Mayor Pete Buttigieg speaks last Wednesday at the Harold Washington Cultural Center in the Chicago neighborhood of Bronzeville. Photo by Conor Bezane

We are facing a massive mental health and addiction catastrophe in this country, and few 2020 candidates have built an action plan more robust than the treatment strategy proposed by Mayor Pete Buttigieg last week.

Mental health and addiction are often linked. This is a concept that is just coming into focus in non-scientific circles. It’s called “dual diagnosis” and few beyond the realm of inside psychology understand it. Pete Buttigieg does. It’s just one aspect of his mental health plan.

Buttigieg unveiled a highly ambitious, aspirational and achievable plan for mental health and addiction last Friday. His plan: Healing and Belonging in America — tackles the myriad obstacles involved in mental health and addiction treatment.

Mayor Pete is uniquely suited to empathize with those who struggle with mental health issues. He experienced depression upon returning home as a Navy intelligence officer in Afghanistan.


Dual diagnosis means this: two illnesses, one problem. It is a topic pinpointed in my recently released memoir The Bipolar Addict: Drinks, Drugs, Delirium & Why Sober Is the New Cool.

I have bipolar disorder. I also happen to be a recovering alcoholic. I tell my tale of nine years in hell in The Bipolar Addict, which I wrote after getting sober in 2012. Through writing the book as well as my personal travails, I’ve learned a lot about mental health and addiction.

Here’s how dual diagnosis works: mental illness or trauma takes hold of a person, whether it’s war or domestic abuse or rape. Individuals turn to substances like opioids or alcohol as an unhealthy coping mechanism. Eventually, they become addicted. Their trauma is never addressed and many times they are trapped in a vicious cycle of addiction and depression.

The toolbox to remedy a dual diagnosis is obtained in therapy — which might include psychiatric medication and/or psychotherapy, i.e. talk therapy.

In order to break the cycle, a person must be determined to get sober. They may go to rehab to gain sobriety, but the mental health piece isn’t typically covered by standard rehabs. That’s where therapy comes in.


In our current system, however, therapy is very expensive and not covered by most insurance plans. Patients pay thousands of dollars out of pocket over years to treat illnesses like major depression, bipolar disorder, or PTSD.

One of the central tenets of Pete’s plan is mental health parity. Parity means mental health should be treated the same as physical health. Treatment should cost the same.

There is already a law on the books, signed by President Clinton, called The Mental Health Parity Act of 1996. Many have pointed out, however, that plan is a joke. Psychiatric care is still exponentially more expensive than treatment for physical health because it is mostly uncovered.


In the past two decades, 450,000 people have died because of opioid overdose.

According to Buttigieg’s math, the annual cost of the opioid epidemic is $800 billion per year.

Drug-related deaths and suicides are known as “deaths of despair.”

“Our health care system is so broken — and our approach to mental health and addiction care so fragmented and often punitive — that less than one in five people with a substance use disorder and two of every five people with a mental illness receive treatment,” Buttigieg says.

Buttigieg notes in his plan that addiction is a family disease, and that it affects each person in a user’s orbit. According to his plan, 100,000 children have been placed in foster care because of parents’ addiction to opioids.


Minority communities are getting hit especially hard by mental health challenges.

LGBTQ youth are more than five times as likely as their peers attempt suicide. And every day, 20 veterans take their own lives, a statistic that Mayor Pete says is “the most shameful indicator of just how badly our nation has failed those who have given so much to our country.”

“It is parents being laid off from the job they’ve had for decades and a society’s inability to provide them with the opportunity to take care of their family. It is teenagers coping with childhood trauma or living in constant fear of hearing gunshots at school,” Buttigieg says in his plan. “It is older people whose aging friends don’t stop by as often, if at all, and a society’s inability to take appropriate care of its elders. Each of these circumstances leaves members of our community searching for ways to numb their pain, manage their anxiety, or cope with their loneliness and isolation.”


Mayor Buttigieg’s plan focuses on healing and belonging. “In order to help those who heal remain well — and to build Americans’ resilience to these illnesses,” Buttigieg says, “we must ensure that everyone feels that they belong in their community and in our country.”

He vows to help at least 75 percent of people who require mental health or addiction services, an increase in 10 million people, in his first term, as well as eliminating one million deaths of despair by 2028.

In addition to a yearly physical, we should all be getting a yearly emotional checkup that is covered by insurance, says Buttigieg. School psychologists should be as ubiquitous as school nurses, according to the plan.

He also wants to create a three digit suicide hotline. The one in place is difficult to remember — 800–273-TALK.

In rural areas, where psychiatric treatment is scarce, Buttigieg suggests telehealth i.e. virtual treatment.

In the case of opioid overdoses, he wants to increase the availability of Narcan, a substance that reverses the effects of an opioid overdose.

Finally, Pete’s plan focuses on belonging or making sure people feel that their addiction or mental health issues are not “moral failings, and that asking for help is not of weakness but of strength and empowerment.”


Fair wages, good jobs, and affordable housing also fit in with this strategy.

Every school in the nation would be required to teach a class on mental health first aid.

Buttigieg also would like to decrease incarceration rates, decriminalize mental illness and boost funding for re-entry programs. This means no more locking people up for drug posession. On the contrary, we should be helping them with their addictions.

In the case of the opioid crisis, Buttigieg wants to keep drug-makers accountable for their reckless and willful prescription of OxyContin and other substances they knew were dangerous.

No other candidate has produced a mental health and addiction plan as comprehensive and extensive as Mayor Pete’s.

Many of these issues are discussed in my new memoir: 

The Bipolar Addict: Drinks, Drugs, Delirium & Why Sober Is the New Cool