Dual Diagnosis 1
Dual Diagnosis: Definitions, Related Counseling Issues & Treatment
Kelly J. Kuehl
A Capstone Project submitted in partial fulfillment of the
requirements for the Master of Science Degree in
Counselor Education at
Winona State University
Dual Diagnosis 2
Introduction and Rationale 4
Review of Relevant Literature 4-16
Defining Dual Diagnosis 4-6
Statistics of Those With Mental Health Issues and Abuse Issues 6
Commonly Abused Drugs and their histories 7-11
Brain chemistry 11-13
Treatment Options 13-16
Personal Reaction 16-18
Appendix A 20-21
Appendix B 22-23
Dual Diagnosis 3
This paper defines dual diagnoses and explores related counseling issues and treatment options.
It identifies commonly abused drugs, their history and effects that these drugs have on the brain
functions of people with and without diagnoses. It also discusses the importance and difficulty in
distinguishing between and treating symptoms of individual diagnoses.
Dual Diagnosis 4
Introduction and Rational
I chose this topic for my paper because I see everyday the hardships and concerns that
over the counter drug and alcohol abuse can cause those with a dual diagnoses. Many of the
chronically mental ill clients I work with have a dual diagnosis and it has become evident that
many are only treated for one of their disorders. Many agencies like the one I work for treat
mental illness and attend to health issues but either does not or is unable to treat addictions. I feel
that many concerns for clients can be attended to if both diagnoses were first acknowledged. I
believe there are limitations to accomplishing these ideas including lack of funding, lack of
collaboration between agencies, lack of cooperation from clients and the readily available supply
of legal over the counter medications that are being abused. I hope that this project will allow me
to gain a wealth of knowledge in the interest of improving treatment of dual diagnoses.
A dual diagnosis occurs when an individual is affected by both chemical dependency and a
psychiatric illness (Dual Recovery Anonymous World Services Inc, 2008). Both illnesses may affect
an individual physically, psychologically, socially, and spiritually. Each illness has symptoms that
interfere with a person‟s ability to function effectively and relate to themselves and others. Not only is
the individual affected by two separate illnesses, both illnesses are interacting with one another. The
illnesses may exacerbate each other and each disorder predisposes to relapse in the other disease. At
times the symptoms can overlap and even mask each other making diagnosis and treatment more
difficult (Dual Recovery Anonymous World Services Inc). (Henderson, 2000) states that the people
who have had the most difficulty with the split between addiction and mental health treatment delivery
Dual Diagnosis 5
systems are those who suffer from the major psychiatric disorders. These disorders are chronic and
significant functional impairment.
Dual diagnosis is often used interchangeably with the terms co-morbidity, co-occurring
illnesses, concurrent disorders, co-morbid disorders, co-occurring disorder, dual disorder, and,
double trouble According to Dual Recovery Anonymous World Services, (2008) professional
literature has used a confusing array of terms and acronyms to describe co-occurring disorders or
a dual diagnosis. Individuals who experience a dual diagnosis often face a wide range of
psychosocial issues and may experience multiple interacting illnesses (more than two). The term
"co-occurring disorders" is becoming a common term used to refer to dual diagnosis, or co-
occurring substance abuse disorders and psychiatric or emotional illnesses (Dual Recovery
Anonymous World Services Inc).
There is no single type of dual diagnosis. There are numerous forms of psychiatric
illnesses. There are also many patterns of alcohol or drug abuse. As a result, a variety of different
forms of dual or multiple disorders are possible (Dual Recovery Anonymous World Services Inc,
2008). For example: psychiatric symptoms may be covered up or masked by alcohol or drug
use, alcohol or drug use or the withdrawal from alcohol or other drugs can mimic or give the
appearance of some psychiatric illnesses, untreated chemical dependency can contribute to a
reoccurrence of psychiatric symptoms, and untreated psychiatric illness can contribute to an
alcohol or drug relapse. Other problems and consequences that are associated with dual disorder
include: family problems or problems in intimate relationships, isolation and social withdrawal,
financial problems, employment or school problems, high risk behavior while driving, multiple
admission for chemical dependency services due to relapse, multiple admissions for psychiatric
care, increased emergency room admissions, increased need for health care services, legal
Dual Diagnosis 6
problems and possible incarceration and homelessness (Dual Recovery Anonymous World
Currently the most common mental illnesses linked with substance abuse according to the
DSMIV include, antisocial personality disorder, anxiety disorder, bipolar disorder, depressive
disorders, generalized anxiety disorders, major depressive disorder, mania, mood disorders,
panic disorders, phobia, post-traumatic stress disorder and schizophrenia, (Mogil, 2001 ). Seven
percent of the general population in the United States falls into the dual diagnosis category.
