Educate Yourself
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In the co-occurring field, is there a focus on peer support and recovery focused services? What role do psychosocial interventions play? What recovery-based models exist and are emerging?
Peer support and recovery-oriented services are a critical component of all models of co-occurring services. Best practice models of integrated treatment, such as IDDT, have recognized that for people with co-occurring conditions to be engaging successfully in care, they need to be in a process that focuses on hope and recovery, not just on symptoms and disorders. In this process, peer support is a critical component.
More and more consumers are working in the field as peer specialists and the vast majority of peer specialists (in my experience, usually about 4 out of 5) are in dual recovery. There is a similar model emerging in the world of addiction treatment, called “peer recovery coaching,” that has been researched primarily at Chestnut Health Systems in Illinois by William White, Mike Boyle, David Loveland and others.
All treatment interventions for substance use conditions, whether abuse or dependence, are primarily psychosocial, whether or not the individual has a co-occurring mental health condition. The best practice of “integrated” care involves the best practice for your mental health condition combined with the best practice intervention for substance use, at the same time, within the same team.
In this regard, psychosocial interventions involve motivational interviewing or motivational engagement (individually and/or in groups) to help people make better choices, build skills to implement choices, develop peer, family and professional supports and help people make slow steps of progress over months and years one day at a time, with rounds of applause for each step of progress.
It's important to distinguish interventions for substance abuse (which involves making harmful choices) from substance dependence or the disease of addiction. Recent research has clearly identified addiction as a brain disorder like other types of mental health conditions, in which there are chemical and structural changes in the brain that cause people to be unable to reliably control their use to keep out of trouble, even when they want to.
In essence, if you have addiction, even if you choose to get sober, your brain is on the other team. For people with addiction, the need for psychosocial supports and skills is much greater, because people need help to gang up against their own brain to be successful.
It is also important to know that there are new types of medications, called anti-craving agents, which are now becoming available that can help young adults with substance use conditions to reduce craving and control use more effectively. These medications include naltrexone (Revia, Vivitrol), acamprosate (Campral) for alcohol dependence and even bupropion (Zyban, Welbutrin) or varenicline (Chantix) for nicotine dependence. These medications don’t work for everyone, and by themselves, without psychosocial supports. They will not make someone sober, but for some people they can be helpful tools.