SAMHSA is working to build a behavioral health system that enables Americans to find effective treatments and services in their communities for mental and/or substance use disorders. While effective treatments exist, far too few people with behavioral health conditions receive the help they need. For instance, data from SAMHSA’s National Survey on Drug Use and Health (NSDUH) show that every year 15.2 million people report having a major depressive episode (MDE). Of those, more than one-third of adults (38.3%) did not seek professional help during the previous 12 months. Other NSDUH data show that 22.7 million Americans ages 12 and older needed treatment for an illegal drug or alcohol use problem in 2013. However, less than 3 million people received the specialized treatment they needed.
While many Americans still go without needed behavioral health treatment, recent changes to the United States health system are removing barriers to accessing behavioral health services. As a result of the Affordable Care Act, a range of health plans are being required to cover essential benefits including mental health and substance abuse treatments. The Affordable Care Act extends the impact of the Mental Health Parity and Addiction Equity Act (MHPAEA) so that many health plans must offer coverage for mental health or substance use disorders with at least an equal level of benefits as the plans offer for the treatment of physical health problems.
Treatments and Supportive Services
Individual paths to recovery differ, and packages of treatments and supportive services for mental and substance use disorders should be tailored to fit individual needs. For many people with behavioral health problems the most effective approach often involves a combination of counseling and medication. Supportive services, such as case or care management, can also play an important role in promoting health and recovery.
Treatments and supportive services are provided in a variety of locations, including:
- Specialty community behavioral health centers
- Substance use disorder rehabilitation programs
- Independent providers
- Community health centers
- Mutual support groups and peer-run organizations
- Community-based organizations
- Jails and prisons
- At home through telebehavioral or home-based services
- Inpatient service providers
- Primary care programs with integrated behavioral health services
- And a variety of other community settings
Individual and Group Counseling
Individual and group counseling include a variety of treatments used to treat behavioral health problems. Counseling and more specialized psychotherapies seek to change behaviors, thoughts, emotions, and how people see and understand situations. Counseling is provided by trained clinicians such as psychologists, psychiatrists, social workers, and counselors.
Different clinicians have different orientations, or schools or thought, about how to provide these services. One common orientation is cognitive-behavioral; clinicians who use this approach provide Cognitive-Behavioral Therapy (CBT). CBT helps people in treatment seek their own solutions to problems by addressing behaviors, thoughts, and feelings with systematic goal-oriented strategies. It is important to understand that even within CBT, as with other orientations, there is a great amount of variability and most clinicians borrow on strategies from many different orientations when they provide counseling or psychotherapy. Finding the right therapist and developing a productive relationship is important for treatment to be successful. Treatment success may be more important than choosing a therapist based on a particular orientation.
Counseling can take a number of forms depending on the type of therapy being used, the goals of the treatment, and other factors in the life of the person receiving therapy. Some courses of counseling last for months or even years, while others can be brief. One brief, goal-oriented strategy, which may be used by itself or as a part of broader course of counseling is Motivational Enhancement Therapy (MET). MET is based on principles of motivational psychology and designed to produce rapid, internally motivated change. Rather than directing an individual through recovery, practitioners make efforts to help to mobilize the person’s own resources and build their own motivation to address a goal, such as reducing alcohol use. Counseling is usually provided on an individual basis, but can also be conducted with small groups of people addressing common issues.
Prescription medications also are an important resource for treating mental and substance use disorders. Medications for mental and substance use disorders provide significant relief for many people and help manage symptoms to the point where people can use other strategies to pursue recovery. Medications work better for some people than others, even if they have the same disorders.
Medication effectiveness can also change over time, so it is not uncommon for a person to find that the medication needs to be changed or adjusted even after it has been working. Medications also often have significant side effects. As a result, it is important for people receiving medications for behavioral health problems to have regular contact with the prescribing provider to ensure that the approach being used continues to be safe and effective.
Medication tends to be most effective when it is used in combination with counseling or psychotherapy. There are many different types of medication for mental health problems, including anti-depressants, medication for attention issues, anti-anxiety medications, mood stabilizers, and antipsychotic medications. More information about these medications can be found at the National Institute of Mental Health (NIMH) website.
Medications are also increasingly being used to treat substance use disorders. This practice, often referred to as Medication-Assisted Treatment (MAT), is the use of medications, in combination with counseling and behavioral therapies, to provide a whole-patient approach to the treatment of substance use disorders. Medications exist that can reduce the cravings and other symptoms associated with withdrawal from a substance, block the neurological pathways that produce the rewarding sensation caused by a substance, or induce negative feelings when a substance is taken. More information about MAT is available through SAMHSA’s Addiction Technology Transfer Center Network.
