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Double Trouble: Mental Illness and Addiction

Week of March 13, 2001

Mental illness and addiction: for 10 million Americans these debilitating disorders, hard enough to cope with on their own, are a deadly team. Sharing their first hand experiences with dual diagnoses are Robert, a client at New York's innovative Institution for Community Living, and writer Emily Carter. Former deputy drug czar Dr. Herbert Kleber and Jean Henry, clinical director of Journey House, in Louisville, Kentucky discuss challenges in diagnosis and treatment. Dr. Alvin F. Poussaint recalls the loss of his schizophrenic older brother to drug related suicide, and the mental health crisis among African-Americans. And Dr. H. Westley Clark, Director of the Center for Substance Abuse Treatment, at the Office of Substance Abuse and Mental Health Services, outlines SAMSHA's strategies to further the mental health field's effectiveness in this field, and answers calls from concerned family members of those living with the double jeopardy of addiction and psychiatric illness.

In an opening essay, Dr. Fred Goodwin comments that many times he sees treatment of depressed and manic-depressive patients run into obstacles when they have a chemical dependency that has not been factored into the treatment equation. He points to an alarming trend - manic depression is on the rise among young people. Why? Dr. Goodwin suggests that substance abuse may be the culprit, as it may kindle an existing genetic pre-disposition for manic depression, and so activate it. This raises the stakes in preventing drug abuse among kids with family histories of mental illness.

The Institute for Community Living (ICL), in New York City, provides carefully designed therapeutic communities for people with severe mental illness and chemical dependency to tackle their problems. Robert, 35, will soon graduate from an ICL residential center to an out-patient program, shares his early experiences with addiction and depression. For more information about The Institute for Community Living, and the range of programs it offers, log onto www.iclinc.net or write to The Institute for Community Living, 40 Rector Street New York, NY 10006. Tel: (212) 385-3030.

Next we hear from Dr. Herbert Kleber and Jean Henry, L.S.W. Dr. Kleber is a Professor of Psychiatry at Columbia University Medical School and the New York State Psychiatric Institute, where he directs the Division on Substance Abuse. Ms. Henry is clinical director of Wellspring's Journey House, in Louisville, Kentucky. Dr. Kleber points out that at least one out of three people with chemical addiction suffer from a co-existing mental disorder. Addiction can mask underlying disorders or trigger them. In making a diagnosis, he asks questions like "Is there a family history of mental illness?" "Did the psychiatric disorder persist throughout abstinence?" and "Which appeared first?" He points out that managed care sometimes fails to provide clinicians and clients with enough time to make an accurate assessment.

Dr. Kleber discusses the role of neurotransmitter imbalances in psychiatric disorders and addiction. Dopamine, for instance, is in short supply and handled erratically in the brains of people with schizophrenia and depression. Cocaine use boosts dopamine levels, but throws off the already imbalanced system, requiring ever higher levels to set off the dopamine receptors. Chronic chemical abuse also creates long-term effects on the brain. Dr. Kleber encourages families of people with co-occuring mental illness and addiction to do get them treatment, but warns "not all treatment is created equal."

Ms. Henry discusses her own experience in being diagnosed with manic depression eight years into her recovery for addiction. At Journey House, Ms. Henry has worked to provide "integrated" treatment for women facing homelessness, addiction, and mental illness. "We take both diagnoses as primary," she says. This approach calls for more flexibility than traditional substance abuse treatment offers, for instance, being willing to work with clients who relapse, rather than kicking them out. "We tell clients 'You don't have a character defect, you have an illness.'" Ms. Henry urges family members to get support for themselves, for instance through contacting the National Alliance for the Mentally Ill (NAMI) at http://www.nami.org or Al-Anon at http://www.al-anon.alateen.org.

To learn more about Journey House, and Wellspring's other programs, write to Wellspring P.O. Box 1927 Louisville, KY 40201 or call: 502-637-4361. To contact Dr. Herbert Kleber, write to: Dr. Herbert Kleber, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 66, New York, NY 10032.

Next, writer Emily Carter reads from her new book, Glory Goes and Gets Some, a collection of short stories, most of which are told in the voice of the title character. Glory's heroin habit lands her in a drug rehabilitation facility in Minnesota, which Glory dubs "Land of Ten Thousand Treatment Centers." Ms. Carter reads from a story called 'The Bride.' "Heroin was the boyfriend that removed the need for boyfriends… Heroin removes any importance or relevance from social interaction. Image such bliss. I was even willing to hang around with other white, pretentious, privileged heroin users to get to the stuff."

