Dual Recovery Movement In recent years several new dual recovery twelve-step fellowships have been established. Currently, the fellowships continue to grow and are gaining wider national recognition. Today, meetings are held in both community and agency settings in the United States, Canada and abroad. The purpose of this series is to provide information that may help programs incorporate dual recovery models and twelve step concepts, while developing working relationships with dual recovery fellowships.
Part One identified literature references; discussed five reasons for establishing new dual recovery organizations; identified the new fellowships; and presented their twelve steps; in addition to their contact information.1 Readers are encouraged to contact each fellowship to learn about their approach to dual recovery. In Part Two, dual recovery is described as a process of integrating the skills to manage two illnesses and the personal recovery process. The role of personal recovery related to dual disorders, and opportunities to support that process are explored. Personal recovery provides a foundation to discuss dual recovery twelve step concepts in future articles in this series.
People Integrate Their Own Dual Recovery Dual recovery is an ongoing process of learning how to effectively recover from both a mental illness, and chemical dependency. As important, it is a process of recovering ourselves, and our ability to hope, cope, and heal, as we improve our inner quality of life.2
In dual recovery, each person is learning how to integrate two aspects or levels that are equally important and interrelated. The two levels include, their skills to manage two illnesses, and their personal recovery. The process of personal recovery may play an important role in initiating and maintaining dual recovery, by providing motivation to manage both illnesses together.
The Recovery Concept The recovery concept appears to be addressed indirectly as a “quality of life” issue, and is frequently limited to concepts such as a “standard of living”, and/or the “level of ability to function”. However, the recovery concept has long been a focus in chemical dependency treatment and the twelve-step recovery movement.3 It has also become a focus of mental health supportive services and the mental health consumer self-help movement.4 A comprehensive review and comparison are beyond the scope of this material. Clearly, they do share common central themes that have significance for dual recovery.
Recovery The process is more than learning how to manage the illnesses. For each person, recovery is a unique process, and a unique experience. Recovery is multidimensional, and encompasses numerous features that may be identified within two domains.
Inside World Self-awareness and inner experience; their perceptions of themselves i.e., self-image and self-esteem, personal dignity and self-respect, self-efficacy and intrinsic motivation, self-determination and sense of empowerment; hope that recovery and a positive quality of life are believable and achievable.
Outside World Personal relationships with their family of origin, peers, partners, spouse, and children; relationships in the community, school, employment, leisure; support resources.
Challenges To Recovery The impact of mental illness poses challenges to recovery. Recovery from the consequences of the illness is sometimes more difficult than recovery from the illness itself. An inability to perform valued tasks and roles, and the resultant loss of self-esteem, are significant barriers.5 Recovery may be further challenged by additional factors. The impact of a person’s dual disorder may undermine their self-efficacy and their intrinsic motivation. Both factors have been associated with motivation to change addictive behaviors.6 Several themes from the recovery concept do have significance for dual recovery. 1) Recovery with illness. 2) Recovery from the impact of illness. 3) Recovery beyond illness.
Perceptions Guide Solutions A dual disorder is a unique experience for each person. The dynamics of a dual disorder may impact both their perception of themselves, and their level of skills to effectively function and relate to other people. The impact may be significant and lasting, posing challenges to recovery. This impact may be explored within an expanded framework of dual
disorders, identifying two interacting levels.
- The presence of symptoms; chemical dependency, and psychiatric illness.
- The process of accumulating impact to personal recovery needs.
The ongoing process of interaction between the two levels and the potential to impact personal recovery needs may be illustrated in the following way.
A dual disorder develops and progresses over time as the symptoms of both chemical dependency and psychiatric illness affect each person’s inner experience (Inside World), and events in their life (Outside World).
Accumulating Impact Frequently, people in dual recovery describe having en-countered similar feelings and experiences, although their choice of intoxicating drugs and psychiatric symptoms are different.
Despite our difference, however, we have found that we have much in common. Each illness has symptoms that interfere with our ability to function effectively and relate to ourselves and others. Our impaired functioning has created a series of problems and consequences for us, and we have responded by trying to protect ourselves in unhealthy ways. The way we coped with feelings and problems very often became self-defeating or self-destructive. We learned to adapt to our illnesses and live with them rather than seek help until we found dual recovery.7
Frequently, people are affected by both chemical dependency and psychiatric illness, over an extended period of time. As a result, the impact to both their personal recovery needs and the challenges to the personal recovery may be significant and long lasting.
Role of Personal Recovery In dual recovery, each person integrates their skills to manage both illnesses and their personal recovery. Developing and using skills to effectively manage both illnesses together is an important level of dual recovery in many respects, to reduce the risk of chemical dependency relapse; reduce reoccurrence of psychiatric symptoms; reduce the severity of persistent psychiatric symptoms. By managing both illnesses together, a person may experience greater stability, which leads to increased opportunities to pursue personal recovery. In turn, personal recovery may increase motivation to manage both illnesses in order to enhance and protect opportunities to improve their quality of life.
Supporting Personal Recovery Designing a framework for personal recovery support systems may be a starting point in that process. The framework may incorporate recovery concepts, identify opportunities to provide is the need to recover from the impact of their dual disorder. Second is the need to recover beyond their dual disorder. It is important to recognize that recovery is multidimensional and many of those dimensions are interrelated. As recovery occurs in one area of a person’s life, the process may have a positive influence in additional areas. Therefore, personal recovery support systems may incorporate many approaches.
Integrating Perceptions and Skills Personal recovery support systems may incorporate an approach to focus on interrelated perceptions and skills. Each person may learn effective ways to develop and maintain their positive perceptions of themselves, and their skills to enhance and expand multiple levels of their quality of life. Their positive perceptions directly influence their motivation to pursue new goals, to engage in activities, and to develop new skills.
Their positive perceptions of themselves may have a direct influence in two ways. First, perceptions influence self-efficacy in their ability to successfully meet challenges. Second, perceptions influence intrinsic motivation or goal directed behavior. Their motivation is based on three factors, which include their perception of personal freedom and choice, their awareness of potential satisfaction, and their expectation of positive outcomes. Developing positive perceptions provides a foundation for personal recovery, new direction, and new goals in dual recovery.
Each person may begin to learn and use new skills as they pursue new goals. The process of developing and maintaining new skills for recovery is an equally important aspect of personal recovery. As each person develops and uses new skills, they increase their opportunities to achieve progress in dual recovery, and to successfully meet various challenges. By using their skills, achieving progress, and meeting recovery goals, they have an opportunity to validate and reinforce their positive perceptions of themselves.
In closing, personal recovery may be the driving force at the heart of the dual recovery process. The current recognition and growth of dual recovery self-help fellowships may be related to their ability to provide ongoing support for the process of personal recovery.
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David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.