Although the definition of dual diagnosis or co-occurring disorders is technically “the coexistence of both a diagnosed mental disorder and a substance use disorder” I believe that we all lie somewhere along the dual diagnosis spectrum. I believe that such a complicated nest of illnesses can’t be defined in such black and white terms. In fact, it’s precisely that kind of “all or nothing” thinking that prevents many of us from ever finding true happiness or a greater sense of wellbeing.
It seems to me that most of us self-medicate with some form of escape mechanism in order to forget about the rather “trivial” traumas that plague our daily life’s existence. I know for me, not getting CC’d on an “important” work email could easily trigger me to check out into oblivion with a bottle of wine after work. Waking up with that impending sense of doom when scrolling through my call log after a “fun Saturday night on the town,” or worse, looking at my bank transactions could easily propel me to indulge in a day of popping Adderall and champagne bottles and dancing on tables for a “Sunday Funday” escape, rather than facing the real life choices and their haunting repercussions on my mental health that I was making.
It wasn’t a DUI or a night spent in jail that made me finally want to seek a way out, it was the look in my boyfriend’s eyes when I knew he had lost all faith in my ability to ever get my shit together. It was the sickness I felt in my gut when recalling how I’d spilled my best friend’s secrets to any old acquaintance that I found myself “bonding with” while staying up all night. It was these small moments that added up and begged me to take a hard look at my life, at my choices, at the person staring back at me in the mirror. I found that not only had I no respect for myself, but also, I didn’t even really like the person I saw staring back at me. I drank and used both in celebration of or to run from my feelings, never giving it a second thought that maybe the root cause of those feelings, is what actually needed to be addressed. The highs I’ve experienced needed to be quelled and the lows needed a boost and I knew exactly the right formula to make me forget how awesomely-good or devastatingly-bad I felt. Drugs and alcohol may have been harmful to my life in many ways, but they merely masked a deeper problem, one far more difficult to treat.
When I did in fact get sober, I found that my coping mechanisms (i.e., drugs and alcohol) were but a mere symptom, just one layer of the onion, in the multitude of issues I seemed to face. Life is hard, and “living life on life’s terms” seemed impossible without my trusty tool kit of uppers and downers to navigate me through the waves.
Shortly after I got sober, I was diagnosed with Bipolar Disorder, and upon removing the self-medicated veil I had hid behind for so long, I became aware of a deeper set of problems that needed to be solved. I thought the answer was in practicing abstinence, perhaps throwing an antidepressant into the mix, and when that didn’t work, I sought help from the 12 steps. The 12 steps greatly transformed my outlook on life and helped me to become a much more self-aware and caring individual, but going to meetings, helping others, and prayer couldn’t prevent my mental illness from striking back at four years of sobriety. I did everything I knew how to do to make me “better,” but I still ended up losing my career, strapped to a gurney and being rushed to a mental hospital in Torrance, California.
The struggle to find adequate help when suffering from dual disorders in this country is real. Even I, who unlike so many people, had an incredibly strong support system, persevered through years of depression, mania, substance abuse and psychosis. It took me a good 25 years of therapy and eight years of sobriety to properly get diagnosed and then another three years of hospitalizations, inpatient treatment, and intensive outpatient therapy in combination with the right cocktail of pharmaceuticals under the care of one of the country’s most qualified psychiatrists to finally arrive at a well-balanced solution.
Ultimately, I found that I had to completely surrender, while at the same time, never giving up on myself in order to find the gold that lay deep within. I am proud to say that recovery is possible, but for me it’s been a very personal and individual battle. A complex solution was needed for a complex set of problems.
An estimated 8.2 million people suffer from Dual Diagnosis according to the most recently issued government survey(1). However, I believe this number to be grossly understated considering these numbers only account for people aged 18 or older in the civilian, non-institutionalized population in the United States. What about the substantial homeless population that is considered to be seriously mentally ill and most likely suffer from coexisting conditions? Shouldn’t they count? Thus, despite the fact that the number of adults with substance use disorder and adult mental illness aged 18 and over corresponded to only 3.4 percent of the adult population, the number is surely much higher than that.
According to the same study, within the 18–25-year-old age group, 6.1 percent suffered from co-occurring disorders. That is almost twice the overall percentage rate. Why could this be? One explanation is that more young adults aged 18–25 are struggling with mental illness and substance use disorder than ever before, or more likely, the older people get, the likelier they are to phase out of society: living a life on the streets or having been incarcerated. These are the forgotten souls with no survey-able-footprint, whose lives filter in and out of the system. Our country needs to band together to help these young adults find an appropriate treatment for their afflictions before they too, fall off the grid.
From my perspective, the key to a happy life, no matter who you are, lies in finding balance, purpose, support, and community. What’s normal to one person is completely out of control to another. The task is not to judge your own or anyone else’s path, but to truly find the right balance that works for you. Many people in 12 step programs say that their drug of choice is “more,” so why shouldn’t their solution be the same?
So how do you know if you are suffering from dual diagnosis? I don’t think most people do. I think that most people think of dual diagnosis as the aforementioned poor unfortunate souls that society has turned its back on. No one thinks about the “high functioning case” sitting in the office next to yours, riddled with anxiety, depression, or a mood disorder, heavily partying on the weekends or forever unwinding with a “glass” of wine after work. It is my view that many people who suffer from mental unrest abuse drugs and/or alcohol, but don’t necessarily identify as having a mental illness, alcoholism or a drug addiction, because…maybe they don’t. Substance use disorder ranges from mild, to binge, to heavy drinking. No doctor will ever diagnose you with alcoholism. It’s not an all or nothing diagnosis…we are way more than the boxes and categories that society would like to put us in. The struggle to recover may appear painstakingly real, but what lay on the other side if you do in fact push through it, can result in a miraculous transformation in to thy authentic self.
So, I ask you to think about what it is you want to change in your life and why you aren’t doing it? Achieving your dreams is a real possibility, but it takes a lot of really hard work. We all have the opportunity to be more than our current self-image, our diagnoses, to make choices and to take back control of our lives. We can all get there. We not only have the opportunity to get better, we can all be better. We can be more.
You are bound to stumble, to cry, to bang your head against the wall, wondering how did “I” ever get “here” — but you are bound to succeed if you hang in there! If you believe that there truly is light at the end of the tunnel, that no matter how big of a mountain or small of a molehill you are faced with climbing, that you can and you will reach the other side if you just keep putting one foot in front of the other. The journey is circular, not linear. Remember: You were born to be more. Whatever that means to you, go after it.
Source: (1) Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17–5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/