The Dance of Shadows: Confronting Dual Diagnosis and the Implications of Integrated, Trauma-Informed Care

Welcome to another episode of Recovery Dialogues and Sober Stories, brought to you by the luxury rehab center Wish Recovery. Wish Recovery understands that healing from addiction is a unique journey for everyone, and that's why they offer comprehensive, individualized inpatient and outpatient treatment programs. No matter where you are on your road to recovery, they'll stand by your side and support you with each step. In today's episode, we delve into Duel Diagnosis. Dual diagnosis, or co-occurring disorders, are embedded in the labyrinth of mental and behavioral health, representing a particularly intricate puzzle, a dance of shadows where substance use, mental health disorders, and behavioral addictions intertwine. This conundrum gains added complexity with the overlay of trauma, making it a significant concern, especially for individuals with severe mental illnesses. The entangled nature of these conditions demands an approach that is as multifaceted as the disorders themselves. Integrated trauma-informed treatments rise to this challenge, providing a holistic exploration of the individual's condition Considering the intricate web spun by these overlapping disorders and the profound impact of trauma, integrated treatment forms the bedrock of this approach, creating a cohesive treatment plan that addresses both mental illness and substance use. It's akin to assembling a jigsaw puzzle where each piece—mental health, substance use, and behavioral addiction— is examined and treated by the same team, offering a comprehensive picture of the individual's health. This approach paves the way for more effective treatment plans, leading to encouraging outcomes, lower relapse rates, greater adherence to treatment, and improved overall functioning. Parallel to this, trauma-informed care acts as the compassionate thread weaving through the treatment fabric. It acknowledges the haunting specter of trauma that hovers over many individuals with dual diagnosis, creating a safe and supportive environment that considers their past traumatic experiences and conscientiously avoids retraumatization. Yet the road to effective dual diagnosis treatment is riddled with challenges. The underdiagnosis and Under treatment of this condition are significant hurdles born from a lack of recognition and understanding. The simultaneous addressing of substance use and mental health issues adds another layer of complexity, as each may demand a unique treatment approach. Furthermore, the stigma and discrimination surrounding dual diagnosis can cast long, daunting shadows, hindering access to appropriate care. Thus, as we navigate the convoluted pathways of dual diagnosis, we must strive to dismantle these barriers. We must challenge the stigma, foster a healthcare system equipped to handle the complexities of dual diagnosis, and promote an environment where integrated trauma-informed treatment becomes the norm rather than the exception. In the face of such complexity, it is clear that dual diagnosis requires a nuanced, multidimensional approach to treatment. By breaking down the stigma and creating a healthcare system that can navigate this intricate landscape, we can move towards a future where treatment for dual diagnosis is not merely accessible, but also practical and empowering. I am honored to introduce my first guest, Cynthia, who is a lived experience expert. She has overcome prescription drug misuse, mental health disorders, and behavior addictions with great courage. Her journey of recovery started at a young age in her teens and has been complicated by the challenges of dual diagnosis. Cynthia will be shedding light on the issue of behavioral addictions, which is often overlooked. She will share her insights on how trauma played a fundamental role in her addictive behaviors. Despite the difficulties, Cynthia found support in various inpatient and outpatient treatment programs and support groups. She continues to navigate her ongoing recovery with resilience, and I'm grateful to have her on the show. Cynthia, can you share your experience with dual diagnosis and how it has impacted your journey to recovery. What were some of your challenges and how did you overcome them?

I want to first say that the addictions I deal with are both substance and behavioral. I have been addicted to medication and I've also been dealing with behavioral things, and I'm in recovery for both addictions, which is like a double whammy. I have severe anxiety, depression, and I have dissociative identity disorder. I think the biggest challenge and impact simultaneously is having dissociative identity disorder because there are so many times where if I slip into an addiction, I can't really say what happened beforehand. I can try to piece together what happened based on what maybe somebody tells me, or if, if I might have been involved in a conversation via text message. There's just a lot of things that I depend on other people for if they've witnessed it or been around me before I slipped into something. But a lot of things also happen when I'm by myself. So it, it makes it harder and more challenging to know what led up to it, to keep track of things. But in my experience, I try my best to, to go on what I do know instead of focusing on what I don't know. And try to maintain sobriety the best I can.

When did you first realize you had co-occurring disorders? Did something specific happen that made you seek help?

