Double Trouble Recovery SELF HELP FOR THE DUALLY DIAGNOSED

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Double Trouble Recovery SELF HELP FOR THE DUALLY
DIAGNOSED

• Presenter
• Howard Vogel
• 2005

2
Acknowledgements

• Thanks to all of the consumers who are made this
  presentation possible by sharing their
  experiences,
• And thanks to the service providers for their
  cooperation.

3
Background

• High prevalence of comorbidity with many
  far-reaching treatment implications
• More severe and chronic than single, pure
  psychiatric disorders
• Associated with a variety of negative
  consequences including clinically,
  therapeutically, psychologically as well as
  socially and economically.
• Predictor of negative treatment outcomes for drug
  users.
• AND
• Interaction between street drugs and medication.

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Self-Help Programs

• A group of individuals who share a common problem
  behavior.
• They learn to accept their problem, share their
  experiences, strengths, and hopes.
• Only requirement for attending is the desire to
  abstain from the problem behavior.
• No professional involvement.
• Most are based on some adaptation of the 12-step
  model.

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Self-Help Programs (continued)

• Recognized as a potentially cost-effective
  treatment modality.
• Often included in aftercare planning and used as
  a complement to formal treatment.
• Little research on self-help.
• Conducted with AA groups.
• Evidence that involvement self-help group has a
  positive effect on recovery.

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How Self-Help Works

• Self-help contributes to the reduction of mental
  health symptoms in five ways
• 1. Provides a social network based on commonly
  shared experience.
• 2. Facilitates move from help-recipient to
  helper
• 3. Specific ways of coping based on experience
  are shared.
• 4. Those who cope successfully serve as role
  models.
• 5. Provides meaningful structure which is
  self-generated rather than imposed from the
  outside.

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Traditional Self-Help and the Dually-Diagnosed

• ONE DISEASE-ONE RECOVERY. Recovery needs which
  fall within that single parameter are ignored,
  misunderstood, or stigmatized.
• DOUBLE STIGMA DANGER OF MINIMIZING, OR IGNORING
  THE OTHER HALF of recovery needs.
• MISGUIDED ADVICE ABOUT MENTAL DISORDERS AND
  MEDICATION can lead to non-compliance with
  medication, increased psychiatric symptoms, and
  substance abuse relapse.

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Traditional Self-Help and the Dually-Diagnosed

• Lack of identification
• NO SOCIAL/EMOTIONAL SUPPORT,
• NO LEARNING/SKILLS DEVELOPMENT, NO DIRECTION
  OR PERSONAL GUIDANCE
• Individuals with dual recovery needs cannot
  typically find the HONESTY, ACCEPTANCE, EMOTIONAL
  SUPPORT AND SHARED EXPERIENCES which are critical
  elements of mutual aid process in traditional
  self-help groups

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• A fellowship of men and women who share their
  experience, strength, and hope with each other so
  they may solve their common problems and help
  others to recover from their particular
  addiction(s) and mental disorders.
• A mutual aid program adapted from 12 step
  programs
• Primary purpose is to maintain freedom from
  addiction(s) and to maintain well-being.
• DTR also addresses the problems and benefits of
  psychiatric medication, thus recognizing that for
  many, having addiction and mental disorders
  represents Double Trouble in Recovery.

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• No dues or fees for DTR membership DTR is
  self-supporting through members own
  contributions.
• Not affiliated with any sect, denomination,
  political group, organization or institution.
• From the first group in NYC in 1989, DTR is now a
  nationwide movement. Currently, there are over
  100 DTR groups in the US, 40 in NYC alone.
• An average of 15 new groups start each year.

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• A 3.5 year effectiveness study.
• Funded by the National Institute on Drug Abuse
  (NIDA).
• Using a 12-month prospective longitudinal cohort
  of 310 members in 25 peer-led DTR groups in NYC.
• Semi-structured interview protocol

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• Male 72
• Median Age 39 years (SD8.6)
• African-American 58
• Hispanic 16
• Caucasian 25
• Other 1
• Primary Income
• Government Assistance 95
• Job 3
• Other 2

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• Less than grad/GED 41
• HS grad/GED 32
• Some college or more 27
• Living Arrangements
• Own apt/house 21
• Community residence/Apt program 52
• SRO 16
• W/friends/relatives 11

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• Ever physically abused 48
• Ever sexually abused 36
• Legal status
• No involvement 91
• Probation/parole/pending 7
• Seropositive for HIV 6

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• Age 1st emotional/MH problems 18 yrs
• Age 1st sought/received help for MH 22 yrs
• Age 1st diagnosed 30 yrs
• PRIMARY DIAGNOSIS
• Schizophrenia 43
• Unipolar (major) depression 26
• Bipolar Disorder 25
• Schizoaffective 7
• Mood Disorder 5
• PTSD 5
• median

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• Symptoms past year 70
• Emotional/mental health past month
• Very Troubled 10
• Moderately 28
• Somewhat Troubled 38
• Not at all 24

17

• Ever hospitalized for MH 89
• Ever in outpatient treatment 97
• Ever on medication for MH 100
• Median age started medication 24 yrs
• Currently in outpatient MH/MICA 91
• Length of current enrollment 8 mos.
• Currently taking medications for MH 92
• median

