DUAL DIAGNOSIS: TACKLING TWO DISORDERS AT ONCE

In many instances, the phrase dual diagnosis refers to the co-occurrence of
a substance abuse disorder and a psychiatric disorder.

According to a 1999 report to the Surgeon General on mental health,
approximately 1/3 of the adult population of the United States meets the
diagnostic criteria for both a substance abuse disorder and a psychiatric
disorder.

Some common types of psychiatric disorders include depression, anxiety
disorders, bipolar disorder, schizophrenia and post-traumatic stress
disorder. The symptoms of these disorders are very emotionally and
physically distressing and an individual will often turn to alcohol or drug
use in an attempt to self-medicate his or her psychiatric symptoms.

In the very short term, self-medicating may offer some relief from symptoms,
which reinforces the behavior. Unfortunately, the long-term effects of using
alcohol or drugs to self-medicate psychiatric symptoms leads to intensified
symptoms. This, in turn, leads to more alcohol or drug use and creates a
vicious cycle of alcohol or drug use followed by increased psychiatric
symptoms.

This vicious cycle leads to devastation in all areas of an individual's
life. The devastation can include homelessness, chronic unemployment, social
isolation, self-destructive behavior, damaged relationships with family and
friends, losing custody of children, financial problems, frequent
hospitalizations and involvement in the legal system including
incarceration.

However, there is hope for people caught up in this vicious cycle. With
treatment, they can develop stable and rewarding lives. For many, for the
first time in their adult lives, they will be able to maintain stable
housing, decrease hospitalizations, regain custody of their children and put
an end to their cycle of involvement with the legal system. They can develop
and maintain healthy relationships with friends and family, obtain steady
employment and become financially responsible.

The journey to recovery for people with a dual diagnosis requires dedication
and hard work to overcome the unique and challenging obstacles with which
they are confronted. Symptoms of a substance abuse disorder and a
psychiatric disorder often mimic each other. For example, symptoms such as a
depressed mood, insomnia and irritability can be indicators of a depressive
disorder or a substance abuse disorder such as cocaine or alcohol
dependence.

A thorough assessment is crucial in determining the appropriate treatment
recommendations for the individual. Such an assessment includes obtaining
both an alcohol and drug use history as well as an emotional/psychiatric
history. The involvement of family members in the assessment process can be
extremely helpful in obtaining an accurate description of an individual's
life.

It is important that treatment for both disorders be integrated; both
disorders need to be addressed at the same time without undertreating one or
the other. Integrated treatment includes medications, when appropriate, and
cognitive-behavioral techniques that address a person's thought process and
patterns, and behaviors.

Rational emotive therapy (RET) is a common treatment approach that helps an
individuals change self-defeating thoughts and behaviors into more rational
thoughts and healthy behavior. RET helps people develop new coping skills to
deal with life problems without relapsing to alcohol or drug use, or to
their psychiatric disorders. These new coping skills provide individuals a
sense of mastery and control over their lives as they improve their
capability in successfully dealing with life problems.

Another important aspect of treatment is an emphasis on celebrating small
victories. Because of the overwhelming impact that dual disorders can have
on a person, it is important to acknowledge every small success in his or
her recovery. Small victories include attending 10 to 15 minutes of a
self-help meeting for someone with social anxiety; remaining abstinent on a
Saturday night for someone who usually drinks until he passes out on
weekends; or eating a nutritious meal for someone who has lost his appetite
because of depression.

Each and every small victory must be acknowledged and celebrated to help the
individual see that his life is indeed improving through recovery. Each
small victory also provides proof that he can change his life and succeed in
reaching goals that he set for himself -- taking that person farther along
the path of recovery, leading to a more stable, productive and rewarding
life.