Mental and/or substance use disorders (also known as behavioral health conditions) affect millions of individuals, as well as their families and friends who are concerned about them. Many opportunities exist to help them reclaim their lives, restore their relationships, and build promising futures. With the right care, support, and commitment, people with behavioral health conditions can improve their health, lead rewarding lives, and direct their own recovery path while managing their condition.
The 23rd annual National Recovery Month (Recovery Month) observance this September will celebrate the effectiveness of treatment services and the reality of recovery. Recovery Month is sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), within the U.S. Department of Health and Human Services (HHS).
This year's theme, "Join the Voices for Recovery: It's Worth It," emphasizes that while the road to recovery may be difficult, the benefits of preventing and overcoming mental and/or substance use disorders are significant and valuable to individuals, families, and communities. People in recovery achieve healthy lifestyles, both physically and emotionally, and contribute in positive ways to their communities. They also prove to family members, friends, and others that prevention works, treatment is effective, and people recover.
The Recovery Month campaign aligns with many of SAMHSA's Strategic Initiatives, which guide SAMHSA's work to help people with mental and/or substance use disorders, their communities, and their families. SAMHSA works to help people prevent and overcome costly behavioral health conditions and to promote overall health and well-being for all Americans.
This overview details the spectrum of behavioral health conditions, prevention, and recovery across different audiences, including active military, veterans, and families; people within the justice system; families and friends of someone in need; and the recovery community. This toolkit provides additional sections about how all types of individuals can harness the strength, hope, and courage to overcome their disorders and actively participate in family life and their communities. In addition, the "Join the Voices for Recovery" document shares positive journeys from the perspectives of multiple individuals in recovery.
The Current Mental Health and Substance Use Landscape – And the Promise of Recovery
Mental and/or substance use disorders and recovery from these disorders are prevalent in people of every ethnicity, age, gender, geographic region, and socioeconomic level. According to the 2010 National Survey on Drug Use and Health, approximately 45.9 million adults aged 18 or older had any mental illness in the past year, and 11.4 million adults aged 18 or older had a serious mental illness.1 Additionally, 22.1 million Americans aged 12 or older were classified with substance dependence or abuse (substance use disorders).2 Of these people, 17.9 million people aged 12 or older met the criteria for alcohol dependence or abuse.3
Mental illnesses include major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder, panic disorder, post-traumatic stress disorder, and borderline personality disorder.4 These illnesses can result in severe functional impairment, substantially interfering with or limiting one or more of a person's major life activities.5 They can also disrupt relationships with family members, friends, co-workers, and neighbors.
However, about two-thirds of Americans believe that treatment and support can help people with mental illnesses lead normal lives. In 2010, 31.3 million adults aged 18 or older received mental health services during the past 12 months.6 Also in 2010, 2.9 million youth aged 12 to 17 received treatment or counseling for problems with emotions or behavior in a specialty mental health setting (inpatient or outpatient care) in the past year.7 Among youth aged 12 to 17, common reasons for receiving specialty mental health treatment include depression (47.6 percent) and suicidal thoughts or attempts (20.8 percent).8 Experts believe that approximately 80 percent of patients with depressive disorder improve significantly with treatment services,9 such as cognitive behavioral therapy, interpersonal therapy, and peer support groups.10 For example, data show that with cognitive behavioral therapy, which focuses on identifying, understanding, and changing thinking and behavior patterns, benefits are usually seen within 12 to 16 weeks of treatment.11
Substance use is another common problem. People with substance use disorders have problems with misuse, dependence on, or addiction to alcohol, tobacco, and/or illicit or prescription drugs. Substance use disorders often include physical, behavioral, and psychological symptoms.12 Similar to many other health conditions, genetics can play a role in the development of a substance use disorder.13
Like mental health problems, substance use disorders are also highly treatable.
In 2010, 2.6 million people aged 12 or older received services for alcohol or illicit drug use at a specialty facility in the past year.14
Treatment options for substance use disorders include residential or inpatient treatment programs, outpatient treatment programs, counseling, and sober living programs.15 Through its national helpline,1-800-662-HELP (4357), SAMHSA provides free, 24-hour confidential treatment referral and information about mental and/or substance use disorders, prevention, and recovery.
The positive news is that millions of Americans are in recovery from mental and/or substance use disorders today.16 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.17 SAMHSA also supplements this definition with four major dimensions that support a life in recovery:18
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.
Long-term recovery is a remarkable achievement, and Recovery Month celebrates this rewarding journey. Through individual desire, local treatment and support services, and the support of families, friends, neighbors, and communities, recovery is possible. People in recovery use personalized solutions to sustain their recovery, achieve wellness, and inspire others to follow their lead in living healthy lives.