National mental health resources suggest that fifty to seventy percent of those who are addicted
to mood altering chemicals also suffer from psychiatric disorders (Mogil). Chemical dependency
is found in 56% of people with bi-polar disorder, 47% of people with schizophrenia, 32% of
people living with mood disorders other than bi-polar and 24% of people with anxiety disorder
(Mogil). According to a report published by the Journal of the American Medical Association;
thirty-seven percent of alcohol abusers and fifty-three percent of drug abusers also have at least
one serious mental illness and of all people diagnosed as mentally ill, 29% abuse either alcohol
or drugs (Mental Health America, 2009). Estimates of the prevalence of substance use disorders
among psychiatric patient populations vary widely, reflecting factors such as the use of samples
with acute versus nonacute illnesses, the geographic site of studies (for example, urban versus
rural or West versus East), and the availability of illicit drugs in the study location. Studies in the
United States confirm that the prevalence of substance use disorders among patients with severe
mental illness is higher than in the general population (Mental Health America).
Dual Diagnosis 7
Commonly abused drugs and their history
The definition of medication abuse is the use of any prescription medication not
specifically prescribed for you or the use of a prescription or over-the-counter medication that is
different in any way that is different from the instructions given by the doctor or printed on the
label of the medication (Mogil, 2001). The most addictive medications, whether they are
prescription or over-the-counter fall into three categories: stimulants, narcotics and sedatives.
Scientific research has shown that when these addictive or abusable drugs bombard the system,
they change the biochemistry of the brain (Mogil).
Many pills like ephedrine, diet pills and body enhancement products are sold over the
counter and contain amphetamines. Amphetamines, or stimulants, date back as far as 1887 when
they were first synthesized by a German scientist (Bayer, 2000). It was then ignored until the
1930‟s when scientists discovered its many uses. It was first used to increase blood pressure and
in treating lung congestion. By 1932 it was marketed as a nasal inhaler, and later this formula
(Benzedrine) was sold in tablet form to treat allergies, colds, hay fever and asthma. Three years
later it was also discovered that amphetamines were useful in treating narcolepsy and
Parkinson‟s disease. According to Bayer, (2000 ) for the next 11 years the drug became more
popular and was used in treating for smoking, low blood pressure, persistent hiccups, and
morphine addiction. As these different uses were discovered, additional forms of the drug were
developed. They included dextroamphetamine (Dexedrine,) and methamphetamine, marketed as
Desoxyn and Methedrine.
Amphetamines became so popular, that even during WWII they were given to soldiers as
“pep-pills” and about this time in America, college students and truck drivers were using them to
stay awake for long periods of time, and housewives used them to curb their appetite and lose
Dual Diagnosis 8
weight. Bayer (2000) finds that athletes also took them to enhance performance, and doctors
began to prescribe it not only for weight loss, but in combination with other drugs to “cure”
depression. It is also reported that by the 1960‟s race horses were being given amphetamines to
enhance performance. At this time, soldiers stationed in Korea and Japan began mixing it with
heroin to make „speed balls‟ (Bayer).
In the early 1960‟s the food and drug administration took measures to decrease the
amount of amphetamines in circulation with their “speed kills” campaign (Bayer, 2000) Despite
this, by 1965 there was a black market for amphetamines and abuse was common.
Amphetamines could be taken in pill form or intravenously in huge doses, and this problem was
made worse due to the fact that Methedrine was used in treatment programs as a cure for heroin
Amphetamines are also used in the production of methamphetamines like ice and ecstasy.
