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• All Ages are Affected by Substance Use Disorders
• All Ages are Affected by Mental Health Problems
• Substance Use and Mental Disorders in Families
• Access to Treatment and Recovery and Mental Health Support
• The Recovery Process
• Contribute to Recovery Month's Mission to Help Others
• Additional Recovery Resources
• Sources

There is a great need to help people who suffer from substance use and mental disorders gain access to treatment and recovery support services. Fortunately, through health reform, this vision is about to become a reality for many. The implementation of the Affordable Care Act, along with the Mental Health Parity and Addictions Equity Act (MHPAEA), provides an opportunity to inform people about expanded access to treatment and recovery services. Individuals with a substance use or mental disorder who seek treatment and recovery support services can live healthy, productive, and meaningful lives in recovery.

To help raise awareness about the benefits of life-long recovery, National Recovery Month: Prevention Works, Treatment is Effective, People Recover (Recovery Month), is sponsored every September by the Substance Abuse and Mental Health Services Administration's (SAMHSA's) Center for Substance Abuse Treatment (CSAT) within the U.S. Department of Health and Human Services (HHS), emphasizes that behavioral health is an essential component of health and one's overall wellness, and that prevention works, treatment is effective, and recovery is possible from substance use and mental disorders. Recovery Month shares that all individuals have the fundamental and inherent value to be accepted and treated with respect, dignity, and worth.

This year's theme, "Join the Voices for Recovery: Recovery Benefits Everyone," emphasizes that:

• All Americans have the opportunity to access provisions within the Affordable Care Act and MHPAEA, aimed to improve physical and emotional health while ensuring people will receive the care they need at a more reasonable cost.
• Public awareness will increase access for those in need of essential substance use and mental health treatment and recovery support services, including behavioral health treatment.
• These legislative changes will improve the overall health and well-being of people in the United States.

The passage of the MHPAEA provides parity, or the recognition by insurance services—both public and private—that substance use and mental disorders are treated comparably to other physical health and medical conditions.¹

This document will discuss how to recognize symptoms of substance use and mental disorders in all ages, how families can reduce the risk of continuing the cycle, tips on helping friends or family members with a substance use and/or mental disorder, how to access treatment and recovery support services, and strategies to sustain recovery and empower others to seek recovery. In addition, this document will provide resources on Recovery Month on how health reform will affect treatment and recovery support services.

All Ages are Affected by Substance Use Disorders

Although substance use disorders are prevalent in our communities, treatment is effective, and people can and do recover. In 2009, 4.3 million people aged 12 or older in the United States received treatment for a substance use disorder.² In fact, recovery from a substance use disorder is so common that half of all adults over age 18 know someone in recovery.³ To help more people seek treatment services, people should learn about the signs and symptoms of substance use disorders, which may vary with age and other health conditions. Information about the prevalence, signs, and treatment techniques for mental health problems can be found later in this document.

Adolescents

Almost 2 million 12 through 17 year olds needed treatment for a substance use disorder in 2009.⁴ By the end of 8th grade, approximately 47 percent of students have had at least one drink and more than 21 percent have been "drunk."⁵ In addition, everyday, approximately 4,700 teenagers under the age of 18 try marijuana for the first time.⁶ Adolescents using alcohol and/or drugs may try everything possible to hide it from parents and their extended family to avoid getting into trouble. Parents are sometimes afraid that they will push their children away by talking about alcohol and/or drug use, but research shows parental discussions prevent teen substance use.⁷ While teenagers normally have mood swings, severe or rapid changes in behaviors may be a sign of a developing substance use disorder. Other warning signs may include:⁸

• Associating with a new set of friends;
• Sudden decline in school performance or skipping classes;
• Poor physical health and altered sleeping patterns;
• Reduced interest in previous hobbies, such as sports;
• Alcoholic beverages or prescription drugs missing from the house; and
• Anxiety, hostility or depression.

