Wall art of outline of a brain in a person's headRoughly 41.2 percent of all people who have a substance use disorder have a co-occurring mental disorder, 2015 statistics from the U.S. Department of Health and Human Services show.1 But until now, specific data as to how often mental illness coincides with opiate use disorders has not been available.

In late January 2017, the Substance Abuse and Mental Health Services Administration (SAMSHA) released such numbers for the first time. The “spotlight report” coming out of SAMSHA’s 2015 National Survey on Drug Use and Health showed that in 2015, about 1.5 million adult Americans who had a serious mental illness in the past year also had misused an opioid during that time. 2 Opioids include both heroin and opioid-based painkillers.

SAMSHA defined serious mental illness as “a diagnosable mental, behavioral or emotional disorder (excluding developmental and substance use disorders) of sufficient duration to cause serious functional impairment in an individual’s major life activities (going to work, school, interacting with family, etc.).”

Per SAMSHA, 13 percent of those who misused opioids during the past year also had a serious mental illness. Along the same lines, 15.6 percent of people with a serious mental illness as a primary diagnosis also misused an opioid.

Many people who end up being diagnosed with mental illness do so because they have been through great trauma. They are not to blame for the mental illness, yet because of the stigma surrounding mental illness, many people don’t understand that and don’t seek treatment. So, they feel bad about being an addict, they feel bad about living with their mental illness, one fuels the other and things just get worse and worse.

Consider the story of Nikki G., who shared her story on the Heroes in Recovery website. 3 Nikki grew up in an upper middle class Greek family in the suburbs of Boston. To people on the outside looking in, Nikki appeared to lead a privileged, glamorous life. “My youth was filled traveling to Greece, playing soccer and going to Greek camp (don’t ask) and church on Sundays,” she writes. “I should have been ecstatic. I had more than the majority of people I knew, but deep down within my soul, I knew something wasn’t right.”

In fact, Nikki was a lesbian. She carried that around for years, living in the closet on what was supposed to be a real-life version of “My Big Fat Greek Wedding,” she explains. And for years, she medicated the pain that came along with not accepting who she was or that it would not fit into the plans she thought others had for her.

“I was drinking and smoking on the weekends, and as time went by, it turned into an everyday thing,” she wrote. “Around this time, I also started experimenting with ecstasy, painkillers, acid and ‘shrooms. By my junior year of high school, I was high morning, noon and night. I failed the majority of my classes, I decided I didn’t want to play soccer anymore, and my parents didn’t know what to do with me.

“My parents had me in and out of psychiatrists’ and therapists’ offices. Over the years, the doctors diagnosed me with depression, ADHD, anxiety disorder, bipolar disorder and mood disorders and gave me a plethora of medications to match. I didn’t know it then, but I know it now: I was running from myself. I was still in the closet and was terrified people would find out and judge me. I was a perfectionist, and being gay was putting a damper on my plans.”

Finally, Nikki got the sort of treatment and support she needed. She began addressing those deep-seated issues that were feeding her addiction. “I had to get down to the root of all my problems, and little by little things started to change,” she wrote on Heroes in Recovery. “Over time my anger and anxiety was disappearing. My resentments toward people and God were healing. I was laughing in meetings and building a fellowship. It took a lot of work, but the miracle had happened. I was now one of those sober people smiling and laughing in the meetings.”

So, while the extent of the opioid crisis is relatively new, we now are learning that people who become addicted to them often are simply self-medicating emotional pain just like so many other addicts do. But according to the National Survey on Drug Use and Health, most people are not getting treatment for both their mental illness and substance use problem — usually between 4 and 8 percent, depending on the age group. The chances of lasting recovery are far greater when both disorders are treated.

“Little is currently known about the co-occurrence of opioid misuse and serious mental illness among adults, but this spotlight from SAMSHA provides greater insight into this phenomenon,” SAMSHA reported in a news release. 4 “SAMSHA’s Primary and Behavioral Health Care Integration program funds 205 grant programs that provide integrated primary and behavioral health care to people with serious mental illness, including those with a co-occurring substance use disorder — some of whom have opioid misuse disorder. SAMSHA also recently released the Decisions in Recovery: Treatment for Opioid Use Disorder, an online interactive aid for people who want information about the role of medications in treating opioid use disorder.

It’s important to understand that the disruption in the activities of daily life is what defines a substance use disorder. While many people on opioid replacement therapy may still have a physical dependence on an opioid, the drug no longer is interfering with them living their lives. Many people do not understand this difference, so medications used to ultimately get people back into the swing of life are sometimes as stigmatized as the opioids that disrupt daily living. SAMSHA’s goal with the above-mentioned link is to replace such myths with facts, so people can feel good about seeking help.


Sources
1. Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. (2015). Key Substance Abuse and Mental Health Indicators in the United States: Results from the 2015 National Health Survey on Drug Use and Health. Retrieved Feb. 3, 2017, from https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2015/NSDUH-FFR1-2015/NSDUH-FFR1-2015.pdf
2. Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. (2017, Jan. 250. The CBHSQ Report Spotlight. Retrieved Feb. 3, 2017, from https://www.samhsa.gov/data/sites/default/files/report_2734/Spotlight-2734.html
3. Heroes in Recovery. (2014, July 15). Nikki G’s story. Retrieved Feb. 3, 2017, from http://heroesinrecovery.com/stories/nikki-gs-story/
4. Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services (2017, Jan. 24). 1.5 million adults experiencing serious mental illness misused opioids in the past year. Retrieved Feb. 3, 2017, from https://www.samhsa.gov/newsroom/press-announcements/201701241230

Written by David Heitz