You Need to Care for Mental Health in Sobriety
Because 12-step recovery groups don’t treat mental health issues
I’ve been clean and sober since 2003.
I sought help from Alcoholics Anonymous (AA), and it worked. Fortunately, I don’t have active co-occurring disorders impeding my recovery.
In 2018, approximately 38% of addicts in the US were reported to have a co-occurring mental illness. They’re not all properly diagnosed, nor are they encouraged to seek treatment. Furthermore, those seeking treatment face challenges, some from fellow AA members.
According to the National Institute of Health (NIH) on drugabuse.gov, 7.7 million people in the US had co-occurring disorders. Of the 20.3 million with substance use disorders, 37.9% have mental disorders. Among 42.1 million with mental illness, 18.2% have substance use disorders.
Why do people with co-occurring disorders not seek mental health care?
For those with mental health issues, cost-prohibitive care is their main barrier. Those with substance use disorders were said to be “not ready” to stop drinking and using drugs.
I disagree about the notion of not being ready because alcoholics and addicts lose their power to choose at some point. They need to hit bottom. Sometimes they have a near-death experience before seeking help.
As a pre-professional educated in psychology and addiction, I see a few other barriers to seeking mental health care. It’s difficult to diagnose a previously unknown mental illness until a period of abstinence. Both substance abuse and other mental disorders have similar symptoms, making it difficult to discern what’s causing the symptoms.
Another common problem is reaching a person who’s unwilling to seek mental health care. Some mental illnesses are hard to treat for various reasons. Schizophrenia, for example, can cause a person to be treatment-resistant. People with schizophrenia often feel uneasy with medications due to harsh side effects.
Another more complex issue lies within the rooms of AA.
There are no rules in AA, only suggestions. Although it’s discouraged, people often give unsolicited advice. Newcomers are more likely to follow suggestions from long time sober folks.
Some advice is dangerous. Members have discouraged taking any medications, including psychotropic meds designed to treat mental disorders. They misinterpret AA’s message to refrain from mind-altering substances, ignoring the mention in the Big Book that medicines might be necessary to aid treatment.
Members misunderstand another part of the Big Book, which states,
There are those, too, who suffer from grave emotional and mental disorders, but many of them do recover if they have the capacity to be honest.~Chapter 5, How it Works, from the Big Book of Alcoholics Anonymous
They attribute relapse as a lack of self-honesty, disregarding a mental health issue as a relapse risk in itself.
People new to sobriety are vulnerable, and commonly make choices that don’t serve their best interest. We can’t guarantee “old-timers” in AA give sound advice, either. Being clean and sober doesn’t mean they live in a state of wellness outside the rooms.
There’s a reason we don’t call it “Well People’s Anonymous.” AA is not therapy. It’s a support group, filled with a spectrum of sober people, not always healthy.
Attending AA meetings isn’t the only way to stay sober.
Members often talk about the danger of not going to meetings. It’s common to hear, “I stopped going to meetings” as a reason for relapse.
Individuals who suffer from the effects of mental health issues might not feel safe going to meetings. It may be traumatic and contribute to a relapse. To further my point, AA isn’t the only way to stay sober.
I’ll speak from my experience. I’m currently over 17 years sober and haven’t attended meetings for over a year. I don’t intend on going back anytime soon, even after the covid restrictions lift.
Meetings don’t keep me sober. I continue to live by the valuable principles I’ve practiced within the rooms of AA. I’ve taken them out into the world, as they apply everywhere. I have no desire to drink and don’t feel it’s risky to stop meeting attendance.
My connection with Source is helping me stay sober and healthy. When I was newly sober, I felt a strong need for the camaraderie of the fellowship. I needed the accountability of other members like my sponsor to help me stay on track. Years later, I needed a tangible way to be of service to those suffering.
I chose to be an AA sponsor. I helped guide several womxn through the twelve steps. Quite a few of them had mental health challenges. It was my moral responsibility to do two things. First, I made it clear I had no authority to give treatment for their mental health or give advice about it. Second, I always suggested they seek outside treatment. It was up to them to follow through.
Sponsorship is an act of service highly encouraged by the program, helping us all stay sober. However, we can’t claim to be experts in the mental health field, unless that’s our profession outside of the rooms. Even then, it’s not our role as sponsors or fellow members. We’re a group of drunks, there to support each other in recovery.
The twelve steps of AA are designed to help alcoholics address the underlying issues getting in the way of sobriety. We agree as a group that alcoholism is a spiritual malady. Therefore, we work the steps to get closer to our personal version of God.
AA claims to not be a religious program, with the focus on connecting with a Higher Power, whatever it means for you. The steps help clear our path and promise to keep us sober if we work them.
Keeping this in mind, AA isn’t for everyone. Atheists can work the twelve steps of AA, but not all of them feel comfortable with the spiritual aspect. Just because AA worked for me, it doesn’t make me an expert.
The same goes for alcoholics with co-occurring mental disorders. I’ve seen first hand how damaging it can be for them to follow what ends up to be ill-fated advice. They tell them to “just keep going to meetings and working the steps, and you’ll stay sober.” Just doing step work won’t necessarily work for them. When they relapse, they carry guilt and remorse as if it’s a moral failing.
I’m familiar with one person in particular who keeps relapsing. I have reason to believe it’s due to unaddressed birth trauma (he was adopted) and subsequent untreated depression. He’s not the only one I know who suffers needlessly from lack of mental health care.
Alcoholics with mental disorders need better access to professional mental health care.
Despite the prevalence of co-occurring disorders in the recovery community, addicts seeking sobriety don’t receive nearly enough support for their untreated mental illness.
Not only does our larger community lack adequate funding or support, but the twelve steps can also be confused as a treatment for a mental illness. Members of AA aren’t professional mental health care providers. They don’t have expertise in dealing with what we call “outside issues.”
We’re lucky in Santa Barbara County (where I got sober) to have wraparound services available for low or no cost. But people with co-occurring disorders are at risk for discontinuing treatment, especially when influenced by misinformed folks in the AA program.
Although we have a pamphlet on outside treatment and taking medications, AA doesn’t have the authority to refer anyone. Inpatient and outpatient rehab centers have built-in resources, but of course, they’re expensive.
Final thoughts
How can we solve the problem? We need to bridge the divide. People with substance use disorders often suffer from mental disorders, and they’re not getting the help they need.
Let’s address the issue in mental health facilities and drug rehab treatment centers. We need to lobby for further funding for mental health care, emphasizing a need for more dual diagnosis services.
We need to recognize the difference between twelve-step recovery programs and mental health care. AA members don’t serve as health care professionals unless they’re working in that capacity.
Finally, I’ll share some of what I’ve learned in AA. Expressing compassion and empathy is the best way for us to be of service.
If you don’t suffer from a debilitating mental health issues, please show compassion to those who do. Don’t pretend to know how they feel.
If you suffer from the effects of a mental health challenge and you’re an alcoholic or addict, please reach out for support. I’m here to advocate for your optimum care.
If you or someone you know needs help treating a co-occurring disorder, please check out the following resources:
Treatment for Co-occurring Disorders
10 Things You Should Know About Dual Diagnosis treatment
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