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The Ecosystem of Mental Health and Substance Abuse Recovery


When someone with a substance use disorder is on the road to recovery, it’s not just about the rehabilitation services — it’s about the entire recovery journey. Important questions to consider are: What happens during recovery? What roles do the various medical professionals play? How does it all fit together? It depends on the patient and the recovery facility, but there are some common themes and paths that characterize the experience.

The Initial Referral

People find their way to rehab in a variety of ways. A person might be required to attend due to a court-ordered mandate, such as for driving under the influence. In other scenarios, family members or even first responders might bring the person in. When someone overdoses in Columbus, Ohio, local emergency medical services staff know they can bring the individual to Maryhaven, a comprehensive treatment center.

Patients might also come on their own if they determine that life is not manageable alone. “It’s most effective when people recognize the need themselves, when they feel that utter powerlessness,” says Mark Blair, M.D., psychiatrist and Chief Medical Officer of Columbus Springs Hospitals, which primarily treats patients with mental health and substance use disorders. When patients self-refer, it often comes after major consequences. Otherwise, they may think they’re getting by well enough on their own.

The People and Places Involved in Recovery

Multiple individuals and institutions play a role in a person’s substance use disorder recovery.

Detox: The first step for many entering rehabilitation is detox. Some patients do this on their own at home, but many go to a center. Detox can take a while, especially for those with opioid addictions, Blair says. “It may take some time, with a maintenance-type replacement like Suboxone,” he says.

Health complications: Someone with a substance use disorder may have health complications as a result of their use. An internal medical physician may assess the person’s overall health, and a specialist might be needed to address specific issues, such as liver damage if the patient is dependent on alcohol or chronic psychological dysfunction resulting from hallucinogen use.

Rehabilitation center: When a person’s head starts to clear, they can begin the next part of the process, which is rehabilitation. That can take place at the same center as the detox process or a different one. It can be an inpatient residential setup or an outpatient program. Treatment facilities work with a variety of clinicians assisting in recovery.

Physicians: Centers often have one or more physicians on staff or contracted, who specialize in psychiatry, addiction or in general or internal medicine. Recovery centers should consult with a patient’s treating and referring physicians as well, especially if they are being seen for ongoing medical or psychiatric issues or are on medication.

Nurses: Nurses play a big role. Licensed vocational nurses, registered nurses and nurse practitioners (with or without an addiction specialty) implement many aspects of patient care. Nurse practitioners with a psychiatric background often conduct the initial psych assessments and begin medication to help stabilize someone with mental health issues if appropriate, says Andrew R. Moss, LPCC-S, LICDC-CS, Director of Stabilization Services at Maryhaven.

Therapists: Social workers and therapists trained in addiction, mental health counseling or both play a major and ongoing role in recovery. These therapists often lead group and individual therapy sessions.

12-step programs: After the initial recovery treatment, those in the relapse-prevention or harm-reduction phase may join a 12-step program as part of their recovery. Examples include Alcoholics Anonymous and Narcotics Anonymous.

Providers Work Together for a Holistic Recovery Plan

Different doctors, therapists and clinicians use a multidisciplinary approach to address all of the patient’s medical needs. “You want to make sure that everyone is on the same page in helping the patient in their recovery,” says Blair. For example, a person with organ damage from substance use disorder, like cirrhosis of the liver from alcohol abuse, typically has an internist on the team. This way, the patient’s mental and physical health’s are considered together, with information shared. “The team can make sure to manage symptoms like anxiety, trying to work together to make sure the treatment offering is going to be beneficial to relieve anxiety symptoms without increasing their risks,” adds Blair.

It’s important to keep referring and outside clinicians in the loop as part of the holistic effort to support the patient. “We try to foster relationships with other providers in the community,” says Moss. “We want to talk with that provider about what we’ve identified as the patient’s needs and how their care could impact the person’s recovery, to make them part of the person’s discharge plan.”

Getting Mental Health Professionals on Board

Many treatment centers now recognize that those with substance use disorders often also have comorbid or coexisting mental health issues that affect their overall health and recovery. For this reason, part of the recovery service ecosystem integrates mental health treatment.

The two most common reasons for substance use disorder are past trauma and self-medication for mental health issues, says Moss. “So many people we see have been traumatized prior to or during their use,” he says. “They’ve been through so many things that could shake anybody to their core. We need to address the trauma and anxiety resulting from that.” Someone with a mood disorder or anxiety may use a substance to manage the symptoms. “When you take that away and they’re no longer using, those symptoms resurface,” Moss says.

Integrating mental health care into the recovery services ecosystem can help the patient find the core issues driving their addiction. That could include biological cause. “If someone has untreated bipolar disorder, they’ll experience swings in mood that trigger their use. Knowing that, if we can find the right medication to stabilize their mood, that can make an extraordinary difference in their ability to participate in counseling and focus on their goals,” says Moss.

Family Support During Long-term Recovery

Moss says he always encourages long-term care for recovery. “It gives people the best chance to maintain their stability,” he says. That may include teaching life skills, continuing with mental health counseling, potentially managing mental health issues with medication, substance use disorder counseling and social support as needed.

The family and support system are extremely important for a person in recovery. “For opioid addiction, the risk for relapse is extremely high in the first week without a strong support system,” says Blair. If the family is willing to participate in therapy during treatment, and the patient is willing to have them participate, that’s beneficial, according to Blair. Because family members can sometimes be a trigger to using, he recommends bringing family members to an inpatient or safe setting to address potential issues that can exacerbate the patient’s stress and anxiety.

Educating the family is another step. Family members sometimes don’t understand that treating a mental illness is more than just telling the patient to pick themselves up by their bootstraps. The person may need medication to treat it. “Surrounding the patient with people who understand to some degree what they’re facing can make a big difference,” says Moss.

While in recovery, the staff helps the patient set up a network of support to reduce the likelihood of relapse. If patients can help identify red flags for their triggers, then that can help them decrease the risk of relapse.

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