Why emotional regulation skills are relapse prevention tools

Understanding Emotional Regulation in Addiction Treatment

Emotional regulation plays a pivotal role in addiction recovery, acting as a critical skill set that helps individuals manage cravings, stress, and negative emotions that often trigger relapse. This article explores why emotional regulation skills are essential relapse prevention tools by examining evidence-based strategies, their integration in comprehensive treatments, and the broader impact on mental health and sustained sobriety.

The Foundations of Emotional Regulation in Addiction Recovery

What is emotional regulation, and why is it important in addiction?

Emotional regulation refers to the ability to manage and respond to one's emotional experiences effectively. In addiction treatment, it becomes a crucial skill because many individuals struggling with substance use disorders (SUDs) often use drugs or alcohol as a way to cope with overwhelming negative emotions. Without proper emotional regulation, cravings and stress can lead to relapse. Teaching these skills helps individuals handle intense feelings and reduces the reliance on substances for emotional relief.

How is emotional dysregulation linked to relapse risk?

Poor emotional regulation is closely linked to an increased risk of relapse. Individuals with SUDs typically have diminished tolerance for negative emotions, impulsivity, and difficulty controlling urges. When faced with stress or emotional triggers, they may turn back to substance use to escape discomfort. Studies have shown that deficits in managing emotions, especially challenges in impulse control and access to effective coping strategies, contribute to both the onset and recurrence of substance abuse.

How common are emotional regulation difficulties among those with substance use disorders?

Emotional regulation difficulties are widespread among people with substance use issues. Approximately 75% of addiction cases show signs of emotional dysregulation. Assessment tools such as the Difficulties in Emotion Regulation Scale (DERS) demonstrate that individuals with SUDs score significantly higher in areas relating to poor strategy use and impulse control compared to the general population. This pattern is consistent across various substances, including alcohol, methamphetamine, cocaine, and opioids, highlighting the broad impact of emotional challenges in addiction.

Why are emotional regulation skills essential in addiction treatment?

Emotional regulation skills are essential because they empower individuals to manage negative emotions, stress, and cravings without resorting to substance use. Since emotional dysregulation directly increases relapse risk, building these skills through treatment programs can reduce cravings and support sustained recovery. Interventions based on evidence, like Gross's emotion regulation model, CBT, DBT, and mindfulness practices, have proven effective in improving emotional control and mental health outcomes in addiction treatment.

Comprehensive Treatment Services Addressing Substance Abuse and Mental Health

What types of comprehensive treatment services are available for substance abuse, mental health issues, and various forms of addiction?

Comprehensive treatment for substance abuse and mental health disorders typically involves a wide range of services tailored to support recovery and prevent relapse. Core components include medical detoxification to safely manage withdrawal, and individual and group therapy sessions to address underlying psychological issues. Behavioral counseling helps individuals develop healthier coping strategies, while medication management addresses co-occurring medical and psychiatric conditions.

Treatment programs often provide a stable environment, such as sober living arrangements, to encourage sustained sobriety. Additionally, aftercare support, including peer support groups and ongoing therapy, plays a crucial role in maintaining recovery. Resources from organizations like SAMHSA enhance these services by offering prevention campaigns and recovery tools that emphasize emotional regulation as a vital relapse prevention strategy.

How do comprehensive treatment services integrate care for both substance abuse and mental health issues?

Integrated treatment models coordinate medical, psychological, and social care to simultaneously address substance use disorders (SUDs) and co-occurring mental health conditions. Multidisciplinary teams create personalized treatment plans that combine psychosocial interventions—such as Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and mindfulness—with medication management tailored to individual needs.

A major focus of these integrated services is the development of emotional regulation skills, which help patients manage cravings, stress, and triggers effectively. By addressing the biological, psychological, and social factors of addiction, integrated care improves treatment outcomes, reduces relapse risks, and supports long-term recovery.

Role of emotional regulation within integrated treatment models

Emotional regulation training is a key component embedded within comprehensive treatment programs. It equips individuals with strategies to handle negative emotions and stress without resorting to substance use. Techniques such as mindfulness, CBT, and DBT teach coping skills essential for impulse control and managing cravings.

This approach not only supports abstinence but also improves mental health outcomes by reducing anxiety and depression symptoms commonly associated with relapse. Comprehensive models recognize that bolstering emotional regulation contributes significantly to sustained recovery by fostering resilience and healthier responses to emotional triggers.

