Pam Adams is talking about one of the many times she’s been in the grips of a manic phase.  Adams, 59, a former Los Angeles-area public school teacher, has been battling bipolar disorder for the past 40 years. When she tells the tale, her broad, expressionless face suddenly comes alive. Her voice is deep and raspy from decades of smoking. This story, like all her manic-phase stories, begins the same way: She has shunned her bipolar medication for a few weeks and has been drinking whiskey or vodka or whatever she can get her hands on to fuel the manic stage, which she finds both scary and seductive. She is out of control – the alcohol gives her permission to be out of control – and, she can’t help it, she likes it.

In the anecdote she tells, Adams has had little sleep for weeks and spends most of her time walking the streets of Eugene, Oregon, in a daze. She takes off all of her clothes while strolling through a hilly residential neighborhood, where she sees a TV dish on the roof of a house. To her, it signifies Satan's house. (When manic she often thinks she has been anointed by God to rescue those in need.) She approaches and hears a kitten meowing in an attached garage with an open door. She decides the cat is hungry, but no one is home, and the side door is locked. She finds an ax in the garage and chops her way through the door. She feeds the kitten and stands in the kitchen eating a brownie she finds on the counter. She stands naked on the front porch for a while, looking down at cars driving by. Then she goes back into the house, finds a robe to wear and calls a friend just to chit-chat.

“Obviously I was psychotic,” she says, interrupting her story.  “But I didn't think I was ill. When you're really manic, you don't think there is anything wrong with you.”

The adventure led, as dozens of such incidents have, to a journey through the local and state mental health systems, this one leading to a few months in Dammish State Mental Hospital.  Adams, like many people who suffer from what mental health officials now call dual, or co-occurring, disorders – for Adams it is bipolar disorder and substance abuse --  uses the hospital to get back on her medication, receive some therapy and sober up. But within a few weeks of her release she has returned to her destructive cycle of relapse, psychotic behavior, brief incarcerations, homelessness and hospitalization.  Twice she has tried to kill herself.

The specifics of her story may be unique, but the general tale is not uncommon: Mental health studies estimate that at least 50 percent of all people diagnosed as severely mentally ill in the United States also have substance addictions – alcohol, street or prescription drugs – that exacerbate the illness, sometimes to a lethal degree. Until about 15 years ago, treatments for the two diseases were almost always administered separately, partly because it was difficult to unravel the interacting effects of addiction and mental illness, and partly because the diseases were handled by agencies that had different approaches to healing.

But, as recovery from both diseases became increasingly problematic, mental health officials began seeing the advantage of integrated treatment. Dual disorders treatment today can involve a coordinating team of clinicians (a psychiatrist, physician or nurse, substance-abuse therapist and a caseworker) whose job is to guide the “client” through the early stages of the recovery process. The goal is to help the person learn to manage both illnesses and eventually live a meaningful life. That's the ideal. Adams says that from the patient's point of view the strength of such treatment is a series of group therapy meetings that explore the connection between addiction and mental illness. The best result, if you're lucky, is to learn coping skills that allow you to eventually live on your own.

“It's a long and complicated process for a person to climb from the bottom to independent living,” says Susan Ban, executive director of a Lane County nonprofit called ShelterCare, which provides various services for the mentally ill. “The cultures of addiction and mental illness are very different, which makes treatment hard. But we are beginning to have successes,” she  says.  When the dual approach works, when the person is getting the support he or she needs, there is at least the promise of recovery.  “Yes, there is hope,” says Ban.