Mental Health U
Mental Health U is a podcast dedicated to demystifying and destigmatizing mental health issues. If you or someone you know is struggling with depression, anxiety, trauma, or some other mental health issue, then this podcast is for you.
Mental Health U
Insights from the Frontline: Andrew Weaver on Confronting Dual Diagnosis
Embark on a profound journey to understanding the tangled web of mental health and addiction with Andrew Weaver from Unison Health, our guide through the maze of dual diagnosis. Andrew, with a wealth of experience in the trenches of addiction and mental health treatment, offers invaluable insights into the unique challenges faced by those who combat intertwined disorders. His expertise illuminates the intertwined nature of these conditions, revealing how they can create a relentless cycle that demands an integrated treatment approach. The conversation is rich with stories from the frontlines, showcasing the delicate balance required in addressing the needs of individuals with co-occurring disorders.
In this episode, we also shine a spotlight on the role of support systems, acknowledging how vital they are for those feeling isolated in their struggle. We discuss the intricacies of outpatient programs that provide not just treatment, but also a lifeline for many. Andrew and I dissect the critical steps in the treatment process, from rapid assessment to the personalization of care, stressing the importance of patient empowerment. The chapter concludes with a heartwarming tribute to the Unison Health team, a dedicated group of individuals whose commitment to mental health and addiction services has been transformative for the Northwest Ohio community. Join us for this enlightening discussion and come away with a deeper appreciation for the journey towards recovery and the unwavering support that makes it possible.
But they were in need of that level of support to maintain stability, which they did do, which is absolutely amazing, because many people would have written them off Right. They would have written themselves off not believing in themselves, which most people with mental illness and addiction don't. Right, because the conditions themselves erode your ability to have that sense of self and achievement, because symptoms are, you know, destructive. And so once they start to believe that I believe in them, then they can start to believe in themselves.
Bill Emahiser:Hello and welcome. I'm your Bill Emahiser and you're listening to Mental Health U, the podcast dedicated to demystifying and destigmatizing mental health issues. So if you or someone you know is struggling with depression, anxiety, trauma or some other mental health issue, then this podcast is for you. This episode is proudly sponsored by Unison Health, dedicated to making lives better through compassionate, quality mental health and addiction treatment services. Learn more at unisonhealthorg. I am super excited for today's show. It's my distinct pleasure to welcome Andrew Weaver, licensed chemical dependency counselor with a dual diagnosis program at Unison Health. Drawing upon years of experience, andrew has demonstrated an exceptional ability to blend expertise with compassion, making a profound impact on the lives of those struggling with both addiction and mental health issues. Andrew, thank you for being here on the show today. How are you?
Andrew Weaver:Great Bill, Thank you very much for having me.
Bill Emahiser:Absolutely Well. Hey, we're going to get right into this today. Can you tell us a little bit about your professional experience and your role on the dual diagnosis?
Andrew Weaver:team. Sure, I've been working actually on the dual diagnosis team which is another way of saying that would be co-occurring disorder treatment at Unison Health for the last 24 years. I'm a counselor, I'm a case manager, I'm a group facilitator. I kind of do whatever is needed in order to help people.
Bill Emahiser:Excellent. Now you mentioned co-occurring disorders. Can you define what that is?
Andrew Weaver:Sure.
Bill Emahiser:What is dual diagnosis? What is co-occurring disorders? What does that mean?
Andrew Weaver:So the original term that dual diagnosis came off of was double trouble, right? So people would say when they had an addiction and a mental illness, a condition like bipolar disorder, depression schizophrenia they would say they have double the trouble, right, which is true, absolutely true. So co-occurring is a newer term for saying that most people have when they have an addiction, and also often when they have a mental illness, they also have a substance use disorder with it, or vice versa, right? So we would call that co-occurring disorder, and then treatment would be the address of both simultaneously, or all of them simultaneously, right, because you'd have personality disorders, mood disorder, thought disorder, right Along with a use or addiction disorder.
Bill Emahiser:Yeah, and as you're talking about that, I can only imagine that it would be really difficult to deal with a mental health issue or a substance abuse issue, let alone both, at the same time. Can you elaborate on some of the challenges that an individual that's experiencing both of these things, these co-occurring disorders?
