you don't get resources, you're not going to get it. you-you're in a state where you need to talk to other policy people because you're trying to sustain a recovery oriented system of care for both mental and substance use disorders that needs to get people coordinated. and what is-what is the primary message? well, i think that there are multiple audiences and that there are multiple messages so-and-and i think one of the things that i've learned being an administrator in the field is that you really have to tailor those messages. so, for example, when you're talking to the criminal justice system, the messages are about how do you reduce recidivism, how do you reduce costs in that system? if you're talking to the educators, one of the things we know is that one of the best predictors of whether or not a child is going to be successful in school is whether they have a social and emotional problem. so you have to frame the issue that way. when you're talking to businesses- and you have to talk to them about assessing the students, you have to talk to them about providing continuity of support or-

yeah, but i think you first have to get their attention on the issue, and i think people don't necessary connect the dots that when you have untreated addiction and mental health problems that that lead to problems in their systems or into their-their realm. when you're talking to the business community, you've got to talk about dollars and cents. we know that there's a huge cost to businesses in terms of absenteeism and presenteeism where people show up and they're just not productive. so i think we have to frame the messages based on the audience, and, unfortunately, because of the prevalence of-of behavioral health conditions, these conditions impact every aspect of society. there's no part of society, there's no tier of society, or no part of society that's not affected. i think we have to just make sure that people see the-the connection and understand how treatment, prevention help folks in some of these other areas. and another audience is policymakers. part of our job, and part of our messaging, has to be to policymakers that it's a good investment,

that people can and do get well, and that there's a reason for them to make it possible and support the prevention, treatment, and recovery support services that people need; and unless we can deliver that message to policymakers, we really have-we have a big job ahead of us in terms of letting them know about the reality of recovery; that it's a good investment and that the discriminatory laws that they have passed that are barriers to people staying in recovery need to be repealed because with the advent of health reform, we're going to be investing in millions and millions of more people getting help and getting well. if those people can't keep their lives together, can't get jobs, can't get housing, then we've only done half the job. so policymakers need to understand the implications of their policies in terms of community health, in terms of parents, in terms of kids, and what that all means. john, i do want to come back to you because i know that you've talked to those policymakers, and i want to get your-your absolute input.

oh, i'll be glad to give that input. we'll be right back. [music] this year, as the affordable care act rolls out and as increased coverage rolls out, we know that people with mental health and substance abuse issues have a harder time sometimes getting enrolled in insurance and in other opportunities they have for getting coverage. so we are trying to do special efforts to help people understand how they might do that, to work with providers who work with people with mental health and substance abuse issues to know how to get people enrolled. the enrollment process is going to be a simplified enrollment process for everyone, and we're-so it's going to be a change and yet it's going to be easier, so the trick is getting people information about that and also,

frankly, getting people information about why it's important to have that coverage. the overall purpose of increasing community support and public awareness about prevention and treatment recovery is to assist those who are in need of treatment services, to enhance the ability of those in the community to promote prevention activities and awareness about the various issues associated with mental illness or substance use disorders, and also to mobilize the resources in the community to help facilitate early intervention and to promote recovery. every day i seek a positive- direction for my life- through my accomplishments- and, now, with help- and support for my family and others, i own- i own- i own my recovery from addition and depression.

join the voices for recovery. it's worth it. for information on mental and substance use disorders, including prevention and treatment referral, call 1-800-662-help. brought to you by the u.s. department of health and human services. [music] well, i think the-we have to overcome that negative stigma out there. we have still got to sell ourselves to the-to the community. it's necessary. we have got to let everybody know that a recovery is abundant, it's available, it's not that expensive, and, you know, where to go get it. we have to let people know where we're at, like our recovery center. you know, we have over 2,000 meetings a year open to the public, and we constantly let our neighborhood know we're there, so you have got to keep reinventing your message. you know, you don't have to reinvent the message,

