A typical day for Oklahoma City case manager Joe Aitson involves getting people placed in evidence-based treatment programs.
His life could have gone in a completely different direction. Describing his former “criminal mentality,” Aitson tells NPR that his introduction to drugs started when he was a teenager.
Thanks to his recovery, Aitson has found meaning in his addiction. Now he uses his lived experience to help others navigate an already complicated system.
The recovery navigator knows that finding addiction treatment should not be overwhelming and leave you defeated. And yet, for many patients and families, that’s exactly what happens.
Searching in a moment of urgency, they make decisions on the fly. When every website claims to offer “comprehensive care,” it becomes hard to tell what’s real and what’s marketing fluff.
That’s where individuals like Joe Aitson take their roles as case managers seriously. They act not as a coordinator, but as a filter. An advocate. And sometimes the only line of defense between a patient and a bad placement.
A case manager’s role is rarely small. Done well, it can change the entire trajectory of someone’s recovery.
The System Patients Are Walking Into
Most patients don’t enter treatment with a reasonable understanding of how the system works. They’re trying to solve an immediate problem. Stop using. Stabilize. Get help. The details come later, if at all.
The treatment landscape is crowded. Some programs are solid and clinically grounded. Others are not. Investigative journalist and author Shoshona Walter shared firsthand accounts in her book Rehab: An American Scandal.
In it, she points out the same issues over again: aggressive marketing, unclear pricing, and admissions processes that are more like sales calls than clinical assessments.
Then there are policy gaps. A recent opinion piece by Helen King discusses how some states still lag in protecting patients from questionable insurance practices.
In simple terms, patients are being asked to make high-stakes decisions in a system that isn’t always transparent.
Why Case Management Carries So Much Weight
Case management comprises coordination. In addiction care, it provides protection.
Case managers ensure that the right level of care is provided to the patients. They also keep an eye on key factors such as housing, employment, mental health, and family dynamics.
That sounds straightforward. But it takes work to slow things down in an environment built around speed.
Red Flags That Should Be Watched
Sometimes, the warning signs manifest early. The problem is spotting them too late, and only after a placement is made.
The Sales Pitch
Patients are told what they want to hear. A quick admission. Promises of tailored care without a proper assessment.
Now that’s a problem.
Legitimate addiction treatment centers should understand the patient, not fill a bed.
Letting the Amenities Be the Hero
While comfort is important, there are more things to take care of. When the focus is on “resort-style living” and “five-star amenities”, that’s when you ask what’s happening clinically behind the scenes. Treatment is not the same as a comfortable stay.
Billing That Doesn’t Add Up
Some programs rely heavily on frequent testing or extended stays with little justification. Patients don’t always see this directly. It does, however, show up in how care is structured.
Weak Discharge Planning
What happens after treatment is not an afterthought. It’s part of the treatment. Programs that lack a path forward leave patients exposed at a vulnerable point in their lives.
What Case Managers Can Do
Avoiding bad programs is one part of the job. The other is actively steering patients toward reputable rehab centers.
Start With a Real Assessment
This sounds basic, and yet it’s frequently rushed.
A solid assessment looks beyond substance use. It includes mental health, living situation, employment, and support systems. Without context, it’s easy to match a patient to the wrong level of care.
Programs that take this seriously tend to build more effective treatment plans.
Focus on Evidence, Not Promises
Holistic. Comprehensive. Personalized. Some of it is meaningful. Some of it is not.
Case managers should concentrate on a facility’s track record. Southern California has consistently ranked among the most successful rehab hubs. It also has the highest concentration of treatment facilities. Malibu, Orange County, and the Coachella Valley are home totrusted treatment programs in Southern California. Look for:
Access to medication-assisted treatment when appropriate
Individual therapy
Mental health support
Structured relapse prevention
South Shores Recovery says that trusted addiction treatment programs offer medically supervised detox programs alongside inpatient rehab.
Check Who is Delivering the Care
Patients should have access to licensed counselors, social workers, and medical professionals. A rotating cast of minimally trained staff is not the same thing.
Outcomes tend to improve when multidisciplinary teams are involved because they look beyond the presenting problem.
Ask Direct Questions
And expect direct answers:
How often does the patient meet with a clinician?
How is progress measured during the treatment process?
It’s easy for organizations to create dependency. A good case manager does the opposite.
The goal is not to complete a program. It’s to help the patient function outside of it. That includes practical things (housing, work, daily structure) that don’t always get enough attention.
The Case Management Society of America emphasizes these factors as a move toward independence as a core responsibility.
FAQs
1. What is the clearest sign of a predatory treatment program?
A sales-driven intake process without a proper clinical assessment is one of the strongest warning signs.
2. How can case managers verify a program’s quality?
Reviewing staff credentials is the first step. Case managers should also ask for detailed treatment schedules. Additionally, they must confirm the use of evidence-based therapies.
3. What should happen after treatment ends?
Patients should leave with an aftercare plan that includes housing, support services, and ongoing recovery resources.
Key Findings
Finding
Source
Coordinated care improves outcomes in substance use treatment
NCBI Bookshelf
Case management improves service access and continuity of care
Rural Health Information Hub
Some states still lack protections against predatory insurance practices
Opinion piece on PennLive
Long-term recovery is strongly tied to social and economic stability
The New Republic
Addressing Bigger Issues
Some challenges are unfortunately bigger than treatment programs. These include problems around access to medication-assisted treatment and long-term recovery support.
There are a few crucial questions that need to be answered. What if people were paid to stop using drugs? It also discussed financial stability and incentives for recovery outcomes.
Case managers cannot fix systemic issues alone, but they can advocate for resources that support recovery beyond treatment.
Author bio
Writer by day, dream catcher by night. Marchelle Abrahams cut her teeth during the infancy of the internet when the dial-up sound of the modem was more than a soundbite at a rave. Not a Millennial and not a Boomer, Marchelle is an in-betweener, making her a special breed of human. As a qualified journalist, Marchelle believes her superpower is stringing a few words together and people reading them. That, and the ability to take her kids on with her unique brand of gnarly comebacks.
Please also review AIHCP’s Case Management Certification program and our CE courses as well, to see if they meet your academic and professional goals. These programs are online and independent study and open to qualified professionals seeking a four year certification
If you already hold a healthcare or compliance certification, it is easy to assume you are covered. That assumption feels logical, especially if your certificate mentions privacy or data protection.
However, HIPAA does not treat certifications as proof of compliance training. Regulators expect training that is tied directly to your job role, workplace policies, and daily handling of protected health information. So the short answer is simple. Certifications help you learn, but they do not automatically satisfy HIPAA training requirements.
What does HIPAA training actually require from you
HIPAA training, especially in today’s digital consciousness, is not designed as a general education badge. It is a structured requirement that focuses on how you handle patient information inside your specific workplace.
You are expected to understand privacy rules, security safeguards, and breach reporting steps that match your actual job tasks. For example, a nurse, a billing officer, and an IT support staff member will not receive identical training content. According to a guide from the US Department of Health and Human Services, covered entities have to offer role-specific training, which should be given at the time of hiring and updated whenever the policies change.
This is significant since compliance monitoring is mainly based on behavior and not on knowledge. If we consider global healthcare systems, including GDPR influenced regions in Europe, the same principle applies. Training must show applied understanding, not just theoretical awareness.
Why do certifications not fully meet healthcare compliance regulations
Certifications are standardized, while HIPAA training is operational. That difference is where most compliance gaps begin.
To understand this better, look at the wider framework of healthcare compliance regulations.These compliance protocols do not only focus on HIPAA. They also include cybersecurity standards, data protection laws, and internal governance rules that shape how training must be delivered and documented.
In actual audits, regulators don’t simply verify if you have passed a course. They require that you demonstrate three things. One, that training took place. Two, it is relevant to your role. Three, that you are capable of implementing it properly in actual situations.
Healthcare reports of risks related to the sector regularly indicate human mistakes as a key factor in data breaches. The study on data breaches by IBM costs also reveals that healthcare is among the most costly sectors for data incidents all over the globe, with losses often measured in millions of dollars per event.
This highlights a key issue. Certifications build awareness, but they rarely reflect your organization’s actual systems, workflows, or patient data handling rules.
When do certifications actually support HIPAA training needs
It is only when certifications act as groundwork for your proficiency that they become helpful, not when they replace it.
For those either entering healthcare for the first time or shifting to positions like medical billing or health IT, certifications will support you in grasping the most important ideas more quickly. They also familiarize you with the privacy principles, access control concepts, and the typical compliance language. They also help organizations during hiring decisions.
A certified candidate usually requires less basic onboarding time because they already understand key terms. However, certifications only support HIPAA training when they are combined with internal, role-specific instruction. They are part of the learning path, not the final requirement.
Healthcare systems of the US, UK, and Australia are role-based compliance training with internal modules, refreshed learning, and continuous competency development at the core. They often make it a point to use such a system in their respective healthcare operations as a reflection of the guidance of Health and Human Services (HHS), the National Health System (NHS) information governance systems, and Australian digital health standards.
Where do certifications fall short in real healthcare environments
The main limitation of certifications is context. HIPAA compliance is deeply tied to how your specific organization operates.
For example, a certification may explain what protected health information is. But it will not show you how your hospital system labels records or how your clinic processes patient communication requests. Certification also faces great difficulty, particularly in making updates. The threats in the healthcare sector change very fast.
For example, phishing and ransomware attacks on medical systems are increasingly common. Internal training programs can be updated at a moment’s notice, but certifications are often not at the level of real-time risks. This gap creates a practical problem.
You may understand the concept, but still fail to apply it correctly inside your workplace system.
So the issue is not knowledge. The issue is the application inside a specific environment.
How can HIPAA training be structured to meet compliance expectations
A compliant HIPAA training system is not built on a single method. It is layered, continuous, and tied to job roles.
