Families in Virginia, Maryland and New York who have mentally ill relatives whose problems are compounded by substance abuse problems have reported their lives have become extremely challenging. Mental health services are not well prepared to deal with patients having both disorders.

While the picture in Maryland, Virginia and New York regarding dual diagnosis has not been very positive at this point, there are now signs that the problem is being recognized and there are an increasing number of drug treatment programs trying to address the substance abuse treatment needs of people with both problems. Research studies are beginning to help us understand the scope of the problem. It is now generally agreed that as much as 50 percent of the mentally ill population also has a substance abuse problem. The drug most commonly used is alcohol, followed by marijuana and cocaine. Prescription drugs such as tranquilizers and sleeping medicines may also be abused.

Substance abuse complicates almost every aspect of care for the person with mental illness. First of all, of course, these individuals are very difficult to engage in dual diagnosis treatment. Diagnosis is difficult because it takes time to unravel the interacting effects of substance abuse problem and the mental illness. They may have difficulty being accommodated at home and may not be tolerated in community residences of drug rehabilitation programs. They lose their support systems and suffer frequent relapses readmits to the drug rehabilitation programs.

We realize that this overview of the problem in New York, Maryland and Virginia of drugs and mental illness is not a very positive one. However, we believe there are some encouraging signs that better understanding of the problem and potential treatments are on the way. Just as families have faced other very troublesome problems in the past and developed adequate responses to them, we believe that they can learn to deal with this one in a way that their lives become less troubled and their relatives begin receiving better dual diagnosis treatment in Maryland, New York and Virginia.

Dual Diagnosis Treatment Programs for the Dually DiagnosedAs many families have probably discovered, service systems have not been well designed with this population in mind. Typically a community has treatment services for people with mental illness in one agency and treatment for substance abuse in another. Clients are referred back and forth between them in what some have called “ping-pong” therapy. What is needed are “hybrid” programs that address both illnesses together. Development of these dual diagnosis treatment programs requires considerable advocacy efforts.
 

Limitations of Traditional Drug Treatment Programs
Drug treatment programs designed for people whose problems are primarily substance abuse are generally not recommended for people who also have a mental illness. These drug treatment programs tend to be confrontive and coercive and most people with severe mental illnesses are too fragile to benefit from them. Heavy confrontation, intense emotional jolting, and discouragement of the use of medications tend to be detrimental. These treatments may produce levels of stress that exacerbate symptoms or cause relapse.
Characteristics of Appropriate Dual Diagnosis ProgramsDesirable dual diagnosis treatment programs for this population should take a more gradual approach. Dual diagnosis staff should recognize that denial is an inherent part of the problem. Patients often do not have insight as to the seriousness and scope of the problem. Abstinence may be a goal of the dual diagnosis treatment program but should not be a precondition for entering dual diagnosis treatment. If dually diagnosed clients do not fit into local Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) groups, special peer groups based on AA principles might be developed. Clients with dual diagnosis have to proceed at their own pace in dual diagnosis treatment. An illness model of the problem should be used rather than a moralistic one. Staff needs to convey understanding of how hard it is to end an drug addiction problem and give credit for any accomplishments. Attention should be given to social networks that can serve as important reinforcers. Clients should be given opportunities to socialize, have access to recreational activities, and develop peer relationships. Their families should be offered support and education