by Tim Hamilton
New Self-Help Over a decade ago, men and women in dual recovery began forming new self-help programs in various regions of the country. Gradually, several organizations independently developed their own twelve step approaches and began to provide meetings. Today, these organizations include, Double Trouble in Recovery, Dual Disorders Anonymous, and Dual Recovery Anonymous. Currently, dual recovery self-help meetings are being held in agency and in community settings in both the United States and Canada.
Recognition In recent years, dual recovery self-help organizations have been identified as a source of support for people in recovery from dual disorders.1, 2 They have also been described as special need groups for people in recovery from substance addictions.3 Organizations that include the National Alliance for the Mentally Ill,4 and the National Mental Health Association have published newsletter articles that have identified dual recovery self-help organizations.5 The Substance Abuse and Mental Health Services Administration (SAMHSA) has produced documents identifying dual recovery self-help organizations. The publications include, “Assessment and Treatment of Patients with Coexisting Mental Illness and Alcohol and Other Drug Abuse” TIP 9,6 and “Co-Occurring Psychiatric and Substance Disorders in Managed Care Systems”.7 In Addition, the new dual recovery self-help organizations have been described as important signs of progress in two respects. First, they encourage men and women who are affected by dual disorders to take responsibility for their personal recovery. Second, they reflect a growing trend toward consumer empowerment.8
A Need For Dual Recovery Self-Help Several reasons underscore the need to develop programs to provide support to people in dual recovery.9
Stigma Today, many people in the general public have not yet learned that chemical dependency and emotional or psychiatric illness are “no-fault” illnesses. They are not aware that people can recover from both illnesses with effective care and support. As a result, many people develop negative attitudes that are based on limited or false information. Unfortunately, these negative attitudes may surface within a meeting. When that occurs, people in dual recovery may find it difficult to maintain a level of trust and safety in the group setting.
Inappropriate Advice (Confused Bias) Members of a group want to see newcomers share in the opportunities for recovery. Older members recognize the real problem of cross addiction and are aware that some people do in fact use certain prescription medications as intoxication drugs. However, confusion about the appropriate role of psychiatric medication exist. Some honestly believe that psychiatric medications are only used as intoxicating drugs. As a result, some members may offer well intended, but inappropriate, advice to newcomers by cautioning them against using medications. It is clear that confused bias against medications creates two sets of problems. First, newcomers may follow inappropriate advice, and stop taking their medications, causing them to experience reoccurring symptoms. Second, newcomers quickly recognize confused bias against medications within a meeting, and feel uncomfortable, keeping a significant aspect of their recovery a secret.
Direction For Recovery A strength of Twelve Step fellowships is their ability to offer direction for recovery that is based on years of collective experience. Dual recovery programs offer an opportunity to draw on the experiences and feelings that members have encountered during the progression of their dual disorder and the process of their dual recovery. In turn, that experience can be shared with fellow members and newcomers to provide direction into the pathways to dual recovery.
Acceptance Twelve Step fellowships provide meetings that offer settings for recovery. Dual recovery meetings may offer members and newcomers a setting of emotional acceptance, support and empowerment (E.A.S.E.). That setting provides opportunities to develop a level of group trust where people can feel safe and share honestly.
Dual Focus Twelve Step fellowships have achieved their success and endured over the years, in part, because they maintain their single primary purpose. The primary purpose of dual recovery programs is to provide opportunities for members and newcomers to focus on recovery from both chemical dependency and emotional or psychiatric illness.
Dual Recovery Self-Help The new organizations help people focus on the need to manage both illnesses, and on personal recovery. Each organization provides a format to conduct their meetings, and provide a setting for recovery. During meetings, members and newcomers have an opportunity to experience emotional acceptance, support and empowerment. They may begin to feel a new freedom from a sense of alienation may be reduced as they find dual disorders are common and they are not alone. They may experience a feeling of validation, as they learn from others that, dual disorders contribute to problems, pose risks, and create challenges that undermine recovery. They have an opportunity to find hope and learn that dual recovery is believable and achievable. Each organization also provides their own steps that are adapted from the Twelve Steps of Alcoholics Anonymous (AA). The Steps provide a plan that can help people to organize and structure their resources and provide direction for their dual recovery. They also provide opportunities for people to learn new ways of looking at themselves, their future, their dual disorder and dual recovery.10
Twelve Steps For Dual Recovery (DTR) Double Trouble In Recovery, (DDA) Dual Disorders Anonymous, (DRA) Dual Recovery Anonymous
1. (DTR) We admitted we were powerless over our mental disorder and substance abuse that our lives had become unmanageable.
1. (DDA) We admitted we were powerless over alcohol/drugs and mental disorders that our lives had become unmanageable.
