Dual Disorders Sometimes Overlooked By Doctors

Danny Watt was a young man addicted to drugs and alcohol, in addition to being schizophrenic. Before Watt died at age 21, doctors and therapists treated his addictions as if they were his only problem. Mary Watt, the mother of Danny Watt, and Dr. Ken Duckworth, talk about the delicate treatment of dual disorders. Duckworth serves as the Medical Director for the National Alliance on Mental Illness.

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MICHEL MARTIN, host:

I'm Michel Martin, and this is TELL ME MORE from NPR News. Coming up, I'll tell you why I have a bone to pick with that other Michelle, you know who, in a moment. But first, it's time for us to go Behind Closed Doors, the part of the program where we talk about issues that people often don't talk about openly for whatever reason, often shame or stigma.

Today, we're going to talk about the 21 tumultuous years of a young man named Danny Watt from Reston, Virginia. He was diagnosed with schizophrenia and he was addicted to drugs and alcohol. But according to his parents, too often doctors and therapists treated either one or the other but rarely both, with tragic consequences, and this is far more common than many people realize.

According to reports published in the Journal of the American Medical Association, roughly half of individuals with severe mental disorders are affected by substance abuse. And 37 percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness. We wanted to talk more about this. So we called Danny's mother, Mary Watt. Also joining us now is Dr. Ken Duckworth, medical director of the National Alliance on Mental Illness and an assistant professor at Harvard University. I welcome you both. Thank you so much for joining us.

Ms. MARY WATT: Thank you.

Dr. KEN DUCKWORTH (Medical Director, National Alliance on Mental Illness): Thank you.

MARTIN: Mary, I want to begin by telling our listeners that Danny lost his life in April of 2008. He had drowned in the C&O Canal, and I certainly want to say we are very sorry for your loss.

Ms. WATT: Why, thank you.

MARTIN: I wanted to ask you if you know what happened. How did those particular events occur? Do you know?

Ms. WATT: No, we don't know. He was found in the C&O Canal. Danny was an expert swimmer. He was on the swim team. So for him to be found in a body of water, slow-moving water, four feet, where he could easily have just stood up or something, it's so hard for me to comprehend how this happened. His state must have been so severe that he was able to go through whatever pain or torture it was, was worth him getting out of whatever pain and torture he was experiencing alive.

MARTIN: How did you figure out his diagnosis?

Ms. WATT: It took a while. At first, we thought he was - I mean, he was drinking and we put him in one of the rehabilitation centers. And then from there, he would be drinking at home. So we were concerned, my husband and I were concerned, is he drinking because he's depressed, or does he get depressed and then starts drinking? Because it came to the point where we went through so many things that it was an issue where we knew that there's something controlling him.

He wasn't out partying with people. He was coming home and drinking after we went to bed. He would drink, so...

MARTIN: How early did this behavior start? Do you remember?

Ms. WATT: I think 13 years old.

MARTIN: Thirteen.

Ms. WATT: Yeah, it's...long time.

MARTIN: So you've been through a lot as a family.

Ms. WATT: Yes, we have. Yes.

MARTIN: Dr. Duckworth, I wanted to ask: How common is what you're hearing from Mary?

Dr. DUCKWORTH: Well, the tragedy that's happened here, you know, is heartbreaking on every individual level, but if you take a step back, you know, you'll see that the people that have dual-diagnosis, co-occurring mental illnesses and substance abuse problems, are overrepresented in bad outcomes like this. And that the service system really hasn't figured out in a coherent, coordinated and welcoming way, how to see both parts of the person's experience as opposed to viewing it through one lens or another.

MARTIN: And I wanted to ask about that. Mary raised the question, which is, you know, what was the chicken, and what's the egg? Is someone drinking because he or she is depressed and they're trying to self-medicate, or are they depressed because they're drinking? How do you go about sorting that out?

Dr. DUCKWORTH: I think you go about sorting that out by basically having a cadre of people who are willing to approach both problems at once. For some people, it isn't knowable which began, which follows, but people have run into so much trouble going to the substance-abuse service system and being told, you know, that their depressive symptoms or their bipolar symptoms or their psychotic symptoms are irrelevant. And in the mental health system, people are told, or have been told, that they have to take care of their substance abuse problems before they can get access to mental health services.

MARTIN: One of the things that struck me is that there have been so many cases like this in the news. For example, Russell Weston of Montana, he has - he was a diagnosed paranoid schizophrenic, he shot and killed two federal officers and wounded a tourist in - at the Capitol in 1998 and, of course, it emerged that his parents had been seeking treatment for him for years, that he had many encounters with law enforcement related to substance and, of course, his parents continually told officials that he had this serious mental illness.

Buford Furrow, the man who killed and wounded several other people at the Los Angeles Jewish Community Center, same story. So what I'm wondering about is, is the issue the way medical professionals are trained? Is it you're trained either in addiction or in mental health and not both? Is it the way people come into treatment, so you tend to get steered one way or the other? What do you think it is?

Dr. DUCKWORTH: I think there's a lot of pieces to this puzzle. I do think the cultures of substance abuse treatment and mental health treatment have traditionally been quite different. And the culture, when you go into a situation of substance abuse settings, people are viewed as the agent of their problem. They're held accountable. People are enabling them if they're not directly trying to help them stop using their substances.

In the mental health field, because people are viewed as having a serious illness that isn't under their control at times, the culture tends to be more supportive, helpful. So even from these two descriptions of these two cultures, you can see how difficult it is to find the middle where a person's illness process, say hearing voices or problems with mood, and their substance abuse is respected and worked with at the same time because the cultural roots of the two fields are so different.

