we hope to see you on the third wednesday of every month. sometimes we do leches with guests in our studio. please join us, and you can get more information that sfgov.org. it is a wonderful day, and i'm going to go get a burrito.

[music] hello, i am ivette torres, and welcome to another edition of the road to recovery. today we will be talking about prevention and early intervention for alcohol and drug disorders and mental health conditions. we will be talking about what's working and what's needed.

joining us in our panel today are: frances harding, director, center for substance abuse prevention, substance abuse and mental health services administration, u.s. department of health and human services, rockville, md; jane callahan, director, national community anti-drug coalition institute, community anti-drug coalitions of america, alexandria, va; jordan burnham, mental health advocate, active minds inc., washington, dc; dr. wendy greene, assistant director of trauma and critical care and program developer, screening, brief interventions and referral to treatment program, howard university hospital, washington, dc. fran, what is the definition of behavioral health, and how

do we distinguish between prevention, early intervention, and treatment within that definition? the definition for behavioral health for samhsa is we are taking the substance abuse and mental health prevention, intervention, and treatment programs, and we are encasing it within the disorder realm. so substance abuse, prevention, intervention, and treatment are exactly the same, same levels, and so is mental health. we are finding that mental health properties for prevention, especially, are very similar to the properties of substance abuse, and treatment is different in one respect, but the intervention to get people into treatment is very similar. it is similar, but there are differences between the treatment aspect of substance use disorders and mental illnesses, correct? yes, there are. we have different treatment centers for substance abuse.

we often have centers for treatment. in mental health, mental health services are delivered by many different realms. we have medical homes that deliver services, we have community centers that deliver services. you don't see traditional structures like in the substance abuse world for treatment. dr. greene, what is the magnitude of mental, emotional, and behavioral health problems in our society? if you look at the national averages of mental health disorders, they may vary by regions, but there... if you look at some of the underlying day-to-day anxieties, you can imagine that it can go upwards of 70 percent if you include a number of the less diagnosed or less appreciated disease processes. in our trauma population, we often see upwards of 60 to 70 percent of our patients may have some sort of mental health. we feel that the patient who actually has a traumatic event

and has some sort of substance abuse associated with it, be it alcohol or some drugs, because they usually have a polysubstance abuse patient. we often find that they aren't just drugging because they want to, but they are usually drugging to a problem. and that problem may be a mental disorder as their underlying problem, whether it be depression or otherwise. so the mixture of the two, trauma, depression, mental health, are very intertwined. fran, i am going back to you. is there a difference between the level in the statistics between mental health and addiction issues? yeah, around mental health we have approximately 9.8 million adults-and we classify that as 18 years and older-that have a severe mental illness. and we have approximately... our studies are showing us that approximately 2 million young people between the ages of 12 and 17 have also been diagnosed with a major depressive episode.

compare that to a statistic for substance abuse for instance; 5,000 deaths occur in substance abuse with young people, ages 12 to 25, with underage drinking in particular. so there is a difference, as well as a difference in cost, which we can get into later. jordan, you have had, yourself, some experiences with the problems of mental illness and substance use disorders. correct? right. i think the two and two go hand-in-hand. i think that, myself, the first time i picked up a drink was when i was a freshman in high school. statistics show that ages 12 to 17, a young adult in that age, they are twice as likely to pick up their first drink or drug if they experience some type of depression within that year. i was diagnosed with depression in 10th grade. for me, i look at, you know, when i speak to high school and even college students, is that 7 out of 10 young adults

who have a serious substance abuse problem also have a serious mental health issue that is occurring with that. so i think, again, they do go hand-in-hand. it is quite high, isn't it? yes, that statistic. and how did you manifest the problem? were your parents aware of the difficulties that you might have been having? yes, i think my parents were very aware of the problem of me drinking, but one of the problems was that no one wanted to see what the root was of the problem of me drinking. everyone looked at me drinking and were saying, "well, that's why he's not doing that well in school." or, "that's why he's not feeling that great." but no one wanted to go to the x-factor and say, "this is why he is drinking; that is getting him to that point." and so when were you finally assessed? when did you start and when were you finally assessed? in 10th grade, when i was 16, that's when i had a very bad argument with my parents that led me to go see a therapist, which at that time, i didn't want to do. being a 16-year-old male student, i just felt as though

