Alcoholism or Something Else?
“My son has just one drink and he becomes completely unpredictable,” my friend tells me. “He is wrecking his life.”
Her face is forlorn as she relays the last several years of her son’s erratic behavior. She’s certain alcoholism is the culprit—that otherwise, her handsome, fiercely intelligent son would have a successful career as an advancing Marine. But I sense something more is at stake. There had been problems before the alcohol. Around the age of 9, Shane had been diagnosed with something called oppositional defiant disorder (ODD). He was unruly and stubborn; if his stepfather liked an NFL team or a certain wrestler, Shane insisted on rooting for the archrival. His tantrums were monumental, and, even as a young boy, he would argue his way out of a paper bag. When he couldn’t, he threw fists.
Now he was being demoted in rank and frequently reprimanded by his higher-ups for episodic behavior he and his mother were certain had to do with bouts of drinking. But as she said, all it took was “one drink.” When Shane did drink, of course, he couldn’t stop. He seemed to have an anger that needed the liquor as either a coolant or a combustible; one never knew what to expect. He’d recently been brought up on charges for allowing a woman in a bar to hold his weapon and his security clearance badge. A photo had been taken and sent to command. Shane was in a lot of trouble, and knowing this, he drank more.
“He’s suicidal,” his mother told me.
This had happened before. Her son, who could be so charming and funny, a great kid to be around sometimes, had experienced long bouts of depression. And when things grew especially confusing, his thoughts had sometimes turned to suicide. At least twice in his life, he had attempted. This was before his service days, and when he’d been recruited as a new Marine, he’d left this information off his mental health background. It could have meant a disqualification.
“There’s a real possibility Shane might be facing something more than problem drinking,” I carefully explained to his mother. “Has he been evaluated by a mental health professional since he was a boy?” I asked.
“No.” Her eyes remained downcast. “But I’ve had a feeling something deeper might be going on.”
Dual-Diagnosis — Addiction and Mental Health
Within a year after this hard conversation with my friend, her son experienced two more episodes—only one involving drinking. He was seen by a military psychologist and diagnosed with bipolar disorder. Because of the nature of his episodes—he had become both violent and suicidal once more—Shane was not allowed to remain in the military, but was fortunate enough to be given a medical discharge and was able to keep his VA benefits and the GI bill. Nevertheless, the experience had been humiliating for him and had sent him into a deep depression, one he still struggles with. A large part of what made Shane’s fight so difficult was that he had gone so long undiagnosed; everyone close to him assumed that he simply had a drinking problem. But his struggle was much deeper than a problem of addiction; it was a mental health challenge that urged him to self-medicate with alcohol, though by doing so, his mood states were made all the more challenging and erratic.
Shane was experiencing both addiction and mental illness. When a person struggles with a substance use disorder and a mental health disorder, he can be said to experience dual diagnosis. It is estimated that 4 million American adults suffer from both drug or alcohol dependency and a serious mental illness.
Treatment for Dual Diagnosis
The symptoms of a substance use disorder can complicate and exacerbate the symptoms of a mental illness and vice versa, so treating an individual who has these co-occurring issues requires special care. It is unlikely that a substance use disorder can effectively be treated without adequately addressing the underlying mental health challenges; it requires integrative treatment—a recovery approach that addresses both sets of issues as a whole. There are many qualified addiction specialists and mental health professionals who are experienced in doing just this, and many excellent recovery centers whose missions involve treating their patients’ dual diagnoses. While the matter is more complicated than one or the other alone, there is hope. People can and do recover.
For Shane, his military experience has ended, but his life is not yet over. Bipolar disorder can be fatal for those who do not seek treatment—many individuals with bipolar disorder will attempt suicide—but the disorder is among the most treatable mental health challenges. There are medications and therapies that show amazing results. If Shane elects to move forward with treatment for his bipolar disorder, he will be further prepared to face down his alcoholism. These demons may seem unconquerable, but thousands of people have fought them before and won. Such battles are engaged one day at a time with a heart that is willing, or as the Marines say, semper fi – always faithful.