By Susan Klein Winston, LCSW-R

	Introduction
	Self Medicating Behavior
	Abstinence from Drugs and Alcohol
	Dual Disorders

Introduction

Many  of us have experienced people in our lives that have had some form of mental illness, and or substance abuse. These problems can range from mild symptoms with little impairment noted to  severe psychiatric, behavioral and social consequences.

Those who experience emotional and psychiatric conditions can benefit from various types of  talk therapy  and medication treatments designed to target their specific problem. Medications for psychiatric conditions are usually prescribed by a psychiatrist who specializes in pharmacology for symptoms associated with these conditions. Some of these conditions include anxiety, depression, phobias, PTSD, (Post traumatic stress Disorder), bipolar disorder and other serious illnesses such as schizophrenia and schizoaffective disorder.

Self Medicating Behavior

At times, manifestations of these illnesses are so intolerable to the sufferer that relief is found through the use and abuse of alcohol, prescription and illicit drugs. This is sometimes referred to as “Self medicating behavior”. While the individual may be seeking relief or attempting to just “feel better”, the person actually is attempting to obtain biological or chemical symptom relief in the absence of medically supervised intervention.

Sometimes social drinking” or “recreational” drug use can develop into more serious dependency or addictive patterns of behavior. This alone can contribute to maladaptive coping mechanisms and problems with family, work and daily functioning. The biological effects of substances can also contribute to mood instability causing psychiatric symptoms, or exacerbate an already existing mental illness.

The majority of treatment services have traditionally been divided into specialized services, one for mental health or psychiatric illness, and another for those experiencing drug and alcohol abuse or dependency. Unfortunately this distinction and splitting of treatment services doesn’t always meet the needs of persons suffering from both disorders.

Abstinence from Drugs and Alcohol

Many substance abuse specialists embrace the philosophy that people must establish complete abstinence from substance in order to achieve their goals. In addition, refraining from drug and alcohol, or total abstinence is viewed as the primary goal before other mental health issues can be addressed. Some psychiatrists will not prescribe the medications required to stabilize the very psychiatric symptoms presented because the patient is labeled as a “substance abuser”. What often occurs here is the individual suffering from their mental illness continues to use their substance of choice in an attempt to stabilize their mood or symptoms in the absence of a more constructive medically supervised pharmacological treatment.

While there are medical concerns, liabilities and risks involved when treating individuals with complicated presentations, medical precautions can be taken in order to safely medicate the psychiatric symptoms. This would then enable the individual to attain sufficient symptom relief in order to positively utilize the counseling and other treatments.

Dual Disorders

Some treatment providers are embracing the concept that individuals suffering from more than one disorder require an integrated treatment approach. Terms commonly used to describe individuals experiencing both psychiatric as well as substance abuse problems include: “Dual disorders”, “Co-Occurring Disorders”, “MICA” (Mentally Ill Chemical Abusers, and CAMI (Chemical Abusing Mentally Ill). There even exists a 12 Step self-help group to address this issue known as “Double Trouble”.

Optimal treatment for co-occurring disorders embraces what is called a “Harm Reduction” approach to recovery. With this philosophy it is recognized that recovery is an ongoing process where one may anticipate success, real life setbacks, possible relapse and then new goal attainment. A commitment to treating each individual and their families with an integrated treatment approach; is essential; one that is based in their individualized needs and choices so that they can best meet their goals.

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