Recent research has shown that dependency on opioids can be directly associated with mental health disorders. Out of an estimated 38.6 million Americans with mental health disorders, 18.7 percent use prescription opioids according to research from the University of Michigan and the Geisel School of Medicine at Dartmouth.
The study, Prescription Opioid Use among Adults with Mental Health Disorders in the United States, also reported 16 percent of Americans who have mental disorders receive over half of all opioids prescribed in the United States.
“It’s clear cut; it’s a direct correlation [between opioid dependency and mental illness],” said local therapist Dana Frasier. “As you could imagine, if you’re going through mental health issues, some people self-medicate.”
“What comes first the egg or the chicken, I don’t know” Frazier said when it comes to mental health illness and opioid misuse.
About 20 percent of individuals suffering from an anxiety or mood disorder also battle a substance use according to the Anxiety and Depression Association of America.
“We’ve certainly seen an increase in people seeking help for misuse of prescription medications that used to not be quite as big a deal,” said Executive Director and Therapist of Fraser Counseling Center in Hinesville, Teresa Winn.
“We’ve seen two bumps in it, 2004 or 2005 we saw an increase demand in opioid misuse,” said Winn. “Certainly in that last three years or so another kind of awareness of a problem [with opioid misuse] in this area.”
An estimated 2.1 million Americans used prescription drugs non-medically for the first time within the past year according to the 2014 National Survey on Drug use and Health.
“As you can imagine a lot of people very appropriately start using opioids to treat real pain for an actual injury or chronic pain,” Winn said. “And we know that there is a high increase of depression when you have a life changing event that might be causing that pain.”
According to World Health Organization, there are more than 300 million people globally who suffer from depression.
In the United States from 2013-2016, an estimated 8.1 percent of Americans age 20 and older had depression in any given two week period according to the CDC.
In Georgia, the Substance Abuse and Mental Health Services Administration reported only 38.9 percent of adults 18 or older with any mental illness received mental health treatment between 2009 and 2013.
“There is definitely an overlap between depression and opioid misuse that we’ve seen that in some ways it’s hard to see which one came first,” Winn said. “I would say depression is one of the biggest issues I’ve seen in combination with opioid dependency or misuse, certainly you can have any other mental health issue, but that’s the one we’ve seen the most research on and the most overlap here too.”
At Fort Stewart, about 2 percent of all visits to the installation’s Substance Use Disorder Clinical Care (SUDCC) are related to opioids according to Clinical Director Keith E. Wheeler.
“We’ve not seen an issue with opiates to the level the local community has which we’re very fortunate for that,” said Chief of the Department of Behavioral Health at Winn Army Community Hospital, Major Carla Schnitzlein.
They attribute that low number to their SUDCC program, prevention, and other alternative measures to keep opioid related visits down.
“It’s a two armed program, there’s what Mr. Wheeler does in terms of the clinical care and there’s the ASAP which is the Army’s Substance Abuse Program which is out at the unit level with prevention officers,” said Schnitzlein. “They go out educate commanders and educate soldiers about alcohol, illicit drug use, safe prescription use which would include don’t share with you peers.”
“I brag on them a lot because they’re very quick to get people who are struggling with any sort of issue in and do a very thorough assessment to include for medical needs with either a medical or psychiatrist as myself,” said Schnitzlein.
Fort Stewart has also initiated some training for battle field acupuncture as an alternative measure, rather than going right to prescriptions.
“We know that whether it’s in the civilian community or other communities like the military we see behavioral health diagnosis run comorbid (simultaneously) with addictions and dependency issues,” Schnitzlein said
At the Recovery Place, Chief Operating Officer and Executive Clinical Director Diane Diver says they’ve seen not only an increase in opioid use but also an increase in opioid and methamphetamine use.
“I think that substance abuse is correlated with mental disorders,” Diver said. “We see an increase in opiate usage with people who have had prescriptions for pain, and then it can lead to a substance abuse disorder, and then lead to a mental health disorder. People use for two reasons, one to feel nothing, and two to feel better,”
Along with Frasier and Winn, Diver agrees that it is hard to determine which comes first between mental illness and opioid misuse.
“Old school substance treatment would say to treat the addiction stuff first, to deal with that before you can address any other issues,” Winn said. “We have certainly grown as a profession from that thought process and realized that that causes a lot of suffering and that we are much more successful when we treat them together.”
“I think it [mental health] is a part of what’s going and if we ignore it we’re not going to be successful in treating individuals or the epidemic as a whole,” said Winn.