Established 2005 Registered Charity No. 1110656

Scottish Charity Register No. SC043760

current issue



Dual diagnosis

April 19 2017
Dual Diagnosis © Freepik (amended by Mat Amp) Dual Diagnosis © Freepik (amended by Mat Amp)
We meet Dual Diagnosis Anonymous founder Dan Ware and his colleagues to find out more about working to help people with mental health and addiction issues

In our last issue we reported on how difficult it is to get help when you have a dual diagnosis – the medical term used when you have both mental health and addiction issues at the same time.

In late January, Groundswell held an action day and invited a range of experts – those living with the conditions and those working to help make things better. One of the most popular talks of the day was given by Dual Diagnosis Anonymous founder Dan Ware. So we sent Mat Amp to meet him and his colleagues to find out more.


The Missing Link

It is the sort of cold night where the crunch of gravel underfoot sounds louder than it should, the echo ricocheting in my raw but racing mind. The bustling throng of worn out commuters on the Northern line, then the District line and finally the bus, feel like an audience to my thoughts. Sometimes it feels like people can hear my sub-conscious gears grinding out a never-ending commentary. I wish it would stop.

Anxiety is like that, stubborn and unremitting. But I need to get my thoughts together as I’m about to interview the founders of a relatively new ‘fellowship’, Dual Diagnosis Anonymous (DDA).

I finally arrive to be greeted by Alan Butler, DDA’s animated spokesman, and the quiet and purposeful John O’Donnell, who also helped set up the support group and social enterprise. Dan Ware, the group’s pioneer, arrives only a few minutes later.

They all give out a warmth and strength that makes me feel comfortable. I don’t notice until later but the ongoing commentary from my overactive mind has stopped. To be clear, it’s not so much that I hear voices. It’s like my voice narrates everything that’s going on in my mind. It makes me feel alive and keeps me creative but it’s also relentless and it rarely stops to let me relax. Heroin used to do the trick but I can’t take that anymore because, unfortunately, it’s not very good for me.

This complex combination of mental health and addiction issues is known as dual diagnosis. We covered it in our last issue, documenting how difficult it can be to get the help you need. During our research we came across Dan, Alan and John, who were inspired to launch Dual Diagnosis Anonymous about a year ago in response to the problem.

It’s a support group, inspired by a US model, that aims to be inclusive in a way that not all others are. For a start, there is the problem with taking prescribed meds at other fellowships such as Narcotics Anonymous (NA) which aims for complete abstinence. Alan explains: “People with a dual diagnosis censor themselves [in other fellowships] because they don’t feel comfortable talking about clinical interventions, prescribed medications and the side-effects from them.”

But it is more than this. DDA has a specially formulated structure with an extra five steps designed to promote mental wellbeing in addition to the traditional 12. Here there is no sponsor/sponsee relationship in order to protect members from potential abuse, and the ethos is centred on the group rather than the ‘clean at all costs’, self-centric focus of other fellowships. There’s no doubt NA works for many addicts. But the experience of the open atmosphere at this DDA meeting feels so positive for those whose issues are more complicated. The supporting energy seems to nurture rather than shame people with dual diagnosis.

John sums this up when he says: “I think our emphasis on the collective of the group and allowing people to give feedback and share their experience, strength and hope around their mental stuff is key to the strength of the fellowship. There is such a wide variety of people with different diagnoses and they are on different medications etc, that it is important that each individual who comes in, usually from very isolated circumstances, feels that they have a sense of belonging and empathy and compassion in the rooms".

With so many addiction support groups already in existence – from Alcohol to Cocaine Anonymous – you may wonder if another fellowship is really necessary, but Dan is sure about what it has to offer. “You can say it's just another fellowship but it's quite markedly different from the others,” he says. “It's not just about the addictive side of the personality. A lot of people have come in and said I like these meetings because I can talk about how I'm feeling, I can talk about the weird thoughts I'm having and I'm not going to get shut down. So it's markedly different in that regard.”

This was certainly my experience in NA rooms. Usually confident and never short of something to say, I found myself tongue-tied when it came to sharing and didn’t like the idea of a sponsor. The focus on the individual and staying clean at all costs ultimately drove me away.

After the interview we make our way to the meeting downstairs and it is a real pleasure to see the three lads’ efforts in action. In the course of an hour we all share, learn, and laugh with each other. It is extraordinarily cathartic and I find myself sharing effortlessly, without that internal voice of mine trying to force its way in. The emphasis here is more on listening than talking so there’s less pressure. As a result I feel comfortable, safe and included and more able to be open.

“We have a good network and a core fellowship,” says John. He’s rightly proud of what they have achieved. “It’s been great to watch people blossom and get clean and watch their mental health and social circumstances stabilise and improve as mine did.”

Dual diagnosis may be one of the single biggest issues affecting the homeless community today. The supposed “complexity” and a lack of funding are blamed for the fact that many people are just not getting the treatment they desperately need.

But with a relatively small amount of money, John, Alan and Dan have started to change all that and are already showing promising results. At the moment there are five meetings, all in West London, but the fellowship will inevitably grow. DDA are already thinking about how that will work and planning to introduce outreach workers and train up more meeting facilitators.

There is no barrier to joining these meetings. You don’t need an official diagnosis, or to be in treatment of any kind. One DDA regular isn’t an addict. You just need to be interested in being healthy and drug- and/or alcohol-free. Everything said is confidential and support professionals, family and friends can come along with you if you want.

One of the members at the meeting describes the fellowship as the missing link in his recovery. It makes so much sense. I start to wonder if I might have found mine.

Find out more at:


Self-help guide

Rob Edgar, of Groundswell, has been there. Here are some of his top tips on how best to help yourself.

It takes two. With a dual diagnosis it will take at least twice the work and effort. You will have to manage both conditions simultaneously, and both are as important as each other. But while there are no shortcuts, the rewards are twice as sweet. Make sure you are getting the help and support for your addiction and your mental health condition. Make it clear to anybody involved in your care that both are equally important.

Medication. Taking your pills that are prescribed at the time and frequency they are meant to be taken will help play a key role in the treatment in dual diagnosis. They can reduce symptoms and prevent relapses of a psychiatric disorder. Medications can also help patients minimise cravings and help keep you away from addictive substances.

If it’s not working, change it. Sometimes we can get stuck in a bad rut because it’s easy or we don’t want to upset the applecart, but remember: “if nothing changes, everything stays the same” and it's time to put yourself first.

Keep a routine. Make a simple plan of what it is you need to do day-to-day that you can build on. Find an activity you enjoy and put it in your diary and keep in touch with friends regularly. This will help to rebuild confidence and self-esteem and give you a purpose.

Let it out. Talking can really help. Get it off your chest! Find a support group in your local area or from a professional if you are able to. It helps if you can share what’s going on for you and may help others to know they are not alone. It can be a great help to put things down on paper too, and clear your head of any fears you may have. More importantly it will give you a better perspective on your thoughts, goals and any hurdles you have to overcome. What is it that makes you “happy”? What are your dreams? What do you want to achieve? What are your solutions?

Have a back-up plan. Plan for when things are bad too. What do you need to avoid that might trigger problems? How do you want to be treated in a crisis? Put pen to paper and make a pocket-sized plan. Keep it with you to refer to when you need it.

Meet the From the Ground Up team