DUAL DIAGNOSIS:

MENTAL ILLNESS AND SUBSTANCE ABUSE

 

 

It can be difficult to find treatment for an individual who has a mental illness and also uses drugs or alcohol.   Many programs that treat people with mental illness are not well prepared to treat substance abusers, and programs for substance abusers are not geared for people with mental illness.  Individuals with dual diagnoses of mental illness and substance abuse often bounce from one program to another, or are refused treatment by single-diagnosis programs.  Gradually, specialized MISA (Mental Illness and Substance Abuse) Programs are being established.  These programs have staff who are trained to deal with both the mental illness and the substance abuse problem.

 

 

How Does Dual Diagnosis Affect Families and Friends?

Dual diagnosis means the condition is especially complex and difficult to manage.  Families with a dually diagnosed member may experience twice the problems of thoses whose family member has only one disorder.

 

Is Dual Diagnosis Common?

The combination of mental illness and substance abuse is so common that many clinicians who work with the mentally ill now expect to find it.  Studies show that fully 50% of persons with mental illness also have a substance abuse problem.  And more than half the persons with a substance abuse diagnosis also have a diagnosable mental illness.

 

What Causes These Disorders?

Mental health and addiction counselors increasingly believe that mental illness and substance abuse are biologically and physiologically based.  Families may feel angry at the person and blame him for being foolish and weak-willed.  They may feel hurt when the person breaks trust through lying or stealing.  But it’s important for them to realize that mental illness and substance abuse are diseases and that the person cannot take control of the problem without help.

 

What Kind of Treatment Works?

People with such difficult problems do not respond to simplistic advice like “just say no” or “snap out of it.”  Psychotherapy, medication and electro-convulsive therapy combined with appropriate self-help and other support groups help most, but these individuals are still highly prone to relapse.  Treatment programs designed only for substance abusers are not recommended for people who also have a mental illness.  Heavy confrontation, intense emotional jolting without adequate support, and discouragement of the use of appropriate medications tend to compound the problems of mentally ill patients.  These strategies may produce stress levels that make symptoms worse or cause relapse.

What is A Better Approach?

Increasingly, the psychiatric and drug counseling communities agree that both disorders must be treated at the same time.  Early studies show that when mental illness and substance abuse are treated together, suicide attempts and psychotic episodes decrease rapidly. 

The patient’s denial is a central part of the problem.  Since dually diagnosed patients do not fit well into most Alcoholic Anonymous or Narcotics Anonymous groups, special peer groups based on AA principle should be developed.  Clients who develop positive social networks have a much better chance of controlling their illnesses.  Healthy recreational activities and peer relationships are extremely important.

 

What’s the First Step in Treatment?

The presence of both disorders must first be established by careful assessment.  This may be difficult because the symptoms of one disorder can mimic the symptoms of  the other.

Once an assessment has confirmed a dual diagnosis of mental illness and substance abuse, mental health professionals and family members should work together on a strategy for integrating care and motivating the client.

 

What Do Model Programs for Treating Mental Illness and Substance Abuse Look Like?

There is a growing number of model programs.  All of them have support groups similar to Alcoholics Anonymous and Narcotics Anonymous.  Members support each other as they learn about the role of alcohol and drugs in their lives.  They learn social skills and how to replace substance use with new thoughts and behaviors.  They get help with concrete situations that arise because of mental illness.  Several programs have support groups for family members and friends.

 

The New Hampshire Mental Health and Substance Abuse Departments sponsors a program with the Dartmouth Medical School Psychiatric Research Center for the state’s 10 mental health service regions.  Case management services are provided by teams of professionals.

 

A New York program operates in a wide range of service settings.  Treatment focuses on eliminating symptoms and developing strategies to prevent relapse.  A residential rehabilitation program in a high-crime and drug-use area of the Bronx helps 45 homeless men who are both drug abusers and have a major mental illness.

 

In Washington, D.C., a program offers case management in integrated treatment and referral to substance abuse services in the community.

 

If Your Loved One is Addicted to Drugs and/or Alcohol:

1.  Don’t regard it as a family disgrace.  Recovery from an addiction is possible just as with other illnesses.     

     2.  Don’t nag, preach or lecture to the addict/alcoholic.  Chances are he has already heard or told himself everything you can say.  You may only increase the need to lie or force him/her to make promises that cannot be kept.

     3. Guard against a “holier than thou” or martyr-like attitude.

     4. Don’t use the “if you loved me” approach.  It is like saying, “If you loved me, you would not have tuberculosis.”

     5.  Avoid threats unless you think them through carefully and definitely intend to carry them out.  Idle threats only make the alcoholic/addict feel you don’t mean what you say.

     6.  Don’t hide the alcohol/drugs or dispose of them.  Usually this only pushes the addict into a state of depression.

     7. Don’t let the addict/alcoholic persuade you to drink or use with him/her.  When you condone the drinking/using, she/he puts off doing something to get help.

     8.  Don’t be jealous of the method of recovery the alcoholic/addict chooses.  You may feel left out when the alcoholic/addict turns to other people for helping stay sober.  If someone needed medical care, you wouldn’t be jealous of the doctor.

     9.  Don’t expect an immediate 100% recovery.  In any illness, there is a period of convalescence.  There may be relapses and times of tension and resentment.

   10.  Don’t try to protect the recovering person from drinking/using.  He must learn on his own to say “no” gracefully.

   11.  Don’t do for the alcoholic/addict that which she can do for herself.  You cannot take the medicine for her.  Don’t remove the problem before the alcoholic/addict can face it, solve it or suffer the consequences.

  12.   Do offer love, support, and understanding in the recovery.

 

Further reading: Evans, Katie and J. Michael Sullivan Dual Diagnosis: Counseling for the Mentally Ill Substance Abuser.  San Francisco, Jossey-Bass Publishers, Inc.:

1991.

 

For more information on mental illnesses - contact:

 

THE ALLIANCE FOR THE MENTALLY ILL

NAMI OF GREATER CHICAGO

1536 West Chicago Avenue, Chicago, IL  60622

312-563-0445 - Fax: 312-563-0467