Substance Abuse and Mental Health in Arizona

The Grand Canyon State is a wonderful place to live, boasting some of the world's most beautiful landscapes and natural rock formations. Despite the natural grandeur, Arizona is not without its rough edges. With a population of about 6.7 million, Arizona is ranked 14th highest in the United States. 4.6% of people in Arizona have been diagnosed with a mental illness. According to the Arizona Department of Health Services, in 2015 19.5 percent of adult and teen clients had a co-occurring General Mental Health Disorder (GMH), while 29.3 percent of adults and teens also had a Serious Mental Illness (SMI), in addition to a substance abuse disorder.

Topography of Mental Illness in Arizona

Services for mental health related illnesses in Arizona are operated and provided by the Arizona Health Care Cost Containment System (ACCCS)-Regional Behavioral Health Authorities (RBHAs). Substance use and addiction treatment services are overseen by the Office of the Arizona Governor-Arizona Substance Abuse Partnership (ASAP).

According to Mental Health America, Arizona is ranked 50 out of the 50 states in access to any types of services for mental health. In addition, according to SAMHSA of the total population of the mentally ill in Arizona, only about 40% of adults receive any form of treatment. This number includes patients served by public organizations as well as private practices. The remaining 60% receive no mental health treatment whatsoever. Undiagnosed and untreated mental illness can have devastating effects on family units as well as the community at large.

Why do mental health issues and substance abuse co-occur?

Mental health issues can trigger one to abuse substances and the reverse is also true. Pervasive drug use can cause the onset of otherwise latent mental illness within an individual. Mental and behavioral health disorders can lead to substance abuse because people tend to want to self-medicate in order to alleviate symptoms. This temporary relief leads the individual to seek out the drug or substance again and again. What people sometimes do not realize is that the drug or alcohol they are taking to escape symptoms is often exacerbating the issues they are trying to escape. This quickly becomes an overwhelming cycle of use and abuse that is almost impossible to escape without help. There are some mental illnesses that co-occur with substance abuse issues more often than others. These include depression, bipolar disorder, anxiety disorders, psychotic disorders, eating disorders and personality disorders. Mood disorders are most commonly co-occurring with substance abuse disorders. According to a study done by the National Institute of Mental Health Epidemiologic Catchment Area (ECA) among individuals with a mood disorder, 32 percent had a co-occurring SUD. Of individuals with lifetime major depression, 16.5 percent had an alcohol use disorder and 18 percent had a drug use disorder. SUDs were particularly common among individuals with bipolar disorder—56 percent had a substance abuse disorder that lasted their whole life.

What are the signs and symptoms of a dual diagnosis case?

It can be challenging for co-occurring disorders to be diagnosed. This is due to the intertwined nature of mental health issues and substance abuse disorders. Suffering from co-occurring disorders presents an unique challenge in recovery because it can be difficult to recover from a substance abuse issue if there is a mental illness preset and vice versa. While causation cannot be determined at this point, there are some signs and symptoms to watch for:

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What treatments are available for a dual diagnosis?

There are evidence based models that the state of Arizona incorporated as the standard of care when treating co-occurring conditions. As of 2014, the state adopted four such models of treatment. These are Assertive Community Treatment (ACT), Supported Employment, Permanent Supportive Housing, and Consumer-Operated Services. These methods are tested and approved by the SAMHSA, the mint of the gold standard in behavioral health and substance abuse.

Assertive Community Treatment (ACT)

ACT is an individualized and comprehensive care plan for patients with mental illness and co-occurring disorders. These programs require the attention of interdisciplinary teams of medical professionals skilled in nursing, psychiatry, substance abuse treatment, social work, and occupational therapy. Individualized care also relies on a small patient to provider ratio. This a key factor in successfully implementing an ACT program. Each team takes on a wide variety of tasks including planning and monitoring treatment, assisting patients at health appointments, personal finance management, and assistance with any legal proceedings they may be facing. In addition, patients receive assistance with home cleaning, grocery shopping, cooking, local transportation, employment, and housing. Patients also receive education regarding their specific disorders, how co-occurring disorders manifest, drug abuse, and abuse counseling. Team members assist patients cope with mental health crises and relapse temptations. Medication therapy will also be monitored.

This comprehensive approach to mental health and substance abuse treatment would require that treatment be brought to the patient. Care is provided in a patient's home, on the streets for the homeless, in shelters, or anywhere a patient can be reached. Team members generally form long lasting relationships with patients, following them for years on their life's journey and providing care where needed.

Supportive Employment

Finding meaningful work and feeling useful is one of life's great necessities. Unfortunately, this fundamental need is too often not met for those who suffer with mental illness or co-occurring disorders. Supportive Employment programs seek to bring the fulfillment that employment provides to those who might not otherwise obtain it for themselves through no fault of their own. According to the SAMHSA, over two thirds of individuals with a serious mental illness desire to procure employment in their lives. Not only does employment provide a sense of purpose in one's life, it also alleviates the pull on community resources to financially support the mentally ill. Supported employment programs offer vocation training services, job matching based on skills, strengths, interests and capacities while providing support throughout the patient's employment journey. These programs are guided by eight principles:

Permanent Supportive Housing

Permanent Supportive Housing is a housing solution combined with mental health and substance abuse counseling services. These types of programs are designed for the mentally ill or those with co-occurring disorders who needs support in order to live successfully within their communities. Services include substance abuse counseling, mental health counseling, case management, vocational assistance and general advocacy. These services can include case management, substance abuse or mental health counseling, advocacy, and assistance in locating and maintaining employment. More specifically, these programs use peer support housing specialists and behavioral health technicians under the supervision of a trained mental health professional to provide services to patients.

Tackling such serious issues as chronic homelessness and mental illness, permanent supportive housing is a clinically proven method for individuals to lead productive lives and removes the need for them to be institutionalized. The programs are rooted in the belief that those with psychiatric or co-occurring conditions should have the right to live in a home of their choosing, on their own, without intrusive surveillance or restrictions. All individuals deserve to lead a dignified existence.

Consumer Operated Services

Consumer Operated Services are known by other names such as Peer Support Programs, Peer Services, Peer Service Agendas, and Consumer-run Organizations. Programs such as these differ from traditional treatment options in that they are run by mental health consumers. This means that patients are receiving services from their direct peers. Given that the programs are run by those in recovery, the programs take a different worldview than traditional programs. Their approach to helping people can have a profound effect because peers are able to help one another in a way that ordinary professionals cannot. These types of programs help people to learn about their mental health and co-occurring disorders, take on new responsibilities, develop personal support networks, learn coping skills, and change the way the perceive themselves.


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