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Experiencing Treatment for Co-Occuring Disorders (Mental Illness & Addiction)

Jabberwocky

Jabberwocky

Frumious Bandersnatch
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Experiencing Treatment for Co-Occuring Disorders
for those with experience of the treatment of mental illness & addiction

So there is another thread I read this morning where the OP asked about basically what I'm about to ask about, and I really thought it would be useful for us to discuss this here in SL openly and honestly. We have a sticky on Treatment experiences, so what about one for Treatment of Co-Occuring Disorder experiences?

My question, for those of your with both mental illness and addiction, particularly those who have experienced any type of treatment for both mental illness and addiction, or only one and not the other (I'll provide an example below):

  • What has your experience been like?
  • What worked for you?
  • What didn't?
  • What advice would you give yourself at the start of your journey, or any day before today?
  • And more generally, what has your experience of mental illness and addiction been like, regarding treatment, acuity or whatever you would care to share?

Here is what I wrote in that thread I referenced earlier, and the example of when one is given one form of treatment (say, in my case, addiction treatment) at the expense of another (in my case, mental health treatment):

toothpastedog said:
And before I go into any more detail, from rereading your first post OP, now hear this: It is highly unlikely you will truly overcome the challenges posed by addiction until you address both those and those cause by your mental illness - e.g. until you address your co-occurring disorder(s). Until I began to really address my mental illness, I was an utter failure regarding my recovery re: addiction. Once I started really, effectively treating my mental illness, my recovery re: addiction really, really took off in ways I couldn't have ever imagined.

When I first sought help with my experience of addiction, I was literally denied mental health treatment, told "We don't do that here," but still told I had to do what they did there anyways. I honestly feel that now, if I had encountered actual professionals and had my mental illness treated, even if my addiction wasn't as much the focus, early on (given my particular history of self medication however), I would have been so, so much better off today. Oh well, live and learn!
Click to expand...

In my case I was explicitly, or rather my family way explicitly, denied mental health treatment and they, nor I, knew any better when I first sought out treatment for my problems with addiction (and again, yet they told me I still had to do their course of treatment despite their acknowledgement that it wasn't at all appropriate for me, so fucking telling of the recovery/rehab industry).

Whether you were explicitly denied access to one form of treatment when you sought another, or didn't know you needed both at the same time until much later on your journey, or got what we all should get and were provided both mental illness and addiction treatment at the get go regardless of what you knew or didn't know, chosen or not, regardless, I would really appreciate to hear what you think. I have a feeling there are a lot of other BLers, Glers and lurkers who would agree.

Thank you :) I just want to let you know in advance any response I am really really grateful for, this is a kind of pet interest of mine, for glaringly obvious reasons =D
 
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Thanks for kicking this off! It's much needed. I'll try to rise to the occasion.

Background
I've been under mental health treatment since childhood. But I began taking it more seriously (trying to find good doctors, researching my meds etc) in my 20's. I'm now in my mid-40's. For what it's worth, I have major depressive disorder and variously named anxiety disorders. I have about four suicide attempts under my belt (some bad dope experiences may or may not have been suicide bids). My mom is schizophrenic, as are several of her sisters.

I've been Rx'ed zoloft, wellbutrin, clonazepam, and trazedone for years, with other meds coming and going.

In terms of illicit stuff, I've been an IV heroin addict for about 3 years. I've been in various forms of "recovery" treatment for about a year: NA, SMART Recovery, various IOP programs (never inpatient rehab, though).


My Experience
It's been my experience that the relationship between psych treatment and addiction treatment is asymmetrical. That is, I've found my various psychiatric practitioners to be--for the most part--keen to understand how addiction and other forms of self-harm interacted with my mental state. In fact it was my current psychiatrist who suggested that I should explore suboxone treatment. But in the other direction, things were different: recovery professionals have almost always met my interest in (and demand for) qualified mental health treatment to be an affront to their brand, their relationship with me, their patient/client.

Full disclosure: Thankfully I never had drug use going on during inpatient psych treatment. I suspect that would have been a worse experience.

Now for the asymmetry. With the exception of my suboxone doctor, every person I've interacted with in the "professional" recovery world has given me bad, ignorant, and often dangerous advice, with respect to mental health. I'm mostly looking at you, NA, though SMART recovery wasn't a lot better. My two CBT therapists were nominally "psychiatric professionals," but even they had a frightening indifference to issues such as suicidality. They were "OK with" me doing more personal, humanistic therapy, but they assured me that it wouldn't do much good (they're very proud of their halo of evidence-based results, though those are now being called into question).