you've just got to keep redelivering, you know. you've got to constantly be out there like a daily newspaper. so, john, let's continue. i know that you are always-you're in richmond. you talk to people. what is your message? well, i did want to follow up on that little prevention dialogue we had. what i wanted to point out was that out of the-there must be 25 million americans in recovery today, and i'm in long-term recovery myself. and in the recovery community, we always marvel on how we're probably one of the best prevention mechanisms out there because when we're recovering, our families are recovering. the people whose lives we come in touch with are in recovery, so i just wanted to touch on that. when we do move forward with prevention ideas, evidence-based practices, i think the recovery community- i know the recovery community has got to be one of the biggest underutilized prevention mechanisms out there, and-and to put some attention in that direction, i think, would benefit us greatly, so- and how do you use them in-in-in your work in richmond?

well, if you're in recovery in our circles and you have families, you will talk about your recovery process. how did you recovery? what did you do that worked? you know, you hear a lot about evidence-based practice, but rarely do they really get down to the nuts and bolts. okay, this is what we do, you know, we show up, we-we get part of the recovery heard, we become part of, so- and is that effective with the legislative sector of the state? i don't think anything's more effective than when you take actual recovering people down to the general assembly building. when-when you've got 100 people running around those floors, giving out recovery information, this is what we're doing. we're not only talking about stories, we bring the burning bush to the legislators. this is the situation. this is what worked. this is what needs to be done. very, very effective, and after a while, these legislators start calling us up when they need help. hey, my nephew's got a problem. could you, you know, can i send him over to you? so we're building not only information networks, but actual service networks.

these-these politicians are coming to the recovering people for services as equal as they would any other provider out there. so i think that speaks volumes right there. well, and also recovery community centers and other services and places in communities that recovery community organizations have developed are places where the whole community can come and do activities that don't involve alcohol and other drugs, so the prevention message, the prevention lifestyle is the recovery lifestyle in so many ways. and as-like there are 25 recovery community centers in new england alone that are open 7 days a week where people know they can come if they need help, family members can come for support, so it's developing a culture of recovery in our communities, is also developing a culture that supports people not using alcohol and other drugs. so that's a really important contribution in terms of changing public attitudes, because someone knows that on main street there's a place people can go if they need help.

and if you're in long-term recovery, you're there also, so it's changing the culture. fran, part of the messaging to the various audiences that we talked about is the cost of addiction and mental illness to society. yeah, it's one-it's one of the most difficult conversations to have with people, and the-the reason why is because we haven't been able to get the messaging out there that we are talking about people with an illness or people with a disease or a condition. it is a biological, psychological, physiological issue that is all combined, so when we try to show them that if we could prevent-and when we get the ear of policymakers, state legislators, or congress, or even county or community leaders-that they can see if we can prevent people from even entering into-to the danger zones of

addiction, if they could understand that there's a predisposition. so they need to look at their life a little differently. just like a-a family that's raising a child with diabetes. well, when they have another child, there's a good chance, because the parents have the diabetes to begin with, that that child is predisposed to have it. doesn't mean they'll have it. same thing with addiction we're finding out. if your parents have addiction, then there's, then you are predisposed of having a greater risk. all of that information and facts are just part of so many issues that we want to get across to the american public, and part of that, especially now with the economy and health reform, is showing them all the cost savings and the expense of treating someone with an addiction, the expense and the pain in a family of treating someone with a mental illness. it's very difficult, very expensive, and preventable, and if we can't prevent certain things, we can intervene and make it easier for them in the future.

so, arthur, i go to someone, i say $247 billion expenditures for people with alcohol or drug problems, over $200 billon for people who smoke, etc., etc., those that have an untreated mental illness or a mental disorder, and-and people say what to you? first of all, if you say that, their eyes are going to glaze over because they're not-not going to be able to comprehend the number. you know, i-i really think we have to-to make things relevant to people's lives and to what they do, and-and so that's why i think that you have to break those numbers down and-and put them in terms that people understand. so teachers understand when children don't graduate from school or children can't pay attention in a classroom, and businesspeople understand when their bottom lines are affected, so i think we have to break those numbers down and make-and make the connection for people; but then more importantly,

