Double Trouble: Mental Illness and Addiction, Part 2

By Richard Zwolinski, LMHC, CASAC

Dr. David Sack of Promises Treatment Centers

On Wednesday, we featured the first part of our interview with Dr. David Sack, psychiatrist and CEO of Promises Treatment Centers. Today, we continue our conversation about co-occurring mental illness and addiction, also known as dual-diagnosis, with Dr. Sack.

RZ: Today, more and more addiction and mental health treatment providers are recognizing that co-occurring disorders are quite common. It used to be that addiction treatment programs didn’t always recognize that large percentages of their clients were mentally ill chemical abusers (MICAs), unless their mental illness was very apparent. Now mental health care providers are getting on the bandwagon and beginning to recognize that many of their patients are medicating themselves with everything from wine to prescription pain killers to illicit drugs—leading to potentially serious chemical abuse problems. Do you have any suggestions about how to motivate mental health care patients to be more upfront about substance abuse?

DS: Mental health patients share the biases of the rest of our society. They experience shame and stigma from their mental disorder and this is amplified when it comes to drug abuse. In the U.S., 90% of individual with drug abuse or drug dependency do not seek treatment. We should not be surprised that MICAs face similar issues.

RZ: That’s so true. Also, many MICA patients who are in an outpatient or continuing day treatment program know that if they admit they are using, they will be referred to coordinated substance abuse treatment or face discharge. I find that many are fearful of this reality. One way to motivate people in outpatient mental health treatment is to educate them. First, the mental health professional must understand that most patients really don’t want to have a mental illness — they want to recover (or be symptom free). I believe it’s important for therapists, whether in private practice or in a clinic, to present information to patients about the consequences of using substances or alcohol, that is, how it can hurt their mental health recovery. I really like working with MICAs because they understand suffering in a unique way and they really want to be relieved of that suffering. My experience has been that MICA patients respond better to gentle, non-judgmental support, encouragement, and also, very importantly, education. Also of importance for therapists is if they suspect substance abuse they need to act like a persistent, but gentle detective because as you pointed out, their patients are experiencing shame and stigma and might not share the facts about their chemical dependence openly.

RZ: What should people who have been diagnosed with a mental illness and addiction look for in a treatment program?

DS: First and foremost they need to know that mental health assessment and treatment is integrated into the program. Evaluation by a psychiatrist is critical as is therapy with a licensed mental health professional who is knowledgeable about their disorder. Many of these clients do poorly in psychiatric hospital and mental health center settings, whose staff may believe that since the drug use was ’caused’ by their psychiatric problems that the drug use will stop if their symptoms are controlled. We have found that MICA [patients] need specific drug education treatment and that if their use goes unmodified it is unlikely that that their other mental health treatment will be successful.

RZ: Exactly. Also, they need to know they can get support with special AA/NA groups for people with mental illness with different names in each state. Google “support groups for dual diagnosis” plus your state for more information.

RZ: Can you tell us a bit about Promises Treatment Centers? How long is the typical stay at your program? What kinds of care do you offer? How do you measure success?

DS: Promises is one of the oldest free standing drug and alcohol treatment programs. We evaluate and treat clients with primary drug or alcohol problems and co-occurring disorders. We focus on meeting each individual’s needs through a range of treatments that include psychiatry, individual psychotherapy, neurofeedback, acupuncture, yoga, and meditation, in the context of a spiritual program that supports abstinence and recovery through twelve-step programs.

We look at success in a number of ways:

First, did the client complete treatment, since we know that nearly all of the clients who leave treatment early, relapse.

Second, were the client’s specific needs and the needs of their family addressed?

Finally, after clients leave the program, we monitor their progress through alumni support groups, telephone contacts, and surveys to evaluate whether they are sober and if there are improvements in their quality of life.

RZ: That is so important. If someone reading this is considering entering addiction treatment they should ask how the program follows up with patients and determines its successful outcome rate. It sounds like Promises’ model is very comprehensive in this regard.

Thank you so much, Dr. Sack. The information you shared was extremely detailed and important. It has been an honor to have you join us.

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Richard Zwolinski, LMHC, CASAC is the author of Therapy Revolution: Find Help, Get Better, and Move On Without Wasting Time or Money and is an internationally licensed psychotherapist and addiction specialist with over 25 years experience as well as a consultant to organizations and companies in the fields of mental health and addiction. Learn more about Richard here.

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Adam at 10:09 am on February 18th, 2010

Thanks a lot for sharing this practical and compassionate interview with us.

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Richard Zwolinski at 8:35 pm on February 20th, 2010

Hi Adam,
You are welcome! It’s important for students and professionals to remember to evaluate for substance abuse and mental healh issues (and medical issues that can imitate or instigate psychiatric disorders, a topic I hope to address later on.
Best,
Richard

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KP at 6:15 pm on April 28th, 2010

12-steps programs do NOT work! 95% failure rate. I wish professionals in the treatment INDUSTRY would quit talking about AA/NA as the only thing that works. A “spritual” solution to the addiction leaves many people who are suffering even more discouraged. Please don’t forget other help such as Rational Recovery, SMART, etc.

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Richard Zwolinski, LMHC, CASAC at 6:28 pm on April 28th, 2010

Hi KP,
12 Steps do work for many people. But not for everyone. And having the peer support of a 12 Step program in addition to therapy and medication is helpful. I haven’t heard the 95 percent failure rate before. But, in general I agree that the evidence shows treating addiction as a disease with all that that entails has the best results.

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KP at 4:19 pm on April 29th, 2010

Here, let me help you understand the 95% failure rate. Please take a look at the Valliant 1995 study:

The A.A. failure rate ranges from 95% to 100%. Sometimes, the A.A. success rate is actually less than zero, which means that A.A. indoctrination is positively harmful to people, and prevents recovery. Some tests have shown that even receiving no treatment at all for alcoholism is much better than receiving A.A. treatment:
One of the most enthusiastic boosters of Alcoholics Anonymous, Professor George Vaillant of Harvard University, who is also a member of the Board of Trustees of Alcoholics Anonymous World Services, Inc. (AAWS), showed by his own 8 years of testing of A.A. that A.A. was worse than useless — that it didn’t help the alcoholics any more than no treatment at all, and it had the highest death rate of any treatment program tested — a death rate that Professor Vaillant himself described as “appalling”. While trying to prove that A.A. treatment works, Professor Vaillant actually proved that A.A. kills. After 8 years of A.A. treatment, the score with Dr. Vaillant’s first 100 alcoholic patients was: 5 sober, 29 dead, and 66 still drinking.

In short, the A.A. meeting room has a revolving door. The therapists, judges, and parole officers (many of whom are themselves members of A.A. or N.A.) continually send new people to A.A., but those newcomers vote with their feet once they see what A.A. really is. Even A.A.’s own triennial surveys, conducted by the A.A. headquarters (the GSO), say that:
81% of the newcomers are gone within 30 days,
90% are gone in 3 months, and
95% are gone at the end of a year.
That automatically gives A.A. a failure rate of at least 95%.

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