Important note: This article addresses suicide. If you or a loved one is struggling, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). A disproportionately large number of U.S. residents have committed suicide while using an opioid. By definition, we are witnessing an epidemic. Dual diagnosis treatment centers are seeing an increase in patients as they themselves effort to understand the connection between suicide and opioid addiction. The Centers for Disease Control (CDC) released alarming numbers during the spring of 2018. Their study determined almost 45,000 Americans committed suicide in 2016 alone and discovered an increase of suicide every year since 1999. The U.S. Surgeon General has advised more Americans use opioids than smoke cigarettes. Considering the U.S. purchases 80% of the world’s opioid medications and prescriptions have increased 300 percent in a nine-year time frame, this makes sense. Together, it appears opioids and an increasing suicide rate may indeed be linked. Continued after infographic:
An Increasing Suicide Rate
The relationship between suicide and substance abuse is a complicated one. While suicide is closely correlated with depression, use of either legal or illicit drugs increases the risk substantially. A 2013 study by the CDC revealed which types of substances were found in those who committed suicide. The leading six substances were:
Alcohol – 38.2%
Antidepressants – 35.3%
Benzodiazepines – 31.3%
Opiates – 26.8%
Marijuana – 16.6%
Anticonvulsants – 11.9%
Use of drugs or alcohol is one of the most common risk factors for suicide. However, substance use is only one half of the equation. In isolation, it would easy to pin a large portion of suicides strictly on substance abuse. But unfortunately, nothing could be further from the truth. In most suicides, substance abuse is the cause or the result of one or more contributing conditions. The CDC completed a study reviewing the mental reports of both medical examiners and law enforcement officials from 27 states in 2015. They acknowledged there may have been other circumstances involved in any single suicide report, but the result sheds light on the types of problems individuals may have been facing prior to their passing:
42% reported relationship problems
29% faced a crisis in the past or upcoming two weeks
22% had physical health problems
16% were confronting job or financial related issues
9% tackled criminal legal problems
4% lost their housing
The study showed that just over one-quarter (28%) of suicides had reported known problematic substance abuse. Understanding the relationship between the CDC’s statistics of the substances found in the bloodstream with the contributing factors is important. The connection underscores the role substance abuse plays in scenarios where the abuse was not a determining factor in the suicide.
The Exploding Use of Opioids
During the late-1990s, prescription opioid pain relievers were introduced to the general public in mass. It was promised these drugs would not be addictive or habit forming. The pharmaceutical companies were wrong. The rate of opioid overdose has risen ever since opioids arrived at the corner pharmacy. In 2015, the CDC reported 33,000 deaths directly resulting from an opioid overdose. This includes prescription opioids such as fentanyl, hydrocodone, and methadone, illegally manufactured synthetics, and heroin. Almost 225 million opioid prescriptions were written in 2015. The CDC study from the same year found approximately 2 million Americans were suffering from prescription opioid substance abuse disorders. The statistics of opioid misuse are staggering:
21% - 29% of prescriptions for chronic pain are misused
8% - 12% of prescribed opioid patients develop an opioid use disorder
4% - 6% of those who misuse opioid prescriptions move onto heroin
Although the sheer number of annual opioid prescriptions has begun to decline, their misuse continues to increase. And as the number of prescriptions decreased, we may begin to see increased heroin and illicit opioid use in the coming years. Consider the following growth in opioid overdoses:
54% increase in large cities in 16 states
70% increase in the Midwest 2016 to 2017
30% increase in 52 surveyed regions in the U.S.
We are in the midst of a public health crisis. The consequences of which are being felt by individuals, families, employers, and entire communities. Finding the link between suicide and opioid addiction will go a long way toward solving this immense problem.
