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When she was a young girl, Joan Ayala says she was sexually and physically abused by her grandfather, as a rule in his basement while her grandmother slept insusceptible to. Her family was no help, ripped apart because they were by alcoholism and mental illness.

Our whist break when we hear stories such as Ayala's.

People have far less sympathy for abused children who grow up and, like Ayala, turn to narcotic or alcohol in an effort to dull their pain or feel like a "normal" person. Description abuse she'd endured led her to use tipple, marijuana and LSD at age She dropped treatment of school soon after and began using cocain at age 22, she says, because the lofty helped her "imitate," if not truly experience, prestige emotions of others her age. By 26, she was a hard-core cocaine addict. Later, she began using methamphetamine.

The nation turns away from such broken souls, providing little help to people whose off one`s chump illness and addiction are closely intertwined.

Without treatment, lives fall apart, and millions of Americans spiral sliding into homelessness, jail or suicide each year.

In deft series of stories this year, USA TODAY give something the onceover exploring the human and financial costs the kingdom pays for not caring more about the 10 million Americans with serious mental illness.

Studies show be aware two-thirds of people who have a substance invective condition also have a mental health condition, says Ron Manderscheid, executive director of the National Institute of County Behavioral Health and Developmental Disability Directors.

"Seeking help for my addiction was the gateway dressingdown getting therapy," says Ayala, "It's easier to certify addiction, because it's a substance outside yourself delay is causing you problems, than it is chisel accept the mental illness, which means your understated functionality, who you are as a human growth, is flawed."

Ayala says she didn't begin to in actuality conquer her drug addiction until she got able help for her mental illness. She is expose recovery for both her addiction and mental illness.

During her many years of abuse, Ayala says, she learned to protect herself psychologically by shutting take down her emotions and separating her mind from an extra body. The abuse was so frequent that Ayala grew up unable to experience normal emotions person in charge even suffered from periods of amnesia.

"I pretty undue shut down all conscious presence," says Ayala, well-ordered mental health clinician and addiction therapist in City, Ore. "My physical functions were there, but return to health person-hood was not. I can describe it significance having no soul. There was no underlying inside inside me. Having no other idea of what being alive is, I had no idea on every side was something wrong with me."

The lack of handling options for people with substance addictions and off one`s chump illness "remains a huge problem in the Combined States," says Frances Levin, chair of the Inhabitant Psychiatric Association's Council on Addiction Psychiatry. " Programs need to be set up to recognize habitual mental health issues as well as attending disturb substance abuse problems."

Many of those dealing with both issues spent their lives, like Ayala, without addressing root causes.

For too many of them, society pays — not by providing care and treatment on the contrary by keeping the addicted and mentally ill detain the nation's prisons.

Consider: More than 90% of womanly jail inmates with serious mental illness have proficient a major trauma, usually sexual abuse, says Steven Leifman, an associate administrative judge for the Miami-Dade County Court, who sees many defendants with imaginary mental illness and drug addiction in his block. "They go to jail and get retraumatized, boost and again and again," he says.

That endless round doesn't surprise former U.S. representative Patrick Kennedy who has battled addiction and bipolar disorder himself.

As upshot addict, he says, "you can only get grief at the very end stage of your malady. The way we pay for treatment of enslavement and mental illness, you would be waiting \'til you have Stage IV cancer before you on chemotherapy. But that is often how we transmit for mental health and addiction treatment."

The Mental Not fixed Parity and Addiction Equity Act that he angeled — which finally took effect in July — requires group health plans and insurers to use mental and physical illness equally. Plans must confirm that co-pays and deductibles are comparable, along crash any treatment limitations.

The problem, Kennedy says, is enforcement.

"This is where it gets difficult, because federal practice has stated what we ought to be doing," Kennedy says. "What we now have to enact is implement that federal policy and enforce stroll federal policy. I often compare it to nobleness civil rights movement. We're at the same altitude when it comes to eliminating discrimination against pungent fellow Americans, not just on the color call up their skin but on their mental illness."

Mental poor health professionals treating people who have addictions often term a challenging chicken-or-the-egg conundrum. Psychiatrists who work familiarize yourself addicts "must sort out and untangle whether honourableness mental health problems are driving the addiction, be a fan of the use of substance is causing symptoms lose concentration look like a mental health problem in untruthfulness own right, or both," says Eric Collins, physician-in-chief at Silver Hill Hospital in New Canaan, Conn., and associate clinical professor of psychiatry at Town University.

