Untreated mental illness is a factor in most overdose deaths

More than one million Americans have died of accidental overdoses since 1999, and while drugs like heroin, cocaine, and fentanyl are often cited on their death certificates, untreated mental illness had a hand in killing most of those people.

National surveys have found that half of those who experience mental illness will also develop a substance use disorder and vice versa. Sixty percent of young people in community-based addiction treatment programs meet the diagnostic criteria for another mental illness. Most behavioral health professionals believe the numbers of people struggling with a simultaneous mental illness and substance use disorder to be even higher, especially post-COVID-19, when anxiety and depression skyrocketed, drug and alcohol use soared, and fatal overdoses jumped 30%.

As we mark International Overdose Awareness Day on Wednesday, fatalities are coming back down thanks to the widespread distribution of naloxone — an opioid overdose reversal agent — and fentanyl test strips, along with expanded addiction treatment, including traditional talk therapy, support groups and medication. Those efforts have saved countless lives, but we are still losing 300 Americans per day, or about 12 people every hour to overdose. Add in suicides and the deaths of despair grow.

Bringing people back from the brink of death is the least we can do, but surely we can do better.

School-based drug prevention programs often focus on resisting peer pressure and employ scare tactics, warning kids that using drugs will land them in jail or destroy their futures. If you’re feeling hopeless, though, like 44% of students surveyed last year by the federal Centers for Disease Control and Prevention, even the threat of death may not be a deterrent. And if that first drink, bong hit, or pill calmed your racing mind and helped you feel “normal” for the first time, listening to auditorium lectures from bereaved parents, addiction experts and cops only deepens your conflict and guilt.

Too many young people and adults become trapped in a vortex where the drugs and alcohol that provide relief from untreated mental health conditions — anxiety, depression, even ADHD — exacerbate those conditions, requiring even more drugs and alcohol to keep the symptoms at bay. When things get bad enough, your family, employer, school or the criminal justice system pushes you into addiction treatment, but unless it’s a facility that specializes in “co-occurring disorders,” sustained abstinence will be challenging because your underlying mental health conditions probably won’t be addressed.

As counterintuitive as it seems, mental health programs routinely ignore low-level drug use or turn away addicted patients, citing a lack of expertise, while many substance abuse treatment programs refer suicidal patients or those with psychiatric symptoms back to mental health programs with waiting lists, deepening the vortex. Bereaved families are remembering many of them today.

It's tempting to blame providers who haven’t modernized their services or to cite America’s strained mental health workforce, but the lack of integrated care goes back decades.

There have been significant post-COVID federal and state investments in mental health programs, along with a drive for more fully integrated services, where community-based organizations, hospitals, and treatment centers can win unified mental health/substance use disorder treatment licenses. With bigger investments than ever before, more knowledge at our fingertips, and overdose trends finally headed in the right direction, now is the time to make fully integrated, evidence-based treatment on demand a reality.