Dear Patti,

My husband Kyle opened up to me and acknowledged that he abuses alcohol and drugs and admitted he thinks he’s an addict. I was so relieved as I’ve known about his problem for a long time. He talked to me first and then confided in his older sister Terri. Instead of being supportive and positive and helping us devise some sort of plan, Terri was negative. Terri knows that Kyle has suffered from serious depression for a long time. She told us that when someone has both an emotional problem and a substance abuse problem it’s extremely difficult to go into treatment for addiction. She explained that of course she wants him to get help for his substance problem but that she’s afraid treatment will make his depression worse.

I know that Terri is trying to help Kyle but all it did was scare and discourage him. I believe that in the long run, getting sober will help Kyle’s depression. And as far as the  treatment being difficult, a lot of addicts have depression or other mental disorders and they become sober. Any light you can shed on the situation would be greatly appreciated. Thank you

— Krystal

Dear Krystal,

It sounds like Kyle might have what is called a dual diagnosis, which is when a person has  one or more mental disorders in addition to one or more substance use disorders. If Kyle is diagnosed with dual disorders, he will need the treatment and care of a professional trained in working with both substance abuse and mental health disorders,

I understand Terri’s concern. In the past, traditional treatment for substance addiction has been characteristically intense and confrontational, designed to break down denial, defensiveness and resistance in the addict. Many treatment methods for mental illness diagnoses were more supportive and nonthreatening, allowing patients to let down their defenses in a slower, gentler pace. Therefore, people receiving traditional substance abuse treatment for dual diagnosis were often conflicting and confusing.

However, substance abuse professionals grew more and more concerned over the increase in addiction and relapse rates in the addict population, conventional treatment methods came under greater scrutiny and more effective ways to work with addicts were sought.

Currently therapists working with patients with co-occurring illnesses have learned how to give treatment more successfully. Addicts come with differing levels of readiness and an addiction specialist’s goal is to reinforce change and avoid confrontation while setting limits. In the case of relapse it is understood that rather than relay it as a failure, it is a need to modify treatment as recovery is an ongoing process.

Many people with concurrent disorders have a heightened sense of shame and a feeling of separateness because they have both a substance abuse disorder and mental illness. There is often an increased feeling of powerlessness and a oppressive silence about their suffering, making it even more difficult to ask for and receive the help they need. This is all the more reason to encourage and support Kyle to reach out for assistance.

It’s often asked which developed initially, the substance abuse or the mental disorder. There’s no single answer. In some cases, the psychiatric problem develops first and the addiction is a way to try to self medicate. For others it’s the addiction problem that originally develops, contributing to the beginning of depression and anxiety.

Motivational interviewing is a type of treatment that is nonjudgmental, non-confrontational and non-adversarial treatment. The strategy is to elicit the addict’s own awareness of his problems, risks and potential consequences of continuing the addiction and then help provide motivation to achieve the future he envisions.

Another popular program for treating dual diagnosis is the Dual Diagnosis Recovery Counseling (DDRC) model. First priority is to stabilize any acute symptoms of mental illness and substance abuse. Then improve coping skills and techniques to redirect urges to use and manage symptoms associated with the mental illness. Then the task is dealing with setbacks and relapses and lastly is recovery and maintenance of recovery.

In the late 1980s, Dual Recovery Anonymous (DRA) was created. This self-help program based on the principles of the traditional 12 steps helps members with their recovery/capacity to cope with both chemical dependency and mental illness. DRA has two requirements for membership; a desire to stop using alcohol and other intoxicating drugs and a desire to manage emotional or psychiatric illness in a healthy and constructive way.

Continue to offer love, acceptance and support to Kyle as he goes through dual recovery.


Patti Carmalt-Vener, a faculty member with the Southern California Society for Intensive Short Term Psychotherapy, has been a psychotherapist in private practice for 23 years and has an office in Pasadena. Contact her at (626) 584-8582 or email pcarmalt@aol.com. Visit her website, patticarmalt-vener.com.