Lack of Treatment for Dual Diagnosis with Substance Abuse

There is a serious lack of treatment for dual diagnosis with substance abuse. A dual diagnosis is two co-occurring mental health conditions, in this case, one of which is a substance abuse disorder. The use of substances as a way to cope with psychiatric symptoms is so common there's a term for it: "self-medicating." Treatment for dual diagnosis with substance abuse is critical, but few get treatment.

According to the Substance Abuse and Mental Health Administration (SAMHSA)--55.8 percent of people afflicted with a dual diagnosis don't get treatment for either disorder.¹ Only 7.4 percent get treatment for both disorders. Imagine the outcry if 56 percent of cancer patients went untreated or only 8 percent of HIV/AIDS patients got the treatment they needed.

Dual Diagnosis Substance Abuse Treatment Facilities Are Scarce

In 2008, the year I was committed to the state hospital system, Indiana had one inpatient facility dedicated to dual diagnosis--and it was abusive. I'll spare you the details, but patients joked that the hospital would drive a person to drink, and it still leaves me with the question if the wrong kind of treatment is better than no treatment at all.

It's a relevant question, because now, there are no inpatient dual diagnosis facilities in Indiana. There are psychiatric hospitals and drug/alcohol rehabilitation clinics, but none address both issues. The rehab clinics are often unprepared to deal with a patient with a psychiatric issue--I was discharged from one rehab program because I was actively symptomatic.

Dual diagnosis treatment, if it exists, is often inadequate. Yet there is no outcry, so things get worse. The patient is forced to come up with a mixture of therapies and pray that they work. For example, a patient must go to therapy to learn coping skills, stay on medication to help with psychiatric symptoms and the substance abuse (for example, naltrexone can treat alcohol cravings and dissociation), and go to Alcoholic Anonymous (A.A.)/Narcotics Anonymous (N.A.) meetings. Yet a lack of one cannot always be helped by the other two. I remember going to an A.A. meeting after not getting my medication for several days and there was nothing they could do.

Stigma Is the Leading Barrier to Dual Diagnosis Treatment

Former President George W. Bush's Surgeon General David Satcher wrote in Mental Health: A Report of the Surgeon General:

Despite the efficacy of treatment options and the many possible ways of obtaining a treatment of choice, nearly half of all Americans who have a severe mental illness do not seek treatment. Most often, reluctance to seek care is an unfortunate outcome of very real barriers. Foremost among these is the stigma that many in our society attach to mental illness and to people who have a mental illness.

Stigma erodes confidence that mental disorders are valid, treatable health conditions. It leads people to avoid socializing, employing or working with, or renting to or living near persons who have a mental disorder, especially a severe disorder like schizophrenia. Stigma deters the public from wanting to pay for care and, thus, reduces consumers' access to resources and opportunities for treatment and social services. A consequent inability or failure to obtain treatment reinforces destructive patterns of low self-esteem, isolation, and hopelessness. Stigma tragically deprives people of their dignity and interferes with their full participation in society. It must be overcome.

Increasingly effective treatments for mental disorders promise to be the most effective antidote to stigma. Effective interventions help people to understand that mental disorders are not character flaws but are legitimate illnesses that respond to specific treatments, just as other health conditions respond to medical interventions. Fresh approaches to disseminating research information are needed urgently. While they are being developed, this report provides information that organizations, experts, and many other individuals can use to educate all Americans about mental health and mental illness.

In other words, treatment works, but stigma caused by lack of treatment makes access to treatment difficult. The most effective way to fight the stigma is to show that treatment works, but very few people want to be the living proof that treatment works because it can affect their social life, housing situation, and access to appropriate care.

So only 8 percent of us get the substance abuse dual diagnosis treatment we need and nearly 56 percent of us get no treatment at all.

Despite This, Recovery from Dual Diagnosis Is Possible

Yes, it is hard to find treatment. A celebrity can just check into rehab; people on Medicaid basically have to hope for luck. But despite this, treatment does work and recovery is possible. You just have to be willing to get creative.

A.A. and N.A. are good ways to get treatment for a substance abuse problem. That's how I got treatment for my substance abuse problem. The good news is that it usually works, depending on the person's attitude. The bad news is it's not for everybody (Is A.A. the Only Way to Recover from Alcoholism?). But if you're willing to put in the effort it's worth it. You just have to work hard and be determined.

Good luck with your sobriety!

¹ Mental Health and Drug Abuse

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