You need onboarding training that is specific to each role
Effective HIPAA training begins with an unambiguous and role-oriented onboarding program. Employees must be able to relate privacy and security rules to their real work activities instead of only understanding the broad compliance principles.
That is why tailored instruction can become more effective to make employees understand expectations from day one and reduce the likelihood of preventable compliance mistakes.
You need annual refreshers
HIPAA compliance is a continuous obligation, especially in your industry; it can’t be treated as a one-time thing only. Some initiatives, like yearly refresher trainings, are beneficial to ensure that employees remain acquainted with policy updates, new cybersecurity threats, and changes in regulations.
Besides, these trainings are a great way to remind the staff about crucial privacy and security measures, which may have been forgotten over time. Consistent training and guidance keep the compliance consciousness alive and help in fostering a culture of accountability.
Scenario-based learning is essential
We remember practical situations much better than rules or laws only. Scenario-based learning can give your staff a chance to use HIPAA principles in their workplace.
For example, dealing with a suspected breach of compliance or responding to a patient whose personal information is not correct. This method enhances one’s decision-making abilities, and employees will be able to react with more confidence and be more suitable when real-life situations happen.
Training must align with written organizational policies
HIPAA training will be effective and relevant only if it truly reflects your organization’s real methods and expectations. To grasp fully how privacy and security requirements are embedded in the work environment, your employees need to be made aware of how to efficiently handle setbacks, like privacy breaches, access restrictions, and patient information.
Compliance, therefore, will increase if training is made consistent with official policies, which also, in turn, helps to prove the organization’s responsibility during audits.
You need documentation
Training records can prove that compliance efforts are underway. Items, like attendance logs, assessments, completion reports, and signed acknowledgments, are great supporting documents to show that employees were taught and understand their roles and duties.
It is highly essential to keep authentic records during audits or investigations when the organizations have to provide evidence for the training activities and for the management of compliance. This structure can make sure that training is not just theoretical. It becomes part of the staff and provider’s operational behavior every day.
How do you prove HIPAA training compliance during audits
Auditors do not get impressed just by certificates. They needproof that training was completed successfully, understood, and eventually used.
HIPAA compliance is a continuous obligation, especially in the healthcare sector; it can’t be treated as a one-time thing only. Certain initiatives, for example, yearly refresher trainings, are beneficial to ensure that employees remain acquainted with policy updates, new cybersecurity threats, and changes in regulations. Besides, these trainings are great ways to remind the staff about crucial privacy and security measures, which, after some time, may have been forgotten.
Consistent training and guidance can keep your workplace’s compliance consciousness alive, crafting and continuing a culture of accountability.
Should you rely on certifications or internal HIPAA training
The most accurate answer is that you should not choose one over the other. Certifications give you a foundational understanding. HIPAA training gives you operational compliance.
You might miss the specific requirements of your workplace if you only depend on your certificates. Conversely, if you only rely on internal training and lack essential knowledge, you may find it extra difficult to understand the compliance concepts in general. The best approach is a combination.
You need certifications to give you mental preparation. Training on HIPAA, on the other hand, can give you a practical starting point. This is why modern healthcare systems treat training as a continuous cycle rather than a one-time event.
What you need to do next to improve HIPAA training readiness
Start by reviewing your current training system. Check whether each role has specific HIPAA instructions tied to daily tasks.
Then compare that with your certification use. If certifications are being treated as full compliance proof, you may have a documentation gap. Next, it might be more advantageous for you to ramp up your onboarding and yearly refresher program. It’s not recommended that you rely on shortcuts; you need to make sure that training is brought up to date each time policies or risks change.
In the end, pay attention to the clarity of your documentation. Each and every training task needs to be both traceable and verifiable. When you shift from “certificate equals compliance” to “behavior proves compliance,” your entire risk profile improves.
That is the real answer to whether certifications meet HIPAA training needs. They help, but they do not complete the job on their own.
About the Author
Shai Curimo is a communication arts professional with a multidisciplinary background in banking, law, human resources, and health-related studies. She focuses more on writing that clarifies complex subjects in healthcare, education, law, and professional development. Through her continued training and applied experiences, she produces content that’s interestingly simple, precise, well-researched, and crafted to meet the needs of her professional and academic readership.
Please also review AIHCP’s Health Care Ethics Certification program and CE courses see if it meets your academic and professional goals. These programs are online and independent study and open to qualified professionals seeking a four year certification
The wonder years are meant to be a time of discovery. Finding out who you really are. Making new friends. Falling in love and experiencing your first heartbreak.
And yet, kids aren’t doing childhood like they’re supposed to. The U.S. is currently in the throes of a teen mental health crisis. The National Institute of Health claims that one in five teens is diagnosed with a mental health or behavioral condition.
Anxiety. Depression. Academic pressure. The list includes the “best of” attractions that feed on the next generation. Most are vulnerable and scared. With little else to turn to, they experiment with substances.
The Child Mind Institute found that over 60% of teens who use substances also have a co-occurring mental health disorder. That percentage is shockingly high.
Psychiatrist Dr. Sarper Taskiran at the institute says that generally, almost half of kids with mental health disorders, if not treated, will end up with a substance use disorder (SUD).
Opioids, an Overlooked Issue
A study published in Health Affairs, in September last year, shed light on another problematic issue. It indicated that only one in three kids with past-year OUD received treatment.
And, in a national 2023 survey, 1.3% of kids between the ages of 12 and 17 reported an OUD. It might not sound like much, but the Prison Policy Initiative puts it into perspective. That percentage represents about 342,000 children, more than the total population of Newark, New Jersey.
Substance use is a serious issue among young people. But experts agree that the treatment protocols are failing them. So, how can counselors like you fix what’s broken? We’ll explain below.
Making Treatment More Accessible
The lack of access to SUD treatment will always be a moot point. The same Health Affairs study found that fewer than one in four treatment facilities offered programs specifically designed for adolescents.
Most families can’t afford private treatment facilities, which is why health insurance can be a lifeline. To make the experience less scary for families, research adolescent treatment centers that accept insurance.
Depending on the policy, a teen rehab that accepts insurance may cover some or all of the cost of teen addiction treatment. Contact adolescent rehabs covered by insurance directly to verify benefits and understand what’s covered. Artemis Adolescent Healing Center explains that teenage brains are still developing, requiring specialized care.
A Holistic Approach
Traditionally, law enforcement visits a school and teaches the Drug Abuse Resistance Education (D.A.R.E.) program. The message is complete abstinence. Don’t do drugs.
This approach doesn’t work. It’s largely ineffective. It’s outdated. And guess what? One study in the American Journal of Public Health even suggested that kids who completed D.A.R.E. were more likely to take drugs.
“We know that the ‘Just Say No’ campaign doesn’t work. It’s based in pure risks, and that doesn’t resonate with teens.” developmental psychologist Bonnie Halpern-Felsher, PhD.
Psychologists suggest using a different method. Instead of preaching not to use substances, acknowledge that some are still going to try it. And help them avoid the worst consequences, says the American Psychological Association (APA).
Harm reduction therapy incorporates respect for autonomy, ambivalence, and lived experience, Barry Lessin tells FilterMag.
Lessin is the co-author of Harm Reduction Approaches With Adolescents Who Use Substances. He agrees that traditional treatment methods lean heavily on abstinence, compliance, and diagnosis. Never mind understanding context and relationship.
Harm reduction therapy centers on safety, collaboration, and small and incremental change. Counselors can build trust by reducing harm in the real world. You can have boundaries about adolescent substance use, and still meet young people where they are.
Harm reduction therapy respects that process by giving teens a sense of agency and supporting healthy identity development.
It Starts in the Classroom
The adage still applies: One size does not fit all. That’s why schools are combining harm reduction with traditional prevention.
Many experts trust this process. NGOs and various civic organizations offer free resources for counselors and schools. Stanford’s Halpern-Felsher REACH Lab has free, evidence-based programs.
Honest discussions must start somewhere. In the home. At school. Encourage teachers and parents to have these discussions. If they fear their kid has a substance use problem, asking for help is not a shame.
FAQs
Why are adolescents with mental health conditions at greater risk for substance use disorders?
Mental health challenges and substance use mostly go hand in hand. According to the Child Mind Institute, more than 60% of teens who use substances also have a co-occurring mental health disorder.
Why is specialized addiction treatment important for teens?
Their brains are still developing, particularly in areas related to decision-making, impulse control, and emotional regulation. Teen-focused treatment programs are designed to address these unique developmental and mental health needs.
What is harm reduction, and how does it differ from abstinence-only approaches?
Harm reduction acknowledges that some teens may experiment with substances and focuses on reducing the risks associated with that behavior.
How can families find more affordable adolescent addiction treatment?
Many treatment centers accept health insurance, which may cover some or all treatment costs depending on the policy.
Key Statistics on Teen Mental Health and Substance Use
Statistic
Finding
Source
Teens diagnosed with a mental health or behavioral condition
1 in 5 adolescents
National Institutes of Health (NIH)
Teens who use substances and also have a mental health disorder
More than 60%
Child Mind Institute
Adolescents with past-year opioid use disorder (OUD) who received treatment
Approximately 1 in 3
Health Affairs
Treatment facilities offering adolescent-tailored substance use programs
Less than 23%
Health Affairs
Where To From Here?
Accessing treatment is one part of the problem. Then there’s the stigma, the lack of available resources, and the thinking that teen drug use is framed as “experimenting”.
Fixing the crisis requires going back to the drawing board and reworking outdated methods. Integrating screening into schools, improving family education, and expanding access to teen-specific mental healthcare.
And it all starts with you. Counselors are aptly tuned into the chaotic daily lives of teens. It’s your superpower. Use it.
