Home Features Health Dealing with a Dual Diagnosis

In a two-part series, Mitzi MacKenzie, M.S.W., explores dual diagnoses, including how to recognize that a loved one has a co-occurring condition and effective treatment processes.



hank you for all of the questions that were received on the Arcadia Angels Web site. These inquiries support the need for additional education, insight and awareness about the mental health and addiction challenges with which many families are struggling. Let’s explore two things in this article: how denial in family systems can paralyze the entire family and impede the treatment process; and of what an appropriate treatment process for co-occurring conditions consists.

Denial is not a famous river but rather enmeshment at the highest level. Typically such disavowal, particularly with parents of a teen or young adult, exists because of the lack of education on what is actually occurring with a loved one. To reiterate a point I tried to drive home several months back, recognition failure can sometimes be as destructive as the actual problem. This conundrum tends to co-exist with a family’s desperation to find its own quick fix for the person with the problem. In actuality, the entire family or support system is in need of the therapeutic intervention.

A skilled family therapist is often able to break through the denial by offering education and insight which builds the awareness factor for families. This approach simultaneously erects a level of trust between the clinician and the family, in turn adding strength to the process that is about to begin, that is, a treatment plan. Sometimes the denial is so strong that clinicians get frustrated, see no end and sadly throw in the towel, simply referring the problem elsewhere. On the other side, families sometimes are so locked down in denial that they get stuck in the anger phase of the grief model, don’t hear what they want to hear, and simply shop for a therapist or doctor that will merely tell them what they want to hear. This cycle is fruitless and impedes the treatment process that must occur to ensure any wellness for both patient and family. The best advice here: Find a doctor and/or therapist that you trust and begin to have faith in the process. Denial only exacerbates the loved ones’ illness.

The appropriate treatment plan for someone struggling with a co-occurring disorder typically starts with a visit to a doctor or therapist’s office. Sometimes an inpatient hospital stay occurs due to an event that requires a higher level of care. Regardless of how the process starts, eventually a course of treatment needs to be implemented. The type of setting—be it inpatient, intensive outpatient or individual therapy, coupled with the length of stay in any of these settings—is a decision that a patient and their family will receive through the doctor and/or clinician’s recommendations. Moreover, the treatment team will recommend specific facility options that offer the above services. 

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Arcadia Angels www.arcadiaangels.com.