Our 43-year old daughter’s behavior is straining our entire family and we don’t know what to do. She has a history of alcohol abuse and bipolar illness. She won’t stay on her meds and then she drinks. Or maybe she drinks and then goes off her meds. It’s hard to tell which happens first. Which problem should she try to address first – the alcohol problem or the mental illness?

My 20 years experience in treating substance abuse suggests that successful treatment of dual-diagnosis requires that the alcohol abuse needs to be treated first. In some cases, the clients’ bi-polar symptoms are somewhat alleviated, and then an accurate assessment of the mental health diagnosis and appropriate psychiatric management can occur.

Second, the family can be involved in interventions and treatment, but this will not work unless the client surrenders to both diseases and is willing to participate in treatment. This is often difficult for families because they are afraid to allow the client to "hit bottom." If the client is at risk of harming self or others, it could mean intervention for institutionalization, possibly giving up their rights. We at Alternative Health Care take a family counseling approach to these cases, and support and encourage families in this situation. If loved ones continue to enable the client, the client may not "hit bottom," or become willing to follow through with treatment.

Third, once involved in treatment, it is essential that clients follow direction of mental health counselors and psychiatrists that have experience with chemical dependency cases. We at Alternative Health Care have found that holding the client accountable for their recovery from both diseases increases their chances for successful long-term wellness. In the most successful cases, clients are also involved in an appropriate Twelve-Step Support Group.

Kevin K. Otis, BA, CASAC
Certified Advanced Substance Abuse Counselor
Director/Owner, Alternative Health Care
314-821-1244

Before being able to answer your question, the treatment team would need to determine if your daughter needed detoxification from alcohol. If so, inpatient treatment for alcohol withdrawal and stabilization of her bipolar illness with medication and therapy could be done concurrently.

After your daughter is appropriately detoxified and her mood stabilized, she would require intensive dual diagnosis treatment in either a partial hospitalization or intensive outpatient setting. Her illnesses are interrelated and she will need medication monitoring, psychotherapy and treatment based on the 12-steps of Alcoholics Anonymous.

Family involvement in the form of family conference as well as attendance at family education groups would assist you in not only offering appropriate support but also in learning the concepts of detachment and enabling. Your daughter will need to begin to take personal responsibility for her recovery and be held accountable for the consequences of her actions.

Upon completion of this phase of treatment, appropriate follow-up is essential for on-going recovery. Medical management with timely psychiatric visits, individual psychotherapy, weekly aftercare groups and regular attendance at Alcoholics Anonymous meetings will provide structure for continual recovery.

Ron Feldman, LCSW, CASACII
Outpatient Supervisor, Edgewood Program at
St. John’s Mercy Medical Center
314-628-6500

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