Author bio
Writer by day, dream catcher by night. Marchelle Abrahams cut her teeth during the infancy of the internet when the dial sound of the modem was more than a soundbite at a rave. Not a Millennial and not a Boomer, Marchelle is an in-betweener, making her a special breed of human. As a qualified journalist, Marchelle believes her superpower is stringing a few words together and people reading them. That, and the ability to take her kids on with her unique brand of gnarly comebacks.
Please also review AIHCP’s Substance Abuse Certification program and our CE courses as well, to see if they meet your academic and professional goals. These programs are online and independent study and open to qualified professionals seeking a four year certification
Personality Disorders are one of the more interesting types of disorders in mental health. They attract the most attention and curiosity about why individuals act the way they do. For the secular mind, it attempts to explain right and wrong, criminality, oddities, and other quirks that step out of bounds within the social structure. As observed in early psychology, it a disorder but the mind still has the ability to possess rationale in its own self. From a religious perspective, it constitutes the reality of brokenness of humanity and how individual acts of deviation can become habitual aspects of one’s personality (McRay, 2016). These disorders distort personality to such an extent to cause inner personal turmoil in one’s feelings towards others and one’s assertion of those feelings outside the norms of one’s cultural context (McRay, 2016). For this reason, many personality orders are not only odd, eccentric, selfish, rude, and withdrawn, but also violent and terrifying to others.
Personality without empathy or ability to properly feel, think and act within the context of its cultural norm is considered disordered. Please also review AIHCP’s Healthcare Certifications
Personality in itself is an essential feature to a person. It involves a person’s overall demeanor, it includes how a person reacts internally and externally with others and the person’s overall temperament. Overall, a personality is one’s unique patterns of thinking, acting and feeling (Myers, 2019). There are numerous theories of personality ranging from the psycho-analytic schools to the humanistic as well as the behavioral schools of psychotherapy. All emphasize their targeted areas of study to the development of personality and all add unique elements to understanding personality. Within personality, exist various traits that are essential to proper functioning within the norms of society. Traits are characteristics or behaviors or dispositions of how a person feels or acts in certain ways (Myers, 2019). Experts list the Big Five Factors of traits that determine personality factors. Myers lists Conscientiousness, Agreeableness, Neuroticism, Openness and Extraversion (2019). When one sways from one extreme to the other in these traits, then imbalance occurs. In addition, the DSM-V-TR also lists these traits in its alternate diagnosis for personality disorder with openness being replaced with lucidity (2022).
When an individual deviates from the cultural norms of his or her culture and society and these extremes manifest against the core basic traits, one will witness odd or deviated social behavior, but isolated acts of misconduct or erratic behavior do not constitute a disorder. A disorder is far more deeper and its duration long lasting. In this blog, we will take a closer look at personality disorders and their striking deviations from cultural norms and behavior.
The DSM-V-TR points out that an enduring pattern of inner experience and behavior that deviates from expectations of one’s culture constitutes a personality disorder. These disorders manifest in one or two ways, via cognition, affectivity, interpersonal functioning or impulse control. The DSM-V-TR continues that these enduring patterns are inflexible and pervasive across the range of the person’s personal and social situations and interactions with others (2022). The DSM-V-TR states that these behaviors cause significant distress and impairment in social and personal relationships and this pattern remains stable and of long duration with origins in adolescence and early adulthood (2022). Obviously, these issues are not related to substance abuse, medication, or other mental defects.
The DSM-V-TR looks at moderate to severe impairment in traits to affect identity, self-direction, empathy and intimacy. In addition, these disorders can portray various distortions of personality traits to the extreme. They can manifest negative affectivity versus emotional stability, detachment versus extraversion, antagonism versus agreeableness, disinhibition versus conscientiousness, and psychoticism versus lucidity (2022). It is because of this one can witness in personality disorders a wide range of odd, eccentric, emotional, impulsive, egocentric, aggressive, violent, unempathetic, and manipulative traits.
The DSM-V-TR groups personality disorders into three clusters. Cluster A includes paranoid disorders such as paranoid, schizoid and schizotypal. Cluster B includes personality disorders such as anti-social (sociopathy/psychopathy), borderline personality disorder, histrionic, and narcissistic disorders. Finally, Cluster C includes avoidant personality disorders such as avoidant, dependent and obsessive compulsive personality disorders (not to be confused the OCD itself). (2022).
Of particular note, based on different case studies and surveys, the percentage of personality disorders within the general population is 9 to 10 percent suffering from some type of personality disorder in some degree or level (Barlow, et al. 2023). Ironically, many of the terms associated with these disorders, are used loosely in everyday vernacular towards individuals who may act a certain way in a given situation but not possess the disorder. Bad behavior, sin, vice, or whatever one wishes to label it is part of the human condition and people are not perfect. Personality Disorders are merely a persistent form of these behaviors at an extreme and rigid level. So, when diagnosing, anyone at some time or some point can see at least a couple undesirable traits and feel guilt or shame for exhibiting these actions. Ultimately guilt and shame and acknowledgement are key signs one does not possess the disorder itself.
Types of Disorders
Personality Disorders are divided into three clusters of paranoid, anti-social and avoidant
Paranoid
Paranoid personality disorders are in the realm of psychotic and the schizotypal form can sometimes be the premorbid phase of schizophrenia itself. One of the key elements is the disorder is persistent before and after any delusional of psychotic episodes.
Paranoid Personality Disorder constitutes a pervasive distrust and suspicion of others. Without evidence, they feel they are being exploited or harmed. They discover unfounded evidence of demeaning actions or threatening meanings in other individual’s remarks or cues. They are preoccupied with doubts of other’s loyalty to them and find it difficult to confide in others. They feel information can constantly be used against them. Emotionally, they can become angry and hold grudges due to the perceived threats (DSM-V-TR, 2022).
Schizoid Personality Disorder is a detachment from social relationships beyond intimate family. They also possess a restricted range of emotions. These traits continue before and after remission of possible psychotic episodes (DSM-V-TR, 2022). Schizotypal Personality Disorder is more severe and resembles Schizophrenia and other schizophrenic spectrums. It can also co-exist with them but also exists outside the psychotic psychotic episodes (2022).
Anti-Social
Anti-Social Personality Disorder is best known a pervasive and consistent pattern of disregard and violation of the rights of others, occurring since age 15 and must be at least 18 (DSM-V-TR, 2022). With diagnosis, three of the following traits must persist
failure to comply with social norms and laws
deceitfulness and pathological lying
impulsiveness and failure to plan
irritability and aggressiveness
recklessness and disregard for safety of self or others
consistent irresponsible behavior
lack of remorse or empathy
Anti-Social Personality lacks empathy and recognition of the rights of others
The DSM-V-TR continues in alternative diagnosis with emphasis on a distorted identity based on egocentrism and self-esteem deprived via power and gain and pleasure. Personal gratification is the primary goal and self direction absence of inhibitions that prevent those gratifications. There is a lack of emotional connection or empathy within the disordered person and intimacy and relationships are meant for exploitation or manipulation to meet one’s own needs. The DSM-V-TR in addition lists these traits of which 6 must be met
manipulation (antagonism)
callousness (antagonism)
deceitfulness (antagonism)
hostility (antagonism)
risk taking (disinhibition)
impulsivity (disinhibition)
irresponsibility (disinhibition)
Horrifying enough, there can be a psychotic specifier as well with psychopathic features which would constitute the differences between a sociopath and a psychopath. Depending on degree and opportunity, these individuals can be very dangerous in what they are willing or not willing to do to others. Many criminals possess these traits and those in trouble with the law. Many can understand something is wrong but fail to care or display empathy or guilt or emotion regarding their actions.
Narcissistic Personality Disorder is commonly comorbid with Anti-Social Personality Disorder. Narcissists, according to the DSM-V-TR, display a pattern of grandiosity. They require admiration and lack empathy. The disorder can manifest in early adulthood (2022). Five or more of the following are necessary for diagnosis.
grandiose self importance
fantasies of unlimited success, power and brilliance
believes oneself is special
requires admiration of others
sense of entitlement
interpersonally exploitative
lacks empathy
envious of others
severe arrogance
In regards to identity, they require excessive reference of others for self-definition. Deep down, they have lower self-esteems and without these appraisals, they can suffer emotionally. In addition, self direction is tied to gaining approval of others. Relationships and intimacy are more superficial as to the image it portrays. Empathetically, they are restricted in understanding the needs and emotions of others at the expense of their own (DSM-V-TR, 2022). Closely related is Histrionic Personality Disorder which faces excessive emotionality and seeking of attention (DSM-V-TR, 2022).
If the other anti-social disorders are more intellectual, then Border Line Personality Disorder (BPD) is the chaos of emotion. According to the DSM-V-TR, BPD is a pervasive pattern of instability in regards to relationships, self-image and affects which onsets in early adulthood (2022). Five or more attributes must be present.
frantic efforts to avoid real and imagined abandonment
pattern of unstable and intense interpersonal relationships
identity disturbance and unstable self-image
impulsivity with spending, sex, substance abuse, reckless driving or binge eating
recurrent suicidal behavior, gestures, threats or self mutilation
affective instability due to marked reactivity
chronic emptiness
inappropriate anger or controlling anger
transient stress related paranoid ideation
In regards to identity, BPD is marked by poorly developed and unstable self-image. Self direction consists of instability with goals and plans. Empathetically, individuals have a difficult time recognizing the feelings and needs of others. In regards to intimacy and relationships, there is a consistent intense, unstable and constant conflict with others (DSM-V-TR, 2022). They experience intense emotional lability, anxiousness, separation insecurity, depression, impulsiveness, risks and hostility (DSM-V-TR, 2022).
Avoidant
Avoidant disorders
Avoidant personality disorders include Avoidant Personality Disorder, Dependent Personality Disorder and Obsessive Compulsive Personality Disorder.
Avoidant Personality Disorder involves more than an introvert life style or bouts with anxiety but a pervasive pattern of social inhibition, inadequacy, and hypersensitivity to negative evaluations of self (DSM-V-TR, 2022). Four or more of the following are need in diagnosis.
avoids occupational activities
unwilling to get involved with others unless certain of being liked
restraint with intimiate relationships
preoccupied with fear of rejection
feelings of inadequacy
views oneself as unappealing, inferior or inept
avoids risks of engagement or new activities
Avoidant personalities are associated with low self esteem identity wise. Their self direction is distorted due to reluctance to pursue goals. Their empathy for others is distracted by their own internal fears and their intimacy is restricted due to shame and fear of rejection. Their traits include anxiousness, withdrawal, anhedonia and intimacy avoidance (DSM-V-TR, 2022).
Dependent Personality Disorder involves a pervasive or excessive need to be taken care of by others which leads to submission and clinging behaviors marked by separation anxiety which manifests in early adulthood (DSM-V-TR, 2022). Five or more of the following symptoms are required for diagnosis.
difficulty making everyday decisions without excessive advice and reassurance
needs other to assume responsibility in life
difficulty expressing disagreement
difficulty initiating projects
goes to excessive lengths for reassurance
feels helpless when alone
seeks relationships for security
fearful of abandonment
Finally, Obsessive Compulsive Personality Disorder concludes the avoidant disorders. This disorder is not to be confused with OCD which can be comorbid but unlike OCD which reacts to stressors and anxiety, OCPD exists in all situational relationships. According to the DSM-V-TR, it is represented by a pervasive pattern of preoccupation with order, perfection and mental and interpersonal control at the expense of flexibility which begins in early adulthood (2022). Four or more of the following symptoms are necessary for diagnosis
preoccupation with details, rules, lists, order, schedules, organization
perfectionism derails task completion
focused on work before any types of leisure
overconscientious, scrupulous and inflexible in matters of morals, ethics or values (not when accounted to religious or cultural identification)
unable to discard worthless objects
reluctant to delegate tasks to others
adopts miserly spending habits
rigid and stubborn
Those with OCPD compose their identity as correlated with work or productivity. Their self direction is complicated due to rigidity in completing tasks and meeting standards. They lack difficulty in empathy to understand the feelings and standards of others. Finally, their intimacy is restricted in relationships since they put relationships secondary to work and maintain a rigid and stubborn life with others (DSM-V-TR, 2022). They adhere to rigid perfectionism, perseveration in tasks, intimacy avoidance, and possess restricted affectivity (DSM-V-TR, 2022).
Etiology and Treatment
Personality disorders are both a product of nature and nurture with roughly 10 percent of the population suffering from them
Personality Disorders like all mental pathologies cannot be originated from one aspect of life but is a culmination of biological, genetic, psychological, behavioral and social factors. In addition, many possess comorbid mood disorders or maladaptive coping strategies involving substances. In the cases of Anti-Social Personality, it is obvious that there are genetic dispositions as well as biological deformities within the brain that restrict empathy and impulsivity (Barlow, et al., 2023). In addition, early childhood mistreatment, abuse, trauma, poverty and malnutrition can play roles in the development of life views and emotional affectivity (McRay, 2016). None of these things guarantee a disorder, but they collectively can contribute to disorders that later develop in early adulthood.
In children, values and morality are also essential to enforce in life. In early development of a children, egocentrism is important to survival but children are exposed to empathy, love and the needs of others. Children that are not properly guided can develop vices that later can lead to habitual life styles (McRay, 2016). Children with natural inclinations to pride, or selfishness, or other vices, without the proper guidance can fall victim to these inclinations as adolescence continues. These maladaptive behaviors manifest as the person is permitted without consequence to perform these actions. Obviously from a religious perspective, morality and restrictions are essential guardrails in anti-social personality development (McRay, 2016). Even without proper social norms and concepts such as the Golden Rule, individuals can develop into habitual disordered individuals in mind, thought, emotion and behavior.
Unfortunately, many individuals with personality disorders do not seek treatment. Avoidant groups are the most likely to seek help but anti-social and paranoid seek assistance less. Those who do find help require extensive and consistent counseling that focuses on emotional regulation, identifying distorted thinking, and understanding the needs of others. This involves comprehensive psychotherapy that includes CBT, DBT and other cognitive therapies. Humanistic therapies can attempt to at least encourage acknowledgement of the needs of others. Medication is rarely helpful but only to alleviate secondary symptoms of anxiety or depression, especially in BPD (Barlow, et al., 2023).
Pastoral and Christian Counseling care has existed well before modern psychology. In these practices, the proposed opposite virtue of the habitual vice was emphasized such as humility over pride or temperance over anger. In these cases, the spiritual treatment of the sinful condition was considered in addition to the mental pathology. Moral virtues, spiritual discipline, submission to God and constant regulation over viceful responses were considered critical. For many, faith left the change to the grace of God due to the sinful nature of humanity(McRay, 2016).Too many times, pastoral leaders or even counselors and mental healthcare professionals can become over involved in personality disorder cases looking to rescue and save these clients. Many of these clients unfortunately are sometimes beyond saving and will attempt to manipulate helpers.
In regards to loved ones, family is encouraged to never withdraw love but to always protect themselves from manipulation or abuse. In addition, they are to set strong boundaries with those facing personality disorders. Boundaries are essential and must be made clear and definitive of expectations but also demands for treatment. Family needs to become psycho-educated on the disorders and be able to identify manipulations or emotional states to better protect themselves but also help the person.
Conclusion
Please also review AIHCP’s Healthcare Certification Programs
Personality Disorders are habitual, persistent, and impairing traits that affect an individual’s ability to show empathy, regulate emotion, or interact with other people in a fair and just way. The disorders affect their ability to properly assert themselves in positive or negative ways. They manifest in types or paranoid, anti-social or avoidant. All individuals to some extent sometimes deviate from the norm or do something wrong, but personality disorders deviate from the cultural norm on a consistent basis and at disproportionate extreme. While those who suffer from these disorders, especially BPD and Sociopathy must be held accountable for bad actions, one still must understand the unnatural impulse that has habitually sidetracked their ability to operate as normal individuals. This leads to erratic, odd, distant, dysregulated, manipulative, rigid, emotional, or dangerous behaviors. These disorders have multiple origins from genetics, biology, as well as past trauma, and behavioral upbringing. It is difficult to predict what factors will lead to a true disorder but roughly 10 percent of the population suffers from a personality disorder. In regards to treatment, psychopathology and some medications can help alleviate anxiety and depression, but overall, a person must commit to life long therapy and continually identify their issues. Ironically, the inability to acknowledge this is the biggest issue for adjustment. Finally, it is important to form healthy boundaries with loved ones who suffer from these disorders. While many are hard to understand or even tolerate, it is important to remember they are broken. This does not mean one surrenders oneself to their desires, nor does it mean one justifies their actions or does not hold one accountable, but it does demand an empathetic condition for their brokenness.
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorder” DSM-5-TR (5th ed., text revision). American Psychiatric Association Publishing.
Barlow, D.H., Durand, V.M., & Hofmann, S.G. (2023). Psychopathology. An integrative approach to mental disorder (9th ed.). Cengage Learning
McRay, B.W., Yarhouse, M.A., Butman, R.E., & Kiple, C. (2016). Modern psychopathologies: A comprehensive Christian appraisal. (2nd, ed.) IVP Academic
Additional Resources
Personality Disorders. Cleveland Clinic. Access here
Burton, A. (2024). “The 10 Personality Disorders”. Psychology Today. Access here
When personality disorders compound, some very disturbing types of individuals can emerge. This video looks at the Dark Triad and the dark disorders it encompasses within the Anti-Social spectrum of disorders. Please also review AIHCP’s numerous mental health certification programs
Interruptions to addiction treatment could make it harder to recover. No one knows this better than case manager Annette Hubbard. Working at a local community clinic in Alaska, she’s seen thousands of patients come and go.
The majority of her clients are in and out of prison. They are the most vulnerable to drug-related deaths. Hubbard routinely checks the court docket for active warrants. She helps those with opioid use disorder get treatment before they go in.
Hubbard tells NRP that she does it voluntarily, even though it’s outside her scope of work. Because she knows that addiction doesn’t happen in a vacuum. Neither does recovery.
If you’re a case manager, you already know this. A treatment plan can look perfect on paper and fail in the real world. Why? Simple. Social determinants of health (SDOH) influence outcomes long before a client walks through your door.
This guide breaks it down in plain terms: what SDOH means in addiction care, where case managers fit in, and how to turn awareness into action.
What Are Social Determinants of Health?
These are the conditions in which people live. Work in. Move through everyday life. Housing, income, education, access to care, and social support; these are all SDOH.
These factors have a bigger impact on health outcomes than medical care alone. That’s not a small claim. It reshapes how we think about addiction treatment, explains the CDC.
The Healthy People 2030 framework groups SDOH into five key areas:
Economic stability
Education access and quality
Healthcare access and quality
Neighborhood and built environment
Social and community context
Case managers view the above as daily barriers.
How SDOH Fits into Addiction Care
Substance use disorders (SUDs) are linked to life conditions. Housing instability. Unemployment. Trauma. Lack of access to care. They all raise risk.
The American Journal of Psychiatry published a paper earlier this year. The piece explored the intersection between the Diagnostic and Statistical Manual of Mental Disorders (DSM) and SCE-DoH.
Researchers found that:
People without stable housing struggle to stay in treatment.
Limited income restricts admission for ongoing care.
Social isolation increases relapse risk.
Poor access to services delays intervention.
The National Academy of Medicine supports these outcomes and has called for a move towards integrated systems that address clinical care and social needs. In other words, treat the person, not only the addiction.
Case managers sit at the crossroads of addiction and recovery care. Clinical teams, social services, families, and community resources all run through you.
Effective case management improves engagement, continuity of care, and long-term outcomes. And it goes beyond paperwork and scheduling. It’s your job to identify social barriers, connect clients to resources, and advocate across networks.
