Virtual Recovery Month Kit

“I am a grateful recovering alcoholic, and every day I do healthy, positive things so I won’t take another drink. My own experience has led me to work to combat the number one public health issue facing our country:  chemical addiction. Expanding access to treatment is a matter of life and death for 26 million Americans." — Jim Ramstad U.S. House of Representatives Minnesota’s 3rd District

Overview of Co-occurring and Co-existing Disorders, Substance Abuse Disorders, Treatment, and Recovery

Substance abuse disorder refers to alcohol abuse as well as use or misuse, dependence, and addiction to legal and illegal drugs. Mental disorders represent the continuum of psychiatric severity from less to more severe.

Substance abuse disorder. Mental disorder. Alone, each wreaks havoc on the lives of millions in this country, and both require intensive treatment. When afflicted with these simultaneously, the result can be debilitating for an individual.¹

Commonly referred to as a co-occurring disorder, people with these conditions either abuse substances as a means of dealing with the mental disorder or complicate their mental disorder through substance abuse. While these disorders can interact differently in any one person, at least one disorder of each type can be diagnosed independently of the other.

Seven to ten million individuals in the United States have at least one mental disorder as well as an alcohol or drug use disorder.² Some examples of co-occurring disorders that can exist with drug and alcohol abuse include depression, anxiety, mood and eating disorders.³

Nearly one-sixth of all Americans have a disability that limits their activity; countless others have disabilities (mostly cognitive in nature) that go unrecognized and undiagnosed.⁴ When a pre-existing condition, such as mental retardation, learning disorders, HIV/AIDS, spinal or brain injuries, hypertension, heart disease, or diabetes, is present with addiction, this is known as a co-existing disorder. Co-existing disorders involve physical and cognitive disabilities coupled with a substance abuse disorder. The statistics surrounding these disorders are startling:

	People with conditions such as deafness, arthritis, or multiple sclerosis have substance abuse rates at least double the general population estimates.5, 6
	Based on a Wisconsin survey, persons with spinal cord injuries, orthopedic disabilities, vision impairment, and amputations can be classified as heavy drinkers in approximately 40 to 50 percent of cases.7
	The presence of severe mental illness may create additional biological vulnerabilities such that even small amounts of psychoactive substances may have adverse consequences for individuals with schizophrenia or other brain disorders.8

Why does this occur? One problem may be that treatment for co-occurring substance abuse and mental disorders is inadequate compared to the treatment programs of other disorders. Two-thirds of adults with mental illness do not get help.⁹ Many individuals with a co-occurring disorder are misdiagnosed. Also, these individuals, depending on the severity of their illnesses, may not be able to be treated at home or tolerated in a treatment facility.¹⁰ Service organizations inconsistently design coordinated treatment programs to address the needs of individuals with co-occurring disorders—treatment for a mental disorder is separate from treatment for a substance abuse disorder. Development of integrated and coordinated comprehensive programs that can treat co-occurring disorders is desperately needed.¹¹

In order to address this issue, the U.S. Substance Abuse and Mental Health Services Administration has issued the Report to Congress on the Prevention and Treatment of Co-occurring Substance Abuse Disorders and Mental Disorders. Within this report is a recommendation for an integrated treatment model based on cooperation, consultation, and collaboration. Provision of integrated treatment ranges across a continuum spanning from single cross-referral and linkage; through cooperation, consultation, and collaboration; to integration in a single setting or treatment model. Such treatment is provided through three levels of service provision:

	Integrated Treatment – interaction between the mental health and/or substance abuse clinician(s) and the individual, which addresses the substance abuse and mental health needs of the individual.
	Integrated Program(s) – the organizational structure for providing integrated treatment, whereby the mental health and/or substance abuse program is responsible for ensuring an array of staff or linkages with other programs to address all of the needs of its clients. The program is responsible for ensuring that services are provided in an appropriate and easily accessible setting and that services are culturally competent.
	Integrated System – the organizational structure for supporting an array of programs for people with different needs, including individuals with co-occurring substance abuse and mental disorders. The system is responsible for ensuring appropriate funding mechanisms to support the continuum of service needs, addressing credentialing/licensing issues, and establishing data collection/reporting systems, needs assessment, planning, and other related functions.12

What you can do is celebrate those already in treatment and recovery and get involved at the local level by speaking out about the need for effective, coordinated services for people with co-occurring and co-existing disorders. The Recovery Month 2003 theme is “Join the Voices for Recovery:  Celebrating Health.” Please consider the facts on the following pages in your efforts to educate others.

