Dual diagnosis a problem of drug addiction and pathology

David & Joyce Djaelani Gordon, Contributors, Yayasan Harapan Permata Hati Kita, Bogor

Dani (not his real name), is 42; he is a drug addict, and one with a mental disorder.

Dani cannot adequately or properly take care of himself or his daily needs. He cannot hold down a job, therefore cannot earn a living. He cannot have the usual relationships with family, friends or associates; he cannot take care of his health and welfare needs.

Conversation with him flashes from the rational to mostly the irrational, from semi-logical to very illogical: All in all he must be taken care of and supervised, daily.

At Yakita Drug Recovery Center, based upon our documentation from 1999, we have found that approximately one in 18 drug abusers or addicts, both men and women, who come to the center for treatment and recovery are dual-diagnoses.

Meaning, they can be clinically diagnosed with having two separate maladies -- drug addiction, and some type of mental disorder.

Drug addiction has long been described as a "physical allergy" (causing a physical craving) coupled with obsession (disorder) meaning, that it is both a physical illness and a mental disorder.

Some of the more severe conditions of mental disorders we encounter regularly include retardation (subnormal, slow, to almost impossible-to-improve learning capacity), depression, manic/depressive psychosis, neurosis, schizophrenia, obsessive/compulsive, illusional, delusional, aggressive (violent) behavior and others.

Drug addiction and mental disorders are always complex and present different kinds of problems. The presence of both problems will surely increase the time for recovery or healing. Often, even when worked with extensively there can never be a return to what would be considered normal.

Importance of therapy

Across the nation many still believe that a doctor, psychiatrist or dukun (shaman) can help an addict or someone with a mental disorder to recover completely. Many still believe medication can help restore someone to normality.

It is a fallacy that medication alone will help someone cease their drug addiction, or get over some types of pathology/disorder.

Medication is often an immense asset in helping to restore balance, a semblance of normality for those who are afflicted with many types of mental disorders, but not so with drug addiction.

Just as often, therapy is just as important but difficult to obtain.

Qualified drug recovery professionals/specialists, who manage recovery centers and facilities, along with the essential ongoing (therapeutic) after-care programs are all exceedingly limited.

With the nation claiming there are approximately six million drug users/addicts, and findings indicating that approximately one in 25 individuals (mostly late-teens upwards) have some kind of mental or emotional problem, disorder or pathology -- Indonesia is presently in the midst of an evolving crisis surrounding recovery from drug abuse and co-related mental health needs and services.

Raising awareness of this extremely serious and vastly complex problem is certainly of utmost importance. We must also carefully consider HIV/AIDS, Hepatitis C and B, and tuberculosis.

All three are rapidly increasing across the nation. People with diminished capacity or pathologies are far more likely to engage in risky behavior patterns, not fully understand their action, or not have the capacity to care about whom they injure, affect or infect.

When individuals are stricken with a mental disorder or dysfunction, and are, for whatever reason, addicted to either illicit drugs, or medications (often only available under prescription) and dual-diagnosis conditions go without attention for some time the conditions always worsen.

Dani is just one individual, yet there are tens of thousands of others who may rightfully be considered as dual-diagnosis. Not only is there a minimum number of safe places; there is a huge shortage of trained mental-health specialists and drug-recovery professionals.

The plight of people with dual-diagnosis is commonly both heartbreaking and exasperating. Mental illness or diminished- capacity is often just poignant, because so little can be accomplished to remedy or rescue the individual from the illness.

Drug addiction is often maddening, in every sense of the word, because of the enormous problems and damage addiction can bring upon the addict, as well as those close to the addict.

Promoting self-help

The most expedient action that should be taken at present would be to create a "house" within local kampongs, where village community leaders, parents, family, loved ones, and peer- counselors could establish self-help groups and programs.

Training for such facilities can easily be locally hosted and supported.

Basic programs, giving an assortment of pertinent information will most likely find only temporary success.

These measures that can be taken are neither ideal nor comprehensive, yet they are workable and a progressive beginning to confront and work with those who are afflicted with an assortment of mental illnesses and are also drug abusers and dual-diagnosis addicts.

These are also prudent ways for families and the community or neighborhood to respond in a semi-secure way to meet the challenges, the confusion, hardships, strain and pain of not knowing what to do, who and where to turn to, and how to find resources that have the capacities and abilities to meet the needs of both the afflicted person, the family and community.

Also, these "houses" are very affordable because they are managed and facilitated by the community and need little, if any, outside assistance or support once established.

Mental illness and drug abuse/addiction cannot be taken lightly or side-stepped. It is a condition that affects many thousands throughout the nation.

Neither government nor the medical health and welfare community has anywhere near the resources, capabilities, or manpower to address this situation with resolve, for it is far too widespread and embedded within the populace.

Therefore, it is clearly a far wiser choice for the general public, families, etc., to learn about dual-diagnosis and create action plans and safe places within their own communities to care for those who need help.

in box: Yayasan Harapan Permata Hati Kita Villa Pandawa YAKITA Jl. Ciasin No. 21, Desa Bendungan Ciawi, Bogor, Jawa Barat

tel. (0251) 243069/077 e-mail: wisma_srikandi@hotmail.com website: http://www.yakita.or.id