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Visions Journal

You Don’t Know What You Don’t Know

Accepting a loved one’s concurrent disorders

Ron Merk

Reprinted from the Families, Friends and Substance Abuse issue of Visions Journal, 2024, 19 (2), pp. 21-23

Ron Merk, author of You Don’t Know What You Don’t Know

Should I or shouldn't I? I wondered, when I was beginning to write about my family’s experience, whether I should be telling people the hard truth about what it's like when you have a family member with concurrent disorders. Concurrent disorders are when someone has both substance and mental health disorders. 

I think it was a character played by Jack Nicholson who said, “You can't handle the truth.” Sadly, for some families, there is fact in those words. I’ve run into people who prefer the ostrich-head-in-the-sand way of acknowledging concurrent disorder problems. I get it! For some of us, any acknowledgement is accepting there are problems with someone we love.  

Most families do face hard realities. You won’t like it—in fact, you’re going to hate it—but it’s better to know what you’re facing than to stumble through the darkness of this particular journey. The sooner you admit there are problems, the more likely it is you can find help, both for your loved one and your family.

Realizing there’s a problem 

For us, there wasn’t a specific moment where we saw a mental health crisis or addictive substance use affecting the person in our family. It came slowly. You put off some of the abnormal behaviours to teenage stuff. Growing pains. We even justified their dabbling in the use of substances as a normal teen curiosity. 

Looking back now, I see some specific landmarks that stand out. For example, we noticed some serious anger issues. We certainly recognized depression. We sought counselling, but it wasn’t successful. That in itself should have been a major “light bulb” moment. We didn’t appreciate that our family member stayed depressed for months, which dragged on into years. That light bulb moment only came when our loved one started talking about things that hadn’t happened. For them it was real, but the events they described were impossible.

We had no experience. There was no guiding hand. Not a clue what was or what would be. We didn’t know what we didn’t know! That made some parts brutal and, in some other ways, more bearable. Today I ask myself: if I’d known certain things, would I have gone screaming off into my own mental health crisis?

When we finally pulled our heads out of the sand, what we recognized first was deeply entrenched substance use. They hid it until it was uncontrollable. But substance use wasn’t the cause. It was only a symptom of underlying mental health disorders. It was their way of self-medicating. 

Relationship strain

The biggest challenge, bar none, from concurrent disorders, is what happens internally in the family. Mental health and substance disorders cause horrendous changes in the personality of the person you love. In our case, we didn’t understand that our loved one’s thinking was being driven by their mental health disorder. It often felt like they were just being deliberately difficult. That led to trying to change their behaviour through traditional parent/child correction methods—a complete fail. You can’t fix mental illness through correction parenting.

That’s how it happens when you don’t know: the family doesn’t understand what’s happening. Behaviour changes often fracture the relationships between the person who is ill and the most important people in their lives. The person who is ill often ends up living on their own or, in the worst cases, homeless. Many families feel they have no other alternative than to break all connections with their loved ones.

Help for concurrent disorders

Having mental health challenges and substance use disorders doesn't double the problems you face. It makes them ten times worse. When you look for help, you run into professionals who will tell you they don't know which one to treat. Some say it’s best to handle their substance disorder first; once that's in control we can look at the mental health disorders. We ran into other professionals who told us it didn't matter: we'd need to treat both.

The learning here is that there's not just one way. Even health professionals struggle at times with which to address first. Mental illnesses are not a linear progression. You don’t start at depression, work your way to anxiety disorders and then on to bipolar disorder or schizophrenia. Often people have some or all of these conditions to a lesser or greater extent. That makes it incredibly hard for professionals to diagnose and treat. In the beginning, rather than name a diagnosis, the professionals treat to minimize behavioural symptoms. It took us years to finally hear a psychiatrist name our family member’s condition—even then it came with caveats.    

Probably the biggest stumbling block to getting help, or at least being in the picture with our loved one, were the privacy guarantees in our laws. I can't tell you how many professionals we ran into who told us “we can't share anything with you.” There were others, of course—those are the ones I called the bright spots in the system—who got around policy. They found ways to give us enough information so we could effectively advocate for our family member.

One thing we learned and that I like to share with other families is that just because they can't talk to you doesn't mean you can't talk to them. That became our primary standard when we were interfacing with professionals. I would start by saying, “I don't want or need you to tell me anything about our loved one, but I have information that's important to their health and here it is.”

Seeing possibilities

Let me say that recovery is possible. Read that again: recovery is POSSIBLE. However, I want to set clear expectations. Recovery isn’t measured in days, weeks, months or years. It’s more likely measured in decades. So yes, you’re in it for the long haul.

You may feel you can’t retain any semblance of a relationship. It might take years for you or them to reach out again. The important part is that even the smallest connection can give hope and make all the difference for your family member. A simple text or phone call, with “I love you” begins the healing journey.

I wish I could tell readers all is well for my family. Although there have been times when our loved one made progress, there has been one huge stumbling block: to date, they have never accepted that they have a mental illness. That’s called anosognosia (look that up on Google). It’s extremely common for people to deny having a mental illness. Every family will have this hurdle to get over before real healing can begin. 

We’re still working on this with our loved one. I’ve seen the success of other families, so I know it’s possible. What I want desperately is for them to be healthy and happy. I’d give anything for that! 

About the author

Ron advocates for people and families who suffer from mental health and substance disorder challenges. He’s a member of the Patient and Family Experience Council of the BC Mental Health and Substance Use Services and co-chair of their literacy committee. Ron edits Learning Moments,1 a magazine for families who need help supporting substance-using family members 

  1. Visit Learning Moments at:

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