co-occurring disorders

Not so long ago, (and still today in some places) if you sought help for life problems and had both a mental illness and a substance addiction, you might be caught up in what one of my colleagues called “dueling disorders,” a situation where a substance abuse provider would tell you “get your mental health issues under control before we treat you for your substance problem” and if you went to a mental health provider you would be told, “Get your substance problem under control so we can treat you for your mental health.” There’s a perfect catch-22 for you, eh? That situation was called “dual diagnosis.” Well, folks who make up catchphrases spent some time thinking about this and somebody realized, “Hey, who in the world only has two problems?” The people coming to clinics have problems with their physical health, mental health, economic problems– you name it. So dual diagnosis became co-occurring disorders. As Shakespeare might have said, a rose by any other name has just as many thorns. At least folks realized that bouncing people from place to place without giving any help only made things worse. In fact, some cities figured out that they had people on the streets who were costing a million dollars per person per year. And then dying 20-30 years sooner than people without these problems. OK, if someone is standing on the corner with a bottle in one hand and waving away their hallucinations with the other, it’s a slam dunk that they’ve got co-occurring disorders. But what if you are still working your day job and are really struggling? Is society(or your family, or your health insurance provider) going to wait until you’re on the street? Statistics suggest that if you don’t advocate for yourself, the answer is most likely to be YES. Fewer than ten percent of the people  who have co-occurring disorders get help for both, and half get help for neither. But when you use substances and  you also have mental/emotional problems, what’s the role? People are notoriously unable to differentiate between whether the substance use– say, a couple of cocktails after work– are part of the solution, or part of the problem. By the same token, some mental health professionals are also notoriously prone to feeling that if you only deal with the underlying issues, the substance use will sort itself out. And by yet another token, there are AOD (alcohol and other drug) counselors for whom all substance use is either problematic or on its way to being problematic: you’d be better able to handle your life stresses if you didn’t medicate them with those cocktails (which also put you at risk for developing alcoholism, says the AOD counselor). The situation becomes even more perplexing when we put it in the context of a society which has a strong Puritan streak in it. If it’s fun and you like it, there must be something bad about it. Now add a rugged individualist streak, and you must pull yourself up by your bootstraps, without getting outside help. What about all those pioneer barn raisings and husking bees? Can’t we get some help from our neighbors and friends? Well, you can, but what if your friends are all your drinking buddies? They’ll tell you don’t have a problem. And there are people who, when you disclose about your depression or anxiety will tell you to “just snap out of it.” That’s why people consult professionals. Someone has to be the “honest broker” who can look at your situation and help you untangle all the threads– without prejudice, and with understanding and compassion.


About jamesmatter

Marriage and Family Therapist (MFT) in private practice in San Francisco. I work with adults, adolescents, and couples, with focus on substance use and abuse and co-occurring disorders (having both a mental illness and an addiction).
This entry was posted in behavioral health, choices, mental health, Recovery, stigma of mental illness, Uncategorized and tagged , , , , , , . Bookmark the permalink.

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