Mental Health Services Administration I And The Substance .
If you have issues viewing or accessing this file contact us at NCJRS.gov.{" \ .Iu.s. DEPARTMENTOF HEALTH ANDHUMAN SERVICESPublic Health ServiceSubstance Ahuse andMental Health ServicesAdministrationCenter for Substance Abuse TreatmentRelapse Preventionand the SubstanceAbusing CrinUnalOffenderTechnical Assistance Publication Series 8 !CJRS. L . . -
Relapse Preventionand the SubstanceAbusing CriminalOffenderAn Executive BriefingTechnical Assistance Publication Series 8Terence T. Gorski, M.A., John M. Kelley, M.A.,C.S.W., and Lisa Havens, R.N., M.S.W., C.A.D.Roger H. Peters, Ph.D.u.s, DEPARTMENT OF HEALTH AND HillvIAN SERVICES Public Health ServiceSubstance Abuse and Mental Health Services AdministrationCenter for Substance Abuse TreatmentRockwall II, 5600 Fishers LaneRockville, MD 20857
This publication is part of theSubstance Abuse Prevention andTreabnent Block Grant technicalassistance program. All materialappearing in this volume exceptquoted passages from copyrightedsources is ir the public domain andmay be reproduced or copiedwithout permission from theCenter for Substance AbuseTreabnent (CSAT) or the authors.Citation of the source is appreciated.This publication was written byTerence T. Gorski, M.A., John M.Kelley, M.A., C.S.W., and LisaHavens, R.N., M.S.W., C.A.D. ofthe CENAPS Corporation and byRoger H. Peters, Ph.D., of theUniversity of South Florida.It was prepared under purchaseorder number 91MF3586101D andcontract number 270-90-0001 fromthe Substance Abuse and MentalHealth Services Administration.Roberta Messalle and Richard Bast ofCSAT served as the governmentproject officers.The opinions expressed herein arethe views of the authors and do notnecessarily reflect the official positionof CSAT or any other part of theU.S. Deparbnent of Health andHuman Services (DHHS).DHHS Publication No.(SMA) 93-2008Printed 1993U.S. Department of JusticeNational Institute of Justice 152332This document has been reproduced exactly as received from thep rson or organization originating it. Points of view or opinions stated inthiS dO?I,lment re those o! t,he authors and do not necessarily representthe offiCial posItion or poliCies of the National Institute of Justice.Permission to reproduce thisgr IDte.t:f by. l:'Ub.r C IbmamHealthana:/U .8.iII4 material has beenDept. ofHuman Serv cesto the National Criminal Justice Reference Service (NCJRS).Further reproduction outside of the NCJRS system requires permissionof the .-,owner.
--------- --------ContentsForeword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . .Why Offenders Are Especially Vulnerable to RelapseHow Relapse Can Be Prevented. . . . . . . . . . . . .Where Relapse Prevention Programs Can Be Set Up . Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Chapter I-An Overview of Addiction, Relapse, and Relapse Prevention.Recovery and Relapse . . . . . . . . . .Alcoholism and Other Drug Addiction . . . . . . . . . . .The Recovery Process. . . . . . . . . . . . . . . . . . . . . .Principles and Procedures of Relapse Prevention TherapyChapter 2-Relapse Prevention Approaches in the CriminalJustice System . . . . . . . . . . . . . . . . . . . . . . .Treatment Services for Substance-Abusing OffendersPrevention of Relapse Among Offenders .Program Approaches for Preventing Relapse .Evaluation of Relapse Prevention Programs. .Chapter 3-Examples of Relapse Prevention Approaches .Individual Local/County/Regional Program::;Florida Department of Corrections Programs .Federal Bureau of Prisons ProgramsI. . v. vii. 427Other Readings29 iii
Forewordhe Center for SubstanceAbuse Treatment(CSAT) of the SubstanceAbuse and MentalHealth ServicesAdministration (SAMHSA) isresponsible for expandingavailable and effective services totreat addiction. No group needsthese services more acutely thanoffenders involved in the criminaljustice system. We know that ahigh percentage of criminaloffenders have problems withalcohol and other drugs. Onesurvey indicates that 62 percent ofinmates in State and Federalprisons-almost two of every threeinmates-used drugs on a regularbasis prior to their incarceration. Inmany metropolitan areas, morethan 70 percent of arrestees testpositive for drugs.Not just the individual, but all ofsociety, benefits when we can helpoffenders avoid relapse to alcoholand other drug abuse. Relapse todrug use accelerates the level ofsubsequent criminal activity.Offenders who use drugs areinvolved in more crime days thanoffenders who do not use drugs.Specialized relapse preventiontreatment can help offenders learnskills that they badly need to avoidthe