General Facts about Mental Disorders and Substance Abuse Disorders, Treatment, and Recovery

As we celebrate Recovery Month, all individuals and groups should be well-informed on the subjects of substance abuse disorders, mental disorders, treatment, recovery, co-existing and co-occurring disorders. Please note the following facts and statistics:

Understanding Mental Disorders

	More than 54 million Americans have a mental disorder in any given year, although fewer than 8 million seek treatment.13
	About half of people with a lifetime addictive disorder also experience a lifetime history of at least one mental disorder. Roughly 50 percent of those with a lifetime mental disorder also have a lifetime history of at least one addictive disorder.14
	In 2001, there were an estimated 14.8 million adults age 18 or older with serious mental illness (SMI). This represents 7.3 percent of all adults. Of those with SMI, 6.9 million received mental health treatment in the 12 months prior to the interview. Among adults with SMI, 20.3 percent were dependent on or abused alcohol or illicit drugs; the rate among adults without SMI was 6.3 percent. An estimated 3 million adults had both SMI and substance abuse or dependence problems during the year.15

Societal Benefits of Drug and Alcohol Treatment

	The social cost of drug and alcohol addiction treatment in the U.S. is estimated at $294 billion per year in lost productivity and costs associated with law enforcement, health care, justice, welfare, and other programs and services.16
	Conservative estimates note that for every $1 invested in addiction treatment, there is a return of between $4 and $7 in reduced drug-related crime, criminal justice costs, and theft. When savings related to health care are included, total savings can exceed costs by a ratio of 12 to 1.17

Illicit Drugs¹⁸

	An estimated 16 million Americans (7.1 percent of the population 12 and older) were current users of illicit drugs in 2001, meaning they had used an illicit drug at least once during the 30 days prior to being interviewed.
	Illicit drug use among youth was highest for those between the ages of 18 and 25 (18.8 percent) in 2001.
	The rate of illicit drug use in metropolitan counties was higher than the rate in nonmetropolitan counties. Current drug use rates were 7.6 percent in large metropolitan counties, 7.1 percent in small metropolitan counties, 5.8 percent in nonmetropolitan counties, and 4.8 percent in completely rural, nonmetropolitan counties.
	The rates of current illicit drug use for major racial/ethnic groups in 2001 were similar to previous years: 7.2 percent for whites, 6.4 percent for Hispanics, and 7.4 percent for African Americans. Rates were highest among American Indian/Alaska Natives (9.9 percent) and persons of multiple race (12.6 percent). Asians had the lowest rates (2.8 percent).

Prescription Drugs

	Prescription drugs can be broken down into three distinct categories:  Opioids, which are most often prescribed to treat pain; CNS depressants, which are used to treat anxiety and sleep disorders; and stimulants, which are prescribed to treat narcolepsy, ADHD, and obesity.19
	In 2001, approximately 957,000 persons aged 12 or older had used Oxycontin nonmedically at least once in their lifetime. This number is higher than estimates for both 1999 (221,000) and 2000 (399,000).20

Alcohol and Tobacco

	Tobacco use, particularly cigarette smoking, is the leading cause of preventable illness in the United States; in fact, nearly one in four adults and one in three teenagers smoke.21
	A little over 29 percent of the American population aged 12 and older, or 66.5 million people, reported current use of a tobacco product in 2001.22
	About 10.1 million persons aged 12 to 20 reported current use of alcohol in 2001. This number represents 28.5 percent of this age group, for whom alcohol is an illicit substance.23

