By Kristian Foden-Vencil

Forest Grove, OR  March 14, 2008 6:04 a.m.

Two of the most difficult problems a person can face are mental illness and drug abuse. Now imagine -- suffering from both.   It's known as a dual diagnoses.

Doctors estimate that about half of the people who struggle with mental illness also suffer some form of addiction. They may have had psychological problems first and then chose to self-medicate  with alcohol or drugs. Or their excessive use of drugs may have altered their brain chemistry or otherwise triggered a mental illness.

Doctors and therapists have been trying to address the special needs of those with a dual diagnoses for years. But as Kristian Foden-Vencil reports in this next installment of  "On Our Minds," getting government, treatment centers and colleges on board has been a slow process.

Kate Oldfield is a 25-year-old mother. Petite, with rich auburn hair and hazel eyes, she lives with her parents and her four-month-old in Forest Grove.

Today, Oldfield is dressing her bundle of joy in the living room of the small ranch home. It's an idyllic scene. But life wasn't always like this for Oldfield.

Her teenage years started off okay -- she got a job with a local fitness company. But then she met a man, 11-years her senior, who after an initial romance, began to beat her.

Kate Oldfield: "I started to work more hours, so I wouldn't have to go home. I got promoted. I moved up the ladder and a lot of people there did cocaine."

She says cocaine helped her work longer hours and feel good about her life. But gradually the drug use -- and her relationship -- spiraled out of control.

Kate Oldfield: "He broke my nose three times. Broke 13 ribs and I'd become a person I didn't even recognize. I never thought I'd be that type of person who'd be in that kind of relationship. And that's where I wound up. And I couldn't even look myself in the mirror."

She says, the cocaine did something important: it numbed that feeling.

Kate Oldfield: "There were no lows. I didn't have to confront the choices that I had made and where I was and toward the end, part of it was, I didn't have the guts to put a bullet in my head."

She's out of the relationship now and on probation for various drug charges.

She's also about to reach her one-year sobriety mark -- an important milestone. But there have been costs.

She's on Zoloft for depression and anti-anxiety medication for Post Traumatic Stress. The flashbacks, she says, are terrifying.

Kate Oldfield: "If I would say no to sex, he would rape me. And to this day, I can't have someone, if someone comes up and puts their hand within five inches of my face, I freak out. I scream. It's not fight or fright mode, it's straight fight mode."

Oldfield attends Narcotics Anonymous four times a week. She also goes to group sessions with mental health therapist, Tina Bialas.

Bialas says Oldfield's case is typical -- in that her drug use and her mental illness are so intertwined that it would be all but pointless to treat one problem without addressing the other.

Tina Bialas: "In some programs, almost 100 percent of the women who are in treatment for addiction are reporting histories of sexual abuse. So it's very clear that this linkage exists between the mental and emotional pain that's caused from having mental illness and that human drive to not want to feel that pain. And I always tell my clients that that's one thing that drugs and alcohol are really good at -- help me not feel this right now."

Bialas says there's a national movement to change public perceptions around drug addiction:  from that of a 'moral failing' to that of a 'brain disease' or mental illness. Indeed, a bill in Congress last year would have classified addiction as a disease. It didn't pass.

Bialas says many  people stubbornly cling to the "moral failing" point of view because there is an element of choice involved.

On Our Minds OPB's series on mental health care in Oregon The health system in Oregon, as in the rest of the United States is in crisis. Costs are skyrocketing, millions of children and adults remain uninsured and even working people are going without health care. Presidential candidates are promising plans that will come to the rescue. Here at OPB, we're focusing on one aspect of the health care system in Oregon: mental health. Our new series, "On Our Minds," examines who's getting and giving mental health care.

Tina Bialis: " I have yet to meet one addict, that when they first started drinking or using had the goal to become addicted.  They're looking for many other things, but they're not looking to become an addict, live on the fringe of society and suffer all these horrible consequences."

As a progressive state, Oregon has been on the forefront of treating addiction as a disease.

In fact, Bob Nikkel recently chanced the name of the state health department to recognize the problem of dual diagnoses, or co-occurring disorders. He now heads what's called 'The Addiction and Mental Health Division.'

Bob Nikkel: "I just think helping educate people about how common people with co-occurring disorders are, and that we have to stop ping-ponging them between the systems. And both systems, I think the public sphere, are working hard to grapple with this issue. Do we have a way to go, yes. But I think we're clearly enlightened about this in Oregon."

That's true, says Vietnam vet and former self-described "dope fiend," Corbett Monica. He founded Dual Diagnosis Anonymous of Oregon, and holds group sessions where patients follow a 12-step process -- plus five extra steps that deal specifically with mental illness.

Corbett Monica: "We used to talk about what was called the ping-pong approach to treatment. Which meant that for my addiction problems I was sent to an alcohol and drug treatment program, and for my mental health problems I was sent to a mental health service provider. Back and forth, back and forth. So that nowhere did the train come together so there was a concerted, what's called these days 'integrated treatment'."

He says that things are changing, but it's taking a long time. People are still turning up at mental health treatment centers and being told to come back when they're clean and sober.

But a bigger problem, he says, is access.

Corbett Monica: "I can tell you this, almost every residential program that I know of that treats dual diagnosis has a waiting list and the time for that waiting list will vary, sometimes into the several months, but at least a couple of weeks usually."

Mental health therapist, Tina Bialas, says it's not uncommon for her to have the friends and relatives of her clients begging to tag along with them for treatment.

The solution, she says, isn't a surprise -- it's money.

Tina Bialas: "An increase in the beer tax is long overdue. Oregon has one of the lowest beer and wine taxes in the nation. We could fund significantly more treatment and it's desperately needed. Folks don't understand how hard it is to get treatment. One in ten people, who need inpatient treatment for their addiction are able to get it. The other nine, even though they want it, have no way to get it."

Back in Forest Grove, at the small home of Kate Oldfield, the 25-year-old mother prepares a bottle of milk.   She knows she's lucky to be in treatment. And, she sees this as her big chance.

Kate Oldfield: "Yeah. I made a decision. I made a decision to turn to a substance to deal with my pain. It wasn't the best decision I made in my life. But I am working my butt off to fix that. And there are a lot of people out there who are suffering still. So the people who say, well they made that choice, they don't know the back-story. They don't know what someone's gone through. That it was so horrible they had to turn to that. They didn't feel they didn't have any other options."

We're getting help reporting the "On Our Minds" series from our Public Insight Network.  People in the Public Insight Network are helping us cover the news by sharing their knowledge and experience.   If you'd like to contribute your knowledge, go to our web site - opb.org/publicinsight .