Coordination of therapies and medical management

Successful comprehensive treatment involves close coordination between behavioral therapies and medical interventions. Psychiatrists, therapists, and medical professionals collaborate to manage psychiatric symptoms, co-occurring disorders, and medication side effects.

This collaboration ensures that therapeutic approaches targeting emotional regulation align with medical treatments, providing a holistic approach to recovery. Ongoing monitoring and aftercare planning, including peer support and relapse prevention strategies, reinforce emotional skills and maintain recovery gains over the long term.

Behavioral Therapies as Vehicles for Emotional Regulation Enhancement

What role does behavioral therapy play in treating various forms of addiction?

Behavioral therapies are vital in addiction treatment because they directly address the emotional and cognitive challenges that contribute to substance use. Cognitive Behavioral Therapy (CBT) is especially significant as it assists individuals in recognizing and transforming negative thought patterns that lead to drug cravings and relapse. This therapy fosters healthier coping mechanisms and supports relapse prevention through structured cognitive restructuring.

Dialectical Behavior Therapy (DBT), on the other hand, integrates cognitive-behavioral strategies with mindfulness practices to strengthen emotional regulation, distress tolerance, and interpersonal effectiveness. DBT specifically helps patients manage intense emotions that often trigger substance use, reducing harmful behaviors associated with addiction.

Use of Cognitive Behavioral Therapy (CBT) in emotional regulation

CBT emphasizes identifying dysfunctional thoughts related to emotional distress and substance use. Through CBT, patients learn to challenge these thoughts and replace them with adaptive alternatives. This process enhances emotional control, lowers anxiety and depression symptoms, and reduces reliance on substances as coping mechanisms. Endorsed by authoritative bodies such as the National Institute on Drug Abuse (NIDA) and the Substance Abuse and Mental Health Services Administration (SAMHSA), CBT is a proven tool in improving treatment outcomes.

Dialectical Behavior Therapy (DBT) core components and benefits

DBT promotes emotional stability through four main skill sets: emotion regulation, distress tolerance, mindfulness, and interpersonal effectiveness. Emotion regulation skills help clients understand and manage their feelings rather than react impulsively. Distress tolerance provides strategies to endure crises without resorting to substance use. Mindfulness fosters present-moment awareness, decreasing automatic, harmful responses to triggers. Interpersonal effectiveness improves communication and relationship skills, which can support recovery success.

Efficacy of therapy modalities in addiction treatment

Both CBT and DBT have demonstrated substantial efficacy in reducing cravings, improving emotional regulation, and promoting sustained abstinence from substances. Studies have shown that these therapies decrease emotional dysregulation, a common relapse factor, and enhance overall mental health. Incorporating these modalities into comprehensive treatment plans aligns with best practices for addressing the complex emotional and behavioral aspects of addiction.

| Therapy Type | Core Focus | Benefits in Addiction Treatment |\n|-----------------------------|--------------------------------------|------------------------------------------------------------------------------------------------|\n| Cognitive Behavioral Therapy (CBT) | Cognitive restructuring | Identifies and modifies negative thoughts; reduces cravings and relapse; endorsed by NIDA and SAMHSA | | Dialectical Behavior Therapy (DBT) | Emotion regulation and mindfulness | Enhances emotional management, distress tolerance; reduces impulsive behavior and substance use |

Behavioral therapies like CBT and DBT serve as crucial frameworks for equipping individuals with the skills needed to regulate emotions effectively. This emotional mastery plays a significant role in preventing relapse and supporting long-term recovery from addiction.

The Gross Model of Emotion Regulation in Addiction Treatment

Structure and stages of the Gross model-based training program

The Gross model of emotion regulation involves a systematic approach to managing emotional responses by targeting different stages of emotional processing. The eight-session training program designed for addiction treatment incorporates these core stages: situation selection, situation modification, attentional deployment (or attention expansion), cognitive change (or cognitive evaluation), and response modulation (or adjustment). These stages help individuals identify triggering situations, modify their exposure or reaction to them, shift attention to relevant aspects, rethink emotional meanings, and adjust emotional responses effectively.

