Dual Diagnosis

Could The Sandy Hook Tragedy Have Been Avoided?

We at Sunrise wish to express our heartfelt sorrow and sympathy to the families and friends of the victims, and to the community of Newtown. Tragedies like this defy expression, and only time can lessen the pain. Along with the rest of the world, we try our best to convey our shock, sadness, prayers and good wishes to all.

There are lessons to be learned from tragedy.  We do not know if Adam Lanza's path could have been changed at some point by the observation of an alert practitioner, or if the freedoms inherent in our way of life would have permitted any sort of intervention, but it is possible.  We do not know if he was a substance abuser or addict.  Nonetheless, these events should stand as a reminder to all addiction professionals that we need to remain alert for the co-occurring conditions that so frequently accompany our specialty.

How do you deal with dual diagnosis? Which issue comes first?

Dual diagnosis, a situation where a patient has a mental disorder in addition to an alcohol or drug problem, is quite common. It is a complex situation, and treatment is not an issue of deciding which comes first. To achieve a successful outcome it is necessary to treat both together. However, the specific treatment will vary depending on how recently the individual has been using alcohol or other drugs, and on the underlying condition.

It is not uncommon for people to self-medicate because they have found that they can relieve the symptoms of other problems to a degree. On the other hand, it is not uncommon for drug and alcohol abuse to create mental problems, complicate existing problems, or both. Depression, for example, can be an underlying problem, the result of drug and alcohol use, or both.  The complexity and need for flexibility in treatment make it extremely important that recovering people with other mental issues be treated by professionals who are specifically trained and have experience dealing with dual diagnosis. They will be able to deal with the underlying causes, rather than simply treating the symptoms.

Generally, a treatment protocol would have three aims:

  • First we would want to support the patient by reducing symptoms of the organic disorders while she withdraws from the addictive substances.
  • Then we would work on maintaining them comfortably until sufficient time has elapsed to allow an accurate diagnosis of underlying problems.
  • Finally, we would work on supporting their recovery from addiction while actively seeking solutions to the other disorders.

Dual disorders can be treated successfully in most cases.  However, it may take time to arrive at the correct combinations of medication, therapy and outside support.  Like everything else in recovery, we need to approach it one day at a time.