Recently two counselors from the Addiction Psychiatry Program at Strong Behavioral Health, Judith Berman and Rita Moore, presented a workshop in Rochester on The Interconnectedness of Families, Mental Health and Chemical Dependency. Their program called Strong Recovery MICA (Mentally Ill Chemical Abuser) was created because other interventions that may work with people who have either diagnosis were not working with people with dual diagnoses. The speakers defined addictions describing the phases and progression of the disease. They set out some of the parallels of addiction and mental illness (see box) and discussed a biopsychosocial model that was developed at Strong Hospital recognizing the link between family background, mental illness and chemical dependency issues. They included survival roles in families, case studies and some practical strategies for promoting recovery.

Addiction as defined by the Office of Alcohol and Substance Abuse Services is "a chronic, progressive, potentially fatal, incurable disease, characterized by a loss of control over alcohol and drugs" and they added "despite negative consequences if left untreated." They demonstrated very graphically with balls of bigger and bigger sizes which they tried to hide in their pockets, how it becomes increasingly difficult to cover up problems that come with chemical addiction. From experiencing unhappiness, worry, and irritability, a person may become suspicious, argumentative, extravagant, self-defensive, depressed, lose self respect and withdraw socially. Without help, this can become a downward spiral to imaginary illnesses, irrational behavior, self-neglect, blaming others and suicide attempts.

After seeing people over and over who stopped using drugs and alcohol and were still having problems, they discovered many had underlying mental illnesses and had used the chemicals to "deaden" their feelings. They were still feeling awful inside. Addicts were being helped by sponsors and 12 step programs but these people didn’t get better using them. The biopsychosocial model looked at the family history of addiction and mental illness discovering a family heredity or chemical imbalance, the fact that some people can handle stress better whether it is anger at their families or trauma, and behavior in families that may have been learned from watching relatives.

Mental illness and chemical dependency is not going to go away but can be arrested. Some of the most surprising information they gave us is that the disease progresses even when a person is not using drugs or alcohol or exhibiting symptoms of an illness. During a relapse the person goes right back to a stage they might have been at without treatment. However they gave hope that with therapy and treatment, a person can get healthy again and put it in remission. You don’t lose what you have learned. It’s getting back there again. It’s chemistry and it’s disappointment.

They discussed some of the other family roles involved in families with chemical addictions and mental illness. The chemical user may be in pain and ashamed, rigid, blaming, withdrawn and tending toward perfectionism.

One role is that of the enabler who may also be in pain, angry and act over responsibly becoming the super worker with physical illnesses, and harboring feelings of low self worth and powerlessness. Another role may be the family hero who is successful, over achieving, working for approval, acting as the "good kid," while feeling numb, inadequate and guilty. The lost child avoids conflicts, tends to be shy and alone, sickly and treasures pets and other objects. The scapegoat is the one who acts delinquently and defiantly, valuing peer groups, may be a low achiever and uses chemicals because of hurt and angry feelings. The mascot attracts attention with humor, may be hyperactive, a slow learner, shows confusion and tension and has fears. People take on some of these roles and characteristics at certain times and they can be helpful and have positive aspects. Sometimes it is the scapegoat who helps the family get into treatment.

After describing some cases that they had worked with and sketching out some of the accompanying family dynamics, the presenters let the participants know about support groups in the community, and other programs such as MICANet through the Rochester Mental Health Center, MainQuest Treatment Center, and the Anthony L. Jordan Comprehensive Alcoholism Outpatient Clinic. They encouraged people to attend or refer people to their ten-week program at Strong. The chain of chemical dependency and mental illness can be broken by discussing and communicating, educating and seeking help. It is important to keep to the program as a family. With the family nine out of ten people successfully completed the program and without them only three of ten did.

Kathy: Please set this off in a box next to the article.

THE TWELVE PARALLELS

Between Chemical Dependency and Mental Illness

1. Mental illness and chemical dependency are both physical diseases which may run in families.

2. Both diseases affect all areas of lives: physical, mental, emotional and spiritual.

3. If you don’t get help you will continue to get sicker, and you may die.

4. Denial is a major symptom of both diseases; difficulty in accepting treatment is another.

5. Both diseases cause us to lose control of our behavior, thought and emotion. This loss of

control is often misunderstood as a sign of weakness.

6. Both diseases affect family and other relationships.

7. Loss of control leads to feelings of guilt, shame, depression and despair.

8. Both are diseases of pain and isolation which make us more sensitive to everyday stress.

9. Symptoms of each disease and loss of control improve with treatment.

10. Recovery consists of:

- stabilization of the acute disease

- rehabilitation of body, mind and spirit and

- launching upon an ongoing program of recovery.

11. Relapse in one disease often leads to relapse in the other.

12. The only hope for a lifelong recovery lies in working our Program(s)

ONE DAY AT A TIME.