In addition to treating the addiction in adolescents, other services are typically required to treat the underlying causes of substance use. Teens often use alcohol and/or drugs due to social pressures. Therefore, their treatment should address both the physical dependence and overall self-worth.⁹ One method is outpatient, multidimensional family therapy created for adolescents with alcohol and/or drug problems and directly involves their family members. This approach helps adolescents develop coping methods to promote better decision-making skills, addresses issues that may have caused them to use substances (e.g., trauma or peer pressure), and strives to improve overall family functioning.¹⁰

Young Adults

Whether it is entering college or beginning their first job after graduation, young adults often face the challenge of adapting to a new environment and lifestyle. For some, this transition is smooth, while others have a difficult time. National data indicates that two in five people in an undergraduate degree program engage in risky drinking¹¹ (e.g., more than one drink per day on average for women and more than two drinks per day on average for men).¹² In addition, this group has a high rate of prescription drug misuse—about 1 in 4 people aged 18 to 20 report non-medical use of prescription drugs.¹³ The negative consequences associated with alcohol and/or drug use include personal injury, physical illness, high-risk behavior, and even death.¹⁴ Signs of substance misuse among young adults may include:

• Increased tolerance for alcohol;¹⁵
• Legal trouble such as arrests for disorderly conduct or driving under the influence;¹⁶
• Falling behind in their studies;¹⁷
• Increased promiscuity;¹⁸ and
• Frequent need of prescription medication refill.¹⁹

Young adults need their family and friends for support during this challenging time. It is critical for young adults to learn how to create a balance between school or work and their outside lives. Many treatment approaches for young adults exist but e-therapy, an online approach to counseling, provides an accessible mode of treatment that specifically targets this age group given their increased experience with technology and social networking.²⁰ In The Rooms, which offers online support meetings, and Recovery Chat, a less-structured online venue that allows users to chat with others in every stage of recovery, are effective online treatment and recovery support services.

Middle-Aged Adults

In 2009, 6.3 percent of adults aged 26 or older were current illicit drug users and 36.3 percent of adults 26 to 34 admitted to binge drinking (had 5 or more drinks on the same occasion).²¹ Treatment can help deal with many problems that are frequently associated with the increased use of alcohol and/or drugs, such as family conflict, emotional or physical violence, trauma, work problems, illness, marital strain, or financial problems.²² If a friend or family member might be misusing alcohol and/or drugs, look for the following warning signs:²³

• Fearful, anxious, or paranoid demeanor, with no reason;
• Deterioration of physical appearance and personal grooming habits;
• Frequently getting into fights, accidents, or illegal activities;
• Sudden lack of motivation; and
• Unexplained need for money or financial problems.

Many businesses offer employee assistance programs (EAPs) that provide access to substance use disorder treatment while maintaining their careers. EAP resources include confidential counseling, treatment referrals, and employee education. Some programs also offer follow-up services that provide assistance to employees who return to work after receiving treatment.²⁴ Refer to the "Addressing Substance Use and Mental Disorders in the Workplace" document in this toolkit for more information on EAPs.

Older Adults

Substance use among older adults is a growing problem. In fact, the use of illicit drugs by people aged 50 to 59 more than doubled to 6.9 percent in 2009 from 2.7 percent in 2002.²⁵ Fortunately, older adults succeed in treatment more than any other age group.²⁶ The health care system must be prepared for a drastic increase in older adults seeking treatment as the sizeable Baby Boom generation—individuals born between 1946 and 1964—grows older.^{27, 28}

Substance use disorders can often be overlooked or misdiagnosed by a health care provider because symptoms for problems common to older adults, such as dementia and depression, mimic the signs of a substance use disorder.²⁹ Also, life changes or transitions can be stressful for older adults, causing them to turn to alcohol and/or drugs as an escape from the problem. It's important to notify a loved one's health care provider to make sure they screen or rescreen for substance use disorders during this taxing time.³⁰ Remember that many medications older adults take should not be mixed with alcohol and/or drugs and attention needs to be paid to erratic behaviors. Develop a relationship with their health care professionals, so they can assess any changes or health problems that might occur. Symptoms of a substance use disorder in older adults include:³¹

• Anxiousness or irritability;
• Increased memory loss;
• New problems making decisions;
• Suicidal thoughts;
• Being out of touch with family and friends; and
• Unusual responses to medication.

