emotion regulation – the ability to respond adaptively to our feelings, urges and beliefs about what is going on in a way that is productive. Difficulties in emotion regulation cut across trauma, mental health and substance use. People may feel powerless, overwhelmed or confused by the emotions they experience. Offering one-to-one interventions will help them to understand their emotions, develop the ability to be aware, curious and separate from their urges, choose their responses before, during and after powerful emotions, and cultivate acceptance and learning from each experience.
This should improve outcomes across all areas of the person’s life, and provide a feedback improvement loop within the therapeutic community. It’s an exciting time for mental health within Phoenix Futures, and I am grateful to have the opportunity to be a part of it.
My role as clinical mental health lead is a new and developing one.
Just as the physical environment is designed to ensure mobility is no barrier to treatment, my position seeks to ensure that psychological and emotional problems are also not a barrier to the curative effects of the therapeutic community.
The role has three main areas of focus:
- Developing a core mental health treatment programme for all residents
- Higher intensity intervention for those with specific and acute mental health needs
- Support, training and guidance for the staff