Many people suffering from addiction also have psychiatric illnesses that require assessment and treatment. The diagnostic picture can be confusing, because the drugs involved in addiction (including alcohol) are powerful brain-active chemicals which can create symptoms of psychiatric disorders. This can lead to misdiagnosis or over-diagnosis of major depression, bipolar disorder, psychotic disorder, attention deficit disorder and other serious mental health problems.

On the other hand, some psychiatrically ill persons will attempt to self-medicate their emotional and psychological symptoms with alcohol and other drugs, but do not have the disease of addiction. And of course it is possible to have both addiction and a psychiatric illness. It is estimated that more than 50% of persons in treatment for substance use also have psychiatric and psychological problems.

For these reasons, when someone has tried 12- Step programs, short-term rehabilitation and/or outpatient psychiatric care and addiction counseling, and is still struggling with bouts of substance use, persistent symptoms of depression and anxiety, and in some cases is able to stay abstinent but is feeling worse than ever, it is vital to explore the diagnosis and treatment plan in greater depth. This person and this family have suffered long enough.

Dr. Tracy recognizes that this situation is not uncommon and has developed a family intervention workshop in conjunction with Dr. Penelope Ziegler a prominent addiction psychiatrist to address the complex issues of addiction and co-occurring psychiatric disorders. Is it addiction, a psychiatric issue or both? We can help families through a process of education and careful treatment planning which can greatly increase the likelihood of a successful outcome. The process will include the following as part of the intervention process:

• A thorough review of the individual’s past history, especially efforts to get better, including addiction treatment programs, psychotherapy, psychiatric care, family therapy and medications

• Intensive education of the individual and the family about the disease of addiction, the process of recovery, and the sorting out of a complicated picture that may include a psychiatric disorder

• Development of a treatment plan that addresses all aspects of the person’s illness simultaneously, and that recognizes the chronic nature of these disorders with a need for continuing appropriate care

• If indicated, a referral for a comprehensive evaluation performed by a specialist or team of professionals who are trained and experienced, in both addiction medicine and psychiatry

• Referral for appropriate treatment and follow-up with the family during the treatment process

• Ongoing family case management after the completion of treatment when indicated


Penelope P. Ziegler, M.D., FASAM, is a board-certified addiction psychiatrist, certified by and a Fellow of the American Society of Addiction Medicine. She is Associate Clinical Professor of Psychiatry at Virginia Commonwealth University, and Medical Director Emeritus of The William J. Farley Center in Williamsburg, VA.

Dr. Ziegler currently serves on the Boards of the American Society of Addiction Medicine and the American Academy of Addiction Psychiatry.

She is a member of the Medical and Scientific Committee of the National Council on Alcoholism and Drug Dependency.