Treating Dual Diagnosis in a 12-Step Program
People with a dual diagnosis of addiction and mental illness face a number of unique challenges, as the interplay between the two conditions can be complex to diagnose and treat.
In some cases, people learn to cope with their mental health issues by self-medicating with drugs or alcohol. In other situations, people are struggling with addiction, which changes the chemical make-up of the brain and triggers or exacerbates an underlying mental health problem. In either case, dual diagnoses must be treated simultaneously and comprehensively in order for individuals to manage their mental illness and stay sober.
As unique as the challenges of dual diagnosis are, there are some facts that are universal, including the fact that the 12-Step program is an important source of strength and support for anyone in recovery. The 12 Steps emphasize the importance of self-acceptance, fellowship, spirituality and mindfulness, which are essential for recovery from both addiction and mental illness.
Twelve-Step programs are a research-backed, time-tested path to long-term recovery. But individuals in recovery must actively work the 12 Steps and embrace them as a way of life.
“The 12 Steps aren’t something that you finish after a specified amount of time – they truly teach a different way of life,” says Lucy Taylor, LPC, the clinical director at Passages to Recovery, a 12-Step addiction and dual diagnosis treatment program for young men set in the wilderness of Utah. “By changing behavior and learning new skills, the 12 Steps show that a new life is not only possible, but probable.”
Self-Acceptance
An important lesson in the 12-Step program is self-acceptance. “Individuals struggling with addiction feel a lot of shame and self-hatred over the decisions they’ve made and the people they’ve hurt,” explains Taylor. “Likewise, people with mental disorders are often shunned by others and feel as though they’re somehow broken.”
As part of the 12 Steps, individuals with a dual diagnosis work through their resentments, let go of the past, and try to repair the damage they’ve done to themselves and others. Through self-reflection, they discover their own strengths and limitations and learn to accept themselves without shame or judgment.
Fellowship
People struggling with dual diagnosis tend to feel isolated and alone. Their relationships have been damaged and, in some cases, their loved ones tiptoe around them because they’re afraid the person can’t handle stress or confrontation.
“When people begin dual diagnosis treatment, their lives are often out of control and they’re terrified at the thought of living without drugs and alcohol,” notes Taylor.
The fellowship component of the 12 Steps introduces people with a dual diagnosis to others with the same struggles and helps them develop resiliency and interpersonal skills. Through 12-Step practice, people learn that they don’t have to go through the ups and downs of recovery alone. They can lean on others and let go of negative emotions without trying to numb them or make them go away.
Spirituality
Recovery from mental health issues, like recovery from addiction, requires treatment of mind, body and spirit. For this reason, having a connection with a higher power is important for people struggling with dual diagnosis. Steps 2 and 3 of the 12-Step program focus on connecting with a power greater than oneself, emphasizing concepts like humility, forgiveness, acceptance and service to others.
Many people who struggle with addiction and co-occurring disorders are resistant to spirituality, mistakenly believing that a spiritual connection is synonymous with religion.
“A lot of young men don’t connect with the word ‘God,’” says Taylor. “In a 12-Step treatment program, they discover that a higher power doesn’t have to be related to God at all. It can be anything that helps them be the person they want to be – a connection with their best self, nature or something else.”
Spirituality, in any form, encourages people in recovery to acknowledge that their behaviors have not brought them fulfillment, take responsibility for the pain they have caused and live a life of purpose. Individuals with a healthy spiritual life feel less alone and are better able to focus on their personal goals and establish meaningful connections with others.
Mindfulness Skills
The 12 Steps teach mindfulness and distress tolerance skills by encouraging people in recovery to focus on the here and now and take one day at a time. While those suffering from addiction often want to avoid living in the present moment and paying attention to their emotions, Step 10 invites them to take a personal inventory each day and to promptly admit when they’re wrong.
When people get stuck in destructive routines, they must interrupt their automatic thought patterns in order to develop new patterns of behavior, explains Taylor. This way, when an individual has a drug craving – which is usually triggered by an automatic association, such as going to a bar or hanging out with old friends – they can identify the thought process and avoid relapse.
Finding 12-Step Treatment for Dual Diagnosis
The 12 Steps are integrated into daily life at the Passages to Recovery wilderness rehab program. Every morning, the young men participate in a prayer or meditation session, a daily reflection and a reading from the Big Book of AA. They also have regular 12-Step meetings onsite and in the community, as well as psycho-educational groups on addiction, self-acceptance and interpersonal skills. After having quiet time to work on 12-Step exercises, each day ends with a 10th Step group.
Each young man’s stay at Passages to Recovery begins with thorough psychiatric and drug use assessments to provide the staff with a clear understanding of any co-occurring mental health issues. In a wilderness environment where drugs are not accessible, young men have time to rid their bodies of substances and work the 12 Steps during wilderness expeditions and at base camp.
During the first five weeks of the Passages to Recovery addiction treatment program, young men participate in an intensive wilderness therapy program and work on Steps 1 through 5 of the 12 Steps. In the second phase of the program, participants have the opportunity to practice the skills they learned in the wilderness in a real-world setting. They work on Steps 6 through 12 while living in a structured, home-like environment and participating in “normal life” activities in the community.
Every step of the way, the young men receive the support and encouragement of other young men. They learn and grow together and hold each other accountable, creating a sense of belonging and instilling hope for a better future. The young men who have finished the wilderness component of the program offer advice and guidance to those who are new to treatment, which gives the young men the support they need and encourages them to continue with 12-Step meetings at home.
Addiction is a complex disease to treat. When accompanied by psychiatric illness, integrated, multidisciplinary treatment is necessary. Twelve Step programs like Passages to Recovery – which integrate 12-Step principles, counseling, psycho-educational groups, relapse prevention planning and other treatment approaches – provide the structure, fellowship and support people with a dual diagnosis need to achieve lasting recovery.
“The skills learned in a 12-Step program are effective with anything that is unmanageable, including mental health issues,” says Taylor. “If someone lives the 12 Steps, they can get past the resentment, anger and fear that come with all afflictions and learn to live ‘Just for Today.’”