Each year, more than 33 million Americans receive health care for mental or substance-use conditions, or both. Together, mental and substance-use illnesses are the leading cause of death and disability for women, the highest for men ages 15-44, and the second highest for all men. Effective treatments exist, but services are frequently fragmented and, as with general health care, there are barriers that prevent many from receiving these treatments as designed or at all. The consequences of this are seriousâ€"for these individuals and their families; their employers and the workforce; for the nation's economy; as well as the education, welfare, and justice systems. Improving the Quality of Health Care for Mental and Substance-Use Conditions examines the distinctive characteristics of health care for mental and substance-use conditions, including payment, benefit coverage, and regulatory issues, as well as health care organization and delivery issues. This new volume in the Quality Chasm series puts forth an agenda for improving the quality of this care based on this analysis. Patients and their families, primary health care providers, specialty mental health and substance-use treatment providers, health care organizations, health plans, purchasers of group health care, and all involved in health care for mental and substanceâ€"use conditions will benefit from this guide to achieving better care.

Estimates indicate that as many as 1 in 4 Americans will experience a mental health problem or will misuse alcohol or drugs in their lifetimes. These disorders are among the most highly stigmatized health conditions in the United States, and they remain barriers to full participation in society in areas as basic as education, housing, and employment. Improving the lives of people with mental health and substance abuse disorders has been a priority in the United States for more than 50 years. The Community Mental Health Act of 1963 is considered a major turning point in America's efforts to improve behavioral healthcare. It ushered in an era of optimism and hope and laid the groundwork for the consumer movement and new models of recovery. The consumer movement gave voice to people with mental and substance use disorders and brought their perspectives and experience into national discussions about mental health. However over the same 50-year period, positive change in American public attitudes and beliefs about mental and substance use disorders has lagged behind these advances. Stigma is a complex social phenomenon based on a relationship between an attribute and a stereotype that assigns undesirable labels, qualities, and behaviors to a person with that attribute. Labeled individuals are then socially devalued, which leads to inequality and discrimination. This report contributes to national efforts to understand and change attitudes, beliefs and behaviors that can lead to stigma and discrimination. Changing stigma in a lasting way will require coordinated efforts, which are based on the best possible evidence, supported at the national level with multiyear funding, and planned and implemented by an effective coalition of representative stakeholders. Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change explores stigma and discrimination faced by individuals with mental or substance use disorders and recommends effective strategies for reducing stigma and encouraging people to seek treatment and other supportive services. It offers a set of conclusions and recommendations about successful stigma change strategies and the research needed to inform and evaluate these efforts in the United States.

Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.

This guide was created to promote the early identification of children and adolescents with mental health and substance use problems as well as to provide guidance, tools, and resources for early identification--including a compendium of the most developmentally, culturally, and environmentally appropriate screening instruments. SAMHSA developed the guide using the input of the members of the Federal/National Partnership* (FNP) Early Identification Workgroup, chaired by representatives from the Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA).

At least 5.6 million to 8 million-nearly one in five-older adults in America have one or more mental health and substance use conditions, which present unique challenges for their care. With the number of adults age 65 and older projected to soar from 40.3 million in 2010 to 72.1 million by 2030, the aging of America holds profound consequences for the nation. For decades, policymakers have been warned that the nation's health care workforce is ill-equipped to care for a rapidly growing and increasingly diverse population. In the specific disciplines of mental health and substance use, there have been similar warnings about serious workforce shortages, insufficient workforce diversity, and lack of basic competence and core knowledge in key areas. Following its 2008 report highlighting the urgency of expanding and strengthening the geriatric health care workforce, the IOM was asked by the Department of Health and Human Services to undertake a complementary study on the geriatric mental health and substance use workforce. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands? assesses the needs of this population and the workforce that serves it. The breadth and magnitude of inadequate workforce training and personnel shortages have grown to such proportions, says the committee, that no single approach, nor a few isolated changes in disparate federal agencies or programs, can adequately address the issue. Overcoming these challenges will require focused and coordinated action by all.

Mental health-substance use is a complex interrelation, with equally complex implications for individuals and their families, health professionals and society. Although its international recognition as an issue of critical importance is growing, clear guidance for professionals on mental health-substance use and its treatment is hard to find. The Mental Health-Substance Use series has been written to address this need, concentrating on concerns, dilemmas and concepts that impact on the life and well-being of affected individuals and those close to them, and the future direction of practice, education, research, services, interventions, and treatment. This first book outlines the specific health issues, experiential aspects, treatment options and wider implications of mental health-substance use, as well as defining the field, through contributions from international experts and practitioners. This Introduction and the subsequent volumes will challenge concepts and stimulate debate, exploring all aspects of the development in treatment, intervention and care responses, and the adoption of research-led best practice. They are essential reading for mental health and substance use professionals, students and educators.

