Demi Lovato in 2016 (from Flickr via Wikimedia  commons, cropped.) The popular singer went through rehab, hired a sober companion and lived in a sober home for a time. Still, after six years of sobriety, she suffered a relapse and was hospitalized for a drug overdose.

The pop singer, actor, and activist Demi Lovato has achieved fame from an early age, and has seemed to handle it better than many of her contemporaries, “seemed” being the operative word. In 2013 she admitted to a plethora of problems, including enduring bullying, drug and alcohol abuse, bulimia, self-cutting and bipolar disorder. Now, shortly after releasing a song, “Sober”, in which she admits to a relapse, she has been hospitalized for a believed drug overdose.

Naturally her finds and family want to keep the publicity to a minimum. When she recovers, she may decide to go public with the details. Even if she doesn’t, this can still be a teachable moment.

Unlike other recent drug overdoses by celebrities – Prince, Tom Petty, Philip Seymour Hoffman – Lovato doesn’t seem to have fallen afoul of opioids such as OxyContin, heroin, or fentanyl, despite early reports. Initial sources said she had OD’d on heroin – and had been revived with a dose of Narcan, the anti-opioid naloxone, an anti-overdose drug – but that was never a drug Lovato admitted to abusing.

Opioids are usually taken, at least at first, for pain. Prince had notoriously abused and damaged his body with his onstage antics and had to endure the type of pain for which there is no final cure. Opioids gave him temporary relief.

Lovato has different demons. She reportedly has body image problems – hence the bulimia, which sometimes manifests as the urge to purge – and wanted to party all night. She also was bullied at a young age, but she soothed that pain with alcohol. Narcan does not help with those drugs. If she was given Narcan by her friends or EMTs, it probably didn’t help.

Lovato also has acknowledged she has bipolar disorder, what used to be called manic depression because the patient’s mood swings between manic highs and depressive lows. To combat the symptoms, some patients attempt to self-medicate with drugs and alcohol.

Rather than opioids, her drugs of choice were alcohol and stimulants such as cocaine and methamphetamine, sometimes referred to as hillbilly heroin. Narcan can’t reverse those overdoses.

Looking at her peculiar mix of addictions and problems, it seems likely that Lovato suffers from co-occurring disorders – substance abuse and mental illness – also known as a dual diagnosis or co-morbidity. Addiction can be considered a form of mental illness, too, so it’s ab addiction and another mental illness.

According to 2014 data from the National Institutes of Health, of the roughly 20 million adults in the US. with a substance use disorder, almost 8 million had another mental illness. Sometimes only one disorder is diagnosed and treated, leading to relapse.

Dual diagnosis is not well-known or understood by the general public and even some addiction treatment centers. Maybe Demi Lovato can change that.