You divided when you should of multiplied

By Max Liles - Contributing Columnist

“And”; Substance Use Disorders AND Mental Health – 2 separate things. Personally and professionally, there is a distinct designation that people make between the two. Whether it be through their own lived experience, stigma, what they’ve been told by someone in the field, or what they have been taught in school – the division exists.

Fun fact: All these diagnoses come out of the same book – the Diagnostic and Statistical Manual of Mental Health Disorders (currently in its 5th edition) AKA the DSM5; a publication of the American Psychiatric Association.

So why the division?

First and foremost, the reference material, the DSM, does place substance use disorders in their own category. With that being said – the DSM also groups other similar disorders: Psychotic Disorders; Bipolar Disorders; and Sleep Disorders – to name a few.

The DSM makes no hesitation to acknowledge that substance use disorders, while similar in the way substances play a role, have much more to them than the substance itself. The DSM states (p. 483), “The essential feature of a substance use disorder is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems.”

Note: Before it even mentions the substance, the manual lists the cognitive, behavioral, and physiological implications of this group of disorders. *Ponder emoji* Sounds mental-health-ish…

Further, the DSM cites on the same page that “An important characteristics of substance use disorders is an underlying change in brain circuits that may persist beyond detoxification, particularly in individuals with sever disorders.”

Note: Wait – “underlying change in brain circuits”; is this a brain thing? Did they just call this a brain disorder?! And even if I dry out, like quit using, I am still going to have symptoms?!

While substance use disorders have a category based on the similarities they share as it pertains to the use and abuse of substances, are these disorders really such an anomaly that they need referenced independently of all other mental health disorders? And if so, or if not – how did that wind up happening?

Note: “Problem definition defines intervention.”

By education, I am a Master’s level Social Worker, an alumni of Ohio University (OU? OH YEA!). During my time in grad school at the main campus, I learned a lesson that I think can shed some light on our topic:

“Problem definition also defines the intervention.” (Shout out Dr. Sarah Garlington – I hope you read this).

With substance use disorders – peoples’ perception of the root of the problem can be various; is continuously using despite consequences in your life a choice? A disease? A moral failing? A criminal issue? Is the person possessed?

Based on your answer to that question – the way you address that problem will be different. If defined as a criminal issue, a judicial approach will be best suited. If the person is possessed, you’re going to need an exorcist. If the issue is of moral failing, the person may be perceived as weak – doomed to repeat a cycle of using and causing harm to themselves and others forever.

As the problem is inappropriately defined, the intervention does nothing to address the problem; further perpetuating the ideology “once and addict, always an addict”.

If the issue of substance use is defined as a medical issue – we can treat it like the disease it is. The integration of primary health care can be implemented; medication utilize to help physically and mentally stabilize individuals with the disorder; integrated teams of counselors, social workers, and recovery support can develop treatment plans that implement evidenced based practices as intervention – healing can happen.

This model – a medical model, which is comprehensive and empathetic in its approach is paramount in improving the mental health of people, regardless of their specific disorder. A model where disorders are not singled out or stigmatized but are treated like human beings. A model that provides folks access to resources to get well, as entire person.

Note: What’s holding us back from that model is stigma.

Frequently, I hear about the situation: So and so is struggling again. Billy Joe fell off the wagon. The Smith boy is back in trouble. She’s strung out again – always followed by the million dollar question: “WHAT DO I DO?”

My advice is pretty simple. What would you do for anyone else going through something difficult? What would you do for a sick friend? Regardless of their specific affliction.

For my pretty simple question, I got a pretty simple answer last week – “Well, I’d text and call them often. Tell them I was thinking about them. Pray for them.”

…and that’s a really good place to start.

By Max Liles

Contributing Columnist

Max Liles is the Senior Director of The Counseling Center, INC. He can be reached at 740-357-7693 or visit

Max Liles is the Senior Director of The Counseling Center, INC. He can be reached at 740-357-7693 or visit