I’ve been trying dual diagnosis therapy for a while, and lately I feel pretty stuck. We talk about both my mental health and substance use, but the sessions still seem to stay on the surface. I leave understanding what I should do, then a few days later I’m back in the same patterns.
The hardest part is that the two problems seem tied together. When my mood gets bad, I want to use, and using usually makes my mood and anxiety worse. It feels like I’m constantly putting out one fire and starting another. I know progress probably isn’t perfectly steady, but I’m having trouble seeing any progress at all.
I don’t want to quit therapy, but I also don’t know how to explain that the current approach isn’t really reaching me. Has anyone found a way to get unstuck in dual diagnosis treatment?
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Cameron, the link you described between mood and using is exactly what I had to bring into the room more directly. Instead of just saying I felt stuck, I started each session with one recent example: what my mood was like beforehand, what I used, and what happened afterward. That gave us something concrete to work with instead of staying at the level of advice.
One thing that helped was asking my therapist to focus on the few hours before I usually use. We made a short plan for that window, including one person to contact and one place I could go where using was harder. It didn’t fix everything, but it helped me interrupt the pattern sometimes.
You could tell your therapist, “I understand the coping skills, but I need help examining the exact moment I move from feeling bad to wanting to use.” That may make it clearer what kind of deeper work you’re asking for.
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@Elizabeth_Simon, focusing on the few hours before using sounds really practical. That’s usually when my thinking gets narrow and I start telling myself it’s already too late to change course.
I like the idea of bringing in one specific example instead of giving a general update. I’d probably ask my therapist to help me map out the warning signs in that window, like isolating, skipping food, or getting wound up over something small. Having one person and one place lined up ahead of time seems more useful than trying to invent a plan while I’m already in the middle of it.