Substance abuse counselor Jerry Manney recalled a case that reminded him of what he believes is the close connection between substance abuse and mental illness.

"I was treating a woman in early recovery for alcohol abuse, but she wasn't showing up on a regular basis," said Manney, coordinator of substance abuse services at LUK, Inc., in Fitchburg. "I also noticed she always came (to counseling) with somebody."

Manney learned a few months later the woman suffered from agoraphobia -- the fear of crowded places where it can be difficult or embarrassing to escape -- such as standing in line at the supermarket or riding on a bus.

"She couldn't take the bus alone because she was having panic attacks," he said. "She couldn't go to Alcoholics Anonymous meetings. I didn't pick up on it for a few months."

Manney started treating the woman for co-occurring disorders -- a condition where a person who is dependent on drugs or alcohol also suffers from psychiatric problems, such as clinical depression, bipolar disorder or post-traumatic stress disorder.

"Unfortunately, a person could have more than one or two problems," Manney said.

Manney is the co-chair of the North Central Dual Diagnosis Task Force, which advocates better services for local people affected by substance abuse and co-occurring disorders.

Mental illness is often at the core of a person's addiction to drugs or alcohol, said counselors who spoke to the Sentinel & Enterprise.

"With a lack of treatment for mental health issues conditions go untreated and people are vulnerable," said Gary Comeau, coordinator of HIV prevention and education programs at the GVNA community services center on Main Street in Fitchburg. "They can be self-medicating without knowing why. It's a coping mechanism."

Self-medicating is a term describing the use of drugs or alcohol to ease symptoms or avoid other problems, such as mental illness.

Co-occurring disorders affect 7 million to 10 million adults in the United States, according to the U.S. Substance Abuse and Mental Health Services Administration -- although children can also experience substance abuse and mental illness.

Self-medicating

Up to 65 percent of people with a substance abuse disorder also have a history of at least one mental disorder, and 51 percent of individuals with a mental disorder have a history of substance abuse, according to SAMHSA.

"The reason some people turn to drugs is to self-medicate high anxiety or depression," said Lucille Cormier, chief probation officer at Fitchburg District Court.

Cormier said probation officers often run into cases with co-occurring disorders.

"The courts and judges realize there is more than a criminal act here with using illicit drugs," Cormier said. "People see it as a moral weakness, and just for scummy or irresponsible people. They get addicted and can't get out of it. But addicts come from good families, and mental health issues are not uncommon in the general population."

Cherie Rivera, a Fitchburg case manager for the state Department of Mental Health, said people with anxiety or other psychiatric problems may use a substance to feel relaxed.

"If left untreated, one exacerbates the other," Rivera said. "Different drugs affect people in different ways, for example alcohol is a depressant, and cocaine is a stimulant. With different illnesses (substance abuse) will exacerbate different symptoms."

Cormier said treatment for substance abuse and other disorders are often part of a convict's sentence, whether it's prison or probation.

"It's here, and people aren't ignoring it," she said. "Judges aren't just rotating people in and out of the courthouses, but they are sending people to treatment as much as is available, and trying to prevent further crime by getting people straight. We don't just spit people back onto Main Street."

A lack of services

But Cormier and others said a lack of services in the region leaves a number of people without the help they really need.

"We have to look harder for programs that take (co-occurring disorder) cases," Cormier said. "There aren't nearly (enough) treatment centers that can handle it. There are some, but we have to look to find them, and beds fill up quickly."

Counselors at the GVNA in Fitchburg encourage drug users, who want to get sober, to fill out paperwork to obtain state health insurance through MassHealth to get into detox programs faster.

No detox centers

Marta Albizu, a substance abuse counselor at the GVNA, said the community suffered a major blow when the SPECTRUM detox center in Leominster closed its doors.

"What do we do with people?" she said. "There are so few free beds, we are constantly looking for detox. Sometimes it's hopeless. I see people just wasting away, and sometimes it can't wait."

Comeau said even if people get into detox, they often do not get access to follow-up counseling to stay sober.

"Often people are out of detox and back on the street, unprepared to sustain sobriety," he said.

Manney, who teaches courses at Fitchburg State College for future mental health counselors, said the state does not require counselors to take a single class about substance abuse -- leaving many unprepared to identify co-occurring disorders in their patients.

"A very large number of therapists go to school for a long time, and they work hard, with no formal training on this," Manney said. "Also you see people who may have become an alcohol or drug counselor through personal experience or through a 12-Step program, who may have insufficient training in assessing mental health disorders. Again, that's a big part of training."

Manney said the regional Dual Diagnostic Task Force, which was established 10 years ago and includes about a dozen state and nonprofit agencies, is trying to bolster awareness about co-occurring disorders and look for gaps in the services that are available.

"Our mission statement says, 'To advocate for integrated treatment services and to improve communication between mental health providers, substance (abuse) counseling providers and health care providers,'" Manney said. "This way we understand more what services are available for clients and how to obtain it, and to bridge the gaps between agencies."