A proper understanding of substance dependence and severe & persistent mental illness includes the characterization of both as chronic, relapsing conditions in which there is at times a loss of control, and a need for help from an external source. In order for the concept of “just say no” to work, it presupposes that the individual remains in possession of enough control to make using/not using, experiencing symptoms/not experiencing symptoms a simple choice, which is simply not the case for most dually diagnosed individuals.