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@samhsa.hhs.gov.

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

Sources

1	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.
2	Addiction in the Workplace Survey. Center City, MN:  Hazeldon Foundation, 1996.
3	Summary of Findings from the 2001 National Household Survey on Drug Abuse.
4	ibid.
5	ibid.
6	Substance Abuse and Mental Health Statistics Sourcebook. Rockville, MD:  U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 1995.
7	Treatment Is the Answer:  A White Paper on the Cost-Effectiveness of Alcoholism and Drug Dependency Treatment. Laguna Hills, CA:  National Association of Treatment Providers, 1991.
8	Worker Drug Use and Workplace Policies and Programs:  Results from the 1994 and 1997 National Household Survey on Drug Abuse. Rockville, MD:  U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 1999.
9	Maloney, J., Normand, J., and Salyards, S. An Evaluation of Pre-Employment Drug Testing. Journal of Applied Psychology, 75(6), 1990.
10	The Costs and Effects of Parity for Mental Health and Substance Abuse Insurance Benefits. Washington, DC:  U.S. Department of Health and Human Services, Substance and Mental Health Services Administration, 1998.
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.

Contents

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

“I’d been a heroin addict for years. My first days of awakening were walking into a faith-based community organization [Teen Challenge International]. I graduated in 1974. [Since then,] I’ve walked the excellence that I know is there to be walked. The man I’ve been now for 29 years is who I am." — Henry Lozano White House Advisor on Substance Abuse and Addiction

Community-Based and Service Organizations

Substance abuse is prevalent in America, affecting both families and individuals. The “2001 National Household Survey on Drug Abuse” highlights the following facts about substance abuse:¹

	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.

Recent events in the world have triggered Post-Traumatic Stress Disorder (PTSD) in people who also have substance abuse problems. In fact, an estimated 5.2 million American adults between the ages of 18 and 54 have PTSD. This is a dangerous situation for someone in treatment or recovery. Today, PTSD is clinically recognized as one of the symptoms of a co-occurring disorder when coupled with drug and alcohol abuse. According to the U.S. Substance Abuse and Mental Health Services Administration’s recently released Report to Congress on the Prevention and Treatment of Co-occurring Substance Abuse Disorders and Mental Disorders, 7 to 10 million individuals in this country have at least one mental disorder accompanied by an alcohol and drug abuse addiction. However, with the help of community-based organizations and faith organizations, people with co-occurring disorders can seek treatment and get the support they need to face their illness.

Why are faith-based and community organizations so successful? Consider these facts:

	For 6 out of 10 Americans, religious faith is the most important influence in their lives; for 8 out of 10, religious beliefs provide comfort and support.2
	Ministries can prevent substance abuse by reaching out to youth and getting them involved in positive activities (i.e., scouts, camping, or sports).3
	For teens, only 13 percent of those who attend religious services four or more times a month have smoked marijuana compared to 39 percent of those who attend services less than once a month.4
	Only 19 percent of teens who attend religious services four times or more a month have drunk alcohol in the past month, compared to 32 percent of those who attend religious services less than once a month.5
	There is evidence that social support from friends and outside influences can moderate the effects of a family history of drug and alcohol problems.6
	Children who coped effectively with the trauma of growing up in families affected by alcoholism often relied on the support of a non-alcoholic parent, stepparent, grandparent, teacher, or others when they were growing up.7
	Factors that have been cited in fostering student ability to resist drugs include positive peer affiliations, bonding/involvement in school activities, relationships with caring adults, opportunities for school success and responsible behavior, and the availability of drug-free activities.8

Making a Difference: What Can I Do?

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

Recovery Month is celebrated each year during September. This year’s theme, chosen to reflect the thousands of organizations who support Recovery Month, is “Join the Voices for Recovery:  Celebrating Health.” Whether your community-based organization or faith community is large or small, you are encouraged to participate in this year’s celebration. Here are some ideas on how to get involved:

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

“I got kicked out of pharmacy school twice due to a full-blown cocaine addiction— the school [called it] ‘academic difficulty.’ I call it the conspiracy of silence. People don’t know where to turn when [addiction] happens. There isn’t a lot of discussion about what to do and where to go." — David Marley Executive Director of the NC Pharmacists Recovery Network

