end it with the conversation. we have to make sure that for generations to come, we have revenue streams as much as redevelopment represented to us, that continues to struggle for to make sure housing is affordable and a lot more people can be in this great city. congratulations to bridge, chp, and all the wonderful participants. congratulations to the city and county of san francisco. thank you. [applause] [applause] [music]

hello i'm ivette torres and welcome to another edition of the road to recovery . today we'll be talking about recovery support and the necessary coordination, collaboration, and recovery management of services. joining us in our panel today are dr. keith humphreys, professor of psychiatry and behavioral sciences, stanford school of medicine, department of psychiatry, stanford, california. beverly haberle, project director, pennsylvania recovery organization, achieving community together, southeast pennsylvania. joe powell, executive director, association of persons affected by addiction, dallas, texas. dr. thomasina borkman, professor of sociology emerita,

george mason university, fairfax, virginia. keith, let's start out by letting the audience know what is the need for treatment in terms of substance use and mental disorders in this country? a lot of people aren't aware of how prevalent these conditions are, but amazingly there are 45 million american adults who meet the criteria for a mental health problem. and 23 million who meet it for substance use, alcohol or drugs. and most of those who also smoke and the overlap between those groups is about 10 million people who struggle with both of those problems. so that means at any given time one in four people in this country could conceivably benefit from treatment for mental health or substance use disorder. and actually, we're using the term now, behavioral health, do you want to explain a little what behavioral health encompasses? behavioral health is a bridging term, i mean,

what is happening around the country is there's much more desire to integrate services, integrate thinking about these different types of disorders. and behavioral health is sort of a way we describe them as a whole because there are certain things that are quite similar about them, having a chronic course, having a part that's about our own behavior environment, things of that sort. so that's the phrase that's being used much more at the federal level and also around the country. and bev, i suspect that many of these folks have co-occurring conditions. do you want to help us understand a little bit what co-occurring conditions are all about? absolutely. you know, many people will have two separate conditions occurring at the same time and so they may have depression along with substance use disorder. and so parallel services need to occur in order for them to be able to sustain long-term recovery. and joe, speaking of co-occurring issues, how many people are actually treated, you know, for co-occurring and for substance use and for mental illnesses?

well, that's a good question ivette, i mean, there are many, of course, there are millions of course, of people that are being treated for both co-occurring disorders and that is all over the country. i think that in treatment they have been parallel and they have been separated, so now is the time for treatment to happen for both. yes. does everyone, thomasina, that wants to get treatment, are they able to find it? is there enough treatment around the country if all these millions of people wanted to be treated for their condition? i mean, there certainly is a lot of self-help groups that are open, and they're almost cost free. i think the question also is of all the millions of people though many of them are not ready for treatment. so it's just because they need treatment doesn't mean that

they're ready and willing to go to treatment. i think that's a really big issue for both mental illness and substance use. i think an important part of that, thomasina, is that sometimes the quality of the services hasn't been there. so sometimes people would like to seek help, but, for example, the treatment program is only open when they're at work or there's no parking, there's no childcare and so part of what our responsibility is, is to make those services more attractive and more accessible to the population because, as you know, only about one in 10 people with an addiction will get treatment each year and only about 1 in 3 with a mental health problem get treatment each year. right, right. and just to add to that, when you were saying it was 45 million people, of course, that was suffering from substance use. it seems that it's 19.7 is what i heard the statistic is as far as people with a co-occurring, so it's almost half of the folks that have a co-occurring disorder.

people need that it's so important to make sure that

services available because you're right, everybody can't go during the day when they need to go to work or they need to do other things, but there needs to be a whole menu of ways for people to get the services that they need. and joe, you had, you yourself are in recovery and are one of our pride and joy in terms of individuals who go around the country talking about your recovery. do you want to tell the audience, really in terms of your own situation,

how you came into recovery and what was your pathway? thanks for asking me, but yeah, i'm definitely in long-term recovery and, of course, it's only because of long-term recovery i'm able to be a father today and a husband and a person also that is the executive director for the association of persons affected by addiction. for years of course-i was 36 years old when i first went into the rooms of a place that reached out for me and it was a 12-step program that actually helped me and welcomed me. but before that i had struggled severely with both addiction, alcoholism, and substance use. and also having a family, out of seven brothers and one sister, five have serious mental illness and all eight of us struggled with addiction and alcoholism. and my mother didn't drink, only my dad did. but for my recovery, of course, once i got in it, it just so happened that the one person that reached out and

