A New Approach to Co-Occurring Disorders

What is the new approach and new information about Co-Occurring Disorders (COD)? Does it apply to our attendance in Double Trouble in Recovery (DTR) groups or Dual Recovery Anonymous (DRA) groups, both of which are 12-step programs based on the Alcohol Anonymous (AA) model?

I believe that Co-Occurring Disorder is a similar term and concept, but is now used to treat a person with the mindset that multiple conditions are related to each other, rather than considering a person’s “double or dual” conditions as mutually exclusive. We have been “coin-flipping” people with several disabilities, and have left people to make a connection between multiple conditions on their own, or to just deal with the confusion.

As a dually-diagnosed person in recovery, who has led DTR and DRA groups, I can see how our target has been missed The question comes up: Do we talk about mental health in the DRA or DTR groups if the patient is already in a mental health facility, being treated there or elsewhere, for a mental health issue? I posed this question to members in one of my groups and the answer was a resounding, “No!” – they had only dealt with the substance abuse and alcohol related issues. I started bringing in recovery-based information to both types of groups. All the members seemed to respond in a positive way, with more open discussion and participation.

There are other issues with the 12-step process. The most notable is, in fact, why we even have dual recovery 12-step programs, such as DRA and DTR, in the first place. There always seems to be negative association attached to persons with mental health issues attending programs such as AA and Narcotics Anonymous (NA). The negative viewpoint appears to be based on the lack of awareness of the use of prescription psychotropic drugs, and a lack of overall awareness of mental health.

Today, in New York State, a totally different approach has been introduced to this “coin-flipping.” The Office of Mental Health (OMH) and the Office of Alcohol and Substance Abuse Services (OASAS) are teaming up to address Co-Occurring Disorders. Another new approach being examined is called Focused Integrated Treatment* (FIT). FIT claims that both mental health and substance abuse issues must be treated together, by one practitioner in the same place, instead of by two different practitioners in two different “places,” hence, “agencies.” The belief is that FIT will lessen relapse rates, promote recovery, and improve overall standards of living for dually-diagnosed persons, from both arenas (substance abuse and mental health).

The theory behind FIT is that persons with mental health issues are more likely to have substance abuse issues, and vice versa. Thus, it makes more sense to study and treat the issues together, as a doctor would if a patient had two physical illnesses, like high blood pressure and diabetes. The argument that one issue - mental health or substance abuse - causes the other is still debatable, yet the understanding that the interaction between substance/ alcohol and prescription psychotropic can lead to relapses and re-hospitalizations seems non-contentious. The promotion of FIT could help decrease relapse and help people who often return to the emergency wards.

FIT has successfully helped participants gain a better standard of living than when participants were in the two different programs. A mantra in recovery and wellness is that when you treat the whole person, you help promote one’s recovery and increase the quality of one’s life.