That's a great question. I got diagnosed with dissociative identity disorder in 2018, and I had severe anxiety and depression. Probably my whole life in retrospect, but I got diagnosed in like 2008, 2009. So the DID came much later and realizing that it was a problem and I had all this stuff piling on top of each other came actually after my diagnosis, especially my diagnosis of DID, to clarify. Especially after I realized I just couldn't remember what would happen. If I would talk about it in therapy or with my social worker and the question would be, "What happened? What led up to this?" I'd always say, "I don't know. I just have no idea." I would sound like a dummy not knowing what in the world happened. So that's when I started to realize that this was all happening and just how far the disconnect was. And that's when I realized I needed help. But talking about addiction, whether behavioral or substance, has been really hard for me. So it took a few years after that even to start talking about it and having the conversation and saying, hey, I'm I'm an addict and I need help. So I started doing that a few years later through a mental health program in New York City, and I'm still going strong. But it definitely— I think asking for help was the part that came last. Everything was just like a domino effect, all these things leading up to one another.

So That's how it happened for me. How did any traumatic experiences lead to addiction, and how did addressing trauma help your recovery?

There's definitely been a lot of trauma in my life that's led to addiction. I suffered from child abuse. It's something that I look back at and I realize the things I went through at home were not normal. And I learned a lot of that really through watching TV, like watching Full House and things like that. And like, I didn't know that it wasn't normal to get cursed out as a 5-year-old little girl and to see a lot of the other things I'd see at home. So there was, there's a lot of things that I don't want to say I didn't have a point of reference because there were good moments in my childhood. But they were far and few between. And when they happened, it was really weird. I didn't know what to do when there was a good moment because there was so much chaos and a lot going on. And I really truly believe that shaped and molded me. And whether or not I wanted it to, that's what I believe. And it's been something that I've never fully recovered from. I don't think any kid growing up can recover from a parent that has literally one job, just to love their children, and all the stuff falls underneath that, nurturing and protecting and providing. But when that doesn't happen from a parent, it's really hard to recover from and to move on. And I thought with all three types of abuse, physical, verbal, emotional, and sexual. And it's really hard to even talk about that, but I dealt with all of it. And I saw a lot of things and heard a lot of things at home in my family that were traumatic. And then my father, who was the abuser, passed away in a really traumatic way. We pretty much just watched it happen. He was very sick for a long time and things just went downhill, like, right in front of us. And I was only 15 when he passed away. So it was just a lot. A person that I had to end up kind of taking care of and helping take care of for the last few years of his life, being someone that hurt me. Then I watched things happen as he passed. So there was definitely a lot of trauma in my childhood and in my teenage years.

How did early intervention affect your overall treatment and outcome?

For me, I actually didn't learn about the DID and admit that I was an addict until a lot later on. So I wouldn't say there was necessarily early intervention. I think I let myself slip into a hole. And it was a lot of stuff in retrospect too, because for me, I started developing addictions when I was 12, but I didn't realize it at the time. And I didn't realize I had been dealing with dissociation for such a long time either, because I do remember feeling like I was watching a movie of my life and feeling things that I learned later on were classic, very textbook symptoms of dissociation. I just couldn't put a word or a phrase or a name to it at that time because I was so young. When I look back, I realize, oh, I was totally addicted to such and such. I was I was totally disconnected and dissociated. So I just didn't know. And then when I learned later on that certain things were happening, I was just, "Oh, that makes sense." So again, it really wasn't early intervention. It was more like going back, going in reverse, and saying, "Okay." what happened at this point in my life does happen as a trauma response, and it really just validated the things that I didn't know were going on, that I just was like, I'm not sure if there's something wrong with me. So the intervention that I did have really proved to be validation, and it made me want to continue in my recovery and having the conversations and asking for help. And I'm still doing that. I'm still seeking as much support as possible professionally and socially. And it's because I did realize a lot and I learned a lot looking back once I did start asking for help.

How important was the support and treatment you received in your journey to recovery? What therapies or interventions were most effective for you in managing your disorders?

