Dual Diagnosis, Co-Occurring Disorder: How Bad Is it?

I just added two segments to my mcmanweb article, When Mood Meets Alcohol and Substance Use. The two segments help open and close the article, but surprisingly they work together as a blog piece without the intervening content. Without further ado ...

In the fall of 2011, I experienced an aha! moment into the true severity of this condition. I was having dinner with a group of individuals involved in NAMI (National Alliance on Mental Illness). NAMI was founded in the late seventies by parents with kids with schizophrenia and all these years later these individuals still form the core of the organization's membership.

Inevitably, the conversation turned to their kids. The intractable nature of their illness, the heartbreak they put their families through, hospitalizations, homelessness, run-ins with the law, on and on. Naturally, I assumed they were talking about schizophrenia. Then one parent mentioned bipolar, then another, then another.

Bipolar? For the most part, even those facing severe challenges manage to settle into some kind of quasi-life. Yes, all hell may occasionally break loose, but the emphasis is on occasional. What I was hearing was different, way different.

You guessed it. It wasn't "just bipolar" I was hearing about. Thanks to drug and alcohol abuse in the equation, life's degree of difficulty for all parties concerned went from "challenging" to "just about impossible." The stories that night jibed with other accounts I had heard over the years from parents and loved ones, plus no end of conversations I have had with individuals experiencing the condition.

How bad is it? Recall, at first I thought these parents were talking about schizophrenia. That's how bad it is. 

Many people I have met in DBSA support groups clearly benefit from also attending AA and NA, but there are limits to this type of divided support. The divide exists across clinical services, as well - with sharply segregated specialities operating in their own isolated silos - despite the fact that expert opinion strongly supports integrated treatment. How ridiculous is that? Consider this passage from Voltaire's "Zadig."

Zadig was more dangerously wounded; an arrow had pierced him near his eye, and penetrated to a considerable depth. ... A messenger was immediately dispatched to Memphis for the great physician Hermes, who came with a numerous retinue. He visited the patient and declared that he would lose his eye. He even foretold the day and hour when this fatal event would happen. "Had it been the right eye," said he, "I could easily have cured it; but the wounds of the left eye are incurable." All Babylon lamented the fate of Zadig, and admired the profound knowledge of Hermes.

In two days the abscess broke of its own accord and Zadig was perfectly cured. Hermes wrote a book to prove that it ought not to have been cured. Zadig did not read it ...

So here we are, our entire treatment and support system in a state of myopia, with doctors of the left eye and doctors of the right eye not talking to each other, totally blind to the real phenomenon - dual diagnosis, co-occurring disorder, whatever you want to call it. Again, how bad is it? Recall my aha! moment with those NAMI parents.