September marks the 31st annual National Recovery Month. SAMHSA (the Substance Abuse and Mental Health Services Administration) describes this event as an effort to “educate Americans that substance use treatment and mental health services can enable those with mental and substance use disorders to live healthy and rewarding lives.”
An estimate 8.9 million Americans are living with a co-occurring disorder- a substance use disorder that occurs simultaneously with a mental health disorder. Mental health and substance use disorders have an interactive relationship. People with serious mental illness may self-medicate unpleasant symptoms with substances. Some substances exacerbate or (provoke) dormant mental health symptoms. Trying to discern which came first is often a futile exercise. While in the past, we tried to identify which was primary and treat that first, we now know that people have the best outcomes when they receive treatment for both conditions at the same time by providers who understand both conditions.
The development of substance use and/or mental health disorders are a complex mixture of nature and nurture. We know that both substance use and mental health disorders are correlated with childhood trauma (adverse childhood experiences or ACES) and toxic stress in adulthood. We also know that the relationship between adverse experiences and negative health outcomes is “dose dependent”—that is, the more stress or trauma people experience in childhood, the more likely they are to have difficulties with substance abuse, mental illness, and a host of medical issues as an adult. Although childhood trauma is particularly impactful, we know that unrelenting stress or multiple stressors in adulthood also have an impact.
The last year and a half brought an unprecedented level of stress for most people. We have feared for our own health and that of people we love, and many of us have lost people we care about to COVID. We may have struggled to manage day-care or attempted to help school-aged children learn remotely while trying to manage our jobs. We may have cancelled or postponed events which were important to us or were unable to visit with family in other parts of the country. We may have lost our jobs or struggled to maintain our housing. During the pandemic, about 4 in 10 American adults have reported symptoms of anxiety or depression, up from 1 in 10 in the first half of 2019. Twelve percent have reported increased substance use. Nationally, overdose deaths also increased sharply in 2020; in Oregon, there was a 30.3% increase.
Recently, as our community has been hit hard with the highly contagious and more deadly Delta variant of COVID 19, many of us who were starting to feel a bit more hopeful about a return to normalcy are feeling stressed, uncertain and weary. Even if we may not meet criteria for a mental health disorder, we may be struggling with motivation or not sleeping well. What can we do?
If you suspect you are concerned about your mental health or substance abuse, please seek help. Many people who have not needed help before may now find themselves needing to talk to someone. There is still, unfortunately, some stigma around seeking treatment for mental health or for substance use—but there shouldn’t be. If we had concerns about our physical health, most of us would see our doctors. Let’s create a community and a culture where people can seek behavioral health support with the same ease.
We can seek support and offer support to others in our circle. This might involve checking in with friends, family and co-workers—especially those who experienced a COVID exposure or who may have an ill family member. When people check in with us, we can decide to be honest about our own ups and downs during this time. Being transparent and honest about our struggles makes it easier for other people to do the same.
We can look at what is in our “circle of control.” During uncertain times, it can be helpful to remember the things we can do. We can follow recommendations about masking and social distancing, to minimize our chance of exposing ourselves or others to the virus. We can seek out accurate information for trusted sources including medical experts on our vaccination and other questions. We can get outside and enjoy the beauty and bounty of this time of year. We can remember we have survived all our hard days up to this point! And, we can be intentional about having gratitude and noticing the good things in our lives.