vicious cycle of relapse andreturn to criminal behavior.First, it has been established thataddiction is a chronic, relapsingdisorder; the gains made duringtreatment are often lost followingany patient's return to theT community. All offenders facedifficulties adjusting to custodyfluctuations. Sometimes thepressures of probation or parolesupervision trigger relapse. Othersexperiencing the transition fromincarceration back to life in thecommunity face an exn'emelydifficult period of readjustment.At this time, they are particularlyvulnerable to relapse.Second, it has been clearlyestablished that there are a host ofphysiological, psychological, andenvironmental factors thatcontribute to the onset andmaintenance of addiction.Addiction is one of the mostcomplex biopsychosocial diseasesknown to science. All of thesefactors tend to converge for theoffender, whose addiction simplycannot be treated in isolation fromhis or her primary health, mentalhealth, or socioeconomic deficitsand disorders. The offender, at atime of extreme stress, must reenterthe community without thesupports available to most otherpatients. Many offenders may haveweakened or no family ties, deficitsin educational and vocationalskills, no job, and long-standingproblems in handling anger andstress. Such individuals are at greatrisk of relapse to addiction byvirtue of their extremesocioeconomic dislocation andtheir exposure to drug-usingassociates, crime, poverty,homelessness, and other high-risksituations conducive to relapse.CSAT is dedicated to workingcollaboratively with the criminaljustice system at all levelsFederal, State, county, andmunicipal-to intervene with thishighly vulnerable population ofdrug-USing patients. We need toprovide offenders with access torelapse prevention therapy, so theyca.n learn the techniques and skillsto help them identify andovercome their own individual"triggers" to relapse. And, workingtogether, personnel in the criminaljustice and community drugtreatment systems need to developcooperative arrangements so thatoffenders may move from relapsepreveni:ion programs withincriminal justice facilities to similarprograms within theircommunities.My hope is that this report willencourage the treatment field andagencies of the criminal justicesystem to forge stronger linkageswith each other and to coordinatetheir efforts and resources onbehalf of offenders who havealcohol and other drug problems.I believe you will find thisdocument to be a valuable tooland reference for setting up andenhancing relapse preventionapproaches in your own institutionand community.Lisa W. ScheckelActing DirectorCenter for Substance AbuseTreatmentv
Executive Surllmaryrograms designed toaddre3s relapseprevention are a criticalcomponent of alcoholand drug abusetreatment for criminal justicepopulations. Relapse to drug use isa common problem for recoveringindividuals-it is one of manysymptoms of the condition ofalcohol and other drugdependency. Even after the mostintensive course of substance abusetreatment, many patients arevulnerable to a return to usingdrugs or alcohol. Many offenders,even when they are motivated tofollow aftercare recommendations,may be unable to maintainabstinence without help andtreatment in a specialized relapseprevention program.Treatment programs within thecriminal justice system and withincommunities can greatly benefitthis vulnerable population byhelping patients build their relapseprevention skills as part of thetreatment process. This report canbe useful as a tool for those who(1) want to tmderstand the processof addiction and relapse and (2)want to plan or set up relapseprevention programming forpersons under criminal justicesupervision, whether they are incustody or diversion, on probation,in community corrections, orsupervised by parole agencies.P Why OffendersAre EspeciallyVulnerable toRelapseOffenders tend to be ill-equippedto handle the stressful situationsthat can bring about relapse, whileat the same time they suffer fromstresses both more numerous andintense than those affecting theusual patient. Upon release fromcustody, the offender mustimmediately assume the unfamiliartask of being responsible for self,while simultaneously attemptingto resume family relationships,locate employment, comply withrequirements of parole orprobation, and resist thetemptations presented bydrug-using associates or familymembers. Faced with a myriad ofdecisions and often with littlepositive support, the offenderfrequently succumbs to drug use toease feelings of failure, anxiety,confusion, and depression. Thecycle of alcohol and other drugabuse and related criminal activitythen