FARAI CHIDEYA, host:
Rich and poor, people of all races find themselves addicted to alcohol or drugs. But what if that use is actually masking or exaggerating depression, schizophrenia, or bipolar disorder? We've got a new edition of our series on addiction.
We are looking at alcohol, drug use, and mental illness. We're going to talk to a recovering addict who is also diagnosed with depression. But first, we've got Robert Drake. He's a professor of psychiatry and community and family medicine at the Dartmouth Medical School. Hi, Robert.
Dr. ROBERT DRAKE (Professor, Psychiatry and Community and Family Medicine, Dartmouth Medical School): Hello.
CHIDEYA: So, Dr. Drake. We did a series of reports on the people at New Directions, and they help a lot with substance abuse and military veterans. That's where I first heard the term "dual diagnosis." What does that mean?
Dr. DRAKE: It just means that somebody simultaneously has a mental illness and also a substance-use disorder or addiction.
CHIDEYA: What are the challenges of that as opposed to people who have addiction issues, but no other mental-health issues?
Dr. DRAKE: Well, the two disorders seem to make each other worse, and complicate their recovery course, and make treatment more difficult. So, the real issue is making sure that the person who's got co-occurring disorders or dual diagnosis gets into an integrated-treatment program, where the treatment team addresses the mental illness and addiction at the same time.
CHIDEYA: I want to bring someone else into the conversation. We have gone many times to New Directions. It's a residential-treatment program based on the same campus as the Veterans' Administration in Los Angeles. They also have outreach programs, and Angel is a recovering addict and a program assistant at New Directions. How you doing?
Mr. ANGEL (Program Assistant, New Directions): Fine.
CHIDEYA: So, thank you for coming in. You're with me here in our studios at NPR West. So, given that you obviously have walked a path, and you're here now, and you're healthy, what was it that you dealt with that made you realize that not only did you have substance issues, but you also had other issues having to deal with your mental health?
Mr. ANGEL: Yes, I understand that very good. I remember at a early age - I'm from South America, and there was a big stigma on the mental illnesses. So, at that time, there was a couple of my relatives who should be in the mental institution because of schizophrenia. So, my thing was too that I didn't want to be called crazy not knowing why.
And the best way that I can describe that was that I didn't want to be labeled. I didn't want to carry that label for - you know, for all my life, and I thought that, you know, drinking and drugging will be the best way to cope with that.
CHIDEYA: Can I ask, what did that do for you? I mean, what was it that you felt before you drank and took drugs, and how did you feel after? Because people drink and take drugs because it makes them feel different. So, I assume that you felt different from what you said in a way that actually for the time that you were high, kind of made you feel safer or more secure?
What was the difference between who you were before you drank and took drugs, and just the hi - the moment you were high, not the moment after that, but the moment you were high?
Dr. DRAKE: The first time that I drank, it was a moment that I think that I had been waiting for all my life. I felt happy. I was able to carry a conversation. I was able to just talk about anything without feeling that - feeling less (unintelligible) 1:36 or feeling that I didn't - I wasn't good enough for anything, you know?
CHIDEYA: And then, when did you realized that this wasn't a path you could continue, that this thing that made you feel happy in the moment was actually destructive?
Dr. DRAKE: Well, the sad thing was that I didn't realize that until I came into a - until I came into recovery, until I came into new directions. And as I was talking to one of the psychiatrists, I was explaining to him some of the symptoms that I've felt for all these years, and one of them was that even when the sun was out and I heard the birds chirping, and I see and I heard people around me laughing and enjoying life, I felt miserable.
I felt that there was a cloud over my head, you know, forever. And at that time - but even then at that time, I was not going to admit that I was feeling those things, simply because I thought about the stigma that was going to be placed on me. I was going to be labeled one more time.
So, but - thank God for this doctor that had compassion for me, and explained to me that that was not the case. The thing was that I needed some help, and I need to understand what was it that I drank and used for all these years. So the turnaround point was when I - you know, when I decided that I needed to turn my life around for a lot of reasons.
Number one, that I was told that there is a light at the end of the tunnel that people do recover from mental illnesses or occurring disorders. And it was at that time that I took that initiative to - you know, to turn my life around.
CHIDEYA: Dr. Drake, when you think about someone like Angel, who has been able to reconfigure his life, what are the challenges for other people who might walk in and say, I am depressed and I've been drinking, or I am schizophrenic and I've been using meth, or whatever combination it is of different mental issues, plus substance issues. What are the challenges?
Dr. DRAKE: Well, the first one which Angel identified is recognizing that you have two disorders. I see patients all the time, who have been in treatment in the addiction system or in the mental-health system, and their second or co-occurring disorder has been missed or ignored for years, and they can't get well from one illness, because the other illness continues to stir things up. So, recognition is really important.
The second thing is, I think people who have been suffering from two illnesses are often terribly demoralized. They've been trying to get well for a long time, and they've not been able to do so. And so, giving them hopeful messages is really important, and it sounds like Angel got that also from the doctor that he encountered.
And then the third thing is just to make sure people get both kinds of treatments at the same time, and that the treatments are tailored for somebody who's got co-occurring disorders, rather than a single disorder.
CHIDEYA: When it comes down to practical issues, and just briefly, where do people turn particularly if they don't have the money to go to some big, fancy rehab center, specific organizations like New Directions, which Angel is a part of, do certain things for certain people, but if you think that your family member or yourself has part of this kind of confluence. Where do you turn?
Dr. DRAKE: Well, most people get their treatment in the public-addiction or the public-mental-health system, if they have long-term disorders of any kind. And the problem there has been two-fold. First that these systems are grossly under funded, and second, the systems have been silo'd, that is the - tend to provide only mental-health services or only addiction services, and it's only been in recent years that there's been wide-spread recognition that these programs need to focus on co-occurring disorders, because about half of the clients that we see in either system have got co-occurring disorders, rather than single disorders.
CHIDEYA: Angel, you are now someone who helps other people, and what do you tell them about the path, people with, you know, what we're calling co-occurring disorders or dual diagnosis. What do you tell them about the path they have to walk, and what they need to do to walk it successfully?
Mr. ANGEL: I believe that there is - you know, it's just like somebody else told me that there is a light at the end of the tunnel, and that people do recover from dual disorders, and that one of the things that I believe is that being medication compliant helps a lot, and having a support group which I'm part of, and also our program, what it does is that we - you know, we turn around veterans.
In just the last year, we had 40 veterans that was - that were placed in jobs, and not only were we placing jobs, but we were able to, you know, assist them in - you know, in other ways. So, yes, that would be one of my main things, is that we do recover from mental illnesses, and find support groups and be medication compliant.
CHIDEYA: All right. Well, Angel, Dr. Drake, thank you so much, and I just want to say we've been speaking with Angel, recovering addict who now works with New Directions and Robert Drake, professor of psychiatry at Dartmouth Medical School. Drake joined us from the studios at Dartmouth College and Angel was here at NPR West. Next up, we're going to talk about the conventions.
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