Many older adults find accepting treatment difficult, but research has shown that illustrating the benefits of recovery, such as the preservation of independence, physical and mental health benefits, and financial security, can motivate older adults to seek treatment.³² It also is important that older adults receive treatment in a way that they feel comfortable. For example, age-specific group treatment may work best for older adults, so they can connect with people their age and find social support.³³

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All Ages are Affected by Mental Health Problems

Mental health problems affect approximately 1 in 4 adults, or about 57.7 million Americans, in a given year.³⁴ An individual's mental health refers to how the person thinks, feels, and acts, which includes cognitive and/or emotional well-being. The most common mental health problems are:³⁵

• Anxiety disorders, which include panic disorder, phobias, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and trauma histories.
• Mood disorders, which include major and mild depression, bipolar disorder, and seasonal affective disorder (SAD).

Like substance use disorders, mental health problems are highly treatable, and recovery or management of the disease is possible. For example, between 70 to 90 percent of individuals have a significant reduction of symptoms and improved quality of life with a combination of medication, talk therapy, and other supports.³⁶ Mental health problems affect people of all ages, races, genders, workplaces, geographies, and socioeconomic levels. As with substance use disorders, people should learn about the signs and symptoms of mental health problems, which may vary with age and other health conditions.

Children and Adolescents

Children are in a state of rapid change and growth during their developmental years, therefore, diagnosis and treatment of mental health problems must be observed with these changes in mind.³⁷ A survey conducted by the National Health and Nutritional Examination found that 13 percent of children ages 8 to 15 had at least one mental health problem, a rate that is comparable to diabetes, asthma, and other diseases.³⁸

The most common mental health problems seen in children and teenagers are anxiety disorders, attention deficit and disruptive behavior disorders, autism and other pervasive developmental disorders, eating disorders (e.g., anorexia nervosa), mood disorders (e.g., major depression, bipolar disorder), and schizophrenia.³⁹ Similar to adults, mental health problems in children and adolescents are often diagnosed by their signs and symptoms. Signs for children include:⁴⁰

• Changes in school performance;
• Poor grades despite strong efforts;
• Excessive worry or anxiety (e.g., nervous to go to bed or school);
• Hyperactivity and/or persistent lack of behavioral control;
• Persistent nightmares;
• Persistent disobedience or aggression; and
• Frequent temper tantrums.

Signs and symptoms of mental health problems in adolescents include:⁴¹

• Substance use;
• Inability to cope with problems and daily activities;
• Changes in sleeping and/or eating habits;
• Excessive complaints of physical ailments;
• Defiance of authority, theft, and/or vandalism;
• Intense fear of weight gain;
• Prolonged negative mood, often accompanied by poor appetite or thoughts of death; and
• Frequent outbursts of anger.

Fortunately, research on mental health problems among children and adolescents is constantly evolving, and effective therapies are known for treating many of these conditions.⁴² If a child or teen might be suffering from a mental health problem, it's important to take action and have them screened by a medical professional or community mental health center. Mental health is crucial to the health and well-being of all children. Losing critical developmental years in a child's life can be avoided by identifying and treating a mental health problem early, losing critical developmental years in a child's life can be avoided.⁴³

Adults

In 2009, an estimated 11 million or 4.8 percent of adults aged 18 or older in the United States had a serious mental illness.⁴⁴ Additionally, 31.9 percent of the 6.1 million adults who reported an unmet need for mental health care, but didn't receive services, believed it could be handled without care.⁴⁵ In most cases, professional treatment and recovery support services, along with medication, is needed to treat a mental health problem effectively. Many people suffer from more than one mental health problem at a given time, with 45 percent meeting the criteria for two or more disorders.⁴⁶ It's important to know the signs and symptoms of mental health problems and seek help for those in need, which for adults include:⁴⁷

• Feelings of extreme highs and lows;
• Excessive fears, worries, anxieties, or anger;
• Social withdrawal;
• Dramatic changes in eating or sleeping habits;
• Delusions or hallucinations;
• Growing inability to cope with daily problems and activities;
• Suicidal thoughts;
• Denial of obvious problems;
• Numerous unexplained physical ailments;
• Substance misuse; and
• Excessive absenteeism in the workplace.

