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When someone has substance abuse problems on top of a distinct (yet probably interweaved) psychiatric disorder, the term used to describe this is "dual diagnosis." Addiction to a substance is not uncommon for people with psychiatric problems. Also, when mental health practitioners or other authorities are initially trying to discern someone's problem, it can be hard for them to know whether the individual's symptoms come from narcotics versus having a psychiatric disorder. After an individual has more of a history with treatment professionals, those professionals have more data to work with. 

Being high on something can make someone appear to have a psychiatric disorder. And in fact, substances can sometimes turn a normal person into a permanent psych patient. 

When someone initially becomes mentally ill, usually in his or her late teens or early twenties, drugs are sometimes involved as a trigger of onset, even when the problem is psychiatric. The narcotic could be the last straw for someone who initially is barely keeping it together. 

A person with both a psychiatric disorder and an addiction to a substance gets a double whammy. Such a person has to maintain sobriety but must also maintain mental health usually by taking medication. Anyone who can do both is quite a strong person.  

The best cure for substance abuse is never to try them in the first place. Now, the U.S. suffers from a nationwide addiction to opioids, and, according to mainstream news sources, China is playing a role in getting these into the U.S., by route of Mexico. 

In housing set aside for people with mental illness, drug dealers are often attracted at the prospect of easy profit. Mentally ill people, due to relative helplessness, may be less able to defend oneself against the violence of drug dealers. Furthermore, mentally ill people are more likely to try a drug, in hopes of escape from the misery of living with symptoms of mental illness, and in hopes of temporarily escaping the difficulties of their situation in life.  

A couple of different times, drug dealers who did business where I was living have come after me, in a threatening and assaultive manner; apparently they believed I was creating an inconvenience for their enterprise. 

With the substances out there, just trying something one time can get someone hooked. Also, doctors who prescribe pain medication, presumably from a place of compassion and not wanting their patient to suffer, inadvertently cause otherwise normal people to become addicts. This is all over the news recently. 

For persons with mental illness, I have heard an expert say that it doesn't work to let them "hit bottom" because death often happens before hitting bottom. 

Apparently, addictive substances modify the brain's wiring on a very profound level. The individual is unable to feel "normal" and "okay" unless they keep their addiction fed.  

With my experience as a nicotine addict, I have learned that it is harder than anticipated to quit a substance once it is in your system. This information has furnished me with a stark warning concerning the danger posed by other addictive substances. I regret ever picking up that first cigarette.  

It doesn't work to simply accuse someone of turpitude--this is often a bad event that happens to good people. We lost the "war on drugs" which started from a bad premise. That premise was that anyone who is addicted to or involved with drugs is a bad person and should be incarcerated.  

My wife commented that law enforcement has begun to take a less punitive and more compassionate approach toward people who are addicted because it is no longer thought to be "a black problem"--it is happening to Aunt Bessie, Grandma, and Grandpa. (This is similar to how HIV was dealt with in the latter part of the 1980's. Movie stars and mainstream people who were not gay men or intravenous drug users started getting it, and it became destigmatized.) 

In fact, I believe it never really was primarily African American people who have taken illegal substances--this was a misnomer. Racial profiling has meant that nonwhite individuals have been disproportionately punished. I have run across plenty of white people on drugs and alcohol.  

For someone with mental illness, my advice is not to try these substances in the first place. If in pain, Motrin, taken according to directions, may sometimes do enough to bring relief--try that first.  

Opioids present a very difficult problem to human beings, and there is no easy solution. Doctors have to be more restrained in prescribing painkillers, and this problem needs to be moved out of the courts, and should be mostly in the domain of treatment professionals.  

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