Therapy has played such an important role in my recovery. It has not always been the most comfortable process, and it will never be because therapy does have side effects when you talk about things and try to work through things and admit things to yourself that are very hard to even articulate. But it's definitely been something that I've learned a lot from. I've learned a lot about myself, and as I've mentioned, I've learned a lot about things in the past that I didn't realize, or even problems per se. There were times where I just didn't know if something was wrong, but it's been something that's really helped me look back, and even now As an adult, I've really, I've really had to learn so much about myself and about my interactions with others and about the importance of staying in recovery and pushing through and accepting the fact that recovery is not linear. So when I do relapse or I feel like I'm going to relapse, It's part of the process, but the point is not to give up. And my faith definitely plays a role in that too, in that acceptance of not giving up. With therapy, I, I had, I've had some phenomenal therapists before, and looking back, there were times where I didn't always understand their approach. And I think of a few people specifically. Who were, who showed me some tough love. And at the time, I thought it was just tough and I didn't like them for it. But then I realized they were just very smart and observant of my behaviors and they were responding to it in a very methodical way where I would have to kind of be stuck with myself. There were times where it seemed like maybe they were ignoring me or they weren't reacting so dramatically, but that was part of the intervention was to be low-key and I had to deal with myself because they weren't dealing with it. And it allowed me to look in the mirror, look at what I was doing, look at if I was engaging in certain behaviors and things for attention, even though I felt like I got a high off of it. And when it came to the substances of medication, I had great support. I had one social worker one time escort me personally to a crisis respite center, and I was terrified to go and I was terrified to stay there, but being escorted there and that social worker stood with me until I got all signed in, it was really helpful. And then I learned that one of the persons in leadership at that respite center was also a recovering addict. So having somebody that could relate but maintain those professional boundaries, I just thought was very comforting. And when I learned that other people I've met professionally speaking, like other social workers and things, have made disclosures in the proper context when they can that they too have been in my position, it has totally been helpful. I think one of the biggest things is when people relate to other people because it's just such a human thing. It's such a human connection. And that has been so impactful. Obviously, I love when my friends can relate and I meet people in groups and things, but when I see somebody on a professional level that they walk the walk and now they turn their life around and they're helping others, it really has a huge impact on me.

What advice would you give someone struggling with co-occurring disorders and hesitant to seek help? How can they find the strength to take the first steps towards recovery?

I would say, not to try to predict what'll happen and not to try to think about being judged or anything like that. Definitely do not predict negative experiences. Just keep it simple and leave it for what it is and just say, "This is who I am. This is what I'm dealing with. I need help," and keep it as simple as that. Because I know for me, I definitely thought way too much about what could happen, what folks might say, and all kinds of things. But when I finally said something and I started receiving support, it was so much better than I thought. So either way, as a recovering addict, before we enter recovery, we're dealing with the addiction. After we enter recovery, the addiction is still there, but we learn how to manage it and how to deal with it and live life around it so that we don't have to succumb to that addiction. If you have to pick between one of the two, just being an addict and the addiction takes over you, or being a recovering addict and you can take over the addiction, which one would you pick? Because that's what it boils down to. It's gonna be one of those two things. So I would say to just Think the best, not the worst, and just speak up to somebody you trust. Start with telling one person. That's what I did. I started with telling one person and then I got more comfortable— I got more comfortable opening up about it in therapy and to the people I needed to, and it went from there.

What are some best practices for managing dual diagnoses? Are there specific resources or strategies that helped you in your recovery?

I think this might be a little bit different than what you're looking for, but I know for me, I actually depend a lot on my faith. I do have a faith system that I really am satisfied with, and it's based on studying the scriptures and getting close to God and doing things that he likes and putting away things that he doesn't like. So for me, I really depend on that and what I learned and the scriptural requirements. And also in terms of just other resources and things, therapy. I still have a therapist. I, I don't think I will not have therapy. I know some folks might have the goal of ending therapy when they feel like they're well enough, but even if I feel totally great, I will always have therapy because I think it's just so important. I don't think you should wait until life starts to crumble or under addiction or whatever it is. To have therapy. So that's something that I utilize a lot, and just being open to learning DBT, CBT. And when I'm tempted to, to use Warm Lines or crisis hotlines and things, it's really hard because of course they're a stranger, they don't know you, but it's, it's better than sitting alone with the urge and the craving. Of an addiction because addiction is very powerful. And when you're alone dealing with it, especially when it's nighttime and you're by yourself, for me, I pray, but also sometimes I feel like I need to pick up the phone and call a crisis line, and that's what I do. So I definitely use whatever resources available that I can take for long-term and short-term coping.

Have you encountered any stigmas or misconceptions about co-occurring disorders? How can we reduce the stigma and promote empathy for those with dual diagnoses?

