Starting Conversations about Mental Health

 

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May marks Mental Health Month, a time dedicated to raising awareness and reducing stigma. To start our month-long conversation about mental health, we started asking some questions:

Who is affected by mental health disorders?

Millions of people in the United States alone deal with mental health disorders. Yet less than half receive help. Chances are you know someone with a mental illness or someone who is affected by a person struggling with a mental illness.

According to recent studies, adults between the ages of 18 to 25 make up the highest percentage of people struggling with mental illness, but compared to other age groups, they also report the lowest rates of seeking treatment.

Why don’t more people seek treatment for mental health?

One of the main hurdles preventing people from seeking necessary treatment is the stigma surrounding mental health. Many people feel their mental health is not as important as their physical health or feel ashamed or embarrassed to admit they have a mental problem. As a result, some ignore their mental health concerns while others try to treat their symptoms by themselves.

What are some signs of a mental health disorder?

The signs of each mental health disorder are unique to that disorder, but here are a few to look out for:

  • Extreme changes in mood and behavior
  • Changes in work or school performance
  • Suicidal thoughts
  • Prolonged feelings of anger or sadness
  • Withdrawal from friends and family
  • Struggles with carrying out day-to-day tasks

What are some examples of mental health disorders?

Depression and anxiety are the two most prevalent mental health disorders in the United States; however, many Americans also live with obsessive compulsive disorder, bipolar disorder, schizophrenia, and post-traumatic stress disorders, among others. The severity of mental health disorders also varies by individual.

Co-Occurring Substance Use Disorders

Nearly 80 percent of people with mental health disorders have substance use disorders. In an effort to cope with the symptoms from their mental health disorder, many people turn to drugs and alcohol. The most common substance people turn to for help is alcohol. However, alcohol and many other drugs can exacerbate symptoms.

How can we reduce stigma?

In the past few years, there has been a change in the conversation around mental health. Mental illnesses, such as bipolar disorder, have garnered more attention due to more celebrities, such as Mariah Carey, sharing their battles. If we continue asking questions and normalizing conversations about mental illness, then we can continue investing in and improving treatment for mental health.

“It’s All in Your Head”

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For centuries, addiction was viewed as a psychological problem, all just in someone’s head. To be “cured” someone simply needed to want to quit. Addiction is, in fact, in a person’s head, but not in the way many believed. It is in people’s heads because addiction alters the brain.

Addiction is a chronic disease that afflicts millions of people across the country and millions more around the globe. It does not discriminate against an individual’s socioeconomic status, gender, sexual orientation, race, etc. It affects people of all backgrounds across all generations. It collaterally affects the families and loved ones of those battling this disease.

Addiction is an extremely complex disease that is misunderstood by many people to this day. Though much progress has been made regarding the stigma around addiction, many still view addiction as a moral failing. Unlike many other diseases, there is a sense of blame that is placed on those that have addictions.  As a whole, society has demonized addiction and made it so that those who are battling the disease have a hard time speaking out and seeking out the necessary treatment for the fear of being ashamed and judged.

Addiction, however, is not a moral failing. It is, instead, a chronic disease that often requires medical and professional help. Much like other diseases, addiction can destroy relationships with loved ones, it can cause many health and financial problems. Even with all of the negative consequences, addiction is hard to break because there is no simple solution or cure.

While no one decides or chooses to have a substance use disorder, some are more genetically predisposed to addiction than others. Through various research regarding addiction, genetics have been found to play a role in the disease. Studies conducted on twins and adopted children show that about 40 to 60 percent of susceptibility to addiction is hereditary. While it is not clear why some people become addicted and others do not, there are some factors such as genetics and environment that increase a person’s susceptibility to having an addiction.

But what is clear is the use of alcohol and drugs alters the brain and makes it harder for those with substance use disorders to quit. The brain starts to rely on the substance. Though the initial decision to try a substance may be voluntary, after a while it becomes compulsive – people begin to lose the ability to say no.

After continued substance use, the part of the brain that controls judgment becomes impaired. Once the brain becomes impaired, the person struggles to have the control he or she needs to say no. Addictive substances flood the brain’s reward circuit with dopamine. Dopamine is a chemical messenger that signals pleasure. Once dopamine is released, the brain begins to associate the substance with that feeling of pleasure, the “high.” This leads to the individual wanting to use that substance over and over again to chase that same feeling.

However, the feeling of pleasure diminishes as the brain adjusts to the excess dopamine; as a result, more of the substance is required in order for the individual to experience the same amount of pleasure. This leads to individuals developing a tolerance, needing more to feel the pleasure they once experienced. In many cases, individuals begin to take more of the substance in order to achieve that high and it becomes more difficult to break the addiction. Long-term use of drugs and/or alcohol leads to sometimes permanent changes in the brain, depending on the frequency and amount the individual used. The repeated use of drugs and/or alcohol begins to affect functions in the brain like learning, judgment, decision-making, and memory.