Health Care Providers and Payers

Alcohol and drug abuse and addiction continues to be a huge problem in the United States. Nowhere is this felt more than in the health care community. Health care providers and those who pay for medical services feel the impact of a disease that affects millions. According to the “2001 National Household Survey of Drug Abuse:” ¹

	There are 15.9 million illicit drug users in the United States—7.1% of the U.S. population over 12 years of age.
	10.8 percent of youth 12-17 years of age used an illicit drug in the last 30 days.
	28.5 percent of all youth aged 12 to 20 drank in the last month— 10.1 million. Of that total, 6.8 million were binge drinkers, 2.1 million heavy drinkers.
	Almost one in five adult Americans lived with an alcoholic while growing up.2

With so many men, women, and youth using or addicted to alcohol and illicit drugs, the chances are that anyone engaged in the provision of health care will encounter people in need of help with alcohol and drug problems. It is almost certain that primary care physicians in managed care settings will encounter many of those with substance abuse problems since many of them have health care insurance and almost 77 percent of illicit drug users are employed.³ If a primary cause of their health problems—drugs and alcohol—is not met head-on, through referrals and support, these patients will continue to tax the medical care system and cost payers because of the need to treat other medical conditions exacerbated by substance abuse or addiction. The list of co-existing diseases is long, ranging from AIDS to hypertension and cardiovascular disease, from diabetes to hepatitis C.

In the course of practice, health care providers can also expect to see people with “co-occurring” disorders, that is, those with both mental and substance abuse disorders. 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.⁴ Unfortunately, large numbers of these people in need of treatment do not receive it.

Failure to treat both disorders almost assures an exacerbation of health problems. The U.S. Substance Abuse and Mental Health Services Administration’s Report to Congress on the Prevention and Treatment of Co-occurring Substance Abuse Disorders and Mental Health Disorders points out: “If one of the co-occurring disorders goes untreated, both usually get worse and additional complications arise. The combination of disorders can result in poor response to traditional treatments and increase the risk for other serious medical problems.”⁵

According to a substance abuse study of primary care physicians and patients, 54 percent of patients said their primary care physician did nothing about their substance abuse—43 percent said their physician never diagnosed it; 10.7 percent said they believed their physician knew about their addiction and did nothing about it.⁶ The study bolstered this perception by stating that “more than nine in ten physicians fail to spot substance abuse in adults. Four out of ten missed it in teens.”⁷ There are several reasons why physicians miss or misdiagnose substance abuse, including lack of adequate training in medical school, skepticism about treatment effectiveness, patient resistance, discomfort in discussing substance abuse with patients, and time constraints^.8

Effectiveness of Treatment

Only a small number of medical practitioners feel that treatment for drug abuse and alcoholism is very effective.⁹ Most of these same practitioners consider treatments for other chronic conditions such as hypertension and diabetes to be very effective.¹⁰ Yet, treatment success rates are comparable for these medical conditions. In a study reported in the Journal of the American Medical Association (JAMA), drug dependence, including alcohol, was compared to type 2 diabetes mellitus, hypertension, and asthma. The study concluded that “medical adherence and relapse rates are similar across these illnesses. Drug dependence generally has been treated as if it were an acute illness. Review results suggest that long-term care strategies of medication management and continued monitoring produce lasting benefits. Drug dependence should be insured, treated, and evaluated like other chronic illnesses.”¹¹

Other studies confirm these findings and even show that brief interventions are effective in significantly reducing dependence.^{12, 13}

Brief Interventions

Brief interventions can be effective in a variety of populations. A study was conducted among older “problem drinkers”—men who consumed 11 or more drinks per week, women who consumed eight or more drinks per week—and those who indicated other difficulties with alcohol. They received two 10-15 minute interventions and reinforcement visits one month apart. Follow-ups were conducted at three, six, and 12 months. At 12 months, the intervention group had reduced alcohol consumption by 36 percent. The proportion of drinkers classified as excessive drinkers declined by 52 percent, and binge drinking declined by 47 percent.¹⁴

A second study was conducted in a trauma center. The study noted that about 50 percent of patients admitted to trauma centers in the United States are intoxicated and among them approximately 85 percent have a serious problem with alcohol. Trauma centers routinely treat the injuries but ignore the underlying alcohol problem. In the study conducted in a level 1 trauma center, a sample of patients screened for alcohol problems received either a brief, 30-minute counseling session or standard trauma center care. Researchers examined records for every hospital in Washington state to determine if patients were re-admitted. Over the next three years, among those who received an intervention, there was a 48 percent reduction in injuries requiring hospitalization. In addition to a decrease in alcohol use and trauma reduction, risk-taking behavior, DUIs, traffic violations, alcohol-related arrests, and other arrests also declined.¹⁵