Andrew Weaver:might face. Absolutely so they work against each other or for each other, depending on your viewpoint of that. Right so most use disorders start with using for pleasure, enjoyment and or relief, right? So when somebody is dealing with a condition like depression, as an example, depending on the severity of the depression would depend on how much relief they're going to get or how much they need, right? So if they start drinking or using marijuana or another substance, they will get euphoria. Right so they're going to have a dopamine release in their brain. There's other effects, every drug has its own properties, but they will experience pleasure, release from care and worry, altered state of reality and absolute alteration of feeling. So in pursuing that like, they can develop what would be, you know, a use disorder all the way to an addiction. The severity of the mental illness kind of determines on how much of a need they have to alter their reality. So, when we're looking at mental health disorders, uh, people, if they're taking prescription for them like a medication, as an example, uh so they're in therapy for that with a psychiatrist or a practitioner. They're trying to push them into euthymic state, which would be a normal range of mood and thought, right, right, and that's not as good as substances, because substances take you beyond that, right To a state of pleasure, maybe ecstasy, absolute euphoria, to the point where people stop caring about anything and everything else in their life because they become obsessed with the process of getting that pleasure, as well as the fact that it's releasing dopamine, which is the neurotransmitter that programs behavior, through a reward system which then overrides, hijacks the brain, overrides all other basic human needs for survival, socialization, achievement, and it becomes their primary objective. In fact, that's all they can really think about and that's where the obsession of addiction comes into play, which makes it such a pervasive and destructive disorder which it really. Addiction in and of itself is a mental health disorder, right? So kind of reclassified somewhat.
Andrew Weaver:There's always this past dispute about who would take the mentally ill or addicted person. You know the substance abuse community didn't really want the severe mentally ill population. Those would be people like schizophrenia or schizoaffective disorder or severe bipolar disorder, maybe even, you know, depression with a severe level. And then, in the reverse, the mental health population didn't know what to do with addiction. So we had separate boards in the past, at least in Lucas County, and there was a transformation in the approach when the boards merged so it became a lot more acceptable to have combined disorders and yet the treatment really didn't still hadn't caught up. So even with the combined boards, if I had a client with schizophrenia and I was trying to send them to a local residential treatment program, they would never accept the referral. It didn't matter how many people I referred, what their symptoms were, how stable they were with their condition, they would look at the diagnosis and reject the referral. So that was frustrating. I believe you know, with one of the mental health agencies taking over what was the largest provider of substance abuse treatment in the city, that changed the dynamics of that to a degree of that to a degree.
Andrew Weaver:But still the SPMI diagnosis, which is severe persistent mental illness, is very problematic for people in coming into recovery, in large part because the symptoms are so severe that even when they stabilize by stopping the use of the substances that create a lot of instability, it really doesn't look much different. They still have massive housing issues, unemployment or lack of income. Maybe they just in the process of using and being sick. They were even unable to even apply for a disability that they would be eligible for. Usually there's criminal history involved.
Andrew Weaver:They'll get arrested, have been arrested, many of them just for being mentally ill and looking as if they're on substances, you know, and some of the behavior that they have, you know misuse of 911 or disorderly conduct, you know, starting a riot. You know disruption of public service because of their symptoms. So they're really coming into the recovery process with many issues and one of the biggest issues that I didn't mention is actually a lack of familial support. So often their family doesn't know what to do with them because of the addiction and the stigma with mental illness and people really they're at a loss. They can't love them into wellness and they really can't help them and they feel like they're enabling them or being mistreated or abused by them. So a lot of them really end up alone without support outside of what's going to be professional support.
Bill Emahiser:As you were talking about all those challenges I kept going back to. I typically work with individuals with OCD or anxiety disorders and one of the big pushes for folks, one of the main behaviors that keeps anxiety in place, is escape and avoidance, and I couldn't help but think about it. Right, it's a negative reinforcement loop and what I couldn't help stop thinking about is like a double-edged sword. If my client has, they want to escape and avoid the discomfort that comes along with OCD or an anxiety disorder, and then they use marijuana or they use some other kind of drug. It's a double whammy, because now there's a positive reinforcer and a negative reinforcement cycle going on at the same time, which I would think would be really hard to unwind once that process gets in place.
Andrew Weaver:So it's an absolute vicious cycle of I feel, I use because I feel, and then I feel worse because I used and the consequences went with it. So then I use again, so I don't feel that, so I can feel the high right and that that literally leads people to death, destruction, incarceration or even a nursing home Right Cause they just can't function Like so. I've had many clients over the years that lived in nursing homes because of their circumstances, ended up getting sick physically with something, but then had nowhere to go Like they. They could not be discharged cause they were homeless which there's actually a program in place that can help them with that to reestablish housing, which is beautiful. But until that happens they're stuck where they're at.
