Addiction and Mental Health

Many clients in treatment for mental health issues are also battling addiction.  Are their counselors prepared to help?

by Abby Haight

Early in his counseling career, Boyd Pidcock thought he understood the connection between addiction and homelessness.

People drank and they took drugs and they became homeless, Pidcock believed. Feeding their addiction cost individuals their jobs, their marriages, and their families. Often it cost them the security of having their own homes. It seemed like a simple equation—addiction plus personal loss equaled a cold concrete bed in a fetid doorway. Also it seemed simple to solve.

“I thought clients would go to detox, get in-patient treatment, and all would be fine,” Pidcock remembers, shaking his head. Now, as director of Lewis & Clark’s Addiction Studies Program, Pidcock teaches a more realistic, and complex, understanding of addiction.

Courses in addiction studies are available through the counseling psychology department of the Graduate School of Education and Counseling. Like Pidcock, the Addiction Studies Program has evolved since it was formed in the late 1990s. Experts in the field say the program keeps abreast of new modes of treatment and new knowledge about the complex interplay of biology, psychological factors, and sociocultural processes contributing to addiction. Its graduates, they say, are prepared to work —and have an immediate impact—in the field.

The need for addictions counselors has never been greater. One American in 10 is addicted to drugs or alcohol, according to most studies. Addiction often goes handin- hand with domestic violence, child abuse, and crime. Families suffer. Meanwhile, community mental health agencies have seen their funding shrink while the demand for their services has grown. Lewis & Clark has sent dozens of interns into these programs, helping provide direct care and freeing up counselors to reach out to more clients. Many of those students have, in turn, been hired later by the agencies.

The Addiction Studies Program is based on an integrated model of understanding and treating addiction, recognizing that alcohol or drugs or gambling can be used as self-medication for deeper mental health issues, such as depression or posttraumatic stress disorder. The 10 to 15 students enrolled each year receive traditional mental health training and extensive education in understanding and treating addiction. Students are also encouraged to nourish their own sensitivity to important issues of family, culture, ethnicity, gender, and spirituality. After completing their master’s degrees, they are prepared to become statelicensed counselors as well as state-certified addiction counselors.

From 40 percent to 80 percent of people seeking treatment for addiction also have a mental health disorder, yet traditional treatment programs usually address only the addiction or the mental health issue, rarely both. A client might be sent to one clinic for addiction counseling and to another site for mental health counseling.

“At Lewis & Clark, we help our students recognize and treat mental health and addiction issues together,” Pidcock says. “An abundance of research consistently indicates that treating them separately neither supports what is best for the client nor results in an economically feasible solution—especially in these hard economic times.”

Another area of programmatic focus is gambling addiction. Gambling opportunities are everywhere in Oregon, from state-operated lottery games and video poker to tribal casinos. In 2004, Oregonians lost $1.27 billion on all forms of gambling, according to the Oregon Department of Human Services.

The recognition of gambling as an addiction is still relatively new. With its wide embrace of legalized gambling, the state also has extensive treatment programs for problem and pathological gamblers—an estimated 75,000 Oregonians. Studies show that problem gamblers have many of the same issues as people with drug or alcohol addiction: crime, spousal and child abuse, suicidal thoughts. Using lottery funds, the state has opened residential and outpatient treatment centers and funded ad campaigns and community outreach programs.

In 2008, Pidcock successfully authored an ongoing State of Oregon Work Force Development grant to address the training needs for counselors working with compulsive and problem gamblers. Working with Tom Ten Eyck, an adjunct faculty member in the Addiction Studies Program, he created classroom and online gambling counselor training courses and is currently codeveloping a course addressing treatment for the families of problem gamblers.

Also, recognizing the often unaddressed impact of addiction on family members, the Lewis & Clark Marriage, Couple, and Family Therapy Program has developed the only graduate-level addiction specialization in the country. “One of our aims has been to help transform the counseling and addiction field on all levels of intervention and treatment,” Pidcock says. “We aren’t just training clinicians; we are creating agents of change.”

Skilled Graduates

Joe Reisman MA ’02 was one of the first students to complete Lewis & Clark’s Addiction Studies Program. A former television reporter, he had covered some of the biggest stories on the West Coast before making his dramatic career change.

Initially, Reisman was interested in family counseling.

“Boyd was the first person I went to see when I visited the grad school to learn about the counseling program,” Reisman says. “I wasn’t thinking that much about addictions counseling, but he made me realize how important it was. It’s an added strength to whatever I do. And as it turns out, it has dictated the road I’m on.”