Other Important Information Regarding Specific Illicit Drugs

Marijuana

	Marijuana is the most commonly used illicit drug in the United States.24
	More than 83 million Americans (37 percent) age 12 and older have tried marijuana at least once.25
	Depression, anxiety, and personality disturbances are all associated with marijuana use. Research clearly demonstrates that marijuana use has the potential to cause problems in daily life or make a person’s existing problems worse.26
	More than two-thirds of the 2.3 million new users reported in 1999 were under the age of 18
	Marijuana is much stronger and more addictive than it was 30 years ago. Average THC levels rose from less than 1 percent in the late 1970s to more than 7 percent in 2001. Sinsemilla potency increased from 6 percent to 13 percent. THC levels of 20 percent and up to 33 percent have been found in samples of sinsemilla at the University of Mississippi, Marijuana Potency Monitoring Project, 2001. Of those who try marijuana at least once, nearly one in ten become dependent.27

Cocaine/Crack²⁸

	Cocaine is a powerfully addictive stimulant that directly affects the brain and is available in two forms: a hydrochloric salt or white powder that dissolves in water and can be taken either intravenously or through the nose. The other form, freebase, is cocaine that has been neutralized by an acid. Freebase cocaine can be smoked.
	Crack is the street name for freebase cocaine that has been processed with baking soda. Someone who smokes crack can experience a high in less than 10 seconds. This, along with the fact that it is inexpensive and easy to produce, has led to the enormous popularity of this drug.
	Cocaine use, which was extremely popular in the 1980s, stabilized in the United States between 1992 and 1999. However, despite the stabilization, the rate of cocaine use still continues to rise.

Hallucinogens

	Hallucinogens include LSD (lysergic acid diethylamide, also known as acid, blotter, boomers, cubes, microdot, or yellow sunshines), mescaline (also known as buttons, cactus, mesc, or peyote), psilocybin, (also known as magic mushrooms, purple passion, or shrooms).29
	Approximately 1.3 million (0.6 percent of the population aged 12 or older) were current users of hallucinogens.30
	In 2001, the percentage of 12th graders who used hallucinogens in the past year was up from 8.1 percent to 8.4 percent. Past-month usage was also up from 2.6 percent to 3.2 percent.31

Heroin

	Heroin mentions in hospital emergency departments increased 15 percent (from 82,192 to 94,804 mentions) from 1999 to 2000.32
	Current heroin use was reported by an estimated 123,000 Americans in 2001. This represents 0.1 percent of the population aged 12 and older and is similar to the number estimated for 2000 (130,000).33
	Among past year users of heroin in 2001, 50 percent (0.2 million) were classified with dependence on or abuse of heroin.34
	Almost 90 percent of people who abused heroin were white; over 50 percent were employed full-time; and almost 89 percent had a high school diploma or higher level of education.35
	Estimates of multi-drug use among heroin-addicted people range from 30 to 70 percent. The most common co-occurring addictions are cocaine, benzodiazepines, alcohol, nicotine, and marijuana. Rates of marijuana use by heroin addicts seeking treatment have been reported to be as high as 66 percent.36, 37, 38
	Estimated costs associated with heroin addiction in the United States were 21.9 billion dollars in 1996.39

Methamphetamine

	Methamphetamine is a powerfully addictive stimulant that dramatically affects the central nervous system.40
	The abuse of methamphetamine—a potent psychostimulant—is an extremely serious and growing problem. Although the drug was first used primarily in selected urban areas in the Southwestern part of the United States, high levels of methamphetamine abuse are now seen in many areas of the Midwest, in both urban and rural settings, and by very diverse segments of the population.41
	Incidence of methamphetamine use rose steadily between 1990 (164,000 new users) and 2000 (344,000 new users). Methamphetamine incidence was at its highest level since 1975.42

MDMA or Ecstasy (Club Drugs)

