Also known as having a co-occuring disorder, people who have a mental illness diagnosis as well as an addiction to alcohol or drugs are candidates for dual diagnosis treatment.

The population receiving the most attention these days is those deemed “severely mentally ill,” which can be a misleading term. While everyone with a diagnosed mental illness, combined with addiction, is dually diagnosed, not all are considered to be severe. The mental illnesses that fit into this category are usually schizophrenia, severe anxiety disorders, severe depression or bipolar disorder, combined with substance abuse and addiction.

In most cases, the substance abuse itself may be the causal factor in mental illness. Whether the illness is a by-product of substance abuse or if substance abuse stems from the user’s desire to medicate aspects of their mental illness can be uncertain.

Other types of dual diagnoses may include less severe depression, anxiety disorders and personality disorders, along with substance abuse and addiction. Many of these people can be medicated appropriately and become functional, which renders them less severely mentally ill. Others may continue their use and abuse of substances and never receive proper treatment. Many of the latter population are those who suffer from mental illness brought about by trauma, such as post-traumatic stress disorder. Symptoms are managed by use of drugs and/or alcohol and then that substance which “helped” them becomes an addiction. This may further their symptoms into a severely mentally ill status, without proper treatment.

The challenge in all of these situations is to properly treat the individual, no matter the severity of their condition. For many, substance abuse becomes the point where awareness comes from the public sector. They may get arrested for crimes having to do with either procuring illegal substances or from crimes committed while under the influences. While incarceration may decrease their criminal activity, it does nothing to address the causal factors for the behavior. Treatment will give them incentive to remain drug and alcohol abstinent, but their underlying (or perhaps initial) mental illness remains untreated.

Treatment for severe mental illness may involve drugs that are difficult to gauge. While some people will respond well to a drug to treat their condition, others with the same (or similar) symptoms will have terrible side effects and responses to the same medication. Therefore, it is important to seek a specialist in dual diagnosis who can closely monitor the treatment recommended.

Kelly McClanahan has an MSW in clinical social work, with a specialization in substance abuse treatment. Having worked in this field for over 20 years, she is currently working on her certification as an addictions’ counselor.

For those who are new to 12-step program lingo, this is a strange-sounding phrase. Its meaning will become clearer over time, but is confusing at first. Just what do they mean by “one day at a time”? Most newly recovering addicts will argue that they are here for long time recovery or to quit forever. As usual, this is a great idea, but a tough one to live out.

For most who have developed a lifestyle that is centered on their addiction, the specter of remaining abstinent looms dark and forbidding into a future that seems bleak without the companions of substances and behaviors that have been the only friends an addict sometimes has left. Take these away, and just what, pray tell, are they supposed to do? A savvy friend or sponsor will laugh then and tell them that they only need to remain abstinent for this one day. “Oh…so that is it,” thinks the newcomer…”but I still don’t understand.” And of course, they do not understand. Other than the loss of the horrendous consequences they have been paying for their addiction and its accompanying behaviors, there is little to recommend a life without the practice of active addiction. And, if there is a life without it, what kind of life could it possibly be?

Certain that there is no more fun to be had in their lives, that they will never laugh or enjoy themselves again, because they are so uncomfortable without the security blanket of their drugs, alcohol, sex, gambling, or whatever their addiction was, even one day seems to stretch out in front of them, dreary and bleak. They have become so used to the feelings of being in an altered state of mind that it is impossible to see how it could ever be any better without the only friend(s) they had left.

So, one day at a time can mean that they only have to figure out how to go through this 24-hour period of time without substances. To even contemplate staying abstinent for any longer is an overwhelming idea. So, it can be broken down into segments that are comfortable for the newly recovering addict…one day, which can be further broken down into hours, or even minutes if their anxiety about not using or drinking or participating in an addictive behavior is at stake. With the help of their newly-formed support group and a strong relationship with a sponsor, it can go that slowly…one minute, one hour, one day at a time. Somehow, they will wake up in the morning after a strenuous day and feel amazed that they remained abstinent for that day!

The true miracles of recovery are those first days. They are absolutely impossible to achieve, and yet, it does happen! With or without a treatment or recovery setting, there is hope! With the hope that they can do it for just one more minute, one more hour, or one more day coupled with the experience of actually having done it for a few minutes, hours and days, there is hope and a sense of certainty. A support group will provide this certainty as well. As the newcomer hears the stories of the recovery of those in the meetings, they become more assured that, “If they can do it, so can I!”

Kelly McClanahan has an MSW in clinical social work, with a specialization in substance abuse treatment. Having worked in this field for over 20 years, she is currently working on her certification as an addictions’ counselor.

After a period of time in recovery, a balance can be struck in understanding when to divulge their recovery to others and how much information to give in various settings. This can be confusing for newly recovering addicts, who vacillate between yelling it from the rooftops and hiding it from everyone, lest they think less of them.

It is not unusual that they would be very excited and proud about their early recovery and abstinence and want to tell everyone they know that they have finally succeeded in overcoming their addiction. This is a very common response to early recovery for those who are experiencing it for the first time. The problem lies in the anonymity that is a vital part of the 12-step programs, which are all “anonymous.” Understanding the concept of what is meant by the phrase “anonymous” in the 12-step programs takes some time and awareness of the programs and how that works for all members.

The basic premise is that everyone is asked to keep their own membership in the 12-step programs to themselves when addressing public entities, such as the “press, radio, film, and television.” It also requests that members not divulge the membership or even attendance of others in the group outside the meetings. This has become a much bigger problem with the advent of celebrities of all types who do not adhere to the traditions of 12-step programs and speak freely in different media circles about their participation in 12-step groups.

