that it comes to me and i can improve and change. the willingness to grow as a human, that starts mentally- they have to believe in themselves and as well taking care of themselves physically. all of that comes together here, and you can usually see it in the client's eyes after three or four months. there's a shine there-i know that sounds like a cliché- but it's there oftentimes after 3 or 4 months. it's the ability that i can change. i do believe, you know, that there is hope in recovery and for the rest of my life, and what's really cool is when a family comes for a visit or a graduation and they see the person is really different, but they're not sure why. you know, and it's more than just sobriety; it's about living. what experience they get from this program can carry onto their life outside.

it's the only program that i've learned so much compared to the hearing program. that they use sign language, they show body language, and i really recommend those who are out there that really need help to come here. and it's hard at the beginning, but once you go through it, it becomes easier. and i think that now it becomes really easy for me, and i'm still learning every day. recovery is an ongoing process; it's a continuous process through your whole lifespan, so it's important to continue working on recovery. what i do to help people that are still in the program- i support the newcomers and show how i've become sober, then explain what i've gone through. i'm always inspired and proud to see when that happens.

you know, comparing them to when they first came in, ill, they come in thin, and now, you know, they leave strong and full of hope. and their life is full of color. it works. it really works, but it's not because just the staff or the place, it works because the person comes here and really tries hard, you know, to make it through. and when that happens, that's the best. we talked a little bit about families. barbara, what is the proper role of a family member when dealing with a disability issue of an individual with a substance use or a mental illness? well, i think it's important for the families to be involved and to help the provider, the care providers, understand the background of the family and the background of the individual. how-what role their disabilities played in their lives, and what kinds of limitations they might have.

but at the same time, you know, you reach a point where you have to let the person, the butterfly go free. so i think families have to have a little balance, have input, but then let the person go. and be part of their own recovery. dr. clark, i want to move now to the affordable care act. under the affordable care act, there is this whole movement to integrate services. how is that going to work for individuals with disabilities? well, it actually may work to the advantage of individuals with disabilities. because the integrated continuum of care should foster, in the essential benefit package, comprehensive assessment of that individual's condition. so not only do you acknowledge the presence of the disability, but you also acknowledge the presence of the mental health or substance use issues. and then have to formulate a treatment strategy

to address that, and that becomes very important. and there are, as you know, under the affordable care act components like health homes or high-risk situations with people with pre-existing conditions. so the-the-the effort is to get these conditions addressed and to get people involved in addressing those. there's also a prevention component under the affordable care act to stress assessing for things like substance use as well as diet and weight et cetera, which then can play a role. but, as barbara was pointing out, what you do need, and practitioners need, is information about the individual who presents. so this is another source of information. so family members, family members can give you some history, some experience- whether it's a spouse or a partner or a mother

or father or sister or brother- the key issue particularly with the developmental disabilities, the literacy issues that ed has pointed out, all those things can be made available with careful assessment in bringing in other historians- getting back, john, to the integrated services issue- housing is a big component of that service delivery system. how is the housing, let me backtrack, is the housing an important aspect for individuals who have a substance use disorder or a mental illness as it relates to their disability? well, you know, our service system relies on, at least in california, a large system of sober living programs. once a person is through treatment or is in the early stages of recovery independently, often they're seeking sober living.

and the-the accessibility of sober living programs, both in the point of view in the physical accommodations that are necessary as well as the understanding of the importance of co-occurring and how to help somebody with a mental issue as well as an alcohol and drug issue, is really kind of lacking. so if the sober living network isn't really there for those folks. one of the things we're hoping for is that under the new health care reform, the affordable care act, and some changes that are underway at samhsa, there will be more support for financing sober housing, and we'll be able to see maybe an improvement of that system for these people. we've been, we also want to keep in mind, though, that samhsa, the va, working with hud, pursuing permanent supportive housing as an integral part of treatment strategy, it becomes then the services associated with the housing. what sober living housing offers is an environment.

permanent supportive housing, however, may be not be as focused initially on recovery, and so we need to facilitate those services in those settings. because vouchers are being handed out by hud and these programs are being facilitated, but we do need to make sure that there's sufficient services available to address the psychological and-and the substance-related issues that a person may experience. and how do people gain access to that information in order for them to go and basically, i wouldn't say demand, but really negotiate for those types of services, barbara? well, there has to be coordination, and one of the things that the affordable care act is gonna offer is also case management, and hopefully through these case management services there can a seamless transition from recovery into the community, and the fair housing act, you know, prohibits discrimination against people in recovery from housing because that's considered a disability.