Screening for mental health problems is critical to properly diagnose and treat individuals. A wide range of options is available to treat mental health problems and by talking to health care professional, the right recovery plan for the individual can be defined.⁴⁸ Refer to the "Treatment and Recovery: Finding Personalized Help" document in this toolkit for more information on effective treatment and recovery options, holistic approaches to recovery, and the impact of health reform on access to these services.

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Substance Use and Mental Disorders in Families

If someone in your family has a history of alcohol and/or drug dependence or mental health problems, it doesn't necessarily mean that you will develop any of these conditions. Research shows that less than half of all children of people with alcohol dependence develop the disease.⁴⁹ You can help reduce your or your family's risk by:

• Socializing without alcohol;⁵⁰
• Avoiding situations and people that encourage drinking and/or drug use;⁵¹
• Developing a strong relationship with your children if you're a parent;⁵²
• Keeping a well-balanced life;⁵³ and
• Effectively dealing with peer pressure.⁵⁴

You also can encourage people in your family to get help if they develop a substance use and/or mental disorder. It's never too late to take action regarding your child's, parent's, grandparent's—or any other family members'—alcohol and/or drug use or mental health. Talk with your loved ones and let them know that substance use and mental disorders are treatable and people do recover. Conditions can be managed with the support provided in recovery-oriented, person-centered care. Reinforce that you are concerned about them, you are there to listen, and you want to help them recover.⁵⁵

Certain strategies can be effective in preventing and reducing the severity of mental health problems. Research has shown that mental health problems have genetic links, and is often hereditary, so knowing your family mental health history and becoming familiar with any mental health problems that have affected your family is important.⁵⁶ Traumatic life events like divorce, abuse, or violence, are all factors that can lead to mental health problems.⁵⁷ It's imperative that you address these issues with a medical professional to help prevent the onset of a mental health problem. Additionally, keeping yourself mentally and physically balanced through exercise, healthy eating, and a normal sleeping pattern, can have a positive impact on your mental health. ⁵⁸ Through its Trauma and Justice Strategic Initiative, SAMHSA strives to reduce the pervasive, harmful, and costly health impact of violence and trauma by integrating trauma-informed approaches throughout health and behavioral health care systems and by diverting people with substance use and/or mental disorders from criminal and juvenile justice systems into treatment and recovery support services.

Remember that sources in your community—including school counselors, college support services, administrators, health care professionals, people in your faith community, and local community coalitions—can guide you toward treatment and recovery options for substance use and mental disorders. Free and confidential information about substance use and mental disorders, prevention, treatment, and recovery referrals in your area can be found by calling SAMHSA's National Helpline, 1-800-662-HELP (4357) or 1-800-487-4889 (TDD), as well as by visiting http://www.samhsa.gov/treatment. In addition, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), a free, 24-hour hotline available to anyone in suicidal crisis or emotional distress.

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Access to Treatment and Recovery and Mental Health Support

With the passage of health reform, people may see fewer financial barriers to treatment, better integrated care, and more prevention and wellness programs. For instance, under the MHPAEA, when employers cover treatment for substance use disorders and mental disorders, these benefits must be covered equally to any other medical or surgical benefits. Co-payments and deductibles for a visit can't be larger and there can't be greater limits on behavioral health inpatient days than for medical and surgical inpatient days.⁵⁹ Included in the Affordable Care Act, effective immediately, employer health plans must cover certain prevention services with no co-payments⁶⁰ and allow, in most cases, young adult dependents to stay on their parent's insurance plan until they are 26 years old.⁶¹ Become familiar with your health care policy and ask your employer or health insurance provider what treatment services are covered. SAMHSA's Health Reform Strategic Initiative is working to educate State and local providers and consumers that many new provisions aim to improve coverage for and access to substance use and mental health prevention, treatment, and recovery support services.

To support SAMHSA's Public Awareness and Support Strategic Initiative, encourage loved ones to seek assistance for a substance use and/or mental disorder with the same urgency as any other health condition. Treatment or recovery support services can be accessed in a variety of ways: through employee assistance programs (EAPs), online support groups, mutual support groups, peer-to-peer services, or hospital treatment services. SAMHSA also is working through its Recovery Support Strategic Initiative to showcase the four prongs of recovery (home, purpose, community, and health) and how important it is for individuals in recovery to reach out to others and encourage those in need to seek treatment and recovery services. For additional information, refer to the resources at the end of this document.