Andrew Weaver:So it really is a double-edged sword. That's ironic. That's a term that's used in recovery literature in one of the Alcoholics Anonymous books, because it's true that they have this physical allergy that when they use they don't stop right, they have to keep using. And then, when they're not using because they've used, they have that obsession in the mind that tells them they need to use again to fix what's already broken right. So, and yeah, definitely OCD like addiction, really does look a lot like OCD. It's just a different diagnosis with some different symptoms.
Bill Emahiser:Are there different types of dual diagnosis that require different approaches? For instance, if someone was dealing with depression and alcoholism compared to, maybe, somebody with a thought disorder like schizophrenia and an opioid addiction, do you do things differently? I mean, how does that work?
Andrew Weaver:So there's definitely some different approaches We'll take, for example, someone that has schizophrenia, let's say paranoid schizophrenia is the example right. So a general requirement of somebody coming into the process of recovery would be to be involved in 12 step programs. They're, as far as I'm concerned, they're vital for the process of recovery. And yet if someone has paranoia and you know some social deficits, some negative symptoms of being even being medicated, you know that'll create negative symptoms of schizophrenia. So they don't connect socially. So they're not really going to gain the same benefit as other participants. Plus, they're going to have a really hard time going there and gaining anything out of it If they're sitting there in fear the whole time that someone's about to hurt them or something is going to get them or people are reading their thoughts, you know, whatever the symptoms may be. So part of that process on my end as a provider is I'm going to be working with them, trying to involve them in that process, work with them through their paranoia, help them reality test some of that stuff, help them get comfortable with specific support groups and people and get them involved in that process. It's one of the good things about the recovery community is that they're very inclusive. So even when someone's symptomatic, they don't reject them at the same level. But there is still, because of my client's lack of ability to connect and it being a self-help kind of concept, right, so if they're not coming in and asking for help, people won't generally provide it. They want the new participant to ask for it. Well, that person has these deficits. So they're really not going to do that, right, so that creates a specific barrier deficit. So they're really not going to do that, right, so that that creates a specific barrier.
Andrew Weaver:So the treatment approach, like I have to take each individual on the basis of who they are, their circumstances and their symptoms and I really don't do that classified just on the diagnosis it really cause. You could have somebody with bipolar disorder and I could say the exact same things about them, right, depending on what their symptoms are. Some people have severe psychosis when they're manic or even depressed, right, so it could be the same thing with a different diagnosis. But I have to adapt what I do to get them with what they're going to need for long-term stability and support. And I have had clients that ended up because of the severity of their symptoms.
Andrew Weaver:I had them in services for eight to 10 years, which is a very long time and not the norm, not usual, but they were in need of that level of support to maintain stability, which they did do, which is absolutely amazing because many people would have written them off right. Absolutely amazing because many people would have written them off right. They would have written themselves off not believing in themselves, which most people with mental illness and addiction don't right, because the conditions themselves erode your ability to have that sense of self and achievement, because symptoms are, you know, destructive, and so once they start to believe that I believe in them, then they can start to believe in themselves, which is always a good thing.
Bill Emahiser:Mental Health? U is brought to you by Unison Health. Unison Health making lives better. So having somebody to help walk through that process and help encourage them, and help give them a path and maybe even do some advocacy to get them into certain programs so that they can be successful.
Andrew Weaver:Absolutely. If I'm working with someone with severe depression, their, their ability to have motivation and drive is absent, right? So I have to be that for them. I have to pick them up, encourage them. You know, uh, when I call them and they tell them that they can't come in, I have to kind of probe that question and then challenge it, and usually they concede and then we get them rolling, cause you know, when you, when you're in that state of inertia where you're not moving with depression, it's really hard to get off the couch. So to get them going, um, it's kind of like I have to be a cheerleader, a coach and a and a taxi driver at times, you know, in order to get people rolling on the road.
Andrew Weaver:And then, once we get them moving, then we can begin to get them in the process, at least for that day, of moving forward and making some progress and then also believing that if they do take action, it does actually matter. Because that's the other thing with depression, like their disease is telling them that, you know, there's no point, there's no use, no one cares anyway and it's not going to do any good. So right for them to begin to believe that it's not based on their own head and their own belief system. At that point it's based out of somebody else's. So it's really important to have support and it goes kind of goes back to like when we're dealing with people with these chronic conditions, I mean addiction of its.
