Recovery: outpatient help for intertwined addiction, mental health problems
“Two years ago ... just two years ago, having a 14- or 15-year-old come in, identifying right at the time of intake (as) addicted to heroin, that just wasn’t a story we were seeing,” said Amy Olson, director of Clinical and Support Options’ Greenfield outpatient mental health clinic.
“Now it is.”
The clinic, at 1 Arch Place, provides general mental health care and addiction counseling.
From Olson’s vantage point, the heroin and opioid problem is getting worse, and colleagues Dan Sontag and Dawn Geller agree.
The stigma and pressure addicts face in general isn’t particularly helpful either, they said, and when people come to addiction counseling the approach is different.
People who are drinking or taking drugs will already be fighting a lot of pressure to change, Stontag said.
“Just adding to that really doesn’t help. They need to find some positive support in making their own decisions and thinking it through and overcoming their own ambivalence,” he said.
CSO offers an array of outpatient and in-home counseling, therapy, family support, and other options for mental illness, behavioral health and substance abuse treatment.
This is because its directors, like most in the treatment community, don’t think there’s a silver bullet response to any of these issues. The treatment is complicated by problems that may exist alongside, feed off or aggravate one another — depression, anxiety, bi-polar disorder, schizophrenia.
“Typically what I would say is folks who are struggling with chemical dependency issues, the majority who have a chemical dependence issue or diagnosis also have a diagnosable mental illness,” said Kirk Woodring, vice president of clinical services for the Center for Human Development, another social service nonprofit focused on mental health.
“Almost 9 million Americans have a co-occurring disorder ... we’re really focused on that co-occurrence. What are the mental health issues; what are the substance abuse issues, how do they interplay and what are the best evidence-based practices to treat both?”
Federal figures back him up. Estimates vary, but according to the federal Substance Abuse and Mental Health Services Administration, 42.8 percent — 8.9 million — of adults with substance use disorders had co-occurring mental illness in 2009.
Woodring gives depression as an example: a patient might come into the clinic for help with depression, but also be drinking heavily. “The problem might actually be their drinking, but they’re not recognizing that, they’re not willing to acknowledge that,” Woodring said.
The older, common approach would be to refuse the patient depression treatment until they stop drinking or using drugs, he said; the new approach is to treat both. Techniques used by CHD clinicians include motivational interviewing: talk therapy geared toward helping the patient recognize the underlying issue without trying to separate inextricably interconnected issues.
From Main Street, the Center has recently moved its Greenfield clinic into the Cherry Rum Plaza and into the Community Health Center offices.
The advantage is that doctors and nurses meeting with patients for checkups or medical complaints can offer these patients immediate access to mental health and substance abuse clinicians, he said.
Community Health Center Chief Medical Officer Dr. Flora Sadri-Azarbayejani said patients are more likely to follow through on a doctor’s recommendation for a mental health or substance abuse evaluation if the clinician is just down the hall.
“Seventy percent of medical visits have a behavioral health component, so without behavior health care ... a lot of our patients will have incomplete care, ” Sadri-Azarbayejani said.
CEO Jim Goodwin said integration has been a hot topic since the passage of the Affordable Care Act, although the connection between mental and physical health isn’t new.
“We all know that, but the system wasn’t actually set up to do it, and now we’re doing it,” he said.
The START intensive outpatient program offered in Northampton by CSO offers a structured approach to the early stages of sobriety, teaching such skills as how to get through the culture shock of AA, how to deal with anger and boredom. Such programs are a level down from long-term inpatient treatment, and can provide an alternative to that difficult-to-find option, said Sontag, who would like such a program in Greenfield.
The three-week, 3.5-hour-a-day programs can also help in demonstrating commitment to recovery to the Department of Children and Families, Sontag said, and may also be mandated by courts, although self-referrals are encouraged.
Another, less time-intensive, option is an early recovery group. These focus on preventing relapse and building support much like the START program but is less intensive and time-consuming.
Sontag, who joined CSO this year, said the agency has a great variety of services, but the substance abuse offerings are surprisingly under-utilized, so her first goal is to build attendance and start more early recovery groups to meet diverse schedules.
Many of Clinical and Support Options’ programs offer alternatives to absent rehab or long-term care options, fill gaps in the system for people who don’t need or don’t yet want those options, and provide support for people on other paths to recovery.