Impact on craving beliefs and relapse risk

Empirical studies have shown that participation in Gross model-based emotion regulation training significantly reduces craving beliefs among drug addicts. Since cravings strongly predict relapse, lowering these beliefs through improved emotional control directly decreases the risk of returning to substance use. The program enhances emotional resilience and reduces susceptibility to negative emotional states such as anxiety and depression, both of which frequently contribute to relapse.

Application in eight-session treatment modules

Delivered over eight structured sessions, the program provides gradual skill-building opportunities. Each session focuses on a specific stage of the Gross model, incorporating interactive exercises that teach identification and management of emotional triggers. For instance, early modules focus on recognizing and altering problematic situations, while later ones emphasize cognitive reevaluation and response adjustment. This sequential design offers comprehensive training that helps individuals gain mastery of regulation skills to maintain sobriety more effectively.

Mindfulness and Meditation Practices for Emotional Control

How mindfulness fosters present-moment awareness

Mindfulness practices encourage individuals to focus on the here and now, cultivating a nonjudgmental awareness of their thoughts, feelings, and bodily sensations. This heightened present-moment attention helps people with substance use disorders become more conscious of emotional triggers without automatically reacting to them, which is crucial for managing cravings and preventing relapse.

Role of meditation and deep breathing in managing cravings

Meditation and deep breathing exercises are key components of mindfulness that promote relaxation and emotional balance. These techniques reduce stress and anxiety by calming the nervous system, lowering impulsivity and the urge to use substances. Practicing meditation regularly helps individuals develop improved emotional regulation skills, allowing them to observe cravings calmly rather than giving in to them.

Contribution to reduced relapse rates

Research consistently shows that incorporating mindfulness and meditation into addiction treatment leads to better emotional control and fewer relapses. These practices build resilience by enhancing distress tolerance and emotional stability, making it easier for individuals to resist temptations during high-risk situations. Consequently, mindfulness-based interventions play a valuable role in sustaining long-term recovery and improving overall mental health outcomes.

Emotion-Focused and Expressive Arts Therapies in Addiction Recovery

How Does Emotion-Focused Therapy Benefit Individuals in Addiction Recovery?

Emotion-focused therapy (EFT) helps individuals in addiction recovery by enhancing their ability to understand, express, and process their emotions. This therapeutic approach targets the emotional underpinnings of addiction, offering a structured way to address feelings that often trigger substance use. By facilitating emotional awareness and expression, EFT supports healthier coping mechanisms, reduces emotional distress, and fosters deeper psychological healing.

How Are Expressive Arts Used for Emotional Expression and Healing?

Expressive arts therapy engages creative outlets such as art, music, and dance, allowing individuals to communicate emotions that may be difficult to verbalize. This modality promotes emotional regulation by providing a safe space for self-expression and exploration. It encourages experiential healing, helping patients process trauma, diminish stress, and reconnect with their feelings in a nonverbal, cathartic way.

How Do Creative Outlets Support Emotional Regulation in Addiction Treatment?

Creative therapies complement traditional emotion regulation techniques by offering alternative channels to manage impulses and cravings. Through creative expression, individuals can develop improved emotional resilience and self-awareness. These outlets enable patients to externalize complex emotions, reduce tension, and boost motivation for recovery. When integrated with approaches like mindfulness and cognitive-behavioral therapy, creative therapies enhance overall emotional stability and support sustained sobriety.

The Critical Link Between Poor Emotion Regulation and Relapse

How Does Poor Emotion Regulation Affect Relapse Risk?

Poor emotion regulation profoundly increases the likelihood of substance use relapse. Individuals struggling to manage their emotions often have a low tolerance for negative feelings, which can trigger cravings and push them toward substance use as a coping mechanism. Emotional dysregulation also contributes to co-occurring mental health disorders such as anxiety and depression, which further complicate recovery and elevate relapse risk. This difficulty in handling emotions may hinder active engagement in therapy and reduce the efficacy of treatment initiatives.

What Role Do Impulsivity and Access to Emotion Regulation Strategies Play?

Substance use disorder (SUD) patients exhibit marked deficits in impulse control and accessing effective emotion regulation strategies. These impairments were particularly noted in the "Strategies" and "Impulse" subscales of the Difficulties in Emotion Regulation Scale (DERS), suggesting that many individuals with SUD find it challenging to utilize healthy emotional coping methods and resist impulsive behaviors during distressing moments. Additionally, these individuals tend to rely more on expressive suppression, a less effective emotional regulation tactic.

