“As I begin my journey through the steps, I will first and foremost remember to be gentle with myself. I will keep an open mind, I will be honest, and I will be willing to do my best. I am thankful for those who have come before me. I will be receptive to guidance from my brothers and sisters in the fellowship of DDA. I will make every effort to focus on my recovery and remind myself that my spiritual journey of recovery begins here and I know that the destination of any journey begins with the first step.”
– Part of the opening meditation from Step 1 in Dual Diagnosis Anonymous: A Journey Through the Twelve Steps Plus Five
According to the National Institute of Drug Abuse (NIDA), six in ten individuals with drug and alcohol issues also have another mental illness. Similarly, of those with severe mental illness, over half have substance use issues. When someone struggles with both substance use issues and another mental illness, they are considered to have a “dual diagnosis.” While millions of adults in the U.S. have co-occurring mental health and substance use disorders, treatment options have been slow to catch up with the need and some estimate over half receive no treatment at all.
At present, many treatments, whether inpatient or outpatient, focus attention on only part of the problem. While, overall, we are better than we used to be, when patients would often encounter the catch-22 of “you can’t get mental health treatment until you get your drug or alcohol use under control” and “you can’t get treatment for drugs and alcohol until you treat your mental illness,” we still often fail to fully treat individuals with dual diagnoses. In her book, Dual Diagnosis Anonymous: A Journey through the Twelve Steps Plus Five, Corbett Monica offers a self-help book for those struggling with substance use and mental illness.
Building on the principles of Alcoholics Anonymous, Dual Diagnosis Anonymous was created to offer structure and support to help those on the road to recovery who are suffering from co-occurring mental health and addiction issues. This book is based upon the culmination of knowledge acquired since the founding of DDA in 1996 for Monica and colleagues. The book is divided into two sections. The first covers the 12 steps of dual diagnosis, based on the 12 steps of Alcoholics Anonymous with the wording broadened to incorporate mental illness.
While the steps in the first section are nearly identical to AA, Monica incorporates mental illness into each part. Step 1 is one of the most explicit, being “We admitted we were powerless over our dual diagnosis and that our lives have become unmanageable.” In this section, he offers a number of different exercises to explore power and powerlessness in the face of mental illness and substance use. Other steps are the same wording as AA, but include mental illness in the exercises.
As with AA, DDA has significant religious undertones that work well for some, but may turn others away. Monica writes, “There is . . . a common quality among every one of us in DDA, and that is that each of us possesses a spark of divinity,” and Step 6 says, “We’re entirely ready to have God remove all these defects of character.” In this instance, Monica has readers make an inventory of various shortcomings and decide whether these are related to mental illness, issues of character or both. This step offers the opportunity for readers to really take inventory of the many factors that are affecting their lives.
In the second portion of the book, Monica delves into the five additional steps created for DDA. Monica notes that, for some, these five steps can “stand alone as the core of their recovery program,” but for most “it is the Twelve Steps Plus Five that constitutes their recovery journey,” with most first completing the twelve steps. These steps have a similar flavor as the original twelve. The first, for example, is “We admitted that we had a mental illness, in addition to our substance abuse, and we accepted our dual diagnosis.” Exercises in this section offer readers the opportunity to both take stock of their mental illness and its impacts as well as consider the supports they need to recover.
As a psychiatrist, I found the discussion of Step 3 interesting. This step reads “We have understood the importance of medications, clinical interventions and therapies, and we have accepted the need for sobriety from alcohol and abstinence from all non-prescribed drugs in our program.” Monica goes on to discuss that medications, used as prescribed, can be key to recovery, but offers, “Others of us are adamant in resistance and/or refusal to consider medications.” He makes it clear that DDA will support the individual in their choice, but urges each to “keep an open mind and be willing to listen to the advice of their DDA support group, their prescriber and their clinician.”
Overall, this is a well-done workbook that may offer support and structure for those dealing with mental illness and substance use.
Dual Diagnosis Anonymous: A Journey Through the Twelve Steps Plus Five
Inkwater Press, February 17, 2016
Paperback, 276 pages