Life Lesson in Co-Occurring Psychiatric and Substance Abuse Disorders (COPSD) or Dual Diagnosis

Today’s blog post was written by contributor Rick TreadwayTeran, former Director of Clinical Services at Austin Recovery.  Rick writes about his life lesson in understanding, diagnosing, and helping those with co-occuring psychiatric and substance abuse disorders.  Thank you for your contribution, Rick!

Screen Shot 2015-09-14 at 4.35.04 PMI have been working with people in the helping field in some capacity since I was 18 years old. I worked as a cook, and later a nurse’s assistant, in a geriatric facility near my home. There was always a lot of discussion regarding medical and psychiatric diagnosis but at that time, people always just seemed like people to me. It didn’t matter if “Sam” was in a wheelchair, with dementia and had a low sodium diet as well as a catheter. He was one whole person who I had to accept and usually enjoyed caring for except for the angry bouts at night time bed routine. I later followed a path into psychology. There I learned some very big lessons. People were categorized based on illness. They were treated by one person for say Depression and another for addictions to pain killers. This is when I met “dual diagnosis” or, as the term now used “COPSD.” (A supervising psychiatrist told me once “When it becomes an acronym, it’s probably over diagnosed.”)

The term is used when a person has a psychiatric disorder (or many), and a chemical dependency/abuse issue (or many). It used to be that Mental Health Professionals would not treat chemical dependency due poor outcomes and general poor progress. Later, chemical dependency counselors and facilities responded by rejecting people due to psychiatric impairments. As you can see, this resulted in a whole lot of people going untreated and ultimately rejected by helping systems. I was too young, naïve and probably just plain silly to know the difference….people were still people to me.

My internship started at a community based non-profit. A board member wanted me to work with his friend who was having a hard time. The board member brought Jose to my office and left him with me. Jose babbled, rotated, gyrated and cussed at about every other word. I was sure that this man was suffering from schizophrenia by the end of a very confusing hour. I referred the board member and friend to Psychiatry. “They won’t see him. They say it is because of his crack cocaine problem.” This guy also had HIV, and I didn’t even know the acronym for this many problems!!!

Please remember that I was naïve. My supervisor was a psychodynamic psychiatrist and allowed me great leeway!


I saw Jose for about 8 months. He had periods of confusion, fear, anger, homelessness and periods of trust, clarity and focus…sometimes all during the same session. His health went up and down. His drug use went up and down. I talked to him about 12 step meetings and took him to some of them. I always made sure they accepted people who were “wing-nuts.” I listened to his tortured pain and realized the great amount of factual information he was sharing with me. I began to understand his verbiage…all that broken communication and odd behaviors. His unkempt appearance projected self hate and rage. I understood his relapses and regressions back to crack. I supported him to get health care.


Eventually he trusted me enough to meet my supervisor and take meds, and then he just disappeared.  I was dumbfounded. The Board member said he had gone homeless again.


A few years later, I was shopping at a local outdoor market, and a very tall Latino man in a large winter style hat (it was relatively temperate) reached out and touched me. I looked up, and it was Jose. Clean shaven, put together and smiling (Some dental decay left over from drugs and meds I assumed). He and I were both shopping for fresh produce. He hugged me and said, “Thank you for listening to me for so long back then. I was so crazy. I’m doing better now.” He informed me that he rents a room from the board member and lived at his home. He said the board member was very ill and that he was going to make him some fresh soup. He shared that he is taking his medication and that he doesn’t do drugs anymore. He was on social security (I assumed for mental illness and HIV). The smile he gave and tears in his eyes told me all I needed to know. Dual, Triple, COPSD….Jose was a real, living breathing soul that was now taking care of  the board member that brought him to me from an alley. That is dual diagnosis treatment and care to me. Person first…then deal with diagnosis and multiple diagnoses. Mental health and substance abuse walk hand in hand and must both be addressed with care, stern objectivity and clinician tenacity. I am thankful that I was so naïve.