Mental health. A key to recovery

Eighty percent of substance abuse problems like alcohol, pot and prescription drugs are complicated by mental health problems such as depression, anxiety and bi-polar disorders . In these “co-occurring” cases, both the addiction and mental health problems must be treated.

Under the circumstances, treatment centers are now required to treat both the substance abuse and mental health problems. Psychiatric hospitals have been doing this as a matter of course, usually with staff psychiatrists, but many substance abuse treatment programs have had to add that capability to their staff or make arrangements for it.

Going to free 12 Step meetings like AA, Al-Anon and Celebrate Recovery are effective ways to deal with an addiction problem but often medical help is also needed. It was in my case, although I didn’t realize it at first. Turns out I had a depression/anxiety problem.

The fact was, when I quit drinking in 1979, I didn’t quit using the prescription drug Valium. I did cut way back on it, to about 5 milligrams a day, but I couldn’t completely let go. It was like a dry martini in powder form. Or like smoking pot. Under the circumstances, I admitted to myself, it was an obstacle to my recovery.

I knew I couldn’t keep doing it, but my attempts at stopping weren’t working. So I called psychiatrist Dr. Harley Harber, who is himself a follower of the 12 Steps.

On my first visit, Harley greeted me in his office at The BridgeWay hospital with a broad welcoming smile and invited me to take a seat on an over stuffed sofa in front of a picture window framing the late spring morning.

I was there, I told him, because my sobriety as a recovering alcoholic over the previous six years was giving me little pleasure. And the reason, which I had been hiding from myself and others, I now wanted to deal with.

Yellow lined pad in hand, Harley and I talked while he jotted down a few notes. He smiled reassuringly and said not to worry. I would get off the valium gradually over the next couple of weeks to avoid severe withdrawal symptoms. He said we’d work through it together.

We did, and it worked. Sure, I had some discomfort. Like jumping three feet in the air when somebody shut the door and watching myself momentarily age like Dorian Grey, but I soon recovered and moved on.

In substance abuse circles, in the Little Rock area especially, Harley’s name is well known and even revered by some.

He has successfully treated a whole lot of folks, and they have gotten well because they felt safe with him and could go through the often-painful process of sobering up with him by their side.

Karen S., a recovering alcoholic who had also struggled with an eating disorder in the past, said, “I get tears in my eyes thinking about all he has given me. I have a life today, so much more than I thought possible.”

About twenty years later, not long before he retired, I called Harley and asked if I could spend an hour or so with him in his office talking about trends in substance abuse treatment today and what role psychiatry has to play for an article I was working on.

On the couch again

We set a time, and I ended up on Harley’s couch again, this time with my own notebook in hand.

Harley, who was, among other things, Medical Director for Addiction Services and on the general psychiatric staff at The BridgeWay, got his B.A. degree from the University of Arkansas and his Doctor of Medicine from the University of Arkansas for Medical Sciences where he also took his three year residency in psychiatry.

He was the only physician in Arkansas to hold certification by the American Society of Addiction Medicine and board status in Psychiatry and Addiction Psychiatry.

In the mid-seventies, Harley had worked on the Haight Ashbury project in San Francisco and in later years attended Gestalt therapy training sessions both here and abroad.

Gestalt therapy is about helping people get rid of denials, facing the truth about themselves and making healthy changes in their lives–not unlike a 12-Step program.

As described more clinically in Corsini and Wedding’s “Current Psychotherapies,” Gestalt Therapy, which was founded in the 1940’s, posits that, “Most people operate in an unstated context of conventional thought that obscures or avoids knowledge of how the world is.

“ Self deception is the basis of inauthenticity. Living that is not based on the truth of oneself in the world leads to feelings of dread, guilt and anxiety.

“Gestalt therapy provides a way of being authentic and meaningfully responsible for oneself. By becoming aware, one becomes able to choose and/ or organize ones own existence in a meaningful manner.”

Our conversation on the state of substance abuse treatment today was far reaching. Here are some bullet points from Harley:

• There are increasing numbers of medical discoveries that will help us treat the physiological aspects of addictions (brain disease itself), but they do not address our character defects and lack of spirituality. That is up to God and us.
• There is a deep and wide chasm between what we do and what we believe. The 12 Steps and recovery bring the differences into closer alignment.
• Impaired physicians and airline pilots have the best recovery rates of any groups–85 to 90% for physicians and 90 to 95% for pilots. That’s because there are huge financial and professional incentives–they get to keep their jobs if they recover–and they are given adequate time for long-term treatment as well as significant professional support and post treatment monitoring.
• Twelve step programs are excellent predictors of long-term sobriety. If you can stay clean and sober for a year the chance of a “slip” drops dramatically. In the short term–less than a year–only one in ten 12-Step newcomers are there and still sober one year later.
• Even if you go to a meeting every day, it isn’t enough in the initial stages of recovery. Remember, the founders of AA (Bill Wilson and Dr. Bob Smith) spent a lot of time together. An hour a day is just a beginning.
• You have to get rid of the substance abuse problem before you can treat the whole person.
• There’s currently not enough money to fund nation-wide treatment programs which will produce recovery rates comparable to pilots and physicians.

Harley said, “today treatment can give you a place where you feel safe and can help you get clean and sober while you are going through the Steps and other aspects of recovery. I just wish it could be longer term.”

Shortly after we met, Harley retired as medical director of chemical dependency services at The BridgeWay to resume full time private practice in addiction medicine. He is fully retired now.