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.

Anger is one of the hardest emotions to deal with in recovery and can often be a factor that leads to relapse if left unchecked. What most people don’t realize is that anger is often what is referred to as a “secondary emotion” – it’s simply a reaction to another primary emotion. Looking at the chain of events that occurs when a person becomes angry can help in identifying the primary emotion that is being felt.

People usually become angry in response to some sort of threat. This threat can be toward the physical body (as in a fist fight), a threat to personal property (like in a car accident), a threat to self-esteem (name calling), a threat to beliefs or values (a difference of opinion in terms of what is right or just), or a threat of not getting what one wants.

Once a person has perceived a situation as a threat, the next event that occurs in the chain reaction of anger is the body’s physical response to the feeling of anger. Typical physical responses to anger include increased heart rate and blood pressure, a clenched jaw and/or fists, shortness or quickening of breath, and the face turning red.

The way in which the threatening event is interpreted leads to further feelings of anger. This stage of the anger chain consists of cognitive distortions that lead a person to jump to conclusions about a situation that can be inaccurate. For example, if someone were to bump into you at the grocery store, and you thought to yourself “Oh, he didn’t mean to do that, he accidentally bumped in to me,” you would not likely become angry. If you instead thought “That guy meant to bump into me, he clearly saw me standing here, and he is trying to start trouble,” your perception of the situation would then further your feelings of anger.

If anger is left unchecked, it is at this point that a person usually decides to act on their feelings of anger. Acting out behaviors can include name calling, physical altercations, yelling, threatening the other person, etc. In order for a person to successfully manage issues with anger, the chain of events must be broken before this stage is reached.

Finally, after the anger episode is over, the person has the opportunity to reflect on how the situation could have been handled differently. This is a key part of anger management, as this allows a person to come up with healthier alternatives to anger the next time a threat is perceived. The earlier the chain of events that occurs when a person becomes angry is broken, the easier it will be for the person to react differently and make a better choice. This is very important in recovery, as anger is a very common relapse trigger. If not managed in a healthy way, anger can tempt a person in recovery to alleviate these feelings by using drugs and alcohol.

Managing anger is a lot like creating a relapse prevention plan. The first step is to identify the triggers to anger, and work to uncover the true emotion that is hiding behind the mask of anger. Once the true emotion is identified, feelings of anger can be alleviated by focusing on deep breathing, progressive muscle relaxation, or even by doing something as simple as taking a walk or a hot shower. Managing anger in a healthy way can also help a person in recovery to communicate with others more effectively and develop patience and tolerance.

Jessica Parks is a certified alcohol and drug counselor in the state of Illinois and has her M.A. in art therapy counseling.Jessica Parks is a certified alcohol and drug counselor in the state of Illinois and has her M.A. in art therapy counseling.

Dual diagnosis aka Co-Occurring mental health conditions and substance abuse disorders affect nearly 14 million Americans each year. Of those only 19% receive the appropriate treatment for both conditions, with the vast majority bounced among different treatment systems and facilities that treat one of the conditions but not the other. Few treatment programs specialize in treating complex co- occurring or dual diagnosis disorders. Nationally, research continues to reveal that people with co-occurring or dual diagnosis disorders need a specialized form of treatment, referred to as integrated services.

Treatment systems for mental health and addiction have historically been and will continue to be separated systems of care. While many research studies have been performed on mental health issues and addictions separately, it has only been within recent years that a few studies have emerged on people who struggle with both conditions in unison. This emerging research identifies that traditional separated systems of care not only alienate the patient from the treatment, but they also result in much poorer outcomes than those experienced by patients with single disorders.

According to researchers and ever more surprising, we are just now learning from these studies that treatment programs designed to treat a specific disorder only are actually only capable of treating the minority of those in need where, in fact, up to 65.5% of patients with a substance abuse disorder had at least one mental disorder as well and 51% of patients with a mental disorder had at least one substance abuse disorder. We are also learning that these poorer outcomes result as much from these separate and contradictory systems of care as from the diagnoses themselves with people who have co-occurring conditions comprising the majority of the 10 percent of people using over 70 percent of the country’s healthcare resources

Some of children had mental issues and they were shunned, ignored. There was another general threat that dashed through the lives of Cho, Klebold and Harris. They were “outsiders”. They were quiet. They kept to themselves. They were “different” by the way they dressed and acted.