begins anew.Criminal offenders areparticularly vulnerable to relapsebecause alcohol and other drugabuse, for them, is often a methodfor coping with stress. Therefore,patients who demonstrateantisocial behavior and criminalactivity are often most in need ofhelp in learning constructivemethods for coping with stress.Relapse is most often triggered bysuch stress as anxiety, isolation,positive and negative socialpressures, and depression. Extremeand varied stress is a tyr' 1experience among offe:s asthey leave the restrict,environment of a prison, and, to alesser extent, for those leaving aperiod of close community custodyand surveillance. Often, thereturning offender must face thesestresses without stableemployment or the support of astable home and socialenvironment. Lacking successfulcoping strategies and socialsupport, the offender often returnsto drug abuse as the familiarcoping strategy.To avoid relapse, recoveringpatients must draw on their innerstrengths, self-awareness, andcoping skills, as well as on theirsocial and family supports. Thistask is made more difficult foroffenders, because so many ofLitem experience multiple andlong-standing psychosocialproblems. These problems, whichcontribute both to their criminalbehavior and to the potential forrelapse, may include: Difficulty in relating to familymembers An inability to sustain long-termrelationships Emotional and psychologicaldifficulties Deficits in educational andvocational skills Employment problemsvii
Executive Summary Multiple contacts with thecriminal justice system Inability to handle anger andstress Inability to handle socialpressures for drug use Inability to handle high-risksituations conducive to relapseHow Relapse CanBe PreventedA relapse to alcohol and other drugdependency is not an immediate orunpredictable event. Each personhas a set of individual triggers,high-risk situations, or associateswhich set in motion the gradualprocess of relapsing touncontrolled drug abuse.Researchers and treatmentpractitioners have developedvarious methods t(l help patientsidentify those areas which presentthreats to their abstinence. Onceidentified, recovering patients maybe able to control and overcomethese threats by use of strategiesdesigned to increaseself-awareness, strengthenresistance, and create positivecoping options.This executive briefing bookpresents one approach for helpingoffenders develop the requisiteskills for preventing relapse. Thisapproach is based on the idea thatrecovery is a process that takesplace over time and in specificstages. To accomplish the tasks, thepatient needs to be aware of thisprogression and to gain the skillsneeded to master each stage. Thestrategy defines recovery in termsof six stages: (1) transition toaccepting the goal of abstinence,(2) physical and psychologicalstabilization, (3) early recovery,(4) middle recovery, (5) laterecovery, and (6) maintenance.Treatment programs forrelapse-prone patients need to bedesigned to provide help in thefollowing areas:,. Self-regulation and physical,psychological, and socialstabilization Self-assessment to help patient;reach a conscious understandingand acceptance of thesituations/events leading totheir past relapses Understanding of the generalcauses and dynamics of relapse Development of coping skills forresponding to their individualstressors and warning signs ofrelapse Development of recoveryactivities to help recognize andmanage each personal warningsign Learning of daily monitoringtechniques for identifyingrelapse warning signs Involvement of the patient's"significant others" in supportof recovery and relapseprevention. Maintenance and regularupdating of the individual'srelapse prevention planWhere RelapsePreventionProgramsCan Be SetUpcriminal justice system-diversion,probation, jail, intermediatesanctions, corrections, and parole.A number of these approaches aresummarized in chapter 3. Researchindicates that court-orderedtreatment can be an effectivevehicle for preventing relapse andrecidivism among drug-abusingoffenders who are unlikely toattend treatment on their own.Court-ordered treatment also tendsto increase offenders' involvementin community programs and thelength of time they spend intreatment.Treatment programs within thecriminal justice system need tointerface with those in communitytreatment settings. The ideal is forstaffs not just to coordinate, but toshare training, the design of theirprograms, and the planning forindividual offenders throughcoordinated case managementprocedures. An offender'streatment and relapse preventionplan, designed while the person isincarcerated or under supervision,would then be continuously inplace as the individual is releasedto reenter the community. Asoffenders leave the structuredcriminal justice setting, they wouldthen receive follow-up care andsupport in practicing their relapseprevention techniques. Thiscontinued involvement givesoffenders a critical opportunity totest out their coping skills inreal-life high-risk situations, toreview their responses, and to beassisted throughout by cOimselorsand other group members. Techniques to prevent relapse arecurrently a component of programsat all case-processing points in the viii
