Should Mental Illness Funding Be Used on Addiction Treatment?
If you read the Breaking Bipolar blog over at HealthyPlace you might have seen a question earlier this week:
People have come down on both sides of this question on HealthyPlace and on Facebook but I think the overarching sentiment is that addiction is not just another mental illness as personal choices lead to its existence. No one causes bipolar disorder or schizophrenia through action but no one puts a drink in an alcoholic’s hand and forces them to imbibe. Moreover, addiction recovery is considerably simpler in that addicts get better by choosing not to use substances while other mental illness treatment involves months of treatment before any turnaround is seen and typically involves lifelong treatment.
But whether you think that addiction (or, more specifically substance abuse and substance dependence) is simply another mental illness or not, there is this question:
- Should funds intended to be used on serious mental illness be used for addiction treatment?
Mental Illness Disability Costs
The reason why this is a critical question is because mental illness funding is so scarce. For example, the World Health Organization has assessed that four of the top ten causes of disability are mental illness worldwide. Those causes of disability are:
- Major depression
- Bipolar disorder
- Schizophrenia
- Obsessive-compulsive disorder
Severe Mental Illness Research Funding
And yet for every research dollar spent on healthcare less than one cent is spent on severe mental illness like schizophrenia. And, in case you were wondering:
- 15 cents are allocated to AIDS
- 10 cents to cancer
- 2 cents to heart disease
And while these, certainly, are worthy research subjects, it doesn’t make sense monetarily as the cost of these illnesses to society for every research dollar spent is:
- $161.26 for schizophrenia
- $65.65 for heart disease
- $9.96 for cancer
- $6.86 for AIDS
Quite frankly the lack of funding makes me sick and shows an institutionalized stigma against those with a mental illness.
Addiction and Mental Illness Funding
And look, I’m not saying that getting addiction treatment funding is a picnic, but by Jove do we ever have a lot more of it. While it certainly takes time to get into a program, those programs do exist and are much easier to get into than mental health programs. Moreover, there are addiction treatment centers all over the place that people with insurance can access. I’m not saying it’s perfect, it’s far from it, but compare it to having schizophrenia some time and you’ll see the difference.
So, again, should the tiny amount of dollars that are spent on serious mental illness be diverted to people with addictions and no other mental illness?
And if you really want to consider the question of funds meant for serious mental illness, consider these uses:
- San Francisco County is spending money earmarked for prevention of “severe mental illness” for yoga, line dancing and drumming.
- King County spends MHSA funds meant for people with “severe mental illness” on youth reading below grade level.
- Butte County is using funds meant for “severe mental illness” to fund a “Therapeutic Wilderness Experience”.
- Contra Costa County is using Mental Health Services Act (MHSA) funding meant for “severe mental illness” for a hip-hop carwash, family activity nights and a homework club.
So money that isn’t going to carwashes, line dancing or wilderness experiences should go to addiction? What is actually being done to help the people with serious mental illness?
Currently, California is diverting funds from the serious mental illness treatment to addiction treatment. So is this OK? Shouldn’t people with severe mental illness get to use those funds? Just how many people with schizophrenia living on the streets does it take for treatment agencies to take is seriously? (People with a serious mental illness make up about one-third of the homeless population.)
OK, so I’m getting worked up and maybe you don’t agree with me.
So I ask you, in a more calm and rational manner – what do you think? Should funds earmarked for severe mental illness go to addiction?
Kay h - September 28, 2012 ←
I have 21 year old daughter with bipolar disorder 1 and addiction. Her bipolar disorder started to manifest itself when puberty started and the substance abuse began later. Both illnesses are extremely difficult and make it extremely hard to treat. I am not an addict but I can tell you that it is a horrible illness and you are simplifying it by implying that it is a choice and therefore could just be avoided. Anyone who has had a drink and is not an addict is LUCKY that they didn’t inherit the addiction traits. It is not that they are a stronger person who made the right choices!
