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2014 Toolkit


Treatment and Recovery Support

Download Word version of "Treatment and Recovery Support" (1,388 KB)

Introduction…

Every September, the Substance Abuse and Mental Health Services Administration (SAMHSA) (http://www.samhsa.gov), within the U.S. Department of Health and Human Services (HHS) (http://www.hhs.gov), 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 recover from these conditions.

The 25th annual Recovery Month theme, “Join the Voices for Recovery: Speak Up, Reach Out,” encourages people to openly discuss mental and substance use disorders and the reality of recovery.  It aims to promote increased understanding about the many effective treatment and recovery support options that are available to help individuals recover from these illnesses and achieve wellness.

Recovery is defined 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.1  Recovery Month encourages individuals in need of assistance with a mental and/or substance use disorder to speak up and reach out for help and works with the recovery community to speak up about the benefits of recovery and support those in need.  The third week of September is also devoted to wellness.  Wellness Week (http://www.promoteacceptance.samhsa.gov-/10by10/default.aspx) is a time to reflect on SAMHSA’s eight dimensions of wellness (http://www.promoteacceptance.samhsa.gov/10by10/dimensions.aspx), which can assist individuals in their recovery and encourage others to work on one of these dimensions.

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Speak Up and Reach Out For Help…

There are many paths to recovery from a mental and/or substance use disorder and several ways to get help.  If you, a family member, or friend needs help, resources are available.  You are not alone.  In your community, there are professionals who are trained and experienced in providing help to individuals and family members with behavioral health conditions.  At the end of this document under “Resources” is a list of national and local resources, as well as toll-free numbers that can connect you to the services you are seeking.  If you or someone you care about needs help, reach out.

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Take the First Step – It is Worth It…

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 can make a positive impact. Recognizing the signs and symptoms of a mental health or substance use problem is the first step toward obtaining help and getting better.  The “Youth and Young Adults” (http://rmdev.relyonmedia.com/Recovery-Month-Kit/Targeted-Outreach/2014-Youth-and-Young-Adults.aspx) section in this toolkit provides a list of common signs and symptoms of behavioral health conditions to assist in this process.  Once individuals are aware of their health condition, they can take the necessary steps to seek assistance.  Investing in one’s recovery through treatment improves an individual’s quality of life, as well as their caregiver’s life.  Intervening early, before behavioral health problems progress, is also among the best and most cost-effective ways to improve health.  From 2004 through 2008, Washington State achieved cost savings by intervening early with at-risk patients in emergency care settings.  Using a model of Screening, Brief Intervention, and Referral to Treatment (SBIRT), the state Medicaid program saved almost $2 million dollars per year for just 1,000 patients.2

Most people who seek help for a mental and/or substance use disorder experience reduced or eliminated symptoms, and they are able to manage their diseases.  According to the National Institute of Mental Health, treatment success rates for mental disorders are 60 percent for schizophrenia, 70 to 80 percent for depression, and 70 to 90 percent for a panic disorder.3  Treatment for borderline personality disorder not only improves psychiatric symptoms but also quality of life.4  Similarly, treatment for substance use disorders has also demonstrated positive benefits.  Research shows that treatment can help people stop substance use, avoid relapse, and lead active lives engaged with their families, workplaces, and communities.5  Additionally, researchers have found that treating alcohol addiction reduces burden on the family budget and improves life for those who live with the alcohol dependent individual.6

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Treatment and Recovery Support Services…

Because mental and substance use disorders are complex and have several dimensions, treatment is provided in different settings based on the nature and intensity of care required.  Treatment for mental and/or substance use disorders is available in outpatient, residential, and inpatient settings.

