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Blog / Dual Diagnosis

Of Moths and Men

Just as we addicts of all stripes often try to find the easiest way to get as un-sober as possible as often as we deem necessary. This behavior can be reflected when we’re seeking a way out. It’s very easy to make an appointment with the next available professional who deals with your problems in some way, shape, or form. And it’s easy to assume that your responsibility ends there.

There’s an old joke, and I’ve got no idea who came up with this, but I know it wasn’t me:

A moth goes into a podiatrist’s office.

”Doctor,” the moth says, ”my life is a mess. I hate my job. It doesn’t fulfill me. I don’t enjoy my work and I can’t stand my boss. I don’t make enough money, and my friends don’t respect me.”

”My family,” he continues, ”they do not respect me. My children are ashamed of what I’ve become. My wife, a woman I once loved, now only warms her half of the bed and looks upon me with disgust. I cannot make them happy.”

The moth sighs and goes on, ”and nothing gives me pleasure, not even the sweet embrace of sleep. My failures haunt my dreams, and I close my eyes every night hoping they will never open again. I just want it to end, doc. I don’t know what to do.”

The doctor thinks for a moment and says, ”I’d like to help you, I really would. Unfortunately, as you can see by the sign on the door, this is a podiatrist’s office. Why did you come in?”

”The light was on.”

Not bad for a moth joke, is it? That might be the best moth joke you hear all day. And it pairs with what I mentioned at first — much like our poor insect friend, we’re often so desperate for help that we’ll try to find the quickest way, even if it isn’t the best way.

My Experience

Maybe that’s a little abstract, so let’s ground this in some personal experience. For as long as I’ve been able to tie my shoes, I’ve dealt with depression. I wasn’t a bad kid, my childhood was strange (whose wasn’t?), I did well in school and I had friends. I just had a chemical imbalance.

As was the case with most disaffected youth, I found myself interested in drugs and alcohol. I liked them more than I should have. Not only were they helping me alleviate the normal stress and boredom of everyday suburban life, they were masking the symptoms of that chemical imbalance. Eventually, one fed into the other to the point where I was submerging myself in drugs or alcohol to avoid feeling anything at all; conversely, in my brief moments of sobriety I was primarily concerned with how long I had to wait until I could get wasted again (or how I was going to make that happen).

In Other Words…

A small part of me even romanticized this kind of behavior; always having been a big fan of counterculture in books and films, I could compare myself to some of the more interesting characters in these genres who avoided sobriety in an interesting way. Trainspotting’s Mark Renton was at heart a troubled youth with a serious heroin problem, but he was was cool. Hunter S. Thompson was very open about his desires to be as high, drunk, or both as possible at any given time, but he was unique. 90% of Kerouac’s characters were drunk 90% of the time, but they were alive.

These are, of course, fictional characters. In real life, being cool or unique in a way that requires substance abuse isn’t romantic, it isn’t pretty, and it doesn’t come with a soundtrack. It does come with consequences. The more I used, or the more I drank, the harder it was to go without. I was running on a treadmill, working harder and harder to get away from my problems but making not an inch of progress. I drank harder, experimented with more and more dangerous chemicals, and eventually found myself spending more time in than out of psychiatric institutions. In fifteen years I’d gone from a guy who spent most of his time thinking about marching band or science fiction to a shell of myself, sweating on a dirty mattress and hearing things that weren’t there.

There’s a Better Way

There is a way out of that situation, of course. It isn’t easy, and perhaps it doesn’t work for everyone, but a large part of recovery is sharing your experience, strength and hope with others; maybe you can identify with some of this, and maybe it could help you figure things out more quickly than i did.

It’s been reported that a third of people with a use disorder – alcohol or otherwise – also have some sort of depression-related disorder (everything from major depressive disorder to bipolar and beyond). One in four people with a diagnosed mental illness have a problem with substance abuse. You can see how these populations would overlap.

Medical Help

Unfortunately, there are very different approaches to treating these problems, even if they both fall under the umbrella of mental health. When you go to your primary care physician and tell them you’re trying to stop drinking, they may introduce you to a series of pharmaceutical options:

  • Naltrexone (or Vivitrol)
  • Campral
  • Perhaps even Antabuse

If you speak to a psychiatrist and let them know you’re depressed, you’re likely to be given an SSRI, MAOI, atypical antipsychotic or something in that ballpark. Finally, if you speak to an addiction counselor, they may recommend detox, rehab and counseling.

I am Responsible…

Some of the responsibility is on the patient here; from personal experience, I I’d been completely honest with everyone who tried to help, i’m sure things would’ve worked out differently. I can’t fault a doctor for prescribing me Xanax when it was obvious I had a mood disorder and anxiety was becoming a crippling issue that affected my professional and personal life. It wasn’t my therapist’s fault that I wasn’t completely honest regarding the reasons I chose to drink or use drugs; some people do these things recreationally and become addicted, but that wasn’t me. At some level I knew exactly what I was doing.

When you’re dealing with specialists, the name is apt; they specialize in treating a specific range of maladies. They’re experts in a certain area, and they work with what they’re given. Integrating all of these solutions ultimately becomes the patient’s responsibility. You can’t expect your plumber to change your oil. And the guy you call for tech support isn’t going to know how to fix your garage door.

Combined Help

If you find yourself dealing with a dual diagnosis, it’s important that you speak to all of your doctors regarding the scope of the problem. Make sure your psychiatrists, your counselors, your doctors and your family know exactly what’s going on. It’s natural to want to hide your faults. But when you’re trying to resolve problems with this kind of co-morbidity, where one is making the other worse in a symbiotic relationship of disorders from hell, vanity isn’t an option.

It’s also important for you to do the most you can to help yourself. Doctors are important. But they aren’t the only thing that can help you, and they certainly aren’t going to go bowling with you on Thursday nights. That’s where support groups come in. It’s easier to relate to someone else who’s going through what you’re going through. It’s easier to take advice from someone who’s been where you are. In an AA meeting, nobody’s wearing a special hat or a white coat; there’s no hierarchy, royalty or presumption of importance. everyone is there for the same reason. The people in these rooms are willing to help you because at some point in the past, someone like you helped them.

It’s hard to sum up a holistic philosophy of treatment for a dual diagnosis. But much like you’ll hear in the rooms, it isn’t easy but it is simple. If you really want to get better, you’ve got to work for it. It’s worth it. You’re worth it.

So start working.

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1 Comment

  1. I love this Wombat!

    Reply

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