Aligning Substance Abuse Prevention with Mental Health and Primary Care

Hello, I’m Dr. Wayne Harding, the principal
investigator of SAMHSA’s CAPT– The Center for the Application of
Prevention Technologies. I’m here today speaking with Francis Harding.
Francis is Director of CSAP– the Center for Substance Abuse Prevention. We’re going to discuss the current status of prevention,
the future of substance abuse prevention, and we’re going to talk about the linkages between
substance abuse prevention and behavioral health. Knowing the current environment for behavioral health,
what do you think the future holds for prevention? …The future three years from now, five years
from now, and speculate ten years from now. I think it’s an exciting time for prevention
because the whole country is focusing on prevention. And in three years time we’re going to have a
lot more Americans who will have insurance cards. Hopefully, if we do our job correctly,
by the time five years rolls around we’ll actually have some of our
services covered by insurance. How much more exciting can that be that
we’ll actually have some of our parenting classes maybe covered by local
insurance… just like parents who have children with diabetes–they get all
of their education classes covered. Wouldn’t it be nice, if you are a parent who
has a child that has a drug or alcohol problem, that you can now, as a parent, get
some education courses for free? That will help our workforce–because as the
money is rolling in our workforce will develop and get stronger–and perhaps we
can even have some pay equity. What are some of the benefits of
connecting substance abuse prevention with mental health and with
primary health care? Well, first of all,
it’s very difficult. We’re having some difficult growing
pains by bringing it together. But what motivates me is seeing that there are
so many similarities between preventing mental disorders and substance abuse. So, the benefits are going to be, again, workforce–
hopefully, one day we’ll be able to work side-by-side. We see the same parents, we see the same kids in
many cases and, hopefully, together will be stronger to be able to march toward primary care.
We must get to primary care. If we can become part of primary care so
that doctors and all the medical community begin to look at substance
abuse and mental disorder prevention as part of the questions they ask parents of
their children, as part of when someone has heart disease–they also ask about
their alcohol use, they ask about depression… If you have cancer, the same thing. Not
only are we asking about nutrition were asking about your stress level and
because all of this will fit. Our goal is to get to primary care so that
our diseases and our problems with mental disorders will be able to be recognized,
accepted, and we can have a healthier nation. What do you see as the primary challenges for substance
abuse prevention in making those kinds of connections? I think the first challenge is getting
out of our comfort zone. Substance abuse prevention has been working for the
last thirty plus years in one direction. Mental health is just coming into their own of understanding that
you can prevent some mental illnesses. More importantly than that, there are indicators
of illness that we can prevent. We can prevent bullying, for instance. We can even teach people to learn the signs of suicide earlier so
we can prevent many suicides. Same thing with depression. We can diagnose
depression almost at the age of fourteen. We need to begin to bring the study and the challenges
and the successes of substance abuse prevention and work with mental health. The problem is bringing
these two fields together. It’s not the science. The science aligns very nicely. The problems
align very nicely, unfortunately. It’s the comfort zone of our country in bringing these
two fields together that is our biggest challenge. So, given that challenge what can prevention folks
at the State level and at the local level do to make connections with mental health
and with primary care? I think a lot of things–what we’re asking our States
to do immediately is to begin to talk to each other. Now many States are already under
the same roof, so to speak… they have behavioral health centers,
or they have mental health and substance abuse under their health department… so they
are beginning to do that. Other States are still separate and we’re asking them to have more meetings
together and to look at programming together. During this time of economy, we need to work together
so that we don’t have duplicate services out there. For instance, if you’re a school, wouldn’t it be better
to have one person come and represent behavioral health, which is both mental health services
and substance abuse services. It’s getting those people
in the room together. And at the community level, we’re asking our
community coalitions to begin to invite, what we call, non-traditional partners. And
for behavioral health, a non-traditional partner– if this is a substance abuse community coalition–we’re
asking them to invite mental health people to the table. But, we’re also, at the same time,
asking them to invite doctors, nurses, and the rest of the medical profession,
as well as insurance companies and Medicaid offices. So, we begin now starting to set the ground work
so everyone knows each other, and so as we get closer to 2014, when the insurance coverage
will expand in our country, we will be able to have already that conversation started,
so I won’t be meeting you for the first time. Resources these days are tight everywhere. What ideas can you share with us to help
the prevention field tie resources together and to leverage them in the