	This category of drugs is most commonly encountered at nightclubs and raves. It includes Ecstasy (MDMA), Ketamine (Special K), GHB, GBL, Rohyphnol, LSD, and PCP.43 MDMA, commonly called Ecstasy, is the number one “club drug” in use.
	These types of drugs have gained popularity due to the false perception that they are not as harmful or as addictive as “mainstream” drugs, such as heroin. This is false. In fact, people who use these substances are at risk for dehydration, hyperthermia, or heart or kidney failure. The combination of the stimulant effect of the drug and the hot, crowded atmosphere of parties or clubs can lead to fatalities.44
	Among 12th graders, past-year use of MDMA increased 46 percent, from 5.6 percent to 8.2 percent. Also, the perceived availability of MDMA increased sharply—up 28 percent. This is the largest one-year percentage point increase in the availability measure among 12th graders for any drug class in the 26-year history of the Monitoring the Future study.45

Important Information Regarding Other Misused and Potentially Addictive Substances

Inhalants⁴⁶

	The term “inhalants” refers to more than a thousand different household and commercial products that can intentionally be abused by sniffing or “huffing” (inhaling through one’s mouth) for an intoxicating effect. These products are composed of volatile solvents and substances commonly found in commercial adhesives, lighter fluids, cleaning solutions, and paint products.
	There is a common link between inhalant abuse and teenagers. Some problems include: failing grades, memory loss, learning problems, chronic absences, and general apathy. Inhalant users also tend to be disruptive, deviant, or delinquent as a result of the early onset of use, the user’s lack of physical and emotion maturation, and the physical consequences that occur from extended use.
	Between 1994 and 2000, the number of new inhalant users increased more than 50 percent, from 618,000 new users in 1994 to 979,000 in 2000. These estimates were higher than a previous peak in 1978 (662,000 new users).47

Steroids⁴⁸

	Steroids are synthetic derivatives of the male hormone testosterone. Scientifically referred to as androgenic anabolic steroids, these derivatives promote the growth of skeletal muscle and increase lean body mass.
	Steroids can be taken orally or via injection with a needle. Some consequences of steroid abuse are: higher blood pressure, liver problems, stunted growth, infertility, irregular menstrual cycles, and testicular shrinkage. Over time, steroid use can cause violent behavior, delusions, and paranoid jealousy.
	The 1995 Youth Risk and Behavior Surveillance System showed that of 9th to 12th graders in public and private high schools in the U.S., 4.9 percent of males and 2.4 percent of females have used anabolic steroids at least once in their lives.49

To learn more about drug and alcohol addiction, treatment, and usage rates, you can access many of the materials cited in this fact sheet by contacting an information specialist at SAMHSA’s National Clearinghouse for Alcohol and Drug Information toll-free at 1-800-729-6686. You can also access the Clearinghouse via the Internet at
http://ncadi.samhsa.gov or by email at recoverymonth@iqsolutions.com.

You are encouraged to share your plans and activities for Recovery Month 2003 with SAMHSA’s Center for Substance Abuse Treatment, your colleagues, and the general public by posting them on the official Recovery Month web site at http://www.recoverymonth.gov.

We would like to know about your efforts during Recovery Month. Please complete the Customer Satisfaction Form enclosed in the kit. Directions are included on the form.

For any additional Recovery Month materials visit our web site at
http://www.recoverymonth.gov or call 1-800-729-6686.

