One of the more interesting aspects of running a recovery program is dealing with clients with a dual diagnosis.

These clients are often referred to us by agencies who don't know what to do with them. They bring them to us, many times out of frustration, because there aren't many programs that accept substance abusers who are also mentally ill or who take daily medication. If they seem functional to us - and we are not professionals - we usually accept them out of compassion. However, if they are too disruptive, we refer them back to where they came from.

One of our early clients with a dual diagnosis came to us in mid 1992 and stayed with us some 17 years before he eventually relapsed and passed away. This man was highly functional and worked in a demanding job. As long as he was on his medication, he was as normal as any other client. He kept his appointments with his doctors and was a contributor to our program for many years. Our experience with him led us to accept others with a similar diagnosis. His passing was a tragic loss to us, not only because he was a valued employee, but also because he became a good friend.

Because many of these clients are on medication they are classified as disabled and receive Social Security or disability income. One of the issues of dealing with clients in this situation is that they can't work because they receive disability. So what do they do with their time? We try to find something for them to do that's not very stressful. We often have them doing such things as answering telephones. Or they might do light janitorial or maintenance work around our facilities. One of the things that experience has taught us is to not put people with a dual diagnosis in stressful situations.

We had this experience recently when we put a man with a dual diagnosis to work in our office. He seemed perfectly capable of doing the job. His responsibilities included filing and answering the telephone. But the location of his desk required him to interact with people coming in and out of the office, while at the same time answering the telephone and doing data entry. While the job was not this intense for eight hours a day, there were times when this fellow did this kind of work for one or two hours in a row. The pressure became too much for him and he asked to be moved to a less demanding job. However, in a position where he was not under the direct scrutiny of management we found that he lost focus. We discovered he was spending a lot of time surfing the internet. After several warnings we laid him off.

When I spoke to him later he was accepting of the fact that he probably wasn't cut out for the kind of job we had given him. We had tried to make it work.

And that was the important thing.