i could keep all of my emotions on the inside. anything that i was going through i could drink it off. i could play sports and not worry about it. so i definitely wasn't in favor of going to see a therapist. but during that time when i went to go seek therapy, one thing that i wasn't completely honest about was my drinking, which was something that hindered me along the way that led up to my suicide attempt. it seems that you were already engaged in a system that was going to provide you assistance when you attempted that suicide attempt. so, if you could talk a little bit about that progression? right. when i was diagnosed, being 16, i didn't know how to handle it, because depressed and depression are two words that are used over and over again in society. i didn't know what the difference was between being depressed and being diagnosed with depression. it was explained to me that, when someone is depressed they know why they are crying, why they can't get out of bed, why their appetite might be a little bit different. but with someone like me, with depression, i can wake up one day and have no idea why i am crying,

why i feel like i don't want to get out of bed, why i feel unmotivated. and so it was a process in getting to learn my depression, having to take medicine, knowing that it is not a cold; it doesn't go away after a couple of weeks, after you take medicine and see a therapist. it was a process, but something that i didn't follow through with. i fell into a lot of tricks that young adults do by taking my antidepressant for about a month, feeling great, and feeling, "well, i am cured from depression," and stop taking my medicine. and so you would stop taking them? exactly. and it was in that period that you attempted to commit suicide? yes. along with self-medicating, with drinking, and taking my antidepressant on and off, that is what led up to my suicide attempt, by going out of my nine-story bedroom window. well, we are glad you are here. thank you, glad to be here. and we are glad you got the appropriate help. so, jane, given all these sets of circumstances, what do parents, really, in terms of beginning to assess a young lady or a young man in their home,

what do they need to know? how do they... what signs do they need to look for? that is a really good question, and i think all of the parents who are out there viewing this program are wondering, "what can i do to increase the likelihood that my kids don't end up with problems that lead to suicide, depression, or substance use?" i think the most important thing, first of all, is to just be a really good parent and listen. and then, secondly, educate yourself and learn about these things, learn about community resources and work together with other parents, particularly in your schools and your communities, to make sure that all of your kids together are getting what they need to grow up to be healthy and avoid problem behaviors. and when things do surface, i think it is really important for parents not to necessarily blame themselves, but definitely proactively get the kind of support they need, both for themselves and their children, to increase the likelihood that little problems won't turn into great big problems. yes. and fran, what do we tell parents in those situations?

i think we tell parents... both jane and jordan talked about the role of parents and how important in each of their stories that parents have. they are the first line to see their young people changing their behaviors, as jane was saying, some of the signs that are out there. we need to tell parents and remind them, first and foremost, that addiction is a disease and it is not their fault. and it is not their young person's fault. they need to know that as well. and if they do what jane said, listen, watch their young people, be interactive with them, get to know their friends, they need to know the signs of what is a normal life for a young person. and when their child begins to act a little differently than they used to act 2 or 3 years ago, that should send some signals to go get help. jordan, your parents obviously saw signs in you. they may not have understood it, and that's okay.

we are not asking everyone to be clinicians, but when you begin to see your young person changing their friends drastically, when they start to seclude themselves or they just don't seem right, that's the time to take them to the pediatrician or a doctor or a therapist or whomever. the worst thing they could do is nothing. jordan? a lot of times what parents ask is, "how can i start that conversation with my child?" because it might feel awkward, it might feel wrong to have that conversation. and two tricks that i always give to parents is: one, everyone asks how you are doing. in our society we all say, "how are you doing?" to make that positive connection, to start a conversation, i tell parents ask your kids how they are feeling, and that can change the entire dialect of a conversation by just one word, "how are you feeling?" and the other thing is relate. i know my parents and i used to do this thing called highs and lows. at dinner we would talk about our highs for the day, what we loved, and then our lows, what was our down point for the day. and for me, that secured me, to know that i'm not just

going through a bad day. my mom, my dad, they can have a bad day too. so always relate and try to start a conversation is a good tip for parents. when we come back we are going to be talking more about what parents can do, what programs are available, and how everyone can really get engaged and get involved to prevent substance use disorders and mental illnesses in our young people. we will be right back. [music] it's really important from the evidence that we have that just doing prevention activities or services in one setting isn't enough. for example, a young person needs to hear the same thing from parents that they hear from their schools, that they hear from their health care provider, that they hear from their church. so these messages, and the activities,

and the direction that a community is trying to go needs to support each other. it's important, whether it's changing norms, about the way children view alcohol and substance use, or about they way they seek help, or are supported in seeking help. and that really takes everybody assisting those children and youth, and the families, altogether in the same way with the same messages. well, prevention-prepared community dovetails into a recovery-oriented system of care because, again, you're mobilizing the resources of the community to create a supportive environment, so you have strong schools, so you have parents interacting with the schools. in a recovery-oriented community, what you are trying to do is make sure that you have access to the agencies in the community. so, all of the agencies in the community are operating to support the individual in recovery. in a prevention-prepared community, all of the agencies in the community operate to support the children,

the young adults in the community. you have got strong supervision in the prevention-prepared community, so parents are actively involved, just as family is actively involved in a recovery-oriented system of care. it's not that the individual is by himself or herself; it isn't just their problem. the same thing with a prevention-prepared community; the community understands that, if a child does not have support, that child becomes the community's problem as well as the child having his or her own problems. i had no idea it was going to be so hard. i didn't know what to expect. you hear the stories, i never took any of it seriously until i found myself here. and i realized i was going to have to work hard for my recovery. if you or someone you know has a drug or alcohol problem you are not alone. call 1-800-662-help. recovery was the hardest job i've ever had and the most important.

