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Dual Diagnosis: Working Sobriety with a Mental Illness

Getting sober is hard enough, but sobering up with an additional mental illness is even more of a challenge. Many addicts bring other disorders to their recovery, such as major depression.

My Story with Mental Illness

I’ve lived with bipolar type I for several years. Since early adulthood, I was diagnosed with major depressive disorder, but in 2017, I had a manic episode. I have had a few other manias in the subsequent years. I found out that it’s common for unipolar depression to switch into bipolar in later adulthood.

Though the manic symptoms were frightening, I stayed sober. It was only through grace, really. I lost touch with reality during the mania but didn’t pick up a drink. I believe that was only the hand of God since I had lost connection with myself and my true motivations that had guided me since I put down the alcohol, the most important of which is to stay sober.

I ended up with an RV due to my first mania and only recently was able to sell it, at a loss. This splurge purchase is in addition to a stay at an inpatient treatment center.

While I usually just lived with the depression for most of my life, the mania had me flat on my back. When I came out of the manic phase, I could not recognize who I was or what I had been doing. It was a wake-up call that I could do everything right in sober recovery but still experience a worsening mental illness that needed new treatment.

Sobriety and mental health can coexist.

It’s not a lost cause if you have a severe mental illness and try to get sober. Therapy and bipolar meds aren’t effective when you binge drink all week. Additionally, sobriety isn’t enjoyable when you’re blowing all your money in manic euphoria. You have to treat both.

The thing I’ve learned, however, is that both addiction and mental illness make for a more strenuous effort to stay well. This means that despite being strong in sobriety, there are days when it’s a struggle to get out of bed. Alternatively, sometimes I might be feeling squirrely about sobriety, but my mental health symptoms are cared for.

I had to trudge along recovery to appreciate the times when everything falls into place, however rare those times may be. I’ve come to savor days when my sobriety and mental health are firing on all cylinders because the day feels so right. Those days remind me that staying the course is ultimately worth it, no matter the crappy days I have to put up with. I’m reminded that drinking would never have brought about good days.

So it comes to giving weighted attention to both disorders. For me, it’s not helpful to think AA can solve everything and ignore traditional mental health treatment. On the other hand, I don’t think it’s wise to go all-in on modern therapies, thinking the latest science can solve all my problems, either. It is a balance that requires me to be honest with myself for finding and doing what I need to stay well.

Others are dealing with the same things. You’re not unique.

I became aware of being different than a majority of people in AA. Most people only seemed to be dealing with alcoholism. Halfway houses turned me away when I first tried to get sober because they said they weren’t equipped to handle severe mental illness. I felt the sting that I may be different from the garden variety alcoholic, and the AA program wouldn’t help someone like me.

Thankfully, I didn’t stop attending. Over time, I met others with mental illness, usually more severe than mine, who had gotten and stayed sober for long periods. They went through the steps and worked recovery the same way everyone else did and got treatment for mental illness in the ways they also needed, often with resources outside the AA rooms.

It was eye-opening to realize that the program didn’t reject people like me. In fact, the Big Book clearly states: “There are those, too, who suffer from grave emotional and mental disorders, but many of them do recover if they have the capacity to be honest” (p. 58, How It Works).

The only baseline requirement for the mentally ill to get sober through AA is complete honesty, and the program can work. So we must conclude that even early AA founders had high hopes that the mentally ill could recover with the program they suggested if they could get honest with themselves and others. This is a profound statement.

In light of the complexity of modern psychology’s treatment for dual diagnosis, the Big Books’ program of recovery is still the best news. It suggests that those with a dual diagnosis don’t need to be separated as terrible cases. We can apply the steps and the principles of the Big Book like any other alcoholic and get well. We can get the same results by following the program without any unique guidelines.

While most people still seek treatment outside of AA for mental illness, AA can still be a refuge and source of sobriety for anyone regardless of mental health.

The 12 Steps Take Willingness. Mental Illness isn’t an Excuse.

The therapy world makes it sound as though you can pop some pills and get on with life. I’ve not found that to be the case. It still takes immense courage and willingness to get sober, even when the steps feel uncomfortable.

A lot of people define themselves by their mental illness. But 12 step programs offer a different perspective. The program says you can become a fully recovered person and not an always-recovering person. Yes, it takes daily work to maintain health, but the bottom line is we become different people. We don’t need our lives to revolve around our sickness anymore, since we are recovered.

Recovery, in light of the 12 steps, means transforming our whole attitude and outlook on life. We don’t need to be afraid of being “triggered” anymore, and we don’t need to shield ourselves from temptation. This is good news in a world that latches onto labels with which to define ourselves. Labels can hold us back from trying to become the best version of ourselves. The program offers hope that we can become new people with new outcomes.

The cost is that I must put in the effort and faith in the steps. The work required isn’t easy, especially not as easy as taking a pill. Some days, it’s a force of will to do the right thing. Other days, it comes naturally. So even though I have a mental illness, I know I have to put forth extreme willingness in order to maintain my sobriety, just like any other alcoholic trying to recover.

Mental illness isn’t a ticket for me to take an easier route because that would mean I won’t get the same results.

Mental illness merely means that I may have to do extra work outside of the AA rooms to stay well.

A Word About Those who Don’t Understand

Admittedly, there are many people in 12 step programs who don’t understand mental illness. For example, they believe the 12 steps are all you need. Or they believe taking mental health medication means you aren’t truly sober.

I tend to avoid these people like the plague. Their comments sometimes cause immense harm to the mentally ill newcomer who comes off their medicine and suffers deeply as a result.

Everyone is allowed to their opinion, but if their opinion tears down what works for me, then I’d rather not spend timing listening when I don’t have to. I shouldn’t waste my time trying to change their minds, either. In a way, their beliefs make sense, and they can pull up passages in the Big Book to back them up, often out of context.

The official literature says nobody in the rooms is a doctor. And if they are a doctor, they’re not your doctor. In other words, they should not give medical advice on matters they have no experience in. You don’t have to internalize what they say.

Stability is Worth It

Living in uncertainty and chaos was deeply painful. I couldn’t keep a job or maintain friendships when I didn’t care about getting treatment for both my problems. Having a life where I say I will do a specific commitment and do it is worth the struggle of sobriety and mental wellness.

When I found a place of stability, good things started appearing in my life. Because I could keep commitments, I now keep jobs long-term and get promoted. Because I can now get out of my mind and listen to other people, I’ve built strong friendships better than any I’ve had in my life.

While TV shows and celebrities sometimes glorify the chaos of addiction, I’ve concluded that stability is much sweeter. It might look boring from the outside looking in, but nothing is worth giving up the sound sleep at night, the comfortable passing of the days where I can predict what I’ll be doing, and the leisure time that’s not sullied by drugs and mental anguish.

In summary, It’s more critical for me to remain a happy, constructive member of society than chase the roller coaster ride of addiction. The benefits far outweigh the sexy appeal of chaos.

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