Over the last few years, I’ve met both medical professionals and psychiatric patients who encouraged me to write about the relationship between mental illness and substance abuse. Since I never abused drugs or alcohol myself, I have been reluctant to write about this topic. However, unfair assumptions and myths surrounding mental illness and substance abuse motivate me to share my thoughts. The thoughts I share here come from my own experience living as a homeless person with mental illness. My ideas are further shaped by my observations of a mental health drug court in downtown Cincinnati during the summer of 2013, after I recovered from mental illness.

Because of depictions in the media and cultural stereotypes, homelessness is often associated with substance abuse, but this is not always the case. Personally, I spent more than a year living outside, homeless, and never once used drugs. When I speak publicly, psychiatrists and mental health workers often find my abstinence surprising, as there is a high use of recreational drugs among mentally ill people.

Mental illness has many causes. Substance abuse often plays a devastating role as a contributing factor in the rise of mental illness, but the relationship between severe mental illness and drug addiction is sometimes misunderstood.  In 2008, a family physician I met for a routine appointment saw antipsychotic medication on my chart, and she chastised me. She pointed out that if I hadn’t used drugs, I wouldn’t need the antipsychotic. I assured her that I had never used recreational drugs. But even if I had, her response would have been uncalled for.

I wondered how this physician could hold such a judgmental attitude toward a young person like me who was struggling with a brain disease. Since then, I’ve met with many trusted doctors who strongly believe that my disease would have developed no matter what choices I made.

For many years, I felt proud to say I never used drugs, as though this fact made me a better person. Today, I no longer see it that way. Instead, I am grateful to have had a life free from pressure to abuse substances. Though I never tried to self-medicate, I know the feelings of desperation one experiences when suffering from symptoms of psychosis, such as loud voices and intense hallucinations. I understand why people with mental illness may turn to illegal drugs because they are suffering and desire relief.

I remember when my hallucinations became so severe that I could not think clearly. I sifted through trash looking for food because the voices in my mind told me to. I was desperate to eliminate the hallucinations and voices that were taking over my life. During that time, I was never approached by a drug dealer, but I can see how mentally ill people could easily become victims of drug dealers. The risk factors for drug use among mentally ill people are complex and likely related to the person’s environment.

When I consider drug addiction and its vulnerable victims, I am skeptical that a jail sentence is an appropriate punishment. When mentally ill people use drugs in an effort to eliminate hallucinations, what they really need is medical help.

Cincinnati, the city where I currently live, has several drug courts, including mental health drug courts. The mission of these courts is to provide “rehabilitation in lieu of incarceration.” I had the opportunity to audit these courts for several months, in 2013. I saw mentally ill drug users on the docket treated as valuable, unique individuals. Case managers, nurses, and other professionals came together to develop a treatment plan for each person. The goal was to help them stay off drugs and rebuild their lives.

Many members of the court were put on various medications including Methadone, Vivitrol, and Naltrexone to help them abstain from drug use. Though many of these people had needed medications like these for years, getting insurance companies to pay for appointments and expensive treatments was often complicated. Through the courts, these people were connected to case managers who navigated through insurance plans and Medicaid. Once these medications are prescribed, drug users can fight their addictions and finally begin to win.

When considering mental illness and drug addiction, it’s tempting to ask which came first. Was it drug abuse, or was it mental illness, that led to a craving for substances?

I don’t know the answer to this question, but I believe it is important for the general public to know that mental illness can happen without substance abuse. Also, it is important to see drug addiction as a disability which can be addressed through rehabilitation. Even so, like many people with disabilities, people with mental illness will struggle with it their whole lives.

I believe that drug courts, and more specifically mental health drug courts, should be available in every district in the United States, to serve people who fall into drug use. All people deserve rehabilitation measures that will enable them to move forward with their lives. When court systems help mentally ill people secure treatment and rehabilitation, the benefit is not just for the individual, but for the larger society as a whole.