Why Is Dual Diagnosis/Co-Occurring Disorder (COD) Necessary to Address?

Two Different Diseases, Similar Symptoms

Once again, after “Jerry” came down off his high, he was left feeling sad and depressed. He often felt lower than before he got his fix. This has been going on since college, maybe even high school. Every time it was the same thing. He’d be feeling down and then have a drink and pop some pills to feel better. This was his cycle, although each time after he came down, he’d feel worse and worse. Everything had been going well in his life; family, career, church, friends, people counted on him.

But lately, his concentration has been lacking and he’s been showing up late or not at all. The promises he’d made to his kids were often broken. His wife would often be angry and until she finally stopped talking to him. His co-workers were often left baffled by his behavior. Jerry had become unreliable and despondent. His boss finally confronted him about his behavior and attitude. “What’s the matter? Do you need help, he asked?”

Jerry doesn’t know where to start. He has no idea what’s wrong or that there was even a problem. Why can’t these people just leave him alone? Can’t they see he’s trying his best? He’s just having a hard time right now. Nothing’s wrong. Nothing that a few drinks and some pills can’t fix… Jerry’s boss finally convinces him to enter a rehabilitation program before things got really bad. While in treatment, for the first time in his entire life, Jerry is diagnosed with depression. But what about the drugs and drinking? They, too, are a symptom, but of another illness, he’s also an addict.

It seems after all these years, Jerry had been self-medicating his depression with the drugs and alcohol. Depression is a mental illness. According to the National Institute of Mental Health (NIMH)[1] some symptoms include: “persistent sad, anxious, or “empty” feelings; Irritability, restlessness; Loss of interest in activities or hobbies; Difficulty concentrating, remembering details, and making decisions.” Jerry certainly fits this description.

At the same time, Jerry doesn’t remember the last time he went without a drink or a drug. Not a day went by without taking something. Only lately, it has gotten out of control. Money problems, paranoia, delusional thinking, restless, forgetfulness, insomnia, troubles at home or just coping with life… and the list goes on. These are some symptoms of drug addiction. According to Narcotics Anonymous, “An addict is a man or woman whose life is controlled by drugs… in the grip of a continuing and progressive illness…”

In many cases, the symptoms of depression and drug addiction overlap. In fact, depression is a symptom of drug addiction! That is why it is necessary to address both, the mental illness, in this instance, depression and drug/alcohol addiction. For Jerry, if he were introduced to a 12 Step Program such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), he may be successful for a while. They focus on the disease of alcohol or addiction. But if his depression continues to go untreated, he is more likely to relapse by picking up a drink or a drug in order to help “treat” his depression, as he had in the past. This can be a vicious cycle, which according to NA, can lead to “…jails, institutions or death.”

For many addicts and alcoholics, their dance with their addictive disease began long before meeting up with drugs and alcohol. As is often the case, people who suffer from a mental illness often seek comfort in addictive substances as way to deal with their anxiety: “I’ll just have a few drinks to calm me down”; or Bipolar disorder: “This speed will pick me up.”; and as we’ve learned about depression: “I just don’t want to feel this way, these pills will help me feel better.” Then the symptom becomes the problem as it manifests into the disease of addiction/alcoholism.

On-going studies published by the National Alliance on Mental Illness[2] have shown that “thirty-seven percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness. Roughly 50 percent of individuals with severe mental disorders are affected by substance abuse.” That’s a lot of people! No wonder Jerry’s having such a tough time, and he’s certainly in good company.

Now, it is quite clear as to why it is necessary to address both the drug/alcohol problem as well as the underlying mental illness. It truly comes down to quality of life. As long as Jerry keeps going to AA meetings and seeks help for his alcoholism, he is more likely to be successful in achieving long-term sobriety, but only if he is correctly treated for his underlying depression. Therein lies the real issue.

At 12 Keys, the issue of Co-occurring Disorder (COD)/Dual Diagnosis is address first and foremost. In order to completely evaluate the whole person, he first needs to detox completely. Then, and only then are the Doctors and Clinicians on staff able to determine if an individual is suffering from a mental illness. Once the mental illness is diagnosed, treatment for healing the whole person can begin.

[1] (What are the signs and symptoms of depression?, 2011),
[2] (Dual Diagnosis and Integrated Treatment of Mental Illness and Substance Abuse Disorder, 2003)

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