Still, we need to encourage more people to embrace the pathways to recovery and increase access to treatment and recovery services. For example, of the 23.1 million Americans aged 12 or older (9.1 percent) who needed treatment for illicit drug or alcohol use problem in 2010, only 2.6 million received treatment at a specialty facility. 19
The Power of Prevention
Prevention and early intervention are integral to combat mental and/or substance use disorders before problems develop or intensify. If effective prevention programs were implemented more broadly nationwide, substance abuse initiation among youths would decline by an estimated 1.5 million.20 Additionally, preventive intervention can reduce the incidence of depressive disorders by 22 percent.21
Behavior and symptoms signaling the likelihood of future behavioral disorders often manifest two to four years before a disorder is actually present, highlighting the opportunity for preventive interventions.22 Half of all mental, emotional, and behavioral disorders are diagnosed by age 14, and approximately 75 percent are diagnosed by age 24, so reaching young people is important.23
An increased focus on preventing mental and/or substance use disorders and related disorders among children, adolescents, and young adults is critical to the Nation's behavioral and physical health now and in the future.24 One of SAMHSA's goals through its Prevention of Substance Abuse and Mental Illness Strategic Initiative is to create communities where individuals, schools, faith-based organizations, and workplaces take action to promote emotional health and reduce the likelihood of mental illness, substance abuse, and suicide. As part of this effort, the responsibility is increasingly placed on families and friends to identify possible symptoms and signs of behavioral health conditions, seek assistance, and support the needs of people pursuing recovery.
For information about prevention, treatment, and recovery options and special services in your area, call SAMHSA's National Helpline at 1-800-662-HELP (4357) or 1-800-487-4889 (TDD), or visit http://www.samhsa.gov/treatment.
Among adults, warning signs of a mental health problem include:25
- Confused thinking;
- Prolonged depression;
- 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 use.
Among youth, warning signs of mental health disorders include:26
- Substance misuse;
- Inability to cope with problems and daily activities;
- Changes in sleeping and/or eating habits;
- Excessive complaints of physical ailments;
- Defiance of authority, truancy, theft, and/or vandalism;
- Intense fear of weight gain;
- Prolonged negative mood, often accompanied by poor appetite or thoughts of death; and
- Frequent outbursts of anger.
The signs and symptoms of substance use disorders among adults include:27
- Feeling fearful, anxious, or paranoid;
- Deterioration of physical appearance and personal grooming habits;
- Frequently getting into fights, accidents, or illegal activities;
- Sudden lack of motivation; and
- Unexplained need for money or financial problems.
Common symptoms of substance use disorders among youth include:28
- Associating with a new set of friends;
- Sudden decline in school performance;
- Reduced interest in previous hobbies; and
- Missing money, valuables, or prescription drugs from the household.
Many situations can trigger a mental and/or substance use disorder, including economic hardships and unemployment.29 Identifying harmful stressors and symptoms of mental and/or substance use disorders will help reduce the growing societal cost of behavioral health issues. In the United States, the annual indirect economic cost of mental illness is estimated to be $79 billion,30 and substance abuse accounts for a total estimated societal cost of approximately $510 billion.31 The economic costs of these conditions highlight their impact on entire communities, as well as individuals.
Encourage Recovery by Meeting Individual Needs
This year's Recovery Month campaign focuses on a range of individuals who pursue a better quality of life, as well as the people whose efforts make it possible for them to achieve and sustain recovery. Now more than ever, there is a chance to engage those who experience behavioral health conditions and support them and their family members in seeking treatment and recovery support services.
Each group described below faces a unique road to recovery, with different challenges, needs, and support options.
Members of the military are often exposed to extremely stressful situations, such as deployment and combat, that can affect mental health and substance use, and they may be hesitant to seek help for fear of damaging their careers.32 Furthermore, individuals may have a difficult time adjusting back into active service following deployment. For instance, nearly 20 percent of service members returning from Iraq or Afghanistan suffer from major depression or post-traumatic stress disorder (PTSD),33 an anxiety disorder that some people experience after seeing or living through a dangerous event.34
Additionally, families of deployed members of the military may face behavioral health challenges. Recent studies show that cumulative lengths of parental deployments are associated with a higher incidence of emotional difficulties among children of military personnel and increased mental health diagnoses among U.S. Army wives.35, 36
One step to helping loved ones receive needed care for both mental and/or substance use disorders is to encourage them to use available and easily accessible resources for members of the military and veterans, such as the Army Substance Abuse Program (ASAP) and the Veterans Crisis Line. Several additional resources are outlined in the "Address Mental and/or Substance Use Disorders among Active Military, Veterans, and Their Families" document of this toolkit. SAMHSA's Military Families Strategic Initiative also leads efforts to ensure that behavioral health services are accessible to those military families in need.
