There was a time in my life when I could not stop drinking. I would wake up with a pounding hangover and continue to drink—taking long swigs from a massive bottle of Bulleit bourbon—until I passed out again. In the darkness of my untreated mental illness, I lost the ability to inhabit my body without substances. I checked myself into an emergency room one fall on three separate occasions because I could not retain liquids without vomiting. Each time, once I was medically cleared, I was discharged. No doctor ever paused to assemble the full picture: the multiple involuntary commitments to psychiatric wards, the brain infection that had inflamed my frontal cortex, or the bipolar disorder whose diagnosis would not arrive for another two years.

While every doctor encouraged me to stop drinking, no one seemed particularly interested in the deeper question: Why did I keep turning to the bottle for relief?

Psychiatrist Edward Khantzian proposed that essential question when he reframed addictions not as moral failures but as adaptive responses to escape psychological suffering. “Persons with substance use disorders suffer in the extreme with their feelings,” Khantzian observed. “Either being overwhelmed with painful affects or seeming not to feel their emotions at all.” The choice of drugs matters, too, because it hints at the shape of the suffering it seeks to regulate.

I turned to a variety of drugs for a variety of reasons. Alcohol was easily accessible, socially acceptable, and it muted the dread. Cocaine and Adderall propelled me into a frenzied swirl of motion, elevating the flatness of depression into a beguiling belief that I was still the best version of myself. When I came down from their high, weed turned the shame I felt into a numbing kind of atmospheric warmth. Every drug ventriloquized what I had no language for: They were crude interpreters that concealed far more than they revealed.

I now see the ruse of their false interpretations. While they regulated me, they did not relate to me; while they soothed me, they never saw me. They were sublimely effective at taking unbearable emotion and converting it into a palatable reality while ignoring the unbearability’s source. This trick that drugs play on users is clinically significant because it shapes what effective treatment should look like.

Many intensive outpatient programs are built on cognitive behavioral therapy (CBT). In the first year of my crisis, I attended one in Wisconsin where we were taught to recognize distorted thoughts and practice skills to stop harmful behaviors. However helpful for some, the framework can obscure the roots of psychic pain. In my case, no one took the time to piece together a life history or offer a comprehensive STI exam. Had they done so, they might have identified how a manic period preceded my depression and how my self-destructive actions were the product of an undiscovered neurosyphilitic brain infection. The drug use was downstream of a biological reality that no worksheets on distress tolerance or cognitive distortions would ever reach. In compressing my addiction and psychiatric symptoms into one CBT framework, the program turned a blind eye to the origins of my psychological chaos.

Far too often, the design of the mental health system perpetuates this divided strategy. The Substance Abuse and Mental Health Services Administration highlights the value of an integrated approach to co-occurring disorders. But most programs lack resources, time, and a holistic vision, ensuring that the mental health and substance use teams operate in separate silos, each holding a piece of the puzzle that neither can complete alone.

Later in my years of crisis, I spent time at Wisconsin’s state forensic hospital, and I experienced the bifurcated method firsthand. I will never forget the empathetic eyes of a substance use counselor who helped me to mine the past of my addictions through a life history assignment, dropping a plumb line from my father’s alcoholism to the shame I felt when I failed in life, to identify a schema I had never spoken aloud: “I need to achieve to be loved.” For the first time in my life, in the absence of judgment, I saw my addictions as a repressed form of somatic speech.

If those insights ever made it to my psychiatrist and mental health team, I never heard a word about it. Treatment team meetings revolved around the mechanical recitation of safety questions: Do you have thoughts of harming yourself? Do you have thoughts of harming others? Each group of experts held vital parts of my story, but the institution seemed not to provide a mechanism to ensure they spoke to each other.

Over the years, I have learned that recovery has two parts: neurochemical stability and relational witnessing. The first consisted of lithium that cemented a chemical floor beneath the ebbs and flows of my moods, complete sobriety from substances that forced the fog of anosognosia to lift, and the correct diagnosis of bipolar disorder that gave me a lens to see clearly my suffering. This allowed me to listen to myself and others. The second consisted of the counselor who was present with my pain, and the mother who diligently answered my phone calls every morning with a compassion that survived the cruelty of my manic insults. This allowed me to be seen.

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When not acting as a ventriloquist, my drug use was a mimic of each aspect of recovery: It chemically simulated the stability my brain was lacking, while it seduced me with its own form of artificial intimacy. Only once the static of psychic suffering diminished was the signal of relationships able to reach me.

For clinicians, Gabor and Daniel Maté invite the heartfelt reversal that humanizes every conversation with someone floundering: Not why the addiction, but why the pain? We will likely struggle to find that answer if we continue to keep the addiction and mental health experts in separate rooms.

I have since come to see the breakthrough of recovery in a new light. Rather than seeking an endpoint, I invite a conversation with my body and emotions before the hand reaches in the dark of the night for the glass or the phone. The space for that conversation requires a stable brain and relationships that reflect reality to me—both honest interpreters in dialogue with each other.

For far too long, nobody asked what the drugs were translating for me. When someone finally did, my journey toward insight and healing could begin.