Quality Treatment and How to Get It
If you’re concerned your child has co-occurring substance use and mental health disorders, it will be helpful to consult a professional who is well versed in both mental health and substance use. This can include an evaluation with a qualified addictions professional. This evaluation can help to develop a preliminary diagnosis and a recommendation for the best treatment approach. Your child’s symptoms, age, gender and culture, among other factors, will help determine his or her treatment plan.
Providers can be found using the Substance Abuse and Mental Health Services Administration (SAMHSA) or American Society of Addiction Medicine (ASAM) directories, Psychology Today or through your insurance provider, who may have an online portal to search specifically for addictions professionals. Evaluations usually take place in a private practice or intensive outpatient setting, although some are done in hospital settings. Regardless of the setting, it’s important to talk to a person who is well-versed in both mental health and substance use to get a good read on what problems need to be addressed. For more information refer to Section Three, which covers differential diagnosis.
Depending on your child’s needs and how severe his or her symptoms are, there are several different levels of care. These include counseling, intensive outpatient programs (IOP), partial hospitalization programs (PHP) and rehab or residential care. Generally speaking, your child will be placed in what is considered to be the least restrictive level of care.
The most effective treatment for co-occurring disorders involves integrated care. This means that both mental health and substance use are treated at the same time by knowledgeable providers (for example, a psychiatrist, psychologist, case manager, medical team, etc.) who develop and implement an integrated treatment plan for both.
The treatment plan should include goals, objectives, treatment team members and their qualifications, evidence-based interventions including therapy and medications, and other services (such as vocational skills or academic supports) that will be offered.
Evidence-based interventions can include:
- Cognitive Behavioral Therapy (CBT)
- Trauma-Focused CBT (TF-CBT)
- Contingency Management
- Dialectical Behavioral Therapy (DBT)
- Motivational Interviewing (MI)
- Multisystemic Therapy (MST)
- Acceptance and Commitment Therapy (ACT)
Programs should also address physical health issues, whether offering on-site testing and counseling or referrals to other service providers. This can include issues like asthma, pain management, sleep disturbances, HIV, Hep C and sexual health.
What Should You Look for in a Quality Treatment Programs?
- A comprehensive treatment plan to address mental health and substance use. Parents and/or the child (depending upon age) should be asked to agree to and sign off on the treatment plan. The treatment plan should be periodically reviewed and updated to reflect progress or modifications to the plan and approach.
- Programs that include a family component as part of the treatment plan to provide education, skill building, resources and support. Often there is an opportunity to interact with other families to share what’s working and what can be improved.
- Programs that promote interactions with mentors, healthy activities and the recovery community. Often adolescents and young adults will need help engaging in activities like sports, volunteering and other organized social events; reconnecting with hobbies and interests that have gone by the wayside; and hanging out with healthier peers.
Many facilities advertise that they offer treatment for co-occurring disorders, but it’s important to do your homework and find out exactly what they mean by that. For instance, some providers won’t work on mental health issues until a person is totally abstinent from substance use. Others might say they treat co-occurring disorders, but what they really mean is that there’s a nurse on hand to dispense psychiatric medications, or a psychiatrist who will write a prescription based upon the diagnosis your child was given prior to admission to the program.
Medications selected must take into account both substance use and mental health, as there are some medications that might not be recommended for people who struggle with substance use. For example, many practitioners won’t prescribe Adderall for ADHD or Xanax for anxiety due to their misuse potential.
Programs may offer yoga, meditation classes, art therapy and other activities as supplements to treatment. Some programs may offer 12-step/mutual aid groups like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) or SMART Recovery on premises, or require that your child attend on days when he or she isn’t in programming at the facility. Other supports that may help include National Alliance on Mental Illness (NAMI)’s OK2Talk Program or the Depression and Bipolar Support Alliance (DBSA) support group.
Quality programs will develop a comprehensive discharge or continuing care plan, including referrals for a step down to a lower level of care (e.g. a PHP to IOP, or IOP to individual counseling and a psychiatrist). One critical component of continuing care is a relapse prevention plan that identifies high-risk situations or circumstances, early warning signs and symptoms, and flags or problems related to medications, providers, relationships, daily structure, transportation or finances. In addition, it may help to identify an “accountability partner” to help keep your child on track with healthy living and to discuss what the next steps will be should a relapse occur.