The overarching trouble I found was that practitioners in the recovery world--almost to a one--operated under some orthodoxy, some view of addiction that made other avenues of treatment (particularly mental health treatment) a nuisance or worse. Their professional (or at least their social) authority was at its strongest when my energy was focused only on their demands and promises.

Are there rehabs, NA groups, etc. who aren't so provincial? I'm sure there are. But I've crossed paths with a lot of people from the recovery professions who I wouldn't trust to run a hot dog stand, let alone my personal well-being.

People facing psychiatric and/or substance abuse treatment are de facto giving up a certain amount of autonomy, we're putting trust in people and organizations that are basically opaque. My strongest advice for all of us (including myself b/c I'm sure I'll forget) is always to demand what you feel you need and if at all possible try to involve many people from many professions in your treatment. To the extent that you can, try them on for size, interview them, and if they're telling you to drink their kool-aid and you don't want to, don't be afraid to get the fuck out.

Unfortunately, the truth of the matter is that for many of is, choice isn't an option. But if it is, try to use it!

Good luck, everyone.
 
I'm completely new to the boards. Been lurking for a week or so. I'm currently trying to ween off subutex. I have major depression/anxiety issues. I'm super scared because of my normal level of anxiety, and the fear of it going up is anxiety inducing in itself. I used Subutex as a crutch to help stop drinking. I was just switching drugs. I don't have much of a history with opiates, so the subutex got me high. I used Subs for 5-6 weeks. I'm scared to death about withdrawing and I don't even know if I will. Highest dose was around 6mg a day. I'm down to somewhere between 1 and 2 mgs/day. Haven't taken any for almost 48 hours. I have that feeling of impending doom because of the terrible experiences I've read on these boards. Anyways, I really feel as though some treatment centers focus too much exclusively on the actual drug and the addiction, and too little on the mental health aspect. It's almost like the doctors had never heard of dual diagnosis.
 
gator guy said:
Anyways, I really feel as though some treatment centers focus too much exclusively on the actual drug and the addiction, and too little on the mental health aspect. It's almost like the doctors had never heard of dual diagnosis.
Click to expand...

Welcome to BL gator guy! I'm sorry to hear of your situation, I hope you make the best choices and work things out for yourself asap. I hope we can keep things on topic here, given the significance of the subject matter. And along those lines, I could't agree with you more. Everyone in TDS, SL and MH are rooting for you. Keep us abreast of your progress (or lack there of), as we would love to support you (and I know I speak for a lot of people here, genuinely and truly so).

Even the one treatment center that did offer true co-occurring disorder treatment I have gone to (I've been in about six programs altogether) still won't allow people on methadone or benzodiazepines to formally do both their chemical dependency and mental illness programs. It's so sad, especially because they have a wonderful mental illness program. I can't wait to see things change, and I'm looking forward to helping that transition along!

Thank you for your input simco, I really, really appreciate it (I'm 28 btw, I forgot to tell you in my pm to you). I am looking forward to adding more about my own history here, but for now bits and pieces will have to do. This is so awesome, I can't thank you enough my friend <3

There is so much stigma out there surrounding mental illness and addiction, not to mention people who experience both!, I am just blown away by how amazing it is that people like yourself M are willing to open up and share with us! I wish I could give you a hug and a ginger snap! Well, since I'm sick maybe not a hug, but definitely some tea and a cookie :)

Awesome man, thanks to both of you!
 
Thanks for the encouragement and nice words, toothpastedog. It really is great to hear from people who understand you, for a change. I'm on my phone, so I'll wait to elaborate later when have a keyboard. One thing that really struck me, and I can't agree more with, is the stringent no benzo or methadone position that these treatment centers enforce. I understand that it is different for everyone and that some should not take these meds. For me personally, I have struggled so so so much with anxiety, while using and also drug free that I find it almost akin to cruel and unusual punishment to blankety enforce the no benzo approach. I suffered almost unbearable anxiety and depression as a child, well before I ever popped a pill or beer. I'm prescribed Klonipin. At one point I was at 2mg 3x day. I'm at 2mg 2x day now. My doc asked me to try and lower my dose and it wasn't a problem for me. I have legitimate needs for relief for a mental physical anxiety that induces is worse than the negatives of withdrawals, some of the time. My Dad and sister are docs. They don't agree with this approach either. They lived with me incapacitated, losing jobs, and my life's goals to uncontrolled mental health issues that addiction docs tend to belittle and/or ignore, only to focus on the addiction, one size fits all approach. This is all just my opinion and my feelings that have been formed through my personal experiences. I really feel for all you guys and admire you all. It feels great to have people understand my problems but, at the same time, I don't want anyone else to have to suffer like we do suffer. I wish you all the best. Thanks for letting me share guys.
 