Andrew Weaver:In and of itself it's so antisocial, with the behaviors that come with it for so many people, that people don't want to be around them unless they're also using Right. So they've lost their supports Right and they couple that with mental illness and it's twofold. So to have to have services that are pretty intimate you know we are a small program, we're not a large facility, you know or are a small program. We're not a large facility, you know we're an outpatient basis. So we're actually pulling people in and doing what we can do to help get them through the process and at the same time, not enabling Right, and that's that's important too, because they have to be the ones doing it right. So I carry them as far as I need to carry them or give them as much support in the process, and then they're doing the rest. And I always tell them that they're the ones that are doing it, not me, right, because it's true, like they are the ones doing it.
Bill Emahiser:So you're the guide, you're the encourager, right.
Bill Emahiser:That's exactly right, and then they need to pick it up and do the work. Well, you started talking a little bit about some of the things that you do within the program. Can you talk? I mean, let's, if I were to start a dual diagnosis program, maybe I'm experiencing a mental health and addiction issue or substance use disorder. What would I, what should I expect? Like I come into unison and I I see I I'm seeing you or Pam or someone, and so how does like, from beginning to end and obviously you can't get into all the details, but kind of like an overview.
Bill Emahiser:What does that look like?
Andrew Weaver:So the process is actually pretty rapid. Um, once somebody comes in and has an assessment which could potentially happen, they could walk in and have an assessment. Um, a lot of times, after that assessment, they have a date to start, and it may be that day or the next day depending on when we have groups, but they're pulled right in the expectation that they begin to abstain happens. But at the same time, we understand that that person may be in need of detox services right, so they may need to go to the hospital and detoxify or an inpatient unit. Sometimes, if somebody comes in for an assessment, if the severity of with their use history and withdrawal symptoms, or depending on what substance they're coming off of, we may just say you really need to go to an inpatient program, you know, for two weeks to 28 days at a minimum, or if they have a long history of chronic use, while in treatment services, many treatment episodes we're just we. I would just tell them you know you need to go to a long-term inpatient facility or residential sober living program in conjunction with outpatient services, like what we're going to provide, in order to give you the support and stability that you're going to need. Plus, they're homeless and they don't have income and you know all the all the variables that make it really impossible for somebody just to come in and say, okay, I'm just going to get clean. They don't have a job, they don't have any money, they don't have a place to stay. I mean, there's so many variables with that. But, coming in, assessment and then starting groups, if that's what would be deemed appropriate, which would just look like four days a week for an intensive outpatient uh services, which would be a two hour and 15 minute group it's not super long, Uh, and in that process we're doing a lot of education, uh, letting them share about their struggles, symptoms, their needs. Um, we're curtailing what we do based upon what clients, participants in the group are saying, and packaging information on that day for them, along with a generally set agenda with something more specific. But they're definitely going to have a platform to talk, discuss, process, identify and really begin to come out of what would be we call it denial.
Andrew Weaver:Right, there are many different defense mechanisms, but denial is kind of a hammer term for it. But part of the disease process is denial. It's not believing that you have what you have and wanting to believe that you need to change what you're doing, because ultimately it goes back to that obsession which is that the doing is the answer. Right, so it's like the poison is my, my solution. Like you can't take away my poison when it's, it's the thing, that I'm relying on it for everything. Right, it's my lover, it's my friend, it's my comfort, it's my care, you know, yeah, it's made me homeless and unemployable and sick. And I mean because using drugs in and of themselves makes people mentally ill in many different ways.
Andrew Weaver:Right, so people will look like they have schizophrenia using certain substances, even alcohol. Like, people develop alcohol induced psychosis and it looks like schizophrenia. Right, If they went to a doctor and didn't tell them they were drinking, they wouldn't know. They would just give them a diagnosis of, you know, psychotic disorder, NOS, or a rule out on schizophrenia because of the symptoms. But when people have both conditions, they really are coming in and are going to need to have the ability to process that and get to the point where they can begin to accept it, so then they can move forward.
Andrew Weaver:Because the reality is, I don't think anybody really wants to change, right, we only change because we have to right. That's right. It's hard If the pain's great enough. Maybe I change, but only until the pain stops. And that's another pervasive part of the addiction cycle process.