What Quantitative Evidence Supports These Findings?

Meta-analytical research clearly demonstrates that individuals with SUD have significantly greater difficulties regulating emotions compared to controls, with a large effect size (Hedges' g = 1.05) on Total DERS scores. These deficits in emotion regulation are consistent across various substances, including alcohol, methamphetamine, cocaine, and opioids. Notably, alcohol use disorder shows the most substantial effect size, indicating profound emotion regulation challenges in this group. These robust findings highlight the dual role of emotion regulation deficits as both risk factors for and outcomes of substance use, underscoring the need to integrate targeted emotion regulation training within comprehensive treatment plans.

Building Emotional Resilience and Coping Strategies in Recovery

Stress management techniques

Managing stress is pivotal in addiction recovery, as stress often acts as a powerful relapse trigger. Embracing methods like mindfulness meditation, deep breathing exercises, and relaxation techniques fosters present-moment awareness and helps reduce emotional overwhelm. These approaches cultivate emotional stability and improve one's ability to navigate cravings and temptations without resorting to substance use.

Development of effective coping mechanisms

Recovery necessitates the adoption of robust coping strategies encompassing emotional, cognitive, and behavioral tools. These include:

• Emotional regulation techniques: Controlling impulses and managing distress through therapies such as dialectical behavior therapy (DBT) or cognitive-behavioral therapy (CBT).
• Support networks: Engaging with peer groups and ongoing therapy to reinforce resilience.
• Problem-solving and decision-making skills: Enhancing the ability to handle challenges without substance reliance.
• Self-care practices: Incorporating physical activity, proper nutrition, and sufficient rest.

The synthesis of these tactics empowers individuals to recognize triggers, manage cravings effectively, and maintain emotional equilibrium.

Impact on long-term sobriety and mental health

Incorporating stress management and adaptive coping mechanisms plays a critical role in preserving long-term sobriety by mitigating emotional dysregulation, which is present in about 75% of addiction cases. Cultivating emotional resilience diminishes the likelihood of relapse and supports improved mental health outcomes by reducing symptoms of anxiety and depression often linked with substance use disorders. A holistic treatment plan that integrates these strategies fosters sustained recovery and promotes overall well-being.

Holistic and Wellness Approaches Complementing Emotional Regulation

Addressing Underlying Triggers Such as Trauma and Anxiety

A holistic approach to addiction treatment begins by identifying and addressing emotional triggers like trauma, stress, and anxiety. These factors often underlie substance use and relapse, and managing them is crucial for effective recovery. Therapies focusing on emotional regulation are designed to help individuals understand and cope with these stressors, preventing the escalation of negative emotions that can lead to substance use as a coping mechanism.

Integration of Physical Activity and Nutrition

Incorporating physical activity into recovery programs supports emotional well-being by reducing stress and improving mood through the release of endorphins. Regular exercise also enhances self-esteem and resilience, which are vital for managing cravings and emotional dysregulation. Nutritional guidance complements these benefits by ensuring the body receives essential nutrients that support brain function and emotional stability, helping to mitigate mood swings and improve overall mental health.

Enhancing Recovery Through Well-Rounded Wellness Practices

Wellness practices such as mindfulness, meditation, and relaxation techniques encourage present-moment awareness and emotional control. These practices foster the development of healthier coping strategies and reduce reliance on substances for emotional relief. When combined with structured emotional regulation training, they contribute to a comprehensive treatment plan that addresses the psychological, physical, and emotional facets of addiction recovery, ultimately promoting sustained sobriety and improved quality of life.

Support Systems and Aftercare for Sustained Emotional Regulation

Why is aftercare support crucial in addiction and mental health recovery?

Aftercare plays an essential role beyond initial treatment, offering ongoing therapeutic, social, and medical supports that help maintain sobriety and manage co-occurring mental health conditions. This continuous support fosters the development and reinforcement of coping mechanisms, emotional regulation, and relapse prevention skills.

What kinds of support does aftercare include?

