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The Correlation Between Substance Abuse and Mental Health

Updated: Oct 26, 2020

By Kian Etemadi

On December 8, 2019, Jarad Anthony Higgins, better known as Juice WRLD, suffered from a seizure and passed away on his way home to Chicago a week after his 21st birthday. His fans were devastated. He was loved by so many for his music and inspiring words to people with mental health issues.

How had this happened? After an autopsy performed by the Cook County Medical Examiner’s Office, results proved that he died as a result of oxycodone and codeine toxicity. That’s when some people’s sadness and empathy turned to shame and disgust. When I told certain family members about Juice WRLD’s death and how it had happened, they did not tell me how sorry they were that my favorite artist died, but instead, criticized me for having a drug-addicted role model and how people like him are ‘no good’. Little did they know, Juice WRLD also suffered from severe depression and anxiety, leaving drugs as the only thing keeping him sane. In fact, not enough people know about the serious mental health issues that Higgins had or even the ones that ordinary people have. Opioids and other types of drugs may have a strong connection to mental health issues, which means there should be more emphasis on treatment for people with addiction and mental health illnesses.

Unfortunately, prescribing fewer opioids or even banning them would not cloud the fact that millions of people suffer from addiction and mental health issues in the United States. Even with certain hospitals and private practices providing alternative drugs to opioids, the Center for Disease Control (CDC) Injury Center, stated that over 67,000 people died of opioid-related causes in 2018. Banning opioids would only act as a band-aid to the problem rather than a real, long-term solution.

Why and how did so many people die from illegal or prescription opioids?

There are three possible explanations. One, they are extremely addictive. They may relieve pain, but eventually, the abuser takes more and more because the prescribed amount no longer brings relief. This is also how alcoholism is developed. The more alcohol is taken in, the more used to it the body gets, meaning that it would take more and more of it to get drunk (or with other recreational drugs-- high). This is how addiction develops.

The second reason may be because of the euphoria associated with these drugs. Getting high is a thrill that comes with taking opioids (but beware of the harmful side effects that may come with it). Methamphetamine (also known as meth), for example, can lead to cardiovascular issues and even psychosis.

The final reason is mental health and escape. Juice WRLD suffered from depression and often stated that he would get high because it numbed the stress he was feeling. Who knows how many others go through the same problem?

How has this not been caught before or at least talked about as much? According to the National Institute of Health (NIH), “Some people take drugs in an attempt to alleviate symptoms of mental health disorders'', just as Juice WRLD did. Doctors who prescribe opioids may see patients return with an empty bottle claiming it is for pain relief, but some physicians may not realize that this is not the case. Some of these patients with mental health illnesses may return claiming they need more for their pain, but in reality, it is to escape the trauma of the real world. Without realizing that the patient may just be trying to alleviate their symptoms of mental health issues and not in physical pain, the physician may be prescribing a dangerous amount of opioids and other medicines (which are highly addictive as it is).

This is why federal money needs to go into mental health research, as well as funding for counseling services. Getting people with depression or other illnesses into therapy will lower the amount of opioid-related deaths.

Think about it: therapy and rehabilitation may help people suffering from mental health, and in addition, clear them away from drugs. Moreover, teaching more doctors about the correlation between substance abuse and mental health will help them when prescribing medicine.

Now, this is where it gets complicated. If a patient does return to a doctor asking for more painkillers, does the doctor give them more or do they implicitly assume that the patient is an addict or suffering from mental health issues? This all depends. How fast did they go through the bottle? Did they follow the recommended dosage or did they take too much? Do they have a history of mental health issues? This would all have to be discussed between the patient and the physician, yet, problems remain. Even if the physician did think the patient was lying about having pain still, they would have no way of knowing for sure, because there is no real, biological way to measure pain.

The agreed-upon definition of pain in the medical community is basically just an uncomfortable emotional and sensory feeling in relation to “threatened tissue damage, or described in terms as such”. It is difficult to come to a solution because the patient may be in real pain and be denied painkillers just to crack down on opioid misuse. Fortunately, there are solutions to this, including drug monitoring systems. These Prescription Drug Monitoring Programs (PDMPs) are an electronic database that, according to the Center for Disease Control (CDC), “ track controlled substance prescription”. Doctors have seen good results while using these drug monitoring systems because it helped them decide if the patient was acting suspicious or not and whether they should prescribe another dose. But how can this be brought back to the mental health conversation?

Studies have been conducted to learn more about the correlation between mental health and opioids. According to a study by the Journal of American Board of Family Medicine (JABFM), 7.2 million people with any mental disorder use opioids. It also states that the “population of adults with mental health disorders receive more than half of the total opioid prescriptions in the United States”. The study found that people with mood illnesses (i.e. depression, etc.) are more likely to develop long-term opioid use than those without mood illnesses.

So how do physicians and clinical workers solve the opioid crisis and help people with addiction and mental health issues at the same time? Along with PDMPs to control how many prescription drugs a person is getting, there are many behavioral therapies that can help these patients. Dialectical Behavioral Therapy (DBT), for example, helps reduce self-harm behaviors that include suicidal thoughts and actions and even drug use. DBT helps patients with addiction and mental health issues remove unhealthy relationships from their lives and also triggers, such as drug paraphernalia, all while providing therapy to relieve symptoms of depression, anxiety, and other mental illnesses.

Clearly, mental health illnesses and drug misuse are correlated. By putting more money into educational resources for medical school students and residents, or even attending doctors, they can learn how to treat patients with mental illnesses while simultaneously tackling the opioid epidemic. Instituting drug monitoring systems may also provide great help when deciding whether to prescribe another dose. Finally, hospitals, schools (including middle schools, high schools, and colleges), and other public resources should offer Dialectical Behavioral Therapy or similar treatments that will help patients suffering from mood illnesses and drug or alcohol addiction.

With that said, it is time for society to quit turning their backs on people who suffer from mental health illnesses and drug addiction, whether it be Juice WRLD, Demi Lovato, or a person in your everyday life. We need to help them.

Written by Kian Etemadi

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