FREMONT, Neb. More than one in four adults living with a mental health problem also has another serious problem they're struggling with. The dual diagnosis can be debilitating.
For the millions of people who suffer from a mental illness, a simple task can be a challenge.
"Getting out of bed in the morning is a huge hurdle," said Methodist Fremont Health Behavioral Health Therapist Bruce Myers.
"People are frozen by anxiety - the fear that something bad is going to happen." They'll stay in their houses and they won't go into interviews. They'll sit outside," Myers added.
It's Myers' job to help but he says instead of coming to him for therapy, many self-medicate.
"'If I have a couple of beers it takes the edge off. And then I'm able to pseudo-function with everyday life. Nobody can tell on the outside can they? That I have anxiety?'" Myers said.
They don't just turn to alcohol. There are pills, meth, painkillers - whatever it takes to cope.
"They want to feel differently. They don't like their current state of feeling. Drugs or alcohol suspends that feeling for a little bit of time and they feel differently. They feel better," Myers said.
More than half of people with a mental health disorder, up to 60 percent, also have a substance abuse problem. It's a combination Myers calls debilitating.
"We see people that can't show up to work, can't navigate a relationship. They're all alone, they're isolated and they have nowhere to go," he said.
Myers says the first step to getting help is knowing there's a problem.
A change in behavior is a big warning sign.
Other signs to watch out for are withdrawal, isolation, irritability or forgetfulness.
If you recognize the signs, do something about it. You can start by picking up the phone.
"We notice there is change that happens at that point because we have decided, 'yes, I'm going to do something about my situation.' Making a phone call starts that process. A call that will hopefully lead to change.
Talking to your primary care doctor is also a good way to reach out for help.
Even after seeking help the next hurdle is the cost of treatment. The average outpatient therapy is about $100 a week, $400 to $500 a month and close to $3,000 in six months. Even for those with insurance, those weekly co-pays add up.