Connecting Suicide and Opioid Addiction
Overdoses, caused by any substance, can often be difficult to evaluate. Was the overdose accidental or were the drugs consumed with a purpose – suicide? What we do know are the increases in suicide risk associated with an opioid misuse. For men, the suicide risk nearly doubles if they were known to have an opioid use disorder. For women, there has been found to be an eightfold increase in the risk of suicide. Yet in most cases, the final factor causing an overdose is never known. Opioid addiction is extremely powerful. The fact that 80% of first-time heroin users were misusing prescription opioids first supports this claim. And regardless of how many of the 115 daily opioid overdoses are attributed to suicide, any number larger than zero is too many. The likelihood of suicidal thoughts can increase upwards of 60% when while taking an opioid. There are studies indicating death by suicide is 13 times more likely in opioid and injection drug users. More evidence that combating opioid addiction’s role in the nation’s suicide crisis cannot be overlooked
The Role of Dual Diagnosis Treatment Centers
Admittance into rehabilitation centers increased 400% in the decade prior to 2010. As more research is conducted and more is learned about the relationship between suicide and substance abuse, the greater positive impact dual diagnosis treatment centers will have on their patients. Dual diagnosis takes a coordinated approach to mental health disorders and substance abuse. By using a multidisciplinary team of clinicians, patients with co-occurring disorders are much more likely to find long-term success after receiving treatment. Traditional treatment centers are becoming much better at identifying individuals who are suffering from two or more conditions. And if dual diagnosis treatment isn’t available, such facilities are fortunately opening on a regular basis. After completing programs offered at dual diagnosis treatment centers, individuals will effectively be able to manage both disorders. If you suspect someone you care about may be struggling with suicide and opioid addiction, let them know not only their friends and family are there for them, but specially trained experts. The community supporting those breaking opioid addiction is growing and help is no further than a phone call away.
Children and teenagers who have been treated for a mental disorder are more likely to abuse drugs, according to researchers at the National Institutes of Health (NIH). They discovered that mental illness among young people can cause them to seek out the medicinal effects of narcotics at a higher rate than those that have not had a mental illness. This information is intended to be a warning to parents. Knowing that your child is suffering, or has suffered, from a mental illness means parents should be especially watchful of potential substance abuse issues. Researchers of the study gathered information from more than 10,000 teens. They found that there was a significant relationship between mental illness and drug and alcohol dependence and noted that prior to first alcohol or drug use, mental illness was already present and documented. According to the study that appears in the Journal of the American Academy of Child and Adolescent Psychiatry, two thirds of teenagers with substance abuse problems also had some form of mental disorder. “Recognizing anxiety, depression, and other mental disorders – and even the symptoms of these conditions – in youth and helping children to cope, treating them when necessary, is the best approach because then they will be less likely to seek drugs and alcohol to treat the symptoms of these conditions,” explained study author Kathleen R. Merikangas, PhD. This is further evidence to support the need for treating co-occurring disorders as well as incorporating more drug abuse prevention measures for young people dealing with other issues.
Those who struggle with an alcohol addiction and also suffer from post-traumatic stress disorder (PTSD) have often struggled to tackle either of their issues, let alone both of them at the same time. The duality of these two problems can make treating them very challenging. Researches have been looking into possible solutions to these problems and the growing population of people who are addicted to alcohol and have PTSD. Research like the kind that is being conducted at the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina is vital for the long term physical and mental health of those that struggle with an alcohol use disorder and post-traumatic stress. A combination of cognitive behavioral therapy (CBT) aimed at treating substance abuse and exposure therapy aimed at treating PTSD seems to be the most effective approach. Attacking the problems individually allows for each issue to receive adequate treatment. Concurrent Treatment of Substance Use Disorders Using Prolonged Exposure (COPE) is the name researchers have given this two-pronged attack to the problems. The research shows that after several months of administering this type of therapy to individuals, many experienced significant gains in mental health. There are other types of treatment that have shown positive results as well. Some researchers have made headway when administering certain kinds of blood pressure medication in conjunction with therapy. A specific study showed that those that received clonidine had longer time between relapses and stayed sober for longer and reported less stress. While these studies are still in the early stages, it does appear that treating both problems at once is possible. In the past, many people were concerned about those who suffered from co-occurring disorders. Figuring out which problem to treat first proved to be difficult. Treating the addiction first oftentimes got the person out of immediate danger and allowed them to better focus on their therapy. However, some people argued that treating the mental disorder first allows for better and longer lasting treatment of the addiction. More information seems to indicate that both issues should be addressed concurrently for the best results, though the types of therapies used can vary widely.
