Many people have a mix of drug/alcohol use and some psychological issues, and each problem can be minor or major.

For example, perhaps you’re depressed and drinking to help turn off your thoughts at night and get to sleep. Unfortunately, the alcohol might be disturbing the restfulness of your sleep and exacerbating your anxiety or worsening your mood in the morning.

Or, you are using some opiates and your mood now goes up and down. People think you’re bipolar but it’s hard to say.

Or there’s some paranoia but is the pot helping or making things worse?

These common issues can be perplexing for many clinicians who tend to do one of two things: 1, they assign blame to the alcohol/drugs, saying you have to quit before you get well or they can’t treat you; or 2, they say it’s all about the underlying trauma and psychiatric issues and once they treat that you’ll be OK.

That’s wrong. You need both issues addressed simultaneously, with a variety of more subtle approaches. Fortunately, that’s exactly what we do well. Dr. Green wrote an article on some of this read here but some principles include:

  • Treat both conditions at the same time.
  • Understand WHY someone is using, what it does for them.
  • Prioritize according to safety concerns, and client interest and willingness.
  • Use medications that help both conditions and don’t exacerbate one or the other.
  • Understand and educate how instability of one will trigger the other.
  • Treat in phases, as things will look different in a few weeks. In other words, don’t rush to diagnose. Stabilize, treat, review.
  • Be pragmatic; teach the basics of self-care and governance.
  • Go gently but bravely into emotions – positive or painful, as things feel very different, much better, on the other side.
  • Work with an extended network of family and supportive people.