Marcia, Leah's mom.
Excerpts from their conversation follow:
Dr. Mark Gold: Co-occurring disorders are quite common. When someone has a substance abuse disorder, the highest co-morbidity is bipolar disorder. We often see people who are bipolar who are chronic pot smokers and who use stimulants to balance their mood swings. In A.A. parlance, these people are known as 'double-trouble.' Unfortunately, it's more difficult to treat co-occurring disorders than it is to treat either disorder on its own.
Dr. Bert Pepper: Of the ten million people who have at least one mental health disorder and one substance abuse disorder, nine million had the emotional disorder first, at a median age of 11, and developed a substance abuse problem several years later as a teen. That means that there is a window of opportunity for drug abuse prevention if we pay attention to troubled 11 to 13-year olds. By the time these kids are teenagers, their cries for help are often seen as acting out by bad kids, rather than pleas for help.
Steve: From the time I was 10 to the time I was 13, I thought I was going insane. I had no one to turn to. I felt that people would be afraid of me. I began to turn to drugs and alcohol for support and to deal with childhood traumas including the death of my brother when I was 13. The more I got depressed, the more drugs I would use to bring myself up. When I was up everybody loved Steve-I was the life of the party. Once I started to come down, though, I got incredibly irritable and depressed.
Dr. Gold: Steve was seen as a 'bad kid' more quickly than a 'sick kid.'
Steve: I started seeing a therapist at 13. At first they thought I had ADD, then they bumped it up to bipolar disorder. It took a lot of careful documentation of my moods to get a diagnosis. I come from a real Leave it to Beaver type of neighborhood. When people learned that I was mentally ill and had a drug problem, the neighbors would pull their kids inside their house.
Leah: For as long as I can remember, I wanted to shut down my feelings. To do this, I experimented with cutting and biting myself, and throwing myself down flights of stairs. I turned to drugs and alcohol because they were a way for me to get completely obliterated. I didn't want to feel; I hated myself, hated my parents. Unlike Steve, I was not the life of the party; I was the scariest one at the party.
Marcia: When drug use is suspected, people say 'look for dropped activities and lower grades.' But Leah kept participating in dance at school, and she kept her grades up. I was the model mom: I baked brownies, I took time off from working as a teacher to be with my kids, I was the homeroom mother at school-and it still happened. We wrote it off as Leah being 'high-spirited.'
Leah: Family therapy didn't help. Every week, I lashed out at my parents in the office. I'd be drunk or high. I was a great actress; it was like Broadway in there. One time the therapist asked me, 'Are you using drugs?' I said, 'nope,' and it was never brought up again.
Dr. Pepper: Treatment for co-occurring disorders is not integrated. 90 percent of people with co-occurring disorders are not being treated for both disorders. Substance abuse counselors don't believe anything patients say, and shrinks believe everything-so it's hard to connect. It's hard to find a holistic treatment.
Leah: I thought my life was a fucked-up movie. I had the end playing in my head, right down to the David Bowie song that played as the credits rolled.
Debra: When my daughter Morgan was in fifth grade, we moved to a new area and she made new friends at a Christian day school. I never said, 'no, you can't spend the night.' It was a good area, full of nice people. Then one night she drank too much at a friend's house, passed out, and was raped by two boys. She was 11 at the time. After that, she did everything: pot, mushrooms, coke, crack, crystal-you name it-to try to forget about the rape. I just never thought it was as bad as it was. I was so blind to it. She finally said, 'I have a problem. I need help.'
Dr. Gold: Very often, we'll see kids who blame themselves for things that happen, and that magnifies the problem. Morgan may have blamed herself because she was drinking, because she was hanging out with boys. And not talking about what happens makes the guilt set in even more.
Dr. Pepper: These things don't come out of the blue. There is a 400 percent increase in the probability of drug abuse if someone has been traumatized. If someone who is close to him or her perpetrates the trauma, rather than a stranger, it's worse. And if it's repeated, it's even worse. Trauma or neglect in childhood (and consider that 52 percent of children experience their parents' divorce before the age of 18) can result in disruption of personality development and maturation, psychiatric problems, self-medication with drugs or alcohol, suicide attempts and experiences with the criminal justice network.
Debra: Morgan's no longer ashamed to talk about what happened that night because she knows it will make her better. She's not a bad person. She's someone who was hurt.
TV Writer: I'd like to ask Steve what types of portrayals of people with co-occurring disorders does he want to see on TV. What would be most helpful?
Steve: I hate seeing TV shows in which people in psychiatric hospitals are shown being restrained. There are some ugly things about being bipolar, but those examples create stigma. Positive portrayals that show mentally ill people being supported by their friends and family give people with mental illness hope. I'd like to see someone say to someone who is hurting, 'It's not your fault. It's your illness.' Those kind of interactions send the message that people with mental illness don't have to be isolated and that they can get help.
*Names have been changed.