It is perfectly understandable when a recovering addict wants to publicly declare their recovery. This is not a breach of anonymity. The issue of their participation, membership, or attendance in any specific 12-step program, however, is a breach of the anonymity of the group and a violation of the traditions that are designed to keep other members safe and to protect the unity and integrity of the group itself.

Because relapse is such a common part of the recovery process, it is seen that keeping one’s involvement with recovery private can be an asset to everyone. We have all read and seen the public displays of drunkenness and active addiction that can soon follow the equally public announcements of many people’s entry into treatment. It carries the message to the rest of the world that there is no such thing as long-term, ongoing abstinence. This is a matter that is confusing and misleading to those outside the recovery realm. That is why the principle of anonymity protects not only other members of the groups, but the people who are actually abusing anonymity themselves. It is hoped that the sense of pride that is felt in early recovery will propel the member through an ongoing process to remain in recovery. In doing so, they will begin to understand why there are safeguards to protect the group itself and its other members. Sponsors who understand the true nature of anonymity will be happy to guide those who do not yet understand how that works. And the group itself is a great place to celebrate the accomplishment of what can seem impossible to those who have not been able to attain long-term, ongoing recovery.

Kelly McClanahan has an MSW in clinical social work, with a specialization in substance abuse treatment. Having worked in this field for over 20 years, she is currently working on her certification as an addictions’ counselor.

To be completely accurate, detox anywhere can be cold turkey, in other words, abruptly done. Whether or not a person pays for detox, some agencies will not provide medications unless they are clinically and medically necessary. Others will give users medication to ease their way out of their addiction.

The distinction I make here is whether or not you need to go to a hospital or clinical setting. Some people can do this at home, unless they are going to suffer seizures (as from alcohol detox from long-term, chronic drinking). Most drugs can be medically withdrawn from the body without substituting other drugs. Some people prefer a detox on medications, due to the fact that coming off pain killers, heroin, and some other drugs can be excrutiating.

Detoxing at a Facilty

The average cost of detox in a facility depends on several factors. If you have insurance, it will range according to how much your insurance company will pay. If the agency provides medical detox, this can get quite pricey, because use of Suboxone or other medications to get you “clean” is expensive. It requires an medical doctor, a nurse to monitor your care, and other personnel. A nonmedical setting may give you a place to be quiet for sleep, food and opportunity to attend groups and client interaction. They will have a room and someone to monitor your progress. It depends on what substances and how long you are using.

Costs for detox facilities can range from $200 per day for a setting with no medical interventions to $10,000.00 per day for all the comforts of home (if you regularly live on a tropical island with servants!) It is possible to get clean from substance use in either setting.

Cold Turkey at Home

It can also be possible to do this in your home. There are a few exceptions, and it will be regularly repeated here that this should only be done with the oversight of your personal physician. If you are coming off of anti-anxiety medication or muscle relaxing medication, please consult your doctor before attempting detox. These drugs need to be slowly titrated from a user’s system. Stopping them abruptly is very dangerous and has serious side effects. Be sure to consult a physician!

If you opt for detox at home, the best advice is to find a friend or loved one who will help you through the worst of it, usually three to five days. During this time, they need to be sure that you do not fall, that your intake of water and other nutrients is consistent, even if it makes you sick. There is a need for your body to have liquids and electrolytes to function during detox. If you can take them, chicken broth, soda crackers, white rice and applesauce are the foods most easily digested during distress. Be sure to ask someone to help you who will not give in and give you medications to get you through. If you are coming off a drug that must be titrated down, have them go with you to the doctor so they know how much and when to give it. They need to be completely aware of danger signs to look for. A safe friend who knows how this detox business feels from personal experience may be the best help you can find.

Kelly McClanahan has an MSW in clinical social work, with a specialization in substance abuse treatment. Having worked in this field for over 20 years, she is currently working on her certification as an addictions’ counselor.

There is little talk in traditional 12-step recovery groups about the practice of meditation. There is little conversation in these groups about the benefits or the reasons for meditation. Today there are special groups of 12-step recovery members who are forming alternative groups with interests that include meditation practices, but they are not as widespread as the bulk of the recovery meetings. It is important that these concepts become more widely available to recovery members who are not able to access these groups.

Long-term abstinence is difficult to achieve when recovering addicts do not know what emotional process they are in. Daily, all cultures, around the world, are faced with the stresses of life. These can range from driving in traffic, difficulty in relationships at home and at work, illness (either personal or familial, or both), birth, death, marriage, divorce, the list goes on and on. Navigating these turbulent waters is a balancing act for everyone. Recovering addicts do not have all of the emotional stability that is required for dealing with these stressors without a great deal of help. While it is important for them to maintain their involvement in 12-step support groups, working with sponsors and other 12-step advisers and friends, maintaining a spiritual connection is tough when you are not aware of how you are feeling about any and all of this activity and its inherent stressors. Meditation can be the safe haven for most addicts when they walk through the fear that bars them entrance into the quietude and serenity that is found within them.

This is the seat of all of the wisdom and answers that anyone needs to access. But it is a task that is intimidating when most of us just want to “check out.” Long after the drugs and alcohol are gone, there is still our addiction to “doing” instead of “being.” This is easily recognized in our cultural addictions to social media, television, cell phones, gambling, eating, spending, shopping, gossiping, reality TV shows, sex, and every form of escape man has created.

So, the challenge is to find a space and time, no matter how “busy” we are to check into the only resource we have for true knowledge and guidance. After the chatter has died down, we will access our real source of inner “knowing.” This is an important part of the recovery process. It will guide us to know our own feelings and when something is either right or wrong for us at this time. We are past masters at self-deception. This is the best and easiest way to find the answers we seek for setting our own course.

Kelly McClanahan has an MSW in clinical social work, with a specialization in substance abuse treatment. Having worked in this field for over 20 years, she is currently working on her certification as an addictions’ counselor.