Sources

1	Co-occurring addictive and psychiatric disorders. Public Policy of the American Society of Addiction Medicine, December 2000/updated September 2001.
2	Improving services for individuals at risk of, or with, co-occurring substance-related and mental health disorders. Substance Abuse and Mental Health Services Administration’s National Advisory Council. Rockville, MD:  U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 1998.
3	Co-occurring addictive and psychiatric disorders.
4	Substance Use Disorder Treatment for People with Physical and Cognitive Disabilities. Treatment Improvement Protocol (TIP) Series 24. DHHS Publication No.(SMA) 98-3249. Rockville, MD:  U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, 1998.
5	Sylvester, R.A. Treatment of the deaf alcoholic:  A review. Alcoholism Treatment Quarterly 3(4), 1986.
6	Preliminary findings from the medication and other drug use survey. Rehabilitation Research and Training Center on Drugs and Disability. Unpublished summary. Dayton, OH:  Wright State University, 1995.
7	Buss, A. and Cramer, C. Incidence of alcohol use by people with disabilities:  A Wisconsin survey of persons with a disability. Madison, WI:  Office of Persons with Disabilities, 1989.
8	Drake R.E., Mercer-McFadden, C., Muser K.T., et. al. A review of integral mental health and substance abuse treatment for patients with dual disorders. Schizophrenia Bulletin 24: 589-608, 1998.
9	Mental Health:  A Report of the Surgeon General. Washington, DC:  U.S. Department of Health and Human Services, Public Health Service, 1999.
10	Dual Diagnosis:  Mental Illness and Substance Abuse, Helpline Fact Sheet. National Alliance on Mental Illness. Arlington, VA, 2002.
11	Report to Congress on the Prevention and Treatment of Co-occurring Substance Abuse Disorders and Mental Disorders. Rockville, MD:  U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 2002.
12	ibid.
13	Mental Health:  A Report of the Surgeon General. 19 Prescription Drugs:  Abuse and Addiction, National Institute on Drug Abuse Research Report Series. NIH Publication No. 01-4881. Rockville, MD:  U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, printed April 2001.
14	Kessler, R.C., Nelson, C.B., McGonagle, K.A., et al. The epidemiology of co-occurring addictive and mental disorders:  Implications for prevention and service utilization. American Journal of Orthopsychiatry 66(1), January 1996.
15	Summary of Findings from the 2001 National Household Survey on Drug Abuse. DHHS Publication No. (SMA) 02-3758. Rockville, MD:  U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 2002.
16	Coffey, R.M., Ph.D., et al. National Estimates of Expenditures for Substance Abuse Treatment, 1997. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, Medstat Group, February 2001.
17	Principles of Drug Addiction Treatment:  A Research-Based Guide. NIH Publication No. 00-4180. Bethesda, MD:  U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, printed October 1999/reprinted July 2000.
18	Summary of Findings from the 2001 National Household Survey on Drug Abuse.
19	Prescription Drugs:  Abuse and Addiction, National Institute on Drug Abuse Research Report Series. NIH Publication No. 01-4881. Rockville, MD:  U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, printed April 2001.
20	Summary of Findings from the 2001 National Household Survey on Drug Abuse.
21	Reducing Tobacco Use:  A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2000.
22	Summary of Findings from the 2001 National Household Survey on Drug Abuse.
23	ibid.
24	Marijuana Abuse, National Institute on Drug Abuse Research Report Series. NIH Publication No. 02-3859. Rockville, MD:  U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, printed October 2002.
25	Summary of Findings from the 2001 National Household Survey on Drug Abuse.
26	Marijuana Abuse, National Institute on Drug Abuse Research Report Series.
27	Anthong, J.C., et al. “Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants:  Basic findings from the National Comorbidity Survey” Experimental and Clinical Psychopharmacology 2:244-268, 1994.
28	Cocaine:  Abuse and Addiction, National Institute on Drug Abuse Research Report Series. NIH Publication No. 99-4342. Rockville, MD:  U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, printed May 1999.
29	Commonly Abused Drugs. Chart produced by U. S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, printed August 2000.
30	Summary of Findings from the 2001 National Household Survey on Drug Abuse.
31	Monitoring the Future:  National Results on Adolescent Drug Use, Overview of Key Findings, 2001. NIH Publication No. 02-5105. Bethesda, MD:  U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, 2002.
32	Emergency Department Trends from the Drug Abuse Warning Network Preliminary Estimates January-June 2001 with Revised Estimates 1994-2000. DHHS Publication No. (SMA) 02-3634. Rockville, MD:  U.S. Department of Health and Human Services, Substance Abuse and Mental Health Administration, 2001.
33	Summary of Findings from the 2001 National Household Survey on Drug Abuse.
34	ibid.
35	Honer, J., Gordon, S.M., and Snyderan, R. Heroin-addicted patient characteristics and drug use histories. Caron Foundation unpublished data, 2001.
36	Epstein, J.F. and Gfroerer, J.C. Heroin abuse in the United States (OAS working paper, RP0919). Rockville, MD:  U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, August 1997.
37	Amass, L., Bickel, W.K., and Budney, A.J. Marijuana use and treatment outcome among opioid-dependent patients. Addiction 93(4), 1998.
38	Matching treatment to patient needs in opioid substitution therapy. Treatment Improvement Protocol (TIP) 20. DHHS Pub. No. 95-3049. Rockville, MD:  U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, 1995.
39	Mark, T.L., et al. The economic costs of heroin addiction in the United States. Drug and Alcohol Dependence 60, 2001.
40	Methamphetamine: Abuse and Addiction, National Institute on Drug Abuse Research Report Series. NIH Publication No. 02-4210. Rockville, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, printed April 1998.
41	ibid.
42	Summary of Findings from the 2001 National Household Survey on Drug Abuse.
43	The National Drug Control Strategy: 2001 Annual Report. The high intensity drug trafficking area program. Office of National Drug Control Policy, White House Executive Office, 2002.
44	ibid.
45	Monitoring the Future: National Results on Adolescent Drug Use, Overview of Key Findings, 2000. NIH Publication No. 01-4923. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, 2001.
46	The National Drug Control Strategy: 2001 Annual Report.
47	Summary of Findings from the 2001 National Household Survey on Drug Abuse.
48	Steroids. Posted on Freevibe at http://www.freevibe.com/headsup/steroids.shtml#whatare. Freevibe is sponsored by the Office of National Drug Control Policy’s National Youth Anti-Drug Media Campaign.
49	Anabolic Steroids. Current Comment. American College of Sports Medicine. Indianapolis, IN. April 1999.