helped me through these last 23 years has been with me for awhile to help me with my recovery. my recovery has taken off with new meaning and quality of life to where, yeah, i can do what i do today, it's only because of my long-term recovery. but i'm also able to give back for me all that i have been given freely, and so i'm excited about samhsa and being able to be a part of this leadership as far as recovery and moving recovery throughout the community. today, of course, being executive director for apaa, association of persons affected by addiction, which is a recovery organization, we're actually able to not only locally but also working with the state and the federal to actually move as being a part of the recovery movement, but it was only because of my personal recovery where it all started. and you're also working with some of the folks in the recovery movement in the mental health community. talk a little bit about that. very important, and, you know, i didn't see this at first and,

of course, also being a licensed chemical dependency counselor to do the work on myself as well as to see about the co-occurring mental illness part and the mental health part of my own family. but the way it worked in my recovery is that being a counselor and working with people with co-occurring and also looking at my own family, now i'm at the level to where we're doing work with the managed care company, we're able to do also as far as the recovery-oriented system of care to integrate both sides of the system, the mental health side and the addiction. so not only do i work with the addiction side but also with nami, mental health association, etc. and we'll be talking a little bit more about the system's framework in some of the other panels, but thomasina i want to get back to the whole issue of really what are the costs to society for individuals that need treatment and don't get the help? i mean, it's huge. a large part of our homeless population either have

mental illness or substance abuse or both, a huge part. and that is a very tragic thing. their health problems are greater. the financial costs are greater. the health problems of particularly like the people with co-occurring disorders, they live a shorter length of time; they have other kinds of chronic conditions. okay. on and on, the family, i mean, we could go on and on about the family consequences, the broken families that can be healed together by recovery. right. and keith, there's also some workplace issues, tremendous workplace issues, correct? oh absolutely. i mean it's one of the most common reasons for absenteeism on the job is substance use or mental health problems-injuries on the job, accidents on the jobs, workplace violence.

i mean, these problems are sewn through every part of american life and that's the really daunting aspect of this problem but the upside is recovery. just as joe was saying so well, you look at how much he's giving back is because addiction is so destructive by definition, then recovery is a chance for us to get double benefits and repair that damage and benefit the entire society, not just the person with the problem. and bev, in terms of that whole issue in the workplace in particular, i know that there are policies in place that companies can adopt, correct? yes, drug-free workplace policies, employee assistance programs where people can access help at the earliest possible moment so they're then supported, integrated back into the workplace. i also wanted to mention the impact on the criminal justice system, and i think what's so exciting is that when people

really have opportunities to access recovery and move into long-term recovery, their involvement with the criminal justice system just goes down so much, and people who haven't had a way out now have a pathway to be able to restore their life and move away from their life of being involved with the criminal justice system. and i'm glad you talked about pathways, because when we come back we're going to be talking about the whole changes in the healthcare system and how they're going to affect substance use disorder and mental health services. we'll be right back. [music] well, the recovery support initiative is really a recognition that a vast majority of americans have some

experience of mental illness or addiction. either themselves or in their families. and we tend to think of this as a quiet or hidden problem and it's really not. people are seeking help through their primary care physicians, they're seeking help through specialty organizations, and they're seeking help through mutual aid approaches. so when we think about who's in recovery or what does that mean we really have to go back to it has to do with people with mental health and substance use problems who have identified themselves as needing that help to move into recovery and it's a very personal path. samhsa is-one of our priorities is recovery, and so our goal is to promote recovery though mobilizing all of the relevant agencies to involve the consumer and people in recovery in that effort, to make sure that families are educated and

that treatment services are available and that we are working with child welfare, criminal justice, as well as primary care so that people have access to services. we want a recovery-oriented environment and that also includes housing, employment, as well as the health care that i mentioned. it's very important to connect recovery and recovery support services to the dimensions of a person's life which would include a home, having a purpose, living in a community and, in fact, having relationships and something to occupy them in a normal meaningful way. so recovery and recovery support services is a construct that samhsa proposes and uses in order to think about the individual living in a community with the appropriate kinds of supports and services that they need in order to make their life a quality one. they tell me i was there, but i don't remember. i don't know where i really was.

