By Maddie Capron
ATHENS, Ohio—About 39 million Americans struggle with mental health conditions at any given time. Nearly 19 percent of those people also use prescription opioids, according to the Institute for Healthcare Policy and Innovation. That’s nearly 7.5 million people in the U.S., which, for context, is just shy of the population of the entire state of Washington.
Of all addictions, opioid addiction is perhaps the most likely to result in a suicide. Due to the nature of overdose, it is impossible to know how many deaths were accidental and how many were suicides, according to Addiction Center.
“You have these very specific dreams for yourself, but addiction can sometimes take five or 10 years from you,” said Daniel Skinner, an Ohio University expert who has extensively studied Ohio’s opioid crisis. “Think about what that does to your mind, in terms of its relationship with things like depression, suicidal ideation, suicidal tendencies. It makes you rethink your entire life trajectory.”
Additionally, researchers at the National Institute on Drug Abuse found that prescription opioid misuse was associated with anywhere between a 40 percent to 60 percent increased risk for suicidal ideation. Those reporting at least weekly opioid misuse were about 75 percent more likely to make plans for a suicide and made suicide attempts at a rate 200 percent greater than those unaffected.
“All people deal with issues. … Not all people deal with depression, but many people do,” Skinner said. “But, if you layer onto that something like addiction where your life becomes really taken away from you and is running its own course for so many years, you can see there’s kind of a multiplier effect that happens.”
Inside the Brain
Substance use affects the brain in at least two ways, said Kim Miller, director of corporate development at the Prestera Center in West Virginia, which specializes in helping people who have a dual diagnosis, which means they have mental health and substance abuse needs.
Miller said substance use affects the brain’s reward system and its neurochemical balance and drugs have an effect on the central nervous system where the brain is the key organ.
“A brain that’s never been hooked on drugs … contains neurotransmitters that operate well to help people feel balanced and feel well in their moods, able to think and reason clearly, exhibit good judgment in decision-making and good concentration and focus for completing tasks,” Miller said. “The brain that has been exposed to drugs over time is noticeably different than one that has not been.”
Those changes in the brain can greatly affect someone’s mental health. Substance abuse and addiction increase the severity and duration of depressive episodes, despite any temporary relief they may provide, according to Addiction Center, an informational web guide for those who are struggling with substance use disorders and co-occurring mental health disorders.
Miller said the reward system and the neurotransmitters in “the synapses of the brain cells themself can be affected by drug use,” meaning substance use can cause many effects on learning, concentration, memory and other functions on the brain.
“When using drugs … there are a few neurotransmitters that flood the receptor sites in the brain – for dopamine especially,” Miller said. Dopamine helps control the brain’s reward and pleasure centers. “When there’s a huge flood of dopamine at the neurotransmitter level, the person experiences a feeling that they say feels like ecstasy, pure heaven, equivalent to 10 orgasms at one time — that’s what they say — a feeling of peaceful calm like they have never felt before.”
After someone uses drugs routinely, Miller said the “brain neurotransmitter factory begins to go on strike” and stops producing those neurochemicals on its own, and people need more drugs to satisfy their brain and body’s needs. That need for the chemicals starts the cycle of addiction.
“Assuming that we’ve gotten to a place, and I hope we have, … where we can talk about addiction as a disease, when somebody is in the grips of disease it infects everything that’s going on in their mind,” Skinner said.
Drug abuse can increase a person’s likelihood of dealing with difficult mental health situations such as depression, anxiety, hallucinations and other problems, according to the National Institute on Drug Abuse, and while mental illness and addiction are two different things, they often coexist for myriad reasons.
“The relationship between mental health and addiction, and maybe opioid addiction in particular, tends to transcend class, transcends race, transcends gender,” Skinner said. “But all of the issues with race, gender and class tend to compound both of them.”
Breaking the perception
Experts agree that mental health and addiction can often stem from someone dealing with some sort of trauma. The Athens-Hocking-Vinton Alcohol, Drug Addiction and Mental Health Services Board, also known as the 317 Board, creates a Network of Care for people who may need mental health, addiction and community services.
In Athens County, Ohio, there were 45 overdose deaths from 2011 to 2015, according to a tool from NORC at the University of Chicago and the Appalachian Regional Commission. Those who reside in Appalachia are 55 percent more likely to die from a drug overdose than the rest of the country. NORC is a nonpartisan research institution that delivers data and analysis to guide programmatic, business and policy decisions, according to its website.
“Many individuals with mental illness have suffered some trauma in their lives and they turn to drugs for relief or masking of their mental illness,” 317 Board deputy director Bill Dunlap said. “We see significant trauma impacts in the lives of those who are addicted to opiates.”
Miller agreed, saying many, if not all, of the people she sees for substance use disorders at the Prestera Center also experienced something traumatic in the past,and the drug use helps them cope with that experience. People who struggle with mental health and addiction cannot “just suck it up.”
“Mental health is still seen as, ‘Oh come on just pull yourself together,’ “ Skinner said. “You know, ‘Toughen up.’ Mental health was seen as a sign of weakness in our society for a long time. … Similarly (with) addiction, … we hope that we’re moving from a place where addiction is seen as a moral failing or weakness to a disease.”
In that respect, mental health and addiction have followed similar paths. Both are stigmatized in society and that makes it difficult for people to reach out to get help if they need it.
“Just as the problem is not one-size-fits all, the solutions are not one-size-fits all either,” Miller said. “After a person decides to get help, they need a menu of options and should be given the choice of what they would like to try to see what will work best for them.”
It can be difficult for those struggling to get help they need, Skinner said, and he hopes people will develop empathy for those struggling with addiction and mental health.
“If all we do is point out how bad it is, they will walk away and not return, feeling misunderstood, ”Miller said. “With substance use disorder and/or depression, when we let someone walk away from treatment, or if we push them away unknowingly, the result could be fatal.”