Contents

Media Outreach Materials | Targeted Outreach Materials | Recovery Month Partners | Resources

“I have been public about my addiction and recovery for almost a year. I’m still amazed by the reaction. Often the response is shock and bewilderment. These reactions result from society’s stereotype of alcoholics and addicts, but I am neither a ‘drunk on the corner,’ nor a social or academic failure. I have dreams for the future." — Molly Potter Student

Youth

Adolescence is a time of experimentation for young men and women, and many who are exposed to alcohol and drugs give in to curiosity or temptation, with potentially damaging results. For instance:

	Today over half (54 percent) have tried an illicit drug by the time they finish high school.1
	Three out of ten (29 percent) have used some illicit drug other than marijuana by the end of 12th grade.2
	Alcohol use remains extremely widespread among today’s teenagers. Four out of every five students (80 percent) have consumed alcohol (more than just a few sips) by the end of high school and about half (51 percent) have done so by 8th grade.3
	In 2001, approximately 10.1 million persons aged 12 to 20 reported drinking alcohol in the past month.4
	Approximately 2 million youths aged 12 to 17 (nine percent) had used inhalants at some time in their lives as of 2001.5
	In 2001, 3.7 percent of 12th graders reported using steroids in their lifetime. That is an increase of 1.2 percent from 2000.6

Unfortunately, these trends in substance abuse often lead to more serious problems for young men and women, including academic difficulties, health-related problems, eating disorders, poor peer relationships, and involvement with the juvenile justice system. Mental/emotional disorders such as depression, developmental delays, conduct problems, personality disorders, suicidal thoughts, apathy, withdrawal, and other psychological dysfunctions frequently are linked to substance abuse among adolescents. Moreover, many substance-abusing youths engage in behavior that places them at risk of HIV/AIDS or other sexually transmitted diseases, unintended pregnancy, and sexual violence.⁷

Studies show that about half of all adolescents receiving mental health services have a co-occurring substance use disorder, and as many as 75-80 percent of adolescents receiving inpatient substance abuse treatment have a co-existing (e.g., co-occurring) mental disorder.⁸ In response to this problem, the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) completed a Report to Congress on the Prevention and Treatment of Co-occurring Substance Abuse Disorders and Mental Disorders. In this report SAMHSA outlines the scope of the problem, identifies current treatment approaches, best medical practices, and seeks to highlight prevention opportunities. Also, included in the report is the recommendation that prevention and treatment services for co-occurring disorders must be culturally competent and age and gender appropriate.⁹

What can be done? Substance abuse treatment programs specifically designed for adolescents, as well as family-oriented approaches, can make a difference. For example, a national study of community-based treatment programs for adolescents found that reported weekly marijuana use dropped by more than half in the year following treatment. Clients also reported less heavy drinking, less use of hard drugs, and less criminal involvement. Other benefits included better psychological adjustment and improved school performance after treatment.¹⁰

Making a Difference: What Can I Do?

