STATEN ISLAND, N.Y. — At the crossroads of mental illness and substance abuse treatment are unstable, vulnerable and complex individuals, trying their best to navigate two disorders impacting them mentally, emotionally and physically.
The presence of both a mental illness and substance abuse is referred to as a co-occurring disorder, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).
In 2014, 7.9 million people nationwide had a co-occurring disorder, SAMHSA reported.
On Staten Island, more than 70 percent of those with addiction or mental illness have a co-occurring disorder. In New York City, it affects more than 40 percent of the total population, according to SAMHSA data.
COMPLEX ISSUES TO TREAT
A key challenge treating a co-occurring disorder is that both illnesses often have similar symptoms.
For example, depression, mania and hallucinations can present in both substance abuse patients as well as people with mental illness.
Further complicating treatment, drugs used to self-medicate symptoms of mental illness can mask symptoms of the illness, making providers unaware that both disorders are present.
Treatment for mental illness can be hindered by drug use because it can exacerbate already present symptoms. Alternatively, symptoms of mental illness may not appear until illicit drug use stops.
“They’re extremely difficult people to stabilize and maintain and sustain their mental health,” said Luke Nasta, executive director of Camelot Counseling.
“When people are exposed, it’s anxiety-producing,” said Nasta. “These folks were once devoid of pain and when they’re exposed again they are raw and vulnerable to relapse.”
‘NO MAGIC BULLET’
“In many cases, people receive treatment for one disorder while the other disorder remains untreated. This may occur because both mental and substance use disorders can have biological, psychological, and social components,” the SAMHSA said about co-occurring disorders.
“That’s what we’re up against and we just keep at it. There’s no magic bullet, no silver bullet. Permanent housing, vocation, education, family, socialization; it all needs to be addressed because that’s what makes a whole person,” Nasta said.
Individuals with co-occurring disorders are more likely to have physical health problems as well, according to SAMHSA.
Providers say the most effective way to treat patients with co-occurring disorders is through integrated treatment, targeting psychological, social, behavioral, medical and addiction issues at the same time.
TREATMENT IS LIMITED AND COMPLICATED
During treatment of patients suffering from a mental illness and substance abuse, detoxing from illicit substances should be the first step in the treatment plan, according to the National Alliance on Mental Illness (NAMI).
Nasta said that even though each individual’s treatment plan is unique, a medical and psychiatric evaluation is done first to determine which is more pressing; the drug misuse or the mental illness.
Generally, treatment will be stabilization for the addiction in combination with psychotropic drugs and therapy for the mental illness, he explained.
Nearly half of those seeking addiction treatment reported other diagnosable psychiatric concerns, including anxiety, PTSD, or depression, according to a study by St. Johns Hopkins Behavioral Pharmacology Research Unit.
Only one of the borough’s three inpatient facilities offers detox treatment, which can create limitations to treatment by forcing patients to go out of borough. Additionally, all three of the facilities have beds for males, while only two have beds for females.
Of the 22, nine treatment centers offer addiction and mental health services in the same facility.
“We’re moving in the right direction, but the short answer is no, there aren’t enough treatment facilities for [mental illness and addiction] in the same place,” Nasta said.
He said the only way to have more access to treatment is acceptance of the addiction problem by the entire community.
“And the professional community needs to stop cherry-picking who they’re going to work with. If somebody has a problem with mental illness but also needs help for addiction, don’t send them someplace else just because they have a drug problem,” he said, adding that doctors have referred patients elsewhere because they don’t want “junkies” in their waiting rooms.
FOLLOW-THROUGH IS ESSENTIAL BUT NOT HAPPENING
“In the last two years there has been a significant decline in the number of referrals,” Nasta said. “People are not following through.”
In an acute stage of drug misuse, only 1.5 out of 10 people access long-term treatment, according to the National Institute on Drug Abuse.
“The national average for successful treatment is five episodes, or five relapses, before the person is sustained in a healthy lifestyle. What that indicates is that is a chronic relapse disorder and, frankly, the odds are against you once you become dependent,” he said.
In his experience, Nasta said a three-year treatment plan is ideal, starting with 24/7 residential treatment for at least one year before moving to daily, weekly and monthly outpatient treatment.
However, once a patient is discharged from an inpatient residential treatment facility, it is up to him or her to follow through with their treatment plan.
When combined with a mental illness, it is more difficult for individuals to continue the continuum of care on their own. After an inpatient stay, feeling better than they have before, individuals may stop taking their medicine and stop attending outpatient because they think they are healed.
“They think everything is OK, so they stop,” said one Staten Island physician. “It’s very common, too common. And then, in time, the illness is back and they’re not even aware of it.”
“In Camelot’s experience, that’s 41 years, those who are successful are the ones whose families are involved with us. There’s a dramatic disparity between individuals and the entire family. Sometimes, even the employers,” Nasta said.
‘LOOK HOW FAR THAT’S GOTTEN US’
Mental illness and addiction are two diagnoses that carry tremendous stigma and shame, preventing people from talking about it and seeking help.
It’s rare that you’ll find somebody who hasn’t been immediately effected or who doesn’t know somebody who is suffering from mental illness and/or addiction.
“The only way to move forward is acceptance,” Nasta said.
He said acceptance and understanding will lead more people to treatment and more treatment facilities being available throughout the Island.
“When people say ‘I don’t want a facility in my neighborhood’ or ‘I don’t want my tax dollars going to the junkies,’ well, look how far that’s gotten us,” he said.
Individuals are reluctant to get mental health treatment as well, fearing judgment and isolation.
“Stigma transfers to employers, education, and the effect of that stigma is less action is taken, more avoidance and denial takes place. We need to talk about it openly and it needs to end,” he said.
According to the city Department of Health and Mental Hygiene (DOHMH), in 2012, the last year that data is available, 39 percent of New Yorkers diagnosed with a serious mental illness did not receive medication or counseling.
(UNTREATED: This is part of a series on the care of Staten Island’s mentally ill. Click here for additional stories in the project.)