Approximately eleven million people in North America have a substance use disorder and at least one other mental health disorder. Those who are struggling with a combination of these disorders may be met with a powerful recipe for destruction, especially self-destruction. The good news is that there is help.

 

Drawing from an evidence-based program by internationally recognized pioneers in the integrated treatment of co-occurring disorders from the Dartmouth Medical School, Living with Co-occurring Addiction and Mental Health Disorders is a handbook designed to inform and empower those with dual disorders. It allows each person to make the best choices about his or her own treatment and, in collaboration with a trained clinician, sculpt a program that works. Key topics include

¨       getting an assessment

¨       reviewing treatment options

¨       selecting the right treatment team

¨       setting achievable goals and making positive changes with cognitive-behavioral therapy

¨       building a support network of family and friends, and connecting with others recovering from co-occurring disorders

 

Introduction

 

How This Book Can Help

Let's listen in as several people talk about their lives:

 

Rashid: It seems like I'm always arguing with people. I'm not a mean person, but many things people say just piss me off. Just yesterday a total stranger walked up to me and dissed my girlfriend, for no damn reason. What could I do but get in his face? Most of the time it's just words, but once in a while, especially after a few beers at Barney's, my neighborhood bar, it boils over into a fight.

 

Natasha: My emotions rule me. I don't want them to, but they do. Sometimes

I feel like I'm queen of the universe, filled with love and great ideas, and I want to hug everyone I meet and tell them about the incredible plans I have. Then, sometimes the very next morning, I can hardly get out of bed. Just making coffee seems like way too much work. Some days if it weren't for the meth, I'd stay in bed and not move all day.

 

Seth: I'm the first to admit that I'm wound pretty tight. The endless details of life nag at me. Just leaving the house in the morning can set off a string of worries. Did I lock the back door? Did I turn off the stove after boiling my tea water? Did I remember to leave the bedroom door open for the cat? Sometimes I start out for work and then, a few blocks from home, I have to turn around and go back to make sure everything's okay. I take lots of deep breaths-ten at a time-to help me relax. They do help a little. But what really helps calm me, especially at the end of the day, is a couple of bowls of weed. The only problem is that, lately, I've been having trouble sleeping without it.

 

Kim: The big problem with coke dealers is that they don't trust anybody. After you've been around one for a while, neither do you. It's not like I hang out with Brad, but when I go to his apartment every Monday to make a buy, often there's a game on his giant plasma TV, and he usually invites me to watch it with him. The problem is that lately I've got the feeling that someone's watching me. At first I thought it was the woman I see each morning walking her dog by the river. Now I wonder if it's my dry cleaner. Last summer she bought a house just around the corner, and now I run into her at least once a day-at Starbucks, at the drugstore, in the park across the street. It's possible that she's a narc staking me out, planning on arresting me. I know that sounds crazy, but just three weeks ago there was a

big drug bust only four blocks away. I can't help but wonder if I'm next.

 

Alison: I don't know how my roommate does it. She always seems to know just what to say to people, how much to smile, what tone to use-all that stuff. I'm the opposite. If I meet somebody, once we've exchanged names and talked about what we do for a living, my brain locks up. I have no idea what to say. I get more and more anxious and embarrassed. Finally I make an excuse and get out of there. Sometimes I force myself to go to a party or art opening, but after ten or fifteen minutes, I just can't handle it. I get a drink, park myself in a corner, slurp the drink down, and repeat the process five or six times. Eventually I'm not anxious or embarrassed anymore, but I'm too wasted to do anything but call a cab, go home, and crawl into bed.

 

Each of these five people has what's called co-occurring disorders (or, sometimes, a dual disorders, a dual diagnosis, a co-morbid condition, or-as some recovering people refer to it-double trouble). Since co-occurringdisorders is the most common variation, it's the term used most often in this book.

 

"Co-occurring" just means that someone has two or more disorders at the same time, like diabetes and high blood pressure. Each of the people quoted above has both a mental health disorder and a substance use problem (either substance abuse or substance dependence).

 

A reasonable amount of stress and a healthy physiology keep us sane and content. When things get out of balance, however, we can become absolutely miserable, and sometimes dangerous to ourselves or others. Medical professionals call this lack of balance a mental health disorder. Like many other disorders, it may require treatment. Also like many other disorders, it can be effectively treated in the vast majority of cases.

 

Although many people don't realize it, substance dependence-or, as it's more commonly known, addiction-is a type of mental health disorder. When someone can no longer control how much of a drug they use, or how much alcohol they drink, and they continue to use it even though it causes problems for themselves or others, they've got an addiction. This means they crave the addictive substance. Even though it causes them harm, this craving, in turn, leads to their uncontrolled drinking or drug use.

 

Co-occurring disorders occur when addiction gets mixed together with a second mental health disorder. This can be a powerful recipe for trouble-mostly to the person who has the disorders.

  

But there's a bright spot: many effective treatments are available for a wide range of mental health problems, for substance dependence or abuse, and for these disorders when they occur together.

 

Yet there is also some very good news for everyone with co-occurring disorders: there is lots of hope-and lots of help. More than two decades of intensive research has enabled professionals to create integrated treatment programs that address both sides of co-occurring disorders, at the same time, in the same place, and with the same group of professionals. These integrated programs have proven very effective, helping countless people to recover their health, their happiness, and their lives. This is true for every type of co-occurring mental health and substance use disorder.

 

This isn't cheerleading or wishful thinking. Scientists know success is possible because it has been evident in a wide range of clinical studies. Since this is a practical self-help book rather than a book for professionals, my colleagues and I won't trot out all the research-but everything in this book is based on studies of real people in real situations. It's all been tested and proven to be the world's "evidence-based practices": the things that work the best, and the most often, for the largest number of people.

 

The result of these evidence-based practices is that large numbers of people are now able to deal with every major type of co-occurring disorder. A great many are in successful recovery from their substance abuse and addictions. Many are in recovery from their mental health disorders. Others are able to control or manage their mental health disorders through proper treatment. And people from all of these groups have built or rebuilt meaningful lives.

 

This book contains the essence of what a small group of Dartmouth Medical School faculty have learned during more than twenty years of research involving people with co-occurring disorders and the professionals who treat them. The single most important thing we've learned is that people who have a co-occurring diagnosis are more likely to get better, to get better faster, and to stay better, when both disorders are treated together, using a unified, integrated approach. But "unified" doesn't mean a lockstep program. Over the years, we've also learned that one-size-fits-all approaches haven't yielded the best results. In fact, part of what does work best is letting each person make certain key decisions about his or her own treatment and recovery.

 

This book informs, empowers, explains what works and what doesn't, and offers a variety of positive choices and options. Its goal is to help people with co-occurring disorders to feel better, recover from their substance abuse or addiction, manage or recover from their mental health problems, build lives worth living, and be empowered advocates for their own health and sanity.

 

Informative, thorough, and easy to follow, this book is designed to help the millions of people with co-occurring disorders thrive and be their own best recovery advocates.

 

Related worksheets are available at www.bhevolution.org.

 

Mark McGovern, Ph.D., is an Associate Professor of Psychiatry and of Community and Family Medicine at Dartmouth Medical School. He is one of the authors of the Hazelden Co-occurring Disorders Program, designed for professionals in treatment and mental health.

 

Scott Edelstein is a consultant, literary agent, and widely published freelance writer.