Which Came First? The Conundrum of Dual Diagnosis

In Mental Health it has been known that many with mental illnesses will self medicate, some of the people who do this then develop addictions.  Some practitioners view the addiction as a side effect of the mental illness that will magically go away once the mental illness is treated.  This is far from true, however.  The problem is many view addiction as a weakness in morality rather than a true medical illness.  The new school of thought is that we are to treat both of these conditions equally, as primary diagnoses.  I tend to agree with this as the evidence supports negative outcomes when you treat just one or the other instead of both equally.

12-step programs are designed to look at any drug as negative, even if prescribed by a physician so they are ill-equipped to treat someone with addiction and Bipolar Disorder who does need to take antidepressants and mood stabilizers to live a productive life.  Sure you may treat the addiction to heroin but you leave the person with grappling with shame and guilt if they do take their psychotropic medications.  If the person does decide to go cold-turkey on the medications that work to help them cope with their myriad of symptoms, you risk a very high chance of hospitalization due to the symptoms of Bipolar Disorder.  The chances of relapsing then on the drug addiction is high because the person is in a very vulnerable state.  I’m not suggesting there isn’t room for Alcoholic’s Anonymous, I am suggesting we need more programs for those who have Dual Diagnoses.

Once someone has developed an addiction, something that has a myriad of causes, is it even necessary to ask “why did this develop?”  In some respects it is, if you can get to the heart of the matter and fix it, you may end up having a better chance of recovery.  But for certain individuals, ones with mental health disorders such as Post-Traumatic Stress Disorder, Bipolar Disorder, and Schizophrenia it may be better to try and get them on the road to recovery of both at the same time.  In that course of treatment, teach those individuals to use medications and hospitalization as tools to manage their illnesses.  I think we see Mental Health treatment as for the weak and “crazy” and therefore it becomes a form of punishment.  During my Advanced Practicum we studied the Recovery Model, it is very promising, in my opinion, for the future of Mental Health.

Cross posted here

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2 thoughts on “Which Came First? The Conundrum of Dual Diagnosis

  1. This is an interesting topic for sure:

    …Once I have named the fear or doubt, I try to see if I can file it under any of the forms of distorted thinking that Dr. David Burns describes in his bestseller “Feeling Good,” like all-or-nothing thinking, jumping to conclusions, magnification (exaggeration), or discounting the positive (ie “None of my accomplishments count”). My obsession almost always involves at least three forms of distorted thoughts. So I then consider Burns’ ten ways of untwisting distorted thinking to help me to undermine my obsession.

    Read more: http://www.beliefnet.com/Health/Emotional-Health/Bipolar/15-Ways-to-Stop-Obsessing.aspx?p=3#ixzz18oGllKIV

    I just happened to be reading this ‘self-help’ essay.

    My problem is with categories. I mean Tiger Woods or Ted Williams were both obsessive compulsive for Chrissakes. Anyone who is good at something, has to be obsessive compulsive.

    Now lining up corn on your plate or having 100 pairs of socks in some sort of perfect order is nuts.

    There are so many drugs for so many different maladies. We have taken the shaman’s trade and turned it into hundreds of billions of dollars and all of these people now depend upon those drugs.

    And AA and NA and a host of other self help groups work for some people and will never work for other folks.

    Interesting post!!

  2. Absolutely right in that this new approach is needed, PsychRN, in cases of Bi-Polar disorder, etc.

    I think the 12-step program is great for a lot of things, but their view of drugs sometimes goes way too far. My mother, for instance, is in AA and this year she had knee replacement surgery. It was strongly suggested – in fact necessary – that she take painkillers while undergoing her strenuous physical therapy after the surgery. But because my mother feared becoming addicted to a mind-altering drug, she kept trying to do her therapy sans painkillers, which only made things worse.

    Finally she gave up on this silliness and started taking the pain meds while going to therapy, and….lo and behold, she finally started healing.

    Great post. I agree with you completely.

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