Bad Trips for the Doubly Troubled

By Christine Gorman

Tom had a problem: noisy upstairs neighbors. At first he would just stew, drink some beer and angrily throw chairs across his apartment living room. Then the burly, 26-year-old karate enthusiast bought an M-16 rifle and vowed "to fire a few rounds into the ceiling." Fortunately his father got wind of the scheme and put Tom (not his real name) in a psychiatric hospital. There, doctors learned that alcohol triggered his violent episodes. Tom is schizophrenic, and a single beer is enough to send him over the edge.

Tom is one of nearly a million Americans who suffer the double jeopardy of mental illness and chemical dependence. "Only in the past few years have mental health professionals realized how devastating the combination can be," says John Talbott, head of the psychiatry department at the University of Maryland and co-author of a study commissioned by the federal Alcohol, Drug Abuse and Mental Health Administration (ADAMHA) that will be released next week. Says Talbott: "There is no such thing as recreational drug use or a social drink for someone with a severe psychiatric illness."

The 150-page report reveals that mentally ill people who drink or use illegal drugs commit suicide at least twice as often as abstinent schizophrenics or manic depressives. Although these doubly cursed patients frequently show up in psychiatric hospitals and emergency rooms, they are unlikely to get much help. "These are the troublemakers," says Talbott, "the ones that everyone has given up on." Thanks in part to the easy availability of street drugs and alcohol, this hard-core subgroup is rapidly growing. "Twenty-five years ago you didn't have this problem, especially among the young," he notes.

The ADAMHA study discloses that at least 50% of the 1.5 million to 2 million Americans with chronic mental illness abuse illicit drugs or alcohol, compared with about 15% in the general population. It also reveals that the dual diagnosis virtually guarantees a hard fall through the cracks of the system. "Most mental health programs screen out people who have substance-abuse problems and send them down the street," explains Julie Boynton, director of a six-month-old rehabilitation center in Los Angeles County that deals specifically with both conditions. "And the alcohol and drug programs won't take people who need medication to control their mental problems. So people , get fragmented treatment if they get any at all."

Talbott and his co-authors conclude that mental illness and substance abuse must be treated concurrently. When that happens, preliminary data indicate, suicide attempts and psychotic episodes rapidly decrease. Even so, there are no hard and fast rules for treatment. "Sometimes the chemical dependency is paramount, and you can't get to the psychiatric disorder until you come to grips with the addiction," says Dr. Robert Morse, director of addictive- disorders services at the Mayo Clinic in Rochester, Minn., one of the few centers with an established track record. "Sometimes it's just the opposite."

Mental health officials are beginning to bow to pressure from parents and medical professionals to create programs tailored for drug-dependent mentally ill youngsters. "There's been a tremendous grass-roots campaign to convince the mental health bureaucracy of the problem," says Kathleen Sciacca, a substance-abuse coordinator at Harlem Valley Psychiatric Center in New York. Indeed, this fall the National Institute of Mental Health plans to fund 13 pilot treatment programs. Says Talbott: "We know what approaches are necessary to treat these people. We just need to use them."

With reporting by Teresa Barker/Chicago and Cheryl Crooks/Los Angeles )