1. (DRA) We admitted we were powerless over our dual illness of chemical dependency and emotional or psychiatric illness that our lives had become unmanageable.
2. (DTR)/(DDA) Came to believe that a Power greater than ourselves could restore us to sanity.
2. (DRA) We came to believe that a Higher Power of our understanding could restore us to sanity.
3. (DTR)/(DDA) Made a decision to turn our will and our lives over to the care of God, as we understood him.
3. (DRA) Made a decision to turn our will and our lives over to the care of our Higher Power, to help us to rebuild our lives in a positive and caring way.
4. (DTR)/(DDA) Made a searching and fearless moral inventory of ourselves.
4. (DRA Made a searching and fearless personal inventory of ourselves.
5. (DTR)/(DDA) Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
5. (DRA) Admitted to our Higher Power, to ourselves, and to another human being, the exact nature of our liabilities and our assets.
6. (DTR)/(DDA) Were entirely ready to have God remove all the defects of character.
6. (DRA) Were entirely ready to have our Higher Power remove all our liabilities.
7. (DTR)/(DDA) Humbly asked Him to remove our shortcomings.
7. (DRA) Humbly asked our Higher Power to remove those liabilities and to help us to strengthen our assets for recovery.
8. (DTR)/(DDA)/(DRA) Made a list of persons we had harmed and became willing to make amends to them all.
9. (DTR)/(DDA)/(DRA) Made direct amends to such people whenever possible except when to do so would injure them or others.
10. (DTR)/(DDA) Continued to take personal inventory and when wrong promptly admitted it.
10. (DRA) Continued to take personal inventory and when wrong promptly admitted it, while continuing to recognize our progress in dual recovery.
11. (DTR)/(DDA) Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
11. (DRA) Sought through prayer and meditation to improve our conscious contact with our Higher Power, praying only for knowledge of our Higher Power’s will for us and the power to carry that out.
12. (DTR) Having had a spiritual awakening as the result of these steps, we tried to carry this message to other Dually-Diagnosed people and to practice these principles in all our affairs.
12. (DDA) Having had a spiritual awakening as the result of these steps, we tried to carry this message to other mentally disordered alcoholics/addicts and to practice these principles in all our affairs.
12. (DRA) Having had a spiritual awakening as a result of these Steps, we tried to carry this message to others who experience dual disorders and to practice these principles in all our affairs.
Double Trouble In Recovery c/o Mental Health Empowerment Project 518/434-1393 271 Central Avenue, Albany, New York 12209
Dual Disorders Anonymous Voice Mail 847/781-1553 PO Box 681264, Schaumburg, Illinois 60168
References 1 Robert L. DuPont, M.D. (1994). The Twelve Step Approach. In N.S. Miller, M.D. (Ed.), Treating Coexisting Psychiatric and Addictive Disorders, pp 177-178. Hazelden, Center City, MN.
2 Bert Pepper, M.D. & Hillary Ryglewicz, A.S.S.W. (1996). Lives at Risk: Understanding and Treating Young People With Dual Disorder, p. 200. Free Press, New York.
3 William L. White, M.A. (1995). Pathways: From the Culture of Addiction to the Culture of Recovery, p. 451. Hazelden Center City, MN.
4 Stephen M. Goldfinger, M.D. (Summer 2000). Integrated Treatment For Dual Diagnosis. The Advocate, National Alliance for the Mentally Il, p. 7.
5 Tim Hamilton (December, 1999). Dual Diagnosis Recovery Can Be A Long Process. The Bell, National Mental Health Association, p.7.
6 Assessment And Treatment Of Patients With Coexisting Mental Illness And Other Drug Abuse, Tip (9) (1994). Center for Substance Abuse Treat-ment, Substance Abuse and Mental Health Services Administration, p.13.
7 Co-Occurring Psychiatric And Substance Disorders In Managed Care Systems: Standards of Care, Practice Guidelines, Workforce Competencies and Training Curricula (1998) Report to the Center for Mental Health Services. Substance Abuse and Mental Health Services Administration, p. 11, 19, 38, 49.
8 Ed Hendrickson, M.A. et al (Fall/Winter 1993/1994). Dual Disorders Treatment: Perspectives On The State Of The Art. Tie Lines, The Information Exchange, Vol. X, No. 4. vol. XI, No. 1, p. 1-5.
9 Dual Recovery Anonymous: A Blueprint (1993). The Dual Disorders Recovery Book, p. 221-231. Hazelden, Center City.
10 Tim Hamilton & Pat Samples (1994). Twelve Steps And Dual Disorders: A Framework of Recovery for Those of Us With Addiction and an emotional or Psychiatric Illness, p. 3. Hazelden, Center City, MN.Contact Us