I have definitely encountered stigma both in my personal life and even in professional clinical settings. And I find that when I've thought about folks who I felt stigmatized by, or I've— when I've seen others be stigmatized, I feel like they just really don't know the person. And for me personally, I feel like they don't know me. And I think the way we can counter that is not only education about dual diagnosis and the trauma and how everything kind of works and leads to addiction. I think education is such a powerful tool, but I think really focusing on getting to know the whole person and having a very strength-based approach. What are a person's strengths? Obviously, we know a lot about a person's weaknesses when they're dealing with certain things, but have conversations with people, get to know people. Not every conversation has to revolve around addiction. There's so many things and hobbies and talents that people have that I think if we focus on that and if we get them to focus on that in themselves, it's also therapeutic. But I think that'll break the stigma when we see people that have addiction and dual diagnoses as whole people that are just responding to pain. And we can't necessarily help these responses. There's changes that we go through that, that cause this, but we're just people that are most likely responding to pain or responding to something that happened in our life is most likely the reason we have the addictions we have and the dual diagnoses and when we focus on the whole person, I think that's just so powerful and it's— it really sheds a lot of light on the fact that these issues don't define a person.

How has your recovery impacted your overall well-being and quality of life? Have you noticed any specific changes or improvements?

Recovery has been helping me to become more accepting of the good and the bad and the need to adjust if there is a relapse. It's not something that I run away from anymore. I just acknowledge it and accept the fact that it happened. And of course, naturally, I will feel guilty if there is a relapse and I'll feel those feelings that are not comfortable. But recovery has even allowed me to say that because there was a time where I couldn't say that. There was a time where I could not accept the bad and the discomfort that does inevitably come with recovery. So it's really given me an opportunity to learn more about myself and grow and just accept the fact that life, nothing in life is perfect, and that includes recovery. And it helps me to be confident with myself as a person that as long as I do my best with the help of God and my loved ones, and when I'm willing to do my best, then that's really a huge thing in itself. And I'm okay with that. I feel confident with myself in that I don't lives in the shame and the guilt of a relapse. And when I don't have relapses and when I can be sober for a long time, I celebrate it and I'm grateful for those moments. And I'm very appreciative of the fact that it did not come easy because again, recovery is tough and there's a lot of work involved. So I don't take that work for granted.

Lastly, what message of hope and encouragement would you like to share with listeners struggling with co-occurring disorders?

It is possible to get the help that you need. It is possible to be honest with yourself and to say the things that you don't think you can say out loud to another human being. It is very possible to do it. Because I know it. I've done it. I've met a lot of other folks who felt the same way, where in the beginning they were just wondering if they could even say they had an addiction, if they could be honest with themselves. But it is very possible to get to that place, and that's the first step. And once that step is taken, being honest and admitting it and seeking help then you get to choose the help you want when you get therapy or group therapy, and you get to, you get to have a say in how that goes. And then there's so many other things you can learn about yourselves. It's like I said before, often we might live in the shame and the guilt, but that doesn't have to be what recovery looks like. We can get the help and we can find out so many beautiful things about ourselves. And when we talked about stigma earlier, I talked about focusing on the whole person as a way to break stigma, but that includes when we look at ourselves, we should focus on ourselves as whole people. People with likes, dislikes, talents, and things that we can teach other people, and people that have wisdom, and so many other great things about us that the addiction becomes something that kind of like sits in the back. It's there and we have to live with it and manage it, but it's not taking over. Anymore. So it is possible to get to that place and it feels so good to admit it. It feels so good to say it and to start taking the steps, even if it's a slow-moving process. It's a forward-moving process. And that's the part that I think is better to focus on, the forward step.

Thank you, Cynthia, for sharing your story and providing your insights. I am thrilled to welcome next 3 distinguished mental health and addiction recovery professionals who will enrich our conversation today. Our first esteemed guest is Kimberly Wing, a New York State licensed clinical social worker currently spearheading as the Chief Program Officer for PeopleUSA. This forward-thinking nonprofit organization is dedicated to crisis prevention, and Kimberly's passion lies in crafting programs and extending support to individuals grappling with behavioral health crises. Her innovative methodology and unwavering commitment to these challenges testify to her relentless determination to affect positive change within the behavioral health landscape. Our second expert guest is Dr. Kelsey Latimer, an authority within the field who wears multiple hats as a registered nurse, psychologist, and certified eating disorder specialist supervisor. Dr. Latimer's expertise spans a broad spectrum encompassing addiction, eating disorders, pediatrics, and trauma. Operating from Florida, she oversees a thriving group practice where she administers comprehensive psychological assessments pivotal for precise diagnosis and efficient treatment plans. Above all, Dr. Latimer's mission is to propagate a potent message of recovery, ensuring everyone knows that help is always at hand. Last but certainly not least, I am honored to introduce Dr. Thomas Franklin, a luminary in the field of psychiatry and psychoanalysis. Dr. Franklin holds the prestigious position of president and CEO of the Mindwork Group. He is a member of the Group for the Advancement of Psychiatry, which is a select group of psychiatrists dedicated to influencing mental health policy, public awareness, and clinical care. His national leadership and invaluable contributions to the field have significantly impacted our understanding and treatment of mental health disorders. I am confident that the valuable perspectives of my guests will enrich our understanding of behavioral and mental health and addiction recovery as it relates to dual diagnosis in our conversation today. Let's start with Dr. Latimer. How would you define a trauma-informed perspective in the context of dual diagnosis? Moreover, how does this perspective shape your comprehension of mental health and substance use disorders?

