USA: Tidal Wave of Substance Use and Mental Health Disorders Coming
Communities in the United States are facing the formation of a perfect storm of factors driving alcohol and other drug use disorders to higher rates than ever seen before – the so called “triple trouble” of a pandemic, unemployment, and diminished personal and community support services for people affected by substance use problems. Mental health experts are anticipating a steep rise in alcohol harm, opioid abuse, suicides, domestic violence and depression that could rival the toll from COVID-19 itself. All this is by political design, as law makers favor Big Alcohol’s profits over communities’ health services.
Experience shows that the mental health impact of disasters usually materializes with a slight delay. Nevertheless, studies illustrate that once the imperative to survive the immediate crisis passes and people begin to grapple with what they have just experienced and what their future will hold, their resilience is challenged. Often, the mental health impact begins to show up in a rise in suicides, alcohol- and other drug-related incidences and new cases of mental ill-health.
Alcohol and COVID-19, a dangerous mix
Research shows a robust correlation between unemployment or precarious household finances plus rising death rates among the working age population, especially men. The numbers are particularly dramatic in white, high school–educated, middle-aged men and women from rural parts of United States, where financial insecurity due to unemployment is pervasive. They, and their children, often have only weak hopes for a better future. They lack health insurance or other government support, and intoxicants like opioids and alcohol are readily available as easy, but harmful tools for coping.
The coronavirus crisis is projected to leave well over 30 million people in the United States out of work and many more without health insurance or other safety-net protections. This is further compounded by the fact that substance use generally rises following major traumatic events. People who were already struggling with alcohol and other substance use disorders are even more vulnerable after crises.
Substance use disorder treatment services in peril
The situation is further exacerbated now, as treatment services are in peril. Millions of people in the U.S. are receiving help and support from government-funded mental health clinics. Often these are the most vulnerable, marginalized and poor people of society. These facilities have been under-funded for years and are now on the brink of failure, due to the impact of COVID-19.
Casualties from the mental health problems are expected to rival the pandemic itself. Deaths from drug overdoses and suicide totaled about 110,000 a year before the novel coronavirus ravaged communities across the U.S. Experts warn that each 5% increase in unemployment leads to about 3,000 additional suicides and 4,800 overdose deaths. Thus, a 20% unemployment rate would cause an additional 20,000 deaths.
We’ve never seen a moment where the demand for mental health care will be as great as it’s going to be in the next few months and next couple of years,” says Tom Insel, director of the National Institute of Mental Health (NIMH), as per Newsweek.
If you add the spike in suicides and drug overdoses we are likely to see to those we were already expecting, the psychological toll from deaths of despair in the months ahead could very likely surpass the final mortality numbers for COVID.”
As of June 24, the U.S. had a COVID-19 death toll of more than 121,000 people – the highest number of deaths in the world. In the wake of the coronavirus pandemic, communities are already heavily burdened by rising deaths of despair.
In June 2019, Movendi International reported that young adults from the millennial generation were more likely to die from alcohol, other drugs and suicide or “deaths of despair“ – over the past decade. America’s Health and Well Being Trust reported that among 18 to 34 year olds,
- Drug-related deaths soared 108% between 2007 and 2017,
- Alcohol deaths were up 69%, and
- Suicides increased 35%.
The increases for these three “deaths of despair” combined were higher for millennials than for Baby Boomers and senior citizens.
Lack of help and absence of health services
The situation is further aggravated by the increasing lack of both help for people struggling with alcohol problems as well as the absence of health services.
Because of self-isolation and physical distancing requirements many vulnerable people are finding themselves deprived of family, friends and other people in their lives who provide support, which is essential to resilience. With people self-isolating at home, interactions with family and friends disappear and so does the chance to notice substance use problems. Without having to go to the workplace, people are less exposed to the consequences of their alcohol use problems. And without consequences, it is harder to see that there’s need for help.