service of prevention? I see this as an opportunity. As our budgets
get smaller, I think that it almost forces us to look to other means of being able to keep our
programs alive. One of the things that we at SAMHSA are doing is we’ve decided, what is the core element
of prevention that we need to keep at all costs? So, as the budget starts to get smaller, what is
the one thing that we’re going to protect? We decided at SAMHSA that one thing for substance
abuse and mental disorder prevention is the logic model of the Strategic Prevention
Framework. Because the Framework– it doesn’t matter how much money I have, as
long as I have taught you how to implement that Framework to help our communities,
schools, families, and individuals learn how to assess their problems,
prioritize their problems, find an evidence-based program to work
with that problem, build your capacity–depending upon
the environment–and, then, evaluate it and start all over again. Prevention, generally, is under the spotlight
in the current administration. To make substance abuse prevention real for
others, what can the prevention field do to persuade their communities that prevention
is important, that prevention is critical to positive emotional health and that everyone
has a role to play in prevention? One of the first things that,
if I had a magic wand, I would do for all my prevention colleagues out there
is to help them learn how to speak prevention in other language than the language
that we talk about to each other. We’re almost like twins–we have a special prevention
language lingo that no one else understands. So, we need to help our prevention professionals
learn how to talk about: What is prevention? How do we fit in with cancer? How do we fit
in a healthy emotional family? And why would you want to do that? The reason why you’d want
to do that is because if you have a healthy emotional family, a healthy emotional kid,
they would have less risk in schools and in their neighborhoods and environment.
And the stress level is very important. So, when we’re talking emotional health, we’re
talking about depression, we’re talking about bullying, we’re talking about suicide–along with someone
who’s in a position to use drugs, someone who’s going to be in a position to experiment
with alcohol at an earlier age. So, as we’re blending this all together, this
is the time to be able to go out to the community, work through our community coalitions, task forces,
neighborhood groups, faith-based organizations– whatever the group structure is that
you’ve chosen in your community–and to help connect with the States so that we can begin
to help our programs work together, talk together, in real-speak. So, I want to be able to say to you,
just as I know how long I need to exercise– four days a week and for thirty minutes–I know
I’m reducing my risk for heart disease. I need to be able to help you see that along with
doing that exercise, I also need to cut down on my alcohol consumption, if I’m an adult over the age
of twenty-one (I shouldn’t even be drinking if I were under twenty-one). And I also need to
look at, how is my social being? Am I sad? Am I happy? Am I depressed?
Where am I at and how can I get help? So, I think with all of this together we’re
moving our country toward an understanding that substance abuse and mental disorders
are a part of our everyday life. We know that, each year, approximately five-
thousand youths under the age of twenty-one die as a result of underage drinking. What do you
think it’s going to take to make a bigger impact on decreasing the amount of underage drinking
that’s taking place in our nation? We have to take the problem out into the
general public. We have to get our country to understand and bond together that this is a
problem in our country that we can solve together. We have to find our second-hand
smoke for alcohol. In the tobacco field we know that tobacco
prevention and the reduction in the use of tobacco products–particularly among the
young–began to improve as soon as we all learned as adults that you smoking
is affecting me. We have to help our country see that
we can solve this problem together, that we can reduce the incidence
of underage drinking, and that it is important to me as it
is to you. We must reduce this… for money, for preventable deaths that we’re
all losing. When a child dies senselessly of a drinking driving accident under the age
of twenty-one (or any age for that matter), it not only affects that family, but it
affects that community, it affects the schools, it affects their classmates–
it affects every part of the community. So, we have to get every part of the community
to speak–but it can’t just be ourselves. It has to be led by, hopefully, our federal
government agencies, bonding together to all focus on the same message.
It has to be all of our communities– our medical communities, our youth offices,
our education departments–everybody in a community who touches a child needs to
say the same message that we’ve had enough… and we are going to
work together to reduce this. Thank you, Fran, for speaking with me today. You’re welcome.

One thought on “Aligning Substance Abuse Prevention with Mental Health and Primary Care

  1. Besides the economy, there is no greater problem in the world today than drug and alcohol addiction. Drug alcohol abuse increases risk for suicide. Persons who suffer from depression are at especially high risk for both substance abuse and suicide. Although the increase of addiction rates is a national concern, each person can do something to battle the trend.

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