The concept of trauma-informed care is incredibly important. I cannot emphasize enough how important that is. So, you know, if you have somebody who's gone through an experience of tremendous trauma and you're not keeping that in mind when then you're, say, treating them for their eating disorder or for their addiction, substance abuse issues, and you are totally missing the mark because it could absolutely change everything that you do in the context of your treatment. So first and foremost, never assume that you know something about a person's trauma history. If they, even if they don't on the upfront say, "Hey, I have a trauma history." A lot of people don't even know they have a trauma history. This might be the first time that they've ever even considered that concept sitting in front of you. Um, so how I do that is I open up the same questions with every single client. I ask them, you know, have you ever had experiences where you— the traditional questions, right? Like where you felt that, uh, you were emotionally abused, physically abused, or sexually abused. Those are the specifics. That's where somebody's checking a box and saying yes, you know, I've gone through those things. But that's assuming that they know they have. Then I get into deeper things like, have you ever been— felt forced to do something? Have you ever felt that you were— that something was out of your control? So all of those types of things, they may not recognize that they have had a trauma experience. And so sometimes you're the first one trying to almost give light to that, or shining light in that dark, dark area of their mind. And giving a voice to something that they've known, you know, didn't feel right, but they had no idea, hey, that's trauma. You know, so I think that that in itself is very important, is don't assume that trauma looks a particular way. Don't assume that somebody's going to come to you and say, this is trauma. Sometimes you're the one that's going to be helping them to validate an experience or a set of experiences or an overall kind of way of life that they've lived for a particular period of time. Now, I think it is so incredibly important in the light of co-occurring because a lot of times the trauma is maybe even a, a core foundational issue that then leads to the symptom that we might be seeing on the other side of it, which could be an abuse of substances, a, an eating disorder or cutting and all of those, or even sexually acting out. That's a big one as well. There's a multitude of different things that people do. And we're trying to figure out, well, why are they doing those things and giving a voice to that? They may not recognize— they might just think that they're an impulsive, out-of-control person. But then you dive more deeply into it and you see that it's actually performing something really important for them. Maybe it's numbing them from the experiences of pain and overwhelm that they cannot manage otherwise, or they don't think they can manage otherwise. Maybe it's giving them a sense of control over their body or their mind when they don't feel that otherwise. So there's a lot of different things that, that a trauma-informed experience can help somebody understand. So on that level, it's going to shape your conceptualization as a clinician. It's also going to shape what you do and what you don't do. So I'm thinking right now in higher level of care, If I have a client that has experienced a deep trauma with, say, um, somebody from a particular gender, right, then I need to maybe keep that in mind when I'm working with that client. So I— and I've had this experience before where I've had to look at this with a client. I might say, um, okay, you know, this client, let's say she's a female a young female, um, and she's experienced a long-standing history with, um, sexual abuse from a male in his 20s. And now I'm in a treatment center setting and I have a choice of which clinician I'm going to place this young person with. Well, if I just place them with a male therapist in their 20s, what I could be likely to do is sort of re-trigger that trauma. So if I'm going to do that as a clinician, I need to have a really good understanding of why am I doing that. Is that going to be helpful to that individual? Am I actually wanting to, to specifically pair those two people together to potentially give a corrective experience, which is an actual thing that we can do in the treatment world? We may give a corrective experience to show that not all men in their 20s are perpetrators. Right? And so, you know, that can be a possibility. On the other hand, that might be the last person I'm going to pair this person with, because potentially it's going to re-trigger them so much that they're going to feel unsafe in the setting, and they're going to leave against medical advice before they ever get the treatment that they need. So as a clinician, you need to be informed about those things. And really thinking from a forward-thinking mentality, have your conceptualization down, and figure out what you think is going to be best for that person at that particular point in time. I also just create an environment of safety everywhere and all around what I'm doing. So if I'm going to pair somebody, or want to potentially pair them with somebody that could trigger their trauma to give them a corrective experience, I'm not going to do that, um, on my own. That person is a part of that treatment plan. I'm going to discuss that with them because that's how you're creating safety and how you're creating a, an experience where things are not happening to that individual, but rather they are a part of their treatment plan. Um, in that in itself, you are actually really doing an amazing thing for that client. And if the client is not ready, allow them to make that decision for themselves, because again, you're reprogramming the sense of trauma— things happen to me, I don't have control over myself. To, yes, I do. I am a part of my treatment plan. These people care. Things, bad things are not going to happen to me. I might get triggered, but that's not the same as being traumatized in the treatment setting. So there's so many different ways that you can consider it, and it's absolutely critical that you as a clinician or a leader of the team are thinking that when you're working with individuals with co-occurring.

