Mental-health treatment options in Southern Nevada, special section for RGJ Media Custom Publishing Group, May 2013

Multi-faceted Treatment Co-occurring conditions require dealing with substance abuse and mental illness for lasting benefits By Lisa Ferguson For decades Judy Bousquet knew she was not like other people. “I just thought I was generically crazy,” she recalls of the dramatic mood swings she experienced. To combat them, she began “selfmedicating” as a teen with alcohol swiped from her parents’ liquor cabinet. For more than 10 years, Bousquet said she existed on a “low-maintenance high” as she worked a career in the fashion industry in San Francisco. Still, the demons in her head persisted. In the 1970s, she recalls being incredibly sick. “My alcohol addiction had totally taken over my life,” she said. She was plagued by periods of deep depression and thoughts of suicide, which she attempted in 1976. “For some reason, I didn’t die. I should have ¬– I took all the pills and drank all the wine you can imagine,” she said. Three years later, she again considered ending her life. “But there was something about the fact that I had gotten it wrong the first time.” The thought of waking up at the end of another suicide attempt kept her from going through with it, she said. “So one morning I got out of bed and said, `This is it. I’m gonna go for help,’” she recalled. Bousquet confessed her alcohol addiction to a neighbor, who contacted the National Council on Alcoholism on her behalf. The council referred Bousquet to a 30-day, inpatient alcohol recovery program whose psychiatrist-director also diagnosed her as suffering from Bipolar II disorder, a mental illness that causes extreme mood fluctuations. The diagnosis changed Bousquet’s life. “I knew that I’d been given something precious,” she said. Co-occurring diagnoses At the time, mental health experts called her condition a dual diagnosis. That term has been replaced in recent years, however, and it is now referred to as a co-occurring condition, which describes individuals with at least one mental illness and one substance use disorder. The Substance Abuse and Mental Health Services Administration (SAMHSA) in Rockville, Md., estimates that 9 million people in the U.S. have co-occurring disorders. Dr. Lesley Dickson is a Las Vegas psychiatrist board-certified in addiction psychiatry, general adult psychiatry and psychosomatic medicine. Since 2009 she has chaired Nevada’s Governor’s Committee on Co-Occurring Disorders, which studies and reviews issues related to persons with co-occurring disorders. The committee, which has also developed recommendations for improving the treatment of such patients, and submitted reports that have been distributed to the state legislature, is in the process of disbanding because, according to Dickson, “We felt we had accomplished all we could accomplish.” It is best for patients with cooccurring disorders to be treated for both their mental health and substance abuse issues simultaneously, Dickson said. That approach is the opposite of how it was formerly treated, she explained. “Mental health professionals used to say, ‘We can’t figure out what psychiatric illness you have as long as you’re using substances, so you should get clean and stay clean for six months and then come back and see us,’” she explained. “That was a total failure,” Dickson added. When the disorders are not treated together, the patient may not receive themost beneficial treatment, Dickson said. “You’re not going to be particularly helpful to the patient,” she said. “If you put them, say, in a mental health facility and ignore the substance abuse, they will probably leave and go right back to the substance abuse. If you put them in a substance abuse facility and ignore the mental illness, you’re going to have a hard time getting them to stay sober.” These days, most co-occurring disorder patients are treated in outpatient settings where substance abuse counselors and mental health providers work as a team in the same location or at least by communicating regularly, according to Dickson. Lengthy hospital stays are uncommon and usually only required when a person has decompensated in their illness enough that they are not safe in the community, she said. If a patient is hospitalized it is typically for a brief period, mostly to stabilize and detox them, if necessary, from drugs, she said. Treatment and recovery plans for co-occurring disorder patients must be tailored for each individual, Dickson explained. “You have to consider the mental illness, the symptoms of the mental illness they’re trying to selfmedicate with substances, and the environment they exist in,” she said. “Ideally, you get them into a sober living situation with good follow-up care … and start working on trying to turn their life around.” Twelve-step meetings and other substance abuse support groups can also be helpful, particularly for those who are sensitive to underlying mental illness. Medications are available to treat mental illnesses, as well as some substance addictions. The latter can help prevent patients from relapsing and abusing substances again. An ongoing learning process “I had to go through the process of finding the right medication and the right dosage, and over the years that has been tweaked several times,” explained Bousquet, who surrounded herself with what she calls a team of people during her treatment and recovery processes. The group was led by the psychiatrist who initially diagnosed her mental illness and determined the correct combination of medications to treat her Bipolar II disorder. It also included a therapist-turned-personal mentor and an individual she calls her “guide in sobriety,” who assisted her in kicking her alcohol addiction. Bousquet also made improvements to her diet and ramped up her fitness levels with exercise (including walking, swimming and tai-chi) which she said provides much-needed structure in her life. “I knew that I had to do everything in my power to continue through the recovery process,” she said. It’s a journey on which she remains today. “It is an ongoing learning process, and it needs to be.” Since the early 1990s, when she began counseling patients over the telephone, Bousquet has assisted others struggling with mental illness. In 2000, she became vice chair of the Sonoma County Mental Health Board in California, where she led support group meetings, created a speakers bureau and educated the public about mental health issues through lectures at area schools. Since relocating to Las Vegas in 2004, she has facilitated support groups and programs for the local chapter of the National Alliance on Mental Illness (NAMI). She currently serves on the Nevada Mental Health and Planning Advisory Council, the Governor’s Committee on Co-Occurring Disorders, and the advisory board of Hope of Nevada, an organization that advocates and provides wellness and recovery training for the state’s mental health consumers. Providing support to other mental health patients is the frosting on the cake, Bousquet said. “I get to work with people in recovery, and they think I’m the teacher, but they’re my best teachers,” she said. Even those who have been clean and sober for 30 years are still in recovery, because they’re still working to stay there, Dickson said. “You have to always keep in mind that most mental illnesses are chronic, and substance abuse is always waiting to rear its ugly little head, which makes it all but impossible to fully cure co-occurring disorders,” she said. “It’s always there, something that could come back, so (patients) always want to manage it.”