So why can’t people learn when such behavior might be the sign of simmering anger, resentment and a penchant for violence? We’ve already learned that many violent people begin by torturing and killing animals.

Near the end of his life, Cho only seemed to have one friend, and when he began acting in a way that made her nervous, she dropped him fast. Warnings about him from fellow students helped in her decision. It was just another negative event in his life.

Yet, his fellow dorm members seemed to accept him into their midst, despite his oddness. Cho, on the other hand, was content to isolate himself from the crowd – to be alone. This was his social anxiety disorder at work. It was his way of protecting himself from humiliation, embarrassment and stress. At this point, we don’t know what other mental illness he might have had, but schizophrenia has been tossed around lately.

Klebold and Harris had each other, to feed off each other’s anger and resentment, to plan their revenge on those who they believed had wronged them in some way. Together, they steered clear of their fellow students, opted out of team events and social gatherings.

Their peers saw them as odd, a duo who liked to dress in black, who avoided any close encounters with other students. They were loners who were isolated from the rest.

Mental Illness and Education

Could the other students have done more? Would it have helped if they better understood mental illness? Could they have made a difference by taking more interest in or an alternate approach to Cho, Klebold and Harris?

It’s understandable that the other students would not get close to them because their actions did not encourage friendship. It is also understandable why students would fear Cho and warn others about him.

It’s now revealed that Cho had several issues in his background that contributed to his mental illness. His parents believed he was autistic, yet he proved to be intelligent. He did not speak well. He was “different” because of his race. He was bullied. And who knows what else he had to deal with during his short life. What demons occupied his mind and where did they come from?

What home life did the three have? Was it a loving environment? Was it a negative or a positive one? Did it encourage open communication where the boys could discuss their concerns, their worries, their issues without fear of retribution or misunderstanding?

For decades, mental illness was a condition people avoided. If they had family members with a mental illness, they were shunned, hidden from society. They were an embarrassment.

Fortunately, much of that stigma has been removed, but there lingers a general fear of people with mental illness. The fear is mostly based on the lack of understanding and knowledge.

When we don’t grasp why a person is acting a certain way, they make us uncomfortable. We can’t help but wonder what’s going on in their minds. We ask ourselves whether that person just prefers to be alone or are they dangerous.

As teens who are looking to enjoy life, we tend to avoid situations that make us uncomfortable or nervous. We avoid people who ‘bring us down’, who are negative, sad, depressed, angry.

Mental illness is a convoluted subject with many theories. Even therapists and mental health researchers don’t know everything. They can’t tell whether a person will become violent, although they might have some inclination as to which conditions are more prone to it.

Despite all that we now know about mental illness, it’s hard to believe that we still know so little. Therapists study and practice for years before they fully understand all the ins and outs, how to differentiate one condition from another, and how to predict their actions. Clearly, the general public can’t be expected to understand as much as the professionals, but there is a level that they can reach.

In light of the increasing incidents of violence, schools are now working hard to figure out how to protect their students from another outbreak, but no one seems able to agree on the proper solution. They’re discussing such things as putting locks on classrooms and dorm buildings.

They’re implementing a better emergency alert system so they can let everyone know when there’s a problem. Part of that will include teaching the students what to do when it does happen.

But these are just Band-Aid solutions. The real solutions lie in spotting the problems before they escalate into violent behavior.

How do we do that?

We make people more aware of signs and symptoms that can indicate a student might need help. Set in place a confidential system for reporting concerns. Put together an investigation team (nurses, therapists and counselors) who have a thorough knowledge of such matters and can do a proper examination and take appropriate steps to find solutions for the individual.