i do not know what i had for breakfast. i do not know who won the game. i don't recognize this man. if you or someone you know is struggling with a drug or alcohol problem, there is a solution. recovery. call 1-800-662-help for information and for hope. through treatment, my life's a whole lot brighter now. brought to you by the department of health and human services. [music] the cool thing is that i'm at the level now of the recovery movement, that i'm at the federal level with samhsa and the white house, you know what i mean, and seeing how the top, how really still today, when we say that stuff rolls down hill. so the cool thing is that thirteen years ago, when csat and dr. clark said, you know, hey we're going to do a

peer-to-peer recovery community support, and then i was part of that in '97-'98, and thirteen years later where we are today. so we've come a long way from thirteen years ago of just advocating for recovery, prevention, and treatment. but i think again five years from now, we're going to come a long way, because now, everybody's on board. i mean, this year is like really turning point and historical point, because we got not only the federal, but we also have the state, i'm involved at the state level and the local level. and everybody's doing the same work right now, transformation of behavioral health leadership integration and definitely recovery community supports. keith, let's talk a little bit before we get into the health care dialogue, let's talk about how has recovery evolved throughout the years? there's been a very positive change in the united states, which i'll just give a personal story. early in my career when i would give a talk about alcoholics anonymous i would get angry emails from people saying,

"that's a bad organization, i got better in treatment." and then i'd give a talk about methadone and people saying, "oh, methadone's terrible, you should tell people to do this in that way." it was like a bunch of little battling sects. and what's changed that's really exciting is that there's this collective sense of we need to honor all pathways to recovery. and i think csat actually deserves a lot of credit for that with the national summit on recovery. when people stood up there with people who had recovered "the wrong way" and said, "this is not my pathway, but i honor and accept that." that's when the recovery movement started to become a force because if you don't divide yourself then you have the ability to influence lots of other people and that's very important because this is a health problem and nobody ever says about cancer, "you know, oh, you got better on tomaxafin instead of chemotherapy, how sad." they say, it's great. you've recovered from cancer. and that's what we should say. everybody who recovers from these disorders, we should hug them, celebrate them, be very, very happy.

and we do during recovery mont. that's right. yes. may i say something about the origin of recovery? the origin really is from alcoholics anonymous, the term. they use the term "recovery." and i think it's really important, as we're going to talk later, about recovery being self-directed, that it came out of a self-help mutual aid movement. it did not start with professionals and that's kind of the key pin of recovery is, i think, due to the historical basis in the 12-step movement. thank you. and bev, you know you were at the meeting in 2005, i believe, when we first gathered all the folks in recovery, i was there as well. and what was magic about that? i think that as keith said, the fact that people were all there talking about the different ways that they were able to

access recovery, but also in one room having the opportunity just to talk about it. i think that there has not been that opportunity to bring people from all different sectors of the community together to really talk about recovery and try to define recovery and recovery principles and what are the values and all of those things. so it was a maybe a leveling of the playing field to be able to honor all of those different perceptions and ideas. and i also-i think that what keith said about the recognition and celebration, i think, many of us for many years hid our recovery and i think the opportunity to be able to talk about it is really a blessing for many people because not only does it provide hope it also is healing. it's not something to be ashamed of. and joe, talk to us a little about those principles for recovery.

yeah, great, i think that, you know, it's so interesting how the principles have came a long way. i mean, like going back to what you were saying, thomasina, as far as alcoholics anonymous but even today when we talk about pathways to recovery, that's one of the principles that we honor all pathways to recovery. and to see how samhsa has really taken the lead, i mean i go back 13 years ago to the first peer-to-peer recovery community support program where we had to put pathways, i mean we honored all roads to recovery and we was creative and gave people that choice. but also honoring the many roads to recovery, of course, and then having hope. hope is another one or recovery principle of hope, instillation, self determination, person centered recovery is definitely has to be for a person of choice and also moving toward how the community flourishes when recovery is also acknowledged and welcomed. so there's many principles, but the cool thing is that

the fed, samhsa, now has initiated principles of recovery in all of their strategies now, which is the lead for all of the states and also in the community. well, certainly because we have had subsequent meetings to 2005 and really it's been a process, a very dynamic process of the agency taking from the field what the elements of the best practices are and what the need is and attempting to incorporate that into the programs. i think one of the things that's so important is really validating that there is not just one way and for many of the people we see they have been traditional treatment failures or traditional 12-step failures and just to understand, or they felt that way, and just to understand that there maybe are other options or other things is so empowering for them that it really does reinforce that hope