In addition, this excess dopamine can also lessen the pleasure an individual feels when they begin to do other things that once brought them pleasure, such as spending time with friend or eating their favorite dessert.

After someone stops using, they face withdrawals. Withdrawal symptoms include anxiety, shaking, fatigue, among many more effects. The only way to get immediate relief from the symptoms is to use the substance. Wanting a release from these unpleasant symptoms and to temporarily experience the “high” once again, the individual oftentimes turns to the substance. The brain has already associated said substance with pleasure and learned that this is the way to feel good. The brain is wired to seek pleasure, and once it has associated a certain action with pleasure, it is begins to seek out the source of the pleasure.

Since addiction affects learning and memory, people may be in danger of relapsing after seeing a beer bottle, for instance if they have alcohol use disorder. Because of conditioned learning, they will begin to crave the alcohol and feel compulsion try to take over – even if they haven’t had alcohol in a long time. The hippocampus and amygdala are the two parts of the brain that store environmental cues and even when an individual no longer wants to continue seeking out the source of their pleasure, the brain still associates the source with pleasure – they develop cravings when they are around the substance.

Many individuals battling addiction feel that they have to go through this fight by themselves, and to carry that burden solely on their shoulders. It is not an easy topic to discuss, but it is one that needs to be addressed differently. Instead of blame, empathy and acceptance needs to be shown towards those who are struggling. The stigma of addiction puts blame solely on those who have it. While breaking the vicious cycle of addiction does indeed take a lot of willpower and inner strength, it is not as easy as an individual deciding to quit.

Much like many other diseases, addiction can be treated and managed. It is important to remember that relapses do occur, but it does not mean that the individual cannot successfully manage their addiction. Having specialized treatment programs and seeking out professional help is the best way to start towards a life of sobriety. Attempting to go “cold-turkey” without professional supervision can be dangerous. There are instances of death and other life-threatening occurrences. Which is why seeking out professional help is the safest and most reliable way to begin the journey to recovery.

Shame, Stigma, and Addiction

Individuals struggling with substance abuse may often feel a sense of shame or stigma and find that it is easier to lie and hide rather than seek treatment. However, more prevalent coverage of substance use disorder-related issues in media and depictions on television of individuals who are not only struggling with drugs and alcohol but also seeking treatment and sobriety, is helping reduce the shame and stigma associated with addiction.

THE FIX REPORTS:

With addiction, stigma can crush you. Stigma is what says your drug and alcohol use is a character flaw. It’s what says you’re a bad mother, it is what says you are a bad son, or a bad husband.

TheFix

It took me a while to get to rehab. I spent years bashing around, harming myself and the people around me before I finally went. I knew I had some serious issues with booze, drugs and sex that I could not get under control on my own, but still, at least people didn’t know I had those problems, and at the time that was all that mattered. It wasn’t like my parents, friends, employers, wives and lovers, knew I was a drunk, a freak and a loser. Sure, it might help if I went to rehab, but as ridiculous as it sounds to me now, the embarrassment of going, and the stigma attached to it, outweighed the fact that I actually might be able to get help. I was terrified of people finding out what my problems were. I had fallen victim to shame, that was perpetuated by stigma.

If you are suffering with an issue of addiction, stigma can crush you. Stigma is what says your drug and alcohol use is a character flaw. It’s what says you’re a bad mother, it is what says you are a bad son, or a bad husband. It is what says you are weak, that you are crazy, that you are a piece of crap. It is why you are afraid to tell your boss that you need some time off to go get help. It is why you would rather lie than tell someone that you are not doing okay. It was why I would rather steal than let people know I needed help.

That was ten years ago. Now, when I look around at the people I know who are struggling with similar issues, there seems to be much less stigma attached to addiction and getting help for one’s problems, at least when it comes to the younger people I know. I am a member of Generation X, my generation hid everything we could about our issues as a rule, but with the coming of Generation Y, otherwise known as millennials, things finally seem to be changing.

Mike Reis, CEO and Founder of DecisionPoint Wellness, had this to say to me about stigma and the younger generation over an email interview: “A big factor that prevents many people from getting the help they need is the stigma associated with being labeled an addict. This is especially true for older Americans who isolate and feel an overwhelming sense of shame. Surprisingly, millennials are leading the way to remove the social stigma. I’ve learned a lot from the millennials that have come through our intensive outpatient program at DecisionPoint in Johns Creek, Georgia. They are connecting to others in recovery through technology and social media. Millennials openly share their recovery stories and daily journey on the Internet too. Unlike previous generations that came into recovery through the anonymity of AA, millennials don’t feel the need to be shackled to those traditions. They are more focused being individuals, and building a community of support. It’s common to see them proudly posting their sober anniversary dates on Facebook. Millennials seem to understand that the way to maintain their sobriety long-term is to publicly share their personal stories as survivors, and bring truth to the spotlight while creating a community of support. In doing so, they help others realize that addiction is a disease, and it needs to be treated as such without shame.”

