‘Tis the Season, Right?: Exploring Dual Diagnosis

by | Nov 26, 2019

feeling depressed at christmas

Any time is right to explore dual diagnosis, but it’s such a great fit for the holiday season. Lord knows the number of times I dosed my anxiety with alcohol all those years ago. Hey, you may be numbing-up now. So what say we toss some things on the wall and see what sticks. Good? 

Sooo, if so many people are having a dual diagnosis experience; shouldn’t help, support, or treatment also have a dual diagnosis approach? And it does!

Our “resident” clinical psychologist Dr. Mae Casanova dropped me a line a week ago asking if she could contribute another post. Stating her mission, she wrote…

…focusing on how mental health symptoms or disorders can be the underlying factors in substance abuse…So much of the time people with substance abuse do not get the help they need with their underlying mental health issues. I wanted to shed some light on it…I was going for educational, stigma-breaking, and resourceful.

What can I say? I was – am – all in. So I’ll turn things over to the good doctor…

Exploring Dual Diagnosis

are there different kinds of depression

Dr. Mae Casanova

Mental health and substance abuse have found themselves in separate categories for quite some time in the public eye – though they were not put there by professionals.

Substance related and addictive disorders have been considered primary mental health disorders in the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) since the third edition. They’re just the same as, say, the mood and anxiety disorders.

However, so much of the time in society’s eye, substance abuse and addiction aren’t recognized as mental health disorders, rather more of a lifestyle choice. While mental health disorders, such as mood and anxiety disorders, are still struggling to break the stigma associated with them, substance abuse is having an even more difficult time.

Bringing Disorder Categories Together

Substance related and addictive disorders do deserve their own category, given the combination of physiological and psychological effects, as well as the severity of the consequences of use. But what if they were connected? What if the use of a substance was to manage the symptoms of another mental health diagnosis?

No one starts using a substance with the intention of abusing or becoming physiologically (needing more of the substance to get the desired effect – tolerance) or psychologically (needing more of the substance to get the desired effect – reality detachment) addicted.

Initial substance use could be experimental or social. But the effects – the calm or alertness, the numbing or the attention, the pleasure or the dissociation – could be providing relief from mental health symptoms like mania, depression, anxiety, or even trauma.

And the dual diagnosis concept was born!

In the US, 9.2 million adults experienced both mental illness and a substance use disorder in 2018, according to the National Survey on Drug Use and Health.

Dual Diagnosis: Help, Support, Treatment

Sooo, if so many people are having a dual diagnosis experience; shouldn’t help, support, or treatment also have a dual diagnosis approach? And it does! There are many different options to receive support and guidance through a dual diagnosis. More than you may be aware of!

12-Step + Therapy
12 step programs and abstinence-based programs have a strong support system of members for whom the program has worked – works. This abstinence-based approach (e.g. Alcoholics Anonymous, Narcotics Anonymous) has provided community and constant support systems through meetings and sponsors for people of all ages “in recovery” for decades.

Lots of success and sobriety have been found in these programs. But the question remains – how can they address other underlying mental health disorders or symptoms?

If AA or 12-step programs work for you, then it could be as simple as adding individual therapy weekly with a licensed mental health professional to help guide you. Therapy with a trained professional can help identify, treat, explore, and build a tool box to support and manage underlying mental health symptoms that will come to the surface after the substance use has stopped.

Non 12-Step + Therapy
There are quite a few options out there for Non 12-Step approaches to substance use. Some have an emotional component built-in.

SMART Recovery is considered a self-empowering recovery program. The main focus is to help explore and resolve underlying issues and related problems, as well as substance abuse issues.

Refuge Recovery is a Buddhist-based recovery program that focuses on finding compassion for oneself and one’s experiences. The focus is on wisdom and kindness, enabling people to be more mindful of the mental and emotional process associated with their addiction. They see addiction as a suffering state for which one needs to have self-compassion.

Only you can decide the direction that will work best for you and your recovery. If you have not been successful using 12-step options it could be beneficial to look around, remembering to add therapy with a licensed mental health professional.

We are all unique human beings, with our own specific experiences. So our treatment and support options need to be just that – unique and specific.

It’s a Wrap

Thank you, Dr. Mae – always good hearing from you. We’ll look forward to the next time.

In closing, as you reflect upon the concept of dual diagnosis, do so within the context of having interactive diagnoses. Say you’ve been diagnosed with generalized anxiety disorder (GAD) and an alcohol use disorder. Though they’re separate on paper, consider them as one entity, constantly influencing each other. So what’s good for the treatment of one is good for the treatment of the other. Got it?

Hey, wishing you the best for the holidays – as you perceive and acknowledge them. Still, always remember, ’tis the season.

Dr. Mae’s website

Her last Chipur guest post: Depression Isn’t Always ‘Depression’: 3 Types You Might Not Know About

Let the Chipur articles help you through the holidays.


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