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The Road To Fort Worth

Read » Chapter 8: Danville


The Challenge of Treating Dual Disorders

In psychiatry, a dual disorder is defined as the co-existence of a substance abuse disease and a mental illness. In my history, my addiction to alcohol progressed as my panic attacks increased in frequency in an almost linear fashion. Panic disorder did not cause my alcoholism. I have a genetic predisposition to alcoholism and have no doubt that the disease would have progressed in the absence of panic disorder.

Early in the progression of panic disorder, I discovered that drinking would wash away the feelings of terror that overwhelmed me. The following excerpt from my book illustrates the tranquilizing effects of alcohol:

"Jack entered the Canterbury Inn at midnight, sat at the bar, and ordered an Old Forester on the rocks. He took a sip, then another and another, and one, two, three, like magic, the terror haunting him was driven out into the ether."

Alcohol dissolved my fears within seconds and within a year or two of experiencing my first panic attack, drinking became the only way I had to deal with the attacks. In the late sixties through the early eighties, when I had a spontaneous remission from panic disorder, anxiety disorders were not clearly understood, and there weren't effective therapies available at that time. I wrote about my dilemma in another excerpt from my book.

"Jack accepted the offer, packed the essentials and moved in with his sister in Virginia. The problem that he had with anxiety, compounded by his enormous drinking problem, wasn't something that could be treated solely by the love of family. He needed support, but he needed far more from the professional community. First, he needed to stop drinking, and he wouldn't do that without some kind of assurance that help would be available to treat his emotional problems. Neither the doctor in Freeport, nor the psychiatrists had been able to help him, and he didn't know where to find the help that he needed. He grew up in a family that was tight lipped about sharing feelings, the way everyone was in those days. Tell me you have a physical problem, and you'll get whisked off to a doctor, but don't tell me your deepest, darkest emotional secrets. I have problems of my own. Pull yourself up by your boot straps, suck it up and go on with your life. Jack needed help."

Today, there are effective therapies for treating panic disorder, which include a course of Cognitive-Behavioral Therapy (CBT), and ongoing support, combined with psychotropic medications. The chemical defense may not be necessary in some cases, or it may be employed on a short term basis. Continued use of medications is often a necessary component of therapy depending upon the severity and longevity of the disorder.

The challenge to therapists is that alcoholics are highly resistant to eliminating their drug of choice from their lives, but are highly receptive to therapy that offers a way to control their panic attacks. The effectiveness of therapy is dependent upon an individual's continued sobriety.

Until recently, the majority of chemical dependency treatment centers have not addressed dual diagnosis, a critical component in recovery for someone with a co-existing disorder. Unless both disorders are treated simultaneously, the probability of maintaining long term sobriety is greatly reduced. Today, many treatment centers are implementing dual diagnosis therapy.

The other challenge for both the dually diagnosed and the therapeutic professionals is the problem of relapse. With the use of medications, that often potentiate the effect of drugs and alcohol, the problem becomes more severe. And there is the tendency for doctors to resist prescribing helpful medications when they know that a patient is an addict.

The good news is that researchers and therapists are addressing the challenges of dual diagnosis: resistance to therapy and relapse. Because relapse often occurs in the recovery process of many addicts, it can be viewed as a step forward when the client learns from the experience and continues to maintain his sobriety.

Copyright ©2012 Michael Jackson Smith


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