It is such a struggle for my daughter to have to go through these difficult illnesses. She is working very hard to be compliant with her bipolar medication and to stay sober. Unfortunately even with the medication she has experienced periods of mania that sometimes lead to relapse. Then the alcohol- and guilt trigger depression and the cycle begins again. I am afraid the judgmental views I’ ve read on this blog mirror those of society and that just makes an awful and isolating situation worse.
rl - September 15, 2012 ←
To tabby, Sorry for the misunderstanding. You didn’t actually mention that you *applied and were denied* in the original comment that prompted my response. To me, it sounded like someone just happen to tell you that you wouldn’t qualify. Thanks for the clarification. Take care. ~ rl
Madam Nomad - September 13, 2012 ←
Here is an article that addresses the connection between addiction and extreme mental states that get labeled as disease.
I don’t agree with you but I admire your energy. I got drafted into the psychiatric cult when I was 16 in 1970 when I ran away from my rapist. I was incarcerated in a psych hospital and drugged. I have brain, endocrine, muscle, bladder and eye damage from the chemicals I was coerced into taking. I did not begin to “recover” until I began an arduous withdrawal from all behavior-control chemicals in 2007. I was raped by my father and then by Big Med. I started sensorimotor therapy and this is curing the ptsd from my childhood that was compounded by the mental illness system. I guess ptsd IS genetic. I got it from my father.
amy gezon - September 8, 2012 ←
This is a complex question as so often addiction coincides or manifests as a symptom of other serious mental illnesses. Without curtailing the addictions it is next to impossible to manage an alcoholic with profound depression. How do you differentiate if a person is drinking in response to depression or depressed due to his drinking?
Natasha Tracy - September 9, 2012 ←
Hi Amy,
I do agree that there is no easy way to know these things although that is what psychiatrists are for.
That being said, the issue isn’t with money being used in cases of comorbidity it’s in cases where no other mental illness is present – and there are plenty of those.
- Natasha Tracy
Elizabeth - September 8, 2012 ←
Funds allotted for mental health treatment should absolutely, unequivocally not be used for addiction treatment. Frankly, lumping addiction in with genuine forms of mental illness weakens the claim for all those with legitimate mental illnesses, making it harder for us to receive treatment–and to be taken seriously.
If a person can afford to buy illegal drugs (or obtain multiple prescriptions to abuse), he can afford to pay for his own treatment.
Natasha Tracy - September 9, 2012 ←
Hi Elizabeth,
I’m not sure if you read my original piece on addiction being a mental illness, but it’s here, if you’d like to check it out: http://www.healthyplace.com/blogs/breakingbipolar/2012/09/addiction-like-other-mental-illness/
Basically, we know that an addicted brain is not like an average brain and there are reasons that makes it a mental illness.
And, to be fair, addicts typically have no money. They get whatever money they can in small dollar amounts – just enough for that next drink or hit or whatever, so asking for them to pay for their own treatment isn’t very reasonable. Plus, many addicts do things society would prefer them not do to get the money.
- Natasha Tracy
rl - September 7, 2012 ←
I absolutely do NOT think funding intended for mental illness research/treatment should be diverted for use in addiction recovery research/treatment. I suffer with Major Depressive Disorder & I am currently on disability. I was first diagnosed more than two decades ago, and I have taken antidepressants for fifteen years. I am also in therapy. My depression is severely debilitating.
I do not drink. I do not take drugs. Am I less important because I’m not a drug addict or alcoholic? I am morbidly obese because I overeat and I self injure. Those have been my ‘drugs’ of choice. What is the ratio of treatment facilities for self injurers vs alcoholics? I’ve been involuntarily committed to the local psych ward (or hell) three times because of self injury. Each time I was kept a few days then kicked out onto the street.
I chose not to drink or take drugs because my mother, uncle and grandfather were all alcoholics. Alcohol indirectly caused my grandfather’s death. My mom nearly died of cirrhosis of the liver due to alcohol consumption, but she survived thanks to a liver transplant. So, I do know the devastating effects of addiction first hand.
It’s been commented here that those with addictions often also battle with mental illness. I agree. So, why not work on recovering from mental illness before people become addicts? And maybe that means access to licensed therapists in every elementary, middle and high school. Of course, that takes money.
My mom no longer drinks. She’s been sober for two years. However, she still takes an antidepressant. She still suffers with mental illness.
Jake - September 7, 2012 ←
From what I understand you are saying is that addiction is a “personal weakness”. This is how mental illness is often viewed. It is theorized that people are pre-disposed or genetically vulnerable to addiction. Self harm is a hallmark of mental heath issues not lack of character.
