Self Help for Persons with Dual Diagnoses

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Participating in self-help groups may be even more important for people dealing with the dual diagnoses of both a mental illness and a substance abuse disorder. Historically, individuals with dual disorders were the first to be referred to self-help groups focused on recovery from substance abuse. Sadly, these referrals were more often caused by an inability or unwillingness of mental health professionals to deal with the substance abuse problem than an appreciation of the benefits of self-help. Still, professionals were aware that attendance at these substance abuse-related self-help groups was often helpful in the recovery process. For many professionals this knowledge led to an appreciation of the contributions self-help could make for persons with psychiatric disabilities.

Individuals who have both a mental illness and a substance abuse disorder are still the consumers most likely to be referred to self-help groups. As discussed in Chapter 8, people with a dual diagnosis require specialized programs and supports. These individuals are often encouraged by their caseworkers to utilize self-help groups to supplement the professional supports and services that they receive. Alcoholics Anonymous and Narcotics Anonymous (NA) are the most commonly utilized mutual support groups for persons recovering from alcoholism and other substance abuse disorders. Unfortunately, some people have not felt welcome in these groups when they disclosed they had a diagnosis of mental illness and take medication. Apparently, the stigma associated with severe mental illness exists even within groups such as AA and NA. In addition, AA and NA groups often discourage the use of psychotropic medications because they are viewed as obstacles to recovery from addiction. Partly in response to this resistance, many consumers have been receiving help in mutual support groups known as "double trouble" or dual recovery groups (Vogel, Knight, Laudet, & Magura, 1998). Note that the term double trouble was used for many years, but dual recovery, a more hopeful term, is currently preferred (Magura et al., 2003). Dual recovery groups are specifically geared to meet the needs of individuals who are coping with the symptoms and challenges of both a mental illness and a substance abuse disorder. Even so, they are very similar to AA and NA groups. Like AA and NA groups, these groups utilize a 12-step process of recovery and are run by persons who have substance abuse problems themselves (Alcoholics Anonymous World Services, 1981). In contrast, dual recovery groups have two important differences from AA and NA groups: (1) acceptance of the importance of psychiatric medications, and (2) a high tolerance of psychiatric symptomatology (Magura, et al., 2003).

Sometimes circumstances arise that require a variation of the traditional self-help model. For example, in certain inpatient settings or community-based agencies where regulations or insurance requirements necessitated staff involvement, consumer-run dual recovery groups have been developed that include the presence of professional staff at meetings or in proximity. Another variation of the dual recovery support group has been used in situations where acute symptoms interfered with group leadership. In this version, staff members, who have received training and information from an experienced dual recovery group member, provide interim leadership (Caldwell & White, 1991).

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