Geoff Zochodne

The Oshawa Express
Date Published: Wednesday, May 30, 2012

View printable version

Sarah (not her real name) has depression, anxiety, recently diagnosed borderline personality disorder and an addiction to marijuana.

All of this makes her the expectation, not the exception, say those working in the mental health fields. This is the message they are trying to get out.

A Concurrent Disorder (CD) is the definition for a person afflicted with both mental health and substance abuse concerns. It isn’t a new term, but it can be a hard one to grasp.

Allison Potts, the concurrent disorders system integration lead for Lakeridge Health, says the dual nature of CD made it difficult to address in the past.

“The care system was sort of set up to help people with addiction issues or mental health issues,” she explains. “It’s been difficult for people with both.”

This is unfortunate, notes Potts, because between 30 to 80 per cent of people diagnosed with a mental health issue will have a substance abuse problem as well.

“Certain mental illnesses will increase the likelihood,” she explains. “It’s quite a complex relationship. We don’t know if it’s one cause or the other. They can mask each other, they can mimic each other, they can trigger each other.”

Substance abuse can hinder the effectiveness of medication as well. To combat this, Potts, Lakeridge Health’s Pinewood Centre and other members of the Central East Local Health Integration Network (LHIN) have been creating programs that screen for both mental health and substance abuse issues.

“We weren’t screening before,” says Potts. “If we don’t ask the questions we give the impression it isn’t okay.”

A recent conference brought together the professionals from the Mental Health and Addictions Network of Central East Ontario and the Concurrent Disorders Network of Durham Region to discuss how better to tackle the problem.

The chair of Durham’s CD network, Paul McGary, noted the newly released strategy from Canada’s Mental Health Commission has taken an interest in CDs too.

“Concurrent disorders is within that strategy as well. It doesn’t have a huge place, but this is coast-to-coast the first mental health strategy,” says McGary. “The degree to which we are now implementing universal screening across agencies…people get it now.”

Jai Mills, an integration consultant with the Central East LHIN, says Durham is blessed with Pinewood, putting it in an advantageous position.

“I find it interesting that concurrent disorders are regarded as a relatively new phenomenon,” remarks Mills. “It seems that people are kind of waking up to the fact that there are so many people in our system who are dealing with a concurrent disorder.”

In the past, the health care system found handling both mental health and substance abuse an awkward problem. Because of this, many people in the system just gave up, says Mills.

Things have changed, and though they have improved, they can still get better. Those who suffer from CD make up 27 per cent of people returning to emergency rooms in the Central East LHIN, Mills states.

“Certainly we need to look at what kind of solutions we are offering for people so they don’t feel the need to make that desperate choice.”

This is what happened to Sarah.

She is now 21-years-old, but had been diagnosed with depression and anxiety at a young age. When she got older she began to supplement her medication, which sapped her energy, for marijuana.

While some of her friends smoked, Sarah began using marijuana more as a coping mechanism.

“I started secretly getting off my medication,” she says.

When her doctor went on sick leave she abandoned her medication completely.

Sarah’s condition began to worsen. She had a falling out with her friends, who saw her as a pothead and nothing deeper. This was coupled with long wait lists for psychiatric help that heightened her anxiety.

“My thoughts started getting worse. I felt like a failure. I thought I’d get help right away but there’s too many waiting lists for mental health and the waiting got to me.”

Finally, in the same manner Mills mentioned, Sarah finally reached her breaking point.

She called up her parents, dropped out of school and returned home.

Coming home from the cottage one weekend she called the police. She was tired of waiting for help and didn’t know where to turn. The police officer recommended she go to the emergency room. Sarah decided to wait.

“Two days later I sat in front of my pills for about four or five hours and contemplated, then I went upstairs and said (to my mom) ‘you can take me to emerge(ncy).’”

Sarah was admitted to the day program treatment at Lakeridge for six weeks at seven hours a day. While she was just being treated for her mental health, therapists there picked up on her mentions of smoking marijuana and invited her to join a substance abuse group as well.

“That was fabulous. It’s a collaborative program, you’re learning about mental health and addiction, I like that,” she says. “It’s analyzing where your triggers are, like what makes you upset and how to calm yourself down.”

Sarah averages a gram to a gram-and-a-half of marijuana a day, usually done in one quick binge. Through her treatment at Pinewood, she is to be admitted to a detox facility.

At this point, she still has an addiction. It has taken some doing, considering the prevalence of marijuana use in society, for someone to take it seriously. But Sarah is eager to get right with herself, her friends and her family, some of whom she has had to explain the connection between her mood and her drug use.

“Some do, most don’t,” says Sarah, when it comes understanding her CD. “My conversations and my thoughts were much different from those smoking around me. I just realized when I was smoking it with some of my friends my thoughts were different and I was specifically using it to numb. They were using it socially.”

Sarah heads to detox soon and she is also on several waiting lists for mental health care at Ontario Shores.

“There’s so much waiting. I want to figure out my life and get going and get back to my degree, but unfortunately it’s a bit of sit and wait,” she says. “I’m going to come out of this eventually.”