Furthermore, access to affordable healthcare is increasingly difficult or even impossible to get. Services are therefore insufficient to restore the health of people struggling with alcohol and other drug problems, and, in the severest cases, to keep them alive. First reports show that patients have inundated crisis services lines. The National Council for Behavioral Health, the biggest association of mental health and community substance abuse clinics in the U.S., surveyed its members and found more than 90% had cut back on some programs, and 30% were turning people away.
Other functions of society also provide no or inadequate help during the current crisis. As many courts are closed, as the police is focusing on country-wide protests in reaction to police-killings of unarmed black people, a side effect is that referrals to alcohol and other drug addiction treatment programs are declining.
Not even peer support groups are able to conduct meetings and support. Thus many people struggling with alcohol and other drugs fail in their attempts to find treatment.
For example The Daily Yonder reports, about 91,000 of West Virginia’s 1.9 million residents reported a substance use problem in 2019, but only 18,115 of them said they had received any treatment, according to the U.S. Substance Abuse and Mental Health Services Administration.
The special vulnerability of rural areas and communities
People with substance use problems in rural areas are already under-served by mental health and behavioral health professionals. For them getting access to treatment is even more difficult as clinics close, practitioners move to telehealth, and funding for services runs out. Especially in rural areas of the U.S. resources for behavioral health services are stretched thin during the public health crisis since states are using all available resources in the fight against the spread of COVID-19. Behavioral health providers were scarce in rural areas to begin with. But now the need for their services is rising while access to providers is declining.
The vulnerability of rural communities is systemic. Most rural residents who do receive mental health services get it from their primary care provider. But in rural regions of the United States, the mental health care workforce is scarce and the scarcity is made worse by the coronavirus.
Primary care providers are on the front lines of mental health care in rural communities. Unfortunately, they are also on the front lines of Covid-19 and every other issue that’s happening in rural communities right now too. It’s putting an enormous burden on them,” said Carrie Henning-Smith, Ph.D., a researcher on rural issues with the University of Minnesota School of Public Health, as per The Daily Yonder.
It’s in rural communities where deaths of despair hit hardest.
It would be disingenuous to talk about mental and behavioral help in the time of Covid-19 without centering it on rural populations,” said Ms Henning-Smith in an interview with The Daily Yonder.
All of the things that are making COVID-19 particularly volatile for mental health – things like economic stress, anxiety, grief over losing loved ones, concerns for your own house – all of those I would argue are heightened in rural areas where they were already more economically vulnerable, where the population is older and you have more underlying health conditions. It could only make mental health issues worse.”
Disasters, self-medication and alcohol harm
Analysis of other disasters underlines the predictions that a tidal wave of substance use disorders might be forming in the current crisis, reports MedScape. For instance, a study analyzing 547 people exposed to multiple disasters, including floods, tornadoes, dioxin contamination, and/or radioactive well water, found most common was alcohol use disorder, which typically predated the disaster, just as much substance abuse predates the COVID-19 crisis in already vulnerable communities.
Evidence shows that the highly prevalent psychological distress caused by disasters leads people to turn to alcohol and other drugs as “coping tools”, with the effect being even stronger in already vulnerable communities.
- Many survivors of 2008’s Hurricane Ike were found to turn to alcohol.
- After Hurricane Katrina, substance use disorders in New Orleans soared and alcohol and other drug use was associated with a greater risk for post-traumatic stress disorder.
- The events of 9/11 led to an increase in binge alcohol use and substance abuse in those affected by the tragedy.
Even if the mental health system had the capacity to treat everyone, research and experience show that 50 to 60% of those who need help for their substance use problems fall through the cracks. Already in normal times most people don’t seek care for a variety if reasons, instead turning to self-medication with alcohol and other drugs.
Addiction experts say there are three factors leading to increased substance use:
- Excess of money, and
Lockdowns, unemployment, and economic stimulus money may combine to create a perfect storm of influences on a persons alcohol and other drug use. And the effects are likely to be massive: people in recovery from a substance use disorder may slide back into addiction; people on the brink of developing severe substance use problems might fall into addiction; even those people not using alcohol or other drugs before the crisis may be turning to harmful substances to cope; even children and youth might start using alcohol earlier, increasing their risks to suffer from alcohol harm.
