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Recovering Wholeness: Dual Diagnosis in Washington

Dual diagnosis refers to the complex relationship between psychiatric disorders and substance abuse. A wide variety of theories have attempted to explain this interplay, but there is little doubt that the two are inextricably linked. With comorbid problems feeding each other in a vicious cycle, self-medicating through substances can be a difficult habit to overcome. Mental health professionals from Washington state share their perspectives on dual diagnosis, a struggle that affects millions of Americans on their road to recovery.

What is dual diagnosis?

You don’t have to be an addiction specialist to be frequented by the all-too-common conjunction of emotional distress and substance abuse that is dual diagnosis, or co-occurring disorder (COD), a comorbidity that afflicts an estimated 4 million people in the U.S. Therapists and counselors across Washington come across its many forms and severities more often than you’d think, but with new medical research exploring the intricacies of dual diagnosis, the prospects of recovery are brightening.

“Substance abuse is similar to any other dysfunction: it’s our attempt to adapt to life's stressors,” says Seattle counselor Reid Stell. “It’s ironically our way of trying to balance. We become addicted to our mood swings as a way to distract us from what's really going on—and that distraction allows us to function as well as we do. When our dysfunction is no longer working for us, we are faced with the choice to create life balance the hard way.”

Despite developing understandings of dual diagnosis, some debate has sparked among researchers over its root –, a “chicken or the egg” dilemma that has many speculating how these two issues influence each other. Whether it was a mental illness that caused substance abuse or the other way around, medical professionals largely agree that they must be treated in synchrony.

“For 25 years, I have been working to help the mental health and addiction treatment providers to understand that even if they think they can separate the issues, they cannot,” says Jeanne Meyer, a counselor in Vancouver, WA. “Every mental health counselor has worked with someone with a substance abuse problem. Every substance abuse counselor has worked with someone with a mental health disorder.”

Why is this relationship so strong?

We asked mental health counselors across Washington why addiction and psychological pain go hand-in-hand and discovered there are multiple answers to this question — none of which are simple. While some professionals acknowledge a genetic influence, most conceptualize COD as a coping or avoidance mechanism, or “self-medication” for existing anguish.

“A common response to pain is to turn to drugs and alcohol,” explains Seattle psychotherapist Treina Aronson. “This makes sense because, quite simply, they do a good job in anesthetizing emotions in the moment. Unfortunately, in the long term, this method only continues the cycle of suffering due to the untold havoc and profound remorse which results from using this coping strategy.”

Bellingham counselor Claire Mannino adds, “[Addictive behaviors and substances] help us cope, they stop us from having to process things that are unimaginable, they satiate our need for something that we cannot or do not know how to satiate in a healthy and adaptive way. For relatively mentally healthy people who happen to stumble upon an addictive substance or behavior, perhaps through a friend, loved one or chance meeting, their mental health often suffers as their addiction progresses.”

“We are whole people, not broken into segregated pieces,” Candice Czubernat of Seattle tells us. “That’s why when one part of us is in pain, it affects the rest of our lives. I believe someone uses substances for very good reasons. Generally these reasons stem from places of pain, loss, disappointment, low self-esteem and trauma just to name a few. To be free from the need of addiction we must take the step towards healing those hurts.”

How do you treat dual diagnosis?

Medical professionals have attempted for years to explain why at least 60% of people with mental illness also struggle with substance abuse, resulting in a range of theories.**WEBMD1. Dual treatment approaches involving simultaneous attention to mental illness and substance abuse are becoming widely accepted, but tend to vary among individual coaches.

“We know that not all treatment strategies work for all people in all circumstances,” says Tom Linde in Seattle. “Sometimes we can get a good idea of what is going to work, but often we have to experience some failed efforts in order to dispose of what won't work before we're able to settle on what will work.”

Jennifer Kennett of Bellevue integrates these holistic approaches in her own practice, claiming, “I have never met an individual with addiction issues who is not in significant emotional pain. It is not possible to treat the addiction without considering where the pain is coming from. I explore when and how the addiction crept into their life, and what promises addiction has made and broken.”

Even with a prevalent awareness of dual diagnosis, resources for holistic recovery are still underdeveloped in many areas of the state. Judy Canter explains some of the difficulties found in Vancouver, where she practices: “There are very poor resources in this area for older adults seeking treatment as the programs here that accept lower income individuals (Medicare) are not geared toward this population.”

There is still much work to be done both in understanding the dynamics of co-occurring disorders and implementing effective and accessible treatment. But even therapists without addiction specialization are recognizing the value of understanding them, as many of their patients are struggling to throw the weight of two yokes off their shoulders.


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