so, you know, theoretically going forward, there should be this seamless transition with support through aca and, you know, the coordination with the providers. dr. clark, are home and community-based services an effective way of serving persons with disabilities? well, again, you have to take into consideration where your client is, where your patient is. as barbara was saying, case management becomes an important issue. yes, there are people who will benefit from home and community-based services, and you have to define what you mean by community-based services. we know that people with identified disabilities may be engaged with a number of community-based organizations that are providing services to them, and that should be coordinated so that you don't have either duplication of services or you- you don't wind up neutralizing the effect of these services

because of alcohol and drugs or other issues. under home health care, of course, a homebound person or a person who has a, say, an accountable care organization or a health home, then that entity needs to be aware of the unique issues that the person has. what we're trying to foster is sort of a recovery-oriented system of care where the individual's unique needs are-are being addressed. you've got a catalog of issues. you've got the person participating in delineating what it is that they need because, indeed, at the core of all of this is what does the consumer need? and where is the consumer in terms of readiness for what it is that they need? so if the patient is not ready for your version of primetime, it's not going to work. so we want a consensus-based professionally facilitated process.

so community-based services linked with the case management will allow that individual to access the best continuum of care possible under the circumstances. i think also in the disability community we look at home and community-based services as the alternative to living in a nursing home or institution, so that's an important buzz word for us. so i think as we see people moving from institutional care- the 35-year-old who lives in a nursing home because he can't afford attendant care, under aca would be able to move into the community, but then now that he's in the community, he has more of a choice in terms of things like substance abuse. because in the nursing home it was a very controlled environment. so there may be some issues. obviously we want everybody to have the choice to live in the community, but we may need to look at some of those things as people all of a sudden- it's kind of like the first time you go away to college. you know, nobody is lookin' over your shoulder

and telling you when you have to go to bed and when you have to do everything. so that, we need to maybe look at that and make sure the supports are there. so it really augers for a system of support of those individuals to be able to sustain their long-term recovery. exactly. and barbara is also talking about one of the areas where there's kind of a collision between independent living philosophy and substance abuse prevention and treatment. you know, if you're about independent living philosophy, you believe people should have all the opportunities available to them in the community that everybody else has, including the opportunity to drink and maybe develop an alcohol or drug problem. if you're about prevention, you're about limiting those opportunities, and we- our experience has been oftentimes when we go to talk to the disability community about this leadership, we need to kind of thread that needle pretty carefully. and when we come back, i want to continue along these lines and also bring up some other mitigating circumstances, other health problems that individuals with disabilities may have.

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 web site at recoverymonth.gov. 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, and, most importantly, help, call 1-800-662-help. brought to you by the u.s department of health and human services.

cam was originally started back in the '90s to address the alcohol and drug treatment needs and mental health needs of people specifically with disabilities. cam stands for the consumer advocacy model, and it was established with the idea of the individual is the expert on what their needs are. so it's a team model. nothing here is decided based on any one philosophy or any one strict practice. we look at what is holistic. it's a strength-based approach of using the individual's own strengths and applying them to the clinical model. the benefits of using technology-assisted care for people who have disabilities and/or for people who have co-occurring disabilities, or sud disorders, are that it provides an arena of access for folks who might not normally be able to get to a treatment facility or might not be able to be served in a traditional setting. ecam is taking all the services that someone would get in a traditional model-counseling, group counseling, and case management-

and putting them in a computer world, a video conference world. and technology-assisted care is taking any of those technology and media that someone might have access, whether it's a text telephone, a video phone, or a web cam, and using them to enhance their treatment experience. i didn't have a lot of experience with technology until i was involved in this program. and it was just fascinating to find out that i could meet with other deaf people on a computer, and i felt much more comfortable sharing my story with other deaf people. the primary barriers i see consumers being able to overcome are the stigma attached to drug and alcohol counseling and the access to the treatment itself. we offer a lot of options for consumers to be able to contact us- whether it's our live video conferencing, emailing, a chatting option, telephone calls, texting- every technology out there we're able to use to connect with our consumers.

