GUEST COLUMN
Robin Williams' death highlights connection between substance abuse and mental illness
AUGUST 17, 2014 9:00 AM • DR. MATTHEW FELGUS
I don’t know what drove Robin Williams to take his life. Like any child of the ’70s, I grew up with his immeasurable talent — he was always there and seemed he always would be.
He suffered from depression. He was in rehab earlier this summer. As we mourn this loss, I can’t help but connect the dots as I see them — as an addiction psychiatrist for the past 17 years in Madison who has spent my career working with people on substance abuse and mental health.
Addiction is a brain disease, as is depression. We have medications that can help. But that does not begin to describe what the millions of individuals, among them Williams, face attempting to treat one or the other.
If you look at the statistics, anywhere from 33 percent to 70 percent of people entering drug or alcohol treatment can be diagnosed with a mental health condition such as major depression, generalized anxiety, panic disorder or post-traumatic stress disorder. This is far too low, in my opinion, and the reason is because we aren’t looking.
Folks entering rehab are encouraged to focus on how to stay clean and sober. The best programs do screen for mental health, and some do an excellent job of it, often starting mental health treatment. But rehab typically lasts 28 days. And most antidepressant medications take one to two months to take effect. And therapy to heal past trauma takes years. And we want it quick.
In talking about addiction, we often neglect the obvious: Alcohol and other drugs numb mental pain. Many of us have our hidden demons, including the most public and beloved figures.
My best armchair guess is Williams was staying clean and sober. Unfortunately, without being able to numb his pain in this way, it came to a head.
The best rehab facilities in the world do not focus on treating long-term mental health. They can’t. It’s not just time constraints. Patients in rehab do not want this.
“Focus on keeping me clean, doc, and I’ll be okay.” So we hope.
Nearly everyone I treat for substance abuse has underlying issues such as past trauma, anxiety and depression when you get below the surface. And they will often deny it, focusing only on their drug or alcohol use when they start.
This work takes years, and lots of support. We need to be doing a better job of educating not only those in treatment, but family members, physicians, insurers and counselors that mental health issues are at the core of many substance use problems. And those problems need to be given equal importance in addiction treatment.
We shouldn’t have to wait for somebody else as well-known and loved as Williams to suffer. Too many already are.
I don’t know what drove Robin Williams to take his life. Like any child of the ’70s, I grew up with his immeasurable talent — he was always there and seemed he always would be.
He suffered from depression. He was in rehab earlier this summer. As we mourn this loss, I can’t help but connect the dots as I see them — as an addiction psychiatrist for the past 17 years in Madison who has spent my career working with people on substance abuse and mental health.
Addiction is a brain disease, as is depression. We have medications that can help. But that does not begin to describe what the millions of individuals, among them Williams, face attempting to treat one or the other.
If you look at the statistics, anywhere from 33 percent to 70 percent of people entering drug or alcohol treatment can be diagnosed with a mental health condition such as major depression, generalized anxiety, panic disorder or post-traumatic stress disorder. This is far too low, in my opinion, and the reason is because we aren’t looking.
Folks entering rehab are encouraged to focus on how to stay clean and sober. The best programs do screen for mental health, and some do an excellent job of it, often starting mental health treatment. But rehab typically lasts 28 days. And most antidepressant medications take one to two months to take effect. And therapy to heal past trauma takes years. And we want it quick.
In talking about addiction, we often neglect the obvious: Alcohol and other drugs numb mental pain. Many of us have our hidden demons, including the most public and beloved figures.
My best armchair guess is Williams was staying clean and sober. Unfortunately, without being able to numb his pain in this way, it came to a head.
The best rehab facilities in the world do not focus on treating long-term mental health. They can’t. It’s not just time constraints. Patients in rehab do not want this.
“Focus on keeping me clean, doc, and I’ll be okay.” So we hope.
Nearly everyone I treat for substance abuse has underlying issues such as past trauma, anxiety and depression when you get below the surface. And they will often deny it, focusing only on their drug or alcohol use when they start.
This work takes years, and lots of support. We need to be doing a better job of educating not only those in treatment, but family members, physicians, insurers and counselors that mental health issues are at the core of many substance use problems. And those problems need to be given equal importance in addiction treatment.
We shouldn’t have to wait for somebody else as well-known and loved as Williams to suffer. Too many already are.