Silent Success

It can be argued that one other factor, unique to the substance abuse field, plays a part in the diminished awareness of treatment success; that is the long tradition of protecting the anonymity of people in recovery. In no other field do millions of success stories go untold. The vast majority of these men, women, and youth in recovery are leading healthy, active, productive lives. But few outside their families and close friends are aware of their successes. This year’s theme, “Join the Voices for Recovery:  Celebrating Health,” underscores the importance of sharing the successes of recovery with the public.

Making a Difference: What Can I Do?

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

We encourage health care providers and payers to take action in support of Recovery Month, which begins in September 2003. Your voice is vital to the success of the 14th annual celebration of Recovery Month. Here are some thoughts for your consideration:

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 Resouces

Sources

“I am a public advocate because a CEO of a very large educational organization withdrew the offer of employment after we talked about my recovery. I’ll never forget the moment he said, ‘How could you ever begin to think we would want someone like you to represent us?'" — Susan Rook Director Communications and Outreach Faces and Voices of Recovery

Treatment and Recovery Communities

Millions of Americans struggle every day with drug and alcohol problems—their own or that of a loved one. The lifeline for many of these individuals in need is treatment. Run by qualified, accredited, and dedicated professionals, treatment programs and services that meet rigorous state standards are the backbone of the public health response needed to address this nationwide epidemic.

The unfortunate reality is that the range of treatment and recovery program options is not comprehensive, available, or affordable enough to ensure that everyone who needs effective treatment can get it. In fact, 76 percent of people in need of treatment for a problem with illicit drugs did not seek or receive treatment.¹

To further compound the problem, about half of people with a lifetime addictive disorder also experience a lifetime history of at least one mental disorder. And, roughly 50 percent of those with a lifetime mental disorder also have a lifetime history of at least one addictive disorder.²

In an effort to address such co-occurring disorders, the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) prepared a Report to Congress on the Prevention and Treatment of Co-occurring Substance Abuse Disorders and Mental Disorders (Co-occurring Report to Congress).³ In this report SAMHSA outlines the scope of the problem, identifies current treatment approaches and best medical practice models, and seeks to highlight prevention opportunities.

Included in the Co-occurring Report to Congress is the recommendation that treatment services must be integrated to be effective. Integrated mental health and substance abuse treatment delivered by multi-disciplinary treatment teams can reduce symptoms and improve functioning in the community.⁴ Moreover, successful treatment requires the creation of welcoming, empathetic, hopeful, continuous treatment relationships, in which integrated treatment and coordination of care are sustained through multiple treatment episodes.⁵

As a member of the recovery community, you are in a position to extend the benefits of professional treatment for those suffering from addiction and/or co-occurring disorders by implementing some of the following ideas.

Making a Difference: What Can I Do?

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

This year marks the 14th anniversary of Recovery Month, which is celebrated every year in September. This year’s theme is “Join the Voices for Recovery:  Celebrating Health.” Beginning in September, you are encouraged to use Recovery Month as a platform to take action to affect positive change. Here are some action steps you may want to consider to make an impact:

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

“My last day [using], I worked 12 hours and came home to cops opening the door for me. I was taken to jail. I cried for days and days, [and] admitted that I was an addict. [The judge] said his conscience would not allow him to find me guilty. Today, I work for alcohol and drug services in the jail. I was destined to be there. Today, I give back.” — Shireda Prince President Substance Abuse Addiction and Recovery Alliance of Northern Virginia

Justice System and Child Welfare Systems

Justice System

Nearly 1.7 million of the 2 million adult Americans in prison or jail are seriously involved with drugs or alcohol.¹ Unfortunately, offenders are faced not only with the legal consequences of their actions, but also with the often overwhelming stigma associated with their addiction. This stigma contributes to an environment in which society views incarceration as the only solution.