Leading experts think there is a growing tidal wave of substance abuse coming but it won’t be apparent for several months.
I definitely feel like it’s heating up,” said Erica Hanner, a substance abuse treatment specialist with LifeSkills Community HealthServices in Bowling Green, Ky, as per The Daily Yonder.
The [substance abuse] epidemic has been there and I think that it’s increasing. This [COVID-19] is only fostering a growing epidemic,” according to Ms Hanner.
Isolation, distress, suicide and alcohol
The mental health impact of economic downturns is usually lagging behind the actual crisis before it begins to show in the statistics. For example, the 2003 SARS epidemic was followed by a 30% increase in suicide deaths among those 65 and older in Hong Kong, reports Newsweek. Half the population remained anxious in the months that followed. Once the coronavirus crisis passes, there will be the crisis of isolation and emotional distress, exacerbated by alcohol and often leading to suicide.
In recent years, psychologists have established strong evidence that loneliness is linked to higher levels of anxiety, depression, as well as alcohol and other drug problems. For example, lonely people feel more pain, which causes public health officials to be concerned about another spike in substance abuse. Lonely people are also more likely to get physically sick.
Suicides were already rising when the pandemic hit, according to Newsweek reporting. The U.S. has seen a 33% increase since the year 2000, according to an analysis released in 2019 by the Centers for Disease Control and Prevention, which placed the rate at 14 deaths by suicide for every 100,000 Americans—the highest age-adjusted suicide rate recorded in the U.S. since 1942.
“Deaths of despair” from COVID-19 are predicted to be rising sharply, according to the Robert Graham Center, a think tank associated with the American Academy of Family Physicians and the nonprofit Well Being Trust. The tidal wave might comprise tens of thousands of additional deaths from suicide, alcohol and drug overdoses, depending on the extent of the economic dislocations and action taken to help those who are struggling.
Estimations range from an additional 27,644 deaths if there is a quick recovery, with the smallest impact on unemployment. In a worst case scenario, predictions amount to 154,037 of additional Americans who will die from suicide, drug overdoses and alcohol-related causes.
Harms to others from alcohol and other drugs
To make matters even worse, harm from alcohol and other drugs is not limited to users themselves only. Already, data on domestic violence and child abuse cases indicate rising problems. For thousands of people in the U.S. staying home isn’t safe. Several cities around the country are already reporting significant increases in calls to domestic violence hotlines. These issues are often linked to alcohol.
For instance, the NYC Administration for Children’s Service reported new data showing that alcohol and other drugs were playing a larger role in reports of abuse. In fact, one in four child abuse reports are linked to alcohol or other drugs – a big increase compared to the same period last year.
That is a concern. We have seen an increase in the proportion of reports, recently, that relate to drug and alcohol use,” said David Hansell, Commissioner of the Administration for Children’s Services, as per NBC New York.
In times of stress we often see an increase in drug and alcohol abuse and we want to be absolutely sure that does not result in increased risks to young people.”
Calls to a government disaster distress helpline were up tenfold in April compared to the previous year. In Los Angeles a suicide and help hotline handled 8,000% more calls than usual in February and March. Domestic violence hotlines are also seeing increased activity: More than 5,000 people have reportedly called the National Domestic Violence Hotline since mid-March, specifically referring to COVID-19 as the catalyst for their problems.
Mental health experts are now bracing for a “mental health tsunami.” Communities are anticipating a steep rise in the diseases of isolation – suicides, alcohol, opioid abuse, domestic violence and depression.
Lack of action to protect people, but not to promote Big Alcohol profits
So far, there has been little action where it is needed most: providing funding to address the mental health challenges brought on by the pandemic. Of the $3 trillion passed for economic stimulus and relief, only a tiny part has been allocated for mental health.
The federal Medicaid program funds behavioral health clinics to low-income Americans with the most severe conditions, such as schizophrenia, psychosis, depression, OCD and other disorders – usually the last stop before the streets or prison. When COVID-19 hit, federal officials at the U.S. Centers for Medicare & Medicaid Services moved with uncharacteristic speed to revise its regulations and allow reimbursement for telehealth appointments, which some mental health advocates have been urging for years. But the poorest patients don’t have laptops or access to broadband internet; many are homeless.