it's to talk about when you do make treatment accessible to people, we have a tremendous return on our investment. so, for example, in-in medicine, one of the highest drivers of-one of the biggest drivers of cost in medicine today is untreated mental illness and addiction, and studies after studies show that if you treat addiction, you save a lot of money on the physical health side, and so we're going into health care reform. i think we have an opportunity, because of how health care is going to be refinanced, to make that argument and to build in mechanisms for treatment of addiction, behavioral health conditions to be a part of it. if the incentives on the physical health side are such that you don't get paid as a provider unless you meet certain kinds of outcomes, there's a tremendous opportunity for the field to say you can't make those outcomes unless you treat these conditions. and i think the-the smart providers understand that, and

so you see now, with accountable care organizations and those kinds of things, people on the physical health side saying we need you and if we don't have you, we can't meet the outcomes; if we don't get the outcomes, we don't get the payments. and so i think that health care reform really gives us an opportunity to really change the dynamic, from one where we're trying to convince people to one where people are going to be coming to the field to say we need your help in order to-to be successful. excellent point. i also want to touch on the fact that because of this transition with the affordable care act, there will be talking about messaging, we will need to message to the people that are going to get those services, and how-how does one go about in formulating the message to those people? well, i think that there's some public policy issues that we-we really have to deal with, and i think one of them is-right now, we have a health care system that is based on illness.

some people have referred to it as a sick care system instead of a health care system. i have a billion-dollar budget in philadelphia, over a billion dollars. less than 3 percent of that budget is spent on anything other than treatment. that means that most of the resources in health care today are spent after the fact, after people are sick, after people need treatment. if we spent even a-a small proportion, a third of my budget, on things like early intervention, on prevention, we'd have a much more efficient health care system, and i-i think that the-the messaging has to be how do we get further upstream, how do we build into our health care system the mechanisms to do early intervention. and some of these technologies exist. there's a technology called screening or brief intervention, but in most systems, it's not a reimbursable service. that's a service that can be built into health care primary care settings that is very effective at both

identifying people who have addictions but intervening in a very low-cost way that has been demonstrated to have pretty significant outcomes and-and impacts in terms of both cost and-and health outcomes. so the message has to go to cms who's putting together- i think cms. i think certainly cms. i think, you know, i'm a policymaker, but, you know, i'm at-i'm at a local level. the policy changes have to happen throughout our-our health care system. they have to happen at the local level, at the state level, and especially at the federal level. i think cms can do a lot to make the reimbursement of services much more flexible, give the people who are running systems around the country the flexibility to do more of the upstream kinds of strategies, and i think we'd get a much greater return on our health care dollar. very good. and when we come back, we're going to be continuing this conversation, get into what people in recovery

can do to get better access to information, and what the government, states, everyone needs to do to really move and improve upon our system of care. we'll be right back. for more information on national recovery month , to find out how to get involved or to locate an event near you, visit the recovery month website at recoverymonth.gov. i felt broken. i needed help from my addiction and depression. and with the help of my family and recovery support community, i am whole again. join the voices for recovery. it's worth it. for information on prevention and treatment referral, call 1-800-662-help. brought to you by the u.s. department of health and human services. [music]

the organization that i represent, and am a part of, is community anti-drug coalitions of america. the work that we do, it is changing communities from the inside out so that they are better prepared to address the issue of substance abuse, and it requires everybody working together, whether it be law enforcement, be health providers, the education community, the faith community, parents, everyone coming together around this coalition in order to solve the problems. cadca has been amazingly successful in teaching us the importance of communicating those messages, best practice, how to do that through strategizers and our trainings where we are educating actually on the grassroots level. on an annual basis, cadca trains more than 12,000 adult coalition leaders throughout the nation. we have our national leadership forum.

