Double trouble in recovery: Self-help for people with dual diagnoses.

Abstract

Self-help is gaining increased acceptance among treatment professionals as the advent of managed care warrants the use of cost-effective modalities. Traditional "one disease-one recovery" self-help groups cannot serve adequately the needs of the dually diagnosed. This article discusses Double Trouble in Recovery (DTR), a 12-step self-help group designed to meet the special needs of those diagnosed with both a psychiatric disability and a chemical addiction, DTR differs from traditional self-help groups by offering people a safe forum to discuss their psychiatric disabilities, medication, and substance abuse. Preliminary data collected at four DTR sites in NYC indicate that DTR members have a long history of psychiatric disabilities and of substance abuse, and extensive experience with treatment programs in both areas. They are actively working on their recovery, as evidenced by their fairly intensive attendance at DTR. Recent substance use is limited, suggesting that participation in DTR (in conjunction with format treatment when needed) is having a positive effect. Most members require medication to control their psychiatric disabilities, and that alone may make attendance at "conventional" 12-step groups uncomfortable. Ratings of statements comparing DTR to other 12-step meetings suggest that DTR is a setting where members can feel comfortable and safe discussing their dual recovery needs.

Effectiveness of Dual Focus Mutual Aid for Co-Occurring Substance Use and Mental Health Disorders: A Review and Synthesis of the “Double Trouble” in Recovery Evaluation

“…Identifying and bonding with other members may be difficult for dually diagnosed individuals if they feel different from or are rejected by other group members. Dual-diagnosed persons who are newcomers to 12-step meetings often find a lack of acceptance and empathy (Jerrell and Ridgely, 1995;Noordsy et al, 1996;Powell et al, 1996;Vogel et al, 1998). Dually-diagnosed individuals' experiences when attempting to use mutual aid as a recovery resource include avoiding initial attendance, dropping out or finding it hard to make a regular commitment, and difficulties identifying with other members (Noordsy et al, 1996).…”

“…The recognition of the limitations of traditional "single focus" 12-step groups for duallydiagnosed persons has led to the development of several 12-step based fellowships specifically to address dual recovery needs: Dual Recovery Anonymous (DRA; Hazelden, 1993), Dual Disorders Anonymous (DDA) and Double Trouble in Recovery (DTR; Vogel et al, 1998). DRA started in 1989 in Kansas City and its educational recovery materials began to be distributed by the Hazelden Foundation in 1993, which greatly contributed to the growth of the organization, which currently holds meetings in most U.S. states as well as in Canada, Australia, New Zealand, India and Iceland.…”

“…Double Trouble in Recovery is a mutual aid program adapted from the 12 steps of AA, specifically embracing those who have a dual diagnosis of substance abuse and psychiatric disorder (Double Trouble in Recovery, Inc., 2000;Vogel et al, 1998). DTR was started in New York State in 1989 and currently has over 200 groups meeting in the U.S. across 14 states, with the most currently in New York, Georgia, Colorado, Oklahoma and New Mexico.…”

Effects of “Dual Focus” Mutual Aid on Self-Efficacy for Recovery and Quality of Life

“…DTR adapts the original 12 Steps of A.A. to dual diagnosis in Step One ("We admitted we were powerless over our mental disorders and substance abuse and that lives had become unmanageable") and in Step Twelve ("Having had a spiritual awakening as a result of these steps, we tried to carry this message to other dually-diagnosed people and to practice these principles in all our affairs"). DTR emphasizes active personalized outreach to severely affected people with co-morbid disorders in settings (e.g., institutions, day treatment) where they ordinarily lack opportunities to participate in consumer-led mutual aid groups that are non-judgmental about medication issues (www.doubletroubleinrecovery.org; Vogel et al, 1998). DTR has been studied through unique community-based participatory research, consisting of a team co-led by both researchers and consumers with dual diagnoses.…”

Interest in and Obstacles to Pursuing Work Among Unemployed Dually Diagnosed Individuals

“…The DTR group is a dual-focus self-help program adapted from the 12-step program [see (58)]. Members were recruited at 25 meeting sites throughout New York City.…”