In the often separate worlds of mental health therapists and substance abuse counselors, professionals began realizing in the mid-1980s that large percentages of the people they were seeing — sometimes 50 percent or more — suffered from both mental illness and addiction to alcohol or drugs.
Treating just one affliction wasn’t helping, hence the term “co-occurring disorders,” or “dual diagnosis.”
“All programs for people with severe mental disorders should be considered dual-diagnosis programs,” wrote psychiatrist Robert Drake of Dartmouth Medical School, one of the leading experts on co-occurring disorders.
The federal government estimates 7 million U.S. adults suffer from co-occurring disorders and that more than 90 percent are not getting the right treatment.
“We’ve got a long way to go,” said H. Westley Clark, director of the federal Center for Substance Abuse Treatment.
“The mix of substance abuse and mental health problems really does complicate things,” said Melissa Anderson, director of Cornerstones, a residential treatment facility in Fairfax, Va. Its dormlike setting provides structure (meetings, meals, “medication calls”) and group activities but not heavy discipline. The doors are unlocked, and clients have the option of walking out. Stores that sell alcohol are nearby.
Those with co-occurring disorders “end up being marginalized in society,” Anderson said. “Because they have mental illness, they can’t handle alcohol or drugs. They get criminalized. They can’t get housing, they can’t get jobs. What’s left for them?”