How is treatment different for someone with a dual diagnosis?
Over half of all individuals struggling with alcoholism are also struggling with some other underlying psychiatric disorder. This has been partly addressed in Question 31 and is addressed further in Question 68. The question of whether one condition causes the other is controversial and fraught with misunderstanding. Although it is likely that depression can lower ones ability to maintain abstinence, it is unlikely that treating the depression will cause the alcoholic to remain abstinent. Alternatively, if one has struggled with long-standing depression even when sober for several months, the likelihood that sobriety will "cure" the depression is extremely low. It is best not to ask "the chicken or the egg" question of what came first because after a while it is a moot point.
For successful treatment, both alcoholism and mental illness need to be treated simultaneously. Patients and their family members too often wish to attribute one's behavior problems all to one diagnosis or the other, thinking and hoping that somehow less stigma is attached to a diagnosis of depression or alcoholism. Therefore, treatment is different only in so far as the underlying mental illness must be managed in conjunction with an appropriate rehabilitation program, not before or after the completion of treatment in the rehabilitation program. Some rehabilitation programs do not treat anyone who is on a psychotropic medication and demand that the medication be tapered and discontinued during one's stay. If discontinuation of the medication is done before a detailed psychiatric assessment is completed to evaluate the appropriateness of the medication, then this type of program is not appropriate for the individual suffering from both alcoholism and a psychiatric disorder. Alternatively, if a psychiatric assessment is performed and tapering medication appears to be indicated, then that is a reasonable rehabilitation program; however, the patient must ask the psychiatrist for the rationale behind the decision to discontinue the medication. If the patient doesn't get a reasonable explanation, then the patient cannot provide informed consent to taper and discontinue the medication. Shop around for a different treatment program, one that will address both the problem of addiction and the underlying mental health problem.
All of the programs I attend are group based. I really feel I need some individual treatment. What should I do?
Many, if not most, patients express an initial reluctance to attend group therapy, thus preferring individual therapy. They think they will feel more at ease and get better care. Although individual therapy provides more individual attention, it generally cannot provide the daily treatment that group therapy can. Published studies generally show no differences in success rates between these two forms of therapy. Group therapy is more cost-effective. The likelihood of getting individual therapy is low unless one is willing to pay at one's own expense. The focus should be on outcomes. Real success depends more on staying in treatment than on the type of treatment. Group therapy can offer something individual therapy cannot: an opportunity to find a support group. At least one person in the group will be the person that one can really connect with in a way that supports sobriety unlike any other connection. The feeling that a professional therapist just doesn't understand often leads to mistrust and an easy excuse to stop treatment. With group therapy everyone understands, and often one individual really understands in a way that is both supportive and profoundly helpful. Alcoholism can be combated only with strong support systems. The more people the individual reaches out to, the greater the likelihood of finding those key supports. After a brief period of time, everyone overcomes the initial reticence to speaking up in a group. The cohesiveness that develops among the group members is unparalleled in its power for the individual feeling understood and supported.