The initial relief bill passed by Congress included about $425 million in additional federal funds to help HHS boost suicide prevention efforts and treat patients with serious mental illnesses and substance use disorders through certified community behavioral health centers. To keep operating, mental health advocates claim they need $38 billion – about 90 times that amount.
While there is little political leadership and action to stem the coming tide of substance use problems, the Trump administration, the U.S. Congress as well as state governments have acted to quickly to support Big Alcohol.
The novel coronavirus public health crisis is leading to quick changes to state alcohol laws across the United States. The alcohol industry has been swift and aggressive in pushing for the weakening of alcohol laws. This comes at a moment when COVID-19 and the alcohol harm epidemic are brewing a perfect storm of violence, injury and trauma, fueled by soaring online alcohol sales during the country’s lockdown, and exerting a heavy toll on the emergency care system that is already on the brink. Nevertheless, lawmakers and governors are weakening alcohol laws, protecting the interests of Big Alcohol.
For instance, the government of California has reported that on-demand delivery apps are driving a surge in alcohol deliveries to minors during COVID-19. A new investigation by the Alcoholic Beverage Control (ABC) department of the state of California found that on-demand alcohol delivery apps harm youth by delivering alcohol to minors. The problem appears to be growing and is a serious concern due to the dangers associated with under-age alcohol consumption.
Food and beverage delivery services such as DoorDash, Postmates, and Uber Eats deliver alcohol and according to ABC findings these and other delivery apps are failing to protect minors. Things have gotten worse due to weakened rules around alcohol takeout and delivery during the coronavirus crisis.
Increasing alcohol availability and affordability have already materialized in increasing alcohol problems. Stay-at-home orders during the coronavirus pandemic have led to more adults consuming alcohol and other drugs as a way to cope with stress, according to a recent study.
More than 28% of adults said they have used alcohol or other drugs to try to cope with the current crisis, shows a new University of Michigan study. Researchers tracked behaviors a week after the World Health Organization (WHO) announced the pandemic in mid-March.
There is a way for political leaders to mobilize resources in order to invest in support for people affected by substance use disorders: alcohol taxation. However, alcohol taxation is at an historic low in the United States, according to a recent study. This is by design, as political leaders have deliberately avoided adjusting alcohol taxation to the rate of inflation and raising alcohol taxes progressively to pay for the costs of alcohol harm.
Inflation has reduced American alcohol tax rates by 70% since 1933, according to a new studyfrom Boston University School of Public Health (BUSPH) published in the Journal of Studies on Alcohol and Drugs. The trend is further compounded by the decision of the Trump administration to cut taxes further for major alcohol producers.
This has led to the alcohol industry seeing gains, not losses – despite the lockdown and closure of the on-trade sector. In fact, Nielsen figures show sales of beer, wine, and liquor increased as much as 53%. The alcohol industry is benefitting from the public health crisis due to the deregulation and weakening of alcohol laws and their aggressive activities to promote alcohol use during the pandemic. At the same time, mental health services and support for people affected by substance use problems are on the brink of collapse – amidst a public health crisis and as experts and communities sound the alarm of another tidal wave of substance use and other mental health problems coming.
For further reading:
USA: Adults Turn to Alcohol to Cope With COVID-19
People’s Alcohol Issues Become More Problematic During COVID-19
People’s Alcohol Issues Become More Problematic During COVID-19
California, USA: On-Demand Alcohol Delivery Apps Harm Youth
“What Past Disasters Tell Us About COVID-19 and Substance Abuse,” by Lloyd I. Sederer, MD, in: MedScape
“Covid-19 Epidemic Severely Undermines Access to Substance Abuse Help in Rural America,” by Liz Carey, in: The Daily Yonder
“Alcohol Use Contributing to NYC Child Abuse,” in: NBC New York
“Diseases of Isolation,” by Adam Piore, in: Newsweek