Kimberly, can you talk about the connection between addiction and trauma? How does trauma affect the development and maintenance of addictive behaviors, and how does it influence the treatment process?

Individuals who experience trauma are resilient as they continue to prevail after the trauma experience. Trauma is painful, and individuals cope with pain in a wide variety of ways, including substance use. Trauma triggers toxic stress chemicals within the brain, causing damage over time. This can result in the rewiring of the brain, which can impact our emotions. There is a clear link between trauma and addiction. Environmental factors such as exposure to substance use as a coping mechanism during a trauma can increase these rates. Individuals who are engaging in substance use recovery plans should be engaged as a whole person, which includes their trauma history. If the trauma is not addressed and the substance use recovery plan is not holistically addressing the challenges, Often individuals who struggle with addiction are engaged in behavioral activities that can be traumatizing within themselves, and individuals can fall into a cycle of trauma. Dr.

Franklin, what are some best practices for managing and treating dual diagnosis? Have you encountered any specific treatment methods or interventions that have shown promising results?

Best practices for treating co-occurring disorders in my mind are to, you know, aggressively, uh, you know, treat the substance use disorder, but also at the same time, um, you know, aggressively evaluate and treat the underlying, um, you know, psychiatric or psychological disorder that is almost always accompanying substance use disorder. This is why it's been, you know, such a tragedy that substance use disorder treatment has been oftentimes split off from psychiatric and psychological treatment such that you have these, you know, parallel universes of treatment centers, you know, that are only kind of, you know, looking at, you know, one part of the elephant. Somebody will go to a psychiatric hospital and you know, maybe get to go to a 12-step meeting like while they're there. Uh, somebody might go to a, uh, you know, drug and alcohol rehabilitation center and, you know, the, the, they might have a part-time psychiatrist on staff that sees people, you know, once a month. Uh, and there's very little, you know, expert psychiatric treatment ongoing. The best treatment for substance use disorders is concurrent treatment of both things at the same time. Treatment for substance use, both psychological and psychopharmacologic and psychiatric. But also evaluation of and, you know, aggressive treatment of, you know, trauma disorders, PTSD, depression, you know, anxiety disorders. There are very few places, unfortunately, where you can get, you know, both of these done at the same time at a high level.

Dr. Latimer, how crucial is early intervention in treating co-occurring disorders? What are the possible outcomes of delaying or not treating both conditions simultaneously? Again, another important question.

And you know, this is a tricky one because what I don't want to do is give the impression that if you don't get early intervention, you can't be helped because that's not true. You can. It's never, ever, ever too late to get help. So I want to make sure that people hear that. And that's critically important because a lot of times, you know, early intervention isn't possible. For a variety of different reasons, and then the person's not to blame for that. Maybe they were a kid and they didn't get help because they couldn't say they needed help, you know, they needed somebody else to say they needed help. Uh, maybe they had no idea that there was even an issue until years later. Maybe they were so stuck in that shame and secrecy spiral that they kept it locked in them and they never got help. But guess what, you guys, if that's you you can still get help. It is absolutely never, ever, ever too late. It's never the time where you can say, well, now it's not worth it. All right? So I think that's so important. I wanna make sure that the audience hears that. Now, having said that, is early intervention important? Absolutely. Intervention as early as possible is critically important. So even if it's been 20 years, Remember, it could be 25 or 30, okay? So that could be early intervention for you. Now, if we see somebody struggling, it is helpful to get help as soon as possible. And why is that? Well, what I look at when I look at things like addiction, eating disorders, all of those things I keep referencing, is that the underlying issues, whether it be shame, which it often is, um, secrecy, a feeling of not good enough, don't matter, don't deserve, all of these things they start weaving around our identity and who we are and how we see ourselves. And that becomes tricky because now we have to unweave all of that and redo all of that, you know. So the earlier we can catch that, the better. All right, so if it's a child, that's great because children are quite resilient. They have the ability to move that thinking pattern around. They're not as solidified and even their thoughts and experiences of themselves are more easily moved around. But if it's an adult, again, it can still be managed and worked around. It's just a little bit trickier, but depending on how long it's been happening, okay? But it's not a, a lost cause. So I think that's the most important thing here. If you are thinking, should I wait? The answer is no, don't wait. Not only is it going to get reinforced on an identity level, but it's also going to get reinforced on a basic behavioral principle. So if you're having panic attacks, the longer you have them, the more they get reinforced in the body through other things like escape behaviors. The more you are drinking, right, the more it's going to get reinforced, the longer, the more complicated it's going to be, the more likely you're going to have a physical in addition to a psychological dependence. I could go on and on. So those are the things that I'm talking about, association conditioning principles, right? And then on a deeper level, the way that we think about ourselves. So early intervention is key, and let's rework the way we think about early intervention. Early intervention is not necessarily how young a person is, it's how quickly you know something is going on with you. So if you found out today something is going on with you, don't wait until tomorrow to get help. Do it as quickly as you can because you are worth it. And you deserve it. And you know what? You do matter. So that's what I have to say about early intervention.

