Dual Diagnosis - Information for Families
by Jonathan Kessler, M.A., M.F.C.C.
The term "Dual Diagnosis" refers to simultaneous diagnoses of substance abuse
and another mental illness (depression, schizophrenia, etc.). A person with
a dual diagnosis often faces even greater challenges than a person coping with
either substance abuse or mental illness alone. Often the two issues
(substance abuse and mental illness)
exacerbate one another and increase the severity of both disorders. Use
of alcohol or drugs may set off an acute episode of mental illness, and may
intensify its symptoms. Conversely, persons suffering from a mental illness
often "self-medicate", turning to drugs or alcohol to try to feel better.
For some general thoughts on dealing with a loved one's diagnosis of a mental
illness, please see our
"Mental Illness - Information for Families" page.
Denial is frequently encountered in regard to both mental illness and
substance abuse, and is often present in the dually diagnosed. The affected
individual is unable or refuses to see that they have a problem, let alone that
they have two problems that compound each other. Getting through the denial
is often an important step in the treatment of the dually diagnosed.
Another difficulty faced by
the dually diagnosed comes in terms of treatment and support. Many persons
involved in 12-step groups believe that taking psychotropic medication (such
as is prescribed for mental illness) is "taking drugs" and is therefore not
acceptable in a program of sobriety. The dually diagnosed person is generally
following a doctor's orders in taking medication which may be essential
to their health and well being. Yet they may find themselves under a great deal of
pressure from others in the field of sobriety to "get off the drugs". Sometimes
they follow this well-meaning advice, only to find themselves in an
acute relapse of their mental illness, which may then precipitate another
relapse into substance abuse.
Treatment of the dually diagnosed involves a two pronged approach, working with
both the mental illness and the substance abuse disorders. Coping skills for
dealing with mental illness, including medication management, symptom
management, and relapse prevention, are essential for the dually diagnosed
person. Similarly, relapse prevention skills, an understanding of triggers
for substance abuse, and coping skills to prevent relapse and maintain
sobriety, are also equally essential. Active participation in a supportive
12-step program is also an excellent adjunct to treatment. Inpatient treatment
may be necessary and warranted by severe cases.
Persons with a dual diagnosis are truly carrying a "double burden", and face
additional challenges. Yet with proper treatment, support, and a commitment to
recovery, the dually diagnosed person can make and maintain successful
recovery.
If your family member is out of control or suicidal (danger of harm
to self or others), stay calm and call 911. Do not try to handle it alone.
