“Dual diagnosis,” or having a co-occurring substance abuse disorder, affects nearly one-quarter of adults with a serious mental health issue. It’s one of the most universally experienced vicious cycles. You’re miserable, so you drink and use. The drinking and using exacerbates those miserable feelings…
Thanks for your heartfelt story, and I wish you well in your recovery.
I’m a psychiatrist and through the many years I’ve practiced, what you have described is one of the toughest challenges.
In the first place, even when we ask about substance use, we know that we typically don’t get an honest answer. It is so easy to deceive the healthcare provider about it. But then, the client knows how to deceive us because they’ve been deceiving themselves so long.
My usual response when I have some evidence is, “I cannot treat your depression successfully unless your honest with me and do something about your substance use disorder.” (I don’t like the words “addict” or “alcoholic.” This is a disorder, treatable.)
And after recovery begins, the depression is always lurking. It’s during those moments when you get depressed and hopeless that maintaining recovery can be so difficult. Some of my patients have referred to those moments as the “fuck its,” the times when you feel you just need something, anything, to give you some relief. It is so hard to stay strong, so easy to slip into old patterns.
It’s then you need both a friend and a call to your therapist. Someone needs to help you carry the pain.
Treatment works, but the first step is always saying, “I can’t do this alone.”
I wish you well in your continuing recovery. Thanks.