brought to you by the u.s. department of health and human services. [music] it is very therapeutic to be able to go around the country to tell my story to young adults, to adults, therapists, psychiatrists, whoever may listen, because i feel that is something that i didn't have before. you know, struggling with my depression and my stress and anxiety, i felt like i didn't have a voice. so to be able to speak about what i do and speak about my story and where i came from, i think it is important because i know there are people listening that can relate to at least one or two parts of my story. and that is a great thing because four out of five americans are affected by mental health, and that shows that so many people are related to mental health in some type of or form of way. and i think that is why the conversation needs to be had, because the statistics out there show how many people

are affected by it, how many people deal with it themselves, personally, and to have that conversation is really where the education starts, and that is what is most important. fran, we started talking about what parents can do, but let's go back a little bit and let's talk about what happens if we really do not prevent these problems within the population of young adults and other populations that we really have to engage with. first and foremost, i think your viewers would be interested that it is predicted by 2020 behavioral health disorders- remember, that is substance abuse and mental health-will surpass all other chronic diseases as the major health problem for our country. that in itself grabs your attention. to break it down even further, approximately $250 billion is spent each year on the cost of mental and emotional and behavioral disorders. to add to that, over $500 billion is cost to our

society for addiction disorders; for instance, substance abuse and alcoholism. so those are huge costs, especially during today, during our current economics, that we can't afford to ignore. we have a saying in samhsa, which is, "behavioral health is essential to overall health." and that is our goal, is to help our country understand: by looking at and treating and preventing and intervening into behavioral health, substance abuse, and mental health issues, we will save our country a lot of money and a lot of health. and dr. greene, it really goes beyond the treatment of mental illnesses and alcohol and drug use disorders, correct? i mean, there are other complicating factors of

individuals that have those problems that then develop or may already be in the dna of the person that has those problems and then the problems are exacerbated, like diabetes, cardiovascular issues, is that correct? yes, the patients who have a mental health disorder may have other chronic illnesses and, as such, when they don't take care of their mental health, they may not take care of their overall body's health, too. other things may get ignored, and whenever you ignore a problem and let it fester, you can imagine that the cost to health care becomes triple that which you could have done had you just spent the money in prevention in the firsthand. so every $1 you spend in prevention you are saving another $3 in health on the other end. you know, as a country we do such a good job taking care of people's physical health, right? correct. we have all kinds of fancy diagnoses and machines and all of those kinds of things, but when it comes to behavioral and mental and substance abuse issues, which really do contribute to all of those things,

we don't do such a good job, do we? no, we don't. those efforts really need to be enforced and supplemented. unfortunately, here in the district of columbia, we have some great programs that need funding and implementation. we know that we can do screening and brief intervention, but we need to get more referral centers so that once we get them identified, then we actually can provide some help for people. and fran, what are the recommended strategies? what does the research tell us in terms of the strategies to use to begin to address these problems? for behavioral health and substance abuse, mental illness and substance abuse prevention programs, we want to get to the young people first. so we have several programs that target the zero to 8 population. and, obviously, we don't teach young people at that age how not to drink or look at them for behavioral health issues, but we are looking at the families and the parents and

the communities that they live in. and that is what these programs do. we go in, we do an assessment. we take an evidence-based program, we implement the program that is targeted to the specific needs of that particular community, family, school, environment as a whole. we need to get in early and often. and jordan, when you were going through your whole ordeal, were you able to really connect with the broader community? did you find support within that community? it was difficult for me, personally, to find support in our community because mental health in the suburb area that i lived in, it was such a hush-hush topic. it was very taboo. sort of a stigma associated with it? yes. absolutely, stigma. and the problem for me was that when someone asked me how i was doing or how i was feeling, i was ashamed to say because here i suffer from depression, but i went to school with this mask on my face like i didn't.

