Supporting Clients In Their Recovery

Recovery is a life-long process which does not end when clients are discharged from formal treatment.  his is particularly true for those suffering from co-occurring chemical dependency and mental disorders. It is therefore incumbent upon the health care professional to support clients in their transition from the structured treatment environment to life outside of the health care system. 

This is done through giving clients tools, strategies and resources which they will be able to use once formal treatment has ended. Self-help groups are such a resource. Self-help (mutual aid) is both a complement to formal treatment during the early stages of the recovery process, and a life-long support for clients as they continue their journey on the narrow path of recovery beyond the treatment phase.

The benefits of mutual aid rest largely on consumer empowerment: Only when self-identity, self efficacy and self-esteem begin to replace stigma, victimization and powerlessness can clients follow on the true path to recovery. As a health care professional working in partnership with clients to support the recovery process, the greatest contribution you can make is to give clients the resources needed to effect that change in themselves:

• Educate clients about self-help
  
  

• Encourage attendance
  
  

• Support clients’ initiatives to take an active part in mutual aid fellowships including starting and running autonomous groups.
  

Double Trouble In Recovery (DTR), a self-help group specially designed to meet the needs of the dually-diagnosed, wants to work with you in partnership to give consumers the necessary resources and support to recover.

WHAT IS DOUBLE TROUBLE IN RECOVERY?

Double Trouble is a fellowship of men and women who share their experience, strength and hope with each other so that they may solve their common problems and help others to recover from their particular addiction(s) and mental disorders.

Double Trouble is designed to meet the needs of the dually-diagnosed and is clearly for those having addictive substance problems as well as having been diagnosed with a psychiatric disorder.

We also address the problems and benefits associated with psychiatric medication; thus we recognize that for many, having addiction and mental disorders represents Double Trouble in Recovery.

There are no dues or fees for DTR membership; we are self-supporting through our own contributions.

We who are dually-diagnosed are compelled to walk a long and narrow path. When we go out of control with our substances of choice, we become lost. If we ignore our doctors, our therapists, and misuse our medications, our path becomes very dark indeed.

In our fellowship, we band together for common good and recovery. With open-minded understanding for each other, we honestly expose our problems and our weaknesses. The humility we show shall never mask the courage it takes to admit who we are as together we find the hope and strength that makes our narrow path into a wide road that leads to peace, serenity and a meaningful life.

Therefore, working the Double Trouble Twelve Steps and regular attendance at Double Trouble and other appropriate self-help groups will help us gain the rewards of sanity, serenity and freedom from addictions.

Double Trouble invites you to join us and continue or begin your mental, physical and spiritual recovery.

WHY SELF-HELP WORKS: FIVE GOOD REASONS

Self-help aids the process of recovery in five ways:

1. Self-help provides a social network based on commonly shared experience. Recipients of mental health services are often isolated due to stigma and discrimination within and outside the mental health services system. In this context, socialization becomes an acute problem. When recipients come together in a self-help setting, they share common experiences which lead readily to the formation of social relationships.
   
   

2. Self-help facilitates people’s move from help-recipient to helper. Always being helped makes one feel helpless. It is a demeaning role in our society, leading to low self-esteem and a negative self-concept, in turn increasing the likelihood of more frequent feelings of anxiety. In contrast, the role of helper is highly valued in our society, leading to high self-esteem and to a positive self-concept. This provides a buffer against anxiety and repeated crises.
   
   

3. In self-help groups, people share specific ways of coping based on experience.
   
   

4. Those who cope successfully serve as role-models for individuals with less successful coping strategies.
   
   

5. Self-help provides people some meaningful structure which is not imposed by the outside but rather self-generated from the members themselves.

• Traditional 12-step groups are single-focus organizations based on the "one-disease - one-recovery" model. This specialization is largely what bonds members together. However, recovery needs which do not fall within that singular parameter are ignored, misunderstood or stigmatized. Dually-diagnosed clients need and want to address their dual recovery with integrity and holistically.

