The Family and the Dually Diagnosed Patient
Authors: Kathleen Sciacca, M.A.Agnes B. Hatfield, Ph.D.Authors' bios:Kathleen Sciacca, M.A., is the Founding Executive Director of Sciacca Comprehensive ServiceDevelopment for Mental Illness, Drug Addiction and Alcoholism (MIDAA)(R), Dual Diagnosis- Co-occurring Disorders. She is the author of the MIDAA Service Manual: A Step by StepGuide to Integrated Treatment, Program Development and Services for Dual/Multiple Disorders.She is a nationally known program developer, trainer, consultant, and lecturer. Ms. Sciacca canbe reached at: 212-866-5935.Agnes B. Hatfield, Ph.D., is Professor Emeritus of the University of Maryland. She is the authorof Family Education and Mental Illness, and a co-author with Harriet Lefley of Surviving MentalIllness: Stress, Coping and Adaptation. She is a Founding Member and Former President of theNational Alliance for the Mentally Ill (NAMI).From: Lehman, AF, Dixon LB (ed). "Double Jeopardy: Chronic Mental Illness and SubstanceUse Disorders,"
Gordon and Breach Publishers
, Chapter 12, 1995.People who have multiple disorders of severe mental illness, drug addiction and alcoholism"dual diagnosis" have the same severity of addictive disorders as do people who have addictivedisorders alone. They also experience exacerbation of both their mental illness and theiraddictive disorder due to interaction effects. Their families experience the disruptions evoked byaddictive disorders alone. This is in addition to the stressors of coping with a serious mentalillness. Although many studies (Hatfield, 1990; Lefley,1987; Marsh 1992) have shown thatfamilies of mentally ill relatives, in general, report enormous amounts of stress due to mentalillness, there are few studies that have looked at the added burden due to substance abuseproblems. One study (Kashner, Rader et.al. 1991) reported that substance abuse contributes tofamily conflict, erodes social support, and generates high levels of expressed emotion, thusdisturbing the vitally needed caregiving network. A dually diagnosed individual can throw thebest of families off balance. Therefore, it is important to provide services for families.Our divided systems of care for mental illness, drug addiction and alcoholism include oureducational programs and clinical training. As a result, there are serious gaps in services for thedually diagnosed (Ridgely, Goldman & Willenbring,1990), and for their families. This has alsoeffected the development of advocacy groups.One example, is the "National Alliance for the Mentally Ill" (NAMI). NAMI is an advocacygroup that began from grass roots movements of families with mentally ill relatives in the 1970'sand has since grown to over 1,000 local chapters (Grosser, Vine, 1991: pp.282-290). The "familymovement" has a strong influence on research and treatment of individuals with severe and