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2013 Toolkit


The 2014 Toolkit will be available in early summer.

Overview:  Together on Pathways to Wellness

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Introduction...

A mental health problem or substance use disorder can affect anyone.  These conditions do not discriminate by age, race, ethnicity, gender, or income status and are as prevalent as many other health issues.  It is estimated that behavioral health conditions – which include mental and/or substance use disorders – will surpass physical conditions as the major cause of disability in the United States by 2020.1  However, optimism is widespread: two-thirds of Americans believe that people can manage a mental illness with treatment and support,2 and nearly two-thirds say they would not think less of a person with an addiction.3

Every September, the Substance Abuse and Mental Health Services Administration (SAMHSA), within the U.S. Department of Health and Human Services (HHS), sponsors National Recovery Month (Recovery Month) to increase awareness and understanding of mental and/or substance use disorders.  This celebration promotes the message that behavioral health is essential to health, prevention works, treatment is effective, and people do recover.

The 2013 Recovery Month theme, “Join the Voices for Recovery: Together on Pathways to Wellness,” represents the many ways that people can prevent behavioral health issues, seek treatment, and sustain recovery as part of a commitment to living a mentally, physically, emotionally, and spiritually healthy life.  The theme highlights that people are not alone on this journey to seek total health every day.  Family, friends, and community members can support individuals throughout the entire recovery process.  The theme also emphasizes that there are many paths to wellness, including professional treatment, medical care, self-help, and group support, and each person embarks on his or her own unique path.

The annual Recovery Month observance aligns with SAMHSA’s mission to reduce the impact of substance abuse and mental illness on America’s communities.  It supports many of SAMHSA’s Strategic Initiatives, including preventing mental and/or substance use disorders, promoting recovery and resilience, and increasing public understanding.  Mental and substance use disorders in particular are closely tied to other chronic health issues.  Research shows that rates of mental health problems are significantly higher for people with chronic health problems such as diabetes, asthma, and heart conditions than for people without these conditions.4  Additionally, excessive alcohol use and substance use are directly linked to increased burden from chronic disease, diabetes, and cardiovascular problems.5

This document outlines the prevalence of behavioral health conditions, describes the warning signs of mental and/or substance use disorders, provides a snapshot of the targeted outreach guides featured in the toolkit to help you reach specific groups with the Recovery Month message, and emphasizes that recovery is possible.


The Issue...

The impact of mental and/or substance use disorders can be detrimental to individuals and can often result in strained relationships at home and in the workplace, affecting friends, families, and communities.  Research indicates that mental illness may lead to an increased risk of living in poverty, having a lower socioeconomic status, having lower educational levels, and experiencing domestic violence.6  Similarly, accidents, crime, domestic violence, illness, lost opportunity, and reduced productivity are directly correlated with substance abuse.7

Mental illness is not a sign of weakness – it results from a combination of biological, psychological, and social factors.8  Additionally, experts estimate that genetic factors account for between 40 and 60 percent of a person’s likelihood of developing an addiction to illegal substances,9 and research also provides strong evidence that genes contribute to the development of alcohol dependence.10

Often, people simultaneously experience both a mental and a substance use disorder, which is referred to as having a co-occurring disorder.  More than one in four adults living with serious mental illness have a co-occurring substance use disorder,11 and people who have substance use disorders are roughly twice as likely to have a mood or anxiety disorder as those who do not.12  A variety of factors contribute to the correlation between mental health problems and substance use disorders,13 including:

  • Certain illegal drugs can cause people with an addiction to experience one or more symptoms of a mental illness.
  • Mental illness can sometimes lead to alcohol or drug abuse, as some people with a mental health problem may misuse these substances as a form of self-medication.
  • Mental and substance use disorders share some underlying causes, including changes in brain composition, genetic vulnerabilities, and early exposure to stress or trauma.

Trauma can result from an event, series of event, or set of circumstances that are physically or emotionally harmful or threatening, and can manifest itself in many ways, including the inability to cope with the normal stresses and strains of daily living; to trust and benefit from relationships; and to manage emotions, memory, attention, thinking, and behavior.14  Not only is trauma strongly associated with mental and substance use disorders, but unaddressed trauma also significantly increases the risk of chronic diseases and criminal behavior.15

The Signs...

To reduce the impact of behavioral health conditions, it’s important to know the signs of mental and/or substance use disorders.  The most common signs and symptoms of mental health problems among adults include:16

  • Confused thinking;
  • Prolonged depression (sadness or irritability);
  • Feelings of extreme highs and lows;
  • Excessive fears, worries, and anxieties;
  • Social withdrawal;
  • Dramatic changes in eating or sleeping habits;
  • Strong feelings of anger;
  • Delusions or hallucinations;
  • Growing inability to cope with daily problems and activities;
  • Suicidal thoughts;
  • Denial of obvious problems;
  • Numerous unexplained physical ailments; and
  • Substance abuse.

The most frequently displayed signs of a substance use disorder among adults include:17

  • Bloodshot eyes and abnormally sized pupils;
  • Changes in appetite or sleep patterns;
  • Sudden weight loss or weight gain;
  • Deterioration of physical appearance;
  • Unusual smells on breath, body, or clothing;
  • Tremors, slurred speech, or impaired coordination;
  • Drop in attendance and performance at work or school;
  • Unexplained need for money or financial problems;
  • Engaging in secretive or suspicious behaviors;
  • Sudden change in friends, favorite hangouts, and hobbies;
  • Frequently getting into trouble (fights, accidents, illegal activities);
  • Unexplained change in personality or attitude;
  • Sudden mood swings, irritability, or angry outbursts;
  • Periods of unusual hyperactivity, agitation, or giddiness;
  • Lack of motivation; and
  • Appearing fearful, anxious, or paranoid, with no reason.

To learn about specific signs of mental and/or substance use disorders among youth and young adults, refer to the “Young Adults” section of this toolkit.

The Pathways to Wellness...

Living with a mental and/or substance use disorder can be challenging, but there is hope, and treatment is effective.  In particular, combining treatment and support methods yields favorable outcomes for overcoming both mental health problems and substance use disorders.  Between 70 and 90 percent of people with a mental illness experience significant reduction of symptoms and improved quality of life with a combination of medication and psychosocial treatments.18  For many patients with a substance use disorder, a treatment and recovery plan – which is tailored to address each patient’s drug abuse patterns and drug-related medical, psychiatric, and social problems – is most effective.  This may include treatment medication, when available, in conjunction with behavioral therapy.19

Prior to seeking treatment, it is equally important to ensure that beneficiaries are insured or have access to health insurance.  Open enrollment for the expansions in coverage under the Affordable Care Act (ACA) begins on October 1, 2013.  In order to ensure that all uninsured individuals with behavioral health needs are able to enroll successfully, SAMHSA is engaging in an aggressive communications effort that reaches the more than 11 million currently uninsured individuals with behavioral health needs.20  Data from the Centers for Medicare and Medicaid Services (CMS) show nearly one in four people with a mental or substance use disorder lack health insurance, and 30 percent of those with both mental illness and substance use issues lack health insurance.21  Recovery Month presents an opportunity to encourage enrollment among uninsured people with behavioral health conditions.

Seeking treatment and recovery support is the first step in a rewarding, inspiring recovery process.  SAMHSA defines recovery from mental and/or substance use disorders as a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.22  Recovery is a unique journey.

For many people, recovery:23

  • Emerges from hope;
  • Is person-driven;
  • Occurs via many pathways;
  • Is holistic;
  • Is supported by peers and allies;
  • Is supported by relationships and social networks;
  • Is culturally based and influenced;
  • Is supported by addressing trauma;
  • Involves individual, family, and community strengths and responsibilities; and
  • Is based on respect.

There are also four major dimensions that support a life of recovery:24

  • Health:  Overcome or manage one’s disease(s) or symptoms – and make informed, healthy choices that support physical and emotional well-being;
  • Home:  Have a stable and safe place to live;
  • Purpose:  Participate in meaningful daily activities, such as a job, school, volunteer opportunities, family caretaking, or creative endeavors, and have the independence, income, and resources to participate in society; and
  • Community:  Enjoy relationships and social networks that provide support, friendship, love, and hope.

Seeking wellness is an important component to the recovery process.  SAMHSA notes that for people with mental and/ or substance use disorders, wellness is not just the absence of disease, illness, or stress, but the presence of purpose in life, active involvement in satisfying work and play, joyful relationships, a healthy body and living environment, and happiness.25  SAMHSA defines the following aspects of life as the Eight Dimensions of Wellness:26

  • Emotional: Coping effectively with life and creating satisfying relationships;
  • Environmental:  Achieving good health by occupying pleasant, stimulating environments that support well-being;
  • Financial:  Feeling satisfaction with current and future financial situations;
  • Intellectual:  Recognizing creative abilities and finding ways to expand knowledge and skills;
  • Occupational:  Obtaining personal satisfaction and enrichment from one’s work;
  • Physical:  Recognizing the need for physical activity, healthy foods, and sleep;
  • Social:  Developing a sense of connection, belonging, and a well-developed support system; and
  • Spiritual:  Expanding a sense of purpose and meaning in life.

Pathways to wellness are not always clearly defined for every person.  While people might face challenges along the way, the recovery journey is worth the effort.

People Affected...

Although anyone can be affected by mental and/or substance use disorders, this year the Recovery Month initiative focuses on four groups that play unique roles on the pathways to wellness.  Detailed information on the following groups can be found in their respective “Targeted Outreach” sections in this toolkit.

  • Health care providers:  All health care providers – including doctors, nurses, physician assistants, pharmacists, emergency care providers, peer support specialists, therapists, and counselors – can benefit from increasing their knowledge of mental and/or substance use disorders.  This opens the door to prevent, screen, intervene, and provide referrals for prevention, treatment, and recovery support services.  Addressing this public health issue requires all healthcare providers to offer integrated care, helping patients to achieve both mental and physical wellness.
  • Young adults:  Compared to people of other ages, adolescents and young adults aged 18 to 25 face pressure from friends, parents, school, extra-curricular activities, and society, and are more vulnerable to mental and/or substance use disorders.  Half of all lifetime cases of mental and substance use disorders begin by age 14 and three-fourths by age 24.27  Emphasizing prevention education, teaching coping skills, and supporting wellness activities will help young people emerge through challenges.  In addition, social media offers a key platform to communicate with young adults where they are already holding candid discussions on the topics of mental and/or substance use disorders.
  • Families and caregivers of young people:  A solid family support environment is a key factor in the prevention of mental and/or substance use disorders, just as strong family support is critical in treatment and recovery.  Knowledgeable relatives and caregivers can recognize the signs of a mental and/or substance use disorder and aid someone on his or her path to recovery.  Family members living with or caring for someone with a behavioral health issue may also experience their own psychological, emotional, and physical stress.  Offering families and caregivers the resources to find proper care will address the specific needs of the family, leading to a more successful treatment and long-term recovery.
  • Community leaders:  The role of a community leader can take on various forms, from a team coach to a faith advisor, elected official, or chair of a neighborhood association.  Community leaders are in a unique position to provide encouragement, counsel, and motivation to individuals seeking prevention, treatment, or recovery support services.  These leaders have a strong influence and can help open doors to the many pathways to recovery.

Additional Resources...

A variety of resources provide additional information on Recovery Month and mental and/or substance use disorders, as well as prevention, treatment, and recovery support services.  The toll-free numbers and websites below are available for people to share their experiences, learn from others, and seek help from professionals.  Through these resources, individuals can interact with others and find support on an as-needed, confidential basis.

