Substance Abuse / Co-Occurring Disorders & 12 Step Programs

When I educate 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 your 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. In addition, people attending these meetings share a common goal, namely, maintaining and fostering sobriety.

However, for those that are truly dual-diagnosed more often than not these meetings will not be enough in and of themselves for maintaining sobriety and balance.

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 the client had been awake for five days and had attended eight meetings. What he really needed at that time 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 is that people can become extremely paranoid, psychotic, and suicidal if they have been awake for three or four days in a row.

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?

Example: “Bring the body the mind will follow.” Not if the mind is on Jupiter.

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 inform them about is DBSA - Depression Bipolar Support Alliance (www.dbsalliance.org/). In their own words: The Depression and Bipolar Support Alliance is a non-profit organization providing support groups for people with depression or bipolar disorder as well as their friends and family.

The largest group within these meetings is “Double Trouble.” This group is for 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 not only talk about their addiction issues, they also discuss 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 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 had a suggestion for them. 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 needed to start a group of your own. They liked that idea (Hopefully they have done so).

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