MARTIN: If you're just joining us, this is TELL ME MORE from NPR News. We're talking about people with so-called dual disorders, who are both mentally ill and struggling with substance abuse. And our guests are Mary Watt and Dr. Ken Duckworth.

Mary, can I ask you, when you first started realizing that Danny had some issues that you would have to confront as a family, do you remember what was your first instinct? Was it the alcohol? Did you first go to address the alcohol or what was your first thought...

Ms. MARY WATT: First thing...

MARTIN: ...of mental illness? Yeah.

Ms. WATT: ...was to address the alcohol. It was to address the drug use. And the point I wanted to say is that when someone has a history of suicide attempt and committing suicide, no one believed that he had a mental illness. It was always he's just a drunk and his parents are going to bail him out again. And he's always high. They, you know whenever he's being brought in he's high so they tend to think there that he's more of a degenerate than a sick person.

MARTIN: When did the suicide attempts start? You were telling us that he engaged in a lot of risky behavior over the course of his life and did have multiple suicide attempts. When did that start?

Ms. WATT: Actually, he jumped off a subway in Harlem and the doctor called me and I said that I was not going to get him because reading all this information and researching everything I - that you weren't supposed to run to their aid at all times. You know, they have to learn to get out. You know, I thought he, nobody really knew what happened to him. Come to find out that the police officer that found him, Danny told him just leave me here.

(Soundbite of siren)

Ms. WATT: Please let me die. And then he overdosed again in February and again in March and that's when we asked the police to have him arrested. And while he was in jail he hung himself in jail. And that was our first real scare and we knew like he was in there a month so he was sober. He wasn't high on anything and he try - attempted suicide.

MARTIN: None of the medical professionals during this period suggested that he should be evaluated for a mental illness, for an underlying mental illness?

Ms. WATT: We talked him into going into the hospital for an assessment, and at that evening, we were told that he was seriously deranged. And it shocked me because I thought we dropped off a drunk and these were aftereffects of the drugs or whatever. But then they said that he was seriously deranged and he was provided antipsychotic drugs.

MARTIN: Dr. Duckworth, I wanted to ask obviously, you never met Danny. You never treated him. You never evaluated him. You don't have his records in front of you. But I do have to wonder when I listen to Mary's story how often, how common this might be, that someone is continually treated as a substance abuser solely when perhaps earlier intervention, at least the consideration of an underlying mental illness, might have allowed a different approach sooner.

Dr. DUCKWORTH: I completely agree that that is a common problem and that the people who have both disorders have the worst outcomes, the highest rate of suicide, the most trouble with violence, the most out-of-control behavior. So it's ironic to me and troubling that our service system isn't organized around making sure that the people who have the worst outcomes, the people with dual diagnosis or co-occurring disorders, the system isn't still constructed for that.

I will say that the leadership of the state mental health authorities and public health agencies are really starting to try to figure out how to integrate these cultures. But I think this experience that Mary has lived with is common, and tragic, and somewhat preventable if the cultures were more sophisticated about this idea that people self-medicate at times with substances when they're having mental distress or mental illnesses. I think that would be a whole way to help people get better care.

MARTIN: We reached out, as you might imagine, to the Fairfax-Falls Church Community Services Board which treated Danny and they sent us this statement and we will certainly post it on our Web site at NPR.org. This statement reads: We are very saddened by this loss of life and the fact that the treatment efforts of the multiple service providers, including ourselves, through his short life were not successful.

The Fairfax-Falls Church Community Services Board, like many public mental health systems throughout the country have been seeing an increasing number of people needing services who have multiple very complex services needs that involve their mental health, substance use, physical health and psychosocial well-being.

Our staff have become increasingly expert at serving people with these challenging problems and have been successful with almost all of the 21,000 people we serve annually. Unfortunately, in this instance, for a number of reasons, we were not.

And this statement was emailed by George Bronstein, Executive Director of the Fairfax-Falls Church Community Services Board. Mary, I just wanted to offer that just in case you had any response to that that you'd like to offer.

Ms. WATT: What I am aware of is, that when Danny died, Fairfax Community Services Board, the Washington Post reporter contacted them and they had no idea how he died, and nor were they interested in finding, in inquiring how he died or at all. They had no interest to know. So I find it hard to believe that they, what they're saying - that how saddened they are. It's now, today they're saddened, but at the time they had no interest.

MARTIN: Mary, it's kind of you to revisit this with us and we appreciate your being willing to talk about something so painful.

Dr. Duckworth, do you have a final thought for us? I mean do you have any advice for families who are living through this now?

Dr. DUCKWORTH: There are some places that I really encourage people to go. The National Alliance on Mental Illness is the largest organization of people who love people or who have major mental illnesses. A whole subset of them have co-occurring substance abuse problems.

One of the things the National Alliance on Mental Illness is trying to do is to get the systems to integrate better, both the substance abuse system and the mental health system. But also the correctional system. We are making progress but I, you know, every time you talk to a family who's lost someone they love, you realize that this is both urgent and important, and so we have to keep this pressure on across the system and the best people to do it are the people who care and who are invested, and that's usually family members and people living with the illnesses themselves. So we are making progress but I believe we have a long way to go.

MARTIN: Mary Watt was kind enough to join us by phone from Lavallette, New Jersey. Dr. Ken Duckworth is the medical director of NAMI, the National Alliance on Mental Illness. He's an assistant professor at Harvard University Medical School and he was kind enough to join us from the studios at Harvard University.

Thank you both so much for speaking with us today.

Dr. DUCKWORTH: Thank you.

Ms. WATT: Thank you.

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