The costs of incarceration are staggering. The National Center on Addiction and Substance Abuse estimates that of the $38 billion spent on corrections in 1996, more than $30 billion was spent incarcerating individuals who had a history of drug and/or alcohol abuse, were convicted of drug and/or alcohol violations, were using drugs and/or alcohol at the time of their crimes, or had committed their crimes to get money to buy drugs.²

Most criminal offenders do not receive help for their addiction; therefore relapse is common. Up to three-fourths of parolees who leave prison without drug treatment for their cocaine or heroin addictions resume drug use within three months of release.³ This is not surprising, given that only about 18 percent of all inmates who need substance abuse treatment actually receive it.⁴ However, an abundance of scientific literature has found that effective substance abuse treatment for drug-abusing offenders saves money, reduces crime, and lowers relapse and recidivism rates. Consider the following:

	Substance abuse treatment cuts drug use in half, reduces criminal activity up to 80 percent, and reduces arrests up to 64 percent.5
	Several studies show that treatment and aftercare in the community are necessary to keep offenders from recidivating. For example, one study found that three years after release from prison 27 percent of offenders who received in-prison treatment and treatment after prison had recidivated, while 75 percent of offenders in a comparison group had gone back to prison.6

Substance abuse is rarely the only problem an offender is facing. Based on the CAGE diagnostic instrument that is used to assess alcohol dependence and abuse, 34 percent of mentally ill State prison inmates, 24 percent of Federal prisoners, 38 percent of jail inmates, and 35 percent of mentally ill probationers have a history of alcohol dependence.⁷

There appears to be wide recognition by drug courts that participants may suffer from mental disorders, including co-occurring substance abuse and mental disorders. In fact, 61 percent of drug courts report screening for mental problems.⁸ In addition, among jail inmates, those held for drug offenses are the most likely to be HIV positive, and female inmates have higher rates of HIV infection than male inmates.⁹ To succeed, a treatment program must include a comprehensive recovery support system to meet the social, physical, and mental health needs of the individual. For example, among juvenile offenders, treatment options that show the best evidence of effectiveness are behavioral therapies, intensive case management, cognitive-behavioral skills training, family-oriented therapies, and multi-systemic therapy.¹⁰

In an effort to address this important issue, the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) prepared a Report to Congress on the Prevention and Treatment of Co-occurring Substance Abuse Disorders and Mental Disorders. In this report, SAMHSA outlines best medical practices and calls for agencies to collaborate to ensure that individuals with co-occurring disorders receive the treatment that they need. According to the report, failure to treat both disorders almost assures an exacerbation of health problems. If one of the co-occurring disorders goes untreated, both usually get worse and additional complications arise.¹¹

Child Welfare System

One of the greatest consequences of untreated substance abuse is the impact on children. Current research indicates that 8.3 million children in the United States, approximately 11 percent, live with at least one parent who is in need of treatment for alcohol or drug dependence.¹² Because the disease of addiction shows no bias, it impacts all social, economic, and racial groups. Not surprisingly, the children most severely affected are those from families without the cushion of financial and emotional resources.¹³ These are our country’s most vulnerable and at-risk children.

Many children impacted by substance abuse come to the attention of the child welfare system.

Problems with alcohol and drug abuse are estimated to exist in up to 80 percent of the families known to the child welfare system.¹⁴ In most cases, the parents’ substance abuse is a long-standing problem of at least five years.¹⁵

Children whose families do not receive appropriate treatment for alcohol and drug addiction are more likely to remain in foster care longer and to reenter once they have returned home, and their siblings are also more likely to end up in foster care.¹⁶ Moreover, children of alcoholics and drug addicts are more likely to develop substance abuse problems, and have higher rates of emotional, psychiatric, and social functioning difficulties than children from families that do not abuse alcohol and drugs.¹⁷

In addition, there are increasing rates of children who have incarcerated parents. Estimates suggest that nearly 200,000 children under the age of 18 have an imprisoned mother and more than 1.7 million have an imprisoned father.¹⁸ This is one aspect of addiction that is destroying families.

The presence of other factors such as a co-occurring mental and substance use disorders complicates the recovery from addiction, further jeopardizing the safety of the child and the possibility of being reunified with their family of origin. Today, the multiple, complex problems faced by parents who abuse substances and have co-occurring mental disorders or co-existing conditions, such as physical or cognitive disabilities, are likely to require intervention beyond what the child welfare system can offer. It is essential that caseworkers have access to the services of professionals who are able to evaluate addiction, mental, and other complex problems and then provide appropriate treatment services.¹⁹

Evidence from various national studies suggests that these families require access to a comprehensive array of services and supports to achieve long-term abstinence. Some of these services include access to housing, transportation, therapy (including family and trauma recovery services), and childcare, to name a few.

