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Families Are the Frontline: Preventing, Treating, and Recovering From Substance Use and Mental Disorders

Nancy Young

06 Preventing Treating and Recovering From Substance Use and Mental Disorders

Ask the Expert:  Dr. Nancy K. Young is the Director of Children and Family Futures, a California-based research and policy institute whose purpose is to improve outcomes for children and families affected by substance use disorders. Dr. Young also serves as the Director of the federally-funded National Center on Substance Abuse and Child Welfare, which provides technical assistance to states, communities, and tribes to enhance cross-system approaches for the benefit of affected families.

1. Question: As a young person in recovery my family has been vital in my process of change.  Other than 12-step meetings for family and friends of alcoholics and addicts, what are some peer resources that I can suggest to my family?  What do they do if there isn't a network of family members in recovery in our area?  How do they find one or start one?

Answer: Some substance use treatment programs provide aftercare services to their clients, including Peer Recovery Support Services, such as Alumni Group and Peer Mentors. The programs can provide opportunities for individuals and their families to mentor and provide support to those receiving treatment, such as in leading recovery support groups, mentoring individuals and their families, assisting individuals in accessing basic needs such as housing, employment and education, as well as providing opportunities to be involved in other aspects of the facility – such as community outreach, public speaking and fundraising.

The Substance Abuse and Mental Health Services Administration (SAMHSA) has developed a  great publication on Peer Recovery Support Services that provides information on the different types of services available. It can be downloaded from:
http://store.samhsa.gov/product/What-Are-Peer-Recovery-Support-Services-/SMA09-4454

Depending on where you live, you can identify what peer resources are offered by contacting the substance use treatment facilities in your area. To identify treatment facilities, SAMHSA has a web-based treatment locator to help you identify facilities in your area. To access the treatment locator, see:
http://findtreatment.samhsa.gov/TreatmentLocator/faces/quickSearch.jspx

Recovery-Oriented Systems of Care (ROSC) Resource Guide – This guide, which contains information from the Substance Abuse and Mental Health Services Administration (SAMHSA), and jurisdictions around the country. The guide can provide information to enhance prevention, treatment, and recovery services as the changes in health care evolve in communities.  The purpose of this resource guide is to share an overview of ROSC and illustrate how these systems are an integral part of the new health care environment. This guide will align the tenets of health care reform to the benefits, framework, and history of ROSC, and the steps for planning and implementing ROSC.  Following each section of the guide’s narrative, you will find websites to direct you to specific resources that will assist you in conceptualizing and developing ROSC. The resources in this guide include research studies, white papers, conference presentations, manuals, practice guides, check lists, regulations and a number of other documents that have been prepared in response to the need for systems reform. More information can be found at:
http://partnersforrecovery.samhsa.gov/docs/ROSC_Resource_Guide_Book.pdf

September is Recovery Month. Recovery Month promotes the societal benefits of prevention, treatment, and recovery for mental and substance use disorders, celebrates people in recovery, lauds the contributions of treatment and service providers, and promotes the message that recovery in all its forms is possible. Recovery Month spreads the positive message that behavioral health is essential to overall health, that prevention works, treatment is effective and people can and do recover. Identifying Recovery Month events in your area should also be useful in identifying supports in your community.
For more information go to:
http://www.recoverymonth.gov/

Faces & Voices of Recovery is a national organization with tens of thousands of individuals and organizations uniting for more effective action across the country. Local and state recovery community organizations work in public ways with people in long-term recovery, families, friends and allies to affect positive changes.   The organizations website has information on event organizing.  The website also includes a listing of regional contacts who may be excellent contacts to become aware of recovery advocacy in your community and state,
http://www.facesandvoicesofrecovery.org/

The following organizations have been awarded funding by SAMHSA to support peer recovery services. They might be a good resource to start your research in identifying resources in your area.

