An Exploration of the Dual-Diagnosis Client Shifting from “Treatment” to the Art of Self-Inquiry

An Historical Overview What is Dual-Diagnosis and how common is it? Definition Prevalence Theories of dual diagnosis Factors associated with dual diagnosis

A Definition Dr Burns: “I will tell you what dual diagnosis means... It is a freaking nightmare to deal with, that’s what it is!” The term ‘dual-diagnosis’ and ‘co-morbidity’ are used interchangeably to define an individual with a combination psychiatric disorder and substance misuse (e.g. depression and cannabis abuse) There are sub-sets with in this definition that place various points of emphasis on the mental disorder causing the substance abuse and vise-versa.

Theories of Dual-Diagnosis Self-medication theory: Substances are selectively used in service of alleviating symptoms of mental illness (i.e. stimulant abuse employed to counter the sedative effects of anti-psychotic medications) Alleviation of dysphoria: mental illness creates dysphoria (feeling bad) and this dysphoria leads to drug use to mitigate the experience of these unpleasant feelings Multiple risk: In addition to the alleviation of bad-feelings, there are additional risks such as: social isolation, poverty, lack of daily structure, residing in areas with drug availability, history of traumatic events

Theories Continued Supersensitivity: individuals with severe mental illness have biological/psychological vulnerabilities for substance abuse caused by genetic and early environmental factors that interact with life stressors It is important to note that these theories might all be present to varying degree’s in looking at the causal links underlying a dual-diagnosis. There are no definitive quantitative links correlating mental illness/substance abuse apart from heavy adolescent cannabis use and early onset schizophrenia, which seems to have a strong evidence based link.

Some Key Factors Studies in the UK and United States have indicated that individuals with dual-diagnosis have a number of difficulties and poorer outcomes including: Increased severity of symptoms and relapse More frequent inpatient hospital admissions Higher treatment costs Increased hostility and involvement with the legal system

Key Factors Continued Increase likelihood of suicide Increased rate of homelessness and insecure housing Increased risk of HIV infection Family problems or intimate relationships

Dual-Diagnosis “Treatment” The term “treatment” is a real set up because it points toward a terminal end-point goal with the dually diagnosed and this, in my experience, is simply not realistic. There are some “approaches” and/or philosophies that have emerged in working with the dual-diagnosed that have varying degrees of efficacy These approaches fall under: Serial Treatment, which treats one condition first followed by the other

“Treatment” Continued Parallel: These intervention approaches focus on both substance abuse and mental illness treatment at the same time Integrated: Treatments are delivered at the same time (like the parallel approach) but are coordinated by the same staff team members in the same treatment setting Specific approaches with in these 3 philosophies include: Biological: This is the psychotropic medication arm of treatment and can be effective toward managing symptoms of mental illness which in turn can facilitate treatment of substance misuse

“Treatment” Continued Social and Psychological: This is a broad spectrum term used to describe therapeutic techniques such as: Motivational Interviewing: Engaging in supportive and directed conversation about individuals behaviors and patterns that are designed to increase intrinsic motivation to change Cognitive Behavioral: weakening connections between life stressors and reactive/habitual responses that are negative and destructive. Self-Help Groups: This includes many 12-step groups that can instill peer support and self-discipline

Lets get “Meta” Physical It is interesting to note that the root of “addiction” essentially means to transcend, to move beyond and to become joined with something larger than one’s self To often counselling omits exploring and challenging the clients basic beliefs about who and what they are as well as the nature of reality in light of political correctness Dual Diagnosis presents a classical “double negative” that wisdom traditions speak of... Failure of egoic identity and failure of strategy to make that false premise work out

Continuum of Being Self-Inquiry is the oldest practice of “psychology” known and is designed to uproot the premise of a separate and isolated ego/”I” From this “non-dual” perspective... The sense of self the dual diagnosis client has is not suffering mental illness and subsequent substance abuse because of some faulty trait or characteristic it has... Rather... The sense of self the dual diagnosis client has suffers because of mistaken identity and is trying to “medicate” this false premise

From “I” to what is aware of “I” I like to use experiential exercises with the dually diagnosed as it brings free attention to the narrative of the drug/etoh abuse as well as the narrative of the mental illness You can’t simply “talk” about the suffering and self- medication but must actively help dually diagnosed client participate in their identity and experience of being Mental illness contains its own resolution/message as does addiction.