Mental health and substance use: responding to changing needs

Clinicians will sometimes encounter people who have engaged with treatment and developed a clearer understanding of their difficulties yet continue to struggle with symptoms or patterns of substance use that affect their everyday lives. They may have spent time in therapy and made genuine efforts to change but find themselves returning to familiar patterns or struggling to maintain the progress they have made.

A person may understand the factors contributing to their anxiety yet still find themselves drinking to manage it. Insight can be an important part of treatment, but it does not always translate into changes that are easy to sustain. When this happens, the person may begin to question whether treatment is working, despite the effort they have put into it.

Progress in psychological treatment is rarely straightforward. However, when difficulties persist, it can be worth looking more closely at what is maintaining them. This is particularly relevant when mental health symptoms and substance use appear to be closely connected, as addressing one without adequately considering the other may leave important difficulties unresolved.

When progress becomes difficult to sustain

Someone may begin to understand their anxiety more clearly whilst continuing to rely on alcohol to manage how they feel. Another person may reduce their substance use and find that emotions they had been trying to manage in this way become harder to tolerate. In both situations, the changes they are making can expose difficulties that still need attention.

Knowing that a behaviour is causing harm does not necessarily make it easier to stop. Similarly, understanding the origins of emotional distress does not automatically make it easier to manage. For the individual, this can be frustrating, particularly when they have already invested considerable time in treatment and expected to feel more able to cope.

There may be several reasons why difficulties persist. Some aspects of a person’s experience may take time to emerge, particularly if they have found it difficult to speak openly about their substance use or other concerns. They may feel more able to discuss these things as trust develops, or new difficulties may arise as their circumstances change. Substance use itself can also affect symptoms and make it harder to engage consistently with therapy.

For the clinician, an important question is whether the current formulation still accounts for what the person is experiencing. Reconsidering this can help establish whether the existing treatment remains appropriate.

Reconsidering the relationship between mental health and substance use

For someone living with anxiety, depression or the effects of trauma, alcohol or drugs may gradually become part of how they manage difficult feelings. What begins as an occasional way of finding relief can develop into something they increasingly rely upon, sometimes without fully recognising how much their relationship with the substance has changed.

Alcohol, for example, may seem to help someone relax or fall asleep, particularly when anxiety is making it difficult to switch off. Yet drinking can disrupt sleep and contribute to low mood or increased anxiety the following day. Over time, the person may find themselves using alcohol to manage feelings that their drinking is also making worse.

The relationship is not always easy to recognise, either for the individual or those close to them. Someone may have been experiencing mental health difficulties long before their substance use became a concern. For others, changes in their mood or behaviour may have developed alongside increased drinking or drug use. It can be difficult to know where one problem begins and the other ends, particularly when both have become part of everyday life.

This can also affect how someone experiences treatment. A person receiving support for depression may make progress in therapy but continue to struggle with sleep and motivation because of their alcohol use. Someone who has reduced their substance use may find that anxiety or difficult emotions become more noticeable without the familiar means of managing them.

For families, these situations can be confusing. They may see someone making a genuine effort to get better but struggle to understand why familiar patterns continue, or why improvements in one area do not seem to bring the changes they had hoped for elsewhere.

Read more: Interventions | Case management and intervention services at Ibiza Calm

Understanding how mental health and substance use are connected can help make sense of these experiences. It may also reveal difficulties that need more attention, allowing treatment to consider the person’s emotional wellbeing alongside their relationship with alcohol or drugs, rather than expecting progress in one area to resolve the other.

When it may be time to look again

Sometimes, despite genuine engagement with treatment, a person’s difficulties remain much the same or new concerns begin to emerge. They may find that symptoms persist, their substance use becomes harder to manage, or medication no longer seems to be helping as expected. At these points, it can be useful to revisit how their difficulties are understood and whether the current approach continues to meet their needs.

The full picture may take time to emerge. Someone may initially find it difficult to talk openly about the extent of their substance use or other experiences or may only begin to recognise certain patterns as treatment progresses. Changes in their circumstances can also bring new pressures or make existing difficulties harder to manage.

