Double Trouble In Recovery: 12-Step Support For Mental Illness And Addiction

By David Susman, PhD

12 step meeting

If you ask anyone dealing with a substance use problem what “AA” means, they will immediately say “Alcoholics Anonymous.” Established in the 1930’s, AA is a well-known, effective peer-run approach used to help people in recovery from alcoholism.

Several dozen offshoots of AA have been developed over the years which use the same “12-step model,” including NA (Narcotics Anonymous), OA (Overeaters Anonymous), CA (Cocaine Anonymous), GA (Gamblers Anonymous), EA (Emotions Anonymous) and WA (Workaholics Anonymous), just to name a few.

One of the more recent spin-offs of the AA-based approach is “Double Trouble in Recovery,” or DTR. Let’s review a few of the frequently asked questions about DTR.

What is DTR?

DTR was established in 1989 to provide a welcoming, 12-step group environment for individuals who are “dually diagnosed” with both a mental illness and a substance use problem. Hence, the term “double trouble” recognizes difficulties in both of these areas. More than seven million U.S. adults reported having both a mental illness and a substance use disorder in 2013.

Are the 12 steps in DTR the same as the AA 12 steps?

Yes, with two slight changes. The language of Step 1 in DTR says “we admitted we were powerless over our mental disorders and substance abuse” and Step 12 in DTR says “we tried to carry this message to other dually diagnosed people.” Apart from these changes, the DTR 12 steps are identical to the AA 12 steps.

Does DTR follow the 12 Traditions of AA?

Yes, but there are two minor differences. In Tradition #3 of DTR, it says “The only requirement for DTR membership is a desire to stop drinking and drugging, and to work on one’s mental health.” Also, DTR uses the term “dually diagnosed person” in place of “alcoholic” in Tradition #5.

Are DTR meetings similar to AA meetings?

Yes, DTR meetings are very similar to AA meetings. They typically include a welcome, a moment of silence, reading of DTR principles, group member introductions, a guest speaker, sharing of experiences, and a closing (often using the Serenity Prayer).

What group guidelines does DTR use?

• Alcohol, nonprescription drugs, or drug paraphernalia are not allowed in DTR meetings.
• DTR group members who have used alcohol or nonprescription drugs in the past 24 hours are asked to refrain from sharing during the second part of the meeting.
• DTR, like other 12-step meetings, is an anonymous program. What takes place in the meeting “stays in the room” after the meeting.
• The names of DTR group members and what they said or did during the meeting remains confidential.
• DTR members are asked to limit their comments during the sharing time to five minutes.

Does DTR use sponsors like AA?

In AA, a sponsor is traditionally defined as a person who has made some progress in their own recovery program who volunteers to share their experience on a regular, individual basis to encourage and support another person in the program who is attempting to attain or maintain sobriety. Similarly, DTR values and encourages the use of sponsors to help others manage their mental illness and addiction. What does DTR say about the use of psychiatric medications? The DTR approach recognizes and supports the appropriate use of psychiatric medications in the treatment of mental illness. This is in contrast to some previous 12-step approaches which have given either direct or indirect messages to members that those
in recovery from addiction should not take any medication. This attitude against the use of medications was due to the potential for addiction from some types of prescription medication, including certain pain medications and some medicines used to treat anxiety. However, for someone with a serious mental illness (e.g., schizophrenia, bipolar disorder, major depression, etc.), this anti- medication message was too extreme, for without medication, such illnesses cannot be adequately treated and stabilized.

What does DTR not do?

DTR is clear in saying it does not:

• Provide treatment other than the mutual support from members.
• Make psychiatric diagnoses or dispense medication.
• Take attendance, keep records, or do case management.
• Provide advice, advocacy, or training.
• Provide religious guidance apart from the spiritual experience members derive from the program.
• Affiliate with community agencies or other institutions.

Is DTR effective?

DTR is listed in SAMHSA’s National Registry of Evidence-Based Programs and Practices. One research study was reviewed. It showed that at a 6-month follow-up (comparing DTR participants to non-DTR participants), the DTR participants:

1) Reported fewer days of drug and alcohol use in the past 90 days.
2) Had better psychiatric medication adherence.
3) Attended traditional 12-step groups more frequently.

How do you find a local DTR group meeting?

It’s been estimated there are over 200 DTR groups in the United States. Since there isn’t a comprehensive directory of all of these groups online, it’s more effective to search online for local DTR groups in your area.

How do you start a new DTR group?

The following suggestions are provided if you are interested in starting a new DTR group:
First attend a DTR group.

• Start with a small group and select a chairperson.
• Find a meeting place.
• Understand the DTR meeting format.
• Keep your expectations realistic.

Where can you find additional resources on DTR?

A “Double Trouble in Recovery Basic Guide” may be purchased through It includes detailed descriptions of the DTR 12 Steps and 12 Traditions, a format and script for DTR meetings, readings for DTR meetings, and a list of peer support group resource websites. A DVD and manual on starting and running a DTR group are also available for purchase. Additional free DTR resources on the same site include suggestions for starting a DTR group, the role of sponsorship, posters of the DTR 12 Steps and 12 Traditions, and a sample script for a DTR meeting.

DTR is certainly a beneficial addition to the array of 12-step group options. If you or someone you care about is dealing with both mental illness and addiction and could potentially benefit from DTR, check out a local group or give some thought to starting your own group.

David Susman, PhD is a clinical psychologist and mental health advocate in Lexington, KY. He blogs about mental health, wellness, and recovery at He was recently named by PsychCentral as one of the “21 Mental Health Doctors and Therapists You Should Be Following on Twitter.” You can follow him on