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Dr. Attia is currently co-president of the Board of Our Place. In 1986 she opened and directed one of the first programs in the United States specifically designated for treating dually diagnosed patients. She later opened dual diagnosis programs across the country.

Dual Diagnosis clients – those exhibiting symptoms of psychiatric illness and substance abuse – are often misdiagnosed and improperly treated. Part of the confusion in diagnosis is since substance abuse can mask, mimic, precipitate or coexist with the gamut of psychiatric disorders. For example, a person displaying poor appetite, insomnia, agitation, anhedonia, loss of energy and feelings of worthlessness could be depressed or in withdrawal from substances. Seeing a client like this for an hour or two and then prescribing medication or any treatment plan based on symptoms alone is irresponsible. A person seen in an emergency room with hallucinations and delusions must be screened for PCP and mescaline as well schizophrenia and mania.

Dual Diagnosis clients generally break down into three categories:

1. Primary Substance Abuse with Secondary Psychiatric Symptoms. An example would be a client with alcoholism whose life is falling apart and develops suicidality amid alcoholism

2. Primary Psychiatric Symptoms with Secondary Substance Abuse. An example would be a client with a Bi-Polar Disorder prior to the development of cocaine dependence.

3. Co-morbid disorders where the onset of both disorders appears at the same time.

Without a careful history, clients may be given medication for psychiatric symptoms that would abate during withdrawal or sent to facilities unable to treat both illnesses. In 1988 I wrote an article on this topic. At that time, I was dismayed at the lack of treatment facilities with the capability of assessing and treating these complex clients. Sadly, over 30 years later, I remain dismayed. I have sent clients to many facilities that purport to treat both illnesses and my findings indicate that 80 to 90 percent of the programming is addiction oriented. Typically, groups are run by less expensive addiction professionals and clients see Mental Health professionals once or twice a week.

Recovery from psychiatric illness and substance use disorders require intense focus and ongoing treatment that may last years, decades or a lifetime. Some dually diagnosed clients may require brief hospitalizations for acute psychiatric symptoms or withdrawal. Discharge planners, case managers and primary therapists need to cobble together an outpatient plan that includes self-help meetings, individual treatment, psychopharmacological treatment (if necessary). If the treatment plan focuses only on one of the two illnesses, clients will inevitably experience a return of psychiatric symptoms and return to substance use. Relapse in either of these disorders invariably leads to relapse in the other.

Community based organizations like Our Place are essential for dually diagnosed clients. Our drop-in centers, sober homes and 12-Step programs, provide enrichment, support, assessment and referral to ensure long term sustainable recovery.

A new and fresh experience to revive your spirit

One of the most surprising things about a spiritual approach is that what’s most effective is often
the opposite of what makes the most “sense”. It seems like attacking a problem makes the most
sense, but accepting is often way more useful. It feels like fighting our way out is the best way to
victory, and then it turns out surrendering the problem to a higher power works way better.

Rebbe Nachman of Breslov teaches that heaven/he world-to-come isn’t when we reach a
spiritual buzz and maintain it forever. Heaven is a state where every moment is a fresh and new
experience of infinite light and love.

So, in a time of isolation and immobility, the best thing to do, the most spiritual approach, maybe
trying something new, or even better, doing something old in an entirely new way. Treat yourself
to a new experience of something or someone you think you know so well. Open your heart to a
fresh experience that can give you a little taste of heaven.

How to make sense of it all in a topsy-turvy world

These days, it feels as though our emotions are flying from one side of the universe to the other,
from panic to faith and back again. The world is topsy turvy so our feeling is topsy turvy… and
that makes sense, but it is really uncomfortable. Can we get some relief?

The path to balance and serenity starts with a DEEP BREATH, an affirmation that this is where I
am and this is how I feel. It is a way of letting our bodies know that it is time to lower the tension
and settle into our reality. It is just enough to remind us to draw our attention to what’s right
about this situation, what’s right about us. It is exactly what we need to bring us back to our
gratitude, our aspirations, and our principles.

In the midst of a moment of panic it feels like a DEEP BREATH won’t change anything, yet, that
often turns out to be a lie. Starting the journey towards a n

Healing: Lean in and take a deep breath

One of the most healing aspects of a therapeutic process is the acknowledgment of endings
and termination. Identifying the ending points within a process, or the completion of the process
itself is the signal light for the spirit of our progress and growth. Without these critical
affirmations, when nothing short of perfection is enough, the process feels like it’s forever. As
we plod on all we feel is dissatisfaction and deficiency. The alternative, maybe the only choice
we really have, is to find ways of honoring our incremental growth while maintaining our
motivation to continue on.

It feels as though that’s a point we are at right now. Two weeks ago the universe went into crisis
mode. Survival dominated our minds. Every fiber of our being told us we could either Lean In or
would retreat into oblivion.

On a personal, familial, communal, national, and even global level, we have rallied against the
forces of an invisible enemy. We have had to adjust our way of doing things, we have engaged
supports, and we have remembered to laugh.

Now, it seems as though the dust is starting to settle. The crisis has not ended and we can’t
afford to take our focus off the prize, yet we also need to draw awareness to a shift that has
occurred, and the beginnings of the turning of a corner. They tell us suffering, beyond even what
we have encountered so far, is on the horizon so the seriousness of the situation has only
begun. But, something has changed and we must acknowledge it. We must honor it, or-else we
will succumb to the terror of “never enough”. We have adjusted, we have adapted, we are
fighting the fight.

So, just for today as we close out March Madness; the Lean In phase of reactionary panic, and
begin to experience the suffering of the long battle ahead, it’s critical that we take a deep breath.
The kind of deep breath that allows us to humbly and gratefully acknowledge the progress
made, and to steady ourselves for the journey to come.