Natasha Tracy - September 7, 2012 ←
Hi Jake,
I’m sorry if that’s the message you got from my writing because that’s not what I’m trying to say. I do think people need to take responsibility for the conscious actions that they took that led to the disorder but addiction isn’t a personal weakness per se as none of us knows who is predisposed to that condition.
I wrote more on this topic earlier this week: http://www.healthyplace.com/blogs/breakingbipolar/2012/09/addiction-like-other-mental-illness/
- Natasha Tracy
Debra - September 7, 2012 ←
I know here the one hospital is meds only. It is bare frustrated bones. Addiction while true it most of the time isn’t forced but it can be a side thing to a severe mental illness. Many using the illegal stuff to make it through the day to the next. If they don’t have insurance or the funds is it fair to let them suffer? Ironic that mental health services are one of the first things they want to cut in a time of budget crisis. It is like they think mental illness is some rollarcoaster ride we chose to hop on. I doubt anyone would seriously want to get on that for any reason. Another twist of irony is the fact China spends a little over 100 billion on defense. We spend almost 700 billion yet we can’t do more for those who truly need it. On Psychiatric Times they have discussed the frustration of funding and patients who need more than they can give. Where and when do we as human beings and citizens say enough? Should addiction be funded? I guesd to a point it should but treat the base illness too. I think we are all deserving of peace and health in our lives.
Natasha Tracy - September 7, 2012 ←
Hi Debra,
I’m definitely not suggestion that addiction shouldn’t be funded or that we should “let them suffer.” Absolutely not. It just seems to be that they have so much funding (comparatively) already that they should not also have the funds earmarked for those with a serious mental illness.
- Natasha Tracy
Courtney - September 6, 2012 ←
Addicts don’t “get better”…It’s a daily struggle. And if killing yourself by using drugs and alcohol isn’t a serious mental illness, I don’t know what is. I know plenty of people who have died due to addiction.
Natasha Tracy - September 7, 2012 ←
Hi Courtney,
I did mention that substance abuse and substance dependence are currently defined as mental illnesses, so there’s no doubt about that. And we do lose people to addiction, this is also true. I’m just not sure it’s the same as other mental illnesses. I wrote more on this topic here, if you’re interested: http://www.healthyplace.com/blogs/breakingbipolar/2012/09/addiction-like-other-mental-illness/
- Natasha Tracy
tabby - September 6, 2012 ←
Interesting topic, in that I work as an administrative within a MH agency that provides Substance Abuse services and relies 100% on State and Federal funding (no private, no private health insurance).
Many of the “hard-core” users/alcoholics have had, over time, their brains altered by the substances and in fact, have developed forms of mental illness. Many of those who abuse alcohol and illicit drugs, do so BECAUSE of the mental illness within themselves.
Many have BOTH diagnoses and for the person who noted the government does not recognize it as a medical disability… the government awards SSDI/SSI for those rendered “disabled” by their substance abuse/usage. Every week, we have several clients who apply and are awarded Social Security disability.
Also, the reimbursement rate is higher for comprehensive SA programs in comparison to standard basic MH benefits because it’s viewed as a higher level of benefit. There are full on service definitions, in Medicaid, to treat solely SA.
I am one with mental illness and it does bother me considerably that, those who choose to do drugs and drink alcohol to excess… get more money, more service, more access to service, and more attention… than one entirely with mental illness. That said, I’ve had my own addiction to narcotics, benzos, and alcohol briefly in the past (the narcs and benzos, were prescribed & as I built up the tolerance, more med was prescribed, etc..) and I was briefly hospitalized (one of my 4 hospitalizations) for the narcotics…
However… I’ve received far far far less assistance for my Bipolar, PTSD, and Anxiety and more and more programs have closed, due to cuts in reimbursement.
Natasha Tracy - September 7, 2012 ←
Hi Tabby,
Thanks for your views and information on this subject. It’s always great to hear from someone who has first-hand experience in the system.
I agree, addicts get far, far more help and it is endlessly infuriating (just from an outsider perspective). It’s not that addicts don’t need help, it’s just that the mentally ill need more than they’re getting.
- Natasha Tracy
Rox1SMF - September 8, 2012 ←
Tabby: ‘Many have BOTH diagnoses and for the person who noted the government does not recognize it as a medical disability… the government awards SSDI/SSI for those rendered “disabled” by their substance abuse/usage. Every week, we have several clients who apply and are awarded Social Security disability.’