Educate parents in teen behavior patterns so they can spot when their child is not acting normally. Teach them how to approach and respond to their children in a proactive way that does not alienate the teen.

Parents need to understand the development of teen growth – what they go through as they adapt to their new world as adults and leave behind their childhoods. In this method, they will be better able to identify when things have gone twisted and intervention is essential. There’s much to be educated about parenting, and mental illness and mental health is a large part that seems to be omitted.

What is called ‘The Blasted terror barrier’?

Have you ever seen your beloved stuck in his spot in your head lights? Just frozen they are unable to move? He is struck with terror and can not move from his spot even if it means he gets squished and dies.

This is what sort of happens to us, we get caught in the bright lights of life, which is our past and how we’ve always acted! We can now break through the terror barrier and move from out of those lights and then we won’t get squished by the past and we then move on past the terror barrier, unto a new reality which is free from terror!

You may be asking your self how do I break all these bad habits and be frozen in the past or the way we have been taught to act in certain situations. First we have to find a way that works for us, to get past the terror barrier. It was put to me in these certain terms, now don’t laugh, it sounds so simple that I even said what the hell, this can’t be it! IF YOU DO THE THING, YOU WILL HAVE THE POWER, IF YOU DON’T DO THE THING, YOU WON’T HAVE THE POWER!

Can you it really be that simple? Yes and no is my answer. For thirty six years of my life I fought the terror barrier and have just recently found out how to break this nasty little wall of terror. The good thing for you is, you will now have a blue print to overcome this terror barrier, which I struggled with for my whole life!

What is our first step in overcoming the terror barrier? Self relation that a terror barrier does truly exist and that you are affected by it every day it literally takes control over you. Now what do you think chances of beating are? If you can’t do this step you sure as hell aren’t going to go to the next step, so if you disagree that there is no terror barrier, then please stop reading this book right now, and send it back for a full refund.

Now what is our next step in overcoming the terror barrier? Recognition that you are helpless over the terror barrier right now, but there is hope and recognize that hope is always there and will always be there and you can tap into the universal power that is one with God. Now once you get a handle on this step you will find out that you can use this and apply it to any situation in your life.

Relentlessness’ pursuit of your goal or dreams, if you get knocked down, get back up and try it again the only way you are considered a failure is if you stop trying. If you but will continue to try then each failure or not getting the right results you want, moves you one step closer to your dreams.

Just because you don’t make on your first try don’t sweat it, you can make it on the second or third time and this is a given. Robert Kiosks says you will fail nine times out of ten, but it’s the tenth one that makes you a millionaire. So being rent less in your pursuit of any dream or goal, will get you that much closer, each time you fail or you do not get the desired Results you are that much closer to your desired results. So being a failure is not so bad because the more you fail the closer you are getting to what you want. So be rent less in your pursuit of your dreams and goals and know that next failure gets you one step closer to your desired results.

Now we have covered the three a r’s, Recognition, Realization, Relentlessness. What is next? Well it sort of goes like this. Zig Ziglar says that failure is an event not a person.
So who cares if you fail that is not you, which is just some event that got you one step closer to your desired results. So please know when you are failing that is not who you are, it is just something that happened to you, it is an event. Your time will come and before you know it you will overcome that terror barrier!

Now do you see that with these three action steps you get closer and closer to overcoming your terror barrier? Well you should because every step gets you closer to your goals. Now you will sometimes erect wall that keep you in the place where you are at. I bet you are saying no way why would I do that? Let me explain.

Every time you think you are getting to where it is you want to go. POW everything falls apart and you have to stay where you are at. Why is this so, the brain knows that it is much easier to stay where you are then to do all the work required to get to the next level.

We erect barriers that weren’t normally going to be there. We self sabotage your plans and we don’t even know this. Now once we understand that this is what we are doing, we can find a way to stop it. How? In the above steps we have just given an outlined view and you will be well on your way to beat the thing we call the nasty terror barrier and this will stretch your realism. A vast new world welcomes you to live healthy life!