Drug Abuse and Mental Disorders: Double Trouble
with Dr. Jonathan
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
Effort in Sacramento, and guest speaker at the November 2008 NAMI-Yolo
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
The above pages are in PDF
format. To view them,
you need the
free Adobe Reader.
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.