Dr. Michael Abrams of Broadlawn Medical Center in Des Moines, Iowa, describes
methamphetamine as “the most malignant addictive drug known to mankind” (Bayer, 2000). It is
reported that the abuse of these drugs can affect a user‟s brain for up to six months following
binge use. Users of these drugs often exhibit paranoid psychosis that includes delusions and
hallucinations that can result in extreme agitation and violence, resulting in harm to others.
Mentioned earlier was ephedrine, this drug is classified often as herbal ecstasy as it is
derived from a plant and mimics some signs of ecstasy intoxication (Bayer, 2000). Although this
is not an illegal drug it still is a dangerous substance that can cause high blood pressure, strokes,
heart attacks, and seizures. More and more reports are being made to describe the bad reactions
users experience with herbal ecstasy causing the government to consider restrictions on its sale
(Bayer). As of March, 1997 ephedrine products have been banned or restricted in at least 20
Dual Diagnosis 9
states, yet the potential for abuse and misuse remains. In New York regulations ban the sale of
products promoted as alternative psychoactives, which allows those marketed as weight-loss or
body-building supplements to still be sold (Weintraub, 1997). It is also hard to control
amphetamine abuse because the ingredients used to make many of these stimulants are also not
illegal. There are regulations to try and control large purchases of these ingredients, yet
methamphetamine use and abuse remains prevalent (Bayer).
According to an encyclopedia entry (Infoplease, 2008), marijuana has been used to
achieve euphoria since ancient times; it was described in a Chinese medical report and is
considered to date from 2737 B.C. Marijuana was originally used as an all purpose medicine,
but there is no record of the Chinese using it a pleasure producing drug, (Hawley, 1992). Its use
spread from China to India and then to North Africa and reached Europe at least as early as A.D.
500. A major crop in colonial North America, marijuana (hemp) was grown as a source of fiber.
It was extensively cultivated during World War II, when Asian sources of hemp were cut off.
Marijuana was listed in the United States Pharmacopeia from 1850 until 1942 and was
prescribed for various conditions including labor pains, nausea, and rheumatism. Its use as an
intoxicant was also commonplace from the 1850s to the 1930s (Infoplease). Marijuana was not
widely used recreationally in the united states until just recently. It was always thought to be
connected mostly to the poor, musicians and youth at that time; but over the last four decades it
is reported that over 25 million of the population use marijuana (Hawley).
A campaign conducted in the 1930s by the U.S. Federal Bureau of Narcotics (now the
Bureau of Narcotics and Dangerous Drugs) sought to portray marijuana as a powerful, addicting
substance that would lead users into narcotics addiction (Infoplease, 2008). It is still considered a
Dual Diagnosis 10
“gateway” drug by some authorities. In the 1950s it was an accessory of the beat generation; in
the 1960s it was used by college students and “hippies” and became a symbol of rebellion
against authority. According to Infoplease, The Controlled Substances Act of 1970 classified
marijuana along with heroin and LSD as a Schedule I drug, i.e., having the relatively highest
abuse potential and no accepted medical use.
Marijuana has been used since ancient times. Its use and users however have changed
significantly. As more research is done more proof emerges that marijuana use has dangerous
effects to the brain, heart, lungs and sexual potency (Hawley, 1992).
Alcohol has been used since the time of Native Americans and slavery. What is striking
about the history of alcohol is that in colonial times it was consumed throughout the day by men,
women and children and integrated into nearly every ritual of social and political significance
(White, 1998). Alcohol was considered the „Good Creature of God” and although public
drunkenness had regulations, drinking itself was not considered a problem (White). According to
white, Benjamin Rush was very influential with his writings regarding alcohol and its abuse.
Rush was considered the father of psychology and wrote quite a bit about his concerns with
drunkenness and alcohol abuse. Rush‟s first writings date back to 1777 where he addressed the
drunkenness of continental soldiers. In 1782 he wrote an article urging farmers to stop supplying
liquor to their laborers. He continued to write articles that made him famous, concerning alcohol
and concerns of abuse. He continued his research and articles, which eventually led to awareness
and others‟ involvement which in turn resulted in the efforts towards the temperance movement.