Co-occurring Mental Illness and Substance Use Disorders: A Guide to Diagnosis and Treatment provides a clinically detailed, evidence-based, and exhaustive examination of a topic rarely plumbed in psychiatry texts, despite the fact that co-occurring mental illness and substance use disorders are common. The authors argue for a more holistic and integrated approach, calling for clinicians to tactfully but persistently evaluate patients for a broad range of co-occurring disorders before determining appropriate treatment. Focusing on a substance use disorder in isolation, without determining whether another psychiatric disorder is co-occurring, can doom treatment efforts, and the reverse also is true. To help clinicians keep the big picture in mind, the book is organized around 18 cases, each of which addresses a particular diagnostic skill (e.g., assessment), group of disorders commonly comorbid with substance use disorders (e.g., PTSD, eating disorders), specific treatment (e.g., pharmacological interventions), or special population (e.g., adolescents). This case-based approach makes it easy for readers to understand strategies and master transferable techniques when dealing with their own patients. Because the initial face-to-face sessions are especially important with this patient population, the book includes chapters on the diagnostic assessment and the initial interview, as well as offering interviewing tips throughout to help the clinician develop the necessary care and skill in this arena. Also included is a chapter on integrating motivational interviewing into the treatment. Each of the 18 cases stands alone, allowing the reader flexibility in using the text. For example, the 18 cases and discussions can be read sequentially, or as needed, depending on the reader's special interest or current need. The book also features chapters on how to effectively work with patients whose disorders might be affecting other members of a patient's family, since the likelihood of a successful outcome is enhanced if an integrated treatment plan is developed for their co-occurring disorders. The questions that accompany each chapter can be used as an organizational tool prior to reading or to test knowledge and comprehension afterward. The text is completely up-to date and provides DSM-5 diagnostic information essential to each case. Co-occurring Mental Illness and Substance Use Disorders: A Guide to Diagnosis and Treatment offers a straightforward approach to people with complicated presentations, offering mental health clinicians the skills they require to effectively assess, diagnose, and treat these patients and their families.

This textbook surveys the current knowledge on substance use disorders (SUD), summarizing scientific evidence from numerous fields. It uses a biopsychosocial framework to integrate the many factors that contribute to addictions, from genetic predispositions, neurological responses caused by drugs, co-occurring psychiatric disorders, personality traits, and developmental conditions to cultural influences. Real-life vignettes and first-person accounts build understanding of the lived experience of addiction. The currently accepted practices for diagnosis and treatment are presented, including the role of 12-step programmes and other mutual-assistance groups. The text also investigates the research methods that form the foundation of evidence-based knowledge. The main body text is augmented by study guideposts such as learning objectives, review exercises, highlighted key terms, and chapter summaries, which enable more efficient comprehension and retention of the book's material.

All across the United States, individuals, families, communities, and health care systems are struggling to cope with substance use, misuse, and substance use disorders. Substance misuse and substance use disorders have devastating effects, disrupt the future plans of too many young people, and all too often, end lives prematurely and tragically. Substance misuse is a major public health challenge and a priority for our nation to address. The effects of substance use are cumulative and costly for our society, placing burdens on workplaces, the health care system, families, states, and communities. The Report discusses opportunities to bring substance use disorder treatment and mainstream health care systems into alignment so that they can address a person's overall health, rather than a substance misuse or a physical health condition alone or in isolation. It also provides suggestions and recommendations for action that everyone-individuals, families, community leaders, law enforcement, health care professionals, policymakers, and researchers-can take to prevent substance misuse and reduce its consequences.

Motivation is key to substance use behavior change. Counselors can support clients' movement toward positive changes in their substance use by identifying and enhancing motivation that already exists. Motivational approaches are based on the principles of person-centered counseling. Counselors' use of empathy, not authority and power, is key to enhancing clients' motivation to change. Clients are experts in their own recovery from SUDs. Counselors should engage them in collaborative partnerships. Ambivalence about change is normal. Resistance to change is an expression of ambivalence about change, not a client trait or characteristic. Confrontational approaches increase client resistance and discord in the counseling relationship. Motivational approaches explore ambivalence in a nonjudgmental and compassionate way.