Breaking Out of the Spiral of Addiction Through Mental Health Counseling

• By School of Health Professions
• July 16, 2020

Assistant professor Dave Schroeder, Ph.D. is the clinical coordinator and former director of the Texas Tech University Health Sciences School of Health Professions (TTUHSC SHP) Master of Science in Clinical Mental Health Counseling Program. He is a licensed professional counselor in Texas and Michigan and a certified rehabilitation counselor. He has more than 30 years of experience in the field of mental health counseling. His clinical focus has been rehabilitation counseling, helping individuals navigate life transitions. 

Dr. Schroeder shares how mental health counseling can help individuals break the cycle of addiction as well as what licensed mental health counselors learn about addiction in their graduate training at TTUHSC. TTUHSC will soon be opening a new telehealth clinic at its main campus in Lubbock that will provide mental health counseling services throughout the state of Texas. 

What is addiction and how does it impact people's day to day lives? Who does it affect?

Schroeder: At the simplest level, addiction is engaging in a behavior that you don't want to be engaging in, but you can't stop. So, if you're doing something that is harmful to you and you aren’t able to stop, then you're addicted. And that can extend to all sorts of behaviors, but most people tend to focus on substance use.

Addiction can affect anybody and at any time in their life. You could have lived your life without any addictions and develop them in your old age or you can develop them as a child. Addiction ranges from being mildly disruptive to completely disruptive to everything else in your life. If for instance, you have a minor addiction to a substance that's not illegal or to an activity that's not illegal, it can be mildly discomforting that it's causing problems for you...You can even be doing things that are perfectly legal and don't cause any harm to anyone else but they cause harm to you and that harm may just simply be in the form of how much time it takes from your other activities.

For me, if you are doing something that is harmful to you and you know that it's harmful to you, then you're probably abusing it. And it slides into addiction if you're having problems not doing the behavior.

What are the most common forms of addiction that you see? 

Schroeder: Probably the one that I see the most is substance use. A lot of individuals have alcohol-related problems that they may not yet recognize as addiction. Video gaming is another one we see often, and for whatever reason, porn is on the upswing. People are spending so much time watching porn or video gaming that they're not tending to the other parts of their lives that they need to in order to be successful.

What is the relationship between addiction and mental health?

Schroeder: It’s like a two-edged blade. Some individuals will experience mental health problems and if they don't get some help for those, they'll slide into addiction as a form of self-medicating or self-treating. Conversely, other individuals will experience substance use that opens the doors to mental health issues. For example, alcohol is a depressant. Someone might start using alcohol and slide into depression. And effective mental health counseling entails a recognition that they have to treat both addiction and mental health.

Are there particular factors that make an individual more prone to addictive behavior? 

Schroeder: Almost all of it, I would argue, is environmental. There are elements of heredity only in the sense that you have a genetic predisposition to process substances in a certain way. But most of the studies that I've read, most of the work that I've done, says that it really ties more to cumulative life experiences. If you look at data on adverse childhood experiences, you’ll see that if you've experienced adverse events in childhood, you're much more likely to experience adverse experiences as an adult, and among those, addiction.

What is the role of mental health counseling in helping someone break the cycle of addiction and maintain a healthier lifestyle moving forward?

Schroeder: The mental health professions as a whole have a growing focus on wellness. For individuals who come to me, a licensed mental health counselor but who does not necessarily specialize in addiction counseling, I'm going to try to connect them so they can be treated simultaneously, maybe by an addiction counselor who has a mental health counseling background. And there are programs specifically for that intersection. But we have to start by figuring out where the origins are for that individual. And so very often we're doing a combined treatment.

Can you talk a little bit about what clinical mental health counseling looks like? When is it appropriate to seek out a certified mental health counselor versus an addiction counselor?

Schroeder: Very often, people will come for services not really recognizing everything that's going on in their lives. They may come to a mental health counseling professional because they're experiencing a divorce or experiencing some alienation with family. And they don't recognize that there are actually some mood disorder things going on. They may not have attributed anything to their substance use because they may not yet realize that they're using their substances in a problematic way. So very often, it's a discovery. I personally like to think that since our standards for training are increasingly similar, that there's no wrong door. That people would come to treatment whatever way they come to treatment and the clinician hopefully will help them get where they need to be.

How would you approach treatment for addiction as a licensed mental health counselor?  

Schroeder: All mental health professionals need to know the medication piece because very often we're going to be working with individuals who need the assistance that medication can provide. So we're going to be guiding them to go see their doctors. Personally, I tend to be very solution-focused in my treatment approaches, but most people doing addiction counseling focus on cognitive-behavioral approaches. Solution-focused therapy is very brief oriented therapy. So we're looking at questions like, ‘What are you doing in your life today? What can you do differently?’

What role does mental health counseling play in helping someone maintain sobriety or abstaining from whatever addiction they're dealing with?

