Dual Diagnosis Is Complicated, but Whole Recovery Is Possible
A boy with a genetic predisposition for depression succumbs to the “black fog” and alcoholism before finding help in a dual-diagnosis recovery program.
Before Cass was 10, he was a quiet boy and only sometimes sad. His father traveled a lot and his mother suffered long periods of depression that kept her in bed. But largely, Cass remembers being a fairly content kid until his adolescence. His own depression didn’t descend until then. He called it the “black fog.” He didn’t have the willpower to do any of the things he normally loved, and often didn’t leave his room for weeks except to go to school. He had no choice in that matter. His father dismissed Cass’s depression at the time, saying he was acting just like his mother. No one in the family understood much about mental illness or genetic predisposition then.
By 18, the mania hit. Sometimes Cass felt wild and euphoric, like he could leap tall buildings in a single bound and everyone would stand by startled and charmed while he did. Other times the mania was harder; he grew agitated and full of rage he couldn’t understand. Like a lot of teenagers, Cass tried alcohol, though most others were using it to be rebellious or feel uninhibited. Cass began drinking to feel sane. The alcohol dulled his senses—he didn’t feel as on-edge or worried about what would happen next because of the painful, growing energy inside him. But the black fog always came again and each time, it seemed to get deeper and darker. He didn’t understand that alcohol was a depressant and should not be used, much less abused, by someone who suffered depression or mood swings.
It would be years – years of lost jobs and lost relationships – before Cass would choose to get help for his drinking. His meetings helped him a lot at first but he could never seem to make it through the first year of sobriety. He’d been hospitalized after a particularly bad manic period when it was finally suggested to him that he might have bipolar disorder, a brain disorder that causes unusual shifts in mood, energy, activity levels and the ability to carry out day-to-day tasks. A psychiatrist placed him on a few different medications and it took some time for the right combination to be sorted out, but when it was, he felt stable for the first time. He started individual therapy, which helped too, and he began to go to AA. This group was great for him and the friendships he made were the closest he’d ever had. Eventually, though, some of the members advised Cass to ditch his medications because they were drugs and drugs were bad for addicts. Cass looked up to these long-timers and stopped his medication cold turkey. A week later he was arrested; he’d been throwing his furniture out of the fifth-story window of his apartment (the mania had returned full blast).
It would be another year before Cass discovered Dual Recovery Anonymous (DRA), a place for people with mental health issues who also experienced addiction—people just like him.
What Is ‘Dual-Diagnosis’?
The term dual-diagnosis describes someone who experiences a mental illness along with addiction to drugs and/or alcohol. NAMI states that taken together, mental illness and substance abuse are more complex than either one alone—although both are separately very complicated issues. Sometimes the symptoms of a mental illness lead a person to seek drugs and alcohol in order to self-medicate, which helps to create the conditions of drug dependence or to further exacerbate it.
It is estimated that about 4 million American adults struggle with a psychological disorder and substance dependency, and this number is thought to be increasing. People who experience dual diagnosis may be unaware of their condition and it may go undetected by others for a period of time. Many are functional in the workforce, for example. More than half of all adults with dual diagnosis do not receive treatment. Certain people with mental illnesses—men, veterans, people dealing with medical conditions and people of lower socioeconomic status—are more likely to become dependent on drugs and/or alcohol. More than one-third of all people who abuse alcohol and more than one-half of all people who abuse drugs are believed to be suffering from mental illness.
Often treatment for people with a dual diagnosis is approached separately, but research is showing that an integrated approach may be more effective. With an integrated approach, a plan for healing from mental illness is combined with a plan for recovering from addiction. If an individual is in a rehab setting, the same doctors and health professionals address both sets of issues. A 12-step model, for example, might be used to address both. Both the mental health issues and the substance abuse issues take place in the same person, and frequently interact—one triggering the other and vice versa. For the whole person to become well, a whole-person approach makes sense—building trust, respect and hope along the way.
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