As the adult daughter of a mother with mental illness, it falls to me to keep doctors and sometimes even law enforcement apprised of my mother’s history and tendencies. She has been involuntarily committed into psychiatric treatment by police on at least four occasions, and has more than once been arrested as a result of actions prompted by psychotic symptoms. My mother’s history with mental illness has often made it difficult for her to maintain jobs, relationships and even the compassion of mental health professionals (she threatened one psychiatrist’s life). But these are not the least of the complications my mother experiences, or that those of us close to her must endure. On top of suffering from mental illness, my mother is an alcoholic and is addicted to prescription medications. In her case, the abuse of alcohol and pills on top of an already fragile mood state or unclear mental perspective are a recipe for chaos and increased risk of death. Sometimes my mother’s penchant for violence turns outward, such as the time she assaulted a surprised grocery store clerk for ringing her up “too slowly,” and at other times, it turns inward, such as when she deliberately crashed her car because, she said, “I can’t take it anymore.”
Defining Dual Diagnosis
Let me be clear: my mother’s situation is the exception; the majority of people who experience mental illness are not violent, even when drugs and alcohol are involved. But the combination of addiction and mental illness does complicate things for any person who experiences dual diagnosis, a term used to refer to people who experience mental illness and a co-existing problem with alcohol or drugs. In my mom’s case, her dual diagnosis makes her even less likely to seek and sustain effective treatment; the medications and therapy required do not mesh with her need to numb out with alcohol, tranquilizers and painkillers. For other people who experience dual diagnosis – especially those who do not have a family advocate in charge of their medical history and sympathetic to their issues – the problem of treatment can come down to missed opportunities on the part of mental health professionals. Addicts seeking to hide their addictions become quite skilled at doing so, even from the pros. And some mental health workers believe the problems of mental illness and drug/alcohol abuse are so different that their treatment should occur in separate settings, at separate times. But as we’ll see, a cohesive, integrative approach is far more likely to succeed.
Important Ingredients in Treating Dual Diagnosis
According to expert Johnny Patout, LCSW, “Approximately 8.9 million adults who abuse drugs also have a mental health disorder. However, only 7.4 percent of these individuals receive treatment for both issues.” Patout explains that there are four key issues mental health professionals must address when treating individuals with dual diagnosis, although frequently, he says, one or more of these key aspects is missed, causing the reduced effectiveness (or complete failure) of treatment. Those key things that need to happen are.
- Integrate treatment. Addiction and mental illness are complicated and intertwined. Attempting to address one while ignoring the other does not work. A problem of addiction will arrest mental health, and mental health issues will make addiction cravings all the harder to resist. Both components of wellness must be addressed simultaneously, in a program suited to the individual’s array of needs.
- Monitor medications. Many folks on the addiction recovery side are anti-med, and with good intentions. Because many prescription medications can be abused, their belief is that addicts should address mental health issues through therapy and 12-step programs alone. But for individuals like my mother who experience very real neurochemical issues and subsequent problems with debilitating depression, crippling anxiety, extreme mood changes or even psychosis, medications are often necessary. When pharmaceuticals are prescribed, however, they should be closely monitored by healthcare professionals who communicate with one another about their patient’s health and well-being. A lack of communication between professionals or pharmacies can mean trouble, especially for addicts.
- Deal with trauma. It is tremendously important for any person suffering dual diagnosis to not only treat his or her symptoms, but to get to the root of problem as well. Very often, trauma or unresolved emotional content from the past is a trigger for the symptoms of mental illness and for the emergence of addictive patterns. This trauma must be dealt with in a constructive, healing way.
- Everyone gets help. My mother loves the quote from Susanna Kaysen’s best-selling book-turned-movie, Girl Interrupted: “Lunatics are similar to designated hitters. Often an entire family is crazy, but since an entire family can’t go into the hospital, one person is designated as crazy and goes inside.” It’s true that the complex combination of mental illness and addiction is not created in isolation; an individual emerges sick from a family, and that family often suffers dysfunctions of its own. For the dually diagnosed to heal, his or her family must also seek healing and, in the end, healing is in the best interest of everyone involved. Take it from me. Pointing at our sick loved one and saying, “She’s the problem!” is easy; being accountable for our part is not so much. But a family who gets help increases the odds of their loved one’s recovery, and they end up with a healing legacy to boot.