Think of it this way: clinicians stabilize. Case managers sustain.
Breaking Down Key Social Determinants
Housing Stability
Housing is one of the strongest predictors of recovery success. Back in 2024, Delaware’s Department of Health and Social Services put the hypothesis into practice.
Homelessness is common for those struggling with addiction, said Joanna Champney, director of the Division of Substance Abuse and Mental Health.
“Reports from our behavioral health treatment providers indicate that when people enter mental health treatment in Delaware, 13% were totally homeless at admission. For people entering addiction treatment in Delaware, 7% were totally homeless.” – Joanna Champney via WHYY.
Using 2023 data, Champney reported that 67% of clients receiving services through the federal Statewide Opioid Response Grant experienced housing instability. The DHSS then initiated the Recovery Support Scholarship program, allowing treatment centers to provide housing support for patients.
As a case manager, you can:
Prioritize housing referrals early
Work with transitional housing programs
Build relationships with local shelters and housing services
Economic Stability
Treatments cost money. So does time off work. Unfortunately, not all rehab facilities accept Medicaid coverage.
New Mexico’s Albuquerque is rife with fentanyl addiction. The city’s Bernalillo County Metropolitan Detention Center is currently struggling with inmates battling drug addiction. Most are forced to detox while in prison.
Medicaid-covered rehab can open doors to detox, in-patient, and out-patient care. Financial stress is a relapse trigger. Reducing it is part of the treatment.
Albuquerque Medicaid treatment programs provide essential support for individuals who cannot afford private insurance, adds Icarus Recovery Center. Focus on:
Verifying insurance early
Educating clients on coverage
Identifying low-cost or no-cost options
Healthcare Access
Access is not having a clinic nearby. It entails getting in, staying in, and being treated.
And yet, the National Library of Medicine says that gaps in care remain an issue. It disrupts recovery during the transition period. Once again, this is where you step in.
Case managers should prioritize coordinating appointments across providers, reducing wait times where possible, and supporting follow-ups.
Social Support and Community
Recovery is hard to sustain.
Isolation and loneliness can trigger relapse. Support networks improve outcomes; it’s that simple.
Research published in Frontiers in Rehabilitation Science supports the suggestion of community integration in long-term recovery.
What works?
Peer support groups
Family engagement
Community-based recovery programs
Common Gaps Case Managers Should Be Aware Of
Even experienced professionals tend to miss a few things. Here are a few to keep on your radar:
Digital access: Telehealth fails without stable internet or devices
Childcare needs: Specifically in outpatient settings
Legal issues: Court dates and compliance requirements disrupt care
None of these sit inside treatment plans. But they do determine outcomes.
FAQs
1. Why are social determinants important in addiction recovery?
They directly affect whether someone can start, continue, and complete treatment. Clinical care alone isn’t enough.
2. What is the most critical SDOH in addiction care?
Housing is the biggest factor. Without stability, recovery outcomes drop substantially.
3. How can case managers improve access to care?
By coordinating services, reducing barriers such as cost and transport, and connecting clients to community resources.
4. Do Medicaid programs improve treatment outcomes?
Yes. They expand access to care for low-income individuals, making treatment more consistent and achievable.
Key Stats on SDOH and Addiction Care
Factor
Insight
Source
SDOH impact
Social factors can influence the majority of health outcomes
CDC
Housing and addiction
7% were totally homeless
WHYY
Housing instability
67% of clients
The Division of Substance Abuse and Mental Health
Medicaid access
Expands availability of detox and rehab services
Icarus Recovery Center
From Awareness to Action
Understanding SDOH is the first step. Acting on them is where you’ll make the biggest impact.
Ask better intake questions. Map local resources. Track barriers over time. Advocate for system-level changes.
You don’t need to fix everything, but you do need to notice everything. And that’s the difference.
Author bio:
Writer by day, dream catcher by night. Marchelle Abrahams cut her teeth during the infancy of the internet when the dial sound of the modem was more than a soundbite at a rave. Not a Millennial and not a Boomer, Marchelle is an in-betweener, making her a special breed of human. As a qualified journalist, Marchelle believes her superpower is stringing a few words together and people reading them. That, and the ability to take her kids on with her unique brand of gnarly comebacks.
Please also review AIHCP’s Case Management Certification program and our CE courses as well, to see if they meet your academic and professional goals. These programs are online and independent study and open to qualified professionals seeking a four year certification
If you work in primary care, the ER, or really any part of general medicine, you’ve probably met patients with co-occurring disorders.
It could be a patient with crushing anxiety who drinks a bottle of wine a night to take the edge off. It could also be the young adult with back pain who’s become increasingly dependent on their opioid prescription.
It definitely isn’t a niche issue anymore. In fact, recent data from SAMHSA revealed that out of 61.5 million adults with mental challenges in 2024, 34.5% also had substance use disorder. Out of this number, more than 41% didn’t get the treatment they needed for either.
For some of the patients who fell in the crack, chances are the clinician they met didn’t know what to look for. That’s exactly what the guide is for. Read on as we discuss co-occurring disorders, why they happen, and most importantly, what you can actually do to help.
What is a Co-Occurring Disorder?
A co-occurring disorder is when someone has a substance use disorder and a mental health condition together at the same time.
You might also hear it called a dual diagnosis. We already gave two examples in the introduction: someone with social anxiety taking alcohol for confidence, and someone with PTSD abusing sleeping pills. As of 2024, approximately 7% to 8% of U.S. adults suffer from co-occurring mental illness and substance use disorder, according to Statista.
4 Things Healthcare Professionals Should Know About Co-Occurring Disorders
Now that we know what co-occurring disorders are and how prevalent they are, let’s look at four truths every healthcare practitioner should know about this condition.
Substance Use and Mental Illness are Bidirectional
Substance use disorder and mental illness have a two-way relationship.
On one side, there’s self-medication. This could be a person with PTSD who uses opioids or sleeping pills just so they can forget.
The second direction is substance use itself, actually causing or worsening psychiatric symptoms. People who consume alcohol heavily, for example, can also suffer severe depressive episodes.
In fact, research shows that 50% of the adults who misuse substances are also likely to suffer from one form of mental illness or another.
So, how do you know if what you’re looking at is a co-occurring disorder? Some common examples include:
Depression and alcohol use
Anxiety disorders with benzodiazepine misuse
PTSD with opioid use
Bipolar disorder with stimulant misuse
The problem? Diagnosing these issues in a single fifteen-minute consultation is almost impossible. You have to see the pattern over time before you can confidently determine the problem and decide on a proper treatment plan.
Integrated Treatment is the Most Effective
It can be tempting to want to treat co-occurring disorders as isolated cases. Most people do this. In fact, the medical system has historically walked separate paths, and treating in isolation has always been the model.
The truth, however, is that when addiction and mental illness are handled as separate cases, a lot of patients will fall through the cracks. The result? Increased risk of relapse. This is why integrated care is the most effective option.
One coordinated care team for mental health and addiction
Shared treatment goals
Better communication between providers
Fewer gaps in care
More personalized treatment
Better long-term outcomes
And it really works, too. A 2025 BMC Nursing literature review found that integrated, patient-centred care that combines psychosocial and pharmacological approaches is the most effective way to treat dual diagnosis. It consistently performs better than fragmented care.
Diagnosis is Highly Complex
Another thing healthcare teams should know about comorbid disorders is that diagnosis can be really complex. Why? Because symptoms tend to mask or overlap.
The quote below by the Mental Health Academy sums this up perfectly.
“Co-occurring mental health disorders are not the exception – they’re the reality for many clients. And they often present one of the most challenging landscapes for assessment and intervention.” – Mental Health Academy via LinkedIn.
Let’s look at some examples of this overlap using the table below:
Substance-Related Presentation
Can Mimic or Mask
Alcohol or benzodiazepine withdrawal
Primary anxiety disorder (tremor, racing heart, panic)
Stimulant intoxication or withdrawal
Bipolar mania or hypomania (elevated mood, agitation, grandiosity)
Chronic alcohol use
Major depressive disorder (low mood, poor sleep, low energy)
Opioid withdrawal
Generalized anxiety or panic disorder (restlessness, GI upset, insomnia)
As we’ve already established, you have to see these patterns over time before you can determine what exactly is happening.
Take Bipolar Affective Disorders, for example. According to Icarus Behavioral Health, if a doctor misses the hypomanic episodes, they can inaccurately diagnose the person with depression alone. Even worse, they can mistake it for just withdrawal from certain substances.
This is why watching for patterns is important. When symptoms only show up alongside substance use and clear up after a period of abstinence, they’re more likely to be substance-induced.
But when they persist even after complete abstinence, then you’re looking at a primary psychiatric disorder.
Recovery is a Long-Term Process
Finally, it’s important to understand that recovery doesn’t happen overnight. It takes time, structure, and consistency.
It’s also important to note that relapses do happen, but this doesn’t mean that the treatment failed. It could simply mean that the plan needs a bit of adjustment.
The biggest part of recovery? What happens after? Transitioning from structured care back to everyday life is a vulnerable point for many patients. Many of them end up getting readmitted within the first 30 days after discharge, especially when there’s no strong system in place.
This is why there should be a proper hand-off, which should actually feel like a continuation of care.
This means:
Clear follow-up appointments before discharge
Direct connection to outpatient or community services
Medication continuity where needed
Warm handoff, not just a referral slip
When these steps are in place, there’s a stronger chance of full recovery.
FAQs
How many people have co-occurring health conditions?
The number of people with these conditions differs based on the study you’re looking at. However, SAMHSA estimates that more than 34% of the 61.5 million people with mental challenges also struggle with substance use disorder.
Should substance use or mental health symptoms be treated first?
Neither should necessarily come first. Co-occurring disorders should be handled together using an integrated care model. Treating them separately may mean incomplete recovery and relapse.