and gets them back on track and then it's always surprising to me, many times, they will then put a collection of things together that many times include what we would have thought of as traditional, but they've kind of had to come a different path and come around to it. and keith, how important is it that the office of national drug control policy now has an office on recovery issues? i think that is-i would have to say personally, one of the things i am most proud of the time i was there and very grateful to director kerlikowske for seeing the value of that. and again to tell a personal anecdote, when i would tell friends of mine who are in recovery they would often choke up, just the thought, they felt like at last we've made it, there's an office in the white house that's focused on us. and so just that office existence, i think, is very important to just remove the shame and help, i hope, roll back the discrimination that recovery people often encounter.

and the other thing to add to it, it's good to have the office but it has to be very active, so it's been important that the director, the deputy director had been out at the recovery marches, have involved recovery people in the development of drug policy listening sessions participation, because there's so much wisdom among people who have experienced this problem about how to help the people and we haven't tapped that. i think recovering people are like this oil shale i hear about, that everyone's trying to figure out how to get the natural gas out of it, is that they're this massive source of energy and if we could just figure out how to tap it we would have enormous benefits for all of us, so i think that's part of it. thank you. thomasina, you wanted to add something a little while ago. i think what is really critical about recovery is that it's self-directed and instead of being professionally directed, it is self-directed. which makes the idea of many pathways of recovery even more important, right.

and then the need for people to get information about the pathways and try and find out what will work for them. if i can just add onto that, giving people the opportunity to develop their own recovery plan as opposed to a treatment plan that has been given to them, we see just such a difference. it becomes their plan and as it's their plan, there are opportunities then for them to really own and manage their own recovery, which is a very different kind of a thing that has transpired over the years. and one of the other things that we want to make sure that we do initiate is culture though, and that's one of the recovery principles, and that is that culture must be honored also. the one thing that samhsa initiated last year that i was excited about being a part of was the dialogue between consumers and peers in recovery on the addiction side. and we came -- and consumers from the mental health you mean? yeah, consumers from the mental health and peers from the addiction side, right.

what we did though was we came up with commonalities that we both had. we also came up with differences and we came up with a definition for recovery that fits for both. which was that it's a process of change through health and wellness and also the communities of your choice. so that choice of what culture did i have because latinos, asians, african americans, and native americans, i mean, there's many different roads and paths to recovery there. absolutely. and we've talked about a lot of the elements of recovery and the characteristics and when we come back we're going to talk about how those are going to fit into the new healthcare reform. we'll be right back. [music] where's mom? did she forget me? i wonder what happened to her?

what if i get left here? drugs and alcohol may make you forget your problems, for a moment, but that's not all you forget. my mother worked hard to be in recovery, and i love her for that. for drug and alcohol treatment for you or someone you love, call 1-800-662-help. brought to you by the u.s. department of health and human services. [music] the mission of the new start program is to provide

treatment opportunities for incarcerated males in the orange county jail system. the program is designed to treat them while they are in custody and continue their treatment into the community at whatever level of care it is that they need for at least 1 year postcustody. the phoenix house provides that treatment. they provide continuing care, a group counseling. they provide fellowship. basically an all-encompassing kind of program from beginning to end, which really enables a person a really, really good shot at making it. what makes this project unique from other projects in southern california is it is an in-custody program, but there is a continuum of care once someone is released from custody, and there is a team that works with these individuals when they are in custody and then follows up outside. it also includes family members. so that is the very important piece of this. once they begin to realize there is a possibility that

they can learn to manage their recovery and that they are better off staying in treatment, they begin to really engage. if an individual voluntarily seeks treatment, right from the beginning they are more invested in it. they already recognize that they have a problem. the phoenix house program was a life changing program for myself. it totally changed my behaviors and helped me to appreciate the person that i was, and help me to really like myself better. going through there was one of the most single influential events of my entire life. it was an opportunity that presented itself at a time when i was ready to change my life. it provided me with the tools, the social support, in order to move forward in a more positive way with my life. everything that i have i really do believe, to the bottom of my soul, is because i was accepted into this program. somebody knew that i was going to need this before i knew i was going to need it, and had it set up and it was in place.