Many millennials just don’t care a whole lot about what anyone thinks. A good example of this is Kassia Kristoff, a 30-year-old woman who once went to rehab to get help with her heroin use. “Fortunately for me, I have never cared much if at all what ‘society’ thinks of me, and as a result, felt no shame going to rehab. My world by the end consisted of only other addicts, so the only shame might have been in throwing in the towel. What I do feel shame about is the fact that people in this country are judged so harshly for being addicts. As someone who now works in a rehab and works with addicts in my personal life as well, I have seen the devastation that addiction causes to all who suffer from it. Most addicts, when clean, are extremely loving, caring and productive people. They simply need to be taught how to live without using first. Rehab is very helpful in this regard, because it teaches addicts (a term I use for all who suffer from addiction to any substance, including alcohol) about their addiction, and ways to cope without the crutch of their substance. Rehab gives addicts an opportunity to temporarily thrive in a safe and compassionate controlled environment, and to allow their brains and bodies to ‘sober up.'”

According to Karen Wolownik Albert, LCSW, who is executive director of Gateway Foundation Alcohol & Drug Treatment, social and traditional media has a lot to do with this change. She said to me in an interview: “More prevalent coverage of substance use disorder-related issues in media and depictions on television of individuals who are not only struggling with drugs and alcohol but also seeking treatment and sobriety, is helping reduce the shame and stigma associated with addiction. Younger generations are more likely to openly discuss the topic and be more transparent with their families and friends about their desire to seek help, compared to previous generations that kept their struggles private due the negative stigma of being an ‘addict.'”

Of course, it isn’t easy to go to rehab, no matter what generation you are in. But the stigma is way harder to deal with when you are going to get help than it is once you come out on the other side. As an obvious example, I have gone from someone who was terrified about letting anyone know about my issues, to writing about them in forums such as this one. Someone else who has done that is Lindsey Hall, who writes for many websites about her experiences with her eating disorder, including her own.

She told me that “I do not feel stigma around my eating disorder. Not anymore, at least… but I also write about it publicly and have connected with hundreds of people who have been through what I experienced, and I think that has slowly worn away the fear of stigma. Also, we live in a world where opioid addiction and eating disorders are on the rise, so it’s more likely than ever that you have a loved one or you yourself have experienced addiction. Due to social media, people talk about their ‘issues’ more openly than ever and for an eating disorder, there are so many body positive Instagram accounts as well as recovery websites and essays and blogs (including mine) about this exact topic that make you feel like you’re actually in a community. However, before I went to rehab in 2013, I absolutely did feel stigma. I was terrified to tell people I was going. I wanted people to respect me and think of me as someone who had her life together, and I felt like rehab had this whole stigma of ‘Oh, you went to rehab? You must be like super messed up. You’re crazy. I can’t take you seriously anymore.’ At the end of the day, I’m not going to say it’s easy to proclaim, when meeting new people, that I’ve been in rehab. But, it’s just becoming more of an acceptable reality in a culture where drug addiction/binge drinking/and eating disorders are rampant.”

David Rosenbloom, PhD, is a professor of Public Health at Boston University where he directs Join Together, a program that helps communities prevent and reduce alcohol and drug problems.

Dr. Rosenbloom told me that he believes millennials are more tolerant of a much broader range of human conditions than their parents or prior generations. When I asked him what we could do as a society to decrease stigma, he said, “We need to significantly expand access to medication-assisted treatment and conduct a public education campaign in support of their long-term use. We also need to apologize for past excesses in the criminal justice system, and systematically review and release hundreds of thousands of people who are in prison or jail because of their substance use disorder. We should repeal all laws that prevent individuals with criminal records associated with drug or alcohol use from getting jobs, housing or education, and expand public investments to provide jobs for these people.”

When it comes right down to it, more and more people of the millennial generation are not only not ashamed of their seeking help for their issues, they make a point of that for all to see. One of those people is Seth Leaf Pruzansky, who is shopping a book about his spiritual awakening that came when he was incarcerated for a drug-related offense.

Seth told me that, “The stigma of being an addict shouldn’t stop anyone from getting help. Taking responsibility for getting it is squarely in the lap of the addict him or herself. Until they really own the fact that despite the circumstances leading to their addiction, they are the ones who ultimately made the choice of devolving into their current station in life, they will remain in a state of not believing that help is available. They will continue to play the victim card because in the short run, it’s a lot easier to stay in that rut rather than to get help and clean up. But in the long run, the continuing spiral into de-evolution and death is all but inevitable. I know. I personally climbed out of that hell.”

View article on TheFix.com >

If you know someone struggling with substance abuse and mental health issues, know that help is available. Visit RecoverGateway.org for more information or call Gateway Alcohol & Drug Treatment Centers for a confidential consultation at 877-505-HOPE (4673).

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