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Why Dual Diagnosis Needs Dual Services

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By Sam Thomas

After three months of abstinence from alcohol, it felt like everything had changed. I was able to function without the need for a substance that had prevented me from ‘functioning’ for too long.

I wasn’t enduring horrendous withdrawal symptoms that had resulted in numerous A&E visits and I was able to do the activities I had been unable to do, due to having to drink in order to avoid these episodes.

During this period of abstinence, on a superficial level, I was doing ‘well’ but regarding my mental health, I wasn’t.

Anyone who has been through episodes of withdrawal and detox programmes will know – it isn’t easy.

Often, it can take more than one attempt to achieve sobriety. Meanwhile, I was dealing or trying to deal with the underlying demons that had led me down that road in the first place.

Suicidal intent was a frequent battle, as well as not eating, sleeping, or generally looking after myself.

Work was a good distraction and going abroad was a form of escapism. Ultimately, it all led to the same outcome: avoidance, or for a better word: denial.

You would think by reading that I meant I was in denial about the drinking but this wasn’t the case. I was open and honest with friends and family.

I’d often say I drank too many glasses of wine again last night, whilst working into the early hours. Goodness knows how many photos of me there were on social media with a glass of wine in my hand. As far as the people around me were concerned it wasn’t a problem.

What they hadn’t realised was the impact the drinking was having; what issues I was attempting to manage and how everything that was going on was building up in my head and leading me down a dark and lonely road.

My experience was far from unique but I was unable to communicate that. Instead, it was easier to numb and suppress it with alcohol which, for all the wrong reasons, worked for a while. Obviously, in the longer term, it resolves nothing.

Understanding the underlying issues themselves is tricky. Sometimes they’re easy to identify. Other times they’re not.

People with mental health problems sometimes aren’t aware of why they are as they are, so they turn to self-medicating, in all sorts of ways, exactly, as I did.

It made sense at the time and every single of us can relate to that. Whether it’s alcohol, drugs, smoking, food, sex, gambling – the list goes on and on.

One way or the other it’s always done to cope, to manage or just get by. However, none of it does any good. We deal with it in the interim but it doesn’t resolve the complex traumas we are experiencing.

Unfortunately, the downside is that services aren’t structured to support people with a ‘dual diagnosis’. In other words, people with mental health problems often live in tandem with substance misuse issues.

They say you must deal with the addiction first and mental health second. They say it’s ‘chicken and egg’ in terms of what causes what first.

It all makes sense and I don’t wildly disagree in principle. However, in reality, when you are in the thick of it, we don’t sit in neat categories. Life does not work like that and nor should services reflect this simply for the sake of ease.

We need mental health services that work for the people affected, not for the sake of the system.

As it currently stands, it’s not good enough.

Services ought to be designed for the needs of those they serve. People with ‘dual diagnosis’ need far more tailored services and that isn’t available under the current provision.

My recovery journey is ongoing and far from done. It never is. I’m determined to keep going, so others are able to get the support they deserve.

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