Pondering what goes unspoken

As I write this, I am at an international conference in which the primary topic is dual disorders–meaning the  not so infrequent clinical situation in which someone is suffering from both a mental health and addictions problem at the same time. The medical field understands dual or co-occurring disorders to be harder to treat than when there is one disorder. Adolescents with co-occurring mental health and addictions, have an even harder time in school then if they had one disorder, have more problems functioning and take longer to get better. To be frank, I think a lot of psychiatrists don’t like to ask about the addictions part of the problem because they are not sure what to do about it. For the patient or client, there is often shame or discomfort about sharing information about their addiction, or they are just not ready or sure how to. So, addictions and dual disorders remain unspoken between doctor and patient. Here are 5 things we can do about that:

  1. Your pediatrician or primary care doctor should be screening for substance use or other risk behaviors regularly. 
  2. All child and adolescents psychiatrists should assess for both mental health symptoms and substance use disorders in their first sessions with adolescents and older children and continue to monitor and offer information.
  3. The doctor should ask about substance use without judgement, asking the patient about both what they find positive and negative about using drugs or drinking. Knowing both sides, negative and positive, helps with discerning motivation for change and brings to light the ambivalence we can all have about change.
  4. Ideally, treatment offered should address both disorders in an integrated fashion (both together).
  5. All of us should remember that both psychiatric disorders and addictions are both treatable, and people often do get better. It can take a while to see change and often only after a series of attempts, lapses and relapses but recovery is possible.

If we can talk about it then we can work on it. 

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