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A year ago, Toni sat in the Colusa County Jail -- arrested for driving under the influence. During Toni's 74-day incarceration, both her 14-year old daughter and her 14-year old step-daughter spent more time doing drugs than schoolwork and her husband was engaged in his own struggle with substance abuse.

Unlike her many other episodes in jail, Toni was to emerge from this one with new insight into her chemical dependency and a new sense of hope. Her breakthrough was realizing that her severe depression was not caused by her addiction, but was a separate and treatable condition.

Toni is a participant in the Colusa County Mental Health's Dual Diagnosis Program. It is one of 13 pilot projects funded by the National Institute of Mental Health to treat the 30 to 40% of alcohol and drug abusers who also suffer from severe mental illness. David Stout, a psychiatric licensed clinical social worker with a background in family therapy and the treatment of addiction, coordinates the Colusa program.

David's job is three-pronged. He works directly with prisoners in the county jail who are chemically dependent and severely depressed. Since November of 1989, he has worked with over 70 clients. He also advises other Colusa Mental Health therapists about treatment for dually diagnosed clients in the outpatient and senior outreach programs. In addition, he trains staff in medicine, law enforcement, and education to recognize and appropriately refer clients who appear to have a dual diagnosis.

An observant jail sergeant who had received this training noticed Toni's depressed behavior and record of alcohol-related arrests and contacted David Stout.

"When I first saw Toni," David recalls, "she was desperately sad and angry and on the verge of giving up on herself and her family."

"I saw a TV program on depression when I was in jail," Toni remembers. "I thought at the time, this sounds just like me. I always felt I was in a bad mood, and ever since I was 14 took drugs or alcohol to cover it up."

When Toni was one-and-a-half years old, her baby brother died at birth. Soon after, her maternal grandmother died. The juxtaposition of the two events left her mother depressed and inaccessible. While her parents didn't drink much, alcoholism was prevalent in her mother's family, and her paternal grandmother had committed suicide when Toni's father was 13. At 14, Toni herself began using drugs and drinking. At 30, her first marriage (of nine years) ended in divorce, a fact she attributes to her alcoholism.

She saw several counselors, but didn't seek treatment for her chemical dependency until a severe beating by an abusive boyfriend temporarily jolted her into confronting the unhealthy life she was living. She spent 28 days in a residential treatment center, mouthing the words of sobriety while swallowing cold pills to make herself drowsy. After treatment, she continued therapy and attended AA meetings (often high), where she met her second husband. She stayed sober and clean for two months. Then the pain of spinal arthritis ostensibly motivated her to dip into the Demerol and morphine readily available to her at the dental office where she worked as an oral surgery assistant. She quit when the dentist questioned her. During this time she also received several citations for driving under the influence. When her husband was offered a job in northern California, they moved to Colusa County. Not long after, she was jailed for yet another DUI and met David Stout.

David first helped Toni recognize that she was dealing with two problems: depression and chemical dependency. He recommended a medication evaluation by his psychiatrist colleague who prescribed antidepressants. While they made her feel agitated, they also lifted the utter hopelessness which immobilized her. David then reintroduced her to the twelve-step program used by Alcoholics and Narcotics Anonymous.

The twelve-step method transforms the way a chemically dependent or dually diagnosed person sees the world. A defensive, self-centered point of view is replaced by an acceptance of a power greater than oneself and an interdependence with other people. Twelve-step programs are the most successful approach for dealing with addiction.

"There is an interdependent healing that occurs with the twelve steps," David explains. "I bring my spiritual awareness to a client relationship. When the client also accepts the existence of a power greater than both of us, our work together is filled with a vibrancy that helps us find healing words and a healing path."

Toni's first assignment was to list six ways her behavior was responsible for getting her into her present situation, and six things she had lost because of this behavior. During her ten weeks in jail, Toni and David explored her pent-up rage, her depression, and her relapses. He also met with the family to help them understand the ramifications of Toni's dual diagnosis, and to provide some acutely needed family counseling.

David meets weekly with his clients when they are in jail. Together they develop a plan for maintaining abstinence and a healthy lifestyle. Both individual and family counseling are continued for at least three months after a client's release. He's found that it is often much more effective to visit the client and family in their home, rather than meeting with them at the mental health center.

Today, Toni's life is not easy, but the positive changes she sees strengthen her. "My children treat me differently now," she smiles. "They want to be with me, now that I'm sober. A strong family is important to both me and my husband, and I want to stay home and raise my children. I'll go back to work eventually, but not to a job where I'll be tempted by drugs."

A year ago, Toni sat without hope in the Colusa County jail. Today, after planting tulip bulbs in her garden, she sits in her sun-filled home and talks honestly and laughingly about her commitment to her family and to her future.

"It's important," Toni advises, "to never give up."