This state of affairs makes me want to scream and rip someone’s face off. I have a 21 year old daughter who’s had a physical condition since 3 years of age that has left her partially disabled. She’s been denied SSDI and SSI already once (a few years ago, and we were too broke and tired to fight). Recently, she was diagnosed bipolar as well (the hits just keep on comin’!). Once again, she’ll have to fight to “prove” she’s eligible to draw even a pittance from the hundreds of thousands of dollars I’ve put into the SS system in the past 35 years. She’s not even trying to get out of going to work, or using her mental illness as the basis of needing help. The kid is physically unable to do many things able-bodied people can. But no, she’s got to jump through hoops and justify why she should qualify for something that addicts seem to get with no trouble at all.
On the other hand, my niece that’s 2 years older and has had NO physical problems was deemed eligible for SSI, quick as you please… because she’s a substance abuser who ended up hospitalized for self-harming, and was subsequently diagnosed as bipolar. She spent 6 months in drug rehab and by the time she got out, boom! Check in hand. Not that I don’t love her and all, but WTF?
My daughter and I have (half-jokingly) wondered whether it isn’t time to just “game the system,” and get the instantaneous okie-doke for SSI by her claiming she’s suicidal – and has a plan – so she’ll get locked up for 72 hours, and shortly thereafter start getting SSI benefits. If she and I weren’t quite so afraid of what might happen to her during those 3 days, it would be a plan deserving of far more serious consideration. Sometimes having morals and values like honesty is more hindrance than help.
In one of her more depressed and despairing moments, she lamented, “Mom… it’s just not fair! I have serious medical problems that aren’t in any way my own fault, and I can’t get a break; but these effin’ people whose problems are due to their own bad choices get everything on a silver platter. Do I have to become a drug addict so that I can get help NOW?” No one should ever have to feel that way, and it’s like a knife in my heart that my own kid does.
While I realize that there’s now a booming “recovery industry” that’s all too happy to take funds earmarked for mental health now that substance abuse is considered (wrongly, in my opinion) a mental illness, there are also plenty of charities that help substance abusers and addicts; let *them* take up the slack when mental health funding is no longer siphoned off to help people with a “disease” of choice.
Yes, it’s too bad that some people struggle with addiction, but after a few decades of watching so many substance abusers get more attention and better, faster care and assistance (while destroying the lives of everyone around them) my sympathy for their plight is at or near nil.
Those of us who are sick through no fault of our own deserve better than having to end up hospitalized before we can even begin to qualify for the kind of help that addicts get as a matter of course.
tabby - September 11, 2012 ←
my friend… I agree
it is not fair that someone with mental illness or even physical disabilities be denied, time and again, for Disability from our government – when those who choose to partake of the alcohol and illicit/sometimes prescribed as well – substances to an extreme… seem to get the disability so readily
my agency has roughly 32 people in their substance abuse programs… most of those 32 are homeless and near all are receiving a SSI/SSDI check… those who do not, are coming in and having their case worker help them complete forms, etc.. in order to apply. The caseworkers (I am not one, I am merely an admin) comment daily, behind me, of this guy wanting the check and that woman wanting her check and primarily so that they’ll have more money to go buy alcohol and their drugs.
Yet… they are in Intensive Outpatient SA treatment, 2-4 hours per day.. fed lunch (my agency feeds them each day cause most are homeless) and they see a psychiatrist every week.. have access to a counselor/case worker, etc..
I am a person diagnosed with Bipolar I or II or whatever a psychiatrist at the time who sees me decides to diagnose me with. Really, I’ve gotten the whole gamut at one time or the other. Along with that, I have Generalized Anxiety and Post-Traumatic Stress.
Unless I am jacked up on 6-8 medications, going to the psych 2 times a month, the therapist 2 times a month, and am in group 2-4 times a month… I, too, am not eligible for SSI/SSDI. YET, I have periods of complete debilitation and decompensation, have been hospitalized 4 times (should’ve much more than but talked myself out of), and have been suicidal off and on since I was 8.
