A Recovery Revolution: Integrating the Addictions and Mental Health Recovery Movements

In the 1930s and 1940s, there was a strong working alliance between the recovery and mental health professions. Noteworthy was Bill W’s correspondence with Carl Jung, the renowned psychiatrist, on the spiritual nature of alcoholism. The writer of the foreword of the big book of Alcoholics Anonymous, Dr. Silkworth, noted that the alcoholic was sick in mind, spirit, body, and soul and that there needed to be a collaboration between the recovery and psychiatric communities (Blocker & Tyrrell, 2003). Over the course of the past 75 years, events have occurred that have created a rift between the addictions and mental health fields. The biggest consequence of this rift has been numerous clients with co-occurring conditions slipping through the cracks (SAMHSA, 2005).

The addictions field has contributed to this rift by:

• ignoring the need that many clients with co-occurring disorders have to take medication with the simple mantra, “a drug is a drug is a drug…”’
• ignoring psychiatric symptoms;
• discharging clients when they exhibit psychiatric symptoms without addressing mental illness;
• refusing to uniformly and collectively increase its knowledge of mental illness and mental health treatment;
• stigmatizing clients for having mental illness; and
• triggering decomposition through the use of heavy confrontation (White & Miller, 2007).

The mental health field has contributed to this rift by:

• enabling addiction to progress by not identifying it and addressing it in treatment;
• facilitating addiction to prescription medication by prescribing addictive medication to clients addicted to alcohol and/or elicit drugs;
• stigmatizing and discharging clients for being chemically dependent;
• the use of therapeutic approaches that have failed to turn alcoholics into social drinkers, facilitating numerous relapses;
• biases against referring clients to 12-step groups; and
• diagnosing mental illness in clients with substance use disorders prematurely (SAMHSA, 2005).

The end result of this rift is that the needs of clients with co-occurring disorders often go unaddressed; thus, they are a part of the revolving door syndrome, seeking services back and forth between each system without getting all of their needs met. As a result, clients with co-occurring disorders have more psychiatric hospitalizations, addiction treatment readmissions, arrests, evictions, suicide attempts, and actual suicide than clients with a single diagnosis of addiction or mental illness (Muesser et al., 2003).

Change is clearly needed.

Both the addiction and mental health fields are simultaneously going through separate recovery revolutions, without either side knowing much about the other’s movement.

The Addictions Field

There are two movements occurring in the addictions field—one is a recovery advocacy movement; the other is a recovery management treatment movement. The recovery advocacy movement is being led by individuals in recovery, their families, and visionary professionals in the addictions field (White, Kurtz, & Sanders, 2005). These groups are advocating for:

• long-term recovery;
• greater emphasis placed on recovery rather than treatment;
• an end to discrimination by insurance companies who routinely pay less for addictions treatment than other medical conditions;
• a recognition of multiple pathways to long-term recovery;
• individuals in recovery having a voice in the direction of that recovery;
• treatment as an alternative to incarceration; and
• the restoring of citizenship.

The recovery management treatment movement is one that shifts from treating addiction in short-term, acute episodes toward how we treat other progressive and chronic illnesses, such as cancer and diabetes, long-term (White, 2005).

This movement involves:

• placing a greater emphasis on long-term recovery rather than treatment;
• a focus on the importance of continuous care rather than treating aftercare “like an afterthought”;
• acknowledging that clients are utilizing multiple paths to long-term recovery;
• clients having a voice in the direction of their treatment and recovery;
• the use of indigenous healers (recovery coaches) who work with clients ongoing in their natural environments; and
• the formation of new partnerships among treatment, faith-based, secular, and other communities of recovery.

The addictions recovery and advocacy movements were triggered by the criminalization of addiction in the 1980s and 1990s. During those years the crack cocaine epidemic prompted insurance companies to use that increased stigma to decrease their coverage of substance use disorders, leaving outpatient as a primary option for clients whose illnesses may have been chronic. While these revolutions have been occurring in the addictions field, a similar paradigm shift is occurring in the mental health arena.

The Mental Health Recovery Movement

This movement is led by consumers and has been triggered by a number of events, including the closing of many state hospitals nationwide, leaving consumers of mental health services to forge their own mental health recovery movement. The movement is also being led by consumers, family members, and professionals in the mental health field, who are advocating for effective mental health treatment. They are working to end discrimination by insurance companies, who routinely attempt, as they have in addiction cases, to cover this care at lower rates than for other medical conditions (SAMHSA, 2004; www.nami.org).

The tenets of this “person-centered movement” include (SAMHSA, 2004):

• The client has ownership of his/her life and is therefore the director of his/her plan.
• Clients have a greater investment in the change process if they choose their own path.
• Family and friends who believe in the client can be great sources of support.
• Services are geared toward helping the client achieve a desired future and a meaningful life.
• The client is approached as a capable human being who is full of strengths.
• What the client has learned from previous experiences should be included in the plan.
• Helpers work to view the situation from the client’s perspective.
• Wellness strategies chosen by the client are used.
• Service planning should include the client’s entire life.
• The helpers strive to understand the clients’ uniqueness, hopes, wishes, dreams, and aspirations.

Integration

Research reveals that an integrated approach to co-occurring disorders treatment and recovery is the most effective (Muesser et al, 2003). The commonalities between the addictions and mental health recovery movements lend themselves well to integration. Both approaches are:

• individualized;
• rooted in the belief that there is no one pathway to recovery;
• longitudinal in their perspective;
• strength-based;
• egalitarian;
• centered in the client’s natural environment;
• respectful of diversity and utilizing indigenous healers in recovery;
• peer-based; and
• deeply rooted in the belief that clients and their families have the capacity to grow and change.

In order for this integration to occur, policy makers and funding sources would have to be on board with the idea of funding integrated programs. Leaders from both fields would have to come together to discuss their philosophical differences, both at the micro and macro levels. There would need to be cross training for addictions and mental health professionals. The client’s voice would have to be a part of all discussions concerning his or her care, including at the policy level, and strategic plans would have to be created to help guard against each field’s instincts to bounce back to the “old way of doing business.”

Each time we provide services for clients who would ordinarily slip through the cracks, we play a major role in strengthening recovery.