• Dually-diagnosed clients suffer the double stigma of mental disorder and of chemical dependency, with associated social prejudice. These negative attitudes are ubiquitous and are as present the single-focus self-help groups as they are elsewhere in society. These negative attitudes are the antithesis of the mutual acceptance and honesty on which rests the essence of the 12-step recovery program. For the dually-diagnosed, these negative attitudes can be devastating to the dual recovery program.

• Many of the dually-diagnosed are on a prescribed regimen of medication which is as crucial to their total recovery as is abstinence from drugs and alcohol. Traditional 12-step groups often have an unspoken bias against medication. In that context, the dually-diagnosed receive misguided advice which can lead to non-compliance with medication, increased psychiatric symptoms and substance abuse relapse. For the dually-diagnosed, this bias can be devastating to the dual recovery process.

• Single-focus 12-step groups cannot offer the dually-diagnosed the honesty, acceptance, emotional support and shared experiences they deserve and need, and which are the most critical elements of the mutual aid process. Where they find these elements, it is often for one aspect of their recovery only: they may not feel comfortable sharing honestly their experiences and cannot relate totally to those who share theirs. They may feel shamed, judged and stigmatized. They may downplay, neglect or hide one side of their recovery needs to other members and to themselves. That is the antithesis of the mutual acceptance and honesty on which rests the essence of the 12-step recovery program. For the dually-diagnosed, this lack of complete mutual acceptance and honesty can be devastating to the dual recovery process.

Thus while there exist many self-help groups, they are single-focus and cannot provide adequate support to individuals dually-diagnosed with a mental disorder and a chemical addiction (alcohol and/or drugs). This is true for the essential areas of social/emotional support and learning/skills development, two crucial ingredients in self-help but also where it concerns the use of medication. Available data show that 76% of DTR members are currently under a prescribed regimen of psychiatric medication,* which is as critical a part of the dually-diagnosed client’s recovery process as is abstinence from drugs and alcohol.

In traditional 12-step substance abuse groups, dually-diagnosed members report receiving misguided advice about psychiatric illness and the use of medication; mental disorders are viewed as mere self-pity or some other character flaw. Traditional self-help groups have always been legitimately concerned about members who use prescribed drugs in a manner which threatens the achievement and maintenance of sobriety. Many individual traditional 12-step groups and members have taken an anti-medication stance and believe that those taking medications should not speak at meetings or otherwise participate fully. This view has resulted in members stopping their medication, with consequent psychiatric breaks as well as guilt and shame in being "dependent" on medication. 

DTR is intended to overcome the problems encountered in traditional single-purpose groups by those suffering from both substance abuse and mental disorders. DTR creates a safe environment where clients can discuss the issues of mental disorders, medication, medication side-effects, psychiatric hospitalizations and experiences with the mental health system openly, without shame or stigma.

WHAT DTR DOES NOT DO

DTR does not provide treatment other than the support mutually shared by its members; it does not make diagnoses or dispense medication; it does not take attendance, keep client records or do case management; it does not provide advice, advocacy or training; it does not provide religious guidance other than the spiritual experience members derive from working the program; DTR does not affiliate with social agencies or other institutions.

WHO CAN BENEFIT FROM COMING TO DTR?

Any client with co-occurring chemical dependency and mental disorder can benefit from coming to DTR.

HOW TO REFER A CLIENT TO DTR

There is no formal referral process to DTR, the organization is consumer-run. DTR meetings are held throughout New York State and increasingly throughout the country in community-based agencies and psychosocial clubs. Although most meetings are open, some are held in treatment facilities or institutions and closed to outsiders. Please call individual meeting sites to find out if a group is open or closed before referring clients.

ATTENDING THE FIRST DTR MEETING

While you are encouraged to refer to DTR meetings clients who could benefit from attending, it is not recommended that you accompany clients to meetings. Having a client attend his or her first meeting with a DTR member is desirable, though not a must. As with any new experience, the first few meetings may be unsettling to clients: many have never been in a place where they hear others share freely about their dual recovery, about psychiatric symptoms, medication side effects and chemical addiction. It is important that clients know that they do not have to share with the group and many will choose not to initially. We believe that partaking in the experience of other dually-diagnosed individuals in a trusting, open and accepting atmosphere will benefit clients from the first meeting; in time they will choose to attend again, and perhaps to participate. 