This movement‟s goal was to push toward more social drinking, urging heavy whiskey drinkers,
for example to drink beer socially. Acknowledging that there was a problem and increased public
Dual Diagnosis 11
drunkenness, the movement also pushed for abstinence (White). Following this was the
formation of inebriate homes and asylums where people addicted to alcohol were sent to stay. It
wasn‟t until the 1900‟s that treatment for addictions emerged and in 1935 Alcoholics
Anonymous was born (White). Today there are many more options for treatment as well as
education and support for those who are addicted to alcohol.
Over the past couple of decades, it has been found that alcohol and every major class of
drugs of abuse all interact with the ventral tegmentum part of the brain, which is connected to the
medial forebrain, (Henderson, 2000). According to a 1950‟s study, the ventral tegmentum
produces the intensely pleasurable reaction to electrical stimulation (Henderson). The tegmentum
is located in the lower central portion of the brain; this is the part that regulates automatic
functions such as breathing and appetite. Henderson reports that this part of the brain is
connected to the relay centers in the brain that include the thalamus and hypothalamus, as well as
higher parts of the brain such as the cortex, where most learning and reasoning takes place. The
primary purpose of the ventral tegmentum seems to be to produce a pleasurable sensation when
it is stimulated and to make sure that the higher parts of the brain remember what this stimulation
was so that it will be repeated (Henderson).
Brain cells communicate messages via chemicals in the brain that are called
neurotransmitters (Henderson, 2000). Normally, once a neurotransmitter has attached to a
neuron‟s receptor site and caused a change in the cell, it is pumped back into the neuron that
released it. When someone has a mental illness, they may be prescribed medication that will
either affect the rate of reuptake of the neurotransmitter or by inhibiting its destruction by
enzymes within the synapse (Henderson). On the other hand, mood altering drugs; which can be
Dual Diagnosis 12
addictive, often override this system by tricking the nerve cell into thinking it is being stimulated
by a natural neurotransmitter (Henderson). In discussing addictive substances, Henderson states
that drugs not only affect the ventral tegmentum but also alter mood. Mood-altering drugs
change brain chemicals and brain cells in a way that affects one‟s mood regardless of the
circumstances (Henderson). Medications that are prescribed for depression or anxiety work
within brain cells to prompt them to function properly. According to Henderson, these
medications permit people to functional optimally, so that a person is better to deal with their
reality; but not true for mood-altering drugs. Henderson states that no matter what the condition
of your brain at the time its use is started, it will be changed. Mood-altering drugs tend to
override normal systems in the brain to produce an artificial mood state (Henderson). When
these drugs leave your system there is rebound effect. Henderson states that the brain resists this
unnatural override, and will not get back to normal for some time. The brain fights the effects of
depressants by becoming over active and to fight the effects of stimulants it becomes sluggish
and depressed (Henderson). An example of this is brought to light by Bayer (2000). A stimulant
causes the neurotransmitter to build up in the gap, or synapse between neurons. As a result, the
chemical keeps affecting neurons long after it should have stopped. Amphetamines also cause
both dopamine and norepinephrine to build in the brain so while dopamine produces feelings of
pleasure for a short time, norepinephrine increases heart rate, blood pressure and pulse rate
Basically this information shows the struggle that dual diagnoses patient must have,
especially those with persistent mental illness. If a client doesn‟t take medicine as prescribed,
neurotransmitters may not be working properly. The use and abuse of drugs affects and changes
their brain. On the other hand if a person did take medications as prescribed but also used or
Dual Diagnosis 13
abused drugs their brain would be changed too. When the drugs leave the system, or attempt to
another change may also occur. So it is easy to see how many different factors could lead to a
person becoming symptomatic and how these different symptoms may be confusing for the
therapist and client as it is unsure if the symptoms stem from the mental illness, the addiction or
As a person neglects his or her mental illness, that illness may recur. This recurrence
may, in turn, lead a person to feel the need to "self-medicate" through drug use (Mogil, 2001).