Supportive services are critical components of a behavioral health system and can help people meet their treatment goals. Supportive services take a variety of forms. Case or care management can coordinate behavioral health services with housing, employment, education, and other supports. Frequently, when individuals are involved in multiple public systems it is important for a single point of contact to coordinate care and engage all the system partners in service planning and delivery. For young people, this is often done through a wraparound process. For people with serious mental illnesses, this can be done through an Assertive Community Treatment (ACT) – 2008 team.
Because people with mental and substance use disorders often have more physical health problems than the general population, assistance in coordinating care across behavioral and physical health care providers can be a valuable support. One important outcome for people with serious mental illnesses is employment, and supported employment services can be an important link to a job that not only supports independence, but also provides important social interaction. People may face barriers like lack of transportation or child care, so the ability to provide some flexible supports can be the difference between wellness and failure to receive treatment.
Another important set of services is recovery supports. In combination with treatment, recovery support services can enable individuals to build a life that supports recovery as they work to control symptoms though traditional treatments or peer-support groups. These types of services support the goals of community integration and social inclusion for people with mental and/or substance use disorders and their families. SAMHSA also encourages the use of peer support services, or services designed and delivered by people who have experienced a mental and/or substance use disorder and are in recovery. Learn more from SAMHSA’s webinars and publications on peer support services and about the different types of services that support treatment at the Wellness topic.
Individual and group counseling, medication treatments, and supportive services are evidence-based treatments that can be offered by providers individually or jointly. Depending on the type of service, some or all of these can be offered in a variety of settings.
SAMHSA also seeks to support the most effective treatment methods possible through its programs, this includes support of evidence-based programs and treatments. Evidence-based programs are programs that have been shown to have positive outcomes through high quality research. In addition to working with grantees to identify and implement appropriate evidence-based programs, SAMHSA funds the National Registry of Evidence-based Programs and Practices (NREPP). NREPP provides descriptive information and expert ratings for evidence-based programs submitted by researchers and intervention developers across the nation. NREPP assists states and communities in identifying and selecting evidence-based programs that may meet their particular requirements through its library of rated programs.
People with a mental disorder are more likely to experience a substance use disorder and people with a substance use disorder are more likely to have a mental disorder when compared with the general population. According to the National Survey of Substance Abuse Treatment Services (N-SSATS), about 45% of Americans seeking substance use disorder treatment have been diagnosed as having a co-occurring mental and substance use disorder.
SAMHSA supports an integrated treatment approach to treating co-occurring mental and substance use disorders. Integrated treatment requires collaboration across disciplines. Integrated treatment planning addresses both mental health and substance abuse, each in the context of the other disorder. Treatment planning should be client-centered, addressing clients’ goals and using treatment strategies that are acceptable to them.
Integrated treatment or treatment that addresses mental and substance use conditions at the same time is associated with lower costs and better outcomes such as:
- Reduced substance use
- Improved psychiatric symptoms and functioning
- Decreased hospitalization
- Increased housing stability
- Fewer arrests
- Improved quality of life
Learn more about integrated treatment for co-occurring mental and substance use disorders from the Integrated Treatment for Co-Occurring Disorders Evidence-Based Practices KIT – 2010.
Cultural Competency in Mental Health and Substance Use Disorder Treatment
Culture is often thought of in terms of race or ethnicity, but culture also refers to other characteristics such as age, gender, geographical location, or sexual orientation and gender identity. Behavioral health care practitioners can bring about positive change by understanding the cultural context of their clients and by being willing and prepared to work within that context. This means incorporating community-based values, traditions, and customs into work plans and project evaluations.
The enhanced National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (CLAS Standards) are intended to advance health equity, improve quality, and help eliminate health care disparities. Implementing strategies to improve and ensure cultural and linguistic competency in behavioral health care systems by using the CLAS standards is a powerful way to address disparities and ensure all populations have equal access to services and supports.
For additional guidelines on how providers can provide culturally relevant services, visit the SAMHSA-Health Resources and Services Administration (HRSA) Center for Integrated Health Solutions website. Learn more from other SAMHSA publications and resources related to cultural awareness and competency.
Learn more about:
- Treatments for Mental Disorders
- Treatments for Substance Use Disorders
- Publications and Resources on Behavioral Health Treatments and Services
To learn more about SAMHSA’s work on mental health promotion, and mental and substance use disorders prevention, treatment, and recovery, visit these other topic pages: