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2013 Toolkit


The 2014 Toolkit will be available in early summer.

Treatment and Recovery

Download PDF version of "Treatment and Recovery" (267 KB) Download PDF version of "Treatment and Recovery" (267 KB)

Introduction…

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 substance use disorders.  This initiative celebrates people in recovery, as well as those working in the behavioral health field.  It 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 also highlights that there are many treatment and recovery paths that can help a person achieve wellness, including professional care, self-help, and group support, allowing each person to embark on his or her own unique path.

SAMHSA’s Recovery Support Initiative emphasizes the value of different forms of treatment and recovery.  This initiative promotes individual-, program-, and system-level approaches and services that foster health and resilience; increase access to permanent housing, employment, education, and other necessary supports; and reduce discriminatory barriers to receiving help.1  These approaches and services, each with unique characteristics and benefits, are explained below.  They include resources to address problems with mental illnesses, substance use disorders, and co-occurring disorders (meaning having both mental and substance use disorders at the same time).

Treatment and Wellness Pathways…

A person with a mental and/or substance use disorder may find it difficult to take the first step toward finding help, but reaching out for support is worth it.  Individuals may find that taking the first step is easier when talking to a trusted confidant such as a doctor, nurse, school or religious counselor, family member, or friend.  People should not wait until they are in crisis to seek help.  The “Overview” and “Young Adults” documents in this toolkit list the most common signs and symptoms of behavioral health conditions.  Seeking treatment immediately after a noticeable change in functioning or thinking can make a difference.

Research confirms that most people who seek help feel better and manage or overcome their diseases.  More than 80 percent of people treated for depression improve and nearly 90 percent of people treated for panic disorders see improvement.2  Treatment can also help people with a substance use disorder – which includes problems with alcohol, illicit drugs, and/or prescription drugs.  This is a medical problem that affects brain circuits that control reward and motivation, learning and memory, and behaviors.3  Because drug dependency alters brain functioning, treatment is not always simple.  However, research shows that treatment can help people stop substance use, avoid relapse, and lead active lives engaged with their families, workplaces, and communities.4  Enrolling and maintaining health insurance coverage is critical to realizing the positive effects of treatment, and as multiple consensus reports from the Institute of Medicine confirm, health insurance coverage helps individuals maintain their health status.5

Services to treat and support individuals with mental and/or substance use disorders are available in a variety of settings including outpatient, inpatient, and residential settings. There are many ways in which treatment may be offered; below are three of the common treatment settings.

  • Outpatient treatment options are offered for people who visit clinical settings at regular intervals.  These settings include private health care provider’s offices, partial day hospitals or day treatment programs, and in-home providers.6  In these settings, individuals are able to receive services, while living elsewhere and continuing to participate in their regular daily routines, and such as work, childcare, or school.7
  • Inpatient treatment includes constant supervision at hospitals or clinics specifically designed for behavioral health treatment.  Individuals who are treated in these settings generally have disorders that pose a risk to themselves or others around them.8  Services offered in inpatient treatment often initiate the treatment process. 
  • Residential treatment9 exists for both short-term and long-term care.  Short-term residential treatment, lasting between 3 to 6 weeks, is usually offered in hospital settings, after which patients are urged to participate in outpatient therapy and/or recovery support groups.  Long-term residential treatment provides 24-hour care, often in non-hospital facilities designed to model living settings, for 6 to 12 months.  Residential treatment, including the best-known therapeutic communities (TCs) model, seeks to treat substance use disorders, helping residents examine damaging beliefs, self-perceptions, and destructive patterns of behavior and adopt new, more harmonious and constructive ways to interact with others.  Many TCs offer employment training and other support services onsite. 

Proven and effective treatment methods for mental and/or substance use disorders are behavioral treatments, medication treatment, and recovery support services.  These services are provided in the variety of settings discussed previously.

Mental and Substance Use Disorder Treatment and Recovery Support Services…

Type of Service Common Mental Disorder Service Description(s) Common Substance Use Service Description(s)
Behavioral Treatments Cognitive behavioral therapy (CBT)10 focuses on the relationship between an individual’s thoughts, feelings, and behaviors.  A CBT-trained professional can help a person explore the links between his or her thoughts and the emotions that occur prior to disruptive behaviors. This allows someone to identify and change inappropriate or negative thought patterns and address the behaviors associated with his or her illness.

Family-focused therapy (FFT)11 is centered on the idea that strong family relationships are vital to managing a mental illness.  Family members attend FFT along with the individual with the mental illness.  Therapists help identify and resolve conflicts among family members that may affect the person’s mental health, and educate family members about their loved one’s disorder.  FFT also focuses on helping family members cope with the stress of caring for loved ones with a mental illness.

Interpersonal therapy (IBT)12 is based on the idea that improving communication patterns and the ways a person relates to others will effectively treat depression.  IBT helps a person identify troubling emotions and triggers, and patterns in his or her interaction with others.   The individual may also examine relationships in his or her past that may have been affected by the mental illness.  This type of therapy guides people to change negative behaviors and express their appropriate emotions in a healthy way. 

Dialectical behavioral therapy (DBT)13,14
consists of a therapist offering assurance that a person’s behavior and feelings are valid and understandable.  At the same time, the therapist coaches the person to understand that it is his or her personal responsibility to change unhealthy or disruptive behavior.  DBT also emphasizes a strong and equal relationship between the individual and his or her therapist.  DBT can decrease the frequency and severity of negative behaviors, increase motivation to change, teach new coping skills, and provide a treatment environment that emphasizes a person’s strengths.

CBT helps patients recognize, avoid, and cope with the situations in which they are likely to use substances.15  CBT helps patients develop skills that can foster abstinence from substances, as well as assist with co-occurring problems.16

Family and couples treatment is based on the idea that engaging the patient’s surrounding network can be helpful in fostering and changing a patient’s behavior pattern related to substance use.  These approaches can include family and individual therapy, skills training, and communication training.17

Multidimensional family therapy addresses influences on a patient’s drug abuse patterns and is designed to improve overall family functioning.18

Motivational interviewing capitalizes on the readiness of individuals to change their behavior and enter treatment.

Contingency management (or motivational incentives) uses positive reinforcement to meet specific behavioral goals, specifically abstaining from using substances.19 It is based on the principle that behavior followed by positive consequences is more likely to be repeated.

Medication Treatment

For the treatment of mental and/or substance use disorders, it is important to discuss the pros and cons of different medications with a health care provider.  In particular, people should ask what symptoms the medication is supposed to treat, when those symptoms should start to subside, what side effects may occur, and what possible interactions could occur with other medications or certain foods and drinks.20  Medication should always be taken as prescribed under a medical professional’s care.21  The dosage and length of time prescribed to take medication is different for each person, but largely based upon the type of medication prescribed and the disorder it is intended to treat.  It’s important to take medication for the recommended amount of time, as it sometimes takes several weeks for the medications to have a full effect.  If a person finds he/she is not responding to a certain medication, he/she should work with their doctor to try another that meets their individual needs.

Medications can help people with mental disorders by treating their symptoms, thereby helping people to function and lead fulfilling lives.22  Many different medication options exist for a range of mental disorders, including depression, bipolar disorder, anxiety disorders, schizophrenia, and attention-deficit hyperactive disorder (ADHD). Certain medications can be used during the necessary initial treatment phase of detoxification, a process when the body clears itself of drugs, but is often accompanied by unpleasant, serious side effects.23  Medications help to manage these withdrawal symptoms.  It is important to note that detoxification is one step in the treatment process, and those who do not receive additional treatment after this are at higher risk of relapse than those who receive ongoing care.24

Medication-assisted treatment is a viable longer-term option for many individuals after detoxification.  Medications are currently available to treat addiction to opioids and alcohol.  Treatments for opioid addiction (such as methadone, buprenorphine, and naltrexone) suppress withdrawal symptoms, relieve cravings, disengage someone from drug-seeking behavior, and help people become more receptive to behavioral treatments.25

Medications approved to treat alcohol addiction (naltrexone, acamprosate, and disulfiram) can reduce relapse by altering the rewarding effects of drinking, minimizing the symptoms associated with withdrawal, or producing unpleasant reactions when a person consumes alcohol.26  When considering treatment options, keep in mind that research indicates that treating substance use disorders with a combination of medication and behavioral therapies is most successful.27

Recovery Support Services (RSS)

RSS are nonclinical services that assist individuals, as well as their families, in recovery from mental and substance use disorders.  The goal is to facilitate long-term recovery and wellness, contributing to an improved quality of life.  RSS can be led by behavioral health professionals or someone who has personal experience. 

These services include employment services and job training, relapse prevention methods, housing assistance and services, child care, transportation services, family/marriage education, peer-to-peer services, mentoring, and coaching, self-help and support groups, life skills, spiritual and faith-based support, child development support services, education, and substance abuse education.28

Through RSS, guidance and support are often provided by another person who has learned how to manage their mental illness.29  People may find comfort in support groups because they can discuss shared experiences with others and realize that they are not alone in their recovery.  Group members share frustrations and successes, referrals for treatment, and ways to help continue on a recovery path.30

Support groups are also available for family and friends of those with a mental illness.  More information about these types of groups, including local groups, can be found at NAMI Connection, American Self-Help Clearinghouse, and the National Mental Health Consumers’ Self-Help Clearinghouse.

RSS are often provided by peers, faith or community leaders, or recovery professionals.  Peers can be individuals who have firsthand experience in receiving treatment and sustaining recovery.  Faith-based services provide care within the context of a religious framework of beliefs and rituals.  Services offered by recovery support professionals employ the expertise of those who are trained with specific credentials to offer care within treatment agencies or other systems.  These providers may be in recovery themselves.

Co-occurring Disorder Treatment and Recovery Pathways…

When a person experiences a simultaneous mental illness and substance use disorder, both conditions must be treated at the same time –merely focusing on one condition will not ensure that the other will go away.31  SAMHSA advocates for integrated treatment, which means that someone should receive combined treatment for mental illness and substance use disorders from the same practitioner or treatment team.32  Integrated treatment relies on cross-trained practitioners, catering to the person’s stage in the treatment process, motivational interventions, and a variety of service formats to achieve positive outcomes.33

The services described in the chart above are also used in the treatment of co-occurring disorders.  The use of proper medication is an essential co-occurring disorder treatment option, as it helps patients to stabilize and control their symptoms, subsequently increasing their receptivity to treatment.34  Various psychotherapy techniques have also shown promise for the treatment of co-occurring disorders. These options include motivational interviewing, contingency management, and CBT.35  Continuing care options such as mutual self-help groups, recovery maintenance groups, continued individual counseling, and psychiatric services play a significant role helping patients with co-occurring disorders to sustain recovery.36

Alternative Pathways to Wellness…

Wellness encompasses more than simply managing a mental illness or recovering from a co-occurring or substance use disorder.  Other aspects of a person’s health are just as important to overall wellness.  In fact, a study by the Centers for Disease Control and Prevention found that people who practiced four healthy behaviors – not smoking, eating healthy, getting enough exercise, and limiting alcohol use – were 63 percent less likely to die within the 18-year study period than those who kept none of those practices.37  People seeking treatment or in recovery from a behavioral health condition can consider the options below to enhance their recovery and encourage individual wellness.  These techniques focus on interactions between the mind, body, and behavior to affect physical functioning and promote health:

  • Meditation:  Uses specific postures and focused attention to increase calmness and relaxation, improve psychological balance, cope with illness, or enhance overall health and well-being.38
  • Yoga:  Combines physical postures, breathing techniques, meditation, and relaxation to help people maintain their health, improve physical fitness, and relieve stress.  Yoga has also been used to address health conditions such as back pain, neck pain, arthritis, and anxiety.  Yoga of Recovery is an organization that uses a 12-step format to help people who are recovering from addictive behaviors.39
  • Acupuncture:  Involves stimulating specific points on the body with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation.  It is often used to relieve pain or for other therapeutic purposes.40

People who have experienced a mental and/or substance use disorder can also look online and to new technologies to help continue on their recovery journey.  Online recovery support groups, which include In The Rooms and Renew Everyday, allow users to share their stories and advice for sustaining recovery with others in the recovery community. People can also find support on Facebook and Twitter – refer to Recovery Month’s Facebook and Twitter accounts to locate others who are currently active in the online recovery community.

Mobile applications are also available to supplement people’s recovery.  T2 Mood Tracker is a tool that allows users to self-monitor, track, and reference their emotional experiences over a period of days, weeks, and months.  The tool can be useful in self-help as well as when the person is interacting with a therapist or other health care professional.  Various mobile applications are available to help people track sober time, manage triggers and emotions, find and share meetings, contact sponsors, and receive daily information. Consult the Addiction Recovery Guide’s Mobile App Listing for a full list of applications.

Many options are available to help people seek treatment and sustain recovery.  Whatever path a person chooses, it is important that each individual finds a combination of treatment and recovery services that best meets the person’s own needs and goals.

Additional Resources…

A variety of resources provide additional information on Recovery Month, mental, substance use, and co-occurring 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 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.
  • SAMHSA’s “Co-Occurring Disorders” Website:  Contains information on co-occurring disorders and treatment options.
  • SAMHSA’s Wellness Initiative:  Promotes the importance of addressing all parts of a person’s life in hopes of increasing life expectancy for people with behavioral health problems.
  • National Suicide Prevention Lifeline:  Provides a free, 24-hour helpline available to anyone in suicidal crisis or emotional distress.
  • Al-Anon/Alateen Family Groups:  Provides support groups for families and friends of people with alcohol problems.
  • 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.
  • BHBusiness:  Offers targeted training and support for behavioral health care 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.  
  • Mental Health America:  Offers resources about the realities of mental illness.
  • Nar-Anon:  Offers a community for family members to share experiences related to substance use disorders.
  • Psychology Today’s Therapy Directory:  Allows users to locate a therapist, psychologist, or counselor who specializes in mental illness by city or zip code throughout the United States.
  • RecoverForever.com:  Offers live online support and contains an abundance of resources on alcohol and drug treatment services that are searchable by state.
  • Racing for Recovery:  Helps people sustain recovery and improve their quality of life by promoting a healthy lifestyle, fitness, and sobriety.
  • 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.
  • Treatment 101: Recovery Today:  Part of SAMHSA’s Road to Recovery Television and Radio series that examines many aspects of treatment and recovery.

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

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