Helping Addicts Who Are Mentally Ill

mental-health1How can we help the addict who is also mentally ill?

A. Understanding “Dual Diagnosis” – Up to one-third of today’s homeless adults are mentally ill. The trend toward “deinstitutionalization” of the mentally ill has meant that our city streets are now being flooded with people who at one time would have been hospitalized for their problems. As many as half of them are also addicted to alcohol and/or drugs. Many are “self-medicating” – using addictive substances to cope with their mental problems. Social service professionals usually do not like working with these “dually diagnosed” people because they can be so demanding and time-consuming. They can be too destructive and troubled for the typical addiction recovery program. And, mental health workers shy away from them because they often do not stay sober long enough for treatments to be effective. So, they end up at the rescue mission.

B. Gaining a Basic Understanding of Mental Illness – The first step in working with dually diagnosed individuals is to gain an understanding of mental illness in general; its causes, symptoms, and treatment. Our staff members must learn how to identify such conditions as schizophrenia, bi-polar disease (manic-depression), and clinical depression so they can know when it is time to make a mental health referral. The good news is that, thanks to great advances in pharmacological technology, even those with severe mental problems can live a relatively stable life. Combining the right medication with some simple tools for recovery can help even the most severely mentally ill people to find sobriety and function on a reasonably healthy level. Because mental illness cannot be treated effectively as long as the active use of drugs and alcohol continues, we do quite a bit when we provide these individuals with a safe Christian environment where they can get off of drugs and alcohol. Because people with these problems do respond to the Gospel and the work of the Holy Spirit in their lives, we can reach out to them spiritually, as well.

C. Networking with Local Mental Health Agencies – The key to helping the dually diagnosed is good “case management” – long-term support working in tandem with local mental health professionals. It is vital that we develop contact in local mental health agencies who understand our programs and philosophy. They can be especially helpful in performing screening of those who we suspect might have mental problems. I have found that most are very willing to work with a mission program if they know it is safe and well-organized. In general, mental health workers are glad to know their patients will have the supervision they need in order to stay on their prescribed medications. It is important to encourage residents to sign a release of information form that authorizes the clinic’s personnel to talk with you about their on-going treatment.

D. Health Screening Before Starting a Recovery Program is Essential – Anyone who wants to come into a rescue mission recovery program should have a thorough medical examination. Many behavioral problems have a biophysical basis, not related to mental illness. For instance, such medical problems as diabetes and hypothyroidism can be causes of depression. Additionally, a health screening is especially important if a person comes to our program with a bag full of pill bottles. If he is taking mood altering drugs he really doesn’t need, he never actually gets sober. The truth is, doctors sometimes hand out pills to alcoholics and addicts almost indiscriminately. Addicts often complain to doctors about the symptoms they know will get them certain types of mood altering medications. They will talk about how they can’t sleep at night, or how nervous and jumpy they are in order to get drugs prescribed to them. So, when a person comes to us with a sack full of medications, how do we know whether or not they really need those pills? It is certainly not appropriate for staff members without medical training to decide which medications a resident should take. This is another type of situation that is best handled by a psychologist, psychiatrist, or mental health professional in the community who is sympathetic to our ministry, to help us sort this all out.

E. Adult Foster Care: An Option for Long-term Care – Our ultimate goal with most of the addicts in our recovery programs ought to be “working ourselves out of a job.” We ought always to be looking toward the day when they return to society as employed, sober citizens, relying on God, the church, and the recovering community for their on-going support. In other words, we truly succeed when they no longer need us. However, those with mental disabilities – the mentally ill and retarded – might never be able to function in society without on-going supervision and care. There is a growing trend among rescue missions to minister to these individuals through providing a safe, structured Christian home and by serving as Representative Payee for those who receive Supplimental Security Income (SSI). Contact the IUGM Office for more information about this type of ministry.

From RESCUE managazine, Spring 1995

Disease Concept – Avoiding Responsibility?

Doesn’t the promotion of the “disease concept” help addicts to avoid taking responsibility for their behavior?

The only people I’ve ever heard using the “disease concept” as an excuse are practicing alcoholics who have no real intention of changing.     I hear something totally different from addiction counselors and other professionals who subscribe to what has been called the “clinical approach” to treatment and recovery.

While recognizing the impact of factors like heredity and brain chemistry in the development of addiction, they know that real change happens only when addicts and alcoholics begin to take responsibility for their lives and truly “own” their own behaviors.   As a matter of fact, they tend to believe that knowing one is an alcoholic or drug addict brings with it a greater accountability.

If an individual truly accepts personal powerlessness over alcohol and drugs, he or she must begin following very specific set of action steps that lead to recovery. Building the right sort of accountability into the lives of recovering addicts includes:

A.         Accountability to God — Every recovering addict must learn is the discipline of maintaining a clear conscience.   Freedom from guilt and shame are essential elements of relapse prevention. This involves 1) learning to be sensitive to the conviction of the Holy Spirit and practicing daily repentance, and 2) increased self-awareness through the discipline of a daily personal inventory

B.         Accountability for Righting Past Wrongs — No one came move confidently into the future if he or she is carrying unbearable burdens from past failures.   Every addict who wants to move into a new, satisfying life must be very deliberate about making amends, especially to family members and others close to them..

C.         Accountability to a Spiritual Community — Real growth in recovery involves much more than just “going to church.”   Spiritual stability and maturity happen in the context of a church home.   They need to develop friendships with “normal” people, find spiritual nurture and guidance, experience the joy of corporate worship, and find an outlet for meaningful Christian service.

D.       Accountability to a Group Of Peers — The Biblical mandate for support groups is found in 2 Corinthians 1:3.4 where the Apostle Paul expresses thankfulness for being able to comfort others with the same comfort he himself had received from God.   There is special power and a special degree of grace present when one recovering addict shares his or her experience, strength and hope with another who is experiencing similar struggles.

E.         Accountability to a Sponsor/Mentor — Participation in support groups and church are essential.   But, they work best when a recovering addict also has one special person of the same sex who is farther along in the journey of recovery to whom he or she can be accountable.   There is no replacement for having this confessor and confidant, especially in the early days of recovery. So, how does this work in a residential recovery program setting?


John Wesley’s Small Group Rules

Christian support groups are not a new idea! I learned that when I first discovered John Wesley’s “Rules for Small Groups” written in 1816. This is an outline of “the Method” from which the name “Methodist” was derived.   It resulted in one of the greatest revivals the world has ever known. What if following these became a common practice in the Church today?

Believers gathered together in small groups, sharing honestly, becoming accountable to one another, asking probing questions, praying for one another with a deep knowledge of their mutual needs and struggles.   Any believer can benefit from this type of gathering.   It can be a tremendously healing and encouraging experience for those in recovery. So, what did they do? In the early days of the Methodist Church, members were expected to agree to six common disciplines or “Rules” found in The Works of John Wesley (1816):

  1. To meet once a week, at least.
  2. To come together at the hour appointed, without some extraordinary reason.
  3. To begin (those of us who are present) exactly at the hour, with singing or prayer.
  4. To speak each of us in order, freely and plainly, the true state of our souls, with the faults we have committed in thought or deed and the temptations we have felt since our last meeting.
  5. To end every meeting with prayer suited to the state of each person.
  6. To desire some person among us to speak his own state first, and then to ask the rest, in order, as many and as searching questions as may be, concerning their state, sins, and temptations.

To learn more about modern support groups and how they can help Christians who struggle with issues in their lives, see The Importance of Support Groups.