best thing about cadca's leadership forum is the fact that we really get a chance to hear about the latest and greatest about how to combat the issues. it's an opportunity for everyone that's part of the coalition movement to come together at one point during the year, receive great training, hear from national experts, actually get to ask questions with, you know, major government officials that you think you'd never be able to connect with, but for the coalitions, it's really an opportunity to look around and go, hey, you know, i'm not in this alone. i'm part of a national movement, and there's people out there that i can network with and learn from. public awareness creates change and without the awareness of the public, then we're dead in the water, and we're not able to move our issues forward, and we're not able to create healthier and safer communities. so we employ a multitude of strategies to make this happen. they have-they have dragged me into the social media age. we have a website.

we hold press conferences. we blog. we tweet. we post on facebook. we podcast. we release press releases. we tie those to major news events. [music] and then there's cadca tv, which not only targets a coalition audience, but it reaches an average of 7 million households, so we have an opportunity to talk to the general public about these important issues. one of the major things that cadca has done for us is in terms of advocacy. you're going to go to capitol hill to meet with my colleagues. about establishing those relationships, why they're important, and how to really make those not only just about the conversations, but truly making friendships, to where when the issues are so important to us, that they automatically become important to somebody who has the power to make a difference. the partnership that we have with cadca and samhsa and our

project officers has enabled us to be successful in ways that i never knew we could be. we would not be successful without coalitions. they are critical to our success. they bring to washington the voice of local members, so the members of congress that will then understand and appreciate and react to their voice. our coalitions are working on one of the most important public health issues of our time, and the great thing to note is that prevention works. prevention saves lives, and it saves money. i come to work every day excited about having the privilege to reach out to communities and to help them address this very critical public health issue. let me go to pat and-and-and note that i know that faces & voices has a particular interest in bringing the message of the changes that aca will bring, and-and

what is that message, pat? that addiction recovery is a health care issue. we have a briefing-briefing document on our website that explains why, and one of the important issues that we cover in that is the opportunity for so many people who haven't been covered in the past to be covered, and we've learned from the state of massachusetts, which implemented health reform a few years ago, that people with addiction and people with mental illness have not been able to take advantage of this opportunity for health care coverage. and so one of the great challenges that we have, as a community, is how to message to people about the opportunity to enroll on october 1st of 2013, and john and many recovery community organizations around the country hold something called rally for recovery each year, and there were 18,000 people in philadelphia, over 100,000 people all over the country. so this year for recovery month , we want to let people know that, with the implementation of the affordable care act, it's time to enroll and to educate

families and others about these new rights and benefits that come to them under the law. so with 20 million americans in long-term recovery, we know that recovery works. the question is how can we get help to those who still don't have it, and that's a responsibility that we have. john. well, you know, i was sitting here chomping at the bit listening to arthur and fran speak earlier. recovery, you would think you've got 25 million people in recovery out there, you would lean on those people, the experiences, okay, what worked? let's implement that. let's add value to what you people are doing. affordable care act, medicaid expansion-that's going to be a solution for a lot of our problems if these states would buy into it. but you drop back on virginia, for example. they spend $5, $6, $7 billion a year on the consequences of addiction. this past july, the governor signed several bills. one was to recognize recovery support services and reimburse, but they stripped the funding out of it, yet he signed a bill that probably added $100 million to

the department of correction's budget, to, you know, further sentencing on, you know, pot dealers and what not. now i'm not saying public safety is, you know, that's very important. i get that part. but we need to shift that conversation. exactly. but the recovery community, i mean, i think that is going to be a major solution, that-that we need to invest more time, energy, money, and, furthermore, we need to respect and value those people, and faces & voices of recovery has done an excellent job elevating the value of the recovery community nationwide, trying to get these policymakers together, these politicians to go, look, let's listen to these folks, you know, they've got game. we want that game. so obviously national organizations such as faces & voices of recovery, and-and-and what other organizations? you know, i know that for the mental health community, there's nami, there's cadca. well there's the coalition for whole health, which is a really exciting national organization where people with mental illness and others are coming together to

advocate jointly, so it's nami, mental health america, faces & voices of recovery, the legal action center working with advocates as part of the coalition nationally and then working in states, because we need to advocate at the state level to make sure that the recovery supports and other activities that we know need to be part of health reform are implemented at the state level. so advocating on the essential health benefit, for example, to make sure that the full continuum of care that people need to recover both from addiction and mental illness are available. and fran, these organizations, are they-how likely are they to really pick up the mantle, as pat was noting that they have to pick up? is there a federal role, state role in this process, and if so, what is it? i think there's both, and i'll let arthur speak for himself, but in the federal role, what we're doing, and we're doing very well by the way.