Introductionrug abuse treatmentoffers offenders anopportunity to breakthe cycle of drugabuse and crime.Preventing relapse-one of thecommon symptoms of drugdependency-is crucial for thispopulation. For detoxified orrecovering addicts involved withthe criminal justice system, therelapse to drug use is likely tocoincide with a return to criminalaciivity. The reverse is also true.A return to criminal behavior islikely to cause relapse to alcoholand other drug use.Those in the drug treatment andcriminal justice systems can do agreat deal to help offenders avoidrelapse. One important goal is toprovide addicted or drug-abusingoffenders with drug treatment thatincludes help in developing thepersonal skills and strategiesneeded to prevent relapse. Relapseprevention depends on a series ofprogressive steps that bring aboutfundamental change in the addict'sassociations, thinking patterns,value system about self and others,and the stopping of self-defeatingbehaviors. This report explains thecomponents of relapse preventionas a part of the treatment process.A second important goal is tooffer continuity of care between thecriminal justice system and thecommunity after the offender'srelease. We can help preventrelapse by better planning for thistransition and by coordinatingD treatment services within ourcommunities. Every segment of thecriminal justice system can playarole, such as through court-orderedand supervised drug treatment.This report suggests many relapseprevention approaches and ideasfor creating community linkagesamong different segments of thesystem.Chapter 1 provides an overviewand introduction on the nature ofaddiction and relapse, includingthe types of patients affected, thegoals of treatment, and strategies topromote the recovery process. Theauthors explain why traditionaltreatment models are sometimesinadequate for helping the criminaljustice population. This populationneeds specific stabilization skillsbefore they can focus on thechange in lifestyle that is requiredfor rehabilitation from drug abuse.Offenders need to learn specificskills to help them identify andmanage the warning signs ofrelapse within themselves. The firstchapter presents an approach forrecovery that includes thedevelopment of these specificskills, and describes the principlesand procedures of relapseprevention therapy.Chapter 2 emphasizes the needto prevent relapse throughprogram and community planning.After highlighting the personalfactors and high-risk situationsmost likely to bring about relapsein offenders, this chapter describesprogram approaches forpreventing relapse and thepotential role that can be assumedby various segments of thecriminal justice system. The authorstresses the importance ofstrategies designed to providegraduated reentry into thecommunity for t. e recoveringoffender. Approaches of thecriminal justice and communitytreatment systems need to beaimed at: Strengthening the returningoffender's motivation andcommitment to treatment Providing an individualassessment of each offender'sabuse and relapse history Developing a foundation ofrelapse prevention skills withinl e offender Providing linkages tocommunity treatment followingthe offender's release fromcustodyChapter 3 provides summariesof a number of specific relapseprevention programs andstrategies used by local, State, andFederal criminal justice agencies.The range of program settingsillustrate how relapse preventionstrategies can be incorporated at allcase-processing points in thecriminal justice system, includingdiversion, probation, jail,intermediate sanctions, corrections,and parole. Many additionalsources of information are listed inthe section, Other Readings.1
