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It has been well documented that substance abuse treatment is an essential element of recovery for dually diagnosed individuals and that even forced treatment regarding substance abuse may reduce the chances of relapse precipitated by substance abuse. Self-help groups have proven a valuable
resource for treatment of the dually diagnosed client's substance abuse.

Participating in such groups seems to strengthen recovery in several ways. First, a client belongs to a community which openly supports recovery as it provides a safe haven from the drug-oriented larger society. Second, groups provide contact with individuals more advanced in recovery who will serve as positive role models by demonstrating behaviors conducive to recovery. Third, clients may feel that their peers are better able to understand and accept them and they may consequently be more receptive to feedback. Finally, participating enhances self-esteem by giving clients responsibility and an opportunity to help others.

These factors are important for clients in treatment for dual diagnosis and are especially important after graduation in light of the dearth of aftercare support services. Participation in self-help groups during treatment serves as a bridge between treatment and community-based self-help groups and can prevent relapse during transition.

There are several types of self-help groups useful for dually diagnosed clients. At the Dual Diagnosis Project in Contra Costa County (sponsored by the National Institute of Mental Health Community Support Programs) three types of groups are available. Clients may attend community 12-Step meetings, peer-run meetings located at a partial hospitalization program and support groups sponsored by the Contra Costa Network of Mental Health Clients. Each of these models for self-help offers particular advantages for dually diagnosed individuals.


12-Step Meetings

12-Step programs such as Alcoholics Anonymous and Narcotics Anonymous offer extensive support for dually diagnosed clients. One of the advantages of these programs is availability; 24-hour hotlines and frequent meetings make support available at all times.

A second advantage is the program structure. The 12 steps and the availability of sponsors-persons who guide newcomers through the program-represent powerful tools which enable many individuals to maintain sobriety.

Since the 12-Step programs were designed for chemically dependent individuals, rather than for those with psychiatric disorders, this design produces both advantages and disadvantages for dually diagnosed clients. A major advantage is that clients participate in an activity which does not carry the stigma of mental illness, and which exposes them to the mainstream of society.

The programs include persons from all socio-economic strata, some of whom have attained considerable professional and economic success. Association with such individuals may encourage clients, increase self-esteem and teach skills useful in mainstream culture. A disadvantage occurs when clients feel that they do not fit in at these meetings due to their psychiatric disability.

Sometimes clients are concerned about the stigma associated with their psychiatric disorder. They may also experience confusion regarding the use of psychiatric medication. The use of some psychotropic is controversial in many 12-Step groups as members have confusing memories of medical intervention during detoxification and confusion about the differences between potentially abusable tranquilizers (e.g., benzodiazopines and neuroleptics for treatment of schizophrenia).

Some recovering individuals may remember getting "high" during detoxification or may have felt that medical personnel were easily manipulated into providing abusable medication and thus may misunderstand the necessity of medication for dually diagnosed persons.

This stance fosters conflict in the dually diagnosed clients who may require medication for both detoxification and treatment of acute psychiatric symptoms.


Peer-Run Support Group Meetings

A peer-run meeting, loosely patterned after a Narcotics Anonymous meeting is provided weekly after program hours at the Partial Hospitalization program. The meeting is led by a program graduate who has been clean and sober for 15 months and is stable on her psychiatric medications. The meeting is open to current Dual Diagnosis Project clients and alumni. Staff are not presenting the meeting. However, a staff member sits on the other side of a room partition and is available for problems if indicated.

The meeting opens with traditional introductory readings with a sensitivity toward members who have limited reading skills. The format includes discussion of topics of interest such as peer pressure, dealing with cravings, denial, etc. One advantage of this model is that it functions as a bridge between treatment groups and community 12-Step meetings. The format familiarizes clients with structures found at community 12-Step meetings, yet clients are comfortable because the setting is familiar and members attain leadership positions because the meeting is theirs and they can advise newcomers.


Network of Mental Health Clients

The Contra Costa Network of Mental Health Clients sponsors self-help meetings chaired and attended by consumers. One of these meetings is designated for dually diagnosed individuals and an advantage of this model is that the group is created specifically for members' needs and members alone determine the format and content. Here, too, the opportunity for consumers to attain leadership positions, with the attendant increased self-esteem and new skills is invaluable.

We have presented three models for the use of self-support meetings for dually diagnosed clients. Clinical observation has again and again validated the utility of such groups for these clients. In this time of limited treatment resources, self-support groups represent an inexpensive and viable treatment
option.