Experts Challenged by Mental Illness Mixed With Addiction

Tuesday, July 28, 2009

In the often separate worlds of mental health therapists and substance abuse counselors, professionals began realizing in the mid-1980s that large percentages of the people they were seeing -- sometimes 50 percent or more -- suffered from both mental illness and addiction to alcohol or drugs.

And treating just one affliction wasn't helping.

Hence the term "co-occurring disorders," or "dual diagnosis."

"All programs for people with severe mental disorders should be considered dual-diagnosis programs," wrote psychiatrist Robert E. Drake of the Dartmouth Medical School, one of the leading experts on co-occurring disorders. The federal government estimates that about 7 million U.S. adults suffer from co-occurring disorders and that more than 90 percent of those people are not getting the right treatment.

"We've got a long way to go," said H. Westley Clark, director of the federal Center for Substance Abuse Treatment. "The public should be concerned, because early intervention militates against florid conditions later."

"Changing the world is a slow process," said Kenneth Minkoff of Harvard Medical School, a psychiatrist who is training public agencies across the country, including Fairfax County, on how to handle dual-diagnosis clients. "This is kind of a recovery process for [mental health] systems. It's kind of like what the clients go through."

Fairfax County opened its first dual-diagnosis facility in 1989. Today the county has three dual-diagnosis residential centers, though the waiting list for a bed ranges from three months to a year, county officials said. Montgomery County opened a residential treatment center in 2003.

At Cornerstones, Fairfax's 16-bed residential treatment facility for men and women, a college-dorm-like setting provides structure (meetings, meals, "medication calls") and group activities but not heavy discipline. The doors are unlocked, and clients have the option of walking out. Stays can last as long as six months. Stores that sell alcohol are nearby.

The residents are adults and must make their own choices. "People relapse," said Melissa Anderson, the center's director. "But they come back the next day."

Anderson said, "The mix of substance abuse and mental health problems really does complicate things." Those with co-occurring disorders, she said, "end up being marginalized in society. Because they have mental illness, they can't handle alcohol or drugs. They get criminalized. They can't get housing, they can't get jobs. What's left for them?"

-- Tom Jackman

For more information on, or help with, co-occurring disorders, call the federal Substance Abuse and Mental Health Services Administration's hotline at 800-662-4357, or go to

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