One in five (47.6 million) U.S. adults are affected by mental health disorders.
Of these disorders, depression affects the most Americans, with over 7 million adults having one major depressive episode a year (NAMI). Unfortunately, many people who develop mental health disorders also have a substance use disorder (SUD). It is challenging to separate the overlapping symptoms of addiction and depression, making diagnosis and treatment of these co-occurring disorders complex.
Since 46% of people who die by suicide had a diagnosed mental health condition like depression – making the correct diagnosis could be the difference between life and death. Additionally, failure to treat a comorbid disorder can jeopardize a patient’s chance of recovery and lead to relapse. In this article, we examine the latest societal and healthcare costs of co-occurring disorders, how healthcare professionals are tackling this crisis in terms of diagnosis and care, and why treating the whole patient matters.
What is the Cost of Depression and Addiction in the U.S.?
Overall, depression is estimated to cost $44 billion a year in lost productivity in the U.S. alone (DeTienne, K.B. et al., 2020). A report by Blue Cross Blue Shield found that depression cases are rising at a faster rate for millennials and teens than for any other generation. Sadly, one in five of them do not seek treatment, and more millennials than baby boomers have declined medical care because it was too costly (Hoffower, H., 2019). In terms of co-occurring disorder statistics, the National Alliance on Mental Illness (NAMI) reveals mental illness and substance use disorders are involved in 1 out of every 8 ER visits by a U.S. adult – or 12 million visits. NAMI also reports on the additional societal and healthcare costs, including:
- 9.2 million U.S. adults experience both mental illness and a substance use disorder.
- Serious mental illness causes $193.2 billion in lost earnings each year.
- 37% of adults incarcerated in the U.S. prison system have a diagnosed mental illness and 20.1% of people who are homeless have a serious mental health condition.
Dangers of Misdiagnosis
According to the National Institute on Drug Abuse (NIDA), 43 percent of people in SUD treatment for nonmedical use of prescription painkillers have a diagnosis or symptoms of mental health disorders, particularly depression and anxiety (NIDA). Unfortunately, even with addiction treatment, if a mental health issue goes undiagnosed, the risk of relapse is very high. Treating addiction and depression at the same time helps patients understand their relapse triggers such as depressive episodes or panic attacks. Integrated treatment is also key in preventing suicide, rising healthcare costs, unemployment, and incarceration.
Traditional addiction treatment protocol often includes assessment, detox, medication, and cognitive-based therapy. Unfortunately, many patients are misdiagnosed during in-take screenings. This crucial first step can determine the difference between the journey to recovery or the road to relapse. Dr. Warren Thompson, an Associate Professor at the Department of Internal Medicine – Mayo Medical School reveals some factors behind alcohol use disorder (AUD) and depression misdiagnosis, “physicians may not have the proper training to diagnose alcoholism. “How much do you drink?” is probably the question asked most commonly by doctors. This question has less than 50% sensitivity for alcohol problems. Blood tests, such as liver function tests, are not particularly effective; even the best test, gamma glutamyl transferase, has a sensitivity of only approximately 50% (Thompson, W. et al., 2018).”
Depression is often difficult to identify as well, mainly because there are few physiological tests to help clinicians make a proper diagnosis. Cancer is diagnosed through biopsies and medical imaging, but mental illness is largely diagnosed through checklists of self-reported symptoms (Ryback, R., 2016). And in many of these assessments, patients do not always disclose the truth out of fear of stigma or losing their job. Genetic testing for both disorders offers insight into how specific gene variations increase the risk of co-occurring disorders. However, predictive tests need more development and published research.
How is the Healthcare Community Tackling Co-Occurring Disorders?
The U.S. is slowly seeing an uptick in more physicians specializing in addiction medicine. Increasing the number of specialists can reduce the SUD treatment gap, as well as the stigma that still pervades many healthcare systems. But this trend only helps one part of a complicated issue. Co-occurring disorders involve the interplay of several elements, and this is why treating the whole patient matters. The current assessments used to diagnose these disorders only provide partial information about a person’s risk factor and history. Expanding the scope of care to include accurate screening tools is the first step in effectively diagnosing these disorders. Looking at the patient from every angle, including their genetic, environmental, and cognitive orientation (or worldview) is also critical in producing an effective treatment plan.
When it comes to mental health, the cognitive domain plays a vital role. In order to understand how the brain registers its environment, healthcare professionals need to look at the patient’s perception, conception, and behavior holistically. This is why cognitive orientation, in addition to inherent and environmental factors, needs to be included during the assessment process to figure out not only the “what,” but the “why” behind co-occurring disorders. Getting an accurate diagnosis the first time is vital in preventing those suffering with a SUD and depression from relapse, poverty, suicide, unemployment, incarceration as well as other societal and healthcare costs. A personalized assessment tool administered by an addiction medicine professional will help create a more individualized care plan – leading to effective treatment and a healthy patient in recovery. A good doctor treats the disease, but a great doctor treats the whole patient who has the disease.
References:
DeTienne, K.B. et al. (2020, January). How to manage an employee with depression. Harvard Business Review. Retrieved from: https://hbr.org/2020/01/how-to-manage-an-employee-with-depression.
Hoffower, H. (2019, June). Depression is on the rise among millennials, but 20% of them aren’t seeking treatment — and it’s likely because they can’t afford it. Business Insider. Retrieved from https://www.businessinsider.com/depression-increasing-among-millennials-gen-z-healthcare-burnout-2019-6.
National Alliance on Mental Illness (NAMI). (2019). Mental health by the numbers. National Alliance on Mental Illness. Retrieved from https://www.nami.org/learn-more/mental-health-by-the-numbers.
National Institute on Drug Abuse (NIDA). (2018). The connection between substance use disorders and mental illness. National Institute on Drug Abuse. Retrieved from https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders/part-1-connection-between-substance-use-disorders-mental-illness.
Ryback, R. (2016, September). 4 conditions that resemble depression, but aren’t. Psychology Today. Retrieved from https://www.psychologytoday.com/us/blog/the-truisms-wellness/201609/4-conditions-resemble-depression-arent.
Thompson, W. et al. (2018, November). Which factors lead to misdiagnosis of alcohol-related problems? Medscape. Retrieved from https://www.medscape.com/answers/285913-41524/which-factors-lead-to-misdiagnosis-of-alcohol-related-problems.