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.

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.

We hear a lot about meditation and prayer in 12-step communities. Few people are comfortable with meditation and fewer still practice it in a formal manner. Some in long-term abstinence have become familiar with meditation as a means of quieting their busy mind and find meditation very helpful. What is not discussed in meetings are the many ways that meditation benefits recovery for those with addictions.

Western culture is unfamiliar with these practices and promotes the daily insanity of multitasking and multifunctioning, to the tune that our healthcare services are overwhelmed in caring for those who live too fast, are continuously stressed out, and are suffering the ills of fast-paced lifestyles with diseases such as heart ailments, digestive disorders, obesity, diabetes, panic attacks and anxiety disorders, depression, many forms of addiction, and cancers of many types. All of these diseases are just that…dis-ease. We are running at full throttle for too many hours a day to acquire, achieve, overcome, overspend, and putting ourselves on treadmills to nowhere, except a hospital bed at a too-early age. Wellness in the Western world is coming very late to the consciousness of everyone.

Recovering individuals are susceptible to stressors. These are the day-to-day irritants that we are not able to find ways to cope with. In early recovery, it is indeed challenging for most addicts to honestly identify their feelings and talk about them in the here and now. They are full of both fear and rage, but cannot talk knowledgeably about their feelings from moment to moment, as they occur. This is an important step in the process of long-term addiction recovery. Identifying emotions is important, because there is no buildup of feelings to be dealt with “down the road.”

Yet, how do those struggling with addiction begin to know when they are becoming derailed emotionally and need to get back on track? The best way is to learn to practice mindfulness on a daily, regular, consistent basis. This can be for as few as 10 minutes initially, once or twice a day. Most of those who have become comfortable with this practice know the benefits of self-awareness and inhabiting their own skin. This is an essential piece of becoming emotionally present to oneself.

Many will draw back from this practice because it is uncomfortable to sit quietly alone without distraction or noise. They have practiced the art of “checking out” with substances over a period of many years and do not care for the idea of “checking in”; because it may be overwhelming emotionally to feel everything at once. They will talk about the “committee” meeting in their head and how loud it gets when they try to get quiet. What makes beginning meditation easier is learning that meditation is not about quieting the committee, but letting the committee talk until they have exhausted what they have to say. All told, this takes only a few minutes, and then peace and quiet do occur. Addicts are so used to drowning out all emotions and thoughts with drugs and alcohol that they are afraid to listen. (continued…)

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.

In early recovery from drug/alcohol addictions, as with other addictions as well, there are things that “trigger” the recovering addict into thinking that may result in relapse behavior. From one addict to the next, these things will have similarities as well as differences, depending upon the person and the addiction.

Examples of situations or items that may trigger a relapse to alcohol use/abuse would be a time of day when the recovering addict would normally have their first cocktail or a time of day when they would begin their drinking behavior if a consistent pattern had been established. Another might be seeing a commercial on television portraying a particular favorite brand of wine, beer or alcohol. Scenes of drinking behaviors in movies or portrayed on television could also trigger that response, as well as certain objects that were significant in the drinking history of someone, such as a favorite martini glass or shot glass. Other triggers for recovering addicts can be the smell of a favorite beverage or driving by a bar or liquor store that was a favorite during their drinking days. Even driving in the same neighborhood or on the same street may bring up memories that are uncomfortable and difficult to contain.

For recovering addicts who used/abused drugs, it may be just as simple to be triggered by events or by seeing certain objects that are reminders of the old ways and behaviors. In those instances, it can be a lighter that was used for smoking marijuana, or a match strike that smells of sulphur for an addict who used matches to “cook” their drugs before injecting them with a syringe. The sounds of certain types of music can act as a trigger, as can many types of sensory stimuli they are not aware of until they encounter them in a new environment and feel the tug of the old days pulling them back into the addictive behavior.

Relapse prevention is an important factor in treatment for addictions. Without an open awareness of what some of their triggers may be, addicts are left unprepared for meeting and working through those triggers without relapsing into behaviors or even ways of thinking that are going to prevent them from successful abstinence. It is the same parts of the brain that will figure largely into their recovery that are heavily inundated with these types of sensory stimulus. Key to recovery being successful is that they uncover and have contingency plans available for these moments when they are hit hard with old sights, smells, sounds and situations that were inviting for them during that time of life and in those circumstances. It is important for the addicts in recovery to have back up plans available so they can be on guard to the triggers and then to walking away without succumbing to the temptations that will arise when those triggers are met.

Relationships with other recovering persons can be priceless in these situations; because they will inform the newly-recovering addict about how they met and overcame similar circumstances and validate the feelings that come up. A misconception that most newly-recovering addicts have is that the knowledge they have gained about their addiction is adequate to keep them from relapse. This is not the case. When those triggers are met and encountered unawares, they have powerful pull on every addict, whether they have knowledge about their addiction or not. So when they learn that they are not alone in fighting off the temptations faced with those triggers, they have a stronger weapon with which to resist.

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.

So, you are newly recovering from an addiction, with maybe a couple of months under your belt now. The holidays are coming to an end; and after the holiday season, the meetings that you attend are filling up with newer members, as is usually the case in 12-Step communities.

Holidays have a way of waking up the addicts to the problems surrounding their use. Either they have made complete messes of their family relationships during this period, or their using is more obvious to family and friends they haven’t seen often during the previous year. However it happens, there are a lot more people coming into recovery in December and January than any other time of year.

For those who really thrive in the attention they received in their 12-Step meetings for being the newest member, or one of them; (and you know who you are!); it can be uncomfortable and disconcerting to see so many new people coming in and getting that attention you thought was all for you. Now there will be a shift in focus for your recovery.

While you may have made some small inroads into sponsorship and recovery work itself, you will have to be completely honest with those who support your recovery about your feelings. This is hard when new, because you know you are supposed to love and support everyone in your meetings, but what is this new feeling? Could it be that ugly monster called jealousy? Is that what is happening?

Some will relapse in their attempt to regain the spotlight and attention of the group. There are some in nearly every group who do this for years and have no recovery to speak of, long term. Their plight is pitiful and heart-wrenching, but the group will soon lose the will to reach out to help these persons, believing that they are not really trying to recover. Who knows what factors are at work in relapse behaviors? Just recognize the futility and insanity of this particular way of receiving the regard of your group.

Others will become overly dramatic when sharing in their meetings, with lots of “look at me” behavior readily recognizable to most in the group, except themselves. A good sponsor will put an end to this behavior, but not everyone works with a sponsor, or is honest with them, or even listens to their words of wisdom and encouragement.

While these may seem like silly solutions, they are commonly used. The other way to deal with the feelings of this loss of attention may be that you will begin to grow into recovery now. Perhaps you can guide these other newer members to the people who have helped you. Perhaps you can talk to them about your experience in the first weeks of this group and how you navigated early recovery. Quite often, it is those with three weeks, a month, or two months who are most easy for new members to talk to.

When they recognize that others may have a year or five or twenty, they are terrified to talk to those people. Other members with just a short time longer than they have are much easier to approach. These new members are trying to figure out how on earth anyone ever gets a week without alcohol and drugs. They cannot fathom a year or beyond that. It will be your recent experience that may bridge them coming to terms with how to do this recovery business one day at a time, not for years on end. That is too overwhelming to think about. While your experiences are not as many, you have been there most recently and the memories are still fresh in your mind. While you should not be sponsoring at this time, due to your own inexperience, you will see how you may be the best ambassador to recovery that they 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.