  • Outpatient treatment is provided in an ambulatory care setting, such as a mental health center or substance use disorder clinic, hospital outpatient department, community health center, Federally Qualified Health Center, workplace, school, or practitioner’s office.  In these settings, individuals are able to receive services while living in their current residence, and are able to participate in their regular daily routines, such as work, childcare, or school.7
  • Residential treatment is provided 24 hours a day in a non-hospital based facility where staff deliver a customized set of services.  Individuals admitted to a residential setting require a safe and stable environment to manage symptoms and to achieve recovery.  The therapeutic community (TC) model is an example of one approach to treatment delivered in a residential setting.  TCs use a hierarchical approach with treatment stages that reflect increased levels of personal and social responsibility.  Peer influence is used to help individuals learn and assimilate to social norms and develop more effective social skills.8
  • Inpatient treatment is delivered 24 hours a day within a general hospital or psychiatric hospital to evaluate and treat an acute psychiatric condition.  Individuals treated in this setting may pose a significant danger to themselves or others.9  Inpatient treatment is also used for medically managed detoxification and treatment for psychoactive substance disorders.

Proven and effective treatment methods for mental and/or substance use disorders include behavioral treatments, medications, and recovery support services.  Effective treatment methods are directed to the various aspects (biological, psychological, and social) of the illness.  For a directory of recovery support services, refer to the “Prevention, Treatment, and Recovery Resources” (http://recoverymonth.gov/Recovery-Month-Kit/Resources/Recovery-Month-Resources.aspx) section of the toolkit.

The following table provides examples of commonly-used treatment methods for youth and adults.

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Mental and Substance Use Disorder Treatment and Recovery Support Services…

Type of Service

Common Mental Disorder Service Descriptions

Common Substance Use Service Descriptions

Behavioral Treatments help change potentially harmful behaviors. Professionals use various types of therapy to replace negative or disruptive behavior with healthy and positive behavior.

Cognitive behavioral therapy (CBT) 10 focuses on relationships between an individual’s thoughts, feelings, and behaviors. A CBT-trained professional can help people explore the links between their thoughts and the emotions that occur prior to disruptive behaviors. This allows people to identify and change inappropriate or negative thought patterns and address the associated behaviors.

Family-focused therapy (FFT)11 is centered on the importance of strong family relationships in managing a mental illness. Family members attend FFT along with the patient. 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 improving communications and the ways a person relates to others. When a behavior is causing problems, IBT guides the person to change the behavior. The individual may also examine relationships in his or her past that may have been affected by or affect the mental illness. This type of therapy guides people to change negative behaviors and express appropriate emotions in a healthy way.

Dialectical behavioral therapy (DBT)13 coaches the patient to understand that it is his or her personal responsibility to change unhealthy or disruptive behavior. The therapist communicates to the patient any unhealthy or disruptive behaviors and then teaches the skills needed to better deal with these issues. Throughout treatment, a strong and equal relationship between patient and therapist is maintained.

CBT helps patients recognize, avoid, and cope with the situations in which they are likely to use substances.14 CBT helps patients develop skills that can foster abstinence from substances and further prevent relapse from substance use.15

Multidimensional family therapy (MDFT) addresses a range of influences on a patient’s substance abuse patterns and is designed to improve overall family functioning.16

Brief Strategic Family Therapy (BSFT) targets family interactions that are thought to maintain or exacerbate adolescent drug abuse and other co-occurring problem behaviors. Such problem behaviors include conduct problems at home and at school, delinquency, associating with antisocial peers, aggressive and violent behavior, and risky sexual behavior. The BSFT counselor helps to identify the patterns of family interaction that are associated with the adolescent’s behavior problems and assists in changing those family patterns.17

Motivational interviewing (MI) is a counseling approach that is based on an individual’s level of readiness to change their behavior. MI uses collaborative conversation and empathy to facilitate motivation to change behavior.18

Contingency management (or motivational incentives) uses positive reinforcement to meet specific behavioral goals, such as abstaining from using substances.19 This approach is based on the premise that behavior is more likely to be repeated if followed by positive reinforcement.

Medications should always be taken as prescribed and under a medical professional’s care. It is important to discuss the pros and cons of taking different medications for the treatment of mental and/or substance use disorders with your health care provider.

Questions may include: what are the benefits of the medication?; what side effects may occur?; and what possible interactions could occur with other medications or foods and drinks?20 The dosage and length of time prescribed to take medication is different for each person, and it is based upon the type of medication prescribed and the disorder it is intended to treat. If a person finds he/she is not responding to a medication, he/she should work with their doctor to try another that meets their needs.

Medications are tools that assist many people with mental illness to lead fulfilling lives. People with mental illness may suffer serious and disabling symptoms that can be improved or eliminated with medications. Medications treat the symptoms of mental illness; they generally do not cure the illness. Very frequently, however, they make people feel better and function better. Medications work differently for different people. Some people get great results from medications and only need them for a short time; others need them for a longer time or take them throughout their lives. Some people get side effects from medications and others do not.

Many medication options exist for a range of mental disorders, including depression, bipolar disorder, anxiety disorders, schizophrenia, and attention-deficit hyperactive disorder (ADHD).21

Medication-assisted treatment (MAT) is the use of medications, in combination with counseling and behavioral therapies, to provide a whole-patient approach to the treatment of substance use disorders. Research shows that when treating substance use disorders, a combination of medication and behavioral therapies can be most successful.22

Certain medications can be used during detoxification, a process when the body clears itself of drugs but is often accompanied by unpleasant, serious side effects.23 Medications help to manage withdrawal symptoms.

Medications 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.24

Several medications are also currently available to treat addiction to opioids. Treatments for opioid addiction (such as methadone, buprenorphine, and naltrexone) suppress withdrawal symptoms, relieve cravings, and help disengage someone from drug-seeking behavior, thereby assisting them in achieving and maintaining recovery.25

Recovery Support Services (RSS)/Peer Recovery Support Services (P-RSS) are nonclinical services that assist individuals, as well as their families, in recovery from mental and/or substance use disorders. The goal is to facilitate long-term recovery and wellness, contributing to an improved quality of life.

RSS can be provided by behavioral health professionals or peers. These services include employment services and job training, housing assistance, child care, transportation, legal services, family/marriage education, peer mentoring and coaching, life skills training, and social and athletic activities.

Peer recovery support services provide social support to individuals at all stages on the continuum of change that constitutes the recovery process.28

RSS are provided through face-to-face and virtual support, including telephone and on-line methods. For many, online recovery support supplements other recovery pathways. They increase access to assistance for those with geographic, time, or physical limitations. Common online methods include Facebook, Twitter, email, real-time chats meetings, bulletin board discussions, blogs, and mobile applications.

P-RSS provide emotional support and coping strategies to manage mental illnesses. Settings for delivering these services include mental health centers, emergency rooms, and crisis centers. Certified Peer Specialists (CPSs) work with consumers to regain balance and control of their lives and support recovery. A CPS operates from his or her lived experience and experiential knowledge.26

RSS and P-RSS are provided in conjunction with treatment, and as a separate service, to individuals and families. The functions of P-RSS span the stages of recovery initiation/stabilization, recovery maintenance, and enhancement of quality of life in long-term recovery.27 RSS are provided within treatment agencies, recovery community organizations, faith-based organizations, and allied systems.

Like CPS, recovery coaches, based on their own life and experiences, remove barriers to recovery and serve as a personal guide and mentor for people seeking, or in recovery from, substance use disorders.

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Alternative Pathways to Wellness and Recovery…

For many, recovery and wellness involve the health of the mind, body, and spirit.  People seeking treatment or in recovery from a behavioral health condition can enhance their recovery and encourage individual wellness through the following techniques:

  • 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.29
  • Yoga:  Combines physical postures, breathing techniques, meditation, and relaxation to help people maintain their health, improve physical fitness, and relieve stress.  Yoga is used to address physical and behavioral health conditions.  Yoga of Recovery (http://yogaofrecovery.com) is an organization that uses a 12-step format to help people who are recovering from addictive behaviors.30
  • Acupuncture:  Involves stimulating specific points on the body with thin metallic needles that are manipulated by the hands or by electrical stimulation.  This treatment is often used to relieve pain or for other therapeutic purposes.31
  • Expressive or creative arts therapy:  Uses expressive or creative arts therapy to help people heal and maintain a sense of wellness through art, music, dance, writing, or other expressive acts.
  • Animal-assisted therapy:  Works using animals to help people cope with trauma, develop empathy, and communicate better.32
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Resources…