A further psychiatric assessment may help clarify symptoms or revisit a diagnosis where there is uncertainty. Medication may also need to be reviewed in light of ongoing substance use and its effects on the person’s wellbeing. Where there are concerns about physical dependence, understanding their pattern of use and any difficulties they have experienced when reducing or stopping can help inform decisions about the support they need.

It is also worth considering how the person is managing between appointments. They may be finding it difficult to put what they discuss in therapy into practice or have limited support when things become challenging. These difficulties do not necessarily mean that treatment is wrong for them, but they may indicate that additional support or a different approach could be helpful.

Sometimes, relatively small adjustments are enough. In other circumstances, the person’s needs may call for closer coordination between mental health and addiction services, or a more intensive level of care.

The importance of coordinated clinical input

For someone experiencing both mental health difficulties and problems with substance use, treatment may involve psychological therapy alongside psychiatric review, medication management or medical support, depending on their circumstances.

At Ibiza Calm, psychiatric oversight from Medical Director Dr Manuel Rodríguez forms part of a multidisciplinary approach to mental health and addiction treatment. Medical and psychological care are brought together within the residential programme, allowing the team to review each person’s progress and adapt their treatment as their needs evolve.

We also recognise the value of the therapeutic relationships already established before admission. We work collaboratively with referring clinicians, maintaining communication throughout treatment and, where appropriate, involving them in discussions about progress and plans for ongoing care. This helps provide continuity between the residential stay and the support the individual receives afterwards.

Residential treatment can therefore offer a period of more intensive support while building on the work already undertaken with the referring clinician. The level of involvement will depend on the individual’s circumstances, and the arrangements agreed with those involved in their care.

When residential treatment may offer a different level of support

For some people, adjustments to their existing treatment or additional specialist input may be sufficient. Others may benefit from a more intensive period of care, particularly when mental health difficulties and substance use continue to affect one another and progress has been difficult to sustain.

Residential treatment offers a dedicated setting in which medical and psychological support can be provided as part of a coordinated programme. Depending on the individual’s needs, this may allow for more consistent therapeutic input and closer review of their presentation as treatment progresses.

At Ibiza Calm, planning begins before admission with a pre-admissions assessment, which helps the team understand the person’s needs and allocate an appropriate therapist. Following arrival, assessment continues as the team gets to know the individual and gains a fuller understanding of their circumstances. The treatment programme can then be adjusted as needed, rather than remaining fixed around the initial plan.

Ibiza Calm accommodates a maximum of 12 clients at any one time. This small residential setting supports an individualised approach, with the programme informed by ongoing assessment and the person’s response to treatment. Medical support is available as part of the wider care plan, including supervised detoxification where clinically indicated.

A residential stay can also provide time to explore patterns of behaviour and the circumstances in which difficulties tend to arise, with professional support available throughout the programme. For someone who has found it difficult to make lasting changes while managing the demands of everyday life, this may offer a useful opportunity to focus more fully on their mental health and relationship with substances. Whether residential treatment is appropriate will depend on the individual’s clinical needs and circumstances.

The transition home is an important part of the treatment process. Familiar routines and pressures can present challenges, particularly when someone is working to maintain changes made during their stay. At Ibiza Calm, aftercare is included in all programmes for a year, with weekly online sessions facilitated by psychotherapists to support clients as they continue with their lives beyond the residential setting.

For referring professionals, residential treatment may be worth considering when someone would benefit from a more intensive and coordinated period of care. An initial conversation with the Ibiza Calm team can help establish whether the programme is appropriate and how it might complement the support already in place.

Looking beyond the presenting problem

When progress stalls, it can be worth considering whether a different level or combination of support might help address the difficulties that remain. Where mental health and substance use are closely connected, treatment may need to take account of both.

At Ibiza Calm, we offer an individualised residential programme within a small setting, with psychiatric oversight, medical and psychological care, and a year of aftercare.

We welcome conversations with referring clinicians who are considering whether residential treatment may be appropriate for someone they support.