Dual diagnosis: Why treat one and not the other?

An article published in today's edition of The Chronicle Herald:

By Christine Stapleton [pictured]

I HOPE we can put an end to the pesky debate about alcoholism.

Alcoholism is an illness — a real illness. The American Medical Association accepted alcoholism as an illness in 1957 and for about as long the American Psychiatric Association has included alcoholism in its Diagnostic and Statistical Manual — the Bible for diagnosing mental disorders.

Alcoholism and drug addiction are more than just a lack of self-restraint and discipline. Just ask anyone who knows me. I have run marathons and countless triathlons. I have held the same job for 23 years, and I contribute to my company pension plan. I have resisted doughnut-day-Friday and the lure of expensive high-heeled, pointy-toed shoes, which certainly would have improved my love life.

I am not an aberration. In fact, many, many alcoholics are like me. We are high-functioning alcoholics who managed to hang on to our careers, cars and homes. We did not live under bridges and we did not panhandle.

Why is this important? Because I believe that dual-diagnosis is the biggest mental health problem today, yet most people do not even know what it is. Dual diagnosis is the coupling of substance abuse with another mental illness. I am talking about people like me who have alcoholism and depression or are addicted to crack and have bipolar disorder.

As I see it, the problem is that we — including the medical community and criminal justice system — do not accept and treat alcoholism as a real illness. Nor do they understand and appreciate how futile it is to treat one illness but not the other. Everyday addicts and alcoholics seek treatment for substance abuse but no one bothers to screen them for a companion mental illness. Likewise, doctors prescribe antidepressants to their patients without screening them for substance abuse.

The addict/alcoholic whose depression is not treated will continue to self-medicate with drugs and alcohol or fail at the attempt to get clean and sober. Those with depression whose substance abuse is not detected will get sicker because alcohol is a depressant and with every sip they are throwing gasoline on their simmering depression or bipolar.

No one knows how many dual-diagnosed alcoholics/addicts are out there but experts believe at least one of every three alcoholics/addicts has another mental illness. They are the most tragic and costliest of the mentally ill. Very often they commit crimes or suicide. They abuse their wives/husbands and children. Police answer their 911 calls and foster parents take in their kids. The dual diagnosed often become homeless and clog our emergency rooms.

So if you want to go on believing that addicts and alcoholics are weak-willed and you have no compassion for them, please have mercy on your wallet. Your ignorance is costing all of us.

Christine Stapleton writes for The Palm Beach Post, West Palm Beach, Fla.

I have changed the headline of this story to the one that appeared in the The Palm Beach Post.

Also see:

Schizophrenia and Substance Use

Concurrent Disorder

Schizophrenia & Substance Use - A Q methodological study

An abstract from the February issue of Mental Health and Substance Use: dual diagnosis:

Self-reported reasons for substance use in schizophrenia: a Q methodological investigation

Mental Health and Substance Use: dual diagnosis, Volume 2, Issue 1 February 2009, pages 24-39.

By Lynsey Gregg, Gillian Haddock, and Christine Barrowclough

Division of Clinical Psychology, School of Psychological Sciences, University of Manchester, UK

Abstract:

Large numbers of people with a diagnosis of schizophrenia use drugs and alcohol, resulting in poorer symptomatic and functional outcomes for many.

Aims: To examine the reasons that people with a diagnosis of schizophrenia give for their own alcohol and drug use.

Method: Q methodology was used to examine reasons for use. Forty-five people with a diagnosis of schizophrenia or schizoaffective disorder and comorbid substance misuse completed the sorting procedure.

Results: Analysis of the Q Sorts revealed three distinct groups of substance users:

1. those who predominantly used for social and enhancement reasons, to 'chill out and have a good time with others';
2. those who used to regulate negative affect and alleviate positive symptoms, to 'cope with distressing emotions and symptoms';
3. those who used substances to augment themselves and intensify their experiences, to 'feel bigger, better and inspired'.
   

Conclusion: People with a diagnosis of schizophrenia who use substances explain their substance use in different ways. The identification of subgroups of users may be useful in the development of interventions aimed at reducing substance use in this group.

Posting of this abstract is for the purposes of research into schizophrenia and dual diagnosis.

I thank the Lancashire Care Library & Information Service for bringing this article to my attention.