Chapter 1-An Overview of AdJ.diction,Relapse, and Relapse PreventionTerence T. Gorski, M.A.John M. Kelley, M.A., C.S.W.Lisa Havens, R.N., M.S.W., C.A.D.hPse is not an isolatedevent. Data show thatrelapse to alcohol andother drugs is aommon event amongaddicts, although it is not a certainor random symptom of addiction.Many addicts experience severalabstinence/relapse episodesfollowing treatment. Studies showthat the ability to resist relapseincreases as the overall period ofabstinence from alcohol and otherdrugs also increases.Treatment practitionersrecognize that relapse is asymptom of addiction. but one thatmay be prevented and controlled.The relapse process is marked bypredictable and identifiablewarning signs that begin longbefore the return to use or collapseoccurs. These warning signs formthe basis for relapse preventionprogramming.R Recovery andRelapse Policymakers, administrators, andpractitioners in criminal andjuvenile justice agencies can benefitfrom information about recoveryand relapse rates among patients inalcohol and drug abuse treatmentprograms. Knowing what is typicalfor the recovering population ingeneral offers useful insights forthose dealing with offenders, manyof whom have problems withalcohol and drug dependency.A February 1992 report by theU.S. Department of Justice foundthat, of 79,000 felons in 17 Stateswho were tracked following asentence to probation, "the 53percent of offenders who had adrug abuse problem were morelikely to be rearrested than otheroffenders. Researchers also foundthat judges did not require drugtesting or treatment for 42 percentof those known to have a drugproblem" (U.S. Department ofJustice 1992).Recovery Rates forPatientsRecovery from alcohol and otherdrug abuse is considered a processrather than a state. In acknowledgment of this process, theAmerican Medical Association hasestablished criteria for recoverythat are based on 3 years ofabstinence from the drug of choicewith no abuse of other substances.Some researchers recommend thatthe criteria for recovery be basedon 5 years of abstinence (Bejerot1975). Knowing that relapse mayfrequently and rapidly occur aftertreatment, members of AlcoholicsAnonymous refer to themselves as"recovering alcoholics." In studiescombining a total of 499 treatedalcoholics, only 18 percentremained abstinent during the6 months following treatment(Gottheil et al. 1982).Relapse also may occurfrequently and rapidly followingtreatment for dependency on otherdrugs. A study conducted byMaddux and Desmond (1981)showed that "70 percent of 1,653treatment and correctionalinteractions over a mean period of20 years were followed by less than1 month of abstinence.Eighty-seven percent [ofinteractions] were followed byabstinence of less than 6 months."Another study conducted bySimpson, Joe, and Bracy (1982)found that "56 percent to 77percent of opioid addicts indifferent treatment groupsresumed opioid use within 1 yearafter completion of treatment."Although studies indicate thatrelapse is part of the recoveryprocess for many patients, otherstudies of lifelong recovery /relapse patterns indicate thatpatients are not without hope.Approximately one-third ofpatients achieve permanentabstinence through their firstattempt at recovery. Anotherone-third have a period of briefrelapse episodes that eventuallyresult in long-term abstinence. Anadditional one-third have chronicrelapses that result in eventualdeath from addiction. Thesepercentages are consistent withlifelong recovery rates from anychronic lifestyle-related illness(Vaillant 1966). Approximatelyone-half of all relapse-pronepatients eventually achievepermanent abstinence, while manyothers improve despite havingperiodic episodes of relapse.Categories of PatientsFor the purpose of relapseprevention therapy, individualsaddicted to alcohol and other3
An Overview of Addiction, Relapse, and Relapse Preventiondrugs can be categorized accordingto their recovery and relapsehistories (Gorski and Miller 1986).These categories are: Patients prone to recoveryo Patients briefly prone to relapse Patients chronically prone torelapseRelapse-prone individuals canbe further divided into thefollowing three distinct subgroups:transition patients, unstabilizedrelapse-prone patients, andstabilized relapse-prone patients.1. Transition patients. In spite ofadverse consequences, transitionpatients fail to recognize or acceptthe fact that they are suffering fromalcohol and other drug addiction.This is usually because thechemical has disrupted thepatient's ability to perceive realityaccurately.2. Unstabilized relapse-pronepatients. Unstabilized patientshave not been taught the skills theyneed to identify their symptoms ofaddiction and addictivepreoccupation. In these cases, thetreatment fails to provide thesepatients with the skills needed tointerrupt their disease progressionand to alter their alcohol and otherdrug use. As a result, such patientsare unable to adhere to a recoveryprogram requiring abstinence,treatment, and lifestyle