Advocates for addiction treatment and recovery face some unique challenges, and lack some of the mental-health field's most valuable policy tools. Nonetheless, there is a great deal that addiction-field advocates can learn from their counterparts in the mental-health community, according to Cathi Coridan, senior director of substance-abuse programs and policy for the National Mental Health Association (NMHA).
Considering the mental-health field's policy victories on parity and its cadre of outspoken supporters in Congress, it's easy to forget that until fairly recently, mental illness, like addiction, was considered a behavioral problem, and society's remedy was usually punishment or confinement, not treatment. As advocates, “It is our job to push the political climate to change this; it's not the political candidates' job,” stated Coridan during a presentation on “Lessons from the Mental Health Advocacy Movement” at the Mobilizing Recovery Through Technolgy conference, held Oct. 21-23 in New Orleans.
NMHA was founded in 1909, but the mental-health field has made its greatest strides against stigma in the past few decades. The advocacy group founded by a mental-health consumer, Clifford Beers, fills a role similar to that of NCADD, said Coridan, by responding to the needs of consumers and families in communities. Ironically, it was the deinstitutionalization of mental-health patients — hailed in concept by advocates, but which often failed consumers in practice — that gave mental-health advocacy its biggest boost. Deinstitutionalization forced the field to find ways to support its constituents at the community level, Coridan pointed out.
Mental-health advocacy received a big boost in 1979 with the formation of the National Alliance for the Mentally Ill, which focuses its attention on biologically-based mental illnesses and the needs of consumers and family members. In the addiction field — at least on the national level — “There is no power to do this yet; the voices of families are silent,” said Coridan.
However, groups like the Alliance Project, along with support from funders like the Center for Substance Abuse Treatment's Recovery Community Support Program, are nurturing an emerging grassroot advocacy movement for people in recovery and their families. Nearly 70 such groups currently exist in communities nationwide, according to the Alliance Project.
In 1986, Congress passed a law requiring each state to set up a mental health planning and advisory council as a condition of receiving federal funding. These councils give mental health consumers and other stakeholders a direct voice in the services planning process, Coridan noted.
“This is an incredible tool that the mental-health field has, but substance abuse doesn't,” she said. “Substance-abuse decisions are made by agency folks and treatment folks. I don't think it's right that decisions are made without the voice of the recovery community.”
Furthermore, Coridan said, states also have a mandated Office of Protection and Advocacy that speaks on behalf of people with developmental disabilities and those in psychiatric facilities. These offices even have to power to file suit against the state if the needs of mental-health patients are not being met. Again, there is no similar authority operating on behalf of people with addictions.
Just because the addiction community is not legislatively empowered, however, does not mean that recovery advocates are helpless. The recovery movement can still take part in policy councils and weigh in on issues in the education, criminal-justice and mental-health systems that affect people with addictions, said Coridan. “You need to have a voice, not be a token,” she stressed. In addition to mental-health advocates, the recovery community can take its cue from leaders in the cancer, gay-rights, and HIV/AIDS communities — each of which has made great strides in reducing stigma and improving services for their constituencies. “You need to communicate with these folks and learn to collaborate with them,” Coridan said.
Coridan acknowledged that the addiction community faces some special challenges, such as the anonymity issue and the practical difficulties of involving AA members in advocacy without threatening their recovery. The illegality of certain drug use also complicates advocacy because it reinforces stigma and makes education difficult. While the mental-health community has done a good job explaining to the public the difference between feeling sad or “blue” and clinical depression, for instance, federal drug policy still makes little or no distinction between casual use of illicit drugs and addiction.
But on the “big picture” issues, addiction and mental-health advocates face many of the same challenges, and can learn from each's others successes. In both fields, said Coridan, the recovering community must have ownership of the recovery process so that it can educate the public about how the disease happens and how it can be prevented. “Both individuals and families need support and to be empowered,” she said.
Language also is very important in reducing stigma, added Coridan. “We need to change how we talk about people,” pressuring the media and policymakers to talk about people with addictions or people with mental illnesses rather than addicts or schizophrenics, for example.
Perhaps most fundamentally, both fields need to portray their disease as “real, common and treatable,” said Coridan. People in recovery prove that “the face of mental health is all around us,” and the same thing is true in the addiction field, she said.