Many options are available to help people seek treatment and sustain recovery.  Whatever path a person chooses, it is important that each individual finds the treatment and support that work best for him or her.  To assist individuals in reaching out, a variety of organizations that provide information and resources on mental and/or substance use disorders, as well as prevention, treatment, and recovery support services are included below.  Toll-free numbers and websites are also available for people to find help, obtain information, share, and learn from others.  Services and supports are available in person and via telephone and the Internet.  Through these resources, individuals can interact with others and find support on a confidential basis.

  • SAMHSA’s Website (http://www.samhsa.gov):  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 (http://www.samhsa.gov/treatment):  Contains information about treatment options and special services in local communities.
  • SAMHSA’s Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS) (http://beta.samhsa.gov/brss-tacs):  Serves individuals and communities that are vital for moving the field towards a recovery orientation. BRSS TACS offers resources and opportunities to a wide audience, including States, Territories, Tribes, direct service providers, advocates, families, and people in recovery.
  • SAMHSA’s “Co-Occurring Disorders” Website (http://www.samhsa.gov/co-occurring):  Contains information on co-occurring mental and substance use disorders and treatment options for these conditions.
  • SAMHSA’s National Prevention Week (http://beta.samhsa.gov/prevention-week):  A SAMHSA-supported annual health observance dedicated to increasing public awareness of, and action around, substance abuse and mental health issues. National Prevention Week 2014 is about Our Lives. Our Health. Our Future.
  • SAMHSA’s Opioid Overdose Prevention Toolkit (http://store.samhsa.gov/product/Opioid-Overdose-Prevention-Toolkit/SMA13-4742):  Equips communities and local governments with material to develop policies and practices to help prevent opioid-related overdoses and deaths. Addresses issues for first responders, treatment providers, and those recovering from opioid overdose.
  • SAMHSA’s Recovery Month Facebook (http://www.facebook.com/RecoveryMonth) and Twitter (https://twitter.com/recoverymonth):  Offers a location to connect with others who are currently active in the online recovery community.
  • SAMHSA’s Resource Center to Promote Acceptance, Dignity and Social Inclusion Associated with Mental Health (ADS Center) (http://www.promoteacceptance.samhsa.gov):  Enhances acceptance and social inclusion by ensuring that people with mental illness can live full, productive lives within communities without fear of prejudice and discrimination. It provides information and assistance to develop successful efforts to counteract prejudice and discrimination and promote social inclusion.
  • SAMHSA’s Recovery to Practice Initiative (RTP) (http://www.samhsa.gov/recoverytopractice/Index.aspx):  Incorporates the vision of recovery into the concrete and everyday practice of mental health professionals in all disciplines.
  • SAMHSA’s Shared Decision-Making in Mental Health Care (http://store.samhsa.gov/product/Shared-Decision-Making-in-Mental-Health-Care/SMA09-4371):  Gives an overview of shared decision-making (SDM), an intervention that enables people to actively manage their own health. Examines research on the effects of SDM in general and mental health care and includes recommendations for advancing SDM in practice.
  • SAMHSA’s Wellness Initiative and Wellness Week (http://www.promoteacceptance.samhsa.gov/10by10/default.aspx):  Promotes the importance of the mental, emotional, physical, occupational, intellectual, and spiritual aspects of a person's life for well-being. Offers tools to incorporate wellness into recovery and life. Aims to inspire individuals, families, behavioral health and primary care providers, and peer-run, faith-based, and other community organizations to improve their health behaviors, while also exploring their talents, skills, interests, social connections, and environment to incorporate SAMHSA’s Eight Dimensions of Wellness into their lives as part of a holistic lifestyle.
  • Healthcare.gov (http://www.healthcare.gov/index.html):  Contains information on how to find health insurance options, compare providers, enroll in a health plan, and on prevention and wellness resources.