change.3. Stabilized relapse-pronepatients. Stabilized patientsrecognize that they are d !pendenton alcohol or other drugs, that theyneed to maintain abstinence torecover, and that they need tomaintain an ongoing recoveryprogram if they are to remainabstinent. Such ongoing effortsusually mean either patientinvolvement with a 12-Stepprogram or other protracted effortsat psychological and physicalrehabilitation. However, despitetheir efforts, these individualsdevelop symptoms of dysfunctionthat eventually lead them back toalcohol or other drug abuse.Many therapists mistakenlybelieve that most relapse-prone4addicts are not motivated torecover. This belief is particularlycommon among those who workwith addicts in the criminal justicesystem, where relapse to drug usecoincides with a return to criminalactivity. However, clinicalexperience does not support thisperception. The relapse preventioncenter at Father Martin's Ashley, inHavre de Grace, Maryland, admitsrelapse-prone patients who needspecial help with relapseprevention. This center reports thatmore that 80 percent of theirrelapse-prone patients had ahistory, at the time of their earlierdischarge, of both recognizing theirchemical addiction and of beingmotivated to follow aftercarerecommendations (personalcommunication to T. Gorski 1989).Despite this, these patients wereunable to maintain abstinence andwent on to seek treatment in aspecialized relapse preventionprogram.Relapse prevention therapy is aspecialized technique that workswith and builds on the strengths ofcurrent treatment methods. Theprinciples and procedures ofrelapse prevention therapy can bestbe understood within theframework of a basic knowledgeabout alcoholism and other drugaddiction and about the recoveryprocess.Alcoholism andOther DrugAddictionAddiction s a disease caused bythe continued use of alcohol orother drugs that producebiological, psychological, andsocial changes in an individual.These changes result in an inabilityto control the usage despiteincreasingly adverse consequences;the changes are most rapidlyproduced in people with a geneticpredisposition to alcohol and otherdrug dependency. Sometimesmasked by periods of physicalwithdrawal, the disease process isoften progressive, chronic, andfatal if not interrupted by totalabstinence.The problems of alcohol anddrug addiction that affectindividuals while they are using,and even after they have ceaseduse, are: Malnutrition and metabolicdysfunction-The addict'sability to function normally isaltered physically until properdiet and supplements canrestore normal body chemistry.This affects the way the addictthinks, feels, and acts. Liver disease and other medicalcomplications-The addict'sliver enzymes may be radicallyelevated, producing toxic effectswithin the body. Infections,illnesses, and accidentsfrequently occur and need to betreated before normalfunctioning can resume. Brain dysfunction due to thetoxic effects of alcohol anddrugs-Alcohol and other drugsdamage brain cells, interrupt theproduction of certain brainchemicals called neurotransmitters, and alter the waythe brain functions. Addictive preoccupationThinking patterns are altered bypsychological conditioningprocesses, causing the patient tohave strong, intrusive thoughtsabout drugs of choice, to havephysical cravings for the drug,and to engage in compulsivebehaviors aimed at seeking outand acquiring the substance.These processes also alterperception, leading to the beliefthat-desiJite adverseconsequences-using ispreferable to not using. Social consequences-As thephysical and psychologicalconsequences (identified above)progressively worsen, behaviorsbecome increasingly antisocialand self-destructive. Frequentsocial consequences of addiction
An Overview of Addichon, Relapse, and Relapse Prevention are job loss, financial losses, caraccidents, domestic violence,criminal behaviors, disease, anddeath. Criminal behaviors-Alcoholand other drug dependency cancause an individual to becomeinvolved in criminal behavior.Individuals who are chemicallydependent commit crimesrelated to: (1) the effects of theiruse (such as drunk driving,public drunkenness, assault),(2) support of their addiction(selling drugs and illegalactivities to get drugs or moneyfor drugs), and (3) secondaryconsequences of their use(failure to pay child support andcourt fines and to followthrough with probationrequirements).While some individuals do notcommit crimes until they becomedependent on drugs, other peoplehave personality problems thatlead to criminal behavior. Anyreturn to criminal behavior is likelyto cause relapse into alcohol andother drug use. Likewise, anyrelapse