The Introduction from At Wit's End.

The Art and Science of Hope

When mental health issues and addiction become enmeshed, we refer to them as co-occurring disorders. Examples include anxiety and alcoholism or depression and addiction to narcotic pain medication. Co-occurring disorders present a greater level of complexity in diagnosis and treatment than addiction or mental health issues alone. If we treat the alcoholism without addressing the anxiety disorder, for instance, the individual may not be able to participate meaningfully in therapy or Twelve Step groups.

This book has been written primarily for family members and friends who are trying to cope  with a loved one’s co-occurring disorder. Our goals are to help clarify what the problems are and to help you to find solutions. We will introduce you, the family member or friend and to the maze of professionals you will meet on your journey. We will describe the most common  mental health problems and will offer insight into the best methods for addressing those problems.

People suffering from co-occurring conditions will also benefit by reading this book. As with any illness, an informed and educated patient works more effectively with the treatment team. We hope this book will bring clarity and hope, as well as provide some simple steps that will complement and enhance any formal treatment plan. By learning more, it is likely that you, the patient will have a speedier recovery and will be more successful in keeping your conditions in remission.

Professionals who work in the fields of mental health and addiction will also benefit by reading this book. The fact is that these two fields have been balkanized throughout most of their history, and have often been at war with each other, to the detriment of the patients they serve. Our goals are to provide a clear understanding of the root of these contentions and to provide fresh insights into how clinicians from the two fields can work together most effectively. The treatment of concurrent conditions contains many paradoxical elements. We must be aware of many levels of complexity, but we must also keep the solutions simple, so they can be implemented realistically. As professionals, we must rely on evidence-based medicine, but we must also inspire our patients to follow their treatment plans. It will surprise practitioners from both fields to learn how they can increase compliance, the number one problem in treating chronic illness.

This book provides hard information, like the meaning of a diagnosis such as Bipolar II. It also provides guidance, including how to evaluate a treatment plan. Finally, it provides case histories that show how a family, a patient, and a treatment team dealt with a problem and found solutions. So, this book will provide knowledge, direction, and hope.

There continues to be controversy in the treatment of co-occurring disorders, even among clinicians at the same treatment center. Some argue for the primacy of mental health issues over everything else, where others claim that mental illness will almost always subside once the addict achieves sobriety. One of our goals in this book is to bring clarity to this controversy, based on the latest research and decades of first-hand clinical experience.

Part of the dilemma that clinicians face is that there is a wide spectrum to the normal human condition, from great joy and exuberance to great pain and sorrow. But we don’t need to put a label of sickness on the extremes of this spectrum unless they are debilitating and ongoing. Some experts have a tendency to label and medicate every psychological ailment, but this is not necessarily helpful. For example, with many forms of depression, especially those with obvious causes, like the death of a parent, there are few prescriptions better than daily walks, sound nutrition, adequate sleep, and time spent talking with family and friends. Such depressions, as agonizing as they are, will normally pass.

  Of course, there are times that psychiatric medication is needed immediately. Active hallucinations, ongoing panic attacks, and crippling depression may all call for medical help. But this should be measured and must be reevaluated as treatment progresses. It is often necessary to medicate patients for anxiety in order for them to participate on any level in group therapy. However, after a period of time, they may need very little medication or none at all.

What all this means is that there are no simple answers for complex problems. Indeed, the answers to a particular dilemma may change over time. But this is not so unusual, if we look at the analogy of a badly broken leg. At first, surgery may be required, followed by a very restrictive cast and crutches. But these interventions are not required forever. Before too long, the leg will heal and rejuvenate with the help of a less restrictive brace and physical therapy.

In the same way, patients with co-occurring disorders may need intensive help early on, including medication. But they won’t always be in need of stabilization. With the help of ongoing therapy and a gradually less restrictive treatment environment they can regain their health and normal functioning.

Co-occurring disorders are also referred to as dual diagnosis and co-occurring conditions, and some people use a more casual and less clinical name: double trouble. Regardless of what term is used, friends and family members of the dually diagnosed are often at wit’s end when trying to fathom the situation, much less know what steps to take to lend some normalcy to everyday life.  Addicts and the mentally ill can wreak havoc on the lives of friends and family members. When a person suffers from both, loved ones are often doubly confused and frustrated.

Many patients suffer from apathy, cynicism and hopelessness. These maladies will never be cured by a pill, and they can’t be turned around overnight. It is necessary that patients come to believe that they can get better, that their symptoms can be put into remission, and that they can develop a new vision of their lives. This new vision–a reason to move forward—is as necessary to successful treatment as any diagnosis. It is also one of the great facts of the human condition. Once a person has a powerful reason to live, whether for love, faith, friendship, or goals, the obstacles become challenges and stubbornness turns into determination.

Treating addiction coupled with mental illness is especially difficult because, at some point, patients must become active participants in the process. They must literally become their own treatment managers and primary care givers. Unlike an acute illness such as appendicitis, which might be treated with an operation, chronic illnesses such as addiction and mental health problems require ongoing help and support. And because patients cannot be in treatment forever, they must learn to manage their own recovery. Part of the goal of treatment is to help inspire a great awakening of a patient’s mind and spirit that will allow this miracle to take place. No one, whether patient, professional, or family member, can command this awakening to take place. But we can help bring all the elements together, along with a pinch of hope, faith, and determination.

The good news is that treatment works and many people are recovering today from co-occurring disorders. Interestingly, many of these people go on to help others, through the various support groups in the community. This activity often provides more meaning and satisfaction to recovering people than most of us can imagine.

War veterans are loath to talk about their combat experiences with civilians. But bring a group of veterans together for a couple of hours, let them talk about issues that are meaningful to them, and you will be hard-pressed to find a stronger fellowship. In the same way, people who have survived co-occurring disorders and have made their way into recovery are veterans of an intense battle. We have learned over the decades that they have a special gift for helping each other and that the exercise of this gift is powerful medicine.

-Excertpt from At Wit's End, by Jeff Jay and Jerry Boriskin, Ph.D., published by Hazelden. Copyright©2007, all rights reserved.