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Biology 202
2002 Third Paper
On Serendip

Double Trouble: Dual Diagnosis -- Individuals Simultaneously Suffering from Alcohol/Substance Abuse and Mental Illness

In this day in age, there are many diseases that one can contract. Sometimes a person contracts a disease because it was contagious, and others because they are genetically prone to it. Still others contract diseases and disorders in ways that are not clear to doctors and medical researchers.

In recent years, alcoholism and substance abuse have been labeled as diseases because of new research findings that doctors have discovered regarding the biological and psychological factors causing someone to become an alcoholic or a substance abuser. Anyone who has a friend of family member who suffers from any form of substance abuse knows the extreme difficulty of helping the suffering individual seek help and recover. The same goes for individuals suffering from a mental illness.

In the past two decades doctors have discovered that at least 50 percent of mental ill individuals in this country also suffer from either alcoholism or substance abuse. (4) Some studies indicate that this percentage translates to 7.2 million individuals between the ages of 18 and 54 are suffering from both a substance abuse problem and a mental illness. (2) These numbers are simply staggering. Many of these numbers apply to the adolescent demographic in particular, who the National Alliance for the Mentally Ill (NAMI) say are most prone to having a mental illness "...that may in fact lead to self-medicating with street drugs and alcohol." (1) NAMI's fact sheet on Dual Diagnosis also states that mental health professionals are discovering Dual Diagnosis in such high rates that they have come to expect that individuals with a substance abuse problem will also have a previously undiagnosed mental illness. These mental illnesses range from Attention Deficit Disorder to Bipolar Disorder and everything in between. (1)

The problem with Dual Diagnosis patients, however, is the fact that they typically seek treatment for one problem and not the other. What makes things more difficult is that most substance abusers and alcoholics do not seek help at all. For the Dual Diagnosis patients that do seek treatment for alcoholism, let's say, do not then get treated for another underlying illness like depression. Doctors, psychiatrists and other mental health care professionals are hard at work in implementing effective treatment programs for these special patients, which I will discuss later. (1)

Another complicating issue Dual Diagnosis individuals face is the fact that often the patient will use one disorder to mask the other from his or herself as well as their friends, families, co-workers, and health care providers. This causes some difficulty in diagnosing someone as having two disorders. There is also the specific issue of diagnosing the teenage population. Most people are keenly aware of the fact that teenagers are hard to figure out due to their fluctuating moods and hormones. "How can [we] separate the normal mood variations of a fifteen year old teenager from certain Bi-polar disorders? When substance use or abuse is present, with resulting mood fluctuation, the variables become staggering," says a counselor in an article for (5)

Dual Diagnosis patients are more prone to relapse of either their substance abuse problem or their mental illness and they are also more prone to commit suicide and be violent. (1) Relapse often occurs because both problems the individual is suffering from were not treated in a manner that addresses both problems simultaneously. This is also something that I will examine later on. Studies have also found that Dual Diagnosis individuals have a high rate of sexual abuse experience as well (as either victim or perpetrator). (5)

As I conducted research on the World Wide Web on Dual Diagnosis, almost every site I visited on the subject had a link to a page authored by Kathleen Sciacca, M.A. Sciacca is both founder and director of Sciacca Comprehensive Service Development for Mental Illness, Drug Addiction and Alcoholism (MIDAA), based in New York. Among other accomplishments, Sciacca has written books and articles (many of which are available her website), is a touring lecturer, and leader in the development of effective treatment programs for individuals with Dual Diagnosis. She began her work in the 1980s and helps to train other mental health care workers in treating these special patients. (3)

According to research done by Sciacca, there were several programs instated in the early 1980s around the US that were working to treat the dually diagnosed patient. The programs tried what most mental health care professionals believe is best for Dual Diagnosis individuals, which is to treat both of their illnesses simultaneously rather than have the patient attend one 12-Step program and psychiatric therapy at the same or different times. One person with two problems does not mean two different treatments; the whole person needs to be treated at the same time. Although these types of patients are not often heard of in mainstream society, Sciacca cites an article in TIME Magazine in the 1980s that a reporter wrote after hearing about one the new treatment programs being developed. That, Sciacca says, was the first time Dual Diagnosis was mentioned on a national level in the popular media. (3)

The early treatment programs took "A "non-confrontational" approach to denial and resistance, involving acceptance of all symptoms [of the patient]...." (3) Not being confrontational or accusatory of patients with alcohol or substance abuse problems especially is key to effectively reaching out to these patients. With so many stigmas in society about drug and alcohol abusers, and the lack of knowledge in general about chemical abuse as a disease and not just a 'problem' or choice, makes most patients feel like seeking treatment means admitting they are wrong or bad. Sciacca explains that many mental health care workers also do not understand and recognize alcoholism and chemical dependency as a disease, and this hinders treatment of such patients. Therefore a comprehensive treatment program for Dual Diagnosis individuals must recognize both diagnoses as diseases that the patient does not have control over. (3, 1)

Some components of the Sciacca's model for treatment include, day programs in clinics, residential programs, and support/therapeutic group work. She cites that many patients find discussing their chemical abuse and mental illness problems in a group setting with others who share similar problems, helps a Dual Diagnosis individual to see in others what is going on inside of them. Another component of the program is incorporating Alcoholics Anonymous and other such groups into the treatment. Most Dual Diagnosis patients find that programs like AA are ineffective for them. However, Sciacca has found that brining in speakers from groups like AA to join group therapy discussions is very effective and helpful to patients. Through group discussion, one on one time with a therapist, and other activities in the program, a patient comes to understand his or herself as having multiple problems that can be treated simultaneously. Sciacca also stresses communication between all therapists and psychiatrists working with a given patient in order that comprehensive treatment will occur. (3)

The difficulty of living with a mental illness is extreme, as is the difficulty of living with a chemical dependency. Both problems are diseases with both biological and psychological causes and symptoms. Treatment is more difficult if an individual is dually diagnosed with both problems. But treatment is possible. From models developed by Kathleen Sciacca and other mental health care professionals, simultaneous treatment of both disorders appears to be the best method for recovery as a Dual Diagnosis individual. For a condition that applies to so many millions of people in the United States alone, it is a wonder that more outreach and treatment programs have not been established to help such patients. But with more awareness of the disorder by the general population, it will become easier to identify multiple problems in an individual family member or friend, and aid them in seeking treatment.


Resources Cited:

1) National Alliance for the Mentally Ill (NAMI), general information on Dual Diagnosis

2) The Dual Diagnosis Pages , Dual Diagnosis Conference Reports

3) Kathleen Sciacca's website , leading resource on treatment methods and program sites

4) National Alliance for the Mentally Ill , Fact Sheet on Dual Diagnosis

5) article on Dual Diagnosis

For Further Information:

7) Dual Recovery Anonymous , an AA-style support ring

8) Dual Diagnosis Recovery Network

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