into alcohol and other druguse is likely to cause relapse intocriminal behavior.These conditions combine tointerfere with the ability to thinkclearly, control feelings andemotions, and regulatebehaviors-especially under stress.Dependency on alcohol and otherdrugs damages the basicpersonality formed prior toaddictive use of these substancesand, as the addiction progressivelyworsens, dependency systematically destroys meaning andpurpose in life. When dependencyon alcohol or other drugs beginsduring childhood or the teenageyears, this dependency interfereswith development of theemotional, social, and cognitiveskills normally acquired duringthis life stage.It should be noted that alcoholand other drug abusers withhistories of criminal behaviorfrequently demonstrate antisocialproblems or attitudes before theonset of their substance abuse.Alllong these patients, abuseincreasingly interferes with theirability to regulate their ownbehaviors.TreatmentDependence on alcohol and otherdrugs creates problems in thephysical, psychological, and socialfunctioning of the individual.Therefore, treatment must bedesigned to diagnose and treateach of these three areas. Thelikelihood of relapse is greaterwhen extensive damage hasoccurred in any of these areas offunctioning. Total abstinence pluspersonality and lifestyle changesare essential to effect full recovery.The type and intensity oftreatment needed for eachindividual varies, depending on: The person's physical,psychological, and socialproblemsIt Stage and type of addiction(s)0Stage of recovery0Personality traits and socialskills prior to the onset ofaddiction Presence of complicating factorsthat produce undue stressAddiction to alcohol and otherdrugs is viewed as a chronicdisease that has a tendency towardrelapse. For this reason, abstinencefrom alcohol and other drugs is thegoal for all addiction treatmentincluding relapse preventiontherapy. There is no convincingevidence that controlled drinking isa practical treatment g
Roger H. Peters, Ph.D., of the University of South Florida. It was prepared under purchase order number 91MF3586101D and contract number 270-90-0001 from the Substance Abuse and Mental Health Services Administration. Roberta Messalle and Richard Bast of CSAT served as the government project officers. The opinions expressed herein are
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Mental Health, Mental Health Europe NGO and the UK Royal College of Psychiatrists7. "No health without mental health" has also been adopted by the Irish organisation Mental Health Ireland, Supporting Positive Mental Health. Burden of Mental Disorders Mental disorders have been found to be common, with over a third of people worldwide
Substance Abuse and Mental Health Services Administration. Permanent Supportive Housing: How to Use the Evidence-Based Practices KITs. HHS Pub. No. SMA-10-4509, Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, 2010. Originating Office
3.2 european Policy 12 3.4 Happiness and wellbeing debates 14 4.0 Concepts and definitions: what is mental health? 15 4.1 Dual continuum model of mental health 16 4.2 Measuring mental health 17 5.0 Benefits of mental health promotion 19 5.1 Benefits of preventing mental illness 19 5.2 Benefits of promoting positive mental health 22
Substance Abuse and Mental Health Services Administration, National Mental Health Services Survey (N-MHSS): 2012. Data on Mental Health Treatment Facilities. BHSIS Series S-78, HHS Publication No. (SMA) 16-4949. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2015. electRonic Access of the PublicAtion
A mental health policy (1996) and plan (2007-2011) existed. Emergency and disaster plans for mental health did not exist. Legislation A new Mental Health Act 846 2012 was passed in 2012 and was awaiting Government to establish the Mental Health Board. Financing of mental health services Mental health had a ring-fenced budget of 1.4% of
Communityed-bas mental health services initiated within 30 calendar days of referral coordinating mental health services with a student's primary mental health care provider and other mental health providers involved in student care. Assisting a mental health services provider or a behavioral health provider as described in s. 1011.62, F.S.,
Community-based mental health services initiated within 30 calendar days of referral coordinating mental health services with a student's primary mental health care provider and other mental health providers involved in student care. Assisting a mental health services provider or a behavioral health provider as described in s. 1011.62, F.S.,