Andrew Weaver:And pain and addiction is that really people. They end up, you know, regressing back into active use. We call it relapse, but a lot of it is because they start to do better and feel better and their brain is still telling them, quite naturally, because of that dopamine reward process, that yeah, it would be okay now and it's perfectly good because that is the answer right. So you know that process. That's where 12-step programs come into play, because they really, through a process of connecting that individual with their own sense of spiritual self and spirituality, gives them the ability to change that thought process in a way that's like common cognitive behavioral therapy techniques will not right, Because it's really ingrained in their head.
Andrew Weaver:So we can't get them to think for a change when it comes to that little thought in their head that tells them they can probably do this or that again because now they have a place to stay or a girlfriend, or you know that it's been a month right, so they're probably good now, right, Like, because that's how pervasive that little you know disease process is and it's a primary symptom that is very difficult to address because there's so many things that individual has to do in order to lose that actual thought process. But it can be lost. It can go into remission. There's no doubt about that. People who are in recovery have remission. That's great, Yep.
Bill Emahiser:Well, we're getting to that point. We're quickly running out of time. Andrew, this has been really interesting. Just a couple more questions. One is if somebody is hearing this today and they are thinking about coming to a dual, getting into treatment, whether it's dual or whatever, wherever they decide to do what are maybe a couple of words of encouragement or maybe a couple of tips for somebody just starting a program? Or maybe they've been in a program many times, but they you know that as part of that addiction cycle you mentioned they they've been in and out. What are maybe just a few ideas or tips or words of encouragement for those?
Andrew Weaver:Yeah, absolutely. I have a strong belief that you only fail when you quit trying, absolutely. So, you know, never stop trying. And the other thing is that there is help and it is a matter of just like baking a cake If you don't have the right ingredients, you're not going to have a cake, you're going to have a pancake or something else that you really don't want, right? So you have to have the right ingredients and they are individualized. They have to be because every individual has different, specific needs. But certainly my job is to help people identify that and address that.
Andrew Weaver:You know, over the years I've seen so many people recover. I've had a lot of tragic experiences as well, of course, because this disease is so pervasive and people that are dealing with the co-occurring disorders know this right, they understand that they really are in I'll call it a trap, for a lack of a better term. It is, you know, so devastating. And yet people are in states of recovery, some very long-term, some unbroken, some that maybe relapse every two to three years or six months to a year. But because they're continuing to pursue and be in the process of that pursuit of recovery, they are alive and they have a chance and they have hope and they do have periods of increased, you know, level of function, success and happiness and enjoyment in life.
Andrew Weaver:So to get involved with dual recovery, uh, dual recovery at Unison uh, they would just really need to go to unisonhealthorg and uh, there's a link on the website or they could actually call, uh, my program director, which would be Dr Anthony Boyer, um, his number is 419-936-7352, um, or at A Boyer that'sB -O-U B O U Y E? R at unisonhealthorg, which would be another link, and he will get you set up for an assessment and get the ball rolling and we will be in contact with them immediately, like, and I would certainly look forward to seeing you know whoever would be in need of services well.
Bill Emahiser:I really appreciate your time, andrew. It has really been a privilege and a pleasure to chat with you today. You've been dropping truth bombs on us all day long with so much knowledge. I'd love to have you back on again. Sure, the work that you and your team are doing, that's truly amazing, and I'm thankful that you're making lives better for those you serve. Thank you again for being on the podcast today, and we'll have to have you back real soon.
Andrew Weaver:Sure, I should probably throw out a quick shout-out to my other team members, because we have some excellent providers Pamela Lee, who's been in the field for I don't know 28, 40 years, something like that forever. She's an excellent therapist and really helping us out. And then we have Candice Hall, who's a therapist and doing a bang up job. We have actually a new employee that started today, Emily.
Andrew Weaver:Young Just met her today, but looking forward to working with her and I know she's had some experience working in recovery housing and dealing with people with co-occurring disorders as well.
Bill Emahiser:I'm excited to maybe have some of those folks on the podcast as well and to chat with them. And again, thank you for all that you're doing that on behalf of the community. We really appreciate all that you're doing to help folks.
Andrew Weaver:Appreciate it. Unison's gone Good. Good to be here and doing it.
Bill Emahiser:This podcast has been brought to you by Unison Health. Unison Health is a nonprofit mental health agency dedicated to serving the Northwest Ohio community for the past 50 years.