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Ask the Expert Transcript

Question: What can be done to effectively treat substance abusers who suffer from co-occurring disorders such as fetal alcohol syndrome (FAS), dual diagnosis (DD) and/or psychiatric disorders? I am talking about more than two disorders.

Answer: It is a little hard to answer this question because the disorders listed are so diverse. There are very specific approaches to working with fetal alcohol syndrome which I can't do justice to in this space. But in general, the ideal approach is to do a thorough assessment for all mental and physical disorders and attempt to manage them simultaneously, to the extent that the staff is able. In other words, don't wait for one issue to be resolved before dealing with another.

A classic example in the past was to wait until a client had a few months of sobriety and "cleared," before treating her for depression. However, some clients were so depressed they had difficulty gaining the required sobriety until also being treated for their depression.

Similarly, a frequent situation in treatment with women is co-occurring post traumatic stress disorder (PTSD) and related anxiety or depression. Even ten years ago many treatment programs resisted allowing women to talk about their trauma for fear of uncovering emotions the clients couldn't handle in early recovery. Yet many women couldn't sustain their recovery until they dealt with their trauma. Since many women use drugs to deal with the pain of their abuse, the more typical approach today is to address trauma during treatment, in a safe and structured way.

If the treatment center is not equipped to address co-occurring problems, then the next best approach is to arrange for treatment of mental health problems in another system, at the same time the client is in substance abuse treatment. Good communication between the systems and caregivers will be critical in this situation.

Question: What are relapse triggers specific to women?

Answer: There are several relapse triggers that seem to be much more common in women, though perhaps not completely exclusive to women.

A. We see too many women leave treatment to try to salvage unsupportive relationships. A typical scenario is that a woman will be doing well in treatment, clear on her desire to change, until she gets a phone call or visit from her using boyfriend. He minimizes her problems and encourages her to leave treatment with him and save their relationship. For this reason we must address relationships and co-dependency within our programs and empower women to focus on themselves and their health first.

B. Issues related to custody, visitation, and removal of children are frequent triggers. That's why it is ideal if children can come into treatment with the mother, removing many of the potential fears and distractions. If a woman successfully enters recovery but then loses custody of her children related to her prior activities, it is a huge challenge to her sobriety. It is tempting for her to wonder why she bothered to get clean.

C. A lack of job skills and work history sometimes leads clients back to high-risk situations like dancing and bar tending. They don't know how else to support themselves and tell themselves they can do the work without relapsing. A similar risk is returning to partners who are a bad influence just because they need the financial support.

D. Depression, while not specific to women, is often a factor in relapse. Ideally depression and addiction should be treated simultaneously so that depression does not lead back to addiction. Clients also need to be prepared to expect life to be somewhat flatter for a while, as they first enter recovery. There is a certain amount of thrill seeking in drug use behavior that the client is leaving behind. It may be a slow process to replace it with healthy activities.

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