Blurred Boundaries – Dual Diagnosis

Blurred Boundaries – Dual DiagnosisImage result for pandora's box hope image
Written and Submitted by Pandora
Mental Health Crises in Chatrooms
Dual diagnosis (also called co-occurring disorders, COD, or dual pathology) is the condition of suffering from a mental illness and a comorbid substance abuse problem.
According to a 2014 National Survey on Drug Use and Health, 7.9 million people in the U.S. experience both a mental disorder and substance use disorder simultaneously. More than half of those people—4.1 million to be exact—are men.
The treatment for dual diagnosis has long been debated, in that there was a sense among physicians and experts that you treated the primary cause of the initial presentation and then dealt with the secondary. .ie. If a service user presents obviously in withdrawal..detox first then mental health assessment and treatment for same…or as the case may be vice a versa.
So here’s the rub…..addiction health professionals have a very specific and targeted set of skills. Within addiction services there are sub sets of even more specialised…those that deal with opiates…those that deal with alcohol..those that deal with benzos…no two drugs are the same…nor is the treatment for dealing with addiction the same…
This is the same within the mental health services…specialist nurses in CBT, eating disorders, self harm etc. Psychiatrist that treat only mood disorders or PTSD, counsellors that deal only with child sex abuse trauma etc…
In much the same way that you wouldn’t bring your beloved family pet to a veterinarian that specialised in cattle, or your vegan grandmother to eat at a steak house, why would you bring your mental health issues to a non- expert? The potential for damage in these situations is very real and dangerous.
So here’s the thing….you are sitting in an internet chatroom and a person enters that is very obviously experiencing a mental health crisis…they are talking about self harm, maybe even harm to others….are you as a recovering alcoholic, sex addict, coke addict etc in a place to advise? NO.
In much the same way as taking your vegan granny to the steak house (which you just wouldn’t do, as it may cause trauma), you don’t relate your recovery to a mental health crisis.
If I break my ankle you can bet your bottom frikking dollar I won’t go to a cosmetic surgeon to fix it…I want the ortho doctor…I *deserve* the ortho doctor.
Chatrooms, and those in them have a responsibility to ourselves and to others. If someone is in crisis and I mean *crisis* and discusses having negative thoughts, thoughts that they may harm themselves or others, please do not advise mindfulness….or a walk or anything you are not an expert in. For those that are experts in mental health…we can’t help in a chat room, it is unethical and unprofessional and we have no collateral or case history to work from. Nor do we have the benefit of *seeing* the person to observe body language and distress levels. Nor can we carry out and implement a risk assessment.
My opinion is that chat rooms should have a protocol regarding this…Moderators and volunteers should step in when it is obviously a mental issue and redirect the member to the Samaritans, or a help line or whatever.
As recovering addicts we also need to understand that we are only qualified in terms of our own recovery. We are in no way, by virtue of attempting to be sober, experts in every field related to recovery issues. As an individual with an alcohol addiction I wouldn’t dare to counsel a heroin addict…two different experiences. Even within alcoholism, a binge drinker will have different issues to that of the person drinking from a hip flask at work. A high functioning alcoholic will have different issues from that of a homeless person drinking medical alcohol or methylated spirits.
Being supportive is great and chatrooms can be wonderfully supportive places. However, the potential to cause damage is very prevalent. Be *mindful* of those that use chat rooms. Be *mindful* of your own limitations and experiences. Be *mindful* that mental ill health is distressing and unpredictable. Be *mindful* that sometimes stepping back is better then giving the wrong advice.
Things you *could* say in a chatroom
Call your crisis team
Call your doctor
Consider an admission
Call your family and friends
I am not a mental health expert so I don’t know what to say to help you
I have no experience of what you are going through
Call the Samaritans

24/7 Crisis Services