Over time, the lack of progress toward recovery on both fronts may trigger feelings of failure and
alienation. In addition, people with serious persistent mental illness and addiction often lack the
ego strength and coping skills necessary to put a recovery program into action (Henderson,
2000). Mogil reports that perhaps the greatest tragedy is the damage that occurs to the
The American board of psychiatry and The American Society of Addiction Medicine
It is critical to identify the coexistence of a major psychiatric disorder or personality
disorder because if it is not appropriately treated, it often results in relapse to substance
abuse. To complicate matters, individuals may present with various types of psychiatric
symptoms as a result of their response and reaction to involvement with addiction
treatment. (Mogil, 2001, Pg. 73)
When a dual diagnosis is made correctly, treatment can be individualized more
effectively, and according to the Department of Health and Human Services‟ Center for
Dual Diagnosis 14
Substance Abuse Prevention, there are three effective approaches to treating dual disorders
(Mogil, 2001). With any treatment, the important things to remember are that to achieve the best
possible outcome, both disorders must be treated simultaneously because the cumulative effect
influences all aspects of the individual‟s life and greatly increases their risk for relapse.
Secondly the body must be cleansed of substances. This is known as detoxification, and should
be monitored in a hospital setting (Helpguide.com, 2008). A successful dual diagnoses program
is staffed by clinicians who have had training and experience in addiction treatment (Henderson,
2002). The first kind of treatment is Sequential treatment. This is where the person first goes to
one kind of therapy and then to the other, alternating procedures between mental health and
substance abuse. The second is Parallel treatment where a person participates in two different
kinds of treatment at the same time. Lastly there is integrated treatment which is generally the
most effective and involves the individual getting help for both disorders in one program.
Henderson brings up that an important principle in the management of a dually diagnosed
individual is that the treatment for both conditions must receive equal emphasis and attention.
Henderson also contends that ideal programming integrates mental health care with
interventions for the addiction; the patient should receive everything necessary to treat both the
condition and the addiction. Utilizing these three treatments can be in several different forms.
According to Helpguide, these include, inpatient treatment, which involves an assessment.
Usually an appointment is necessary and there are many centers available 24 hours a day. If
there is a serious problem a person can also go directly to an emergency room. Medical
detoxification (detox), this usually involves a 3-5 day stay for alcohol detox in a medically
supervised treatment center. The program includes counseling; medications, and group sessions.
Long-term residential programs involve a stay for a few months but it can last 12 months. These
Dual Diagnosis 15
therapeutic communities are geared toward addicts and those with mental illnesses who have
more severe problems and more than one relapse. There is an emphasis on group affiliation and
counseling to prevent relapse. Dual diagnoses treatment centers are where services are tailored
to the individual and include different types of assistance that go beyond standard therapy or
medication: assertive outreach, job and housing assistance, family counseling, even money and
relationship management. A comprehensive program takes into account a number of life‟s
aspects including stress management and social networks. These programs view substance abuse
as intertwined with mental illness, and therefore provide solutions to both illnesses at the same
time. Outpatient/partial hospitalization involves a relapse prevention treatment program usually
meets 3-5 days a week, 4-6 hours/day and is for people who require medical monitoring on an
outpatient basis. Intensive outpatient programs (IOPs) meet 3 days a week, 2-4 hours/day.
Insurance companies encourage attendance at IOPs. These relapse prevention treatment
programs are scheduled around your work or school schedule. Intensive case management is
where a case manager is assigned to the individual to provide frequent weekly contact and
phone calls to follow-up regarding their compliance with attending doctor‟s appointments,
medication management, and aftercare. Finally there is also counseling or talk therapy offers an
opportunity for emotional healing through exploration and education. Treatment is most
effective when it occurs once a week. People with severe mental illness and addiction make
steady progress in these programs, achieving recovery from the addiction and remission from
mental illness (Helpguide). It is also important to help find support groups for people with co-
occurring disorders that can serve to reinforce important issues such as opportunities to
socialize, having access to recreational activities, and developing peer relationships. Attendance
in groups that deal with education and awareness of dual diagnosis issues, medication
Dual Diagnosis 16
management, life skills, and improvement in activities of daily living is also helpful
Dual diagnosis is defined as any psychological disorder that co-occurs with substance
abuse, (Dual Recovery Anonymous World Services Inc, 2008). This paper discusses the
histories of the substances most commonly abused by those with a psychiatric illness. This is a
complicated disorder that can be hard to treat as patients with dual diagnosis disorders can be
extremely challenging. Lateness, rudeness and demanding behavior are common during
consultation, Kahn, A (2007, June 28). Substance abuse can also make it difficult to distinguish
between psychological symptoms and effect of substances. The Journal of Mental Health
(December, 2006) also states that it is common for people with co-occurring disorders to have
low motivation for change, making treatment difficult. Throughout this paper, different
substances and their histories are discussed as well as treatment options. There is treatment
options out there that have been proven to be effective, however for them to be successful there
needs to be an understanding of the interaction between psychosis and substance use
(Barrowclough et al, 2006).