Kimberly, in your opinion, what level of support and treatment do individuals with dual diagnosis need to achieve long-term recovery? How can individuals access the necessary resources and support?

Individuals experiencing dual diagnosis need consistent, reliable support options that invest in their recovery with the lens of hope and empowerment. Peer support programs are a great example of a best practice as they treat an individual as a person and not as a disease. Individuals know themselves best, and giving them the self-determination to define and lead their wellness journey will increase the chances to long-term success. But recovery is not linear. Recovery is expected, but it involves setbacks, which we should normalize and not stigmatize.

Dr. Franklin, could you share personal success stories from your clinical practice of individuals who have conquered co-occurring disorders? What were the primary factors that contributed to their recovery?

Well, here at Mindwork Group in Baltimore, you know, where I practice, we have an intensive program that has, you know, very small groups and, you know, several doctors like that are working intensively with these people. And oftentimes folks will come to us after not being able to find recovery at other treatment centers. We had a young man about a year ago now come to us after things not going so well at a different treatment center. And, you know, he was basically, you know, homeless at that point. He had been, you know, discharged, you know, from the other treatment center after being, you know, very disruptive there. And, you know, over a period of 6 or 7 months of, you know, very intensive treatment, you know, 20 hours a week, you know, much of that like in small groups and, you know, the rest like an individual treatment, like with, you know, very senior expert providers, uh, with a lot of family therapy. Like, this young man really came along. Like, he was somebody that, uh, you know, really— it was near death, uh, and, you know, now as a full-time college student and trusted sort of senior resident of the sober house that he lives in, has sponsees in his 12-step community, is somebody that is a happy, trusted member of the community. And, you know, this is what really excellent treatment can do for people if it can be accessed.

Kimberly, what are some of the stigmas or misconceptions surrounding co-occurring disorders that you have encountered? What can we do to reduce these stigmas and promote empathy and understanding?

Stigma is very much alive in today's world. We often see individuals struggling with co-occurring disorders being blamed for their own experiences. Stigma also paints the picture that recovery is linear, and if someone has a setback, that they are not trying or putting in the effort. In addition, stigma often results in inaccurate stereotypes such as believing individuals with co-occurring disorder are violent, lazy, or that they chose their current situation. A common stigma is that only certain people experience co-occurring disorders and that doesn't affect all walks of life. Due to stigma, people are less likely to seek the support and communities can become fearful of the development of supportive services. We could combat stigma by talking about substance use and mental health on a more regular basis, showing up in the world and being okay, that these are aspects of all of our lives that affect everyone, and working within a preventative framework where we normalize these things, just as we normalize going to the doctor for physical health care, we make people not feel shamed by their experiences and what they're going through, and we provide a sense of hope.

Dr. Latimer, how can individuals with dual diagnosis build resilient and develop coping strategies to manage their symptoms?