A recent article from the American Psychiatric Association (APA) urges better cooperation between states and Veterans Affairs (VA) health centers regarding prescription drug monitoring among Veterans, especially for opioids and benzodiazepines. It cites the necessity to ensure quality treatment and alleviation of pain while being more aware of addiction problems for the purpose of prevention and rehabilitation.
Last Fall, a statement was provided to the House Veterans Affairs’ Subcommittee on Health hearing, “Between Peril and Promise: Facing the Dangers of VA’s Skyrocketing Use of Prescription Painkiller’s to Treat Veterans" by APA CEO and Medical Director Saul Levin, M.D., M.P.A. Dr. Levin recommended more specialty training for physicians within the VA system for the diagnosis and treatment of co-occurring disorders as well as opioid addiction.
The APA produced a series of webinars focused on the use of treatments for opioid dependence and on the safe use of opioids in the treatment of chronic pain. The free webinars were available for psychiatrists, physicians of other specialties, other prescribers, residents, and other interested clinicians. Example webinar topics included:
- The Use of Buprenorphine to Treat Co-occurring Pain and Opioid Dependence in a Primary Care Setting
- Learning the Evidence Behind Alternative/Complementary Chronic Pain Management – Emphasis on Chronic Low Back Pain
- Patterns of Opioid Use, Misuse, and Abuse in the Military, VA, and US Population
- Enhancing Access to PDMPs [Prescription Drug Monitoring Programs] Through Health Information Technology
- Identifying and Intervening With Problematic Medication Use Behaviors
- Assessing and Screening for Addiction in Chronic Pain Patients
- Psychological Management and Pharmacotherapy of Patients with Chronic Pain and Depression, Schizophrenia, and Post Traumatic Stress Disorder (PTSD)
The number of Veterans dealing with anxiety, PTSD, depression or any other disorder in conjunction with substance abuse is higher than ever. A large portion of the addiction problems are connected to prescription drugs, especially for those who are also combating chronic pain symptoms. A greater awareness and higher level of education and training on how to deal with the multi-layered problems will help to ensure better outcomes for the health of our Veterans.
In the broader addiction treatment community, there has been some discussion in the past about whether addiction or mental health issues should be treated first, while others feel that they can be treated at the same time in a co-occurring or dual-diagnosis setting. At Desert Cove Recovery, we feel that it is essential to address the multiple issues and challenges toward living a rewarding life that come with substance abuse and other disorders. In fact, it can be the critical difference between repeated relapses or lasting sobriety.
Rather than arguing the chicken-or-the-egg theory, time and efforts are better spent finding solutions to the problems individuals face in life, and studies have suggested that one disorder can exacerbate another. With multiple program and therapy tools available, experienced clinicians and other treatment professionals work together with the patients to improve the symptoms of each disorder, which can continue to get better over time through involvement in support groups.
For example, in the upcoming issue of the journal Alcoholism: Clinical & Experimental Research, study authors from the Department of Veterans Affairs and Massachusetts General Hospital found that dual-diagnosis patients responded well to active ongoing participation in 12 step meetings. Other research has demonstrated that simultaneous treatment of co-occurring disorders improves substance abuse rates as well, rather than treating one diagnosis at a time.
With the new year upon us, there isn't a better time than now to start on the road to recovery with successful treatment. Whether you are seeking help for yourself or a loved one, contact Desert Cove Recovery today to find out more about our mental health and addiction treatment program.
According to the latest National Survey on Drug Use and Health (NSDUH), the percentage of drug and alcohol rehab centers that also treatment mental health issues increased from 29 percent to 32 percent during the last four years. The trend appears to continue the growth in that direction.
Critics say that people are being over-diagnosed with mental disorders and then overly medicated. Whether or not there is any truth to that, the usefulness of identifying symptoms and finding effective treatments for them still remains. In the case of co-occurring substance abuse and other mental health issues, there are many different ways to address these and can usually be developed on an individual basis.
The tools available for treating behavioral health conditions are vast, and finding the right recovery center with experienced professionals can be essential. Desert Cove Recovery has a clinical team that will customize a dual-diagnosis treatment program for each individual.
These individualized treatment plans may include any combination of a number of approaches such as group counseling, private therapy sessions, cognitive behavioral therapy, appropriate medications, social skills training, relapse prevention and more.
Contact us today for more information about how we successfully treat co-occurring substance abuse and mental health disorders.