May 9, 2005 speaker meeting of NAMI PA, Main Line

Loren Crabtree, MD, co-founder of Project Transition (Chestnut Hill and Warrington), spoke on “Dual Diagnosis: What to Do”.   He discussed recovery for individuals who have both serious and persistent mental illness and substance abuse problems (drugs and/or alcohol). The first section focused on useful approaches when an individual with dual diagnosis is ready to make a change; the second part addressed the person whose readiness has not yet happened.

When a person with dual diagnosis is ready to make a change, he or she may start anywhere –the psychiatric challenges, addiction issues, or medical and lifestyle aspects of the problem situation. Ultimately, though, treatment will be needed for the whole person, including mental illness, substance abuse, health problems, and psychosocial rehabilitation. Typically, medication and counseling will be needed to treat the mental illness. 12-step programs can be very helpful in the treatment of substance abuse, particularly because they provide a social network of support and caring. It takes considerable courage and sacrifice for a person to successfully tackle the multiple, difficult problems and changes required to recover from dual diagnosis and the associated life problems. Once a person is recovering from mental illness and substance abuse, he or she will often need psychosocial rehabilitation, including restoration of role functioning (worker, friend, etc.) and other aspects of “how to live a life”. A person with dual diagnosis is never “cured”, since the individual will always be vulnerable, but members of Project Transition testified to the enormous improvements in their lives which they described as aspects of recovery.

Family members can contribute to this process by educating themselves (e.g. by participating in Alanon, Naranon, Adult Children of Alcoholics, Family-to-Family and other aspects of NAMI), by investing in living, and by providing caring and support. The ups, downs, and practical implications of family member responses are explored in the article, “Patterns of Family Caring: Help That Helps — Help That Hurts”.*

Dr. Crabtree then addressed the situation of person with dual diagnoses who is not ready to address his or her problems. Only the individual can become ready to begin recovery: it cannot be forced upon, done to, or done for the person. However, the family may be able to help by modeling appropriate behaviors such as abstinence, learning about mental illness and substance abuse, bringing spirituality into your life. Sometimes it is beneficial for the individual to live on his or her own. This type of setting encourages the person to   confront the problems resulting from untreated illness in contrast to being rescued by family members. Also, the family may need to set limits when the situation becomes too painful or harmful for other family members. For example, the family as a whole may become socially isolated as a result of having a family member with untreated dual diagnosis.

Stefanie Bauman, Admissions Counselor for Project Transition (PT), explained that the programs are apartment-based therapeutic communities with intensive psychiatric, substance abuse, and psychosocial treatment. This is augmented by practical education, coaching, and residential supervision that emphasize independence and interdependence, as well as the development of skills to live, work, enjoy friendships, and self-manage recurring psychiatric problems. Additional information is available at

Respectfully submitted,
Ingrid Waldron and Cathy Fay


*This excellent article describes “Help That Helps” as follows:Rather than ‘doing for’ (equated with ‘Help that Hurts’), the ‘Help that Helps’ response steers the ownership of problem solving back to the person. It’s a supportive, mindful way of ‘throwing the ball back’. Help that Helps is a cornerstone of personal restoration and recovery because it promotes:

  • greater autonomy and personal effectiveness through the practice (and gradual mastery) of skills related to coping and problem solving
  • self-management of the ups and downs of psychiatric problems and of life’s challenges
  • the cultivation of relationships — within and beyond the family — that reflect mutual support (interdependence) rather than exclusive reliance (dependence) on the family.