Substance Abuse / Co-Occurring Disorders & 12 Step Programs

When I am educating my patients on community resources one of the first statements I make to them is that if you are attending, or, plan to attend traditional 12 Step meetings, please, please, for your own sake do not discuss or talk about any medications that you are prescribed and currently on for a co-occurring disorder.

It just takes one person to hear what is being said and feel the 'need' to tell the person they are 'chewing' their booze, and that they are not sober.

Before going into more detail and examples, I feel I should state for the record that I am NOT ANTI-12 STEP. As a matter of fact, many people that are 'dual-diagnosed' utilize traditional 12 Step meetings as their base of recovery. Traditional 12 Step meetings can help one to learn again (or for the first time) how to socialize without a drug or drink in their system. Also, people attending these meetings share a common goal, namely, maintaining and fostering sobriety.

Conflicts can arise for the dual-diagnosed person in these meetings with regards to some of the traditionally held sayings and beliefs.

Example: I had a client that was told at a meeting to, “Just go to another meeting.” Well, the fact of the matter was my client had been awake for four days and had attended six meetings. What he really needed was a medication adjustment for his bipolar disorder.

Example: “No one ever died from lack of sleep.” I have never sought research to confirm or deny this statement. I can tell you from working in the psych/addiction field for twenty plus years now, people can become extremely paranoid, psychotic, and suicidal if they have been awake for a number of days (particularly people in a manic episode for instance).

Example: “They broke out because they stopped going to meetings.” This is definitely a blanket statement. What if the person was ‘so depressed’ they could not get out of bed?

I recently had a patient I was working with inform me that his AA sponsor was telling him to ‘get off’ the anti-depressant he is on. He asked me what he should do. I asked him if he felt the anti-depressant was working for him, he said yes. I told him I think you have your answer then.

So what are some of the other support groups? The first one I tell them about is DBSA - Depression Bipolar Support Alliance (www.dbsalliance.org/ ). These are meetings for people that have major depression with or without anxiety, and those with bipolar disorder.

The largest group within these meetings is “Double Trouble.” These are people with substance abuse coupled to the aforementioned above. People who often times were trying to self-medicate. Many of these members also belong to traditional 12 Step groups as well.

In much the same way that 12 Step programs have sponsors, people in “Double Trouble” can find a sponsor that not only has their same addiction, but the other mental health issue as well; “you pace your kitchen at 3am agitated and drinking – I thought I was the only one!”

The reason support groups work for many people is the identification factor. I realize now that I am not the only person that has ever felt or feels the way I do. I am not alone.

Another group is DRA – Dual Recovery Anonymous (http://draonline.org/ ). This is a 12 Step based group. In these meetings people can not only talk about their addiction issues, they can also discuss their other mental health issues as well. In traditional 12 Step if you want to discuss the other mental health issues you do so after the regular meeting (sometimes referred to as the meeting after the meeting).

DRA is relatively young compared to the other support groups; and meetings can be far and few between. Several months ago I had a couple of former patients drop by the program where I work and they were complaining about this very fact.

I told them I had a suggestion. There are two of you, and it only takes two to have a meeting, right? So why don’t you contact DRA to get the materials to start a new meeting group of your own. They liked that idea (Hopefully they have done so).

Until the next blog,

WRD