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Hello Friends
We all know that mental illness is very difficult to treat ans so is drug addiction.
Research is showing that it is nessesary to treat both at the same time be of the close interactivity of the two. Many people ask, what comes first, the mental illness or the drug addiction. Well, according to research being done now, it appears that drug addiction may very well be on of the stmptoms of mental illness.People in pain want to stop the pain whether it be physical, mental or both so sometimes the will tend to self medicate. I hope this information helps someone out there with a duel diagnosis situation in their lives.
The Family and the Dually Diagnosed Patient
Authors: Kathleen Sciacca, M.A.
Agnes B. Hatfield, Ph.D.
Authors' bios:
Kathleen Sciacca, M.A., is the Founding Executive Director of Sciacca Comprehensive Service Development for Mental Illness, Drug Addiction and Alcoholism (MIDAA). She is the author of the MIDAA Service Manual: A Step by Step Guide to Integrated Treatment, Program Development and Services for Multiple Disorders. She is a nationally known program developer, trainer, consultant, and lecturer. Ms. Sciacca can be reached at: 212-866-5935.
Agnes B. Hatfield, Ph.D., is Professor Emeritus of the University of Maryland. She is the author of Family Education and Mental Illness, and a co-author with Harriet Lefley of Surviving Mental Illness: Stress, Coping and Adaptation. She is a Founding Member and Former President of the National Alliance for the Mentally Ill (NAMI).
From: Lehman, AF, Dixon LB (ed). "Double Jeopardy: Chronic Mental Illness and Substance Use Disorders," Gordon and Breach Publishers, Chapter 12, 1995.
People who have multiple disorders of severe mental illness, drug addiction and alcoholism "dual diagnosis" have the same severity of addictive disorders as do people who have addictive disorders alone. They also experience exacerbation of both their mental illness and their addictive disorder due to interaction effects. Their families experience the disruptions evoked by addictive disorders alone. This is in addition to the stressors of coping with a serious mental illness. Although many studies (Hatfield, 1990; Lefley,1987; Marsh 1992) have shown that families of mentally ill relatives, in general, report enormous amounts of stress due to mental illness, there are few studies that have looked at the added burden due to substance abuse problems. One study (Kashner, Rader et.al. 1991) reported that substance abuse contributes to family conflict, erodes social support, and generates high levels of expressed emotion, thus disturbing the vitally needed caregiving network. A dually diagnosed individual can throw the best of families off balance. Therefore, it is important to provide services for families.
Our divided systems of care for mental illness, drug addiction and alcoholism include our educational programs and clinical training. As a result, there are serious gaps in services for the dually diagnosed (Ridgely, Goldman & Willenbring,1990), and for their families. This has also effected the development of advocacy groups.
One example, is the "National Alliance for the Mentally Ill" (NAMI). NAMI is an advocacy group that began from grass roots movements of families with mentally ill relatives in the 1970's and has since grown to over 1,000 local chapters (Grosser, Vine, 1991: pp.282-290). The "family movement" has a strong influence on research and treatment of individuals with severe and persistent mental illness (U.S.News and World Report, 1989). However, as recently as 1984 when pioneer programs were developed for the treatment of persons with mental illness and substance disorders in the psychiatric facilities (Sciacca, 1987), many family members accepted a mental health system and a substance abuse system that did not address their relative's addictive disorders.
In a recent national survey of family perspectives on meeting the needs of people with mental illness conducted by NAMI (Steinwachs, Kasper, and Skinner,1992) 18 per cent of the respondents indicated that getting drunk or using drugs occurred in their families. Of these families 62 per cent found this a serious problem.
It is important to note that the 18 per cent substance abuse reported in the NAMI study is a much smaller prevalence rate than most other studies report. For example the Epidemiologic Catchment Area (ECA) study conducted by the National Institute of Mental Health (Reiger,Myers,et.al.1984) found that 47% of individuals with a diagnosis of schizophrenia or schizophreniform disorder were abusing drugs. In a national survey conducted by the Alcohol, Drug Abuse and Mental Health Administration (ADAMHA) (Ridgely,Osher,& Talbot,1987), it was reported that at least 50 per cent of the 1.5 to 2 million Americans with severe mental illness abuse illicit drugs or alcohol as compared to 15 per cent of the general population. The lower rate reported in the NAMI study may be explained in one of several ways. Members of NAMI are not fully representative of all families with mentally ill relatives. It is possible that there is less substance abuse in their relatives. It is equally possible that families see the mental illness as the primary source of disturbance and overlook the substance abuse. Some families may not be able to distinguish problems due to mental illness from those due to substance abuse. Still others may deny the problem out of shame, guilt or embarrassment. A growing awareness of the problems and some solutions to the provision of treatment of persons who are dually diagnosed is under way. Much has been written about the problems of substance abuse among mentally ill patients. These patients have been characterized as systems misfits with poor outcome, more relapses, more acting out behavior, and more likelihood of being homeless (Minkoff and Drake,1991). Dually diagnosed patients experience interaction effects that compound their distress and disability (Evans and Sullivan 1991). These patients tend to respond to their distress by exhibiting highly disturbing acting-out behaviors (McCarrick, Manderschied, et.al. 1985)
Despite these serious consequences, the family movement has not attained the degree of knowledge about addictive disorders as they have about mental illness. There is a need for education that demonstrates that addictive disorders are illnesses. Understanding mental illness as a disease that is not caused by families was necessary to successful advocacy for the mentally ill. The same advocacy must happen for those who are dually diagnosed, through a clear understanding of the addictive disorders. Families of the dually diagnosed continue to experience frustration resulting from a service delivery system that does not meet their needs, or the needs of their relatives.
The purpose of this chapter is to discuss some of the issues and problems, and to outline a model program "MICAA-NON" for families of the dually diagnosed. We will begin by clarifying some of the areas that effect the delivery of services. Next we will report on our family survey, the Maryland study, which provides a family perspective of the issues. This will be followed by an outline of a pioneer program and some assessment considerations.
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