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The Recovery Process

Substance use and mental disorders are treatable and the benefits of treatment and recovery are widespread, not only to the individual but to everyone around them. In 2009, more than 20.8 million adults aged 18 or older in the United States suffered from a substance use disorder—people of all ages, races, genders, workplaces, geographies, and socioeconomic levels.⁶² Additionally, 8.9 million adults suffered from both a substance use disorder and a mental health problem, also known as a co-occurring disorder.⁶³ Millions more are affected because they are a family member or loved one of someone who has a substance use and/or mental disorder. According to several studies, the societal cost of addiction is estimated at over $121 billion annually⁶⁴ and the indirect cost of mental illnesses is estimated to be at least $79 billion annually.⁶⁵

The social and economic burden of untreated substance use and mental disorders affects our whole society. Given this prevalence, it's important to address this public health issue and help people who suffer from these problems seek recovery to manage their condition. With treatment, one's overall health improves, community crime decreases, and employment increases.⁶⁶ Fortunately, in 2009, 4.3 million people were treated for a substance use disorder⁶⁷ and 30.2 million were treated for a mental health problem,⁶⁸ starting their road to recovery.

In 2009, 8.5 percent of the 20.9 million people who needed, but did not receive treatment for a substance use disorder, felt that they may be perceived negatively for entering a treatment facility.⁶⁹ In reality, fewer than 20 percent of people in the United States would think less of a friend or relative who is in recovery.⁷⁰ Similarly, 8.7 percent of the 6.1 million adults who reported an unmet need for mental health care and did not receive services in the past year, felt that receiving care might cause their neighbors or community to have a negative opinion of them.⁷¹

While successfully completing treatment is a major accomplishment, achieving long-term recovery and continued abstinence from drugs and/or alcohol can be challenging and may require continued treatments over time.⁷² SAMHSA supports recovery-oriented systems of care (ROSC), which stress the importance of a personal recognition of the need to change and transformation to sustain recovery. ROSC also acknowledges that there are many pathways to recovery and that while service types may vary, all services should offer choice, honor an individual's potential for growth, focus on a person's strengths, and attend to the individual's overall health and well-being.⁷³

Recovery exists on a continuum of improved health and well-being, and involves a personal recognition of the need for change and transformation.⁷⁴ In treatment for substance use or mental disorders, individuals will learn how to identify their relapse triggers, manage their cravings, and develop plans for handling stressful situations and setbacks.⁷⁵ If you are in recovery, the following tips and strategies can help you sustain it:

• Avoid tempting situations. Avoid associating with people who use alcohol and/or drugs. Avoid places or activities that remind you of the times when you misused substances or that cause sadness or anxiety.⁷⁶
• Express your feelings. Don't bottle your feelings inside. Confide in others to "escape," or to relieve stress. Express your feelings to connect with others and develop stronger relationships.^{77, 78}
• Find constructive ways to spend your free time. Become involved in hobbies and extracurricular activities so that you remain occupied and have feelings of accomplishment. Through treatment and recovery involvement in productive activities, your health, well-being, and quality of life improves.^{79, 80}
• If you accidentally slip up, continue moving forward. Contact one of your support peers. This does not mean that you failed, learn from your choices to help you in the future.⁸¹
• If you are receiving medication assisted therapy for your substance use disorder or mental health problem, routine check-ups are essential. Visit your doctor if you're not feeling well—it may be due to your medicine or a symptom of your condition that can be treated.^{82, 83}

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Contribute to Recovery Month's Mission to Help Others

Individuals who are already on the path of recovery can help others achieve recovery to live a healthy, productive, and meaningful life. Your words of encouragement can profoundly impact children, middle-aged adults, and older adults alike. You can:

