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picking a treatment

Have you ever been humiliated by a barista? I have.

I was told once that ordering Chai Tea was redundant, because the word ‘chai’ means ‘tea’. She punctuated the insult, while handing me a pile of sticky change, by pointing out that I wouldn’t ever order a coffee-coffee. And she was right. (Unless, of course, I’d already had a few coffees that day, in which case I can’t be held accountable for much of anything I say…)

Being shamed in a café is pretty bad. But experiencing shame in a clinical setting? That’s much, much worse.

My colleague recently told us a story that made me cringe. She had taken a friend of hers to an emergency-counseling clinic in town, as her friend was in desperate need of assistance. To her dismay, and now mine, “help” arrived on the scene in the form of just one question: “Will this be addictions or mental health today?”

According to the nurse behind the desk, all patients reporting for addiction were directed to a waiting alcove at the left of the room, while those who were seeking help with a mental health issue were told to find a chair on the right. In that moment, her friend could have comfortably found a spot on either side.

Hearing this, I envisioned a desperate woman, who has just taken the first timid steps toward treatment, straddling an invisible line with shaking legs. Now faced with the task of choosing between two seating areas, two labels, exhausted already by the effort it took to make the choice to come in the first place, she ultimately uses her last bits of strength to turn around and leave.

Despicable, antiquated, and bullshit were just three choice terms spewed toward the center of the circle we’d formed with our colleague as she spoke. Together, we compiled a list of questions we’d like to ask the nurse, should we ever encounter her in a dark alley. Questions like, “What would the assessment process be moving forward for people on the right versus those on the left?” and “When the f*ck did you even go school, Gladys? 1910?!”

But as I revisited the story in my head later that night, carving sores like craters into the roof of my mouth with sour candies, as one does while deep in contemplation, I could only think of one question I’d take back to that agency: What the hell’s the difference?

As a student in the field of addictions treatment, I believe it’s my right and my duty to be conversant. To know as much as I can about what’s available today for treating the disease of addiction, as well as what still needs to be done.

You can subscribe to CCSA’s (Canadian Center on Substance Abuse) daily emails and squint at articles on your smartphone while simultaneously brushing your teeth every morning, like I do. Or you can simply enter the words “co-occurring” or “dual diagnosis” into Google news, and find a multi-page queue of articles suggesting that there is indeed great need for more research and skillful implementation of best practice in treating addicts who also have depression, or anxiety, or BPD, or OCD, and so on and so forth.

Sometimes, putting down the drug and the drink is enough. In my experience, once the substances were gone, so were my symptoms. Throughout my addiction, I battled persistent feelings of anxiety, alarmingly low mood, impulse control issues, and suicidal thoughts so frequent that I wondered if my feelings alone might kill me. Though sobriety hasn’t permanently fastened rose coloured glasses to my face, I no longer live my life in the dark either. But I know I’m one of the lucky ones.

Sometimes there lies an existing diagnosis, buried deep beneath the substance use, which cannot simply be pacified by leading a clean and sober lifestyle. The “pink cloud” evaporates eventually, and what’s left is a disappointed shell of a person who is substance free, and no happier for it. Not everyone can just switch the light back on.

The DSM-V offers criteria for the classification of mental disorders. (It also offers hours of entertainment for those who like to play Who-In-My-Family-Has-What?!?) Though the DSM does not expressly recognize “addiction” as a singular diagnosis, it does list a series of Substance Use Disorders.

So if dependence, or Substance Use Disorder, is classified as a cluster of eleven symptoms equaling an illness, is there really a pressing need to differentiate at intake? To set the two apart before the real problem is defined? To seat some of us one place, and the rest of us someplace else? Simply by being included in the DSM, addiction falls under the umbrella of mental illness, or mental disorders. In many ways, addiction can feel like mental illness, and mental illness can imply addiction. It’s not exactly apples and oranges here, people. It’s ‘chai’ and ‘tea’.

The system, though constantly improving, is still largely broken. It’s rife with yawning cracks for us all to fall in to. We are a complex species, with complex problems, and cannot afford two waiting rooms divided by invisible lines. As whole people, our edges are too bowed for boxes, so let’s not struggle to fit into them.

If you’ve ever suffered, you know that when it comes to crisis, nothing makes sense. It all sounds a little like coffee-coffee, even to you. Asking for help shouldn’t be a tall order anymore. There needs to be change. Even if that change is sticky.

About Carli Stephens-Rothman

With a BA in Journalism from Ryerson University, Carli has been writing professionally for seven years. Today she can admit that six of those were mostly a blur. Reaching a year clean and sober in December of 2015 -- after privately (and then not so privately) battling addiction for much of her twenties -- Carli has refocused her personal and professional lives in order to nurture a new path. From her home on Vancouver Island, she continues to freelance for a number of Toronto-based publications, including The Toronto Star and SheDoesTheCity, while setting out upon a new academic journey in the field of addictions and mental health. When not writing or studying, or exploring the brilliant world of recovery, she teaches yoga with a focus on healing and confidence-building.

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