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Frequently Asked Questions
about Double Trouble in Recovery

What is Double Trouble in Recovery?

Double Trouble in Recovery (DTR) is a fellowship of men and women who share their experience, strength and hope with one another so that they may solve their common problems and help others to recover from their particular co-occurring addiction(s) and mental disorders.

DTR is designed to meet the needs of the dually diagnosed and is clearly for those having addictive substance problems as well as having been diagnosed with a psychiatric disorder.

We also address the problems and benefits associated with psychiatric medication as well as other issues crucial to mental health; thus we recognize that for many, having co-occurring addiction and mental disorders represents double trouble in recovery.

Why might people with mental disorders and substance abuse want a separate Twelve Step program?

Traditional Twelve Step groups are single-focus organizations based on the "one-disease - one-recovery" model. This specialization is largely what bonds members together. However, recovery needs that do not fall within that singular parameter are ignored, misunderstood or stigmatized. Dually diagnosed clients need and want to address their dual recovery integratively and holistically.

  • Dually diagnosed clients suffer the double stigma of mental disorder and of chemical dependency, with associated social prejudice. These negative attitudes are ubiquitous and are as present the single-focus peer-support groups as they are elsewhere in society. These negative attitudes are the antithesis of the mutual acceptance and honesty on which rests the essence of the Twelve Step recovery program. For the dually diagnosed, these negative attitudes can be devastating to the dual recovery program.
  • Many of the dually-diagnosed are on a prescribed regimen of medication which is as crucial to their total recovery as is abstinence from drugs and alcohol. Traditional Twelve Step groups often have an unspoken bias against medication. In that context, the dually-diagnosed receive misguided advice that can lead to non-compliance with medication, increased psychiatric symptoms and substance abuse relapse. For the dually diagnosed, this bias can be devastating to the dual recovery process.
  • Single-focus Twelve Step groups cannot offer the dually diagnosed the honesty, acceptance, emotional support and shared experiences they deserve and need, which are the most critical elements of the mutual aid process. Where they find these elements, it is often for one aspect of their recovery only: they may not feel comfortable sharing honestly their experiences and cannot relate totally to those who share theirs. They may feel shamed, judged and stigmatized. They may downplay, neglect or hide one side of their recovery needs to other members and to themselves. That is the antithesis of the mutual acceptance and honesty on which rests the essence of the Twelve Step recovery program. For the dually diagnosed, this lack of complete mutual acceptance and honesty can be devastating to the dual recovery process.
  • Thus many peer-support groups exist, they are single focus and cannot provide adequate support to individuals dually diagnosed with a mental disorder and a chemical addiction (alcohol and/or drugs). DTR is intended to overcome the problems encountered by those suffering from both substance abuse and mental disorders. DTR creates a safe environment where clients can discuss the issues of mental disorders, medication side-effects, psychiatric hospitalizations and experiences with the mental health system openly, without shame or stigma.

For many persons with co-occurring disorders (dual diagnoses), DTR is a vital link between being hospitalized and entering society. It provides an ongoing means of support for pursuing recovery, maintaining sobriety and living life in the community.

As one DTR member put it, "for me, coming to DTR was like coming home."

How does Double Trouble in Recovery work?

DTR follows a Twelve Step approach to recovery. The Twelve Steps of Double Trouble in Recovery have evolved from the original Twelve Steps of Alcoholics Anonymous.

In DTR groups, we band together to help ourselves recover from our addictions and mental disorders. We share our experiences to help ourselves become honest, open-minded, and willing. Sharing helps all of us to remember how it was and how we arrived at where we are today. We live one day at a time and practice the Double Trouble in Recovery Twelve Steps.

There are no dues or fees for DTR membership; we are self-supporting through our own contributions.

What can Double Trouble in Recovery do for you?

  • DTR can help you realize that you are not alone; that there are others who understand what you have gone through.
  • DTR can help you believe that you can recover from the co-occurring problems of addiction and mental illness.
  • DTR can give you an opportunity to be helped by helping others who have had similar experiences.
  • DTR can help you learn how to take responsibility for your recovery.
  • DTR can help you overcome secrecy and be more comfortable about having a mental disorder and taking prescription medications.
  • DTR can help you deal with a variety of recovery needs, including mental disorders and forms of substance abuse.
  • DTR can help you develop a stronger self-esteem and a clearer sense of who you are.
  • DTR can strengthen your ability to cope with daily life.
  • DTR can help you challenge stigma and loosen its grip.
  • DTR can help you make choices and have more control over your life.

What Double Trouble in Recovery does not do

  • DTR does not provide treatment other than the support mutually shared by its members.
  • DTR does not make diagnoses or dispense medication.
  • DTR does not take attendance, keep client records or do case management.
  • DTR does not provide advice, advocacy or training.
  • DTR does not provide religious guidance other than the spiritual experience members derive from working the program.
  • DTR does not affiliate with social agencies or other institutions.
Contact Information

For information about using these materials or starting and running a group, contact us at training@hazelden.org.


Evidence-BasedDouble Trouble in Recovery is listed in the National Registry of Evidence-Based Programs and Practices (NREPP).

Review the analysis by NREPP

In a 6-month followup study, researchers found that study participants exposed to DTR group meetings:

  • Reported fewer days of drug or alcohol use during the past 90 days than study participants not exposed to DTR group meetings
  • Had better psychiatric medication adherence than study participants not exposed to DTR group meetings
  • Attended traditional Twelve Step groups more frequently than study participants not exposed to DTR group meetings

Browse a list of journal articles about Double Trouble in Recovery

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