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• Age 1st used drugs/alcohol 14 yrs.
• 1st Substance used
• Alcohol 65
• Marijuana 23
• Heroin 4
• Crack/cocaine 3
• Why started Peer pressure/to fit in 63
• Primary substance (lifetime)
• Crack/cocaine 42
• Alcohol 34
• Heroin 11
• Marijuana 10
• Other 3

19

• Past year any drug/alcohol 47
• Any drugs 36
• Any alcohol 34
• Past month any drug/alcohol 9
• Any drugs 5
• Any alcohol 6

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• Age 1st DA treatment 28 yrs.
• Ever hospitalized for DA 75
• Ever in outpatient for DA 96
• Currently in outpatient for DA 77
• Length of current enrollment 8 mos.
• median

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• Overall, what has caused you the most problems?
• Substance abuse 29 - Mental Health 17
• Both Equally 49 - Not sure 6
• When you have symptoms, how much do you feel
  like using?
• Very much 44 - A little 14
• Moderately 17 - Not at all 25
• When/if using...
• Symptoms get worse 69
• Symptoms get better 16
• Symptoms stay the same 15

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• Overall, what has caused you the most problems?
• 1-3 months 12
• 4-12 months 25
• 1 year or more 64
• When/If you have symptoms, how much do you feel
  like using?
• Through a therapist 41
• Through a friend/assoc 19
• At drug treatment prog. 16
• When/If using...
• Twice a week or more 37
• Once a week 60
• Less than once a week 3

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• Length of attendance
• 1-3 months
• 4-12 months
• 1 year or more
• Frequency of attendance
• Twice a week or more 7
• Once a week 60
• Less than once a week 3
• How did you first hear about DTR? (Top 3)
• Through a therapist 41
• Through a friend/assoc 19
• At a drug treatment prog. 16

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• Importance of DTR in recovery
• Very important 85
• Moderately 13
• A little/not at all 3
• Importance of other DTR members in recovery
• Very important 79
• Moderately 15
• A little/not at all 6

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• Currently attending Alcoholics Anonymous 73
• Currently attending Narcotics Anonymous 64
• Speak about MH in AA or NA 49
• Reasons for attending other 12-step groups (Top
  2)
• To stay clean and sober/deal w/drug issues 51
• To hear others stories 18
• Reasons for not attending other 12-step meetings
  (Top 2)
• DTR meets my needs, dont miss groups. 32
• Dont feel accepted/comfortable. 17

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• Why do you come to DTR?
• To identify with, relate to other dually
  diagnosed people 38
• To stay clean and sober 22
• For help, support, acceptance, understanding, and
  respect 20
• How has coming to DTR affected your life and
  your recovery?
• Give me hope, support, encouragement, a new
  outlook on life 20
• Better understanding of self, issues,
  dual-diagnosis 20
• I dont use, I stay clean and sober, I am
  restored to sanity 19

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• How would your life be different now if you
  hadnt come to DTR?
• I would be using/getting high 32
• I would be confused, lonely, searching for help
  16
• Overall, what has changed in your life since you
  started attending DTR?
• Greater self-esteem, respect, acceptance,
  understand for self and others 21
• Goals and hopes for the next year
• Vocational/job mentions???? 47
• Housing 30
• Stay clean and sober 29
• Educational 20

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• As part of its effort to educate about dual
  diagnosis, DTR organized dialogues where
  consumers and service providers exchange ideas
  and concerns outside of the therapeutic
  environment.
• One question is What has been your most
  difficult struggle in your recovery from
  dual-diagnosis?
• Proceeds from ten dialogues held in New York
  State in 1996 and 1997 representing over 200
  participants were combined to eliminate
  redundancy.
• The resulting list of 36 items was incorporated
  into the baseline questionnaire of the study.
  Specifically, the question was Following are
  issues and situations that people may struggle
  with during their experience dealing with these
  issues in recovery.
• The answer categories were on a 4 point
  Likert-type scale Very difficult to deal
  with/to do, moderately difficult, a little
  difficult to deal with, and not at all difficult.

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• Working, finding/keeping job
• Very difficult 46
• Dealing with feelings
• (anger, pain, shame, guilt) 46
• Fear of picking up 44
• Having money problems 41
• Dealing with inner conflicts 39

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• Accepting a Higher Power
• Very Difficult 13
• Following a program such as the 12-steps 16
• Not being accepted at other 12-step groups 19
• Being open minded, listening 20
• Asking/accepting help and support 22

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• Interest in self-help is growing rapidly in the
  context of managed care health service delivery
• The single focus (one disease-one recovery) of
  traditional self-help groups is an important part
  of their appeal to members. However, it often
  falls short of meeting the needs of those with
  multiple recovery needs
• Self-help groups designed to embrace the
  dually-diagnosed, such as DTR, provides a safe
  forum where the combination of mutual support and
  acceptance, honesty, and role modeling creates a
  feeling of self-confidence and empowerment that
  is helpful in the struggle for staying clean and
  taking ones medications
• DTR members credit DTR for giving them the
  ability to stay on the path of their double
  recovery. For me, coming to DTR was like coming
  home.

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• The End