I have a nearly 35 year psych history… over 53 prescriptions taken, at various times and various types/combos, and still… I’ve been told that I would not qualify to even apply and to not even try for it would take upwards of potentially 2 years of repetitive attempts to even get a potential approval. So, I work… I work full-time… until I go through another debilitating episode and my employer either fires me, lays me off, or asks me to resign.
Really… it does chiz me off some days and yet, I do know that many who are addicted to alcohol and drugs, be it illicit or prescribed by a doc… are in a very bad way mentally and emotionally, as well as physically. So, the conflict still reigns over what or who is more deserving of the extremely limited and ever further decreasing funding?
Government even cuts the developmentally disabled children’s funding (formerly, mentally retarded) and closes down special schools and takes away personal care services, respite, etc…
There just is not enough money to supposedly go around and of the groups clamoring for the funding… the substance abuse programs tend to get the biggest “visibility”… in my honest opinion, of course
rl - September 11, 2012 ←
“I’ve been told that I would not qualify to even apply and to not even try for it would take upwards of potentially 2 years of repetitive attempts to even get a potential approval.”
tabby
As you know, disability is based on whether or not a disability renders a person unable to work. If you are capable of working please be thankful. If/when you do lose your job because of your illness and are unable to work, apply.
I really don’t think you should feel slighted by the system if you’ve never bothered to apply for disability.
tabby - September 15, 2012 ←
i am not “slighted” by the system of determining whether a person with mental illness is “disabled” enough to be rendered unable to perform ANY job, be it sedentary or physical… because I applied some years back – when unable to work, due to my illness and a month long psych hospitalization and 4 meds coursing through my system making me unable to even keep 1 eye fully open. I kept getting rejections… had no money coming in… quit re-applying and went back to work (course, had to stop that Thorazine in order to actually work, but what the hey).
I’ve thought of re-applying since, have even been told to apply – but was told by 2 attorneys, a therapist, and the psychiatrist I was seeing at the time I mentioned it – that it could be upwards of 2 years. The therapist and the psychiatrist both told me that though they agreed that I really was unable to handle the job stresses, I was more unable to handle the financial stresses of waiting it out… because i have a family that depends on me and only me to keep the roof over our heads.
A pharmacist, I know very well, got her SSDI after 3 years of fighting the system and 2 attorneys (she had to change firms). She has degenerative discs and pinched nerve, “out of it” on pain lollipops most of the time. It took her 3 YEARS, but she got it. Her husband, has his own business and thankfully, has been able to cover the costs of all 4 of them while she waited everything out… that and well, her savings, etc..
Another, horrendous migraines does she suffer.. she is still in the throes of trying to get her disability determination and she’s been at it about a year now. The medical bills, the prescription bills… she talks of just chucking it and trying to find even a 15 hour a week job somewhere to help out her mom who is covering not only her bills (mom’s) but her’s as well (friend). Yet, she is afraid if she does – she’ll be seen as “being able to work”.. so, she is in conflict right now.
So many are working part-time and full-time, hopped up on so many drugs that the docs prescribe (even quite a few of the therapists and psychiatrists folks go to see).
I know.. folks would be so glad to not be disabled and be able to return to work, if it weren’t for the mental illness… be thankful you can work while struggling with your mental illness, so many can’t.
Yeah, I know… I’m different.. not better, just different… cause i suffer horrendously also, i just keep mine stamped down as much as possible… can’t let the employer see, ya know?
I vaguely remember even Natasha worked. If I remember correctly, and could be fuzzy on the details, she worked for a big software company here in the states. I do remember that she used to blog quite a bit about struggling to work, while taking the meds and even having that “nerve implant” device thingie (hate topiramate). It’s what drew me to her blogs years back… her working and struggling while dealing with her mental illness.
I can barely work a job, for much of the time, because of MY ILLNESSES… I just do not have the resources, as many do not have, to wait out the government to determine that I’m not able. I’m working while unable to work and struggling to keep that work because I”m mentally ill and need to keep a roof over my head. Yet, that’s what the drugs are for… right?
If you are on disability, RL, because you’ve been determined unable to work due to your illness or what have you… then be grateful and thankful that you are receiving some form of compensation… it sucks out here, working while unable and under fear your job and your income will be gone at any moment… especially if the mental illness shows. It also sucks not being able to take time off from work, each month, to attend all those much needed appointments with therapists, psychiatrists, and neurologists (me)…
The disability determination system is not equitable, not quick, and not set up to just award. As i said, I know 2 women who struggled (and 1 still struggling), in particular, to get disability awarded.
