The dual tragedy of fatal drug overdoses from addiction and suicide rates surrounding mental health has underscored a disturbing trend in the United States. Namely, that more and more individuals are feeling despair. The fact that suicide rates have been increasing steadily across every demographic over the past 20 years, rising nearly 28% from 1999 to 2016. 45,000 Americans died by suicide in 2016, making it the 10th leading cause of death that year.
Alcohol induced fatalities and drug overdoses have steadily rising as well. In 2016, 142,000 Americans died from alcohol related causes, drug overdose and suicide, or roughly one person every four minutes. Between 2015 and 2016, the average life expectancy for Americans decreased for the first time in years.
We see even further evidence of a growing national crisis in the number of mental health and substance abuse hospitalizations over the past decade. Admissions into hospitals for these diagnoses were the only types of admissions to increase from 2005 to 2014, with opioid-related hospitalizations being responsible for the majority of this growth.
Our nation is facing a mounting crisis related to alcohol and drug misuse as well as a mental and behavioral health crisis that can be glimpsed in the rising suicide rate. If this public health crisis were related to the spread of disease, our country would call for a nationwide response to combat the epidemic. However, because mental health and addiction are taboo subjects that are either pushed under the rug or relegated to victim blaming, it’s challenging to coordinate a response from the government that can adequately and comprehensively address the situation.
The Connection Between Mental Health and Addiction
Not long ago, there was a hard line drawn between two conditions: mental health and addiction. They were looked at as two separate issues that were unrelated. Today, the 21st Century recognizes that these two are more connected than once realized. In order to properly treat mental illness and addiction, we need to understand how they affect an individual.
When someone struggles with addiction problems simultaneously with being diagnosed with a mental illness such as depression, bipolar, or anxiety, it is called “dual diagnosis.” Either one can develop first to be considered dual diagnosis or “co-occurring disorder.” Many who suffer from a mental illness will attempt to cope with their illness by self-medicating with drugs or alcohol. Self-medicating is where a person will use drugs or alcohol to cover up or mask their mental illness symptoms. However, research shows that drugs and alcohol can make mental illness symptoms worse. This creates a vicious cycle of mental illness symptoms and drug or alcohol abuse.
On their own, both addiction and mental illnesses alone make maintaining a stable life difficult, but when the two are combined, it makes the situation even more complicated. “When a mental health problem goes untreated, the substance abuse problem usually gets worse. And when alcohol or drug abuse increases, mental health problems usually increase too,” states HelpGuide.org. When these problems are ignored, they do not get better on their own. Professional treatment is the route to stability and happiness.
A 2014 National Survey on Drug Use and Health showed that 7.9 million people in the U.S. experience both a mental disorder and substance use disorder simultaneously. Of those Americans, more than half of them or around 4.1 million, are men. Also, the NSDUH found that 45% of people with addiction had a co-occurring mental illness.
The best way to treat co-occurring addiction and mental health disorders is to offer individualized, integrated care. This kind of care also has to come from a place of experience through clinicians that are familiar with the distinct nature of addiction and why it is such an insidious disease. There is a commonly held theory that people have to be allowed to hit rock bottom before they can begin to recover, but this can be a dangerous and life-threatening approach.
Unfortunately, being desperate enough to change because your life is being spiraled downward by addiction makes for a good story, but allowing yourself to get to that point doesn’t exactly make for an effective treatment plan. Public perception about addiction must catch up with the medical consensus of addiction being a disease. One study from 2014 found that 43% of adults across the country actively opposed giving people with addiction equivalent medical insurance benefits as other illnesses, while 21% believed the same thing regarding mental illness. Perhaps worst of all is that 59% of people believe that treatment options are not effective for drug addiction and 41% for mental illness.
The Human Cost of the Opioid Epidemic
Over the past two decades, the opioid crisis has reached peak levels of severity and one research institute estimates that the toll will continue to rise over the next two years. The Center for Disease Control found that from 2016 to 2017, drug overdoses in the country rose by 22% from almost 53,000 to just over 64,000. The spike in drug overdose deaths from 2016 to 2017 is minuscule when you look at the larger picture that has been taken over the past couple decades, or even just the past five years.
The National Institute on Drug Abuse found that since 2013, annual opioid overdose deaths have risen from just over 2,500 to almost 30,000. This represents an increase of 1200% in just five years.
The Impact of Opioids on the Workforce
Research indicates that the opioid crisis has had a substantial impact on America’s workforce. Higher rates of opioid prescriptions are associated with lower labor force participation rates in counties across the United States, and opioids could account for as much as 43% of the decline in labor force participation among men over the last 15 years. According to the Council of Economic Advisers, the opioid crisis could be costing over $500 billion annually, nearly 3% of the GDP. Surveys also show that 80% of employers are concerned about inappropriate use of opioids among employees, while 70% report feeling the direct impact of prescription drug misuse in the workplace.
Fortunately, managers and organizations can help alleviate the problem through strong workplace policies, education, health benefit programs, and management practices. These include: regular drug testing (associated with a 51% reduction in workplace injuries and a 12% reduction in compensation claims), providing workplace training on Employee Assistance Programs, auditing workplace drug policies and benefits plans for addiction treatment, hosting workshops on identifying drug use in the workplace, and educating employees about ADA and FMLA policies. Employer supported and monitored treatment has been proven to yield longer treatment stays and improvement in employment related problems.
While all other drugs except for methadone has seen increases as well, none have been as severe as opioids. There is a growing mental health crisis in America that has opened the door to discussions about the amount of drug-related overdoses sweeping the nation. To stem the growing tide of suicide and drug-related deaths in the United States, we need a comprehensive, nationwide call to action. Here are some ways that states and local communities can reduce deaths from suicide and drug overdose. Here are some opportunities that states can focus on.
Better Mental Health Screening
Screening for substance abuse, suicidal ideation, and other mental health indicators is a critical step that healthcare systems and businesses can implement to begin saving lives. SAMHSA outlines a method called SBIRT (Screening, Brief Intervention, and Referral to Treatment) that has been linked to lower healthcare costs and lower rates of substance misuse. This tool should be adopted by more healthcare organizations to become a regular screening tool to help identify and assist those struggling with suicidal ideation or substance abuse problems.
Reducing Access to Lethal Means
One successful method for reducing access to lethal means (whether through medication or firearms) is the CALM approach (Counseling on Access to Lethal Means). One study on this approach in Colorado found that parents of children being treated for suicide risk made significant changes in behavior, increasing the percentage of medication and firearms safely stored by more than 50%. Schools, businesses, or state organizations could take it upon themselves to distribute information about this method.
Increasing MAT Awareness and Access
MAT or Medication Assisted Treatment is one of the National Principles of Care for Substance Abuse. However, it is still stigmatized as a band-aid solution that simply replaces one drug with another. A Blue Cross Blue Shield study found that while the rate of patients diagnosed with an opioid use disorder between 2010 and 2016 increased, the rate of those receiving MAT did not increase at a comparable rate. MAT deserves credibility as a viable and effective solution to curbing addiction. A comprehensive 2012 study on Methadone found that treatment of opioid abuse with MAT was associated with increased retention rates, reduced mortality, improved social function, and decreased drug use and improved quality of life.
Improving Pain Management & Treatment
While patients should not be made to suffer during their recovery, it is vital that doctors administer painkillers in a responsible manner to ensure patients are not susceptible to developing a crippling addiction. The CDC outlines specific prescription guidelines for opioids that all physicians should adhere to. The guidelines can be found here.
Harm Reduction through PDMPs
PDMPs (Prescription Drug Monitoring Programs) are a tool that states can use to successfully address prescription drug diversion and abuse. PDMP’s are databases that allow government entities to monitor the flow of drugs throughout a state to potentially identify patients who may be doctor shopping, doctors who may be over prescribing medications, and patients who could be being co-prescribed medications. Studies on states that implement PDMP’s show that they have reduced opioid prescription rates by 8% and opioid overdose deaths by 12%.
Boosting Recovery Housing in Rural Areas
Nonprofit groups working in rural areas now have a new opportunity to help create sober living and transitional housing properties for people in recovery from opioid misuse. All thanks to the U.S. Department of Health and Human Services as well as the Department of Agriculture. In February, they announced a brand new partnership through which organizations can apply for and purchase single-family homes from the USDA and convert them into transitional housing for recovering addicts.
The USDA spokesman says the program is available now and will continue indefinitely; the agency will be looking for buyers with experience in transitional housing. The agency has not set quantitative goals for the development of recovery housing, with the spokesman explaining that “the right fit and situation for transitional housing units is more important than the number of homes.”
According to one press release from SAMHSA, itself and the USDA Rural Development office are working to combine their efforts in order to sell single-family home properties at a discount to people in recovery who need the assistance. The collaboration began in 2018 when SAMHA began supplementing grants to help expand the purchasing power of the USDA. The USDA also launched a community opioid misuse toolbox that includes a robust database for assisting community leaders in tackling the opioid crisis in their region.
“We know that the opioid crisis has hit rural communities hard, and we need to leverage all possible partnerships to support these communities,” said HHS Assistant Secretary for Mental Health and Substance Use Elinore McCance-Katz, MD. “Housing plays a vital part in the recovery process for those living with opioid use disorders.”
At Landmark Recovery, we do everything possible to make sure our patients receive the best possible care regarding their addiction and mental health. We believe in creating a supportive network of love and access to resources that can help you break free from the chains of addiction. Visit our website to learn more about drug and alcohol rehab.