Kaiser Permanente offered Reisman the opportunity to be the first intern in its addiction program, and he didn’t hesitate.“I was thrown in doing assessments, figuring out the computer system, working with kids and their parents,” he says. “Because of the addiction courses I’d taken, I felt prepared and ready to carve my own way. I had gotten a strong background.”

Now, as program director for gambling treatment services at LifeWorks Northwest, Reisman often hires interns from the Lewis & Clark program.

And it’s not because he’s an alum.

“The graduates I key in on are the ones coming out of Lewis & Clark with the background in addiction studies,” he says. “They’ve always been really well prepared.”

Lewis & Clark graduates are ready to work in the field because they are steeped in the newest science-based methods of treating addiction, says Wendy Hausotter, coordinator of public health and prevention for the State of Oregon’s problem gambling services. Those methods range from the trans-theoretical model of change, with its work toward developing strategies and processes to change, to dialectical behavioral therapy, which calls on Buddhist meditation techniques to build mindful awareness.

“Lewis & Clark puts a strong emphasis on making sure, through assessment and support, that its students come out with demonstrable skills,” she says. “They use evidence about what works in addiction treatment to inform their program.”

Program Leadership

Practitioners in the field point to Pidcock as the heart of the program.

“He’s had this dogged determination to make it work,” Reisman says. “I’ve never seen his commitment waver. He’s not the kind of guy who puts his feet up on the desk. He doesn’t wring his hands. He rolls up his sleeves and gets to it.”

Pidcock’s office in Rogers Hall is narrow, lined on one side with books about the history and forces of addiction. An amulet of feathers hangs from a tack, and a guitar—brought out occasionally to bring peace or clarity—leans against the wall. A single window looks out on an evergreen landscape of cedar and fir.

Pidcock has the easy charisma of a natural-born storyteller. His voice carries the twang of central Texas, where he was raised and began his career, first as an addictions and mental health counselor and then as a scholar. His stories tend to have a river-like flow, often touching on the power of the human spirit in addiction and in healing.

Pidcock was drawn to help the seemingly hopeless on the streets of Austin. He was working in community mental health there during the 1980s and 1990s and seeing large state-run hospitals close, their patients scattered into community services that struggled to keep up with the new demand. It was then, talking to people who were on the street and battling addiction, that Pidcock realized his original beliefs were far too simple.

These were people who had been hospitalized long term for severe and chronic mental health problems. Now on the street, drugs and alcohol had become their way to cope. “The face of addiction is really, really complex, and the reasons for people being homeless are often more related to systemwide failures, not that of the individuals themselves” Pidcock says.

While working on his doctoral degree at Texas Tech University in Lubbock, Pidcock studied the historical relationship the American medical and psychological communities have had with people consumed by addiction—which has included treating them as patients, criminals, or weak failures, or viewing them as mentally ill or immoral. He is fascinated by both the history and the changing currents of addiction treatment.

But Pidcock worries as community addiction services try to do more with less. When a northeast Portland counseling center shut down last year for lack of funding, leaving 500 clients without support, Pidcock and other professionals stepped in to reopen the facility as Russell Street Counseling Center. But, unable to raise enough money to run day-to-day operations, they were forced to close again after a few months.

“Recovery does work,” Pidcock says. “And it is cost-effective, even with severe, chronic disorders. We have many proven models for providing effective treatment. But do we have the resources and the will to provide treatment?”

Keeping Perspective

Teal Bohrer is just months past graduating from Lewis & Clark’s Addiction Studies Program. She works as a counselor with the Turning Point program at the Coffee Creek Correctional Facility, a women’s prison in Wilsonville. Her clients want to return to their families and their children, but first, they have to get clean. All have dual diagnoses, such as drugs and depression or alcohol and posttraumatic stress disorder.

Bohrer says her studies prepared her for the work now in front of her.

But she spoke of another important insight she uses every day, one passed on to her by Pidcock.

Take care of yourself, he told Bohrer. “Exercise. Eat well. Read outside of the field. Make sure work stress doesn’t take over your life,” she says. “That’s something I really got pounded into my head.”

Being an addictions counselor is important and rewarding work. Pidcock demands a lot of the Lewis & Clark students who pursue that career—and admires their drive and dedication.

“I have incredible respect for my students,” he says. “They’re taking on an extremely difficult career, and they’re not doing it for the money.

“It’s tough work.”

Abby Haight is a former Portland newspaper reporter who, like Boyd Pidcock, turns to music for peace and clarity.