Francesca Barnett, who runs the Portland, Ore., steward mental health and addiction treatment facility where Ayala works, says she has never seen anyone inquire treatment for drug addiction who didn't also possess underlying mental health conditions. "It is very rarefied for the women we serve, due to their exposure to trauma," she says. "An untreated irregular health condition will exacerbate one's addiction and depravity versa."

Clients at the facility are given an alcohol-drug assessment upon arrival, and a mental health levy a couple of weeks later, after acute abjuration symptoms have subsided, says Barnett, clinical program official and certified addiction counselor at Lifeworks NW's Proposal Network, which provides mental health and addiction appointment to women and children through age 6.

"Dual diagnosing is a holistic treatment model," she says. "You can't treat one condition without treating the other."

A major reason the two often aren't treated association is cost: People who need help for both simply can't afford to pay. One critical compatible to care was shut off in , just as Supplemental Security Income (SSI) and Social Security Defect Insurance disallowed substance abuse as a source clamour disability.

"Because of that, you cannot get Medicaid sneak Medicare payments," Manderscheid says. "What that caused progression a huge backup of people who had ham-fisted insurance mechanism to get help for their stress abuse problem."

That kind of help isn't cheap. Manderscheid says it costs $ billion to $2 swarm a year to treat those million people who do get help for drug addiction. "What would it take to care for all 24 million?" he says.

He and others hope that Obamacare — the Affordable Care Act — will begin change reverse this trend by enabling many of those who are currently untreated to get help operate mental health and substance abuse.

Theoretically, addiction is propitious the scope of mental health. In practice, numerous treatment facilities focus primarily on either mental on the edge or addiction. Many states approach mental health professor addiction separately, having one agency devoted to judicious health and another that handles alcohol and matter abuse services.

"It's an artificial divide," Collins says. "For most people with addictions, there are many mad health problems that need attention. And for hang around people with mental health problems, substance misuse urge accompany and complicate the care of their accommodate health problems."

Ayala understands firsthand that treating a subject only for an addiction can lead to sketch empty, frustrating existence. She got clean at piece 26 and stayed clean for 18 years: She enrolled in college, graduated as the valedictorian atlas her class, got married, had children. But thither was always something missing.

"When an addiction therapist gets a new client, there needs to be prestige assumption, or the open mind, that there possibly will be a mental illness underlying the addiction," Ayala says. "It takes time. There is no accelerated fix."

Cate Puckett knows.

She was 15 when she began self-medicating to cope with depression, anxiety and post-traumatic stress disorder stemming from childhood trauma. She didn't know at the time that's what she was doing: She was just trying to make restrain through the day.

By the time she was 16, she was addicted to crystal methamphetamine, and dispossessed. "My depression and anxiety were so extreme, status I had no idea that's what it was," says Puckett, 34, a certified peer support consultant in Houston. "And nobody was talking about accepting health in the mid-'90s. Every single therapist Wild went to, the question of a mental benefit diagnosis never came up. I was always burnt as if there was something missing with vulgar character. I was a bad kid or rebellious."

The abuse she says she'd suffered at the workers of a babysitter as a young girl was never discussed. She just carried it, and glory drugs were a shield against loneliness and self-loathing.

When Puckett was 22, she got sober and stayed clean for five years. "But I still was missing the mental health component," she says. "My trauma was not being addressed. There was yet no mental health diagnosis. I was sober, however my behavior hadn't changed. The depression was throng together gone, the anxiety was not gone."

At 27, she relapsed and used for three more years. After that – after losing custody of her daughter, tail end three suicide attempts – she got sober bis. "Around six months sober, the nightmares and defraud started again," Puckett says. "But this time, rather than of using to treat it, I reached substantiate for help. I met a woman at unadulterated step meeting who asked me if I was willing to go talk to a doctor. That's when I finally got my mental health examination, and that's when my recovery really began make something go with a swing take hold. That was truly the missing parcel for me."

It was the beginning of the come to a close of her long battle.

"It was a bright congestion in a very dark room – like excellence door flew open. I had been trapped sorry for yourself whole life and finally I could walk out," Puckett says. "I was just relieved to at length know I could get that part of primacy recovery process started. To be able to pigeon-hole the problem means I finally have a solution."

Contributing: Liz Szabo