One successful and cost-effective innovation in working with families involved in the child welfare system that have alcohol and drug issues is the use of Family Drug Treatment Courts that provide timely and coordinated access to treatment and support services for families. This coordination reduces the trauma that families experience when faced with multiple systems, policies, and competing timelines.

Making a Difference: What Can I Do?

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

Recovery Month is observed each year in September to promote the importance and efficacy of substance abuse treatment. This year’s theme is “Join the Voices for Recovery:  Celebrating Health.”

This is a time for all individuals working in the child welfare system and criminal justice system, including judges, attorneys, correctional facility directors, police officers, probation and parole officers, drug court professionals, and representatives of Federal and state justice associations and agencies, to get involved. Recovery Month is an ideal time to take steps to create awareness that treatment is effective and recovery is possible for those suffering from addiction and their families. Following are some things you can do to contribute to this effort:

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

The proudest voices of recovery belong to the people who live it every day and the people who support them. These inspirational Americans are at the heart of this year’s National Alcohol and Drug Addiction Recovery Month (Recovery Month) theme, “Join the Voices for Recovery:  Celebrating Health.” Each day these individuals find strength in the positive way they have reclaimed their lives, and in the positive messages they deliver to others. Read on for their unique stories. Share these experiences with others who are on the road to recovery, and encourage them to share their success stories as well. Your encouragement can empower them to raise their own voices and inspire even more people to celebrate health and recovery.

“I am a public advocate because a CEO of a very large educational organization withdrew the offer of employment after we talked about my recovery. I’ll never forget the moment he said, ‘How could you ever begin to think we would want someone like you to represent us?" — Susan Rook, Director, Communications and Outreach, Faces and Voices of Recovery

“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

“Father Vaughan Quinn, who ran the Sacred Heart Rehabilitation Center in Detroit, and I talked for three hours. The conversation was frank. I put my life on the table. All the loneliness, the depression, the anger, frustration with people and jobs, thoughts of suicide and fears. Quinn listened to all of it without interruption. Finally it was his turn. There was no hesitation. He said it quietly but forcefully:  ‘The problem in your life is alcohol.’ He was right. Father Quinn [then] told me about a group of non-drinking alcoholic friends he wanted me to meet. They were the ones who helped me quit drinking. I couldn’t do it on my own.” From “The Courage to Change:  Personal Conversations About Alcoholism” by Dennis Wholey — Dennis Wholey, TV interviewer, Host of “This is America!”

“I used to be terrified of passing through the beer and wine aisle to get to the milk section of the supermarket. I’m an alcoholic and a drug addict, you see. My addiction also came with a criminal record. I had gone from a comfortable life in New England to a Federal prison in West Virginia for conspiracy to import cocaine. I got out, discovered crack, and continued my downward spiral. Eventually, through the support of friends, family, and others suffering with addiction, I was able to get clean. But I still had this nagging shame. Then, about eight years into my recovery, I decided to produce an autobiographical documentary about my recovery process. It aired in early 2002 on ABC’s “Nightline.” Addiction is a serious problem that we live with amid temptation every day. But I have found that my management and openness about it is a source of pride. And that takes the fear out of getting milk every week.” — Peter Nicks, Producer/Director

“I got kicked out of pharmacy school twice due to a full-blown cocaine addiction—the school [called it] ‘academic difficulty.’ I call it the conspiracy of silence. People don’t know where to turn when [addiction] happens. There isn’t a lot of discussion about what to do and where to go.” — David Marley, Executive Director of the NC Pharmacists Recovery Network

“I never felt comfortable in my own skin. I only felt lovable when I excelled at school or sports. By the time I was 12, I was drinking and smoking pot every day. I progressed to cocaine and heroin. By 15, I knew I used differently than others; ashamed, I knew I was an addict. At 29, my sister and my employer intervened. Already demoralized, it wasn’t a struggle to get me to an inpatient residential treatment center. My insurance did not cover my treatment. I am grateful that I had loved ones who could. I stayed clean for six years. My relationships with my family, my employer and my past were healed. I made new friends who were living a recovery lifestyle, and I became a vice president of a lobbying firm in Washington, DC. My life was flourishing, except in the area of intimate relationships. After a particularly painful breakup, I relapsed and went back to treatment. I’ve been clean five years, am happily married, and have helped found a new government relations firm in Washington, DC—one of the few focusing on addiction and recovery issues. I am grateful that I had two shots at treatment and that my relapse gave me the gift of learning to be vigilant about protecting and sustaining my recovery.” — Carol McDaid, Principal, Capitol Decisions