• Become a peer leader. Peer-to-peer support programs are designed and provided by leaders in the recovery community who are often in recovery themselves. Peer leaders build strong and mutually supportive relationships and can expand the capacity of formal treatment systems by initiating recovery, reducing relapse, and intervening early when relapse does occur.⁸⁴
• Make a public statement. Express your support for Recovery Month, treatment, and individuals in recovery and the importance of raising awareness of substance use and mental disorders. This can be accomplished in many ways, ranging from giving speeches at schools or retirement homes to submitting an op-ed to your local paper. Refer to the "Press Materials for Your Recovery Month Event" document in this toolkit for a sample template and ideas to make your op-ed relevant and compelling.
• Take part in a local event. Volunteer at a Recovery Month event in your community during September. You may wish to offer yourself as a spokesperson, or connect the event organizers with treatment providers in the local community who may be able to lend additional support. To find local events in your community, visit the Recovery Month Community Events page.
• Spread the recovery message online. Promote and support through Recovery Month networking sites, including Facebook, Twitter, and YouTube. In addition, connect with others through blogs and online forums to let them know that prevention works, treatment is effective, and that people can and do recover.

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Additional Recovery Resources

A variety of resources provide additional information on Recovery Month, substance use and mental disorders, and prevention, treatment, and recovery support services. Use the toll-free numbers and websites below to increase your knowledge, and seek guidance from professionals. Through these resources, individuals can interact with others and find support on an as-needed, confidential basis.

• Substance Abuse and Mental Health Services Administration (SAMHSA) Website – Leads efforts to reduce the impact of substance use and mental disorders on communities nationwide.
• SAMHSA's National Helpline, 1-800-662-HELP (4357), or 1-800-487-4889 (TDD) – Provides 24-hour free and confidential information about substance use and mental disorders, prevention, treatment, and recovery referrals in English or Spanish.
• SAMHSA's "Find Substance Abuse and Mental Health Treatment" Website – Contains information about all treatment options and special services located in your area.
• SAMHSA's ADS Center – Provides information and assistance to develop successful efforts to counteract prejudice and discrimination and promote social inclusion.
• National Suicide Prevention Lifeline, 1-800-273-TALK (8255) – Provides a free, 24-hour hotline available to anyone in suicidal crisis or emotional distress.
• RecoverForever.com – Offers live online support and contains an abundance of resources on alcohol and drug treatment services that are searchable by State.
• Alcoholics Anonymous and Narcotics Anonymous – Contains an array of resources for individuals suffering from alcohol or drug dependence, respectively, and allows them to find and join a local chapter.
• Al-Anon/Alateen Family Groups – Provides support groups for families and friends of people with alcohol problems.
• Nar-Anon – Offers a community for family members to share experiences related to substance use disorders.
• National Association for Children of Alcoholics – Provides information and educational materials for children and families of people with alcohol or drug problems, as well as treatment professionals.
• Alliance for Children and Families – Offers services to the nonprofit child and family sectors and economic empowerment organizations.
• Mental Health America – Offers resources about the realities of mental health and mental illness.
• Narconon – Provides prevention, education, and rehabilitation programs for drug misuse and drug dependence.
• SMART Recovery® – Offers free, self-empowering, science-based mutual help groups for all types of addictive behaviors.

As health reform continues to be implemented, use the following resources to learn about the impact of these changes on how to access treatment and recovery support services:

• HealthCare.gov – Managed by HHS, this Federal website provides information for the general public, people with disabilities, seniors, young adults, and employers on how the law affects access to health care, insurance options, available preventive services, and comparing care quality.
• Kaiser Family Foundation – Issued by a nonprofit, health policy and communications group, this document provides a summary on the comprehensive health reform law, The Affordable Care Act, signed into law on March 23, 2010. The document discusses the law and subsequent changes, provisions to expand coverage, control health care costs, and improve the health care delivery system. Visit the Kaiser Family Foundation's Health Reform Source for more information.
• The Parity Implementation Coalition's Parity Toolkit – Created by organizations, including Recovery Month Planning Partners, this toolkit aids individuals seeking help, individuals in recovery, as well as their families, providers, and advocates in understanding their rights and benefits under the MHPAEA law.

Inclusion of websites and resources in this document and on the Recovery Month website does not constitute official endorsement by the U.S. Department of Health and Human Services or the Substance Abuse and Mental Health Services Administration.

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Sources

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