Substance Use, Mental Health, and Obesity: Changing the Paradigm

What do treatment for substance use, mental health disorders, and obesity have in common?

For decades, we treated them exactly wrong: as if they were signs of personal weakness, moral failings, or a lack of willpower on the part of the person struggling with a substance use or mental health disorder or the person struggling with obesity. To put it another way, for all three conditions – substance use,  mental health disorders, and obesity – we tried to shame people into getting better.

First, we told people with substance use problems to quit using, as if quitting was a matter of willpower alone.

Next, we told people struggling with emotional disorders like depression to stop being sad, as if it were a choice they could make easily.

Now, we tell people with obesity to just stop eating so much, as if it were really that simple.

Those approaches clearly did not work.

Substance Use Disorders

We’re starting to get treatment for substance use disorders right: we now know it’s not a character flaw in the person struggling to get clean and sober, but rather a mental health disorder that can be treated effectively with a wide array of evidence-based therapies. We know that more often than not, those with substance use disorders also have a mental health disorder related to their substance use disorder, especially in the adolescent population.

Here’s what research shows:

  • 60%-70% percent of adolescents with a substance use disorder also have a co-occurring mental health disorder
  • Rates of relapse for single-focus treatment programs at one-year post treatment are 60%-70%
  • 70%-80% of individuals who participated in programs that treat co-occurring disorders alongside substance use disorders show no relapse at one-year post treatment.

A growing number of treatment centers around the country understand the implications of this data: personalized, integrated treatment programs that address the whole person have far better outcomes than traditional, single-focus programs. We know it’s not as simple as hustling a person through detox and sending them home with a list of AA meetings they can attend (although both detox and AA can be essential elements of successful treatment). It takes a coordinated effort that addresses lifestyle, family dynamics, and any underlying mental health issues that are present.

Mental Health Disorders

We’re also starting to get mental health treatment right. Slowly but surely, as the stigma attached to mental health disorders fades, more and more people who struggle with them come forward to get the treatment they need. We know treatment works, and we know that even those with severe mental illness can manage their symptoms and lead productive, fulfilling lives. But we still have a lot of work to do.

Here’s what research shows:

  • 18.5% of adults in the U.S. experience a mental health disorder.
  • Less than half – just 41% – of those adults receive adequate professional treatment
  • 20% of adolescents age 13-18 have a mental health disorder
    • 11% experience a mood disorder
    • 10% have a conduct or behavior disorder
    • 8% have an anxiety disorder
  • Only 50% of youth with a mental health disorder receive adequate professional treatment

Although we know treatment works, the data clearly show that not all the people who need treatment get the help they need. In addition, there’s often a significant delay between the onset of symptoms and participation in treatment. Some people who experience their first symptoms as adolescents don’t seek or receive treatment for decades. We’re starting to see the light at the end of the tunnel, but the statistics show we still have a long way to go.

Obesity and Overweight

Unfortunately, we’re not even close to getting treatment for obesity right: we still body-shame people considered to be overweight, obese, or fat. A recent article outlines the depth and severity of this problem: we still assume the primary reason they struggle with their weight is that they’re simply weak-willed and literally unable to keep their hands out of the cookie jar. It’s not just kids in elementary school and middle school who do this. Medical doctors do it. The media does it. Retail clothing manufacturers and their advertising strategies do it. The multi-billion-dollar weight-loss industry does.

All of us do it.

Here’s what research shows about obesity and overweight:

The last two bullet points are critical.

They’re where research, culture, and the science of treatment for obesity meet. Just like treatment for substance use and mental health disorders, treatment for obesity or overweight means treating the whole person – not just their weight. It means looking at their entire lives – not just their eating habits. It means not judging them for being obese or overweight – it means changing our attitudes and perceptions about size, weight, and health.

A New Approach

Those are precisely the areas where the paradigm is slowly shifting in the treatment of substance use and mental health disorders. Mental health professionals know treating the whole person works better than treating a substance use or mental health disorder alone. They know people with substance use disorders often have a co-occurring mental health disorder, and vice-versa. We all know we need to remove the stigma from addiction and mental illness. When we do, more people will come forward and get the help they need. Therapists know what works and know what needs to be done. And collectively, we know we’re starting to do what’s right for people struggling with substance use and mental illness. And we also know we have a lot more work to do.

We now know what works for obesity and overweight. It’s very similar to what works for addiction and mental illness. We’ve barely even recognized we’ve been doing it wrong all along. But we know the paradigm needs to shift – and we know what we need to do.

Now that we know, the question is this: will we step up and do it?