How can clinicians determine whether a patient has a co-occurring disorder or not?
Clinicians can determine whether it’s a co-occurring disorder or not by looking at patterns. Probably the best giveaway is symptom persistence. If symptoms continue during the period a person is abstaining from substance use, then it may suggest an underlying mental health condition.
Co-Occurring Disorders: Final Thoughts
Co-occurring disorders are common, complex, and frequently missed. But they don’t have to be. By understanding the bi-directional relationship, embracing integrated treatment, and knowing symptoms that overlap, healthcare practitioners can make a real difference in patient outcomes.
Hopefully, this article has helped bring some clarity to a topic that often feels more complicated in practice than it looks on paper.
Author Bio
Agwalogu Bob believes great content doesn’t just inform, it resonates, and then sticks. For over eight years, he’s been helping agencies across four continents craft just that kind of content: sharp, engaging cut-through-the-noise copy across SaaS, finance, tech, health, and lifestyle.
When he’s not putting pen to paper, you’ll likely find him scouring the internet for funny memes.
Connect with him on LinkedIn or Medium.
Please also review AIHCP’s Substance Abuse Certification program and our CE courses as well, to see if they meet your academic and professional goals. These programs are online and independent study and open to qualified professionals seeking a four year certification
For decades, addiction was treated as a criminal problem. And then research suggested that we view it as a medical condition and address it as such.
This understanding is now helping rehab centers take a more holistic approach in treating millions of people with a substance use disorder (SUD). But the divide remains.
Even with all the evidence pointing towards addiction as a moral failing, many experts believe that SUDs and crime are inextricably connected. Add physician and author Dr. Gabor Maté’s unshakable views as a coping mechanism for unresolved trauma, and the discourse becomes deafening.
It doesn’t matter which hypothesis you subscribe to: criminal, medical or trauma. The question is how you treat it. Rehabs are at the center of this paradigm. And treatment is an industry too.
A Broken System?
Talk to enough people in recovery, and a common thread emerges: one where patients feel misled, pressured, or exploited.
This isn’t a reputational issue. It’s a clinical one. As a rehab counselor, you know that when trust diminishes, outcomes suffer. Dropout rates rise. Relapse risk increases.
Oftentimes, patients feel taken advantage of in treatment centers. So, what can you do to fix it?
The Trust Gap: Where It Starts
A study published in the National Institutes of Health sought to identify barriers to optimal inpatient rehabilitation outcomes among patients with spatial neglect (SN).
It was determined that specific needs, such as family support, training, and treatment engagement, were strong predictors of recovery outcomes. However, engagement depends heavily on trust. And trust is what many patients say is missing.
Across forums like Reddit, a recurring theme appears: “I don’t know who to trust.” That uncertainty influences every interaction from intake to discharge.
One Redditor posted a desperate plea to find a real treatment program that wasn’t “predatory.” The responses ranged from empathy to helpful advice to join a program that offers CBT, trauma work, and relapse prevention.
Lack of Transparency Around Costs and Insurance
Patients regularly enter treatment without understanding what their insurance will cover. Or what they’ll owe out of pocket.
Unexpected bills can put them back, psychologically. Cases involving lawsuits reinforce this perception.
Case Study
A 32-year-old patient enters a residential program believing her insurance covers 30 days. She’s discharged after 10 due to coverage limits. She receives a bill for the remaining balance. The patient leaves feeling misled, even if the provider followed policy.
The Fix
Walk through insurance coverage line-by-line before admission.
Provide written cost estimates (and update them as needed).
Assign a financial liaison patients can reach.
Transparency upfront reduces resentment later. It’s that simple.
Forced or Coerced Treatment
In some states, civil commitment laws allow individuals to be placed in treatment without consent.
In Idaho, for instance, only a peace officer or qualifying members of medical staff can initiate an emergency evaluation, per Idaho Code 66-326. The Treatment Advocacy Center (TAC) recommends that family members directly file an emergency court order for court-ordered treatment.
Case Study
A young adult in Ada County is admitted under family pressure. They feel stripped of autonomy and resist participation. Even after transitioning to voluntary care, they remain disengaged.
Shift toward collaborative goal-setting as early as possible.
Reinforce autonomy in small ways.
Icarus Wellness and Recovery advises counselors to use involuntary commitment laws as a guideline to obtain court-approved treatment providers.
Patient Brokering and Questionable Referrals
Patient brokering, where individuals are referred to specific facilities in exchange for financial incentives, has become a major concern.
Families report being steered toward programs that benefit the referrer rather than the patient.
Case Study
A parent seeking help for their son is contacted by multiple “advisors.” Each pushes a different facility, sometimes in another state. The son cycles through programs without improvement. The family later learns those referrals were financially motivated.
The Fix
Be transparent about referral relationships.
Avoid commission-based referral structures.
Focus on clinical fit over bed availability.
Patients can sense when they’re being “placed” instead of helped. Counselors should make clinical reasoning visible.
General Treatment Plans
Patients report feeling like they’re being pushed through a system rather than treated as individuals.
Standardized approaches don’t work for everyone.
Case Study
Two patients with different trauma histories receive identical treatment schedules. One engages. The other shuts down.
The Fix
Tailor treatment plans to individual histories and goals.
Adjust pacing and modalities based on response.
Involve patients in treatment decisions.
Personalization now becomes a requirement for buy-in.
Poor Communication from Staff
Confusion around rules. Expectations and progress. When these aren’t communicated to them, patients get stressed and anxious. And that leads to mistrust.
Patient satisfaction impacts recovery outcomes, patient adherence, and the facility’s reputation.
Case Study
A patient violates a rule they didn’t fully understand and faces consequences. They interpret this as unfair treatment instead of a misunderstanding.
The Fix
Set clear expectations from day one.
Repeat key information regularly.
Encourage questions without judgment.
Clarity builds safety, which builds trust.
The ‘Revolving Door’ Experience
Some patients cycle through multiple programs without lasting results.
The New York Times recently reviewed a book by investigative reporter Shoshana Walter on systemic issues in parts of the rehab industry, including profit-driven practices.
Case Study
A patient attends three facilities in two years. Each promises a fresh start. None address underlying trauma. The patient begins to believe rehab itself is the problem.
The Fix
Concentrate on continuity of care beyond discharge.
Build realistic expectations about recovery timelines.
Address root causes, not symptoms.
Recovery isn’t a 30-day event. Treating it like one sets patients up for failure.
FAQs
1. Why do patients distrust rehab programs?
Many patients report unclear costs, inconsistent communication, and feeling like decisions are made for them rather than with them.
2. Does forced rehab work?
It can stabilize individuals in the short-term, but long-term success improves when patients transition to voluntary, engaged participation.
3. How can counselors improve patient engagement?
By involving patients in decisions, setting expectations, and showing measurable progress throughout treatment.
4. What is patient brokering, and why is it harmful?
Patient brokering involves referrals driven by financial incentives rather than clinical need, which can lead to poor treatment matches and repeated relapse cycles.
Key Facts at a Glance
Insight
Source
Treatment engagement is a key predictor of recovery success
NIH (2021)
Patient satisfaction improves with better communication
Net Health
Patient brokering continues to impact treatment quality
Partnership to End Addiction
Outcome tracking improves care effectiveness
NIH (2024)
What Counselors Can Do Differently
Fixing these issues starts with small changes.
Be transparent, even when the truth is uncomfortable. Treat patients as partners, not participants. Prioritize long-term outcomes over short-term metrics. Build trust intentionally, not passively.
Patients don’t expect perfection. They expect honesty.
Author Bio:
Writer by day, dream catcher by night. Marchelle Abrahams cut her teeth during the infancy of the internet when the dial sound of the modem was more than a soundbite at a rave. Not a Millennial and not a Boomer, Marchelle is an in-betweener, making her a special breed of human. As a qualified journalist, Marchelle believes her superpower is stringing a few words together and people reading them. That, and the ability to take her kids on with her unique brand of gnarly comebacks.
Please also review AIHCP’s Substance Abuse Certification program and our CE courses as well, to see if they meet your academic and professional goals. These programs are online and independent study and open to qualified professionals seeking a four year certification
Christian Counselors and Spiritual Directors help many individuals coming from deeper issues of loss, trauma, pain, and spiritual darkness that are searching for healing and love in the presence of God. The dichotomy of Christian theology that expresses the human soul as a child of God but at the same time notates the nothingness of self compared to God is a striking polar opposite. Obviously, a person in need cannot be declared as nothing and stripped of all goodness that innately exists within their personhood. With an awakening of self, the spiritual journey and crosses have life has injured many elements of self image and concept, so it is important to elevate self esteem but also eliminate pride. There lays the delicate balance of understanding and communicating the value of humility but also the praise of self in the healing process.
Humility ironically leads to greatness because it recognizes our dependency upon God
God the Creator, chose to create humanity from nothing due to His infinite love. As a creatures, it is an essential truth to acknowledge two things. First, creatures are nothing in comparison to the Creator and second, creatures owe the Creator everything. God does not wish to force servitude on His creatures, but He is the source of their creation and hence it is only natural and right that creatures worship and adore Him. This is not due to a sense of entitlement by God, or self-interest and pride in His greatness but a true reality of existence. When creatures cease to worship and serve the Creator, then their end becomes unnatural. This unnatural end results in corruption. Lucifer and his minions rejected this law of nature and instead chose their own will and attempted to alter the natural reality of existence by refusing worship and obedience to the Creator. The choice did not liberate them from worship but forever corrupted them in pain and suffering. Since God is infinite love, when one abandons self and seeks God, the act of worship is likened to breathing. It is natural and just.