While clients should be encouraged to withhold judgment until they have attended a few meetings, the engagement process must not be hastened; rather, we must empower the client to make his or her own decision, to take charge of his or her recovery and to proceed at his or her own pace.

WHAT DO CONSUMERS GET FROM COMING TO DTR*?

Fellowship as safety net: Most clients who come to DTR have had superficial experience with traditional 12-step programs but typically did not feel connected and thus did not share, or shared only about their substance use, which bothered them (12-steps are based on honesty, and dually-diagnosed individuals do not feel they can be honest about their mental health disorders and medications at "traditional" 12-steps).

Coming to DTR, members are overwhelmed by the feeling of being with others who had had the same experiences with drugs and psychiatric symptoms and medication and could freely discuss it in a non-judgmental, supportive atmosphere.  

For the first time, they report, they can be themselves, be accepted and trust; this is in the context of a history where they felt no one could be trusted, be it psychiatrist, drug counselor or peers at 12-steps meetings. What is more, members report that DTR allows them to feel more comfortable seeking help for both their addiction and their psychiatric disorders; it gives them a more positive attitude toward medication and provides them with a safety net: "When you’re walking a tight rope, if you know there is a safety net under you, you don’t think about falling: DTR is my safety net."

Because Double Trouble is a true mutual-help group, members are invited early on to take and active role in the group, be it "qualifying" (being the main speaker at a meeting and speaking of one’s experiences in front of the entire group), making a presentation about DTR at another facility or becoming group facilitator ("chairman," that is, leading the group protocol, opening, closing, etc.) The combination of sharing with others who have had similar experiences (mutual support), seeing those who are further along in their recovery (role-models), and becoming a helper to other newer members (as opposed to being a stigmatized service-recipient), brings about a new feeling of self-confidence and empowerment which facilitates in the struggle for staying clean and taking one’s medications. Thus, DTR members credit the fellowship for giving them the ability to stay on the path of their double recovery - "If it was not for DTR, I would be back in the hospital or using: it’s my rock of Gibraltar."

* Data compiled by National Development and Research Institutes, Inc., New York, 1996.

WHAT CAN YOU, THE HEALTH CARE PROFESSIONAL, DO TO SUPPORT CLIENTS IN THEIR RECOVERY?

The benefits of self-help rest largely on consumers empowerment. Thus DTR groups are consumer-run and peer-led. This empowers clients and gives them the resources necessary to continue the life-long recovery process beyond treatment termination.

As a health care provider working in partnership with consumers to support the recovery process, you can:

• Find out more about DTR, learn about how self-help complements formal treatment, provides a bridge for the aftercare transition and a stable source of support for clients in their life-long struggle to recover.

• Refer clients to DTR meetings
  
  

• Encourage regular attendance
  
  

• Support clients’ initiative and efforts to start a DTR group meeting at your facility or in the community
  

To find out more about DTR, including meeting sites and client support for group development, please contact:

Mental Health Empowerment Project, Inc.
at 718-373-2684 (sometimes it is on as a fax, sometimes as a phone. If you don't get through try again at another time.)

DTR
PO Box 245055
Brooklyn, New York 11224

HOW IT WORKS

We band together to help ourselves recover from our addictions and manage mental illnesses. We share our experiences in order to help ourselves to become honest, open-minded and willing. Sharing helps all of us to remember how it was and how we arrived at where we are today.We live one day at a time and practice the following Double Trouble Twelve Steps

1. We admitted we were powerless over our mental disorders and substance abuse -- that our lives had become unmanageable.
   
   

2. Came to believe that a Power greater than ourselves could restore us to sanity.
   
   

3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
   
   

4. Made a searching and fearless moral inventory of ourselves.
   
   

5. Admitted to God, to ourselves and to another human being the exact nature of our wrongs.
   
   

6. Were entirely ready to have God remove all these defects of character.
   
   

7. Humbly asked Him to remove our shortcomings.
   
   

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 whenever possible, except when to do so would injure them or others.
   
   

10. Continued to take personal inventory and, when we were wrong, promptly admitted it.
    
    

11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
    
    

12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to other dually-diagnosed people and to practice these principles in all our affairs.