although it took all the way until 10th grade for me to be diagnosed with depression, in a way when i hear about the screening that we do for physicals, you know, every year that they do for schools, i am thinking to myself, physically we do screening for physicals every year, but how come we can't do that mentally? elementary school, just like you do that for physical things, why can't we do that mentally for children as well? and start it at the elementary age. so, i would have known that in elementary school, what i was going through were symptoms of depression, middle school all the way into high school. and i wish that was something that was implemented in my community. jane, what is a prevention-prepared community? that is a really good question, ivette, and it is a term i think we are going to be hearing a lot more. the notion of a prevention-prepared community is all of the systems in the community, be they the health care sector, the business sector, families, schools, neighborhoods, law enforcement, they are all prepared to create a prevention system for the

community that really does increase the likelihood that everybody will be making an important contribution together and rates of these problems will actually decrease over time. dr. greene, you mentioned screening and brief interventions. many people in the audience may not know what this program is all about. do you want to tell us a little more? i will be happy to, yvette. one of the things that howard university and howard university hospital has identified was that we have a large population of at-risk drinkers, substance abuse patients, and that we wanted to find a way to try to really help our population. we didn't have enough social workers or frontline people to do it. so what we had done was put together a proposal to train our residents. and samhsa was very helpful in that and provided us with a grant to train our residents and our staff about screening, brief intervention, and referral for treatment. so when a patient comes in on whatever service... they may not have come in for an alcohol or substance abuse

problem, but the results of the discussion may have been screening that patient just to see, is this person at risk? and once you have done that, you really go through a process of educating the residents and staff about how you can have open-ended questions, affirmative listening, reflective listening, that really allows a person to open up and tell you what is going on. now we know physicians and health care personnel are very busy, so the training was a consinct one, but it was effective. and the studies, especially in the trauma literature, show the reduction at the moderate-risk drinkers was very impressive, by allowing the physicians to come in and do these screenings and brief intervention. and the big thing we emphasize is that we are not telling the patient what to do. we are letting them know, we are giving them the information, we know what the statistics are, now you make a decision. is this something you are interested in? are you interested in negotiating a different way of managing this? do you want to cut down from six drinks to three drinks a day?

what is it that you want to do? what have you done before that has shown that you can do a reduction strategy? do you want help with this? so our goal is to really empower the patient. it is not me telling you that you need to lose weight. you need to do this. this is the program. no. you decide for yourself that you are ready to do this, and then you feel more committed to it and why do you want to change? what are the motivating factors? and actually asking them... there is a reason why you do it, because you get something out of it. it is not all bad. there is a reason why people continue to go back to that drug. so you have to get to that root also. there is a reason why people continue with their particular drug. so empowering a larger group of health care professionals has been our mission, and we hope they will continue to carry it on in their practice and then refer them for treatment. and really sharing the responsibility for the wellness with the patient? correct. obviously it is a very important part. buy-in, absolutely. and it works, too, right?

yeah, absolutely. i mean, the research shows that it really works. it does. fran, dr. greene basically told us that within screening and brief interventions there are some referral issues that you tell the patient, "this is where you may get help." what components in a community need to be engaged in support of a program such as screening and brief interventions? almost all of the components that jane just mentioned that makes up the community. you have to have the families involved with that type of intervention and screening process. eighty percent of most of the screenings that are done with the sbirt program do not lead to a diagnosis. so what does that mean? that means only 20 percent need an actual traditional treatment. the other 80 percent need everything from a prevention program that is building awareness in education to a prevention program that is looking... targeting on their particular specific needs, whether they have a... they are living in an economic environment that is very tough for them or they are a certain ethnic group that

doesn't feel like they fit well, things like that or then that they need that intervention, they are not quite into the diagnosis, but what they need is a strong program that teachers and their physicians and their faith leaders can all rally around and help change the environment and their behaviors. very good. when we come back i want to talk about other programs that are also going to be very helpful to communities in need. we will be right back. [music] when you have a drug or alcohol problem, your whole world stops making sense.

you can get help for yourself or a loved one and make sense of life again. for information, treatment referral or most importantly help call 1-800-662-help. brought to you by the u.s. department of health and human services. [music] they decided that they wanted to have a talent show, that they would have an [inaudible] talent night and

invite the whole community to show some of the positive things that kids are doing, some of the talents that they have, help the kids feel good about themselves, have a nice adult and kid, family, community get- together and have the kids have a lot of fun planning it, preparing it, and putting it on, and have the whole thing be sponsored by the drug-free coalition, so the message being, we know how to have a good time, drug free. so i just wanted to talk to you guys about the talent show and what we are working on. when are we going to do the actual show? is it going to be an in-the-evening performance? an after-school performance? a prevention-prepared community is a group of concerned citizens that come together and meet, and they all have the same focus around substance abuse prevention. any community can decide it is time to make the change, and let's really try to get... let's try to rally around and energize