By Dan Waters
Dual diagnosis is a term used to describe the experience of a mental illness simultaneously with a substance abuse disorder. Either can develop first. The person with a mental illness can self-medicate with opioids — although in fact, opioid abuse worsens the conditions of a mental illness. According to the National Alliance on Mental Illness website, more than 7.9 million people in the United States experience both substance abuse and mental illness simultaneously. Many mental health clinics are using drug screening tools to identify patients who are at risk for substance abuse.
The outdated philosophy that one cannot treat mental illness when someone is still “using” has no place in current treatment plans. An integrated treatment plan is most effective. Both issues must be addressed, and an inpatient setting has many advantages including, a structured setting, 24/7 medical and mental care and supportive group work. Detoxification is the first step, and inpatient is more effective than outpatient for the same reasons.
Chaplains have the skills to be an integral part of supportive group work. The skills to walk with individuals through feelings such as “I feel alone in the world,” “Why is God punishing me?” or “I feel useless” are regular tools of a chaplain. A trained chaplain can accompany a person as they peel back the layers to identify grief, loss, or pain.
The patient in the story below was admitted with clinical depression, suicidal ideation, and heroin abuse. The Rev. Sally Martin, our chaplain assigned to the Behavioral Health Institute, relates this experience.
“In a worship service on the unit a young man came in late but was taking in everything that was said. At the end of the service, he began to share his opioid addiction story and what it has done to him. He had served in prison for a while. He found Christ in prison and successfully continued his walk of faith when he got out.
“Then he had surgery and was given pain medication and relapsed. He said that when he was using drugs, his family would lock up all medications, purses, and anything of value because he would steal to support his habit. Then he came up with something very profound. He said it was arduous work being an addict. He was forced to find or steal the money and then hide the fact that he was using drugs yet again from others. He was tired of it.
“The other patients sat there and were taking everything in like sponges. He was crying as he told his story. I tried to convey to the group that with God’s help this or other addictions can be beaten. I encouraged the young man that this was just a temporary setback. He shared that he had even made a noose to hang himself in the bathroom when his fiancée walked in. God’s providential hand was on this man’s life. My heart goes out to those that are searching for something. My prayer is that they will connect to their spirituality and be strengthened beyond words.”
The Rev. Sally Martin is an assistant chaplain working in the BHI units at Mercy Health St. Charles Hospital in the Toledo, OH, area; Dan Waters is the manager of mission and spiritual care at the same hospital.