As creatures, justice alone suffices to acknowledge the creature’s obligation to serve and worship. It also clearly points out the dependency and imperfections of the creature in relationship to the Creator. It would be a delusion of grandeur to glorify one’s stature, talents, appearance, or works as one’s own accomplishments without reflecting the design and influence of the Creator. This is not a false humility but a reality that every creature must accept as natural. When a creature attempts to glorify self, it leads to delusion and corruption, but when a creature understands its relation to the Creator, it lives in truth. Mary, the greatest and most magnificent creature ever created by God, teaches others one’s own nothingness. At the Annunciation. she responds to the Angel Gabriel’s salutation with a statement of her graceful state as a reflection of God and not of her own doing.
As Children
God transformed creation with His infinite love. He transformed creatures to His children, from something to someone and ultimately nothing to everything. God’s love elevates His creatures to children of God. It is in that relationship that individuals have true identity, self-image, value, and beauty. God created humanity in His own image and likeness according to Genesis. In this way, He infused intellect and will. This permitted His creation to possess a true image of the Divine that possessed sentience and freedom of choice. It permitted the relationship to be a mutual relationship of love as between parent and child. In this way, humanity became a prized possession of God, so much, that even after its fall, He was willing to become human, suffer, die and rise to save them from their own folly. It is through this additional act of love, beyond creation, but also redemption and sanctification that one sees the great value of one single human soul. The ransom price for each soul at the cross was a heavy price and God gladly paid it through Jesus Christ.
From this, one can see a balance of creature and child. Nothing and everything. It is within reflection and acknowledged dependence of the Divine that humanity’s nothingness becomes everything and it is through that a true Christian self esteem can emerge in a directee and spiritual child. It involves anchoring self-esteem and self-image to the connection with the Divine.
Christian Humility
Since pride corrupts and distorts reality between creature and Creator, then it is important to flee it and foster humility. Ironically, Scripture points out, the last will become first, and the one who destroys his own life will save it. These phrases in Christianity all point to a deeper mystery. It points to the truth that for one to truly find value in self, it is dependent upon complete rejection of self. This is clearly the opposite message of Lucifer and his fallen temporal world. The world whispers success at all costs, elevation of self, collection of riches, and exaltation of achievements. In modern psychology, congruence is seen as self-fulfillment and finding happiness in what one deems to be good. So many false images of happiness are sought to fulfill one’s own ego and desire in the mirage of temporal happiness only to be illusions that lead to chaos, loss, dissatisfaction, and moral degeneration. As Lucifer looked to idolize self, and how Adam sought self actualization without God, the temporal and secular man seeks self approval, pleasure and acknowledgement of others. The demand and adoration of the narcissistic self distorts the reality of creature and attempts to worship self as Creator. While this may seem subtle and maybe not as dramatic as Lucifer or Adam, the continuation of actions and their temporal gratification and glorification of self create narcissistic qualities that through habit become one’s own deification. Whether its through social media, fame and fortune or power, the creature becomes intoxicated with self and loses its identity. This in turn leads to corruption as pride, the source of all sin, leads to further deformity in greed, avarice, lust and envy for more. It is of no wonder then that creatures then attempt to define their own laws of moral conduct since they have become their own god.
Christian humility is the answer to this disastrous corruption of self. It is not a degradation of self but is a truthful mirror of a creature in dependence of a Creator. Like new born babies and infants, Christian humility acknowledges the need of a parent and the inability to exist or succeed without the Divine. It acknowledges that all accomplishments, successes, fortunes, riches, blessings, talents, virtues, and spiritual progress are God’s grace. It acknowledges that the creature cannot walk without the gentle guidance of the Creator. Likening the fallen world to a baby’s crib or playground, the great empires that are built in the creature’s mind are merely tall Lego blocks as compared to omnipotent and eternal presence of God. To exalt such feeble success to infinite greatness is a folly that Christian humility illuminates. Christian humility in spiritual direction does not look to tear the person’s success down, or make the person feel insignificant, it seeks to awaken the person from the illusion of the Matrix and to embrace the truth that all good comes from God and not self. Humility protects the creature from corruption and aligns the creature to reality and truth so that it can grow and become fulfilled as a child of God. Humility teaches a far greater self value then the self can ever afford for it is supported by a Divine enterprise and loving Father.
When the God, via the Second Person, became incarnated in Jesus Christ, He taught creation these truths. Jesus highlighted the folly of self adoration and the foolishness of seeking the world before the soul. Jesus refused the powers afforded to Him by a mere creature, namely Lucifer. Who in his delusions sought as a creature to afford the Creator power and wealth in a fallen world. Jesus rejected the pride of Lucifer in the desert and revealed the truth that humility over pride is reality. Jesus did not grant Himself a rich palace, but instead chose to be born in a stable. He lived for 30 years under moderate means as a carpenter supporting His mother. He enjoyed life in its simplicity as a testament to truth of reality. In His ultimate act of humility, as both God and man, the omnipotent and eternal God, hid Himself in His humanity and permitted the profane hands of creatures to mock and crucify Him. He stood before the pompus pride of Pilate and permitted this execution to take place, although as Creator, He could at any moment smite the entire Roman legion. In this humility, He surrendered Himself willing out of love for all His creation to be openly executed. He never reprimanded them, or exposed His Creatorship but with humility accepted the will of the Father. Christ said to His apostles regarding this fallen world, that if this place rejected Himself, the Creator, it will reject His followers. He taught them to seek these injustices, these rebukes, and embarrassments and to offer them to God. These slights should be seen as opportunities to suffer with Jesus and for Him to offer our imperfect deeds to the Father in His name.
In the text, “The Spiritual Combat” by Dom Scupoli, like many writers of his time, there was a great emphasis to acknowledge the nothingness of self. One sees this in the writings of Avila, as well as Loyola. Scupoli states that one should completely distrust self and place all trust in the Creator. In doing so, one accepts the reality that without God, one is truly nothing. One cannot do a single good deed without the merits of grace earned for oneself by Jesus Christ. In addition, one should honestly realize that without the gift of love from God, one deserves nothing from God, but nonetheless owes Him everything. Scupoli points out that pride corrupts the soul and breaks one from the reality of a creature’s true status. One should then seek the opportunity to be humbled by others and to always reflect one’s accomplishments to God. In this way, one experiences the truth of reality and avoids the destruction of self glorification.
Self Esteem in Counseling Vs Christian Humility
Christian humility acknowledges God as Creator and source of all our gifts and virtues. Please also review AIHCP’s Christian Counseling Certification and Spiritual Direction Program
While many humanistic counselors may see the degradation of self and one’s inability to do good without the external source of God as undignified, the reality is it prevents the disastrous lies that lead to vice and ultimate maladaptive coping. Self-esteem is critical for the depressed and broken. Individuals need to be taught to respect themselves, to love themselves, and to find joy in success. Counselors help them cultivate the tools to create and meet goals. It is healthy to find “pride” in accomplishments. It is also not sinful to accumulate temporal goods and find joy in temporal successes. However, when the source of one’s self esteem is rooted in self-glorification and one’s own morality and laws, then it becomes untruthful to reality and can cause degradation and misery. One’s self-esteem must be tied to God. When tied to God, it is more than it can ever be alone. One whose self-esteem is tied to God values and loves oneself because God loved oneself first. One whose self-esteem is tied to God is placed on an objective and unbreakable foundation of Divinity rather than shaky subjective weak foundation of frail humanity. Finally, humility with God grants a calm sense of peace in the presence. Unlike pride which is always moving and self serving, seeking and never content, humility grants peace about the past and security about the future. Depression of the past or anxiety of the future is tied to pride and not humility. The humble soul is content and secure in the grace of God because it submits to His will and serves Him.
It is natural than that true self-esteem correlates not with humanistic pride and narcissism, but with Christian humility. The acknowledgement of weakness and dependency does not weaken self-esteem, but grants it the source of its power through the Creator. Humility grants to the Creator His reflection and image in the creature. This humility then elevates the creature beyond any limits imaginable. This may not translate in this valley of tears as success but it does translate in eternity with Christ by emulating Christ on earth. Christ’s message of truth was humility because it frees oneself from the illusions of Lucifer. A great saint once said, the greatest weapon against the devil is humility because he does not know it.
Humility and Psychology
Since humility is so critical to salvation, it is no wonder then that is critical to temporal existence as well. While counselors help navigate individuals through issues of depression and low self-esteem there needs to remain a balance that does not transgress into narcissistic behavior. While even secular psychology looks to free the self to find happiness, even it recognizes the dangers of extremes in behavior. When self esteem becomes narcissistic pride it becomes dysfunctional and socially impedes a person’s mental and emotional progress in life. In the article, “What Is Humility & Why Is It Important?, Schaffner points out various critical elements of humility in psychology and social interaction. She points out that humility is key accurate self portrayal, modesty and awareness of others (2020). In addition, Schaffner lists other key elements of humility which include a willingness to see one’s true self, an understanding of one’s appropriate place in the world, an understanding of one’s faults, limitations and mistakes, a true openness to change, a focus on others, and an ability to appreciate other things outside ourselves (2020).
Like the spiritual benefits, the emotional and psychological benefits seem to both open oneself to others, service, and truth. Pride that becomes malignant is detrimental to self, growth and society. Pride becomes an injustice to reality, self and others. It makes sense than that a Christian perspective on humility is far from detrimental to self-esteem but in reality beneficial.
The Devil and Spiritual Pride
Pride becomes narcissism and creates the illusion of greatness which leads to corruption.