we are bringing these federal-these national organizations together, and then we're asking in a local level, in a state and local level, to do the same thing. so-and we're bringing what we call not traditional partners. so the mental health organizations are meeting with the substance abuse organizations. the mental health and the substance abuse organizations are coming together and meeting with insurance companies. they're meeting with business companies. they're meeting with families. and why is it important for them to meet with the insurance sector? because if we're going to go together hand in hand into health reform and we want to change the message and we want to be able to have america be able to take those brand-new cards for insurance and be able to bring them to get services, so there is more accessible, affordable treatment for addictions, there are more prevention programs for people, especially around in schools and-and communities for kids that are being bullied and-and the lgbtq communities and-and all these

areas that we've kind of left alone for a while. we're all working together, and that's the key-that prevention, treatment, and recovery services with the national and local organizations coming together will march, so to speak, to be able to send the same message. it's all about messaging, and it's all about supporting each other. arthur? well, what i would say is that i think government plays a large role in supporting these organizations, and it's really critical. so pat mentioned that in philadelphia we had 18,000 people at our recovery walk last-this past fall. that is significant. the first recovery walk in philadelphia, which is done by an organization called pro-act, a-a community of recovery, had maybe 150 people. but because of our partnership with them, bringing our providers to the table, and the emphasis that

we've had in philadelphia on the fact that recovery is possible, we-we in our department do a variety of things from- during recovery month . well, throughout the year. for example, you know, one of the things that we think is really important, and pat's organization has been the leader in the country around this, is putting a face on recovery. we think that's really, really important. most people work next to, they worship next to people in recovery. most of the time they don't know it, and so people in recovery seem like the other. and so the idea of putting a face on recovery is something that we've really adopted in our-in our service system, and we've done a lot of things to support that, in addition to a number of other things that we've done. but that partnership has led to, now, a recovery walk, which i think is the largest in the country. it's 18,000 people. think of this-18,000 people walking in the streets of philadelphia saying recovery is possible. i mean, that was unimaginable even to us in the city even 5 or 6 years ago.

so it really talks-it speaks to the power of the partnership and what can happen, and we fully expect that next year we're going to top 20,000 people, or hopefully larger, and every time we do that, it sends a very strong message to the community that recovery is possible, that people in recovery are your neighbors, and that we ought to work together to-to achieve this. and there are a lot of opportunity to garner that support and that strength in issues-other issues that are going to be coming up on with aca, so just electronic health records, for example, which is a whole new way of really communicating health information to the patients and between and among doctors. so is-is that an area that we can also look at where this particular force, you know, within-within the state and within the local community can-can also help?

sure. i think that the issue of electronic health records is really important. if we're going to have an integrated health care system, we have to have an integrated medical record system, and, right now, as you may know, that in the aca legislation, behavioral health care was left out. i think that was a huge mistake, mainly because of some of the-the issues we've talked about before, which-which is you really can't treat even most chronic health conditions without having a strategy around treating behavioral health conditions because it's so interrelated. and if you don't have an integrated record that includes the behavioral health conditions along with the physical health conditions, you're just not going to be effective, so i think you're absolutely right. we have to think about-and, you know, there are people in congress that are trying to change that. and when we come back, i want to go back to-because samhsa is really in the forefront of working toward really getting behavioral health integrated into aca, so

i want to come back to that. we'll be right back. [music] before, addiction and depression kept me from living my life. and now every step i take in recovery benefits everyone. there are many options that make the road to recovery more accessible. it begins with the first step. join the voices for recovery. for information and treatment referral 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]