• Ongoing Therapy: Provides a safe space to process emotions, tackle triggers, and strengthen regulation skills.
• Peer Support Groups: Connection with others in recovery offers encouragement, accountability, and a sense of belonging.
• Sober Living Environments: Structured, substance-free living spaces promote emotional stability and reduce exposure to triggers.
• Medication Management: Assists with mental health stabilization, which supports emotional control.

How does aftercare reduce relapse risk?

By maintaining engagement with therapy and peer networks, individuals continue practicing emotional regulation strategies taught during treatment. This sustained effort significantly lowers the chance of relapse by enhancing resilience against stress and negative emotions.

What impact does personalized aftercare have on long-term recovery?

Personalized aftercare addresses individual emotional triggers and stressors, tailoring support to specific needs. This approach maximizes the benefits of social support and improves overall outcomes by maintaining emotional balance and supporting healthy decision-making.

Cognitive and Behavioral Strategies Targeting Negative Thought Patterns

How do CBT techniques challenge maladaptive thoughts?

Cognitive Behavioral Therapy (CBT) helps individuals identify, challenge, and change negative thought patterns that contribute to emotional distress and substance use. It trains clients to recognize distorted thinking and replace it with more balanced, realistic thoughts. By restructuring cognition, CBT decreases emotional triggers linked to cravings and relapse.

What is the relation between maladaptive thoughts, emotional distress, and substance use?

Negative or maladaptive thoughts often fuel anxiety, depression, and intense emotions, which can increase vulnerability to substance use as a coping mechanism. Emotional dysregulation worsens when these thoughts remain unchecked, heightening risk of relapse.

Why is CBT important in emotional regulation enhancement?

CBT is widely endorsed by organizations like NIDA and SAMHSA for addiction treatment because it improves emotional regulation by targeting root cognitive processes. It equips individuals with tools to manage distress, reduce impulsive reactions, and sustain recovery by promoting healthy thought patterns and emotional control.

Dialectical Behavior Therapy: Skills for Managing Intense Emotions

Teaching distress tolerance

Dialectical Behavior Therapy (DBT) equips individuals with distress tolerance skills to help them endure and survive emotional crises without resorting to substance use. These skills teach how to tolerate pain and discomfort in difficult situations instead of impulsively acting out or using drugs and alcohol as coping mechanisms. Distress tolerance techniques include distraction, self-soothing, and improving the moment, which foster resilience during moments of intense emotional distress.

Mindfulness and interpersonal effectiveness components

Mindfulness is a core component of DBT that helps individuals develop present-moment awareness, allowing them to observe and describe their emotions without judgment. This practice enhances emotional control and reduces reactivity, contributing to lower relapse risk. Interpersonal effectiveness skills focus on developing assertiveness and maintaining healthy relationships, which are crucial for recovery. By improving communication and boundary-setting, individuals better manage social stressors that might otherwise trigger substance use.

Evidence of DBT success in reducing relapse

Empirical studies have demonstrated that DBT effectively reduces relapse rates among individuals with substance use disorders. The therapy's comprehensive focus on emotion regulation, distress tolerance, mindfulness, and interpersonal effectiveness addresses the complex emotional challenges that contribute to relapse. Research indicates that DBT lowers cravings and improves psychological well-being, supporting sustained sobriety and enhancing overall recovery outcomes.

Emotion Regulation Deficits as Both Cause and Consequence of Substance Use

How Does Emotional Dysregulation Relate to Substance Use?

Understanding the link between emotional dysregulation and substance use disorder (SUD) reveals a complex, bidirectional relationship. Emotional regulation difficulties can predispose individuals to substance use as a maladaptive coping mechanism. Conversely, chronic substance use can further impair emotional regulation, creating a challenging cycle of addiction and relapse.

How Do Emotion Regulation Deficits Vary Across Different Substance Types?

Research shows that emotional regulation difficulties are consistent across various substances but vary in severity. For example, the largest deficits were recorded among individuals with alcohol use disorder, potentially influenced by larger study samples. Similar significant impairments appear in methamphetamine and cocaine/opioid use disorders, especially in impulse control and effective strategy utilization.

What Are the Treatment Implications of These Findings?

The dual role of emotional dysregulation as both cause and consequence of SUD highlights emotion regulation training as a vital component of treatment. Interventions like dialectical behavior therapy (DBT) have demonstrated their effectiveness in reducing difficulties in emotion regulation scales and supporting abstinence. Addressing impulse control and enhancing access to adaptive emotional strategies can break the relapse cycle, making comprehensive emotion regulation programs essential in addiction recovery.

