Mental Health: Myth or Fact?
People with mental health disorders can still work, have relationships, and live fulfilling lives. Myth or fact?
FACT. A mental health diagnosis does not determine someone's ability to live a meaningful and productive life.
A person has persistent sadness, loss of interest in things they usually enjoy, low energy, and difficulty concentrating. What disorder might you consider?
Major Depressive Disorder
A client is extremely anxious, restless, and has a racing heart after using a stimulant. Substance or mental health?
Possibly substance-related or mental health. Stimulant use can produce symptoms that resemble anxiety.
A client says, “I’ve been really depressed lately, and drinking is the only thing that makes me feel better.” What would you do?
Appropriate Response:
Acknowledge the concern, assess for immediate safety concerns, consult with your supervisor and facilitate an appropriate mental health referral while continuing to address the client's substance-use needs within your role.
Discussion Prompt:
Why is recognizing a mental health concern different from treating it?
Which is more common: having only a substance use disorder or having both substance use and mental health concerns?
Both are common. Mental health and substance-use concerns frequently overlap.
If someone hears voices, they must have schizophrenia. Myth or fact?
MYTH. Hallucinations can occur for many reasons. One symptom alone is not enough to determine a diagnosis.
A person experiences sudden episodes of intense fear, racing heart, sweating, shaking, and feeling like something terrible is about to happen. What might they be experiencing?
A panic attack.
A client reports feeling depressed and having little energy several days after stopping heavy substance use. Substance or mental health?
Could be either—or both. Symptoms may be related to withdrawal, a mental health condition, or co-occurring conditions.
A client tells you they stopped taking their psychiatric medication because they don't like how it makes them feel. What would you do?
Appropriate Response:
Listen to their concerns and refer them back to their prescribing provider. Do not advise them to stop, restart, increase, decrease, or otherwise change their medication.
True or false: A person can experience anxiety, paranoia, or hallucinations because of substance use or withdrawal.
TRUE. Substance use, intoxication, and withdrawal can sometimes produce symptoms that resemble psychiatric disorders.
Substance use can sometimes produce symptoms that look like a mental health disorder. Myth or fact?
FACT. Intoxication, withdrawal, and substance use can produce or worsen psychiatric symptoms.
Discussion Prompt:
How could that complicate assessment?
A person has periods of unusually elevated energy, needs very little sleep, talks rapidly, and engages in risky behavior. What disorder might be considered?
Bipolar Disorder
Discussion Prompt:
What substances could potentially make someone appear manic?
A client who has been awake for several days using methamphetamine becomes paranoid and reports seeing people who aren't there. Substance or mental health?
Substance use and mental health conditions must be considered. Stimulant use and prolonged sleep deprivation can produce psychotic symptoms.
A client becomes increasingly paranoid and says, “I know people are watching me.” What would you do?
Appropriate Response:
Remain calm, assess immediate safety, don't argue with or reinforce the belief, and seek supervision and appropriate mental health evaluation.
Discussion Prompt:
What is your responsibility here, and what part belongs to another professional?
Who can formally diagnose a mental health disorder: an addiction counselor, a qualified licensed mental health professional, or either one?
A qualified licensed mental health professional. An addiction counselor can recognize concerning symptoms and make appropriate referrals, but diagnosing mental health disorders is outside the addiction counselor's scope.
Discussion Prompt:
Why should addiction counselors still learn about mental health disorders if they don't diagnose them?
Someone with both a substance use disorder and mental health disorder should treat one condition first and deal with the other later. Myth or fact?
MYTH. Co-occurring conditions generally need coordinated attention rather than treating them as completely separate problems.
Discussion Prompt:
What could happen if we ignore one condition?
A client reports hearing voices that other people do not hear and strongly believes others are watching them. What type of symptoms are these?
Psychotic symptoms, such as hallucinations and possible delusions.
Discussion Prompt:
Does experiencing psychosis automatically mean the person has schizophrenia?
A client says they use alcohol every night because it is the only thing that quiets their anxiety enough to sleep. Substance or mental health?
Potentially both. The alcohol use and anxiety symptoms both need attention.
A client says, “Sometimes I think everyone would be better off if I wasn't here.” What would you do?
Take it seriously. Assess for immediate suicide/self-harm risk within your training and agency procedures, notify the appropriate supervisor/clinical professional, and obtain emergency assistance when indicated.
Discussion Prompt:
Why can't we simply refer someone out and send them home when there may be an immediate safety concern?
A client reports hearing voices. Which should happen first: determine their diagnosis, assess immediate safety, or figure out which medication they need?
Assess immediate safety. The addiction counselor should recognize the concern, address immediate safety within their role, and involve the appropriate supervisor or mental health professional.
If someone's psychiatric symptoms disappear after they stop using a substance, that automatically proves they never had a mental health disorder. Myth or fact?
MYTH. The relationship can be complicated. Timing, substance effects, withdrawal, history, and other factors must be assessed before drawing conclusions.
A person experiences nightmares, avoids reminders of a traumatic event, feels constantly on guard, and has intrusive memories. What disorder might be considered?
Post-Traumatic Stress Disorder (PTSD).
Discussion Prompt:
Why might trauma and substance use sometimes occur together?
A client has experienced depression during periods of heavy substance use and during long periods when they were not using. Substance or mental health?
A co-occurring mental health condition should be considered. The history suggests the symptoms may not be explained solely by substance use, but a full assessment is still necessary.
A client's behavior suddenly changes. You aren't sure whether they are intoxicated, experiencing a psychiatric crisis, or having another medical problem. What would you do?
Don't diagnose or guess. Focus on immediate safety, document what you actually observe, seek supervision, and involve the appropriate medical or mental health professional.
Take your best guess: What may be the most important skill for an addiction counselor working with someone who has co-occurring mental health concerns?
A. Being able to diagnose the disorder
B. Knowing exactly which medication they need
C. Recognizing concerns and knowing when to seek help
D. Trying to handle the problem independently
C — Recognizing concerns and knowing when to seek help.
Discussion Prompt:
Why can knowing “this is beyond my role” actually be a professional strength?