The Rejection Loop: Why Crisis Care Is Failing Addiction and Neurodivergence

There is something about the way we respond to addiction that I believe we desperately need to talk about.

If somebody walks into an emergency department having a heart attack, we know what happens. There is a pathway. There are protocols. There is urgency. Nobody asks them to sort themselves out first and come back when they are in a better position to receive help.

But when the crisis involves addiction, intoxication, severe psychological distress, or all three at once, the response can look frighteningly different.

And when neurodivergence is thrown into that already complicated picture, the barriers don’t simply add up.

They multiply.

This matters enormously to me because addiction and recovery are a significant part of my work. The more I work in this field, the more convinced I become that we cannot continue treating addiction as an isolated behaviour that simply needs to be stopped.

We have to start asking:

What is happening underneath it?

What is this person trying to regulate, escape, quieten, survive, soothe or cope with?

Because sometimes the substance isn’t the whole problem.

Sometimes it has become the person’s solution to a problem nobody else has helped them solve.

When Someone in Crisis Is Treated as a Behavioural Problem

A recent NPR investigation highlighted the devastating case of 26-year-old Jean Descamps in Oregon.

He was experiencing a severe drug-related medical crisis. According to the reporting, his presentation was characterised as “100% behavioral.” He was removed from the hospital and subsequently died.

It is a horrifying case.

But the uncomfortable conversation it raises goes far beyond one hospital, one country or one group of healthcare professionals.

Because we have created systems in which people experiencing addiction, mental distress and complex behavioural presentations can find themselves falling between services.

And we see versions of this problem here in the UK too.

The Dual-Diagnosis Ping-Pong

Imagine someone who is intoxicated, terrified, dysregulated and suicidal.

They need help now.

But intoxication can complicate psychiatric assessment. A person may be told that a fuller mental health assessment needs to happen when they are sufficiently sober, or they may be redirected towards drug and alcohol services.

But community addiction services are generally not emergency psychiatric units.

They may be brilliant at what they are commissioned to do, but they are not necessarily designed to contain somebody experiencing an immediate, life-threatening mental health crisis.

So the person can end up trapped in what I call the rejection loop:

Mental health says: “The addiction needs addressing.”

Addiction services say: “The acute mental health crisis needs addressing.”

And somewhere between those two statements is a frightened human being who needs somebody to take responsibility for their care.

This is the problem with siloed services.

Human beings don't arrive in neatly separated diagnostic boxes.

Addiction does not politely wait outside while we treat depression.

Trauma doesn't disappear while somebody detoxes.

ADHD doesn't switch itself off during a psychiatric assessment.

Autism doesn't go away because somebody has consumed alcohol.

Everything arrives through the door together.

Yet our services can still expect people to separate themselves into the correct category before they are allowed through the correct door.

And Our Emergency Safety Net Is Changing

There is another important piece to this.

Historically, when somebody was experiencing an extreme mental health crisis, police and emergency services frequently became involved—not necessarily because police were the most appropriate people to respond, but because somebody had to.

The UK's Right Care, Right Person approach is intended to shift responsibility for health-related incidents away from police and towards health and social care professionals, except where there is a significant safety or policing need.

Conceptually, that makes sense.

Mental illness isn't a crime.

Addiction isn't a crime.

Neurodivergence isn't a crime.

A person experiencing a meltdown shouldn't automatically need a police response.

But removing one part of the emergency response only works if the appropriate health response is actually there to replace it.

Otherwise we risk creating another gap.

And people in crisis are extraordinarily good at finding the gaps in our systems—not because they want to, but because they are the people most likely to fall through them.

Now Add Neurodivergence

This is where I think the conversation becomes even more important.

What happens when the person experiencing addiction is also autistic?

Or has ADHD?

Or is AuDHD?

Or perhaps has spent 30, 40 or 50 years completely unaware that they are neurodivergent?

We are increasingly recognising the relationship between neurodivergence, emotional regulation, trauma, impulsivity, burnout and problematic substance use.

Yet many addiction pathways still operate around a fundamentally neurotypical model of recovery.

And then we wonder why some people repeatedly “fail” treatment.

Perhaps treatment has sometimes failed them.

Imagine Experiencing Crisis Through a Neurodivergent Nervous System

You are already overwhelmed.

Perhaps you are withdrawing.

Perhaps you're frightened.

Your nervous system is screaming.

Then we put you somewhere with fluorescent lighting, alarms, strangers, unpredictable noises, uncomfortable chairs, constant interruptions and people asking you questions you can't process quickly enough to answer.

Someone asks you the same question for the fourth time.

You become overwhelmed.

You stop communicating.

Or you become distressed.

Or angry.

Or you pace.

Or you raise your voice.

