Triple Trouble: BPD, Substance Abuse, and a Lack of Dual Diagnosis Treatment

Last night, I decided I wanted to get sober. Since I've been drinking heavily the past few days and have had DTs in the past, I went to my treatment team's hospital and told them I was afraid to sober up in an outpatient setting. The crisis counselor and I talked for a while, then she told me they didn't have inpatient treatment for alcohol and drugs. She gave me a one-page list of places that offer substance abuse treatment and sent me home.

Dual diagnosis treatment, at least in Indiana, is hard to find. And that makes a difficult situation almost impossible.

Where is the Treatment for Dual Diagnosis?

In 2008, I was committed to the state hospital system. At that time, only one hospital in the state offered dual diagnosis treatment. Unfortunately, the program treated substance abuse first and mental illness second, which often resulted in me not getting treatment for my psychiatric symptoms. Doubly unfortunately, that unit has since been closed.

In Indianapolis, a city of more than 800,000 people, there are only four places that offer inpatient substance abuse treatment: a hospital in Greenwood, an expensive private hospital that does not take Medicare or Medicaid, a community mental health center on the Northside, and a Salvation Army program that requires a $115 fee. This effectively puts inpatient substance abuse treatment out of reach for people with low incomes.

My best treatment option would probably be the Salvation Army program. Unfortunately, the $115 is out of my price range (I spend less than that on the alcohol!). In addition, I have to have medical and psychiatric clearance, which has been a problem in the past. This basically renders said treatment impossible.

Why is Dual Diagnosis Treatment Hard to Find?

So why is dual diagnosis treatment hard to find and hard to access? I don't know. My belief is that it is due to mental health stigma.

It's not due to lack of need. Approximately 75 percent of all mental health consumers have a drug or alcohol problem of some kind. It's common enough to have a nickname among mental health professionals; they refer to it as "self-medication".

I believe that stigma is responsible for the lack of easily accessible treatment. We, as a society, have not accepted addiction as a sickness. We still see the cause of addiction as a moral issue. If the person just tried harder or just had more moral character, the addiction wouldn't be a problem. As a result, we're hesitant to pay for addiction treatment.

Another problem is the reality of poverty. I remember asking a social worker "How come it's so easy for celebrities to check in to rehab and so hard for me?"

She replied "Because celebrities have lots of money and you have Medicaid." There simply is no profit in treating a poor person with a dual diagnosis.

What Can We Do?

So what can we do about this lack of dual diagnosis treatment?

We have to demand that this treatment be affordable and available. We have to frame it as a moral issue: this treatment should be affordable and available not because it is profitable, but because it is the right thing to do. It is wrong to allow someone who wants help to suffer and deny them that help.

It's like heart disease: yes, it's expensive; yes, there are certain lifestyle choices that raise the cost of treatment; but ultimately it is a medical issue, not a moral issue. It's like former U.S. Surgeon General C. Everett Koop said--"I'm the Surgeon General, not the Chaplain General." To borrow Koop's example, if two people with gunshot wounds come into the ER, the doctor doesn't treat the most moral one first, he treats the one who's hurt worse first.

Why should addiction be any different?