the first time they saw other people on the camera using sign language who were deaf themselves, who were experiencing the same type of problems, that for the first time they really felt connected. and they really felt like they had found their home. well, that day the first time i joined an aa meeting, and i saw these people coming on the computer and popping up, and i realized there were other deaf people out there- i was really excited. we could all work together. we could share our support and have our discussion. and to have a conversation that i felt comfortable in was great. i would like to encourage other professionals in the field to look into the benefits of technology-assisted care; to really have an open mind when it comes to our ability to meet a consumer where they are; to realize that the same clinical services can be delivered just as effectively and efficiently through technology as they can in an office setting. and in this day and age of having to do more with less, everybody is looking for a way to deliver quality services with limited resources,

and we learn that by using technology-assisted care, we can expand our service delivery area and meet people where they are. whether it's to remain drug and alcohol free or to make other changes in their life, to be able to adapt what we're doing to meet their needs is in the best interest of the consumer. to have a program that was specialized for me helped me succeed. i have a job. i have a better life now. it gives somebody a choice, and i believe, as an advocate, any time someone has more choice, that's a good thing. john, you were talking about before, during one of the breaks, about issues related to hiv/aids and individuals with disabilities. talk a little bit about those elements. well, it's an accommodation issue. one of the ways that my program stepping stone has had to adapt is we have so many clients who are hiv positive or have aids, that we have to be medication savvy. you know, many treatment programs will have kind of

a blanket prohibition on psychoactive drugs or, you know, heavy-duty medications. we-we decided years ago that we couldn't- we couldn't hold to that. that our clients who either had co-occurring disorders and required psychoactive medication or who were on the various cocktails they needed as a part of their hiv/aids treatment really needed a treatment program that was very savvy about that. so we began to develop some case management services with funding from the hiv/aids side as well as co-occurring. and i think, as a result, our clients have a much better access to recovery because their medications are not being prohibited by the treatment program. john's point is well taken; it's not just individual with hiv/aids, it's people with co-morbidities that require medications or unique accommodations. and the programs have to be sensitive to it. and i think the hiv/aids population is a good example because of multiple medications. but you may have people who have heart disease,

may have seizure disorders, may have liver dysfunctions, which is very common in-among substance users. people may even have an individual whose status post-transplant and is on some fairly heavy medication. so the key issue is-is the program adaptive enough and flexible enough to accommodate the needs of the individual who not only wants to focus on the substance use disorders but also have other issues. such as trauma for women, i mean, in terms of, i mean, that's a-that's a big, big issues for ... that's a big issue depending on the treatment program; it can have up to 90 percent of the women in a specific program. so 70 percent, 65 percent of the people seen in substance abuse treatment are men. thirty-five percent are women. the problem with that is for the women unless there's a woman's specific program in the community, it's hard to get her needs met, particularly if she's suffering

from post-traumatic stress disorder, depression, anxiety disorders associated with the history of trauma and substance use disorder. so there are unique issues and if you've got medication for the other problem, then you're balancing that. so it's important for treatment programs to be flexible. and barbara and ed, i want to throw out the whole issue of- there is prejudice and discrimination related to, certainly, substance use disorder and mental illnesses. but when you add to that the whole disability component, how can families begin to deal with that? barbara, i'll start with you. the biggest need for people to see in-in people with disabilities is competence. because, you know, we-we have research that says that when people see competence in people with disabilities, they are more accepting of them. and i think that that's a problem, and that's something that families can really help foster. the side of what this person is able to do.

their work, their job, their contribution to the family. so that people see and get- develop a sense of competence about the person, the individual. because that, indeed, it is that competence that's going to allow individuals to go out into the work life that-to be able to secure independent living, correct? well, that's true, and i think it just takes- it takes a matter of getting over the threshold. you know, a lot of the prejudicism and-and-and thoughts of that nature are inside of ourselves. we, being the-the person with the disability; not to say that it doesn't come from the outside but the fear in all- once i step through the fear and-and-and by going to the-to the rehab, you know, that was one of the most fearful times in my life because, you know, i was different.

i was completely different than all the rest, but once i was accepted-and in the world of alcoholism, i found over the years that everyone is acceptable of whoever you are. no matter what you are. there's one thing that they want- is for you to recover from substance abuse that you're suffering from. and-and thank god for that, you know. once it's a matter of making the first steps, getting-getting through the door. dr. clark, in addition to what ed has said, the substance abuse and mental health services administration and csat, through the attcs, and are there other resources where individuals can avail themselves of some information to help them with some of these issues? well, we get-we've got information on disabilities and substance use disorder. but there are other groups. barbara was talking about-bazelon center is one,

