The Challenges of Living with Co-Occurring Disorders

In his short life, Danny Watt leapt from a moving train, hurtled through the windshield of a rolling car, was beaten by drug dealers, overdosed, swallowed rat poison, and tried to hang himself. In April 2008, two college students found him facedown in the Chesapeake and Ohio Canal—the medical examiner said he had drowned. He was 21 years old.

Danny’s parents, Bobby and Mary Watt of Reston, Virginia, had been fighting for Danny to stay alive for years. They refinanced their house three times to put their son in substance abuse and mental health programs; they went to countless meetings and hearings and hospitals and jails, but they couldn’t save him. “We just went through so much for so long,” a tearful Mary told the Washington Post. “We tried and tried for so many years, fighting, only to lose.”

Danny was one of an estimated 7 million US adults who suffer from co-occurring disorders, also called dual diagnosis. This means that a person suffering from bipolar disorder could also be addicted to drugs or alcohol. About half of all adults who are seriously mentally ill are also thought to be dependent on drugs and/or alcohol in an attempt to “self-medicate.” The federal government estimates that 90 percent of people with co-occurring disorders do not get the treatment they need.

Although Danny was diagnosed with schizoaffective disorder (a combination of schizophrenia and bipolar disorder) on multiple occasions, many Fairfax County therapists thought that Danny’s addictions were the source of his problems and that if he stated clean long enough he could help himself.

Fairfax has three dual-diagnostic centers, but none of them are locked, so Danny frequently walked out of treatment to resume drinking and taking drugs. He heard at least one destructive voice in his head, firmly believed that others could hear his thoughts, and believed that he was close friends with rapper Jay-Z and pop singer Mariah Carey.

Officials at the Fairfax-Falls Church Community Services Board (CSB) told the Washington Post that they did everything they could for Danny and that he repeatedly refused their help. Because he was an adult, they said, they couldn’t force treatment.

But E. Fuller Torrey, a psychiatrist with the Treatment Advocacy Center in Arlington, said that forced treatment is essential when people are too mentally ill to realize they need help.

Torrey said that not being able to force treatment is “fine for something with substance abuse, but if you’re dealing with psychosis, then there’s no way you’re going to treat someone like that in an unlocked facility. What you’re looking at is the system is not set up to treat the difficult patients.”

Danny’s parents agreed with Torrey; they wanted him in a place where he was secure and head proper medical attention until he became stable. “I begged them to put him in a mental hospital,” Bobby Watt said. “I told them, ‘If you put him out on the street, he’ll be dead in a week.’” Eleven days later, Danny was found dead.

Danny started playing guitar when he was 8, and it remained a huge part of his life, no matter where he was. When he was 12, he started drinking beer and wine and smoking marijuana. Bobby moved the family to Savannah, Georgia, in hopes of changing Danny’s habits, but nothing changed. Bobby found a 13-year-old Danny guzzling a bottle of wine one night, and Danny told his father that he couldn’t sleep and had racing thoughts.

The family returned to Reston when Danny was a junior in high school, where he soon became known as one of the top drug users. In March 2003, Bobby drove his 16-year-old son to an inpatient alcohol rehabilitation center in Pennsylvania. He completed a month of treatment but it didn’t take.

Records show that Danny told the staff he drank large amounts of beer, smoked pot daily, was snorting cocaine, and was taking “unidentified pills.” He later tried Alcoholics Anonymous meetings, but they didn’t help either. After landing in juvenile court for showing up to school high on drugs, Danny went back to inpatient treatment. But he was asked to leave after two weeks due to aggressive behavior.

After overdosing in 2004, Danny was placed in three different private hospitals. After another overdose, doctors told Mary and Bobby that Danny was bipolar, or manic depressive. He was prescribed Depakote, but Danny refused to take it, saying he was afraid of the side effects.

By 2005, Danny was shooting heroin and smoking methamphetamine and crack cocaine. Now that Danny was 18, his parents no longer had legal control over him. He began having minor scrapes with the law, including petty larceny, reckless driving, and public drunkenness.

Around his 18th birthday, Danny started having delusions, usually involving television. He believed he became part of certain shows and soon could no longer watch them. His parents took him to a private mental hospital in 2005, where he was diagnosed with schizophrenia.

In early 2006, Danny attempted suicide and overdosed three times in two months. His parents begged the police to arrest him, simply to keep him in a safe place. While in jail, Danny began having delusions that someone was coming to kill him, and he tried to hang himself with his shoelaces and then with a sheet.

Danny was then sent to a psychiatric hospital where he hanged himself with a sheet again and had to be resuscitated. The CSB wanted Danny to go to its main dual-diagnosis residential home, Cornerstones, but it had an eight-month waiting list. Once in, he lasted about a week until he was discovered with wine and was kicked out.

Most outside examiners diagnosed Danny with schizoaffective disorder and recommended he be hospitalized, but many CSB therapists weren’t sure he had co-occurring disorders. Fairfax County mental health therapist Cynthia Anderson wrote that Danny “has not had enough sobriety/clean time after eight years of polysubstance use/dependence to ascertain that he has a separate and comorbid thought disorder.”

Williams, the CSB’s alcohol and drug services director, said in an interview after Danny’s death that his staff thought Danny needed to stabilize his addictions before treating his mental illness. “Addiction is a chronic, relapsing brain disorder,” Williams said. “That’s the answer. The question is his unwillingness, or inability because of his disorder, to have enough stabilization to accept treatment at the level we were attempting to offer it to him.”

But experts in co-occurring disorders say that this attitude needs to change as research sheds light on how to treat dual-diagnosis patients. “It’s a relatively new phenomenon to talk about co-occurring,” said James Reinhard, commissioner of the Virginia mental health department. “In my residency in the ’80s, we were taught you treat substance abuse first, because you can’t get a clear picture of mental illness first. . . . We’ve at last realized that doesn’t make sense.”

In 2007, Danny was finally diagnosed with schizoaffective disorder and poly-substance dependence. His therapist recommended that he be placed in a more intensive, locked psychiatric hospital until a prescription could be found to stabilize him for the long term, but he was released. Danny was clean but still delusional, and he kept getting arrested for minor charges, mostly shoplifting.

He spent the next year in and out of jail until he said he was suicidal. He then entered a substance abuse treatment facility, where he was again kicked out for bringing in wine. Soon after he was notified that he was facing six months in jail due to his long list of misdemeanors.
In April 2008, Danny showed up at his parents’ house crying, and handed over a book of poems he’d written. When Danny didn’t call or show up for several days, Mary knew something was wrong.

On April 14, two Georgetown University students were walking along the C & O Canal when they spotted what looked like a pile of rocks in the shallow water. Police pulled the body out of the water and identified it as Danny when they found the business card of Danny’s last counselor in his pocket. The medical examiner ruled the death as suicide by drowning.

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