  • National Suicide Prevention Lifeline (http://www.suicidepreventionlifeline.org), 1-800-273-TALK (8255):  Provides a free, 24-hour helpline available to anyone in suicidal crisis or emotional distress.
  • Addiction Recovery Guide’s Mobile App Listing (http://www.addictionrecoveryguide.org/resources/mobile_apps):  Contains online recovery options, including self-evaluation, recovery programs, online treatment, and chat rooms.
  • Alcoholics Anonymous (http://www.aa.org) and Narcotics Anonymous (http://www.na.org):  Contains resources for individuals suffering from alcohol or drug dependence and allows them to find and join a local chapter.
  • Al-Anon/Alateen Family Groups (http://www.al-anon.alateen.org):  Provides support groups for families and friends of people with alcohol problems.
  • Depression and Bipolar Support Alliance (http://www.dsballiance.org):  Envisions wellness for people who live with depression and bipolar disorder.  Because DBSA was created for and is led by individuals living with mood disorders, its vision, mission, and programming are always informed by the personal, lived experience of peers.
  • Faces and Voices of Recovery (http://www.facesandvoicesofrecovery.org):  Offers resources on recovery from addiction to alcohol and other drugs.  Through nationwide regions, organizes and mobilizes Americans in recovery from addiction to alcohol and other drugs to promote their right and resources to recover.
  • In the Rooms (http://www.intherooms.com):  Provides 24/7 online recovery support that allow participants to reach out to one another, share their experiences, and give support.  Offers social networking tools to support recovery and an online network for friends and families.
  • Mental Health America (MHA) (http://www.mentalhealthamerica.net):  Offers resources about mental illness. Through their affiliates, MHA provides America’s communities and consumers direct access to a broad range of self-help and professional services.
  • National Alliance on Mental Illness (http://www.nami.org):  Works in local communities across the country to raise awareness and provide essential and free education, advocacy, and support group programs.
  • National Council on Alcoholism and Drug Dependence, Inc. (NCADD) (http://ncadd.org):  Provides, through the national NCADD and its affiliate network, numerous resources and services dedicated to fighting alcoholism and drug addiction.
  • National Organization of Children of Alcoholics (NACoA) (http://www.nacoa.org):  Works on behalf of children of alcohol and drug dependent parents.  NACoA provides information on its website about the ways to help children of alcoholics and other drug-dependent parents and maintains a toll-free phone available to all.
  • Psychology Today’s Therapy Directory (http://therapists.psychologytoday.com/rms):  Allows users to locate a therapist, psychologist, or counselor who specializes in mental illness by city or zip code.
  • RecoverForever.com (http://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 (http://www.racingforrecovery.com):  Helps people sustain recovery and improve their quality of life by promoting a healthy lifestyle, fitness, and sobriety.
  • SMART Recovery (http://www.smartrecovery.org):  Is a self-empowering addiction recovery support group. SMART Recovery sponsors face-to-face meetings and daily online meetings.
  • SSI/SSDI Outreach, Access, and Recovery (SOAR) (http://www.prainc.com/soar/about/default.asp):  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.
  • StopAlcoholAbuse.gov (https://www.stopalcoholabuse.gov/default.aspx):  Provides a comprehensive portal of Federal resources for information on underage drinking and ideas for combating this issue.
  • T2 Mood Tracker (http://t2health.org/apps/t2-mood-tracker):  Allows users to self-monitor, track, and reference their emotional experiences through a mobile application 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.
  • Youth M.O.V.E. (http://www.youthmovenational.org):  Improves youth services and systems by uniting the voices of individuals who have lived experience in various systems, including mental health, juvenile justice, education, and child welfare.
  • Young People in Recovery (http://youngpeopleinrecovery.org):  Educates, advocates, and collaborates to mobilize the voices of young people in 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.

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SOURCES

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