1.	Recognize the Signs of Addiction. If you are regularly interacting with young people, it is important to know about the symptoms of substance abuse. Be on the lookout for the following warning signs, which may indicate that alcohol or drugs have become a part of an adolescent’s life:     Sudden changes in personality without another known cause     Loss of interest in once-favorite hobbies, sports, or other activities     Sudden decline in performance or attendance at school or work     Changes in friends and reluctance to talk about new friends     Deterioration of personal grooming habits     Difficulty in paying attention, forgetfulness     Sudden aggressive behavior, irritability, nervousness, or giddiness     Increased secretiveness, heightened sensitivity to inquiry
2.	Take Advantage of the Power of Parenting. As a parent or legal guardian of an adolescent, make all efforts to become a “hands-on” parent, consistently establishing rules and expectations for your teen and regularly monitoring his or her behaviors. Parent power is the most underutilized tool in combating substance abuse. Nearly one in five teens (18 percent) lives with “hands-off” parents—parents who fail to consistently set down rules and expectations—and faces four times the risk of substance abuse as teens with “hands-on” parents. In a 2000 survey, far more teens who had not tried marijuana credited their parents (49 percent) with this decision than any other influence.11
3.	Address the Specialized Treatment Needs of Youth. When referring youth with alcohol or drug problems to treatment and recovery services, make every effort to identify programs that are specifically designed for their age group. Adolescents have special developmental needs and benefit from treatment approaches that increase their motivation and commitment to recovery.12 Treatment approaches should also be tailored to take into account the child’s age, gender, ethnicity, cultural background, family structure, cognitive and social development, and readiness for change.13 Sober schools that provide an alcohol- and drug-free learning environment are available in some parts of the country for students in recovery. In addition, because young people with substance abuse problems are also often suffering from mental disorders, there is a critical need for concurrent psychiatric treatment, both during and following treatment.14
4.	Open the Lines of Communication. If you have direct contact with young men and women, take the opportunity to become a mentor—an authority figure whom young people in your community feel comfortable with and can turn to for advice, for help with problems, and as an advocate for their positions. Children who live in alcohol- and drug-dependent families learn not to trust adults. By offering your time and an open ear to provide assurance and validation, you can counteract much of that mistrust and make a positive impact on a child’s life.15
5.	Offer Training in Schools. Educators who interact with youth on a daily basis can have a tremendous impact on their students by modeling positive behaviors, providing guidance and support on a personal level, building self-esteem, and helping them to make smart decisions. Schools can support treatment efforts and help youth suffering from co-occurring disorders by offering training for all administrators, teachers, coaches, counselors, nurses, and other school staff to spot the signs of substance abuse and mental disorders and know how to respond; providing strong no-use messages every year from preschool through the 12th grade, tailored to the age, culture, and sophistication of the child; developing and enforcing strong and commonsense substance abuse and treatment policies; improving and expanding existing prevention and intervention programs; and creating a school environment to engage parents (family members) in each child’s education. School personnel should develop student attachment to schools, and help students build supportive peer groups so they can resist negative peer pressures.16

Making a Difference: How Can I Focus My Efforts During Recovery Month?

September 2003 marks the 14th annual observance of Recovery Month, promoting the effectiveness of substance abuse treatment nationwide. People who interact with young men and women on a regular basis, including parents, teachers, youth group leaders, coaches, clergy, counselors, health professionals, social workers, and others, can all take actions to contribute to this national education effort. Adults should support youth in need of treatment and recovery services, and those who are suffering from co-occurring disorders. Following are a few suggestions:

You are encouraged to share your plans and activities for Recovery Month 2003 with SAMHSA’s Center for Substance Abuse Treatment, your colleagues, and the general public by posting them on the official Recovery Month web site at http://www.recoverymonth.gov.

