One of the biggest failures of dual diagnosis treatment is that we often label those active in addiction or early in recovery with mental health conditions that they don’t have. One of the benefits of “old school” treatment was the recognition that an accurate baseline is unattainable prior to significant sober time (six to twelve months ideally). There are certainly times when addiction is masking and/or medicating a major mental illness, but too often clinicians jump to premature findings.
The old adage that applies here is that if it walks like a duck and quacks like a duck, it’s probably a duck. Unfortunately, many of the behaviors exhibited by those who have lived with addiction simply mimic organic conditions like Bi-Polar disorder, Attention Deficit Disorder, and Major Depressive Disorder. These false (grossly over diagnosed amongst addicts & alcoholics) diagnoses tend to become self-fulfilling prophecies in which the person is unwittingly given enormous fodder for explaining away and rationalizing their behavior. This flies in the face of “old school” focus on accountability and personal responsibility.
The temptation of simply blaming our way of being on an organic illness is extraordinary. If we are willing to adopt a victim mentality (no hardship for an active addict or alcoholic) we exonerate ourselves of blame. Worse, when we are medicated for symptoms that are a natural outcome of addiction (feelings of anxiety, depression, mood instability) we muddy the waters at a juncture in which attaining clarity is vital. Still worse, we may be prescribed medications that are addictive when we’re trying to get clean and sober.
I once worked with a young man who had studied far too much psychology. He presented himself to me with several plausible diagnoses that he felt described his condition. I listened to his stories and concluded that his primary issue was being an active alcoholic. He acknowledged this offhandedly but then demanded, “And what else?” In talking further, it was very clear that he considered himself severely mentally ill. I gave him the good news that he was a “garden variety drunk.”
It’s funny how differently people react when I tell them they’re not crazy. Most alcoholics and addicts are dubious about my claim. I explain that there are countless adages and useful expressions in the halls of AA & NA but that the phrase, “The insanity of our disease…” is actually a literal statement. Addiction looks like, acts like, and feels like insanity. It is – it’s just not a condition we’re going to treat with medication and it’s not a condition that can be improved without abstinence.
Ultimately the young man experienced relief. He explained, “It’s good to know that I don’t have some rare condition or terrible prognosis. All I have to do to get better is stay sober.” I agreed with him in spirit. Getting sober doesn’t necessarily make life better – it keeps it from getting worse. Recovery is the transformative process that makes life better.
Being a “garden variety drunk” is liberating. It means discovering that we are not unique and that millions have struggled and suffered as we have. Instead of