Dr. Thomas Schear, is a Certified Alcohol and Drug Counselor with about 20 years experience in the field. The discussion centered around alcohol and drug addiction and dual diagnosis, along with self-medicating.

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.

David: Good evening everyone. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Addictions and Dual Diagnosis" and our guest is Dr. Thomas Schear. We'll be discussing addictions treatment and the topic of dual diagnosis - having a psychiatric disorder and an addiction at the same time.

Dr. Thomas Schear is a licensed marriage and family therapist and a Certified Alcohol and Drug Counselor. He has over 15 years of experience working with clients who deal with substance abuse problems and dual diagnosis. Just so everyone is clear on the term dual diagnosis, it means someone who has a mental illness, psychiatric disorder and an addiction. Sometimes that involves self-medicating behaviors. Tonight, we will be talking about addictions issues AND also dual diagnosis.

Good evening Dr. Schear and welcome to HealthyPlace.com. Thank you for being our guest tonight. Why is it so difficult to kick an addiction?

Dr. Schear: I am glad to be here. I have been looking forward to this.

There are a lot of reasons why it is so hard to kick an addiction habit. Part of the reason is that it becomes part of a lifestyle that begins to set the person up to behave in certain ways and expect certain outcomes.

For some, reality is too hard to handle in some ways. It seems that the addict is someone who feels pain more readily than the rest of us. They salve the pain by using alcohol or drugs. Then, we counselors try to convince them they don't need it.

David: So, would you say that some people are "more susceptible" to developing an addiction habit than others?

Dr. Schear: Perhaps. To some extent, addictive behaviors are a lifestyle choice. To another extent, people see how a parent, or other adults, deals with life's challenges by using a substance so they try it. For most of us, using alcohol is no big deal, but for the person who may be more susceptible, their first drink is a sensation and clearly the solution to their problems. It is when the person's usage is more of a problem than a solution, that they are faced with a dilemma.

David: At this time, I want to give our audience the link to the HealthyPlace.com Addictions Community. Here, you will find lots of information related to the issues we are talking about tonight. Also, you can sign up for the mail list at the top of the page so you can keep up with events like this.

Dr. Shear, when it comes to treatment for addictions, when is it time to say "I need help"?

Dr. Schear: Frequently, the user has to experience the consequences of their usage and resultant behaviors before they decide it is time to get help. Generally, family, friends and others, enable the user by paying fines, making excuses, tolerating the intolerable behavior. These people need to withdraw their enabling behaviors, so the user begins to experience the pain associated with their use. Usually, it is the pain that leads to seeking help. The pain of recovery is seen as less than the pain of continuing the addictive behaviors.

David: And before we get to some audience questions, I have one more question: there's self-help, seeing a therapist, getting outpatient treatment and inpatient treatment. How does one figure out which treatment for addictions to choose? And, in your experience, what works best in initially treating an addiction habit?

Dr. Schear: In recent years, Client Placement Criteria have been established by ASAM to better determine what level of care is appropriate for the addictive client. Everyone is measured on several continuums having to do with withdrawal symptoms: how much of a support system does the person have, if they also have medical problems, psychological problems that need additional support, etc. Depending on how "healthy" a person is, will determine where they ought to go for treatment. The person who has no withdrawal symptoms, who has the support of clean and sober family and friends, has a job, no psychiatric or medical problems and maybe a couple of drunk driving charges, may be appropriate for an outpatient setting. However, the person with no support system, who has experienced withdrawal symptoms in the past, has medical and maybe psychiatric problems, will need more intensive and long-term care. The level, or intensity of care, really depends on a lot of these factors. It appears that the introduction of managed care and funding issues seems to drive some of this, but it does better utilize the resources too.

David: Here are some audience questions, Dr. Schear:

squeaker: I have been sober for nine months now. My doctor says I am not an alcoholic, it is solely due to my bipolar disorder. That I am self-medicating. People close to me disagree. What is your opinion?

Dr. Schear: The concern I have when someone has a psychiatric diagnosis and drinks is that the combination of medication with alcohol can negate the effects of the medication. The result, then, is that a bipolar condition is not being properly treated because the client is also using alcohol. It is less of a question of whether you are alcoholic or not, than it is a question of properly treating the psychiatric condition. By the same token, if a person wants to drink so badly that they will interfere with their treatment for a bipolar condition, maybe the alcohol use is a problem. The main concern should be properly treating the psychiatric condition.

GiddyUpGirl: I was wondering if you know anything about SSI (Social Security Insurance), and if one could be terminated if they were found to be a substance abuser. I really need treatment and I am close to signing myself into a psych ward for depression and need to know if I should tell them about my addiction?

Dr. Schear: I don't know much about SSI except that a few years ago there was the push to get addicts and alcoholics off SSI. Too often the checks were going to the alcoholic's bartender.

Yes, you must tell the people at the psychiatric ward about your addiction. They cannot properly diagnose or treat the psychiatric problem, if they do not know about that. Your use of substances is likely contributing significantly to the depression, and the depression may lead you back to substance use. Both need treatment or you likely won't recover from either.