It’s all about choice… I make mine and others make their’s.. it doesn’t make either one of us better than the other. My illness rages and torments as badly as others and I’ve been with it, or it with me, for nearly 35 long years.
It’s choices we all, within ourselves, have to make… the need to be thankful and grateful is perceived on both sides towards the other.
Betsy - September 6, 2012 ←
At this time, the government does not view ALCOHOLISM and DRUG ADDICTION as a medical disability for purposes of giving disability benefits to those afflicted. I do not want to bore everyone with the details, so just ask Google. TONS of drug companies POUR their money into research to helpe alcoholics and drug addicts because – SURPRISE – they want to make a profit to help people who want / need it (not bad yet true). So, funding is coming from the private sector for alcoholics and addicts. People with psychiatric challenges are said to have been BORN with neurological problems and/or brain malfunction. Our country is spending TOO MUCH MONEY on housing prisoners that ended up in jail for stupid choices relating to drugs and alcohol — the MATH does not add up when there could be assisted outpatient services provided to alcoholics, drug addicts AND psychiatrically challenged individuals. My opinion is that those BORN with neurological problems and/or brain malfunction, are in a SEPARATE category. I am very disgusted on how our society is “handling” citizens of the USA in regard to any of their psychiatric conditions — it’s near inhumane. Medications can help yet are not foolproof and many have horrible side effects, yet it is that OR stay ill. Psychotherapy is essential as well (in my opinion). Universities offer very affordable care because residents need to get through school helping people or they don’t graduate. Anyway, I guess what I am trying to say is that NO funding for those BORN with neurological problems and/or brain malfunction is best SEPARATED from funding for alcoholics and drug addicts —- JUST MY OPINION.
Natasha Tracy - September 7, 2012 ←
Hi Betsy,
Thanks for your thoughts. I did talk more about the fact that so many mentally ill are housed in jail here, if you’re interested: http://natashatracy.com/treatment-issues/mentally-ill-people-institutionalized/
- Natasha Tracy
Harryf - September 6, 2012 ←
This is a funding issue for you folks in the US, to I make no comment about that. However, may I suggest addiction IS linked to mental health and the treatment of mental illness is affected by addiction. They – are – linked, and it must not be forgotten that alcohol and drug abuse are very often “self-medication” for people who have undiagnosed mental illness. It’s one of the possible symptoms of Bipolar, for example, and my one-time binge drinking was seen in that light and part of the diagnosis. Indeed, there is a history of alcoholism on one side of my family where the evidence points to a history of untreated Bipolar Disorder. Treat the underlaying illness and there is a chance that the alcoholism may be contained but any alcoholic will tell you, “once an alcoholic, always an alcoholic – there are just some alcoholics that don’t drink anymore.” So, like mental illness, it’s treatable but it’s not curable. Moreover, alcohol and drug abuse are linked with mental illness treatment, too – while the patient self-medicates, the doctor prescribed medications don’t work properly, but they “need” to self-medicate because the medication isn’t helping! It’s a vicious circle. Indeed, it’s often a dance of partners, addiction with mental illness, and they have to be treated together, not separately, if the mental illness is going to .be controlled
Natasha Tracy - September 7, 2012 ←
Hi Harryf,
Oh, I totally agree with you in the cases where there is comorbidity (both addiction and mental illness). Always in those cases they have to be treated at once otherwise neither treatment will be successful.
But the issues is for funding of addiction programs where no mental illness is present and keep in mind that less than half of people with a mental illness have addictions issues – many addicts are just that, addicts and do not have another condition.
- Natasha Tracy
Littlemissmagic99 - September 6, 2012 ←
This is very simple. The money is for mental health so it should go to mental health. NOTHING ELSE not addiction. Insurance is there for that in most cases, but mental health coverage is not.
Natasha Tracy - September 7, 2012 ←
Hi Littlemissmagic99,
You have a point about insurance, but as I mentioned, substance abuse and substance dependence are considered mental illness. I talk more about that here: http://www.healthyplace.com/blogs/breakingbipolar/2012/09/addiction-like-other-mental-illness/
- Natasha Tracy