Glory Goes and Gets Some reflects Ms. Carter's own experiences with drugs, depression, and recovery. For Ms. Carter, the first years of recovery from addiction revealed depression as her major issue. For the first time, she made a point of taking her anti-depression medication "religiously." The anti-depressants gave her the energy to take on other depression fighting measures like exercise and volunteer work, "all those things that if you tell a depressed person to do they'll say 'Are you kidding? I can't even find my socks.'" Recovery has required absolute honesty with herself, which Carter draws strength from in her writing. "You can't bamboozle your readers. If you can sense a false note, so will they."

You can order Glory Goes and Gets Some by clicking here. To contact Emily Carter, write to her in care of Coffee House Press, 27 North 4th St., #400, Minneapolis, MN 55401.

Our next guest is Dr. Alvin F. Poussaint, Professor of Psychiatry at Harvard Medical School and the Judge Baker Children's Center in Boston. He is the author, with journalist Amy Alexander, of Lay My Burden Down: Unraveling Suicide and the Mental Health Crisis among African-Americans, published by Beacon Press. Dr. Poussaint begins by recalling his older brother, Kenny, who had discovered heroin in his teen years and was diagnosed as a young man with paranoid schizophrenia. He was hospitalized for his schizophrenia, but after his release was soon back in his addiction, and struggled with it for many years. Kenny died at the age of 42 from meningitis contracted through using a dirty needle, a death that Dr. Poussaint calls suicidal. In discussing the mental health crisis among African-Americans, Dr. Poussaint points out that many blacks have a deep mistrust of health care professionals, stemming in part from a long history of unequal treatment and even experimentation. Risk-taking behavior like drug use and homicidal behavior can mask underlying suicidal impulses, made worse by the overall stressors of discrimination and resulting low self esteem. Dr. Poussaint recommends that African-Americans move past equating an acknowledgement of mental illness with weakness, and that the mental health community show greater sensitivity to African-American concerns.

Dr. Alvin Poussaint can be contacted at the Judge Baker Children's Center, 3 Blackfan Circle, Boston, MA, 02115-5794 or can be e-mailed at Alvin_Poussaint@jbcc.harvard.edu

Finally, Dr. Goodwin interviews Dr. H. Westley Clark, who heads the Center for Substance Abuse Treatment at the Office of Substance Abuse and Mental Health Services (SAMSHA) SAMSHA is the Federal agency charged with improving the quality and availability of prevention, treatment, and rehabilitative services in order to reduce illness, death, disability, and cost to society resulting from substance abuse and mental illnesses.

Dr. Clark discusses the need for comprehensive treatment for co-existing addiction. Dina, a caller from New Jersey, brings up the problem of doctors proscribing addictive medications like benzo-diazepenes to depressed patients who have a history of addiction. And Diana, also from New Jersey, calls to share the tragic result of a hospital's rejection of her son's appeals for hospitalization for homicidal feelings. Days after the hospital refused him in-patient treatment, her son over-dosed on drugs. Dr. Clark brings up the need for better training of physicians, who may discount the full scope of an addict's condition, and the need for more resources and education in general. For family members, Dr. Clark advocates they do what they can to create a safe environment, for instance, by not keeping alcohol in the house if they are living with an alcoholic. Family members also continue to play an important role in coordinating treatment efforts between doctors, psychiatrists, substance abuse counselors, the client, and other family members.

To find out more about SAMSHA and the Center for Substance Abuse Treatment, log onto www.samsha.gov. E-mail for SAMSHA or Dr. Clark can be sent to info@samsha.gov. SAMSHA's telephone number is (301) 443-8956.

 

Other Information and Links:

The National Alliance for the Mentally Ill (NAMI) is a nonprofit, grassroots, self-help, support and advocacy organization of consumers, families, and friends of people with severe mental illnesses, such as schizophrenia, major depression, bipolar disorder, obsessive-compulsive disorder, and anxiety disorders. You can reach NAMI at Colonial Place Three, 2107 Wilson Blvd., Suite 300, Arlington, VA 22201, call 1-800-950-NAMI [6264] or visit at http://www.nami.org.

Dual Recovery Anonymous is an independent, twelve step, self-help organization for people with a dual diagnosis. We are chemically dependent and we are also affected by an emotional or psychiatric illness. To contact: write to DRA, Central Service Office P.O. Box 218232 Nashville, TN 37221-8232, call toll free 1-877-883-2332 or 1-888-869-9230 or on the Internet at http://www.draonline.org

http://www.soberrecovery.com/links/dualdiagnosis.html Links to dual diagnosis web sites, support groups, up to date information, etc.

http://users.erols.com/ksciacca/ Kathleen Sciacca has worked in the field of dual diagnosis since 1984, providing important training to health care providers in the field. Her site features good information and links.

 

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