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Drug Abuse and Mental Disorders: Double Trouble
with Dr. Jonathan Porteus

Is a person with mental illness using drugs or alcohol to feel better?
Today, this is a pivotal question for the National Institute on Drug Abuse (NIDA). Since the late 1980’s, it has been shown that over 50% of first time psychiatric hospitalizations also involve drug or alcohol use. For people with a mental health disorder, using drugs is a way of changing how they feel, a personal and often instinctive attempt to try to feel better. This “self medication” can spiral into drug addiction, indeed into what NIDA calls a “disorder of self medication.” The result? Co-occurring disorders, according to  Dr. Jonathan Porteus, Director of Clinical Services at The Effort in Sacramento, and guest speaker at the November 2008 NAMI-Yolo monthly meeting.

Dr. Porteus has generously made his presentation on co-occurring disorders available on the NAMI website in two forms. The "one slide per page" is easier to read online while the "4 slides per page" is more suitable for printing (9 pages long instead of 35 pages).

Drug Abuse and Mental Disorders: Double Trouble
by Dr. Jonathan Porteus

He's also made available two "cheat sheets" used by staff at the The Effort,  a Sacramento program providing prevention, intervention, and treatment of substance abuse, addiction and the region’s first co-occurring disorders clinic.

Ways to Talk about Co-Occurring Disorder Referral and Treatment options for People

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People with co-existing disorders are the norm, not the exception in mental health programs and addiction programs
Research suggests at least a 60% rate for co-existing disorders in treatment programs.  Professions have started to include substance abuse counselor training with mental health competencies, and mental health training with substance abuse competencies. In the most far-reaching change, money tied to the Mental Health Services Act of 2004 (Proposition 63) can only be spent on programs that document competency in treating people with co-occurring disorders.

What are the benefits of co-occurring disorder treatment?
Dr. Porteus, a PhD. Clinical Psychologist who has conducted extensive co-occurring disorders training regionally and around the globe, notes that, “Clients report feeling cared for as ‘whole people’ by not being required to seek treatment in an unnatural and sequenced fashion. Addressing the conditions in sequence may actually do more harm than good. Secondly, families feel their loved one is receiving more comprehensive care – a real emotional boon when facing two issues that each still carry a great deal of negative societal stigma.” He notes that it’s clinically wise to treat the two conditions simultaneously.  For example, methamphetamine use ‘switches’ mood states and accelerates the manic-depressive cycle in bipolar disorder. The resulting depressive states can give rise to more Meth use which in turn accelerates the manic-depressive cycle even more.  Treating both conditions together can help break this escalating cycle.

Which came first?  Drug-abuse or Mental Illness?
A common question for Dr. Porteus is, “Was there a mental health issue before the drug use, or did the drug use cause mental illness?” Learning from this region’s involvement with the Meth epidemic, and the connection with acid and the drug exploration of the 60’s, it's clear that drug use can sometimes give rise to symptoms that, over time, lead to a diagnosis of mental illness.

“For the vast majority of people with co-occurring disorders, however, the picture is more complex,” says Dr. Porteus. “It is dangerous to conclude that drug use caused a mental illness. The interaction between substance use and/or dependence, and mental illness symptoms makes both conditions worse. The chicken and egg question of what came first can be addressed in time, but only when the two conditions have been stabilized and are relatively under control.”

What of the future of co-occurring disorders treatment?
Dr. Porteus thinks the future will bring more and better co-occurring disorders treatments, especially in light of Paul Wellstone’s Mental Health Parity Act, passed as a rider on the recent financial bailout. The Wellstone Act which requires the same treatment for mental health conditions as for other physical disorders/illnesses, identifies addiction as a mental health condition. Thus, more programs should develop that offer co-occurring disorders treatment.

The Effort Inc.
, where Dr. Porteus is employed, is leading the regional response to the methamphetamine crisis. For over ten years now, The Effort has served many thousands of people with methamphetamine addiction. Their services are provided across different levels of care (detox, residential, outpatient, medical clinic) and along with full service treatment, including medical support through our primary care clinic and co-occurring disorders treatment for those clients with co-existing mental health issues.