“When I was 12, I experimented with inhalants for the first time. A year later, I was smoking marijuana on a regular basis. Over the next four years I abused even more serious drugs. I depended on them to make it through the day, but didn’t have the power to stop. I feared I would never get clean if I didn’t get help from my parents and a residential treatment program. My parents sent me to the Caron Foundation. I went through the four-week primary care program and, luckily, the six-week extended care program. I say ‘luckily’ because my parents’ insurance company only covered my first 19 days. But if I had gone home then, I would’ve never stayed clean. The Caron Foundation let me stay free for 10 days while my parents gathered money from my family. After treatment, I returned to society and changed my lifestyle. I started hanging out with people who were better for me, and going to places that would not harm my recovery. I will be celebrating five years clean and sober in March 2003, and I owe it all to God and the Caron Foundation. Treatment works and saves lives.” — Tim Bradley, Uturn Director/Founder

“My last day [using], I worked 12 hours and came home to cops opening the door for me. I was taken to jail. I cried for days and days, [and] admitted that I was an addict. [The judge] said his conscience would not allow him to find me guilty. Today, I work for alcohol and drug services in the jail. I was destined to be there. Today, I give back. — Shireda Prince, President, Substance Abuse Addiction and Recovery Alliance of Northern Virginia

“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

“My son is five years old. A couple of months ago, some friends were over and I had a [soda] can in my hand. One of my friends said to my son, ‘Look, your dad has a beer in his hand.’ And my five-year-old said, ‘No, my dad doesn’t drink. He teaches people not to.’ I’ve had three car crashes and by the grace of God, I never ran into anybody. I got four DUIs in about four years. The end result was a Class D felony that resulted in a five-year prison sentence. The lawyer worked out a deal to get me into treatment in the department of corrections. Now I’m in a master’s program in clinical psychology, and things are unbelievable. I can’t even tell you how I got here or how this is happening. [I went] from a scared, shamed, beat-down little boy to a flourishing adult, and all because of recovery.” — Darrell Williams, Prevention Specialist

“I’d been a heroin addict for years. My first days of awakening were walking into a faith-based community organization [Teen Challenge International]. I graduated in 1974. [Since then,] I’ve walked the excellence that I know is there to be walked. The man I’ve been now for 29 years is who I am.” — Henry Lozano, White House Advisor on Substance Abuse and Addiction

“I was 18 years old when I hit bottom. I [was] on the run from [drug dealers], on the run from the police, and on the run to get high. The only person I could turn to was my probation officer. He took me to a treatment center and since that day I’ve been clean. I was that kid that everybody said wouldn’t live to see age 21. I was the kid that society had practically given up on, but the recovery community embraced me. I went back to school, got my bachelor’s, my master’s, and I’m planning to start a Ph.D. program. The freedom that staying clean has given me [has] allowed me to travel, meet people, and go places. It’s just a beautiful feeling. That’s enough to keep me on this road of recovery.” — Andre Johnson, Project Officer, Partnership for Drug-Free Detroit

I was over 40 years old when I first got out of treatment and had control of my life. I went from riding a city bus and walking the streets to having two vehicles, a camper and a Harley. It is amazing. I have a relationship with my daughter. She hadn’t acknowledged that I was her father since she was 11. But we have a real close relationship now. For her to give me a hug, tell me she loves me, and call me ‘Dad’ means a lot. When I went through treatment, I was an older person. Kids, when they go through it, have to give up people they have grown up with and people they still go to school with. That has got to be extremely hard. But recovery works if you work at it. The main thing is the desire. If you have the desire and the willpower, you can do it. I’ve been in solid recovery for about four years.” — Dwight Johnson, Truck Driver