2. Question: Where is the evidence that families are the frontline in preventing, treating and recovering from a mental illness? The focus on social supports in recovery would seem very misguided since these factors account for a very small portion of the outcome variance.  Maybe, we are missing something important here.  In particular, I believe that we totally ignore the influence of behaviors, traits, characteristics and cognitive skills that the individual had BEFORE he/she ever began to show symptoms of mental illness. Yet, if we studied and recognized the potential effect that PREMORBID factors had on recovery, perhaps we could create and implement much more highly individual treatment and recovery plans. Premorbid dispositions play a significant role in the recovery of many chronic illnesses: why should this not also be true in mental health?

Answer: The issue of environment vs. biology has been a long-standing research question and it is still unclear which plays the greater role in the development of chronic illnesses, including mental health disorders. The National Alliance of Mental Illness (NAMI) is an advocacy organization and their website includes a comprehensive listing of mental health disorders, including what the research indicates on the cause of specific disorders. For instance, some anxiety disorders, such as Obsessive Compulsive Disorder (OCD), have been found to have a very clear genetic link,  a link between  some cases of OCD and infection to a certain bacteria have been found and other anxiety disorders have been found to be caused by brain injury. More information can be accessed from the NAMI website:
  http://www.nami.org/Template.cfm?Section=By_Illness


3. Question: We have a client whose 30 year old son smokes pot everyday sometimes 2x a day or more... he uses it for "medicinal" purposes. He refuses to acknowledge there is a problem and instead states it calms him down. He was referred to anger management and a trauma psychiatrist, but was referred back. The Psychiatrist refused to treat him until he stopped smoking pot. How can we help him?

Answer: You can find a psychiatrist who specializes in co-occurring mental health and substance use disorders who is board certified by the American Society of Addiction Medicine (ASAM). ASAM certified physicians must first be board-certified in another medical specialty prior to meeting ASAM criteria.  Addiction medicine physicians often treat patients who are experiencing both substance use and mental health or psychiatric conditions. The ASAM website has a search function that allows you to locate a certified physician in your state. See: http://asam.site-ym.com/search/

4. Question: What would be the best treatment approach for clients with co-occurring disorders?

Answer: SAMHSA developed a publication entitled Treatment Improvement Protocol 42: Substance Abuse Treatment for Persons with Co-Occurring Disorders. This guide provides information on co-occurring substance use and mental health disorders and offers assessment and treatment strategies and models. This guide may be downloaded for free online at: http://store.samhsa.gov/product/TIP-42-Substance-Abuse-Treatment-for-Persons-With-Co-Occurring-Disorders/SMA08-3992

SAMHSA also offers the Integrated Treatment for Co-Occurring Disorders Evidence-Based Practices KIT, available online at: http://www.samhsa.gov/co-occurring/news-and-features/integrated-treatment.aspx. This kit offers practice principles about integrated treatment for co-occurring disorders. Integrated treatment offers mental health and substance abuse services at the same time and in one setting, and treatment components include stage-wise treatment, motivational interventions, cognitive-behavioral approach, integrated medication services, and cross-trained practitioners. Integrated treatment has been found to reduce substance abuse, improve psychiatric symptoms and functioning, decrease hospitalization, increase housing stability, improve quality of life and lead to fewer arrests.  For more information on co-occurring mental illness and substance use disorders and integrated treatment, visit the SAMHSA website at: http://www.samhsa.gov/co-occurring/

SAMHA’s National Registry of Evidence-Based Programs and Practices (NREPP) is an online registry of more than 230 evidence-based interventions for mental illness and substance abuse. The registry offers information about the intervention a description of the research outcomes, a list of studies and materials, and contact information to obtain more information about implementation or research. You can search this registry for particular research-supported interventions for persons with co-occurring disorders. You may access NREPP at: http://nrepp.samhsa.gov/Index.aspx

5. Question: I have a 29 year old son who suffers from schizoaffective disorder and schizophrenia...at first diagnosed with the latter and then the former - what is the difference?  We have sent him to 3 different treatment facilities for his dual diagnosis (he uses codeine/marijuana and cough syrup) since he has had highs so bad that I have had to rush him to emergency and now he sits in jail possibly looking to up to 60 months in prison for shoplifting (6 month sentence of jail) but he threw a coffee container at the judge and is now looking at prison time.  Where can he go after he gets out?  We have been living this nightmare for 10 years...he keeps saying he doesn't have a drug problem, doesn't comply at the treatment centers and then gets thrown out.