  • SAMHSA’s Website:  Leads efforts to reduce the impact of mental and/or substance use 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 treatment referral and information about mental and/or substance use disorders, prevention, treatment, and recovery in English and Spanish.
  • SAMHSA’s “Find Substance Abuse and Mental Health Treatment” Website:  Contains information about treatment options and special services located in your area.
  • National Suicide Prevention Lifeline, 1-800-273-TALK (8255):  Provides a free, 24-hour helpline available to anyone in suicidal crisis or emotional distress.
  • Technical Assistance Centers:  SAMHSA supports technical assistance centers that promote peer-directed approaches for adults with behavioral health conditions.  Such programs maximize self-determination and recovery and assist people on their path to recovery, ultimately decreasing their dependence on expensive social services and avoiding hospitalization.  The five technical assistance centers include:
  • Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS):  Provides policy and practice analysis, as well as training and technical assistance, to states, providers, and systems to increase the adoption and implementation of recovery supports for those with behavioral health issues.
  • BHBusiness:  Offers targeted training and support for behavioral healthcare executives, CEOs, and directors, including health care insurance enrollment training information.
  • Center for Financing Reform and Innovation:  Supports the need for information, analysis, products, and technical assistance to address significant changes in the organization and financing of behavioral health care, as well as the need to guide and support governments and people on how to most effectively and efficiently use available resources to meet the prevention, treatment and recovery support needs of the public.
  • Healthcare.gov:  Contains information on finding health insurance options, help using insurance, information on the Affordable Care Act, help comparing providers, and information on prevention and wellness resources.
  • SSI/SSDI Outreach, Access, and Recovery (SOAR):  Increases access to Supplemental Security Income and Social Security Disability Income for eligible adults who are homeless or at risk of homelessness and have a mental and/or substance use disorder.

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.


Sources:

  1. World Health Organization (WHO).  (2004).  Promoting Mental Health: Concepts, Emerging Evidence, Practice. Summary Report.  Geneva, Switzerland: WHO.  Retrieved August 29, 2012, from http://www.who.int/mental_health/evidence/en/promoting_mhh.pdf.
  2. Substance Abuse and Mental Health Services Administration.  (2007).  What a Difference a Friend Makes. Retrieved August 29, 2012, from https://store.samhsa.gov/shin/content/SMA07-4257/SMA07-4257.pdf, p. 5.
  3. Substance Abuse and Mental Health Services Administration.  (2008).  Summary Report CARAVAN Survey for SAMHSA on Addictions and Recovery.  Rockville, MD: Office of Communications, SAMHSA.  Retrieved August 29, 2012, from http://www.samhsa.gov/attitudes/CARAVAN_LongReport.pdf, p. 1.
  4. Russell, L.  (2010).  Mental Health Care Services in Primary Care: Tackling the Issues in the Context of Health Care Reform. Center for American Progress.  Retrieved August 29, 2012, from http://www.americanprogress.org/wp-content/uploads/issues/2010/10/pdf/mentalhealth.pdf, p. 6.
  5. National Institute on Drug Abuse.  (2012).  Medical consequences of drug abuse. Committee on the Prevention of Mental Disorders and Substance Abuse among Children, Youth, and Young Adults:  Research Advances and Promising Interventions.   Retrieved September 18, 2012, from http://www.drugabuse.gov/consequences.
  6. Russell, L.  (2010).  Mental Health Care Services in Primary Care: Tackling the Issues in the Context of Health Care Reform.  Center for American Progress.  Retrieved August 29, 2012, from http://www.americanprogress.org/wp-content/uploads/issues/2010/10/pdf/mentalhealth.pdf, p. 5-6.
  7. Office of National Drug Control Policy.  (1999).  Consequences of Illegal Drug Use.  Retrieved August 29, 2012, from https://www.ncjrs.gov/ondcppubs/publications/policy/99ndcs/ii-b.html.
  8. Substance Abuse and Mental Health Services Administration.  (n.d.).  Mental Illness: Myths and Facts.  Retrieved August 29, 2012, from http://www.whatadifference.samhsa.gov/learn.asp?nav=nav01_1&content=1_1_mythsfacts.
  9. National Institute on Drug Abuse.  (2010).  Drug Abuse and Addiction.  Retrieved August 29, 2012, from http://www.drugabuse.gov/publications/science-addiction/drug-abuse-addiction.
  10. Dick, D., and Agrawal, A.  (2008).  The Genetics of Alcohol and Other Drug Dependence.  Alcohol Research and Health.  Retrieved September 18, 2012, from http://pubs.niaaa.nih.gov/publications/arh312/111-118.pdf, p. 1.
  11. Substance Abuse and Mental Health Services Administration.  (2012).  Mental Health, United States, 2010. HHS Publication No. (SMA) 12-4681.  Rockville, MD: Substance Abuse and Mental Health Services Administration, p. 14.
  12. National Alliance on Mental Illness.  (n.d.).  The High Costs of Cutting Mental Health.  Retrieved August 29, 2012, from http://www.nami.org/Content/NavigationMenu/State_Advocacy/About_the_Issue/HealthCare.pdf.
  13. National Institute on Drug Abuse.  (2010).  Comorbidity:  Addiction and Other Mental Illness.  Retrieved August 29, 2012, from http://www.drugabuse.gov/sites/default/files/rrcomorbidity.pdf, p. 3.
  14. Substance Abuse and Mental Health Services Administration.  (2012).  Part One: Defining Trauma.  Retrieved December 12, 2012, from http://www.samhsa.gov/traumajustice/traumadefinition/definition.aspx.
  15. Substance Abuse and Mental Health Services Administration and National Association of State Mental Health Program Directors.  (2004).  The damaging consequences of violence and trauma.  Retrieved December 12, 2012, from http://www.nasmhpd.org/docs/publications/archiveDocs/2004/Trauma Services doc FINAL-04.pdf, p. vii.
  16. Mental Health America.  (n.d.).  Mental Illness and the Family:  Recognizing Warning Signs and How to Cope.  Retrieved August 29, 2012, from http://www.nmha.org/go/information/get-info/mi-and-the-family/recognizing-warning-signs-and-how-to-cope.
  17. HelpGuide.  (2012).  Drug Abuse and Addiction:  Signs, Symptoms, and Help For Drug Problems And Substance Abuse.  Retrieved August 29, 2012, from http://www.helpguide.org/mental/drug_substance_abuse_addiction_signs_effects_treatment.htm.
  18. National Alliance on Mental Illness.  (n.d.).  What is Mental Illness: Mental Illness Facts.  Retrieved August 29, 2012, from http://www.nami.org/template.cfm?section=about_mental_illness.
  19. National Institute on Drug Abuse.  (2009).  Principles of Drug Addiction Treatment: A Research-Based Guide.  Retrieved August 29, 2012, from http://www.drugabuse.gov/publications/principles-drug-addiction-treatment, p. 3.
  20. Substance Abuse and Mental Health Services Administration.  (n.d.).  Behavioral Health Needs of the Newly Eligible and Enrollment Assistance Best Practice.  Retrieved December 14, 2012, from http://www.nga.org/files/live/sites/NGA/files/ppt/1204POPULATIONMALONE.PPT.
  21. National Alliance on Mental Illness and National Council for Community Behavioral Healthcare.  (2008).  Coverage for all:  Inclusion of mental illness and substance use disorders in state healthcare reform initiatives.  Retrieved December 14, 2012, from http://www.nami.org/Template.cfm?Section=Issue_Spotlights&template=/ContentManagement/ContentDisplay.cfm&ContentID=119024, p. 12.
  22. SAMHSA Blog.  (2012).  SAMHSA’s Working Definition of Recovery Updated.  Retrieved August 29, 2012, from http://blog.samhsa.gov/2012/03/23/defintion-of-recovery-updated.
  23. SAMHSA Blog.  (2012).  SAMHSA’s Working Definition of Recovery Updated.  Retrieved August 29, 2012, from http://blog.samhsa.gov/2012/03/23/defintion-of-recovery-updated.
  24. SAMHSA Blog.  (2012).  SAMHSA’s Working Definition of Recovery Updated.  Retrieved August 29, 2012, from http://blog.samhsa.gov/2012/03/23/defintion-of-recovery-updated.
  25. Dunn, H.L.  (1961).  High-Level Wellness.  Beatty Press:  Arlington, VA.  Retrieved September 7, 2012, from http://www.promoteacceptance.samhsa.gov/10by10/dimensions.aspx#footnote1.
  26. Substance Abuse and Mental Health Services Administration.  (n.d.).  Eight Dimensions of Wellness.  Retrieved September 7, 2012, from http://www.promoteacceptance.samhsa.gov/10by10/dimensions.aspx#footnote1.
  27. Kessler, R.C., Berglund, P., Demler, O., Jin, R., Merikangas, K.R., and Walters, E.E. (2005).  Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication.  Archives of General Psychiatry, 62(6), 593-602.  Retrieved August 29, 2012, from http://archpsyc.ama-assn.org/cgi/content/full/62/6/593.


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