Or you desperately try to leave.

What one clinician sees as “challenging behaviour” could actually be an autistic meltdown.

What looks like refusal might be shutdown.

What looks like aggression might be sensory overload.

What looks like somebody being deliberately difficult might be a nervous system that has completely exceeded its capacity.

And if we don't understand the difference, we can make an already dangerous situation considerably worse.

Then We Call People “Non-Compliant”

This is another part of addiction treatment that I think needs serious examination.

Think about what we ask somebody to do when they enter recovery.

Complete forms.

Remember appointments.

Answer phone calls.

Navigate referrals.

Attend different buildings.

Organise prescriptions.

Remember medication.

Follow treatment plans.

Turn up at specific times.

Sit through meetings.

Complete homework.

Make lifestyle changes.

Build routines.

Regulate emotions.

Avoid impulsive decisions.

Now imagine asking somebody with significant executive-function difficulties to manage all of that while they are simultaneously withdrawing from a substance and trying to rebuild their life.

Then, when they miss three appointments, we write:

“Did not engage.”

“Non-compliant.”

“Lacks motivation.”

Maybe.

But perhaps we should also ask whether the pathway demanded neurological skills that person was struggling to access.

Even Our Recovery Models Don't Work for Everybody

Group recovery can be transformational.

Twelve-step fellowships have helped enormous numbers of people.

CBT can be incredibly useful.

I'm not interested in dismissing approaches that clearly help people.

But one size does not fit every nervous system.

For some autistic people, sitting in a circle of strangers, navigating social cues, speaking spontaneously, processing other people's emotions and trying to understand the unwritten rules of a group can be exhausting.

They may spend the entire meeting masking.

And then we wonder why they don't come back.

Likewise, cognitive approaches alone may not adequately address sensory overwhelm, interoceptive differences, impulsivity, emotional dysregulation or chronic nervous-system overload.

We have to stop asking:

“Why won't this person fit our treatment?”

and start asking:

“How can treatment fit this person?”

That is a very different question.

Sometimes Addiction Starts as Adaptation

This is perhaps the most important part for me.

I don't believe we can properly understand addiction without understanding what the substance does for the person.

Particularly when we're working with neurodivergence.

Alcohol might quieten a relentlessly busy ADHD brain.

Cannabis might soften sensory overwhelm.

Stimulants might temporarily create focus.

Cocaine might create confidence, energy or social ease.

Sedatives might finally make somebody feel still.

None of that makes substance dependence healthy.

But it makes it understandable.

And understanding something is not the same as condoning it.

Understanding gives us somewhere to work.

If we simply remove the substance without helping somebody develop another way of meeting the need underneath it, what have we actually given them?

We've taken away their coping strategy.

And sometimes we've left the original pain completely untouched.

This is why I believe recovery has to be holistic.

We need to work with the behaviour, yes—but also the nervous system, trauma, identity, environment, relationships, sensory needs, emotional regulation, executive functioning, physical health and the person's sense of meaning and purpose.

We Need to Stop Treating Complexity as an Inconvenience

Most healthcare professionals don't wake up intending to reject vulnerable people.

There are incredible doctors, nurses, paramedics, mental health practitioners, addiction workers and emergency professionals doing extraordinarily difficult jobs within overstretched systems.

This isn't about blaming them.

It is about looking honestly at what happens when systems are built around rigid thresholds and separate services while the people walking through the doors are anything but simple.

Human beings are messy.

We have trauma and ADHD.

Autism and addiction.

Grief and alcohol dependence.

Chronic pain and prescription medication problems.

Depression and cocaine use.

Sensory overwhelm and self-harm.

There isn't always one diagnosis.

There isn't always one service.

And there certainly isn't always one simple solution.

So What Needs to Change?

We need genuinely integrated mental health and addiction care, where having one condition doesn't disqualify somebody from receiving help for the other.

We need neurodiversity-affirming addiction services that understand sensory processing, executive functioning, communication differences, impulsivity, burnout and masking.

We need greater flexibility around how recovery is delivered—including individual work, smaller groups, quieter environments, accessible communication and practical support with engagement.

And we need trauma-informed education that teaches professionals to look beyond the behaviour in front of them and become curious about what might be driving it.

Most importantly, I think we need to stop asking:

“What is wrong with this person?”

and become much more interested in:

“What has happened to this person, what does their nervous system need, and what is this behaviour trying to achieve?”

Because the person experiencing addiction is still a person.

The autistic person having a meltdown is still a person.

The intoxicated person experiencing suicidal thoughts is still a person.

The person who missed three appointments is still a person.

And the person who has relapsed for the fifth time is still worthy of care.

Recovery should never depend upon somebody becoming uncomplicated enough to fit through the door.

We need to build better doors.