I'm bipolar and an alcoholic. When looking at rehabs the one we chose claimed to treat dual diagnosis.
They didn't tell us that the program I would be assigned to didn't, only the longterm 3 month care program that only dealt with more serious cases.
Most of the counselors weren't very educated on mental health issues, they kept going back to the drinking. Even though I tried to explain that my drinking habits seemed to stem from either manic or depressive episodes and the reckless decision making from bipolar led to the bad decisions I made involving alcohol.
One counselor even told me I might not even be bipolar that it could just be that I was mixing psych meds with alcohol and that was making my moods and actions unpredictable. Meanwhile I'm telling her I have a written diagnosis from a doctor from years before I bacame a problem drinker.
They also insisted on giving me certain detox meds that when I listed off to my family and they double checked were actually very bad for bipolar and also interacted with my own meds.

However I've had a positive experience post rehab. I see a regular therapist in addition to seeing a therapist in the same practice who specializes in addiction. And of course my psychiatrist.
 
I've had the same thing happen M. Went inpatient for alcohol and the doctors refused to acknowledge my depression/anxiety issues, except for pertaining to my addiction. They refused to treat my mental health problems independently. They told me the same thing. They said that my mental health issues stemmed from my addiction and that if I got sober I would just be great. Only problem being is that I had the mental health problems pre addiction. Apparently that didn't matter to them. They basically said to trust them. I stayed inpatient for 14 days or so and the doctors advised I follow up with intensive outpatient program, which I did. Four nights a week. Four hours a night. I was sober for months but in a major depression. Sobriety did not help I'm sad to say. Long story short, I was so sick from being depressed that I was suicidal and hospitalized in the same facility but in a different wing that specializes in mental health. The doctors focused on mental health and even prescribed Klonopin for me for sleep. I got stable with my meds and was released after a couple weeks, stable and feeling good. Of course short thereafter I started using again.
 
Suboxone "worked" for me, in the sense that I eventually stopped using opiates all together. It's going to vary from person to person.

Nothing else really works for my PTSD. I am not really willing to try antidepressants. I would get on α blockers but doubt I will ever get prescribed them in the near future.
 
Wellbutrin and methadone, in conjunction with individual counseling and lots of group therapy (mental health group therapy as opposed to just chemical dependency group therapy) seems to be working really well for me. I can't wait to get off the methadone though.

Thank you for all your responses folks! I'm really pleased to see all this wonderful teachings emerge from your posts :)
 
Another problem with dual diagnosis treatment is the obvious bias of most addiction professionals (some who aren't even true professionals, just former addicts with a certificate to counsel) against psychiatric medication. To some people a drug is a drug is a drug. But when you have a true chemical imbalance you can't just have a higher power take it off you or meditate it away. You may need medication (although I'm not discounting the people who control their illnesses without meds because some people do that and it works for them). But too many non-doctors try to tell you that you don't need the meds or that using meds keep you from being truly sober.
I'm on a well regimented cocktail of mood stabilizers and antideppressants. I see my doctor and get regular bloodwork. Finding the right mixture of medication has been more helpful in keeping me sober than rehab itself because it keeps me stable enough to realize that I'm an alcoholic who can't have a just a few drinks without dire consequences. Not that addiction counseling and rehab were useless, I learned coping mechanisms and other skills, but I don't think I could utilize them without my bipolar being controlled first and foremost.
 
Thank you.
My mother always compliments me on the fact that I take my medication willingly and regularly and never pull one of those "I feel great, I don't need these..." Which is common with bipolar patients and often results in tragedy.
We joke that I have a philosophy of "accept the crazy" where I openly admit to the fact I have a problem and I do what I have to do to control it.
 
Mmp85 said:
Thank you.
My mother always compliments me on the fact that I take my medication willingly and regularly and never pull one of those "I feel great, I don't need these..." Which is common with bipolar patients and often results in tragedy.
We joke that I have a philosophy of "accept the crazy" where I openly admit to the fact I have a problem and I do what I have to do to control it.
Click to expand...

