Vocalist72 has been part of our community for years. She came back to the site with an update on her Loved One who has given up harder substances but still struggles with alcohol and marijuana. Since she first discovered CRAFT, her husband was diagnosed with serious mental illness. She wonders if CRAFT is compatible with his mental health issues.
“I started your program a few years ago. But I had forgotten about it until recently. Since then my husband made some improvements. He has had some therapy in which we discovered his reason for his substance abuse was due to mental illness. He has given up harder substance use but still struggles as he never really stuck with therapy to deal with his mental illness of social anxiety disorder, OCD, PTSD, and depression. He still drinks and smokes marijuana most of the day to cope.
He promises to go back to therapy. He had started prior to the pandemic but it disrupted the progress we made. I find myself fallen into the negative communication that you talk about in the program. I am glad I found it again. I am hoping we can turn things around.
He refuses any type of medications but is willing to do psychotherapy and other holistic approaches. But he keeps putting it off. I find that I have been pushing him. I will continue to listen to the program to find the best way to get him there.
How does mental health fit into this program?”
Great question Vocalist72, I’ll try to answer in two ways.
Mental illness and substance use disorders go hand in hand
First, as many of you already know, mental health vulnerabilities are highly associated with substance use disorders (SUD), as the graph below demonstrates. Keep in mind that this graph doesn’t tell us which came first, the drugs or the mental illness (which SAMHSA defines as “Adults aged 18 or older with any mental, behavioral, or emotional disorder in the past year of sufficient duration to meet DSM-IV criteria” — excluding developmental disorders and SUDs). 1
2019 also marked a substantial increase in the rate of suicidal behaviors among young people as compared to ten years prior. My own information from colleagues in the field is that 2020 will be even higher with all that we are experiencing from COVID and the general spread of inequalities. 2
Young girls and women are disproportionately affected by serious depressive episodes, as can be seen in this graph, with rates increasing significantly for younger women, and rising in the same direction for adult women. 3
Focus on the mental illness, ignore the use as much as you can
In your situation, addressing the mental illness prevails over addressing the SUD. Use the planned talk to get him into mental health treatment because that is the path of least resistance. You can call the facility and ask them for help guiding your husband to the counselor. The professional should recognize the addiction.
You talk about how your husband doesn’t admit to having a SUD. You are not going to talk him into admitting a problem. You are simply going to say that his use and his struggle are causing you pain.
If he gets defensive and denies that he needs help with his mental illness, that is a signal for you to back off:
It's a "no" to your suggestion of treatment.
Thank him for listening to you.
Tell him you will talk again.
Next time you see an opportunity, whether he simply expresses regret about the status quo (“a dip”) or “a wish” for a change in his life (watch Module 8 for more on wishes and dips), set up to bring up treatment again. Not arguing with him and not trying to convince him of anything will be a change for both of you. You are stating the obvious. A negative response just quietly shuts you down and ends the conversation, until next time.
You have realized that you have fallen back into less positive communication and started pushing him lately. I applaud your willingness to question your stance. Communication can be so difficult and having a Loved One dealing with SUD is hard, especially with the added pressure of mental health issues. I have never met anyone who gets it right every time. What is important here is that you love your husband and are ready to learn and question your own behavior/communication patterns.
Remember, CRAFT is meant to be implemented gradually and gently. The idea is not to upset your husband with abrupt changes in your behavior. Head to Module 4 for tips on how to smoothly shift the way you talk to your Loved One. Your comment tells me your instincts are spot on. CRAFT and the e-learning program — along with self-care — are indeed key to keep you calm and collected. You might even grasp concepts that didn’t speak to you the first time around.
Vocalist72, welcome back. Thank you for writing in and for raising such an important question.