Suicide: What They Aren’t Telling You

A dual diagnosis—mental illness combined with substance abuse—can be deadly.

Posted Jun 13, 2018

I kept waiting to hear it discussed on the news.  After the horrible suicides of Kate Spade and Anthony Bourdain, both in one week, the media coverage about suicide was intense.  A bright light was finally being shone on a dark and terrifying topic—and to a large extent, the coverage was respectful.  The media seemed sensitive to the guidelines which have been urged for years by the suicide prevention community:  don’t sensationalize or glamorize the topic, don’t unduly focus on the methods used, and offer positive outlooks and resources.

But again, I kept waiting.  According to reports after Kate Spade’s death, she had been self-medicating with alcohol for years.  Anthony Bourdain had been very open about his own tortured history with drug addiction.  Both of them had struggled with depression.  And yet—and yet—why wasn’t the all-important connection made by the media?

In short, where were the words “dual diagnosis?”  If they were spoken, I didn’t hear them.

Dual diagnosis means that a person has both a mental disorder and a substance abuse disorder.  (The clinical term is now “co-occurring” or “co-morbid” disorders, but those are such horrid words I refuse to use them.)  It can occur in any combination:  for example, bipolar disorder with alcoholism; depression with opiate addiction; schizophrenia with cannabis abuse, etc.  It’s a problem that affects at least 8 million adults in the U.S., and up to a third of all people with mental illness.  Spade and Bourdain were obviously, unfortunately, members of this demographic. 

The reason it’s so important for the public to know about dual diagnosis is that it’s deadly—it undeniably increases the risk of suicide.  It also causes severe suffering, because the problems of one disorder inevitably exacerbate the problems of the other.  For example, a depressed person who abuses alcohol—a known depressant—will only enhance and prolong his misery.  A bipolar person who abuses methamphetamine will exponentially increase his risk of mania.  A person with schizophrenia who abuses cannabis is much more likely to have psychotic episodes, and so forth.  Addiction is hard enough on its own; mental illness is hard enough on its own.  Combine them, and it’s a conflagration.

There are lots of theories about which comes first:  the mental illness, or the substance abuse.  Mentally ill people frequently self-medicate with drugs and alcohol, to try to ease their symptoms.  Addicts and alcoholics inflict damage to their brain, which then presents as mental illness.  In the end, I’m not sure it matters.  The important thing is to know that the problem exists.

You’d think, given the statistics and the severity of this issue, that mental health professionals would be on the lookout for a dual diagnosis.  You’d think primary care doctors would investigate this possibility in their intake questionnaires.  You’d think that, but my experience says that’s not the case.  Far too often, people are only treated for one ailment, usually the most pressing one at the time.  The other problem continues unchecked.  Or worse yet, it’s simply ignored.  This happens even in the most clinically sophisticated settings.  

I know, because I spent a long time in the UCLA psychiatric hospital fighting my own battle with bipolar disorder, suicidality, and the ungodly lure of alcohol.  The main focus of the outpatient program was mental illness.  Of the many therapy sessions that were included in the treatment regime, one—exactly one—dealt with substance abuse.  

My treatment has succeeded—I’m over 18 years sober—because I receive medication and therapy which takes into account the needs of both my disorders.  For me, that means AA and group therapy to maintain my sobriety; along with psychiatric medications and personal therapy to help keep my bipolar disorder in check.  I owe my life to the people who have helped me with these simultaneous challenges.

Ultimately, that’s why it’s so important to publicize the dual diagnosis problem:  because it’s so eminently treatable.  Recovery requires hard work and personal awareness and public education—but I’m living proof that it’s possible.  

I hope I hear the words “dual diagnosis” spoken over and over and over again, until they become a part of the national vocabulary.  Until then, it’s up to all of us to start that conversation now, in private; because I’m sure that everyone knows someone with this problem.  A good place to begin is the helpline from SAMHSA, the Substance Abuse and Mental Health Services Administration:  1-800-662-HELP (4357).  

As the recent suicides tragically prove, dual diagnosis is not an isolated phenomenon.  For far too many people, it’s a fact of life.  And here’s the good news, that’s not being broadcast:  it doesn’t have to be.