Um, I think I've addressed some of this before in my other answers. In terms of resilience, here's what I'm going to say about it. This might even feel a little controversial because how I see people that, that have co-occurring, um, and again, not even co-occurring, just addiction, eating disorder, whatever it might be, okay, is that You're a survivor. Listen, if you survived something, if it helped you get through something, then you already have resilience, right? You just are not using it to help you. You're using it against you. You don't know how to kind of hold on to your, your strengths and make them work for you. And that's the role of people on your, your coping team. That's the role of your therapist and your psychiatrist and your dietitian and your your family and your support community, all those people to rally around you and lift you up and help you see everything that you don't already just know about yourself. People with eating disorders, people with addiction have often survived incredible trauma, incredible feats. And you keep hearing me use the word survive. They have survived them. And that addiction and that eating disorder may have been the thing that helped them initially survive whatever it was. Unfortunately, it is also the thing that's now stopping them from getting to where they need to be and where they deserve to be and where they want to be in life. So it's a double-edged sword, right? Um, but they're already resilient, so we can take that and then rework it and look at, you know, what are the things that are already there so that we can get them to actually work for you um, instead of against you. And how we do that is by a lot of the different things that I've already talked about. But simply saying, I have an issue and I need help and support, makes you strong. It doesn't make you weak. I always think, like, what's the easier thing to do? If the easier thing to do is to hang out in your eating disorder and your addiction and to merge with that, that's probably not the, the most helpful. And it doesn't make you strong. The thing that makes you strong is doing the thing that's hard for you to do. Having the courage to say, I have an issue, I have a problem, I need help, um, that makes you strong. And my clients are strong people and they want to be strong. And so even just seeing themselves in that way, as that is resilience and that is courage, is incredibly helpful. And including people in your life— we cannot do this alone, you guys. We, even those of us that don't struggle with eating disorders or addiction, we can't do life alone. Life is a partnership with and connection to other people. So bring people in and allow them to be a part of that with you and to lift you up over time.

Lastly, Dr. Franklin, can you discuss the role of self-care and self-compassion in the recovery process for individuals with co-occurring disorders?

I'm so, so glad you asked about this. You know, because, you know, things are difficult enough for folks with co-occurring disorders, you know, without, you know, them, you know, also sort of piling on themselves, like, you know, psychologically, you know, one critical part of therapy for folks with these problems is to really kind of learn self-compassion and, you know, take things very slowly, right? Um, you know, people are, you know, prone to think that they're sort of further along and doing better, like, than, you know, than they think, right? Uh, the folks that do best, like, you know, are able to kind of orchestrate their lives, like, in a way that sort of allows like for a lot of self-care, like, you know, allows for a low stress level, allows for, you know, a lot of community. I mean, these are serious chronic illnesses and, you know, the treatment for them, like in, you know, many important ways is to sort of orchestrate your life, like to allow for as healthy and low stress, you know, a living arrangement, you know, as is reasonable. Um, I must say though that, um, you know, oftentimes like, you know, the sort of self-care mantra, like, you know, gets under my skin a bit, uh, because sometimes like it's this kind of suggestion that, um, you know, the problems like in organizations and the problems in society, um, you know, really aren't the, the issue here. Instead, it's, you know, sort of people's sort of personal responsibility to take care of themselves, right? Uh, but if people aren't, you know, paid a living wage, or, uh, you know, they are sort of constantly on call like for work and can't do anything, uh, lest they be summoned, uh, or, you know, any of the other kind of, you know, foibles of life like that, like we all as a society, as a society need to address. Um, you know, oftentimes this kind of self-care thing sort of suggests that, uh, oh, like, you know, you know, we, we all need to sort of take care of ourselves, right? Uh, when You know, really, if we have a functioning society that promotes health, like, you know, we're not just taking care of ourselves, we're taking care of each other. You know, we are social animals, right? We're not meant to do it alone and we're meant to do it in community. Thank you all for your comments and insights.

As we draw this enlightening episode of Recovery Dialogues and Sober Stories to a close, I wish to extend my heartfelt gratitude to our extraordinary guests. Cynthia, your bravery and transparency in sharing your journey has been genuinely inspiring. Kimberly, your commitment to crafting supportive programs for individuals in crisis is genuinely commendable. Dr. Latimer, your invaluable insights stemming from your broad expertise have given us a deep understanding of dual diagnosis. Dr. Franklin, your competence in psychiatry and psychoanalysis has illuminated our discussion here today. Thank you all for your enlightenment and inspiration. A special shout-out goes to our dedicated, compassionate sponsor, Wish Recovery, whose unyielding commitment to providing luxury dual diagnosis treatment is making a significant difference in many lives. To our esteemed listeners, thank you for joining us in exploring the intersection between addiction and mental health. Your continued support and engagement are what keep us going. If you haven't already, please subscribe to our podcast to keep up with our ongoing journey as we delve deeper into this important landscape with upcoming episodes of Recovery Dialogues and Sober Stories.