For those who seek God, spirituality opens many doors of illumination and unity with Him. However, like the souls who seek power in secular venues, spiritual people can befall pride in spiritual endeavors. Instead of riches and money and fame, the soul boasts of virtue and sanctity and holiness. Scupoli notes that this is one of the traps of the devil. Individuals exposed to the world are ensnared differently than individuals seeking spiritual perfection. Like the Pharisees, spiritual virtue becomes source of power over others. It becomes their own cultivating gifts instead of a grace given by the Creator. These souls then find pleasure in their own virtue as a end in itself. In this pride begins to rot within the soul. Instead of thanksgiving, gratefulness and humility for grace, the individual gravitates towards holy deeds as their own. In turn, instead of empathy for others in sin, they find judgement. Instead of reflection of their own failures and past falls, they only condemn those committing the same offenses. They feel a sense of entitlement and status and wish for their spiritual sanctity or message to be seen and heard. They fall into disobedience to spiritual authority and envy others of spiritual status, as well as seek ways to overcome spiritual rivals. This is the corruption instilled by Satan in spiritual pride. It utilizes the same schema but unlike utilization in a secular setting, it finds its use in a spiritual one. This is why Christ was so abrupt with the Pharisees because He understood their rottenness and pride.
Scupoli recommends that individuals flee all vanity in the spiritual life and to recall one’s own distrust of self and complete reliance of God. While thankful and happy to receive graces from God as any child, he also reminds one to never believe that these gifts are a result of sanctity or worthiness. He warns one to never find disgust in another’s faults but to remember the same faults that exist in oneself and if not for God’s grace, how one would be no better. He reminds one that one fails God or sins to not scrupulously over analyze the fall but to seek immediate forgiveness. When one over analyzes failure, one tends to oppositely attribute success or failure as to one’s own means. One can never reach perfection. One is never worthy. Only through blood of Christ and the ransom paid is one made worthy. A humble soul participates with Christ but no works or deeds can ever save himself but only through the faith of Christ which produces a living faith of works energized by His grace. So, no matter how hard one may try to reach Christian perfection, no creature of himself or herself can ever be perfect. Many sincere souls rightfully fear offending God and seek each day to avoid sin at all costs. While this is important, it is equally important to understand that one when fails, it is due to our one’s own brokenness and one cannot allow pride to seep in the crevices of thinking one cannot sin. Humility since it is based in truth is also aware of brokenness and sin as a part of an imperfect nature due to Original Sin. Hence when sin occurs, one should humbly acknowledge the brokenness and pray harder to God for future graces. Humility constantly re-directs oneself to God after sin because it acknowledges that oneself cannot live a good life without God’s grace.
Scupoli reminds individuals that sin and suffering and crosses are tools God utilizes to foster humility. Through failures, the soul realizes even more so its utter dependence upon God. The moment the soul falsely feels it can move forward of its own devices and virtue, then it is destined for failure via the vice of pride. In this way, God reminds His children that they need Him, not out of arrogance but out of necessity of reality.
Conclusion
Work hard, stay humble and reflect all greatness to God in your life. Please also review AIHCP’s Christian Counseling Certification and also its Spiritual Direction Program
Christian humility is not meant to deface self-esteem, or identity. It is meant to strengthen it through connection with God. It is based in reality and not the false assumptions and illusions of the world that celebrate arrogance, power, and success over piety, reliance and thanksgiving. Pride is the great illusion of self where one puts self on a pedestal as god. It corrupts and destroys like it did to Lucifer. The great deceiver hopes to trick humanity into being prideful about self and elevating the creature to the level of Creator. It is not depraving or neglectful to rightfully and truthfully understand one’s nature of dependence upon God. It does not depress self-esteem but permits self-esteem to actualize itself through the connection of grace with God. Humility is the tool for this relationship because it, unlike pride, acknowledges the reality between Creator and creation.
Karie Fugett will never forget that morning in November 2008 when she found her husband lying next to her. Suffocating on his own vomit, he turned purple.
Frantically, she performed CPR. When the paramedics arrived, they injected him with naloxone into the heart. Cleve Fugett survived that day. Four years later, he wasn’t as lucky.
The veteran developed a dependence on prescription opioids after sustaining injuries during his deployment in Iraq. He later died from a fentanyl overdose while at an inpatient facility for veterans with PTSD.
Karie says Cleve died afraid of losing his military status. For thousands of military personnel, the shame of addiction weighs heavily on them. And so, Karie wrote a book, Alive Day, detailing the hardships her husband endured.
Today, she remains actively involved in desperately finding a solution to the U.S. fentanyl crisis. Her 2025 opinion piece for The Guardian is grounded in facts and research, pleading with the government to do more for military families.
Trauma and Shame are Major Barriers to Seeking Help
Cleve Fugett should have received addiction counseling when he became dependent on prescription opioids.
Instead, his doctors switched him to something new. It went from Dilaudid to Percocet, then methadone, OxyContin, and eventually fentanyl. The main reason vets don’t enter treatment facilities is the fear of losing their rank.
“Until the military publicly ensures no veteran’s job, rank, or benefits will be taken away for substance abuse, service members and veterans will continue dying from overdoses.” – Karie Fugett via Vox.
Limited Access
Those who choose professional help may find themselves hitting a wall.
On paper, coverage exists. Programs are listed. Resources are available. In practice, families struggle to find a qualified counselor who understands their needs and takes their insurance.
In a treatment setting, this shows up as missed referrals, delayed admissions, and patients arriving after months of trying to get help.
As a counselor, you need to understand where the breakdown happens when working with military-connected clients.
The Demand Is Higher Than Many Realize
Military personnel face increased risks when it comes to substance use and co-occurring mental health conditions.
Exposure to trauma. Repeated deployments. Chronic stress and reintegration challenges. They all play a role.
Research shows strong links between PTSD, depression, and substance use disorders (SUDs) in veteran populations, according to Psychology Today. Citing figures from the 2024 National Survey on Drug Use and Health, the publication claims that 7.5% of veterans reported heavy alcohol use compared to 6.5% of non-vets.
There’s also the issue of identity. Substance use is tied to ongoing struggles around purpose, belonging, and transition back to civilian life. The National Council for Mental Wellbeing says that without a clear mission and support network they once relied on, many experience uncertainty and isolation.
These are not simple cases. They require specialized, often long-term care.
TRICARE in-network treatment programs cover a wide range of services, including outpatient counseling, inpatient care, and substance use treatment.
Coverage is only one piece of the puzzle.
A shrinking pool of providers, longer wait times, and limited access to specialized addiction care are some of the problems encountered. TricareRehabs.com suggests families consult a private placement service that provides information on addiction treatment programs that accept TRICARE.
Why Providers Opt Out
For counselors, the decision to accept or reject insurance is rarely personal. It’s practical.
Low Reimbursement Rates
One of the biggest concerns is compensation.
Therapists report that reimbursement rates can be substantially lower than other insurance plans, sometimes below Medicaid levels. Over time, that becomes unsustainable.
Administrative Burden
The paperwork is another major issue.
Providers describe increased documentation requirements, ongoing compliance checks, and time-consuming claims processes. In some cases, clinicians are required to submit detailed notes after every session.
That time comes out of clinical work.
A Reddit discussion among therapists highlights the administrative demands. They can outweigh the benefits of participation, pushing providers toward private pay or out-of-network models.
Payment Delays and Uncertainty
Even when services are provided, payment is not always predictable.
Delayed reimbursements and claim denials create cash flow issues, particularly for smaller practices. For counselors, that uncertainty is enough to step away from insurance panels altogether.
Clinical Complexity Requires Specialized Care
Not every provider is equipped to work with military populations.
Some veterans are seeking these treatments for PTSD and related conditions outside traditional systems.
Gaps in Continuity of Care
The challenges don’t stop when a patient enters treatment.
Continuity of care is fragmented. Transitions between detox, inpatient, outpatient, and community support are not always smooth.
The National Institutes of Health’s research on substance use treatment systems shows the need for coordinated care across levels of treatment. Unless addressed, these gaps can lead to relapse or disengagement.
Moving Toward Better Access
Understanding the “why” helps counselors set realistic expectations, advocate more effectively, and design treatment plans that account for system-level barriers.
There is no single fix. Yet a few steps can make a difference:
Building referral networks that include TRICARE-approved rehab centers
Strengthening case management and care coordination
Supporting policy efforts that address reimbursement and access
Awareness is a starting point. When counselors understand the barriers their patients face before they walk through the door, they are better positioned to respond.
FAQs
1. Why don’t more counselors and rehab centers accept TRICARE?
Low reimbursement rates, administrative burden, and payment delays make participation difficult for many providers.
2. Are military clients more complex clinically?
Many present with co-occurring conditions such as PTSD and substance use, which require specialized, integrated care.
3. Does stigma still affect military families seeking treatment?
Yes. Concerns about confidentiality, career impact, and judgment can delay help-seeking.
4. What can rehab counselors do to improve access?
7.5% of veterans reported heavy alcohol use compared to 6.5% of non-vets
2024 National Survey on Drug Use and Health
Coordinated care improves outcomes in substance use treatment systems
PMC (2023)
TRICARE covers a wide range of mental health services, but provider participation varies
TRICARE Newsroom
Veterans experience higher rates of co-occurring PTSD and substance use disorders
Psychology Today (2024)
Recognizing the Obstacles
Military families are not struggling to find addiction counselors because they lack coverage. They are struggling because coverage does not guarantee access.
Between provider shortages, administrative barriers, clinical complexity, and stigma, the path to care becomes harder than it should be.
As a counselor in a treatment setting, recognizing these obstacles is helpful and necessary. It shapes how patients enter treatment, engage, and recover.
Author bio
Writer by day, dream catcher by night. Marchelle Abrahams cut her teeth during the infancy of the internet when the dial-up sound of the modem was more than a soundbite at a rave. Not a Millennial and not a Boomer, Marchelle is an in-betweener, making her a special breed of human. As a qualified journalist, Marchelle believes her superpower is stringing a few words together and people reading them. That, and the ability to take her kids on with her unique brand of gnarly comebacks.
Please also review AIHCP’s Substance Abuse Certification program and our CE courses as well, to see if they meet your academic and professional goals. These programs are online and independent study and open to qualified professionals seeking a four year certification
Written by Marchelle Abrahams,
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