Just as the body can suffer from more than one illness at a time, so, too, can the brain.
And more often than not, an addict has both an addiction and a mental illness, such as depression or bipolar disorder. Addiction specialists refer to such cases as a dual diagnosis or a co-occurring mental disorder.
According to the federal Substance Abuse and Mental Health Services Administration, 8.9 million adults have a co-occurring disorder.
Vince Mercuri, executive director of The Open Door Alcohol and Other Drug Treatment Center in Indiana, said that as many as 70 percent of the people who turn to his organization for help are suffering from some form of mental illness. Roughly half of those have already been diagnosed. The other half, he said, are diagnosed after undergoing an evaluation at the center.
Ralph May, chief clinical officer at the Community Guidance Center in White Township, said he, too, sees many people with mental illnesses struggling with substance abuse problems.
“There is a very strong correlation between mental illness and addiction,” he said.
Alone, each is a treatable problem. And together, it remains a treatable problem, although there are some special challenges.
For one, there is the basic problem of numbers — the addict is suffering from not one, but two illnesses. And secondly, each illness on its own carries a negative social stigma. Put the two together, the barrier between the addict and social support becomes all the larger.
However, that’s not to say treatment is unattainable. Because it is, May said. The key, he said, is the degree to which the person is engaged in his or her treatment.
“It’s not always sunshine and rainbows. But if you work the program, you recover. You get better. You get your life back,” he said.
Mercuri and May said the idea of co-occurring mental disorders is relatively new, dating to the 1980s. And the current approach to treating it is even newer, maybe going back about 15 years.
Initially, Mercuri said clinicians took a sequential approach to the problem, believing that the addiction had to be treated first before treatment for the mental illness had any chance of being successful.
“This model fails miserably,” said May.
The problem, he said, is one of practicality: “It’s awfully hard to dry out when you’re not in touch with reality and can’t stick with a treatment plan.”
So clinicians never really could begin to treat the mental illnesses because the addict was constantly cycling in and out of addiction.
In the current thinking, clinicians recognize they need to treat both. At the same time. As one problem. This is what’s known as the integrated approach.
“We want to amplify the opportunity for good outcomes by treating both,” Mercuri said.
In this model, the severity of the problem can be graphed on a quadrant. An addict might have a mild mental illness and mild substance abuse problems, or a severe addiction and a severe mental illness. Or he or she may have mild substance abuse problems and a severe mental illness and vice versa.
Plotting the severity of the overall problem allows clinicians to tailor a treatment plan to the addict. And treatment isn’t necessarily predicated on determining which problem begat the other, Mercuri said, calling it a chicken-egg dilemma.
Mercuri said that sometimes the addiction leads to the illness. Other times the illness leads to the addiction, such as when a person begins taking drugs to alleviate the illness’ symptoms.
And in other times, a person simply happens to have both, and the two create a sort of feedback loop.
Explains Krista Pounds, a clinical psychotherapist at the Community Guidance Center: “You use because of your mental health condition and because of your mental health condition, you use. So they kind of rebound off of each other.”
But no matter the cause, the problems have to be treated, and therefore, Mercuri said, the important thing becomes finding a way to help the addict improve the quality of his or her life.
One of the first steps, then, is to get a diagnosis. And to that end, the Open Door, the county’s primary addiction treatment center, and Guidance Center, the county’s primary mental illness center, work hand in hand.
The two organizations have adopted a “no wrong door approach,” which means that regardless of whether a person has an addiction alone, a mental illness alone, or both, he or she can turn to either place for an initial evaluation. And based on the result, each will steer the addict to the more appropriate facility. Or to both, if need be.
And beyond that the staffs of the two facilities closely consult each other. Once a week, they sit down and discuss patients, their progress and their treatment on a video conference call, May and Mercuri said.
When it comes to treating the problem, Mercuri said there are two important aspects.
One is that the overall treatment has to be specific to the mental illness the addict is suffering from. And nor should the mental illness be given priority over the addiction or vice versa, he said.
The other aspect is compliance with doctors’ orders on prescription medications. Taking medication for treatment of a mental illness is just as important as going to support groups for treatment of addiction, Mercuri said.
“Those two things needs to work together,” Mercuri said. “Neither one should be seen as more important that other.”
May said that can be a bit tricky, as on one hand, clinicians are telling an addict to stop taking a substance, but then on the other, telling them to take a substance.
In fact, some treatment models dictated that the patient had to be completely free of all substances. But the reality is that with medication, the chance of relapse declines because the addict is less compelled to self-medicate, May said.
Pounds, the psychotherapist, said that another important component of treatment is an early diagnosis. The earlier, the better, she said.
“If not identified quickly,” she said, “it could turn into something else. An adolescent could turn to drugs instead of a prescription.”
Read the next in the series here.