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"I used to feel like a big cloud, but now I'm down to earth. I can help myself now and I care about myself. I didn't believe that I could be clean and sober, but now that I am, I feel really proud."

This statement was made during an interview with Tim, a 25-year-old man afflicted with schizophrenia since early childhood coupled with a ten-year history of drug addiction. He represents what can happen when the substance abusing mentally ill are encouraged and challenged to take back their lives from the powerful grip of despair brought on by addiction and mental illness.

I have had the opportunity to work with the substance abusing mentally ill in the residential treatment program of Beverlywood Mental Health Center in Los Angeles. Our psychosocial program focuses upon serving chronically mentally ill adults. Three years ago we "scraped together" a drug program without additional money or staff. Staff worked overtime without pay, dealt with the angry and massive client denial indicative of addictions and the program lost important and scarce monies when drug-related evictions were necessary. But we struggled to keep our hope buoyant in the face of these obstacles because the destruction caused to our residents by drugs and alcohol was profound; residents were involved in greater incidence of violence, hospitalization and the general demise of daily life experiences.

At the time the dichotomy between mental health and substance abuse treatment providers was alive and well; integrated models for treatment were basically nonexistent. We decided to take our cues from our clients and use their expertise and feedback to build the program. We started by inviting "medication tolerant" Cocaine Anonymous panel speakers to our facility. Gradually we added our 12-step meetings to our calendar, created a token economy to stimulate motivation and began urine analysis. But most importantly we consulted our most precious resource -- our dually diagnosed clients-and shaped the program to address their needs. Eventually we were able to add a drug and alcohol specialist Clarence Williams to our staff. By sharing the "highs" and pitfalls of his own recovery process, he has confronted, stood by and embraced our clients as they struggled to redefine their relationship to drugs, alcohol and mental illness.

And what you may ask is our "success rate?" At times we have suffered the consequences of naïve decision-making and have been discouraged by unrealistic goals, but I believe our clients are responsible for remarkable levels of success.

One such case involves the recovery process of Kevin, a 32-year-old. His schizophrenic symptoms and addictive behaviors seemed to unfold concurrently during his teenage years. Kevin was the type of person who was everyone's friend and attempted continually to please others. On the outside he appeared "okay enough," but below the surface he battled with feelings of shame, worthlessness and desperation. Smoking pot and drinking with friends were moments of "normalcy" that Kevin feared losing. We contracted with Kevin to go to a 90-day social-model drug treatment program and upon completion he would still have a place at Beverlywood.

Kevin elected to extend his stay in the drug treatment program and five months later he has transformed into an articulate young man with a more secure sense of identity and purpose. His psychotropic medications have been greatly reduced and he exudes pride. He has been interviewing for a part-time job, aware that full-time employment might stress his well being into a state of collapse -- leading to symptom relapse. When interviewed, Kevin reflected back on his progress and said, "At first I thought I was being treated unfairly, but deep inside I knew I had a problem. I now have friends like I've never had before and I feel proud to be a part of the people that have made it."

There is another type of story that needs to be told; that of the client who does not remarkably transform. Keith was a bright, articulate and charming young man dually diagnosed with manic depression and drug dependence. We attempted first to work with Keith in our program, but he continually relapsed. He swore he wanted sobriety and begged for "just another chance," so we redesigned our therapeutic strategies and redefined our goals with each relapse. We educated, empathized and confronted Keith and yet he still used. Potential can be seductive and we had fallen prey to his addiction. Eventually we discovered that he was dealing pot to others and had no inner commitment to sobriety. We referred him to other drug treatment programs where he attempted to perform the same deceptive dance; he was asked to leave those programs too. Last I knew he was in a homeless shelter.

And then there is Tim who, at age 18, moved to Beverlywood when he became out of control and impossible for his family to manage. He was highly paranoid, exploded regularly into episodes of yelling and swearing and threatening violence if he didn't get his way. Tim bullied other residents and teetered continually on the edge of eviction.

Residence and staff were exhausted by Tim's offensive barrages. The turning point emerged quite unexpectedly for him during a trip to a 90-day drug and alcohol treatment program. I was taking two other residents to the program for an intake interview and Tim asked if he could go for the ride. Looking back, I now believe I was witnessing the unfolding of a certain internal wisdom held by this young man. He rode with his friends "who had been busted" to their new 90-day sober home and, upon saying goodbye to them both was painfully confronted by all the losses he had experienced due to his addiction to drugs. Friends had died of drug-related accidents; his family had turned away because of his sundry verbal assaults; and sometime long ago he had lost his "self."

This moment marked the beginning of Tim's recovery; since that day he has worked concomitantly on his problems related to his addiction and to his mental illness. His paranoia has decreased considerably, he no longer explodes into episodic tirades, has established new friends and works diligently to nurture self-esteem and to discover how he might best live his life despite the intrusion of schizophrenia. When asked about the quality of his life now, Tim replies, "the man that I want to be is right here, instead of a distant dream."