One of the most frustrating challenges for individuals in recovery from mental illness and substance abuse is setting goals. But without goals, there is no sense of progress or forward direction. And hope is required in order to have the ability to envision goals in the first place. Given that goals are vitally important to every person in recovery, how can those with mental illness and substance abuse get help – or help themselves – to understand both the importance of setting goals and become better able to set them on their own? This is a complex issue but a vital one that needs to be addressed by the families and loved ones of those recovering from mental illness and substance abuse as well as the individual in recovery. According to a recent survey by the Substance Abuse and Mental Health Services Administration (SAMHSA), there are an estimated 9.8 million adults aged 18 or older living with a serious mental illness. The prevalence of serious mental illness is greatest among the 18 to 25 age group, which is also the group least likely to receive counseling or services for mental health issues. And, among those 9.8 million adults with serious mental illness, 2.5 million (25.2 percent) were dependent upon or abused illicit drugs or alcohol. Developing a Therapeutic Alliance Recovery doesn’t happen in isolation. The individual in recovery from mental illness and substance abuse needs professionals in his or her corner to help navigate uncertain times, deal with stress, overcome marginalized employment or living conditions, build skills and/or continue improvement in areas of cognitive ability, among others. After completion of a treatment program for substance abuse and co-occurring mental health disorder, counseling should be continued on a regular basis. The length of time will vary depending on the individual’s needs and progress. There’s no one-size-fits-all plan for such individuals, just as there is no defined blueprint for any person in recovery from addiction. The fact that an individual has a mental illness that is being dealt with means that the therapeutic alliance is perhaps even more important. Many families with loved ones with a serious mental illness and substance abuse wonder if things will ever be better. Many of these individuals have been institutionalized for years or have been hospitalized at times for various conditions, or lived in isolation within the family. While there are certainly those who remain at a low level of functioning due to the severity of their mental illness, there are many more that are able to make significant progress toward achieving normalcy. With ongoing counseling and therapeutic alliances, they can and do learn how to become, if not self-sufficient, at least better able to set and accomplish goals. Their overall quality of life improves and that extends to their family members and loved ones as well. Restore or Build Hope The ability to set realistic goals – even to envision a future that encompasses such goals – depends, in large part, on the individual having hope. But how do you find hope when your life has been a series of crushing disappointments, repetitive failures or losses, stigma and discrimination because of mental illness and addiction, or a combination of all of these? Some individuals in recovery can’t see anything other than a bleak future when they’ve tried in the past to pick up the pieces over and over again only to see them fall apart. Some individuals never had hope, so it must be built. Others had it at one time, necessitating restoration of hope. In either case, it takes time and patience. When a person has no hope, it’s important that others carry hope for that individual until such a time as the person begins to believe that his or her life can get better. Engaging the person in social activities that are pleasurable, helping him or her to develop friendships or meaningful relationships, and activating spirituality or faith are some ways to help the individual build or restore hope. In addition, others who have come through similar circumstances and have been able to find hope can serve as tangible proof that recovery is possible. These peers, possibly care staff or support, provide inspiration to those who desperately need it. Identify Interests, Desires, or Aspirations Talking about setting goals may seem scary to some in recovery from mental illness and substance abuse. Instead of diving right in and asking the person what they want to do with their future, a better approach for mental health providers and family members is to help the individual identify what interests them, what they’ve always wanted to do, or even think they’d like to do. Who do they admire most? What types of activities give them the most pleasure? Do they like to garden, crochet, or cook? Is being out in nature something that makes them smile? Have they ever developed a hobby? Are they good with their hands? Do they have mechanical aptitude or like to work on cars or machines? What about artistic endeavors such as painting, sculpting, or music? What may start as an exercise to pass the time may turn into a lasting pursuit that brings self-satisfaction, pleasure, a sense of accomplishment, and even open up opportunities for future growth. It’s also possible that, during the time the person is putting together the materials or getting ready or doing the activity, he or she will become more communicative, open up more, and the care professional or family member can learn more about the interests, desires, or aspirations. Dealing with the Fear of Taking Risks Before you can get an individual in recovery from mental illness and substance abuse involved in doing an activity, it may first be necessary to deal with their fear of taking risks. If they’ve been accustomed to repetitive failures, or been involved in a care situation where they are nothing more than their diagnosis or problem, symptoms, or deficits, it may take some peeling back the layers to get at why they’re afraid to go forward. What is it they fear most about doing this activity? Let’s say it’s riding a horse. The individual may have expressed an interest in horses, or maybe he or she loved horseback riding as a child, or always dreamed of competing in horseback-riding. But today, they can do no more than look at others involved with horses. They can’t envision themselves actually doing anything about their interest. Moving the individual from passive observation to actual doing requires ongoing encouragement, understanding, and patience. There will be anxiety and doubts to overcome, maybe in equal or better measure to excitement about the possibility of actually doing the activity. Gaining confidence in one’s abilities goes a long way toward overcoming the fear of taking risks. Perhaps someone needs to help the individual get on the horse to show the person that he or she is capable of doing so. Practicing mounting and dismounting does two things: it increases the person’s skill level and raises self-confidence. Progressing