Increase Awareness of Treatment, Recovery, & Support Services

Introductory Paragraph

Substance Use Disorder (SUD) is a substantial problem for Americans, with nearly 20 million reporting having a substance use problem . Despite such a prevalence, only 1 out of 5 receive any form of SUD treatment. This is alarming, as the effects of a SUD extend well beyond the individual, impacting families, communities and the economy in a significantly negative way. The social stigma surrounding alcohol and substance use has made equitable access to treatment unattainable. Despite evidence-based, successful methods for treatment and recovery, barriers are ever-present and include a severe professional shortage, costs, social stigma, and fear of retaliation,. Creating social awareness of the benefits of treating and supporting those with a SUD is essential to breaking down barriers and improving access.

Key Information

Costs of Substance Use Disorder: A Snapshot The price of addiction weighs heavily and impacts everyone, whether they are aware or not. Aside from the physical damage to the body, the distressing mental health, and familial conflict that comes about, SUD can inhibit personal and community economic growth. Loss of education and career opportunities means less access to life’s necessities. As a whole, substance use costs the American society over $740 billion per year in lost productivity, healthcare expenses, and crime-related costs. On the other hand, treatment for SUD can cut this cost dramatically, as every $1 spent on treatment saves $4 in healthcare costs, and increases work participation significantly (Ohio programs saw a 91% decrease in absenteeism) (5). Treatment and supportive recovery are vital to the success of the individual and to reduce the economic impact.

Benefits of Treatment, Recovery, and Support Services Recovery from a SUD is possible, as evidenced by roughly 10 million Americans who identify as recovered and many of which have been in recovery for well over five years. The benefits that blossom from effective treatment, recovery, and support services can be radical for the individual and their loved ones. Those who receive treatment and support can experience a wide array of physical, social, and emotional improvements that include ,:

• improved relationships
• increased confidence
• emotional stability
• improved mental health
• improved and increased work productivity (financial stability)
• improved overall physical health
• longer and healthier sleep
• decreased risk of long-term health issues
• healthier habits

Having access to and receiving services for treatment and recovery brings its own innate benefits, versus trying to recover on one’s own. Those who receive structured SUD treatment are likely to benefit from:

• access to professional counselors and local group programs (i.e., AA, NA) that will help find insight into the root causes of addiction
• learning relapse prevention strategies
• help for family members and loved ones
• peer support and modeled recovery
• enhanced safety in detoxing

Personal Barriers to Seeking Treatment Living with addiction is difficult, with it impairing most aspects of life. Recovery can seem just as big of a hurdle, if not larger. Fort Behavioral Health and a study by Arun, Chavan, and Kaur report that the main reasons for not getting SUD treatment and potential recovery include ,:

• not thinking they need help or have a problem,
• not being ready to stop using, even if aware of negative consequences (weight risk & reward),
• fear of withdrawal symptoms,
• lack of awareness of long-term drug use effects,
• feeling of psychological wellness,
• they couldn’t afford treatment,
• not knowing where to get treatment,
• afraid of social stigma, and
• concerned about losing employment when seeking treatment.

Even individuals who are ready to seek treatment and have tried to do so report significant barriers to receiving and maintaining effective treatment and support. NSDHU data states the main reasons as :

• lack of health coverage and costs of programs,
• felt they were able to handle the problem without treatment,
• lack of transportation or inconvenient distance, and
• uncomfortable with social stigma/impact.

Types of Treatment, Recovery, and Support Services

Treatment for substance abuse is going to look different for everybody and can be dependent on substance type, polysubstance use, and mental health comorbidities. The National Institute on Drug Abuse has put forth a research-based guide on effective types of treatment programs. The most common beginning to treatment is the detoxification process, which may give participants pause. Detox can and should be done under the care of a medical professional to monitor for any dangerous side effects and manage symptoms with appropriate medication (medically managed withdrawal). Once detox is complete, it’s recommended that the patient receive some form of treatment for psychological, social, and/or behavioral problems that can trigger a relapse. One option for detox after-care treatment is long-term residential treatment, where they will receive care 24 hours a day in a non-hospital setting. These will often focus on the issues surrounding drug use, behavior and psychological therapies, and other support services to promote long-term sobriety. Short-term residential treatments will be brief but intense and it’s recommended to stay engaged with out-patient programs and support to reduce relapse risk. Outpatient treatment is less costly and more flexible for those who need to retain their employment or other commitments. Programs vary from simple drug education to intensive day treatments and many offer group and/or family counseling. Group counseling settings supply opportunities for positive social reinforcement and real-life examples of recovery. Individual counseling will address the substance use along with “other areas of impaired functioning” in the person’s life such as employment, criminal engagement, and relationship issues. The patient sets short-term, attainable goals, learns coping strategies, and receive resources for medical, psychiatric, and employment help.

Recovery The successful completion of treatment is a major accomplishment, but it’s important to remember that substance use disorder is a chronic, life-long disorder, and there is a great risk of relapse. Recovery and support services can help an individual stay the course of sobriety, providing encouragement and resources. Recovery should include a personal support system (family, friends, mentors) along with:

• continuing their recommended therapy (individual, group, or family),
• check-ups with medical and healthcare providers,
• finding a long-term peer support group within the community,
• participating in aftercare and educational programs, and
• finding healthy ways to spend time (volunteering, new hobbies, physical fitness, etc.)