Accept and Own your madness baby! That's the way to heal as you walk the path otherwise known as Recovery:)
 
What has your experience been like?
My experience is that you really need to be selective when seeking a rehab. Behavioral therapy rehabs as opposed to 12step based rehabs tend to have much better co-morbid addiction counseling protocols.
What worked for you?
For me, finding a good therapist after attending a two month rehab that actually worked on me with my issues. For once there was a psychologist that understand OCD and has also worked with people on it. He and it did a course of CBD, and I continued to pursue it after rehab. The other thing that really works for me is being on medication. I only rarely take my xanax now, and only when I know a panic attack is coming on. As for my major depressive disorder I take zoloft, which actually helps with my anxiety as well. The psychiatrist I went to through lifestream was not very good. She only spent about ten minutes with me and kept changing my doses of medication or adding more medication. I have agoraphobia as a result of the panic disorder and OCD and the course of medication she eventually had me put me in a place where I was so tightly wound and scared that I couldn't leave my couch for fear that something bad was going to befall me or my family.
What didn't?
12step programs. They kept telling me not to take my meds, and that a higher power will take it from me. It didn't matter that I explained that I legitimately have a problem that requires meds. During active use the opiates and benzos controlled my feelings really well, but eventually they stopped working and I became an even bigger ball of neurotic anxiety.
What advice would you give yourself at the start of your journey, or any day before today?
When I first diagnosed they put me on prozac which did not work. In fact it had me up all night every night cleaning and organizing things over and over and over again. I ended up not trying meds again for a long time which led to me going back to active use. I would tell myself that just because one med doesn't work, that is no reason to not work with your psychiatrist to find something that does. All the time I spent feeling like I was batshit crazy could have been a lot easier on me if only I had continued with my psychiatrist and therapist at the age of eighteen. I had been in therapy since childhood and I guess I had been burned out on it as well. I would have told myself that maybe you should seek a different therapist with some fresh ideas.
And more generally, what has your experience of mental illness and addiction been like, regarding treatment, acuity or whatever you would care to share?
The only general idea that I want to share is that most addicts have a co-morbid mental health disorder along with substance abuse disorder. It is paramount to your recovery to seek treatment for your mental health in order to have sustainable long term sobriety.
 
Hey chef hit me up direct message. I clicked on your name to try but I'm really busy and I couldn't find how. I'm in central Florida and back in the day used to deliver all the meals to the life stream centers.
 
It took me years to chemical depndency treatment alone to address my mental health issues, and even then im still working through them, particularly in terms of trauma and medication.
 
MICA, or mentally ill and chemically addicted, has somewhat of a stigma attached to it. Years ago, I was labeled "MICA." Not only was I an addict, but I also had mental health problems to adjust to. When I was being told the story of MICA and how it affects you, etc. etc., I thought aren't most addicts also mentally ill? For example, an alcoholic quits alcohol after 20 years of heavy drinking. He now has a liver problem and is depressed. Does this mean he is MICA? Lots of addicts get depressed when they quit, that's just a way of life. I don't think MICA is an effective program, and it misses some important issues.

Just my two cents.
 
When I did 28 day rehab for punching out a cop(28 days or jail. I took rehab). I had to threaten to leave when the intake doc said I couldn't get my kpins in there. With my ptsd that is the only thing that works at keeping flashbacks in the night at bay. I was there for booze and to stay outta jail and no criminal record. Wasn't even addicted to opiates then

. My career was over, my husband died so I got drunk and when a cop tried to man handle me(he should not have grabbed me from behind knowing I was a vet with PTSD not long out of a war zone, sorry he deserved it). They said it was their policy blah blah blah.. I told them about my ptsd. About ssri's making my nightmares and anxiety worst and the countless doctors that settled on kpins because that's all that would work. Dumb ass doc said he wanted to switch me to an antidepressant that I had to go to emerg for taking from a bad reaction. Needless to say I'm a stubborn asshole so I got to keep my benzos. After hours of arguing , calling my doctor, and threatening to leave. No one there had a clue on mental illness , I had to explain that they were going to risk my recovery(I wasn't a drunk just didn't want jail lol) all over a medication that specialist had me on over a year Finally they realized I wouldn't cave and I was there as a civi but under my C.O' orders. If I wasn't the only combat veteran there and they were not worried how bad it would look on the place if I walked out back to base angry and all because the didn't understand my mental issue and tried to cut my only med that worked they would have string armed me until I gave in and any recovery would have been tossed out the window. Pissed me off. I'm quite vocal and stand up form self but what about others who don't ? How many have left that place because they didn't want Paxil drove down their throat? My ptsd led to my addiction to treat my addiction but to ignore the root cause is absolutely crazy.
Looking back I should have dropped the kpins. Back then I was waking with night terrors and fiashbacks every night. I wouldn't have slept and no one else would have either
 
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