Dual Diagnosis Principles
1) Ego, in the Buddhist sense, is the prototype of addiction.
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2) The specific permutations of the addiction process are limitless.
At the same time, a common feature is that one is engaging the addictive activity in order to avoid awareness of the effects of practicing the addictive activity
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3) Our own path of working with our mind, ego, and life, is the prototypical path of recovery.
This provides lived experience for the clinician
Specific knowledge, discipline, and appreciation for the subtlety of the recovery process
If the therapist’s experience involves substances or gross behaviors, all the better
Conveys confidence that this is workable
Honesty with ourselves can create an environment in which our client may possibly recognize, relax, and feel safe with his or her own honesty
Discrimination around self-disclosure is important
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4) Mental health challenges and substance/behavioral addictions exist in a synergistic relationship.
Both need to be considered when organizing recovery planning
As a rule, it is difficult to get sober if the underlying mental health issues are not tamed, but mental health instability can be potentiated by substance use or engaging in addictive behaviors. As a rule, we work on both at the same time, while understanding that the person probably won’t get sober until the mental health problems are relatively under control.
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5) Motivation for recovery is the key element in how successful one’s path is likely to be.
Conflicting desires for recovery between the family and client reduce the probability of success.
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6) The more dependent the client is on the family, the more the entire family system is the real client
Systemic recovery must be included in the team process.
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7) As with any body-mind de-synchronization, it is critical to understand the intelligence behind the behavior.
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8) We are all in this together, but don’t take on the client’s problem as our own.
Relax, and avoid becoming associated with sobriety as being our agenda.
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9) The basic contract requires an assessment to determine our general approach: harm reduction or abstinence.
The contract can be modified over time.
This depends on family and client’s needs, and recovery developments.
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10) Specific substance and behavioral practices have their own “local knowledge.”
It is critical that the team have skillful means and knowledge of the specific addictive practices.
We need to understand the medical safety issues around various behaviors and uses.
Detoxification, medication combinations, toxicity, life-threatening conditions (starvation, etc.)
— Seeking the help of experts should always be considered
— We will offer better and safer help for our clients and families
— Our teams will learn a lot in the process
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11) Addiction to intense emotional states is becoming recognized through brain research.
There is a lot of highly compelling brain chemistry payoff involved in hopes, fears, anger, lust, etc.