Answer: The National Alliance of Mental Illness (NAMI) is an advocacy organization and their website includes a comprehensive listing of mental health disorders, including schizophrenia and schizoaffective disorder. The listing provides a description of each disorder, including symptoms and research. According to the website, schizoaffective disorder is now considered a type of schizophrenia. It differs from schizophrenia in that affected individuals experience both symptoms of schizophrenia (such as delusions, hallucinations, disorganized speech, disorganized behavior) along with major depression or manic episodes. See http://www.nami.org/Template.cfm?Section=By_Illness&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&ContentID=87235 for more detail.

While in prison, your son may be able to access treatment for both his mental health and substance use, depending on which programs are available in your area. The U.S. Department of Justice, Federal Bureau of Prisons (DOJ BOP) funds various programs, including Residential Drug Abuse Program (RDAP), a 9 month program in which participants live separately from the general population and participate in activities to support vocational and educational goals. The program is available in approximately 64 sites, with 3 serving those with co-occurring mental health and substance use issues. For a listing and more information, see:
 http://www.bop.gov/inmate_programs/RDAP_locations.pdf

To access the above resources, contact the services coordinator/case manager/social worker type person that is assigned to your son’s case. You can also work with the assigned coordinator to work on a transition plan to assist your son in returning to the community. Upon release from prison, the following resources may be useful.

The DOJ BOP also funds a Release Preparation Program, in which individuals re-entering the community are supported through placement in residential reentry centers (RRC) or halfway houses. Depending on the programs in your area, services can include substance use treatment and mental health services. For more information, including a listing of RRCs, see:
 http://www.bop.gov/locations/cc/index.jsp
Other programs seeking to help individuals re-enter the community include:

6. Question: What do you think of the SPECT brain scan imaging that can be used to help with diagnoses? I’m particularly interested in the work of Dr. Amen (http://www.amenclinics.com/). Do you know if there is any funding available to go to a clinic such as his, my son is on SSI and Medicaid. We are hoping this will help him be properly diagnosed and treated. We live in NE and these types of clinics are not available in our area. 

Answer: Brain scan imaging is typically used within the research arena and is not commonly linked to clinical practice, and brain scans cannot typically be used alone to diagnose mental illness. For more information about brain scan imaging and brain science, visit the National Institute of Mental Health: http://www.nimh.nih.gov/health/publications/neuroimaging-and-mental-illness-a-window-into-the-brain/neuroimaging-and-mental-illness-a-window-into-the-brain.shtml.

To locate a clinic in your area that can provide comprehensive assessment and treatment for substance use and mental disorders, visit the Substance Abuse and Mental Health Services Administration (SAMHSA) website at: http://findtreatment.samhsa.gov/TreatmentLocator/faces/quickSearch.jspx. A treatment center will offer experienced treatment professionals that will conduct proper screening, assessment, treatment planning and appropriate treatment to meet your son’s needs. Screening services determine the likelihood of a substance abuse or mental health disorder by looking at the presenting signs, symptoms or behaviors. Following screening, an in-depth assessment gathers information and seeks to determine if a person’s condition meets diagnostic criteria for a given disorder and to identify appropriate treatment responses geared toward the individual’s strengths, challenges and needs. Treatment planning leads to a comprehensive set of treatment interventions and services that take into account the challenges related to the mental health or substance use disorder. The treatment plan is client-centered, and is matched to the person’s needs, diagnosis, level of care needs, readiness for change, preferences and goals.



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