In today‟s ever changing world, many people‟s needs can be overlooked or neglected
because resources are not in place or not enough is known to effectively help people; but as our
world changes, so come improvements in many things including new findings, new treatment
methods and available funding. As these things change and improve, I believe that already
established programs that treat mental illness can make the step upward to improve and include
Dual Diagnosis 17
treatment programs for dual diagnoses that helps people address both issues and become
successful at understanding and compliantly treating their illness. As Mogil (2001) stated, the
idea of addressing both the mental illness and the addiction is crucial to finding appropriate
As illustrated in this paper, drug and alcohol use and abuse has been around for decades
and many of people have experienced the struggled that is presented with it. These drugs and
methods used have also evolved over time creating struggles for those diagnosed with dual
diagnosis. The symptoms of each are so similar that they mask each other and contribute to
resistance in treatment, (Dual Recovery Anonymous World Services Inc, 2008). How easily
most abused drugs and alcohol are available also make it hard to monitor and control.
I feel that it is very important for any community to understand dual diagnoses and the
importance of how easily attainable these abused drugs are. As someone who works day in and
day out with the mentally ill I can attest to the large amounts of people who have a mental
illness and also have a drug, alcohol or prescription addiction. I feel that there is an enormous
need to understand the individual components surrounding dual diagnoses. As I look around a
community like mine that strives to provide as many services as possible to people, I am
disappointed to see that there are not more programs or affordable programs at that that can
offer the intensive therapy needed to treat dual diagnoses. Many people are treated for one
disorder and not another. I can‟t help to ask myself what good this can do. It is difficult at times
to distinguish between symptoms from mental illness and those that result from drug or alcohol
abuse. I also see people who work with individuals with dual diagnoses and their tireless efforts
seem not to pay off. Psychiatrists in busy programs who are often spread too thin as it is, are
pressed to choose between treating only one of a person‟s disorders. Social workers and case
Dual Diagnosis 18
managers work hard to ensure a person can stabilize and be successful; yet deciding if someone
is symptomatic or are reacting to drug or alcohol abuse is also hard. These workers do the best
they can but years can go by with no significant improvement in a person‟s status. I believe
there would be much more visual change and success in these programs if people had the
opportunity to work on both diagnosis and it was affordable. There are programs that offer
treatment of both at once as well as individual ways to treat. I believe this would also affect
research and design of medications currently on the market.
When you think about it, it is a terrible thing that as a society we have learned from
several avenues on how to self medicate when times are tough or we feel that there are no other
options. This learning does not exclude anyone, including the mentally ill. It begins a vicious
cycle that most likely ends in addiction and worsening the condition of someone‟s mental health
As our world continues to change, it is important to remember that we as a society shall
too. I believe that stronger efforts need to be made to recognize problems like dual diagnosis and
efforts made to treat it. We can not continue to allow individuals to fall through the cracks by
overworking our therapists, social workers and case managers. We need to expand services and
work as a team to help these individuals become informed and educated about their disorder.
We then need to offer the effective treatments to these individuals so they to can become stable
and successful, in turn offering there support and knowledge for those who may follow.
Dual Diagnosis 19
Barrowclough, C., Haddock, G., Fitsimmons, M., Johnson, R. (2006). Treatment development
for psychosis and co-occuring substance misuse: a descriptive review.
