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

Admit you have an illness

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

By Christine Stapleton {pictured]

IN 1957, the American Medical Association accepted alcoholism as an illness. At about the same time, alcoholism found a place in the American Psychiatric Association’s Diagnostic and Statistical Manual — the hallowed handbook that doctors use to diagnose mental illness (and that insurance companies use to deny your claim).

In other words, alcoholism is an illness. It is a mental illness. People who have alcoholism, like me, are not weak or lacking discipline. In fact, most of the alcoholics I know — in recovery and still drinking — are very strong and very disciplined. That’s how we convince ourselves that we are in control and what makes us so annoying.

Learning that alcoholism is a legitimate illness helped me immensely. It gave me some self-esteem, hope and the final word in conversations with know-it-alls who believe we could quit drinking if we really, really tried: "Well I guess you know more than the American Medical Association because the AMA decided that alcoholism is an illness 50 years ago."

Depression is different. There are a lot of people who admit that depression is a real illness. They feign sympathy and tell you about someone else’s struggle with depression.

But you can tell by their zealous enthusiasm that they don’t really believe it. I hate to admit this: I was among them.

I knew that Hippocrates declared depression a real illness several thousand years before the American Psychiatric Association.

Folks that I admired — Michelangelo, Eric Clapton and the guy who played Beaver’s brother, Wally — all suffered from depression. But when dealing with someone with depression, I privately thought: "Get a grip already, will ya?"

When I was diagnosed with a depression — a major clinical depression — what helped me more than the manuals and medical endorsements were the aw-shucks comments from friends: "I’ve been on antidepressants for years." Or, "Actually, I am on two antidepressants." Or, "I have to be on either antidepressants or hormones or I’m a mess."

Really? Who would have guessed?

The moral is simple: Do whatever it takes to accept and forgive yourself for being mentally ill.

Also see:

Accepting problems hard, but worth it