We would like to know about your efforts during Recovery Month. Please complete the Customer Satisfaction Form enclosed in the kit. Directions are included on the form.

For any additional Recovery Month materials visit our web site at
http://www.recoverymonth.gov or call 1-800-729-6686.

Additional Resources

Sources

Contents

Media Outreach Materials | Targeted Outreach Materials | Recovery Month Partners | Resources

“We’ve had people with breast cancer and no one would ever suggest to us, while they’re going through chemo, ‘You should just get rid of them.’ To say that about alcoholism or an abuse situation makes no sense to us. We can be a voice in the community and say, 'It’s time to step up to the plate and do something.'" — Diane Crookham- Johnson Vice President of Administration Musco Lighting

Workplace

Most people who are addicted to alcohol or illicit drugs are employed. According to the “2001 National Household Survey on Drug Abuse,” 76 percent of illicit drug users are employed either full- or part-time.¹ More than 60 percent of adults know someone who has reported for work under the influence of alcohol or other drugs.²

Rates for current alcohol use were 59 percent for full-time employed adults aged 18 or older in 2001 compared with 52 percent of their unemployed peers.³ In fact, alcohol is the most widely abused substance among working adults. Most binge (five or more drinks on the same occasion at least once in 30 days) and heavy (five or more drinks on the same occasion on at least five different days in the past 30 days) alcohol users are employed. Among the 43.9 million adult binge drinkers in 2001, 35.4 million (81 percent) were employed either full- or part-time.⁴ Similarly, 9.8 million (80 percent) of the 12.4 million adult heavy drinkers were employed.⁵ These disturbing data underscore the point that all businesses, regardless of their size, may at some point need to deal with an employee who has an alcohol or drug addiction.

Substance abuse in the workplace can cause a myriad of problems for businesses, including increases in absenteeism, on-the-job accidents, errors in judgment, legal expenses, medical insurance claims, and illness rates, and decreases in productivity and employee morale. For example: 

	Alcohol and drug abuse has been estimated to cost American businesses roughly $81 billion in lost productivity in just one year—$37 billion due to premature death and $44 billion due to illness.6
	Alcoholism is estimated to cause 500 million lost workdays annually.7
	Individuals who are current illicit drug users are also more likely (12.9 percent) than those who are not (5 percent) to have skipped one or more work days in the past month.8
	Results from a U.S. Postal Service study revealed that employees who tested positive in a pre-employment drug test are 66 percent more likely to be absent and 77 percent more likely to be discharged within three years than those who tested negative.9

The good news for employers is that the benefits of achieving an alcohol- and drug-free workplace through substance abuse treatment and recovery for employees are substantial. Results can include improvements in performance, motivation, and morale, increases in overall customer satisfaction, and financial savings through incentive programs offered by insurance carriers. In addition, a commitment to alcohol and drug abuse treatment for employees in need can help reduce accidents, absenteeism, employee theft and fraud, insurance claims, and workers’ compensation costs. Numerous studies have shown that the resources required to support such treatment and recovery programs are well worth the investment. For example, full parity for alcohol and drug treatment services in private health insurance plans that tightly manage care would increase family insurance premiums less than one percent.¹⁰

Making a Difference:  What Can I Do?

Making a Difference: How Can I Focus My Efforts During Recovery Month?

Each September, Recovery Month is observed and celebrated by hundreds of organizations across the country to spotlight the importance of substance abuse treatment. This year’s theme is “Join the Voices for Recovery:  Celebrating Health.” Your company can make a difference by taking part in outreach efforts to promote and observe Recovery Month. Here are a few ideas to help you begin:

You are encouraged to share your plans and activities for Recovery Month 2003 with SAMHSA’s Center for Substance Abuse Treatment, your colleagues, and the general public by posting them on the official Recovery Month web site at http://www.recoverymonth.gov.

We would like to know about your efforts during Recovery Month. Please complete the Customer Satisfaction Form enclosed in the kit. Directions are included on the form.

For any additional Recovery Month materials visit our web site at
http://www.recoverymonth.gov or call 1-800-729-6686.

Additional Resources