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Alcohol and other drug services don’t belong with mental health

It is #MentalHealthWeek and that provides a unique opportunity to discuss the commonalities and important differences between the mental health and AOD sector.

Alcohol and other drug use has historically been seen first as a moral deficit, and then a criminal issue, and only relatively recently has there been a broader shift in thinking about it as a mental health issue.

But understanding where alcohol and other drug problems fit into mental health is not straight forward.

Not all alcohol and other drug use is problematic. Very few people go on to develop long term problems (overall the estimate is around 10%), so our understanding of alcohol and other drug use as a mental health issue only applies to the end of the use spectrum where people are experiencing significant problems.

Taking that further, alcohol and other drugs have another unique dimension to them.

Most people with depression and anxiety don’t enjoy those feelings, even when they are not at the problematic end of the spectrum. Alcohol and other drugs on the other hand…

With alcohol and other drugs, use does not equal problems. So we need to take a broader view that encompasses both a health and a human rights perspective.

Unlike most other clinical health areas, our AOD service sector spans prevention, harm reduction and tertiary intervention. Sometimes that means we aren’t all peas in a pod, but it is also one of the strengths of the sector.

We philosophically view alcohol and other drug use on a continuum, and understand that merely (non-problematic) use of a drug does not necessarily constitute a problem.

Jim Orford’s idea of alcohol and other drug problems as an ‘excessive appetite’ captures the idea nicely – use is generally fun and purposeful, and only becomes a problem when it is excessive.

So while some alcohol and other drug problems might be viewed from mental health perspective, the issues for our sector are much broader. Under some circumstances alcohol and other drug use might be viewed as a mental health problem but they shouldn’t be integrated into the mental health system.

In many ways it maintains the stigma around (especially illicit) drug use by perpetuating the idea that use is a mental health issue.

Professor Nicole Lee is 360Edge’s Director and an international leader on alcohol and drug policy and practice.

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