and there's a disability- dredf, the disabilities rights educational fund, i think, but we'll-we'll provide you with that information. okay, and what do they do, barbara? they're advocates, and they have a lot of information on their web sites about people with disabilities and- and what your rights are and what kinds of things you can do. and why is it important for people to really begin to avail themselves of this information? are there steps that they can take? well, as i said earlier, there are no ada police. nobody is going to come out and tell people, you know, tell recovery centers this is what you have to do. it's really up to the person to become their own self-advocate, and the way you do that is by learning more about disabilities, your rights, and what you're entitled to in the world. one of the best publications, and we refer people to all the time, is treatment improvement protocol 29 from dr. clark's center for substance abuse treatment. it is, really, it goes through the kinds of accommodations that are necessary, and it's kind of a primer

for alcohol and drug treatment providers who want to serve this population. excellent. and, john, let's go back, how do we basically, overall, not-not on the legality of whether someone is-is upholding the ada, which has its own set of actions that people can take, but overall what would you tell an individual with both a substance use disorder and perhaps a co-occurring mental illness and on top of that-that have a disability in terms of helping to deal with discrimination and prejudice and stigma? well, they're going to have to work to get into a treatment program. they're going to have to work at it, and it really helps if they've got a family member who's an advocate or maybe even a formal advocate through the independent living centers that are interspersed kind of throughout our communities. and they're probably going to have to make sure that the treatment program has the flexibility that dr. clark talked about

and has at least some basic willingness to work with him. i think if a treatment program may not be trained, may not have all the pieces in place, but if there is a willingness to work with that client, then let the client help educate them about what their needs are- there's a good chance they'll get in and get some help and-and hopefully start the recovery process. and, dr. clark, what do these behavioral health providers need to do? let's, you know, recap on that. well, one-one of the things i want to stress is many state authorities take the issue of disabilities very seriously. and when they license or regulate programs, they want them to have a plan to put into effect for individuals who present with co-occurring conditions, disabilities being a component. so what a program needs to do is to recognize that in 2011 you've got to be prepared to deal with the full range of issues that confront a-a person.

and that includes that individual's disabilities if they are present. and it also calls for specialized training to be able to-to conduct extremely well these assessments. but, of course, our attcs' state authorities are programs that are targeted to help facilitating the information. so, again, depending on the community in which you live, for instance, if you're in a community where you're going to have a substantial number of returning veterans, you need to know about post-traumatic stress disorder, you need to know about traumatic brain injury. you need to know about spinal cord injuries, you need to know about family problems associated with those conditions, in addition to the substance use disorder with which that person may present. and you do well to know as much as possible about a full range of psychological conditions in terms of depression, anxiety, beyond ptsd et cetera. john, final thoughts? we have some work to do, but we're well on our way,

let's put it that way. there's a lot of people out there, i mean, they say that 17 percent of the population are people with disabilities. that's a large number. and the incidence of alcohol and drug problems among people with disabilities is higher than the general population. so we have a lot of work to do, we're well on our way, but let's keep going. ed, final thoughts. communication and awareness. i found, it's amazing to me how many people are just not aware of-of what's going on with disabled folks. they just don't have a clue. very good. barbara. well, substance abuse may not be the highest priority among the disability world because the disability community has so many needs, this one-it really has to come into the forefront because it has an impact on every other one. if you have a substance abuse problem, you're not going to be employed, you're not going to get good health care, you're not gonna have a place to live in the community. so i think it needs to move up the scale.

dr. clark. well, we've heard my three colleagues comment, and their comments are very substantial. we can anticipate having more resources with the affordable care act, but we must do, however, is make sure our programs are trained, they have staff that are trained, they are prepared, they have the information systems that will allow them to link up with other resources in the community, whether it's housing, employment, child welfare, criminal justice. we want to make sure that these programs are able to address the unique needs of individuals with disabilities. and i want to remind our audience about national recovery month celebrated each september. and, as we have heard today, it is imperative that we conduct our activities, events, and celebrations in a way to allow individuals with disabilities to also participate.

so i want to encourage everyone to get engaged, get involved, conduct events, and make sure that we engage the disability community in september and throughout the year. it's been a great program, thank you for being here. for a copy of this program or other programs in the road to recovery series, call samhsa at 1-800-662-help. or order online at recoverymonth.gov and click multimedia. every september, national recovery month provides an opportunity for communities like yours to raise awareness of substance use and mental health problems to highlight the effectiveness of treatment and that people can and do recover. in order to help you plan events and activities in commemoration of this year's recovery month observance,

the free recovery month kit offers ideas, materials, and tools for planning, organizing, and realizing an event or outreach campaign that matches your goals and resources. to obtain your copy of this year's recovery month kit and gain access to other free publications and materials related to recovery issues, visit the recovery month web site at www.recoverymonth.gov or call 1-800-662-help. [music]