Relapse Prevention: Emotional Regulation as a Continuous Process

Recognizing Emotional and Mental Relapse Signs

Relapse is often preceded by emotional and mental stages before any physical substance use occurs. These early warning signs include increased stress, heightened cravings, mood swings, and difficulties managing negative emotions such as anxiety and depression. Because individuals with substance use disorders (SUDs) typically have impaired emotion regulation, these signals may go unnoticed or be poorly managed, increasing relapse risk. Being vigilant and aware of these signs is crucial for timely intervention.

Developing Personalized Prevention Plans

Personalized relapse prevention plans focus on integrating emotion regulation training with coping strategies tailored to individual needs. Such plans often incorporate cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), mindfulness, and other therapies that improve skills like impulse control, distress tolerance, and emotional awareness. The aim is to equip individuals with techniques to handle triggers and cravings effectively and adjust their responses to emotional challenges.

Lifestyle Changes Supporting Emotional Regulation

Sustaining emotional stability requires lifestyle adjustments that promote overall well-being and resilience. Incorporating mindfulness practices, regular physical activity, and adequate nutrition supports mental health and emotional control. Additionally, participation in peer support groups and ongoing therapy provides a social and therapeutic safety net to maintain sobriety. Stress management and self-care routines further help reduce vulnerability to relapse.

Together, recognizing relapse warning signs, customizing prevention tactics, and embracing supportive lifestyle changes form a comprehensive and continuous emotional regulation approach that significantly reduces the chance of relapse and fosters long-term recovery success.

Coping Skills Integration: Mindfulness, Social Support, and Stress Management

What is a comprehensive coping skills framework in addiction recovery?

Coping skills in addiction recovery encompass emotional, cognitive, and behavioral strategies that individuals use to manage stressors and cravings effectively. This framework integrates mindfulness practices, emotional regulation techniques, distress tolerance, problem-solving skills, and decision-making abilities. Together, these skills promote resilience and help individuals navigate the challenges of maintaining sobriety.

How do social networks and problem-solving contribute to sustained recovery?

Supportive social networks play a vital role in addiction recovery by offering emotional encouragement, accountability, and a sense of belonging. These connections can come from peer support groups, family, or therapy settings, creating a safety net during vulnerable times. Problem-solving skills empower individuals to identify triggers and develop practical strategies to overcome obstacles, reducing the likelihood of relapse.

What are the benefits of these coping skills for sustained recovery?

Implementing this integrated approach promotes emotional stability and self-awareness, allowing individuals to manage cravings and stress without turning to substances. Mindfulness practices increase present-moment awareness and reduce impulsive reactions to triggers. Stress management techniques, combined with strong social support and effective problem-solving, build emotional resilience. Collectively, these elements support long-term sobriety by diminishing relapse risk and enhancing overall mental health.

These coping skills form the foundation of personalized relapse prevention plans often employed in addiction treatment programs, underscoring their critical importance in recovery journeys.

The Imperative of Emotional Regulation in Sustaining Recovery

Strong emotional regulation skills are foundational to preventing relapse and supporting sustained recovery from substance use and co-occurring mental health disorders. By reducing cravings, managing triggers, and improving psychological resilience, these skills empower individuals to navigate the challenges of recovery with greater stability. Integrating emotional regulation training within comprehensive treatment programs—encompassing behavioral therapies, mindfulness, wellness approaches, and robust aftercare support—enhances treatment outcomes and fosters long-term well-being. As research continues to elucidate the vital role of emotional regulation, addiction treatment services increasingly prioritize these strategies, recognizing them as indispensable relapse prevention tools necessary for lasting sobriety and improved quality of life.

References

• Effectiveness of Emotion Regulation Training on the ...
• Empowering Wellness: Emotional Regulations Impact On ...
• Emotional Regulation in Addiction Treatment at Antrim, NH
• Emotion regulation in substance use disorders: a systematic ...
• Coping Skills & Relapse Prevention in Addiction Treatment
• Integrated Treatment of Substance Use and Psychiatric ...
• Integrated Treatment for Co-Occurring Disorders
• Integrating Treatment for Co-Occurring Mental Health ...