Journal of Mental Health, 15(6), 619-632
Bayer, L. Ph.D. (2000). Junior Drug Awareness: Amphetamines and Other Uppers. U.S.A:
Chelsea House Publishers.
Dual Recovery Anonymous. (2008). Dual Diagnoses or Co-Occurring Disorders. Retrieved
August 23, 2008 from www.draonline.org.
Hawley, R.A. (1992). Drugs and Society: Responding to an Epidemic. U.S.A.: Walker
Publishing Company Inc.
Helpguide.com (2009). Information on Dual Diagnosis. Retrieved February 17, 2009 from
Henderson, E.C. Ph.D. (2000). Understanding Addiction: A Concise overview for all those
affected by addiction—addicts, their family members, their employers. MS: University
Infoplease. (2009). History of Marijuana Use. In the online encyclopedia Infoplease. Retrieved
December 12, 2008 from www.infoplease.com.
Kahn, A. (2007, June 28). Dual Diagnosis. Pulse Clinical, 36-37.
Mental Health America. (2009). Mental Health America: Dual Diagnosis. Retrieved January 19,
2009 from www.mentalhealthamerica.net.
Mogil, C.R. (2001). Swallowing a Bitter Pill: How Prescription and Over-the-Counter Drug
Abuse is Ruining Lives—My Story. NJ: New Horizon Press.
Weintraub, J. (1997). Adverse Effects of Botanical and Non-Botanical Ephedrine Products
Retrieved January 29, 2008 from www.hsph.harvard.edu/Organizations/DDIL
White, W.L. (1998). Slaying the Dragon: The History of addiction treatment and Recovery in
America. IL: Chestnut Health systems/Lighthouse Institute.
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Dual Diagnosis 21
Appendix A: The Twelve Steps of Dual Recovery Anonymous*
1. We admitted we were powerless over our dual illness
of chemical dependency and emotional or psychiatric
illness - that our lives had become unmanageable.
2. Came to believe that a Higher Power of our
understanding could restore us to sanity.
3. Made a decision to turn our will and our lives over to
the care of our Higher Power, to help us to rebuild
our lives in a positive and caring way.
4. Made a searching and fearless personal inventory of
5. Admitted to our Higher Power, to ourselves, and to
another human being, the exact nature of our
liabilities and our assets.
6. Were entirely ready to have our Higher Power
remove all our liabilities.
7. Humbly asked our Higher Power to remove these
liabilities and to help us to strengthen our assets for
8. Made a list of all persons we had harmed and
became willing to make amends to them all.
9. Made direct amends to such people wherever
possible, except when to do so would injure them or
10. Continued to take personal inventory and when
wrong promptly admitted it, while continuing to
recognize our progress in dual recovery.
11. Sought through prayer and meditation to improve
our conscious contact with our Higher Power,
praying only for knowledge of our Higher Power's
will for us and the power to carry that out.
12. Having had a spiritual awakening as a result of these
Steps, we tried to carry this message to others who
experience dual disorders and to practice these
principles in all our affairs.
*From Dual Recovery Anonymous (draonline.org, 2008)
*Adapted from The Twelve Steps of Alcoholics
Dual Diagnosis 22
Dual Diagnosis 23
Appendix B: Additional Resources
National Clearinghouse on Alcohol and Drug
Dual Recovery Anonymous World Services Central
P.O. Box 8107
Prairie Village, KS 66208
Toll-Free Number: (877) 883-2332
Website URL: http://draonline.org
P.O. Box 549
New York, NY 10163
Phone Number: (212) 870-3400
Website URL: http://www.alcoholics-anonymous.org
Narcotics Anonymous World Service Office in Los
P.O. Box 9999
Van Nuys, CA 91409
Phone Number: (818) 773-9999
Fax Number: (818) 700-0700
Website URL: www.na.org
Alanon and Alateen Family Group Headquarters Inc.
1600 Corporate Landing Parkway
Virginia Beach, VA 23454-5617
Phone Number: (757) 563-1600
Fax Number: (757) 563-1655
Email address: firstname.lastname@example.org
Website URL www.al-anon.alateen.org
Dual Diagnosis 24