Navigating Dual Diagnosis: A Guide for Parents

A conversation with the celebrated psychotherapist, Dr. Cheri Sotelo


Dual diagnosis, a term once reserved for the coexistence of a mental health disorder and substance addiction, has evolved into a complex issue that affects individuals of all ages, including children and adolescents. If you’re a parent facing the challenges of a dual-diagnosis child, you will gain valuable insights and guidance in this article.

It’s crucial to grasp the ever-expanding landscape of dual diagnosis to support your dual-diagnosis child effectively. Beyond the traditional scope of mental health conditions and substance addiction, dual diagnosis now encompasses a wide range of addictive behaviors and substances, from drugs and alcohol to behaviors like gambling, eating disorders, and excessive gaming or shopping.

Recognizing the Signs

Behavioral Changes: Pay attention to shifts in your child’s behavior, such as increased secrecy, withdrawal from family and friends, or sudden changes in academic or work performance.

Emotional Distress: Be attuned to signs of emotional distress, such as increased anxiety, depression, mood swings, or expressions of hopelessness.

Substance Use: Look for signs of substance use or abuse, including the smell of alcohol or drugs on their breath, missing prescription medications, or hidden drug paraphernalia.

Coping Mechanisms: Understand that your child may be using addictive behaviors as coping mechanisms to numb emotional pain or discomfort. These behaviors can mask underlying mental health issues.

Modern dual diagnosis is not confined solely to mental health and substance addiction but includes an array of behavioral addictions as mentioned above. These behaviors often serve as coping mechanisms or ways to numb emotional pain and discomfort.

For instance, eating disorders encompass various behaviors, including overeating, undereating, bulimia, and more. These disorders frequently emerge as individuals attempt to regain control over their lives when they feel overwhelmed, mirroring the coping mechanisms often seen in substance addiction.

Inherent complexity arises from the combination of mental health conditions and addiction, where each can exacerbate the other. Individuals with conditions like obsessive-compulsive disorder (OCD) may engage in repetitive behaviors to alleviate anxiety, just as those with substance addiction use drugs or alcohol to self-soothe.

However, it’s crucial to note that OCD, for example, can manifest differently. Some individuals may engage in compulsive behaviors to reduce anxiety, while others do so to maintain control over their environment. Similarly, addiction can serve as a way to cope with emotional pain or numb overwhelming feelings. This complexity emerges because addiction and mental health issues often intertwine with past trauma and emotional wounds.

Addictions can start when a person seeks to change their state of being—“I don’t want to feel the way I am feeling; this substance or behavior provides me with some relief; this is how I cope with uncomfortable things.”

Yet, the repression of feelings leads to emotional disturbances, physical symptoms, unhealthy coping mechanisms, relationship challenges, and low self-esteem.  Alice Miller, PhD, said, “What is addiction really? It is a sign, a signal, a symptom of distress. It is a language that tells us about a plight that must be understood. The drug business would not nourish if there were not so many people who, in refusing to acknowledge their wounds, are in a permanent state of self-betrayal. Thus, people work to get rid of symptoms instead of searching out the cause.”

Dual diagnosis involves the intricate interplay between mental health conditions and addiction, with each potentially exacerbating the other. It’s essential to recognize that your child’s mental health and addiction challenges are not a result of personal failure but rather a complex interaction of genetics, environment, and life experiences.

Understanding the Role of Trauma

Trauma plays a pivotal role in the development of dual diagnosis. Many individuals turn to addictive behaviors or substances to cope with unresolved emotional trauma from their past. During the conversation with Dr. Sotelo, we talked about a poignant encounter I had with a homeless man who witnessed a traumatic event in his childhood, leading him to rely on alcohol as a coping mechanism. This coping behavior was learned from his early exposure to his parents’ emotional coping behavior of using alcohol to numb.

Children go through developmental milestones . . . we are human sponges from ages 1-24. It all starts within the home. Children will take on feelings of guilt, fault, and responsibility for anything the parent does. The child thinks, “I am not good enough; I must do better.” Contributing factors to dual diagnosis include trauma, a lack of coping skills, and a lack of parenting knowledge. This connection between trauma, the lack of coping skills, and the coping mechanism of addiction underscores the importance of addressing underlying emotional wounds in dual-diagnosis treatment.

“Children will always take on the feelings of guilt, fault, and undue
responsibility for everything the parents do.”—Dr. Cheri Sotelo.

Generational Trauma and Its Impact:

Generational trauma, transmitted through family lines, can also contribute to dual diagnosis. Dr. Sotelo described how generational patterns of emotional suppression and coping mechanisms were passed down through the family, creating a cycle of addiction and emotional pain.

Generational trauma often stems from a lack of emotional coping skills passed down through family lines. Reflecting on my own family, my father, as a sensitive child, endured abuse from his father for not conforming to society’s rigid standards. In his struggle, my grandfather turned to alcohol to numb his emotional pain, and my father, in turn, adopted the same coping mechanism. During his era, post-Depression, society imposed strict gender roles, expecting men to be stoic and women to be nurturing caretakers. My father had to suppress his emotions to meet these societal expectations, struggling to survive amidst these pressures. Consequently, he resorted to alcohol as a numbing agent, which unfortunately led to abusive behavior while intoxicated. This is the painful cycle of generational trauma. Recognizing and comprehending these recurring patterns is essential to break the cycle and guide individuals toward healthier coping strategies.

“Experience has taught us that we have only one enduring weapon in our struggle against mental illness: the emotional discovery and emotional acceptance of the truth in the individual and the unique history of our childhood.”—Alice Miller, PhD

The child carries no blame, for they were never guided through the intricate maze of their emotions without succumbing to the burden of their painful experiences. Their mind, a sophisticated apparatus of thoughts and feelings, tirelessly turns the cogs of their inner world, in perpetual motion, etching a profound rabbit hole within the narrative of their circumstances while permitting their emotions to persist. Thoughts such as, “I don’t want to feel this way,” serve as the lever, propelling the child into numbing behaviors.

There exists a transformative process capable of disconnecting the child’s mind from their emotions—the process of Focused Attention. This entails directing one’s focus onto the emotion, mindfully observing every facet of it, and perhaps even assigning it a name. Furthermore, it involves permitting oneself to fully experience the emotion. This unwavering concentration on the emotion compels the mind to disengage from the story surrounding their circumstances, allowing the emotion to flow freely and soon dissipate.

Supporting Your Dual-Diagnosis Child

Open Communication: Foster open and non-judgmental communication with your child. Let them know you are there to listen and support them.

Professional Help: Seek professional assistance from mental health experts and addiction specialists with dual diagnosis experience. A comprehensive treatment plan tailored to your child’s unique needs is essential.

Family Therapy: Consider family therapy to address generational patterns, improve communication, and strengthen family bonds.

Education: Educate yourself about your child’s specific mental health condition and addiction. Understanding what they are going through will allow you to provide more effective support.

Community Support: Connect with support groups and organizations that specialize in dual diagnosis. Sharing experiences with other parents can provide valuable insights and emotional support.

Self-Care: Remember to take care of yourself. Supporting a dual-diagnosis child can be emotionally taxing, and self-care is essential to supporting your child effectively.

Until recently, various psychological challenges were addressed using distinct therapeutic approaches, sometimes even involving separate healthcare providers. Each practitioner operated within their own isolated domain, unable to exchange medical information with their counterparts. However, in today’s context, where dual diagnosis awareness prevails, it has become increasingly convenient to locate a single practitioner capable of comprehensively addressing a wider array of challenges.

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