“I got into cocaine and acid by the time I was in high school, and I smoked a quarter ounce of pot a day. I got into a lot of illegal activities. I graduated, got introduced to crystal methamphetamine, [and] within two years was incarcerated. I was in prison for a year-and-a-half, got out, continued with my criminal lifestyle, [and] was again sent to prison, sentenced to serve four years. On Christmas, 1997, a man in his sixties asked me for a cigarette. I realized that if I continued the life I was living, I would end up old, alone and incarcerated for the rest of my life. From that day on, I stayed clean and sober. I got released from prison on September 1, 1999, [and] am now involved in a lot of positive things. My friends and I formed a group called Wai'anae Men in Recovery. We dedicate our time to sharing our experiences with drugs and crimes and the pain and consequences. I am proud that I have friends that care for me. I would not be able to do this alone. It is only through God and the people in my life that I look forward to experiencing the fruits of life.” — Willie Leong, Assistant Chef/Su Chef

“I am a recovering alcoholic and drug addict. I am also quadriplegic. When I wanted treatment, I called 32 treatment programs. Not one could handle my personal care needs. Through an anonymous recovery program, a great sponsor, and good friends, I’m now in recovery. But I had no help from the county or state. The Americans with Disabilities Act is over 11 years old, but there’s virtually no compliance with this law when it comes to treatment. Clearly, people with disabilities need access to high-quality drug and alcohol treatment, just like everyone else.” — Steven A. Towle, Washington Liaison, National Association on Alcohol, Drugs and Disability, Inc.

“Alcoholism has affected my life in many ways. I grew up with two active alcoholics. I married and divorced an unrecovered ACOA (Adult Child of an Alcoholic). I remarried, this time to a now-recovering alcoholic. I was challenged to focus on recovery, and break the cycle for my children, my grandchildren, and myself. In doing so, I contributed to my dear husband’s recovery in a significant way. I have been to private counseling, attended and facilitated ACOA groups, participated in an in-depth 12-step program for ACOAs, and now volunteer as a facilitator for a family member program offered by a local treatment center. My daughters have benefited from this program, and I believe in my heart that due to their knowledge and our now healthy home environment, they will not continue the cycle. I truly believe in the power of recovery programs for all family members—for their own healing and growth, as well as a powerful aid for the recovering addict in their lives.” — Kathryn Fitzpatrick, Information Technology Executive

“Alcoholism is a painful disease for those who have it, as well as those who love them. As I learned about it through a children’s support group program offered by a local treatment center, I discovered it is a disease—but one for which recovery is possible, although it is very tough. It requires all the energy and effort the person has. I have watched how it affected my mom. She had a very tough upbringing with both parents being alcoholics, then marrying an alcoholic. But instead of having a negative outlook, my mom found strength and continued to focus on her recovery from being the child of alcoholics. I look up to no one more than my mom and stepdad. They have been able to provide a healthy and happy environment for our family, and I know I will do the same for my own family in the future.” — Tahra Luther, Student

“I was using marijuana before I was out of elementary school. By 19, I started getting into heavier drugs like heroin and cocaine. When I was 25, my son came up to me and said, ‘You know Dad, I’m almost five years old.’ I looked at him and it hit me:  I don’t even know this boy. It broke my heart, and I thought about committing suicide. My grandma’s teachings saved me because I didn’t think I’d be going to heaven if I did. That night, I went to a meeting for the first time. That was the start of a rocky recovery. I was still working in the oil fields, which didn’t promote my recovery. So I resigned and started working as a janitor and, later, as a night monitor in a treatment center. After awhile I started working with clients. I enjoyed this work and felt I had a lot to offer since I had been there myself. Within a year, I was a substance abuse counselor. But soon after, I relapsed. Fortunately, my boss didn’t give up on me. Instead, he said, ‘Victor, I don’t need you to quit. I need you to straighten up and get back to work.’ That is what I did. Since then, I have been sober for over 14 years and have won the 2001 Robert Wood Johnson Community Health Leadership Award. The award was given to me for developing a unique substance abuse treatment program that serves Alaskan Native Families who live in rural Alaskan areas only accessible by plane, boat, or snowmachine. But the best award I've received is my sobriety. For that I need to thank the Lord and the clients I have worked with over the years. The old saying is very true:  When you help someone it helps you. I’m not a saint. I just think I’m doing what I’m supposed to be doing. This is my path.” — Victor Joseph, Director, Old Minto Family Recovery Camp Program, Tanana Chiefs Conference

Contents

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