Bipolar 2 From Inside and Out

Posts tagged ‘dual diagnosis’

One or the Other? How About Both?

Who does this sound like?

Someone—child or adult—who hyper-focuses on a particular topic or interest, exhibits repetitive behaviors, responds to routines and consistency, and can be diagnosed in early childhood.

And who does this sound like?

Someone—child or adult—who needs novelty and change; is distractible, restless, and impulsive; and who is usually diagnosed as an adult.

I bet you said an autistic person for the first description and someone with ADHD for the second. But recently, there has been a diagnosis that covers people with both conditions: AuDHD.

At first, it sounds illogical that someone could have both disorders, given the very different traits. But if you look at them closely, there are places where they overlap. And sometimes the same trait is expressed in different ways. Both may interrupt conversations, have difficulty maintaining friendships, have sensory differences, and seek sensory stimulation. This overlap can make it difficult to diagnose AuDHD.

Still, there are noticeable differences. For example, people with autism need familiarity, while those with ADHD want novelty. With autism, a person is detail-oriented and resistant to change. In ADHD, there’s a tendency to miss details and crave change and novelty.

But the combination of autism and ADHD sometimes produces surprising strengths. People with AuDHD are creative problem-solvers and think outside the box. They love puzzles. They can hyperfocus. Someone with AuDHD can be productive. The combination of traits can be balanced and lead to valuable strengths.

Of course, there are drawbacks to a person having AuDHD. They may not have the combination of traits that make them handy in business, for example. They’re bundles of neurodivergent traits that may or may not line up in ways that suit neurotypical individuals. And they are susceptible to the stigma and harassment that come with being neurodivergent.

AuDHD is not a medical diagnosis that appears in the DSM. AuDHD is often self-diagnosed, particularly as an adult, based on symptoms. It’s a condition recognized by the neurotypical people themselves, much as ADHD sometimes is (though it requires a professional to make an official diagnosis). Even professionals can have a hard time recognizing it, though. Because of the difficulties in diagnosing the condition and its relative newness, AuDHD isn’t well understood. Research usually focuses on either autism or ADHD, so there isn’t a lot of scientific data about the prevalence of AuDHD or treatments for it. And AuDHD is perhaps underdiagnosed in women and girls, given the difference in diagnoses of autism and ADHD. Also, autism is often stigmatized, even more so than ADHD.

While there are diagnostic criteria that point to a diagnosis of autism and ones that appear with ADHD, there aren’t any official ones for AuDHD. The phenomenon is so new that not much research has been done on it. And because many cases are self-diagnosed, therapy professionals may not be up on how to help or even react to someone who believes that they have the co-occurring diagnoses.

That being said, professionals sometimes start with a diagnosis of autism (sometimes difficult to pinpoint itself) and then look for characteristics of ADHD. Sona Charaipotra suggests that the non-medical condition be diagnosed by combining autism with one of the subsets of ADHD (inattentive or impulsive/hyperactive), demonstrating five characteristics of either one. A combination diagnosis would require five traits from each of the subtypes. And the traits must cause some kind of functional impairment.

Treatment for the condition? Therapy is the first option. But because there is no medication treatment for autism, medications like Ritalin that are used for ADHD are sometimes prescribed. Lifestyle and environmental supports are also called for. Persons with AuDHD can help by suggesting what accommodations they need. After all, they know better than many psychiatric patients what they’re feeling and thinking, and what they need.

This is just a brief overview of AuDHD. There’s so much that still isn’t understood that, as time goes by, more exact definitions, diagnoses, and treatments for it will begin to emerge.

Category:

Mental Health

Tagged with:

Dual Diagnosis and AA

Dual diagnosis, also called co-occurring disorders or co-morbidity, is one of the most complicated conditions that affect people with mental illness. The heart of dual diagnosis is that the person has both a brain illness and a substance use disorder (SUD). Estimates differ wildly as to how common dual diagnoses are, depending on differing definitions of dual diagnosis, for example. According to SAMHSA, 21.5 million Americans experience both SMI and SUD.

