Elias 1

Eldah Elias

Chawkat

Independent Research I GT

4 December 2017

Interview with Dr. Cabrera-Bentley

1. I have found discrepancies in sources listing substance abuse an individual disorder

versus a coping mechanism for mental illness disorders. Can you corroborate either of

these statements, or is it is dependant on the circumstance of usage? ​From the treatment

perspective, there are many ways in which a person might be introduced to services and

rendered a substance use disorder diagnosis. There is the individual who has recognized

that he/she might have a problem with substances, and has made the decision to seek help

without the assistance of others. This person is considered a self-referral. For others,

external factors may dictate them having to seek treatment, i.e., the court system, family,

employers or significant others. Whether a person receives a diagnosis for a substance

use disorder, or their use has resulted from trying with cope with life’s stressors, the

determining factor should be made after the individual has submitted to an in-depth

bio-psycho-social assessment. Someone who is identified as having a substance use

disorder, very often will have mental health, family or social stressors that have

contributed to their use. This is called Co-Occurring, because the connection between

substance use and mental health disorders is so closely linked, and is recommended to be

treated concurrently. At the other end of the spectrum, there are individuals who may

have experienced issues involving substances, but have no history, pattern or family hx.
 Elias 2

This situation could be best described as a teen who receives an alcohol citation after

attending a party, or perhaps an adult who made the poor decision to drive after drinking,

then receives a DWI charge. These scenarios may be determined to be more situational

following an assessment, and perhaps may be viewed as stemming from the substance

use only, rather than relating to a mental illness/coping mechanism.

2. Have you observed ways in which lower socioeconomic status, job availability, and lack

of mental health awareness further impact the dual presence of substance abuse and

mental health difficulties among different ethnicities?​ I have never conducted research on

which ethnicities might be more susceptible/impacted, however I suspect that it depends

on many factors, including, but not limited to the ones you mentioned. The feedback I

can give based on my experiences is that anyone with co-occurring needs, but with

limited access to care is at risk for increased difficulties. Limited access could be as a

result of no employment, thus no insurance to cover needed services. On the other hand,

individuals who are unemployed but may be enrolled in state issued insurance plans, may

also encounter barriers with waiting lists or limited provider pools to choose from. In

addition to the lack of mental health awareness that some people may have, there is also

the stigmatization that can occur from others when a person seeks co-occurring treatment.

The individual may be too ashamed of what others may think, say, or perhaps be afraid if

they access co-occurring benefits via their employee insurance, their employer might

learn of their issue, so they may choose to not engage altogether.

3. How are family dynamics of different ethnic groups impacted by one member’s

substance usage? ​I have not conducted research on this matter. From my professional
 Elias 3

experience, families dealing with a chronic substance using member struggle with lack of

trust, scapegoating, ostracizing and abandonment issues, which can often times go back

and forth between the family system as a whole and the struggling individual.

4. Can you interpret research findings stating mental illness and substance abuse is

somewhat more prevalent among patients in their 50s or younger?

Based on my experiences, I will agree that many of the clients I have serviced has been

around the 50 or younger mark. However, quite a few are over the age of 50 as well. It is

important to note that individuals with co-occurring needs do not always present and or

remain with one provider throughout their course of treatment. So, some of them I have

met at the beginning of their treatment experience, whilst for some, I have met after they

have engaged with multiple treatment providers previously. No one can predict when a

person is ready to change, only that individual knows. In my opinion, there are 2 factors

to be explored related to your question……..is the statistic based on when a person may

have finally acknowledged (perhaps to themselves or family) that they have co-occurring

needs, or, at the point when they may have decided to seek help? You can imagine that

there may be some time lapse between the two, as an individual may take time to come to

terms with this acknowledgement, may have grappled with denial or dealt with other

stigmas related to these conditions.

5. Are their ways in which community outreach efforts to aid the ongoing mental health

epidemic have been conducted?

a. Which are the most effective?

 Elias 4

Howard County has been committed and focused on addressing the overall public health

needs of the community. With particular emphasis on the behavioral health needs, which

encompasses co-occurring issues, the Howard County Health Department offers resource

and referral services so residents in need can learn about and access care. The department

also offers opioid prevention/awareness, and training to reverse and opioid overdose, as

well as peer support services. In addition, the department maintains a frequently updated

resource directory of county services to be utilized by anyone in need.

6. Between family dynamics, socioeconomic status, or peers/environment, have you

observed which has the strongest correlation with greater mental health and substance

abuse struggling?​ In my experience, a person with a family history of a substance use or

mental disorder has an increased risk of developing similar concerns.

a. Are there additional factors that stand out in impacting the reliance of substances

relating to mental health?

I encourage you to visit the Substance Abuse Mental Health Services Administration’s

(SAMHSA) website to review applicable articles, research and data that would be helpful

to your project.