While anyone may be at risk of developing behavioral health issues, people in the criminal justice system experience mental and/or substance use disorders at increased rates compared with the general population. In fact, inmates in local jails are 3 to 6 times more likely than the general population to have a serious mental illness,37 and between 60 percent and 80 percent of individuals in the criminal justice system have a substance use disorder.38 Those in the criminal justice system also face a higher risk of co-occurring disorders, meaning they suffer from two or more disorders simultaneously, therefore increasing overall health risks and need for treatment. Approximately two-thirds of State and local inmates with mental health problems also meet clinical criteria for substance use disorders.39
People in the criminal justice system face the challenge of rebuilding their lives after release and need personalized supports that meet their needs. Additionally, a personal history of trauma is often present, requiring specific supports to address individuals' past experiences.40 Overcrowding and a lack of accessible services also present barriers. Fortunately, research suggests that improved services for prisoners and inmates with mental disorders could reduce recidivism as well as improve health.41
As outlined in the "Recovery among People in the Justice System" document, many resources are available to individuals in the criminal justice system, as well as their families, including government-sponsored programs, drug courts, and peer support groups. SAMHSA's Trauma and Justice Strategic Initiative addresses the needs of people within the criminal and juvenile justice systems with mental and/or substance use disorders who have histories of trauma, and sets out to reduce the effects of this trauma.
Family and friends are often the unsung heroes in the recovery process. Close relatives of those in need may need to seek help for themselves and their families to help them cope with their loved one's problem. Friends who are positive influences can be important allies and offer continuous support for individuals working toward their recovery.
As outlined in the "Families and Friends Can Make a Difference" document, awareness of the signs of behavioral health conditions is the first step to providing loved ones with the support to overcome mental and/or substance use disorders. Symptoms manifest differently for everyone, but learning about the various signs of behavioral health conditions enables family and friends the opportunity to intervene before a condition progresses.
Various techniques can be used by family and friends to effectively reach someone experiencing a mental and/or substance use disorder and give individuals the strength, guidance, and confidence to seek help. Their support can encourage someone with the will to live a fulfilling life in recovery.
There is perhaps no stronger advocate for recovery than peers who are already sustaining recovery. Many people who are struggling need someone they can empathize with, trust, and relate to while embarking on their own journey. The "Partner with the Recovery Community" document in this toolkit highlights how social supports can improve recovery outcomes.42
People in long-term recovery can gain a sense of pride from helping those in need, and individuals beginning their road to recovery can learn from their experiences. While each individual experiences his or her own unique journey, for many people, recovery:43
- 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.
Both the Families and Friends section and Recovery Community piece are highlighted by SAMHSA's Recovery Support Strategic Initiative, which partners with people in recovery from mental and/or substance use disorders to promote individual, program, and system-level approaches to recovery. The goal is to foster health and resilience; increase permanent housing, employment, education, and other necessary support structures; and reduce discriminatory barriers.
Overcome Barriers to Recovery
Despite the growing accessibility of recovery support services due to recent changes in Federal legislation, such as the implementation of the Affordable Care Act, barriers and challenges on the path to recovery still exist. For example:
Ethnic and socioeconomic disparities in the United States are prevalent. In 2009, 34 percent of Hispanics, 28 percent of American Indians/Alaska Natives, 23 percent of African Americans, and 18 percent of Asian Americans reported being uninsured - compared with only 14 percent of white Americans.44 Those who do not have health insurance may be less likely to receive the care they need.45 However, SAMHSA is helping narrow the gap to better serve all minorities through education and the Affordable Care Act, which will expand health care coverage to nearly 32 million non-elderly Americans.46 Additionally, SAMHSA's Strategic Initiatives focus on addressing such disparities in care. Its Minority Fellowship Program aims to reduce health disparities and improve outcomes by increasing the number of culturally competent behavioral health professionals available to help diverse populations.
Social prejudice or fear of being exploited or judged for a mental or substance use disorder often trumps a person's desire to seek treatment and support. SAMHSA's What a Difference a Friend Makes campaign seeks to promote acceptance and support for people with behavioral health conditions and counter the negative attitudes, beliefs, and behaviors associated with these issues. The SAMHSA ADS Center is a technical assistance center with multiple resources, including a map of national, State, and community-wide campaigns and programs that address social prejudice and discrimination toward people with behavioral health conditions.
It's Worth It
Every year, millions of Americans demonstrate the resilience to overcome mental and/or substance use disorders and lead healthy, productive lives in recovery. Through Recovery Month, many more Americans will become aware of the opportunities that make recovery possible and will hear about the triumphs of people's recovery journeys.
It's worth it for all individuals and communities to provide a positive influence for people suffering from mental and/or substance use disorders. Prevention, treatment, and recovery results in improved relationships within the community, workplace, and home environments. Treatment services can result in decreased crime, improved health, increased employment, and increased social function – demonstrating the widespread benefits of addressing mental and/or substance use disorders in communities across the Nation.
Once on a path toward recovery, individuals, families, and communities can truly realize that it's worth it to address these serious and all-too-prevalent disorders. Through individual action, family support, and available resources, people can regain their lives and spread the message to others that prevention works, treatment is effective, and recovery is possible.
Additional Recovery 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, 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 with behavioral health issues.
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.