Alcoholics Anonymous, of course, is the best-known support group for alcohol abuse disorders. Narcotics Anonymous focuses on illegal drugs rather than alcohol. But there are fewer opportunities for people with dual diagnoses to find similar kinds of support. There is a group called Dual Diagnosis Anonymous (DDA), but it doesn’t have nearly the reach of the older, more familiar organizations.

So, how do dual diagnoses and substance use disorders share the support group space? Is the standard AA model open to or beneficial for people with dual diagnoses?

I recently spoke with Tony, a friend who has bipolar disorder and alcohol addiction. He’s currently in recovery in a treatment program that addresses both problems. Tony, who has been in the program for around six weeks, has started out in a sober house and with AA meetings. While he discusses his SMI, for now the primary focus of his treatment is substance abuse.

According to Tony, the relationship between AA and SMI support is sometimes fraught with contention. The history of AA doesn’t prohibit people with co-occurring disorders, but in practice, the situation can be different. Tony, in his early years of association with the organization, was dropped by his sponsor when he revealed his dual diagnosis.

Part of the problem Tony has found is that many people involved in AA are biased against the use of psychotropic drugs, even those properly prescribed by a psychiatrist and taken as prescribed. To them, drugs are drugs, and they are universally thought to be addictive. This is, according to Tony, an old-school and literalist interpretation of AA’s principles.

But if a person with a dual diagnosis goes off their psych meds, their condition can deteriorate. And untreated SMI can cause a person to self-medicate with alcohol, creating a vicious cycle. AA literature says that group members should not stop taking doctor-prescribed meds, but the problem persists. People with dual diagnosis may therefore avoid AA.

Of course, people can be addicted to prescription medications (whether they get them from their doctors or not). AA and NA can be extremely beneficial for them. Still, according to DDA, people with dual diagnoses can experience “a sense of ‘symptomatic difference’ between addicts and alcoholics and dually diagnosed persons. Some symptoms may result in disruptive behaviors during meetings, further alienating the dually diagnosed. Many dually diagnosed people experience increased levels of fear, anxiety and/or paranoia in group settings. Additionally, there is a common perception among some more traditional 12 Step members that medical management represents the ‘easy way,’ and do not consider those individuals who take prescribed medications to be ‘clean and sober.’ For these reasons, the feeling of ‘not fitting in’ at traditional 12 Step meetings is common for many individuals with dual diagnosis.”

A report published by the Veterans Administration of Virginia focuses specifically on the combination of PTSD and SUD. It notes, “Substance abuse co-occurring with PTSD is often a chronic disorder that
requires long-term help, which AA may provide” and that “aspects of 12-step activities may address core issues of trauma-related symptoms and enhance treatment outcomes.” However, it also discusses how the faith component of AA can be problematic: “Trauma, and PTSD-specific symptoms of loss of faith and hope for the future, may deter individuals from embracing the concept of a higher power and the directive to surrender…. Trust is shattered such that a benevolent spiritual force is hard to imagine, and so surrender to a higher power may be seen as impossible. Further, hypervigilance and the need to
maintain control are integral parts of a traumatic stress reaction, creating hardships in turning
over one’s will and life to God.”

DDA has developed 5 steps that coordinate with AA’s 12:

1. We admitted that we had a mental illness, in addition to our substance abuse, and we accepted our dual diagnosis.

2. We became willing to accept help for both of these diseases.

3. We have understood the importance of medication, clinical interventions, and therapies, and we have accepted the need for sobriety from alcohol and abstinence from all non-prescribed drugs in our program.

4. We came to believe that when our own efforts were combined with the help of others in the fellowship of DDA, and God, as we understood Him, we would develop healthy drug- and alcohol-free lifestyles.

5. We continued to follow the DDA Recovery Program of the Twelve Steps plus Five and we maintained healthy drug- and alcohol-free lifestyles and helped others.

Tony’s treatment program is focusing first on substance abuse programs, specifically achieving one year of sobriety, though in his shares at group, he does discuss his dual diagnosis. And he finds the spiritual component of his recovery to be essential. After his formal treatment ends in mid-January, Tony wants to continue working in faith-informed service to workers in the field—perhaps in a virtual capacity with the intention of helping prevent burnout.

I’m not in AA or DDA, but it seems to me that some discussion and communication between the two organizations would help matters.

Category:

Mental Health

Tagged with: