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.

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.

Service is one of three principles in Alcoholics Anonymous. The other two are unity and recovery. While service may seem to be an obvious principle to interpret, it can cause some confusion when it is used as a manipulative way to attempt to control others. Recovering addicts may be some of the best manipulators in the world. They certainly have the skills, which are honed sharply while in active addiction. Because they may not be completely laid to rest when in early recovery, there are some who are using that skill in 12-step groups. This is not news to any members attending the groups. However, there will be things said frequently in the groups that are not in the spirit of what the founders had in mind when they stressed the importance of being of service to others as a way of enhancing and strengthening personal recovery from substance abuse.

Early in Alcoholics Anonymous, there was a completely different need for service than that seen today. There were only two original founding members. They were hard-pressed to spread the word about recovery to those who were still in the thralls of practicing alcoholic drinking. As they were able to achieve success with new members, there was some relief of the workload as those members began to spread the good news. Soon they had a small group and from there they changed the history of addiction by forming Alcoholics Anonymous. This is a brief explanation of work that was done for the love of the recovery they had found. This kind of work is no longer needed in Alcoholics Anonymous. While there are thousands of meetings in countries all over the world, there exists a huge need for service work to be done at many levels.

This work does not go away, but increases every day. Service to Alcoholics Anonymous and in other 12-step communities is rewarding, sometimes frustrating, and usually under-appreciated, but it most often leads to a stronger recovery for the person who performs it. The problem occurs when those who do not understand the nature of service tell others in the group things that are patently untrue. A frequently heard phrase is, “Never say no to an AA [or NA] request.” The origins of this saying are unknown. Too often, it is used to bully others into doing what that person wants them to do. This is not service; it is manipulation. The person being cornered into doing what the other member wants them to do will perform this function, but do it with much less than the spirit with which service is intended. They have been conned, manipulated, and trapped into doing something because that phrase is believed to be true by them.

It is strongly hoped that their sponsor will enlighten them about this untrue phrase. It has become a widespread expression, used altogether too often. New members of 12-step groups fall prey to it frequently. They are manipulated into doing things that they do not want to do by guilt imposed from another member mouthing a phrase that should not be used. Again, this is NOT what service is about, nor what it was intended to be. Anything done through manipulation, guilt or shame is not service, it is slavery. Resentment and anger are the byproducts of this type of work. Love is the byproduct of service. Anything that is undertaken through guilt cannot produce the love that was the very spirit of those early founding members. This is truly the spirit of service.

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.

Steps 8 and 9 in the 12-step programs talk about “…making a list of all persons we had harmed…” in step 8, and “…making direct amends, wherever possible…” in step 9. This is confusing for many addicts in their early recovery. Sponsors who have worked through these steps and have maintained abstinence for many years are just as puzzled and confused about what constitutes an “amends.”

Because they frequently apologized for their words, behaviors, attitudes, and addictions in the past, many are prone to look at amends as another round of apologies they need to make to those they have harmed. This is not in the nature of these steps, nor is it what the founders of the 12-step movement intended to pass along to those who were to follow. If apologies meant anything to those who have been burned by the selfishness and inconsideration of active addiction, it would have worked when first performed by the chronic addict. Of course they never did anything about the behaviors that were being apologized for. They continued to lie, cheat, steal, and forget about everyone and everything in their path, except the procuring and using and behaviors necessary to maintain their addiction.

Since apologies are not what is meant by these steps, just what is an “amends” anyway? According to Dictionary.com, amend can mean a) to alter, modify, rephrase, or add to or subtract from (a motion, bill, constitution, etc.) by formal procedure; b) to change for the better; improve; c) to remove or correct faults. So it is seen that nowhere in these definitions is the word apology listed. So it is important to understand the language of recovery and make sure that what is being taught is what is truly being learned. By changing for the better, as listed in b), it is thought that this is the best definition for purposes of amending ones’ addicted behaviors. Therefore, if an addict is guilty of lying to his wife and children, boss, parents, friends and other family members, perhaps his best way of amending that behavior is to practice telling the truth to them under any and all circumstances. Other amends will involve paying back stolen money and taking time to spend with neglected family members and friends who are hurt by the neglect of selfish addicts.

Many addicts will defend themselves by saying they only hurt themselves in active addiction. This is just not the case. Even living on a deserted island, there is universal ramification for every behavior. If they drove while under the influence, they owe amends for that by not doing that particular behavior any longer. If they worked anywhere, for anyone, they impacted their bosses, their coworkers, their subordinates, and everyone who did business with that agency by virtue of the fact that they were illegally involved in some form of behavior that was injurious to themselves and potentially those around them. If they had parents, spouses, children, or any familial relationships whatsoever, their relationships were damaged by the residual effects of addiction. Therefore, it is almost impossible to find an addict whose behavior harmed no one.

Making amends is difficult to think about for all addicts. They create imagined monsters which seldom materialize while making amends. Making the effort to rectify old behaviors is much less difficult than it is in the mind of an addict. Few who have performed these steps are heard to share that what was necessary to clean up their messes is too outrageous. Most feel that they have walked away from the process clean and free.

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 are numerous reasons why I quit drinking. Even though I was told I would always be an alcoholic, I successfully overcame my addiction to alcohol. Although I hate the word “addiction” many people thrive on it; it’s their excuse for the life they have been living. I was told I was sick and I had no choice, no voice, no self-control; alcoholism made me feel like a stone, thrown out to sea. I couldn’t control my own destiny or my life and I would eventually wash up wherever the alcohol had wanted me to. I know many others are out there, feeling just like I had—like a stone with no thought, drive, power or motivation. That is why I want to share my story of how I overcame alcohol.

My story began when I left a 12-step program which shall remain nameless, I needed to get away from the damaging mentality they gave me. It was so negative and never made me feel good. So you may be wondering, why did I leave? It wasn’t easy, but I figured after five years of being in and out of recovery, that I had had enough. I work up one day and realized I didn’t want this life anymore; it’s not the legacy I wanted to leave behind. So I kept things simple and created a plan with realistic goals in a journal. I knew since I was drinking for hours a day I couldn’t go cold turkey so I slowly dropped down my drinking each week, tracking when I drank and how much. This slow process didn’t leave me feeling extremely shaky or with extreme withdrawal. It took me a few months to eventually fully stop but I had never felt so liberated.

I started being proactive about my choices and tried to keep busy on making plans for my future. Once I had my goals in order, drinking didn’t seem like it had to be such a huge part of my life. I always kept my goals small so I could achieve them easier. It felt so amazing to check things off in my journal, such as get out of bed before 10 a.m. or work on my resume. The entire process brought such positive energy to my life. By doing these small steps I learned from my past mistakes. I also tried not to look back on my former life in the 12 step program. I knew if I truly wanted a fresh start I couldn’t focus on the past and what I could have done differently. I was living in the present and planning for the future.

This process of self-awareness worked incredibly for me but only when I realized I did have control of my own life. It’s been three years since I stopped drinking and I couldn’t be happier. My life is now consumed with my job, family, friends and fun, no longer alcohol. If you’re struggling with alcohol or drugs, my advice to you would be to stay strong, surround yourself with the right people, focus on yourself and start off slow. Most of all never give up on yourself— anyone can do this. You just have to be strong enough to endure the process.

Melissa Kluska is the Saint Jude Retreats Online Public Relations Manager and specializes in non-12-step drug and alcohol programs and alternatives to addiction treatment. She currently is researching non-12-step and non treatment programs as the only effective way to stop a substance abuse programs.