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Distinguishing between side effects and a dual-diagnosis

Discussion in 'Dual-Diagnosis Treatment' started by JohnBrock, Feb 15, 2015.

  1. JohnBrock

    JohnBrock Active Contributor

    I am concerned regarding a case I am working with, I have no real background within it and work more as a counsellor, and I need some help in how to approach a situation I am dealing with currently.

    Subject suffers from alcoholism and severe depression, the latter of which triggered the former, I am wondering how to go about his case, finding proper knowledge on the subject seems somewhat sparse, and I don't know if handling either side of his case first, or handling both at the same time is the most reasonable.

    I fear that handling his alcoholism will make his depression far worse, or that handling his depression will be too hard for him to cope with while still suffering from his alcoholism.
  2. Jane

    Jane Active Contributor

    The alcohol makes the depression worse and vice versa, though, so I think you're going to have to tackle both at the same time. They go hand-in-hand and one isn't going to get better without the other one getting better, too, so just take it one step at a time. Alcohol abuse doesn't stop overnight (nor does depression) so it certainly takes time.

    Is there an option for medication to help with the depression?
  3. pineywood

    pineywood Community Champion

    I understand that medication can and does help certain individuals with depression. What concerns me in this situation is the the subject already abuses alcohol. What is likelihood, that they will begin abusing the newly prescribed medication? Or worse yet, what if the person mixes the drugs and alcohol? Now the situation, becomes even more compounded.

    Of course, I do agree with you that the two can not necessarily be separated, but how to balance the care has got to be a very complicated situation.
  4. stellaluna

    stellaluna Member

    I work as a mental health counselor with a behavioral science background, and I am also a consumer in the sense that I suffer from alcohol and substance abuse and mental health disorders. First, I'll tell you my perspective as a consumer and what worked for me (I assume it is different for everyone though). Focusing solely on the addictions was nearly pointless. The whole reason I was using was because I severely lacked adaptive coping skills. It didn't matter what tools I learned to combat addictions, my MH struggles overpowered that. I just simply didn't care about using because I felt awful emotionally. I wanted to change, but it seemed impossible. Focusing solely on MH helped a little more, but my addictive behaviors inhibited me from making a lot of progress. Finally, I got hooked up with a counselor who helped me address the whole picture. Rather than seeing two separate issues, we took it on as one problem.

    Now, from a clinical perspective: some of the other commenters mentioned medication management. This is for a psychiatrist to determine with the knowledge of both afflictions. There are certainly some medications that if taken while consuming alcohol can result in side-effects, and additionally, some medications are simply not as effective when consuming alcohol (namely mood stabilizers). For me, as a consumer, being on medication was imperative, but like I said, this is really something your client and the doctor need to communicate.

    Hope this helps in some way!
  5. DancingLady

    DancingLady Community Champion

    I think they will both have to be treated at the same time. Most medications can not be safely taken with alcohol, or at least not with the amount of alcohol an alcoholic would likely be drinking. This person may need to go to a treatment center in order to safely get off the alcohol and onto medication for the depression. If his depression is severe, I do not think it would be wise to try to have him do this away from 24hr supervision in case he struggles with suicidal thoughts if the depression gets worse before he is able to get on an effective medication.
  6. kana_marie

    kana_marie Community Champion

    A lot of people ask that same question whenever a situation like this arises. Sometimes the only way to treat someone is to give them medication. That's also why a lot of people tell their doctors that they AREN'T a drug user or alcoholic... the fear that they'll be denied the very treatment they need to break the cycle. What I can tell you for sure is if someone really wants to get better and they DO have a mood disorder, or what not, denying them the medication because of "what if's" is going to make things a lot worse. I have been on a regimen of 5 medications for the entire 3 years I've been clean. They took out lithium and added seroquel, and they took out Remeron and added amitryptaline. Other than those two changes my regimen has worked. Aside from the fact I'm not prescribed anything the least but addictive, I was one of those people who genuinely wanted to get better. Without them treating my mood disorder I would still be a pill head, (assuming I was still alive and not in prison). Oh yeah, I was one of those people who thought it best not to tell the doc about my bad habits out of fear he would say the same thing you did.