Support Systems

Peer Support: Everything that comes with treatment and recovery may overwhelm the patient; providing peer support is a clinically effective method of giving the patient emotional, informational, instrumental, and affiliation support from someone with “lived experience”. A peer-support person is a paraprofessional in successful recovery, someone who knows the “ins and outs” of treatment and recovery from where to get services, withdrawal support, insurance navigation, to “tough love” and emotional support. They are a liaison between the patient and all involved services to make sure there is support, continuity, and transparency.

Addiction Recovery Support Groups: While addiction support groups cannot replace rehab, they can supplement more structured treatment efforts and provide a community of help and support. They can be used concurrently with treatment programs or solely as aftercare. The most well-known are Alcohols Anonymous and Narcotics Anonymous, but there are many others in various settings such as communities, hospitals or outpatient clinics, online, and Al-Anon. While support groups foster accountability, they also teach that “excessive self-reliance may be counterproductive to recovery,” and promote help-seeking behaviors and social support.

Relevant Research

• Philips and Wennberg (2104) found that lack of patient motivation for treatment significantly impacts retention and successful outcomes, implying that increasing patient motivation is critical prior to and during treatment programs .

• Livingston, et al. (2012) evaluated programs that sought to intervene to reduce self-, social-, and structural- stigmas surrounding SUDs. They found that effective strategies include: motivational interviewing and positive storytelling with people with SUDs (social stigma); group-based acceptance and commitment therapy (self-stigma); and contact-based training and educational programs for professionals (structural stigma).

• Women, Children, and Addiction provide a chapter that addresses the importance of gender issues in substance abuse research and emphasizes the importance of gender-sensitive treatment and approaches.

• Acevedo, et al. (2018) address the disparities in treatment and access to treatment for SUDs regarding the economic status and race/ethnicity.

Impactful Federal, State, and Local Policies

• An ACA Medicaid expansion now allows those leaving incarceration to have Medicaid coverage, expanding their access to MOUD and other treatment options upon release from jail or prison .

• Outpatient methadone treatment can only be used when the patient is enrolled in a state or federally certified opioid treatment program (i.e. methadone clinics) that usually requires a daily visit .

Available Tools and Resources

“Introduction to the Therapeutic Community” handbook is an interactive guide for the participant, with information and activities to enhance their use of TC on their sobriety journey (https://www.cdhs.udel.edu/content-sub-site/Documents/CDHS/CTC/Introduction%20to%20the%20Therapeutic%20Community.pdf)

Addiction Center provides a list of proactive ways to reduce the stigma around SUD within communities and to (https://www.addictioncenter.com/community/raising-addiction-awareness/)

Rural Prevention and Treatment of Substance Use Disorders Toolkit - an evidence-based toolkit on effective methods of increasing residential education and awareness of substance use disorder and its impact. This covers methods that utilize print and digital media, mass media, and meetings and conferences. (https://www.ruralhealthinfo.org/toolkits/substance-abuse/7/dissemination-methods).

Taking Action to Prevent & Address Prescription Drug Abuse: A Resource Kit for America’s College Campuses (https://www.bemedwise.org/wp-content/uploads/2019/12/WhatYouCanDo_Tips.pdf) Drug & Alcohol Counseling patient infographic and information on various types of resources (https://futuresrecoveryhealthcare.com/blog/drug-alcohol-counseling/)

Promising Practices

• Therapeutic Community (TC) long-term residential treatment model that is whole-person centered ,: Labeled the best-known residential treatment model by the NIDA-NIH, TCs are 6-12 months long and focus on “resocialization” of the patient and “use of the program’s entire community - including other residents, staff, and the social context - as active components of treatment.” TC is highly structured and sometimes “confrontational,” as it moves towards developing accountability, responsibility, and productivity. In TC, residents will confront harmful beliefs, ideas, self-views, and behavior patterns while learning to replace these with healthier behaviors, cognitions, and habits. TC may include other support services to aid in the transition.

• This site addresses the benefits of group therapy, when led by a trained professional, to include, but are not limited to: recovery education, social support, and motivation in recovery, observing various issues and methods within recovery, peer empowerment, and feedback, learning healthy coping skills, and build a sense of optimism, self, and connectedness: https://drugabuse.com/treatment/therapy/group/

• The Drug-Free Communities (DFC) Program - a nationwide, collaborative effort led by the ONDCP and CDC; provides funding and support for community coalitions that aim to prevent and reduce youth substance use. The coalition work must use evidence-based frameworks and address the unique community challenges surrounding substance use and overdoses. Annual data has shown a marked decrease in youth substance use.

• World Drug Day is an international day dedicated to raising awareness about SUDs and the importance of treatment and equitable access. Recovery Village gives a guide on how to participate in World Drug Day (https://www.therecoveryvillage.com/drug-addiction/news/world-drug-day/).

• UPMC has given guidance on how to expand tele-treatment for addiction post-COVID-19. They argue that this expansion will help address the gap in service and allow for more far-reaching, equitable access to treatment and support, especially in the wake of the pandemic consequences on SUDs, mental health, and an increase in “deaths of despair.” Noted benefits of tele-treatment during the pandemic include virtual initiation of treatment, relaxed restrictions that allowed for more access, contactless medication pick-up, and ease of virtual therapy and group meetings. (https://inside.upmc.com/four-steps-to-continue-tele-addiction-treatment-growth/)