State links addiction, mental-illness treatment

By CANDACE CHASE

The Daily Inter Lake

Substance abuse and mental illness, long treated as distant cousins, become conjoined in the latest treatment model in Montana.

Community Program Officer Mary Jane Fox with Montana's Addictive and Mental Disorders Division came before the Kalispell Mental Health Local Advisory Council recently with a clear message.

"Individuals with co-occurring disorders need to be thought of as the expectation, not the exception," Fox said.

Early identification and treatment potentially saves lives. Fox said the risk of suicide goes up phenomenally when a person has a mental illness and abuses drugs and/or alcohol.

Other risks include family disruption and abuse, violence, exposure to sexually transmitted diseases, criminal activity and homelessness.

She defined a person with a co-occurring disorder as someone with at least one major mental illness such as major depression, schizophrenia, bipolar or psychotic disorder and one substance abuse problem.

According to Fox, 89 to 100 percent of people who returned to the state hospital at Warm Springs relapsed due to substance abuse. According to federal studies, alcoholics and drug addicts reflect the other side of the coin.

"The most common cause of substance abuse relapse is untreated mental illness," she said.

Fox said the reason these people take drugs or drink alcohol comes down to making themselves feel better. They abuse to lessen anxiety, worries, fears, depression and hopelessness.

She said it's an escape from the bleakness of their lives.

"It is not fun to have a mental disorder," she said.

In Montana, two-thirds of people in treatment in the public mental-health system have co-occurring disorders. As a result, the state has placed a priority on linking professionals working in mental health and substance abuse treatment.

So which problem do you treat first? Fox said both.

"There is no wrong door to come in to get treated," she said. "Integrated treatment is what the state adopted as the model we're moving toward."

Fox said counselors need to collaborate on treatment plans. She said that serial treatment doesn't work and parallel treatment only works with highly motivated people.

Statistics have documented the increased effectiveness of integrated treatment of clients with both severe mental illness and substance abuse. To move toward integration, Montana contracted two top experts, Dr. Ken Minkoof and Dr. Chris Cline, for training and consultation.

Their model stresses screening every mental illness client for substance abuse and every substance abuse client for mental illness in a welcoming atmosphere. Success comes from "empathetic, hopeful, continuous treatment relationships."

"There is no one correct treatment approach," Fox said. "Everyone is an individual."

She called collaboration "a contact sport." A dual-diagnosis client's therapists need to talk and share treatment plans.

Derek Dalton of the Flathead Valley Chemical Dependency Clinic shared his perspective at the meeting. He said his agency has a professional cross-trained in mental illness and drug-abuse therapy.

"This has been a long time in coming," he said.

He said the clinic has taken some steps to become collaborative. But Dalton listed some obstacles such as making clients fill out seven or eight pages of application asking for the same information at each agency where they seek treatment.

"How welcoming does that make a person feel?" Dalton asked.

He suggested a simple step of some sort of blended application process.

A bigger problem involves different income qualifications for substance abuse and mental health treatment from state agencies. For substance abuse a person can earn up to 200 percent of the poverty level while a mental-health client can earn only 150 percent of the poverty level.

Dalton points out a person in treatment for chemical dependency may earn too much for cross treatment for mental illness.

Fox said that the state is at the very first phase of raising public awareness of the move to integrate treatment of co-occurring disorders.

"A paradigm shift begins with an idea," she said.

Reporter Candace Chase may be reached at 758-4436 or by e-mail at cchase@dailyinterlake.com