STUDY: TREAT ADDICTS' MENTAL ILLNESS

Mental disorders are common among alcoholics and drug abusers, but their
mental illness and addictions are seldom treated at the same time,
preventing many from recovering from either, says a report sent to Congress
this week.

And the government, to get the most value, must take the lead in tearing
down the "firewall" between programs that treat addiction and those that
treat mental illness, the report concludes.

People who suffer from mental illness and are substance abusers have
traditionally been considered exceptions, "but it's time to get real," says
Charles Curie, administrator of Substance Abuse and Mental Health Services
Administration (SAMHSA), which wrote the report at Congress' request.

Major Overhaul Needed

About one-third of drug and alcohol abusers have mental disorders, Curie
says, and adults with mental illness are three times more likely than
others to be substance abusers. An estimated 7 million to 10 million
Americans have mental and addictive disorders, he says. There's strong
evidence that integrated programs work best for them.

But that's going to take a major overhaul of our treatment system.
"Virtually all programs are designed for one or the other," says
psychiatrist Kenneth Minkoff, a clinical professor at Harvard. People with
both problems "have poor outcomes at higher cost, and they're more likely
to end up in the correction system."

A recent study of the Pennsylvania state prison system found that 85
percent of inmates had addictions, and half of them mental disorders as
well. "That's typical of prison systems nationally," Curie says. "And we
know if these inmates recover from the disorders, they're unlikely to
repeat crimes."

In the past few years, states have started some model integrated programs,
but the pace needs to quicken, he adds. The report lists several key steps
SAMHSA will take. Among them:

* Federal financial incentives that will spur states to try integrated
programs.

* Incentives to combine therapy with medication in long-term treatment
plans that help patients find employment and housing.

* A SAMHSA-sponsored "national summit" next year for experts in treatment
and criminal justice, and consumer advocates.

* A SAMHSA-created "tool kit" to help local agencies replicate excellent
programs.

In Connecticut, a Yale study showed heroin addicts were far more likely to
drop out of methadone treatment if they were depressed or had anxiety
disorders. One-third of the state's methadone treatment programs have since
added psychiatric screenings and treatment. That's kept more clients in the
program and off heroin, says psychologist Tom Kirk, Connecticut's
commissioner for mental health and addiction services.

"We have to change the programs to fit what people need, not try to fit the
people into programs. It's better value because patients are more likely to
recover," he says.