toward the next degree of difficulty is then possible. With each successful accomplishment comes increased self-confidence. Another fear of taking risks involves the person’s fear of relapse or setback if they fail. That’s why many individuals in recovery for mental illness and substance abuse resign themselves to a limited or isolated lifestyle. It’s comfortable, routine, and stable. They don’t have to challenge themselves – and risk failure or relapse. If they don’t venture outside their confined environment, they don’t experience joy or hope, but they don’t have to worry about falling backward either. One way to address this fear is to begin with very basic, incremental personal goals. Getting Help with Neuro-Cognitive or Skill Impairments Motor functioning may be difficult for some individuals in recovery for mental illness and substance abuse. They may also have residual or lasting cognitive impairment that needs to be addressed. If they have difficulty communicating, it may be more difficult for them to identify goals or express their fear of not being capable of doing well in certain situations. Skill-building exercises, strength training, help with communication skills, or a combination may help with all of these. As a person’s abilities, strength, coordination, and communication improve, so too does their self-confidence and self-esteem. While it may seem like a minor achievement to some, to the individual who has faced limited prospects for perhaps a long time, such improvement can be a very big deal. And it is. It means they are one step closer to being able to identify and set goals. Even a small goal is important, like deciding that tomorrow the person will complete a crossword puzzle or ride a stationary bike for 15 minutes. Naturally, the individual needs the assistance of others in order to overcome neuro-cognitive or skill impairments. Such assistance may come from local or community agencies and organizations, hospital or medical facilities, mental healthcare providers, support groups, and family members or friends, among others. Expand Access to Participation in Pleasurable Activities In order to participate in activities the individual has identified as ones that hold interest, there needs to be access. For many individuals in recovery for mental illness and substance abuse, such access is limited due to financial considerations or lack of transportation or need for others to accompany him or her. Even in the case of individuals with severe mental illness who are also recovering from substance abuse and are fairly confined to the home, there are things that the family can do to raise the loved one’s participation in pleasurable activities. Include the loved one in family meals and everyday activities, such as watching a comedy movie on TV, planting flowers in the backyard, folding laundry or setting the table. Increasing contact with family members is a small but vital step in eliminating the isolation that many individuals recovering from mental illness and substance abuse endure. Overcoming their loved one’s stated desire to be alone is often a hurdle that family members don’t understand or appreciate. In actuality, the person may be screaming inside for attention, dealing with the dueling opposites of wanting to be with the family and afraid that he or she is destined to waste away alone. All About Choices Some experts in the field of recovery from mental illness and substance abuse say that while establishing specific goals and revisiting those goals is an important part of the recovery process, providing the individual with knowledge and experience can help them internalize a structure that supports and facilitates their recovery. It’s all about choices: • Making the individual aware they have choices. – Again, this gets back to the issue of hope or the lack of it. If there’s no hope, there can be no thought of setting goals. Why bother? But when individuals are given the opportunity to see that they do have choices that they can make, this gives them some measure of autonomy. They choose what they will do, which direction to take – given responsible and appropriate choices. It is important to note that the individual needs to become aware that they have choices, and then be able to recognize the choices. What those choices are is not that important at this stage. It’s enough that they recognize they have choices and that there are numerous choices available to them. • Encouraging the individual to make choices. – Just recognizing choice isn’t enough. The individual needs encouragement to get and keep them motivated enough to make choices. Once again, the choices the individual makes are not as important as the act of making the choices. • Supporting the individual’s choices. – Support, in this instance, involves assisting the individual in creating an action plan to achieve the goal or choice they’ve decided upon. It doesn’t mean doing the work for them, but facilitating the process of their being able to do the step-by-step work of deciding on a goal, figuring out what it will take in order to achieve the goal, and building a network of support to help them continue in their goal setting, pursuit, and achievement. This circle of support helps bring about a sense of social connectedness and belonging. It also facilitates empowerment – the belief that the individual has choices, wants to make choices, and takes actions that result in a more satisfying life. The more they learn and do, the more their array of choices – and, thus, their horizon – expands. In the end, goal setting is important as individuals recover from mental illness and substance abuse, but it has to go hand-in-hand with a gradual building-block process of restoring or building hope; developing a therapeutic alliance; identifying interests, desires, or aspirations; dealing with the fear of taking risks; getting help with neuro-cognitive or skill impairments; expanding access to participation in pleasurable activities; and becoming aware of, receiving encouragement, and support in making appropriate choices. Not every individual in recovery from mental illness and substance abuse will have the same trajectory of growth. Some will be able to achieve significant success toward identifying, setting, and working to achieve goals. Others will have a more modest rate of improvement. But any improvement is a good sign – particularly for those whom society may have written off or cast aside. Everyone deserves to have the opportunity to live a healthy and productive life – to the extent that they are able and willing and given the availability of counseling and support services that can help them succeed. One thing is certain: With the prevalence of serious mental illness and substance abuse or dependence in America today, this is something that we’d better get right. What may be an issue or problem that your neighbor or co-worker has to deal with today in their family may tomorrow be one that you and your loved ones will need to address.