Dual diagnosis is the term mental health professionals use to describe someone diagnosed simultaneously with drug or alcohol-related abuse/addiction and a separate mental disorder such as depression or schizophrenia. People who receive such a diagnosis face unique challenges on their road to recovery and restoration of physical/mental health. In a study published in September 2013 in the journal Alcoholism: Clinical & Experimental Research, a multi-institution research team examined the usefulness of 12-step self-help programs in facilitating the recovery of young adults with a dual diagnosis. The members of this team concluded that, despite the extra issues involved, 12-step attendance provides a significant benefit for these individuals.
Dual Diagnosis Basics
Under current guidelines established by the American Psychiatric Association, people who abuse drugs or alcohol—o r have physical addictions to drugs or alcohol—qualify for a mental health diagnosis called a substance use disorder. For this reason, a dual diagnosis actually involves the presence of two co-existing mental disorders. However, because of the special challenges facing someone who has simultaneous abuse/addiction issues and a second mental health diagnosis, mental health professionals find value in maintaining dual diagnosis as a separate category from other forms of coexisting mental illness.
Current figures indicate that more than 50 percent of people with a drug-related substance use disorder qualify for a dual diagnosis, while roughly one-third of people with an alcohol-related substance use disorder qualify for such a diagnosis. Conversely, about 50 percent of people affected by schizophrenia or some other severe non-drug- or alcohol-related mental illness qualify for a dual diagnosis, while almost one-third of all people with a non-drug- or alcohol-related mental illness qualify for such a diagnosis.
12-Step Program Basics
Twelve-step groups get their name because they focus on 12 progressive stages or steps in the recovery process from an addiction to drugs or alcohol. Generally speaking, these groups put a high value on abstinence from drug and/or alcohol use during recovery. To help their members achieve this goal, they use an approach that emphasizes honesty regarding one’s substance-related history and current challenges, ongoing mutual support and recognition of a higher power or some sort of larger force beyond the self. Well-known 12-step groups in the U.S. include Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Marijuana Anonymous (MA) and Cocaine Anonymous (CA). Two 12-step programs, called Dual Recovery Anonymous and Double Trouble in Recovery, specifically address the issues facing people with a dual diagnosis.
In the study published in Alcoholism: Clinical & Experimental Research, researchers from Harvard Medical School, Massachusetts General Hospital and the Hazelden Foundation examined the effectiveness of 12-step participation for people with a dual diagnosis. They conducted this examination with the help of 296 adults between the ages of 18 and 24 enrolled in a residential treatment program for various types of substance use disorder. Over the course of a year, each of these individuals was assessed at three-month intervals on aspects of program participation such as attending sessions regularly, remaining drug- or alcohol-free, finding a sponsor, interacting with other program members and progressing through each of the program’s 12 steps.
After reviewing their findings, the authors of the study concluded that, at the start of 12-step program, people with a dual diagnosis typically have more debilitating problems than their peers who only have a substance use disorder. However, they also concluded that dual diagnosed individuals commonly show a higher level of initial motivation than their peers. In terms of program effectiveness, the authors found that people with a dual diagnosis attend their 12-step sessions just as often as people who have only a substance use disorder, and participate just as thoroughly. However, dual diagnosed individuals generally have a harder time abstaining from drugs or alcohol than their peers affected only by a substance use disorder.
Significance and Considerations
The authors of the study in Alcoholism: Clinical & Experimental Research attribute the lower abstinence rate in people with a dual diagnosis to the emotional and mental stresses of various coexisting mental disorders. However, they also note that the most thoroughly involved participants with a dual diagnosis have abstinence rates equal to those of individuals diagnosed only with a substance use disorder. In addition, they note that—despite the diminished rate of drug or alcohol abstinence for some people—as a whole, dual diagnosed individuals still gain enough benefit from 12-step programs to warrant their ongoing participation.