Navigating dual diagnosis in the context of 12-step fellowships can be challenging as some oldtimers believe that the 12 steps are a cure-all. AA and NA literature is very clear on the fact that should you experience health problems you should include the opinion of a medical professional.

AA Big Book, Page 133: “But this does not mean that we disregard human health measures. God has abundantly supplied this world with fine doctors, psychologists, and practitioners of various kinds. Do not hesitate to take your health problems to such persons. Most of them give freely of themselves, that their fellows may enjoy sound minds and bodies. Try to remember that though God has wrought miracles among us, we should never belittle a good doctor or psychiatrist. Their services are often indispensable in treating a newcomer and in following his case afterward.” (1)

NA – It Works: How and Why, Tradition Eight: “We do not diagnose anyone’s condition or track the progress of our patients—in fact, we have no patients, only members. Our groups do not provide professional therapeutic, medical, legal, or psychiatric services. We are simply a fellowship of recovering addicts who meet regularly to help each other stay clean.” (2)

NA – In Times Of Illness: “Mental Health Issues”: “It is possible to find freedom from active addiction in NA and to be taking medication prescribed by an informed healthcare professional for a mental illness.”(3)

Also, the work of addiction expert Lance M. Dodes offers valuable insights into the process, emphasizing the importance of understanding the psychological factors that contribute to addiction. By integrating 12 Step philosophy with evidence-based therapies, individuals with dual diagnoses can find support and healing within the fellowship.

According to Dodes, addiction is primarily driven by feelings of helplessness and powerlessness (4). If patients have a co-occurring mental health condition, these feelings can be exacerbated. Acknowledging and addressing these underlying emotional factors is essential for successful recovery.

The 12-step fellowship offers a supportive environment for individuals with dual diagnosis to explore these emotional factors and build a strong foundation for recovery. By working a thorough 12 Step programme with the help of a home group and sponsor, individuals can begin to deal with the root causes of their addiction. Once this is done they develop a sense of accountability that empowers them to develop authentic connections with themselves, the people around them and a higher power of their own choosing. This is the essence of 12 Step spirituality – rebuilding broken bridges and reconnecting.

As discussed at the start of this article we must recognise that the 12-step fellowship alone was never intended to address the complexities associated with a dual diagnosis. Evidence-based therapies, such as Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT), are useful tools to complement the 12 steps. Using therapies that help target the thoughts, emotions, and behaviours that can contribute to addiction and mental health issues makes complete sense.

To effectively navigate dual diagnosis within the 12-step fellowship, individuals should consider the following steps:

1. -Seek professional help
2. -Consulting with a mental health professional or addiction specialist can provide valuable guidance on the most appropriate treatment options for dual diagnosis.
3. -Engage with the fellowship.
4. -Attend 12-step meetings regularly, and consider finding a sponsor who has experience with dual diagnosis. Incorporate evidence-based therapies.
5. -Work with a therapist or counsellor who specializes in treating dual diagnosis and can integrate evidence-based therapies into the recovery process.
6. -Practice self-care.
7. -Prioritize physical, emotional, and spiritual well-being by engaging in activities that promote relaxation, stress reduction, and personal growth.
8. -Maintain open communication with friends, family, and the fellowship, as a strong support network is essential for lasting recovery.

STAY CONNECTED. As recovering people we desperately need to move from a life of active addiction and isolation to getting and staying connected.

Having a dual diagnosis requires a comprehensive approach that combines the emotional and spiritual support of the fellowship with evidence-based therapies. Following the guidance of experts like Lance M. Dodes and the actual 12-step literature, not the unqualified opinion of some person in the rooms! Use relevant experts in their relevant fields to your advantage and embrace a holistic recovery plan. Individuals with a dual diagnosis can find the support and healing they need within the 12-step fellowship, including others should you need to.

Here’s an interesting video about our need for connection by Johann Hari.

(1) https://anonpress.org/bb/Page_133.htm
(2) https://www.na.org/admin/include/spaw2/uploads/pdf/litfiles/us_english/IP/3130_MHR.pdf
(3) https://na.org/admin/include/spaw2/uploads/pdf/litfiles/us_english/Booklet/In%20Times%20of%20Illness.pdf
(4) Dodes, L. M. (2002). The Heart of Addiction: A New Approach to Understanding and Managing Alcoholism and Other Addictive Behaviors. HarperCollins.