More than one million Americans have died of accidental overdoses since 1999 and while drugs like heroin, cocaine, and fentanyl are often implicated on their death certificates, untreated mental illness had a hand in killing most of those people.
National surveys have found that half of those who experience mental illness during their lives will also develop a substance use disorder and vice versa. Sixty percent of young people in community-based addiction treatment programs meet the diagnostic criteria for another mental illness. Most behavioral health professionals working in the field believe the numbers of people struggling with a simultaneous mental illness and substance use disorder to be even higher, especially post-COVID, where anxiety and depression sky-rocketed, drug and alcohol use soared, and fatal overdoses jumped thirty percent.
As we mark International Overdose Awareness Day on August 31st, the fatalities are coming back down thanks to the widespread distribution of naloxone - an opioid overdose reversal agent – and fentanyl test strips, along with expanded addiction treatment, including traditional talk therapy, support groups and medication. Those efforts have saved countless lives, but we are still losing 300 Americans per day, or about 12 people every hour to overdose. Add in suicides and the deaths of despair grow.
Bringing people back from the brink of death is the least we can do, but surely we can do better.
School-based drug prevention programs often focus on resisting peer pressure and employ scare tactics, warning kids that using drugs will land them in jail, destroy their futures or at the very least in the case of methamphetamine, ruin their youthful good looks. If you’re feeling hopeless, though, like 44% of students surveyed by the federal Centers for Disease Control and Prevention (CDC) last year, even the threat of death may not be a deterrent. And if that first drink, bong hit, or pill calmed your racing mind and helped you feel “normal” for the first time, listening to auditorium lectures from bereaved parents, addiction experts and cops only deepens your conflict and guilt.
Too many young people and adults, for that matter, wind-up trapped in a vortex where the drugs and alcohol that provide some relief from untreated mental health conditions – anxiety, depression, even ADHD - exacerbate those conditions, requiring even more drugs and alcohol to keep the symptoms at bay. When things get bad enough, your family, employer, school or the criminal justice system pushes you into addiction treatment, where unless it’s a facility that specializes in “co-occuring disorders,” sustained abstinence will be challenging because your underlying mental health conditions probably won’t be addressed during 50-minute outpatient sessions or even a thirty-day inpatient stay.
As counterintuitive as it is given everything we know about the human brain, mental health programs routinely ignore low level drug use or turn away addicted patients, citing a lack of expertise, while many substance abuse treatment programs refer suicidal patients or those with psychiatric symptoms back to mental health programs. Those folks often bounce between systems or languish on long waiting lists and bereaved families are remembering many of them today.
It's tempting to blame providers who haven’t modernized their services or to cite America’s strained mental health workforce, but the lack of integrated care goes back decades and is reinforced by rigid regulations, billing rules and how behavioral health staff are credentialed. New York even has two separate state agencies – the Office of Addiction Services and Supports (OASAS) and the Office of Mental Health (OMH) - to deal with problems tightly intertwined above the neck.
There’s been a massive post-COVID investment in mental health services from both the federal and New York state government, along with a drive for more fully integrated services, where community-based organizations, hospitals and treatment centers can win unified mental health/substance use disorder treatment licenses. With bigger investments than ever before, more knowledge at our fingertips and overdose trends finally headed in the right direction, now is the time to make fully integrated, evidence-based treatment on demand a reality.