Schroeder: Most people who are experiencing addiction are also having some mood disturbance. For substance abuse, an addiction counselor might help them become sober. A licensed mental health counselor would help them get their lives back on track, resolving whatever is driving the mood issue. A mental health counselor can also help individuals learn how to live well when they've been surviving — but not thriving. So they have to learn how to be well so that they don't cycle right back into that same pattern.

Most individuals who become sober after a long period of using substances of any kind literally have to find a whole new way of living, a whole new group of people with whom to interact. So, if you get sober and you don't interact with new people, but you're also no longer interacting with the folks that you drank with or the folks that you smoked methamphetamine with, then you're alone. You're not interacting with anybody and that's not a healthy way to live.

What role do families and other support groups play in treatment? 

Schroeder: At least from my perspective, families play a huge role because usually by the time you get to treatment with substance abuse issues or mental health issues, you've really done a lot of damage to your support system. You've stolen drugs, alcohol, money, you’ve “borrowed” drugs, alcohol or money and not replaced it. You've lied to people. You have to start to rebuild those relationships, but it's not entirely isolated to the person who is struggling with the addiction issue. Families have to begin to learn how to let go of some of that hurt from the past and how to address that hurt in a helpful way so that they can resolve their relationships.

At some point, you also need to be interacting with people who have commonality with you and understand where you've been but have also committed to pulling you out of that. And that's true whether we’re talking about mental health issues or addiction issues. If you bottle it all up inside, there isn't a good resolution in terms of learning how to interact in ways that are less harmful. You're just stuffing it all inside, which is what leads many of us into trouble to begin with.

What kind of training do licensed mental health counselors need in order to help their patients deal with addiction issues, whether it's substance abuse or other types of addiction?

Schroeder: The system is changing a little bit and we're becoming much more unified as a counseling profession. We're asking that students coming into the field today, as future practitioners, have at least 60 hours of graduate training and that they understand the process of assessing the client where they are, determining what services the person needs, and connecting those individuals and providing the services that are guided towards helping them find their way into recovery. So in Texas, we're requiring 60 graduate credits. Some states require some additional training beyond licensure and then all states require some level of structured, supervised practice before you become a licensed mental health counselor.

So in the clinical counseling and mental health department at TTUHSC, we have three specific master's programs. We have a master’s in Clinical Mental Health Counseling, we have a master’s in Clinical Rehabilitation Counseling and we have a master’s in Addiction Counseling. Across all three programs, students have to take a minimum of one semester of addiction counseling work.

In the clinical counseling program, that semester of addiction work allows us to learn how to assess for substance use and be prepared to deal with the fact that many of our clients will come to us with multiple service needs. Graduates from the TTUHSC clinical counseling program can treat people with addictions or treat people with rehabilitation needs. You can think of us as the general practitioners of the mental health system, but we also refer clients to specialists.  

Is there anything else that you’d highlight about the mental health counseling master’s at TTUHSC?

Schroeder: Another real positive part of our program is that we have been able to recruit highly qualified faculty. Almost all of our adjuncts have Ph.D.s and are really skilled individuals. We are also among the least expensive counseling training programs out there, and to the best of my knowledge, we are the only fully online-with-no-residency program.

What kind of qualities do you need to be an effective mental health professional?

Schroeder: By and large, you need to be really motivated to hear people, to work with people, to help people, but also to understand the fact that the person has to find their way, not necessarily your way. We're looking for folks who might have had some exposure to or experience with mental illness or what mental health problems might look like and they want to help. 

Can you talk a little bit about how the mental health counseling program at TTUHSC helps address the shortage of mental health professionals in Texas and across the country? 

Schroeder: We developed into the three programs specifically to address some of the shortages of mental health professionals, especially in rural Texas. We have a projected shortfall of about 20% in West Texas, which means we will be producing about 20% fewer counseling graduates than are needed in the state. And that's projected to go on for at least the next 10 years. We have 23 counties in West Texas that have no licensed mental health professionals in their counties. One of the things we did when we started developing our program is to embrace the idea of telehealth. We're not only going to be offering telehealth services through our clinic, but we're training our students to offer telehealth services in the future. That allows us to provide access in rural communities so people won't have to drive 30 to 70 miles to get mental health services.

We are opening a new mental health clinic in the spring that will have three telecounseling rooms so that we can provide those mental health services to folks wherever they are in Texas. And we're a broad enough program, because we have staff from all three programs serving in that clinic, that we can get them to an addiction counselor. And through the TTUHSC F. Marie Hall Institute for Rural & Community Health, we can even access psychiatry at a distance.

For more information about the Texas Tech University Health Sciences School of Health Professions Master of Science in Clinical Mental Health Counseling Program, you can email the SHP Office of Admissions and Student Affairs at health.professions@ttuhsc.edu or phone: 806-743-3220.