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How do doctors know if someone has mental illness brought on by substance abuse or if they already had an underlying disorder?

Globe Gazette - 5/2/2017

Experts say that's one of the most challenging things when dealing with patients who have mental illness and are struggling with substance abuse.

"Almost everyone who uses meth will tell you initially they didn't do it to get high. They did it to level out and feel normal," said Dr. Jeffrey Reynolds, who specializes in substance abuse and addiction disorders. "In the case of meth, you will hear people say, 'I started using because it made the voices go away.'"