Substance Abuse and promoting mental health and preventing mental and/or substance use disorders are fundamental to SAMHSA’s mission to reduce the impact of behavioral health conditions in America’s communities.
Mental and substance use disorders can have a powerful effect on the health of individuals, their families, and their communities. In 2014, an estimated 9.8 million adults aged 18 and older in the United States had a serious mental illness, and 1.7 million of which were aged 18 to 25. Also 15.7 million adults (aged 18 or older) and 2.8 million youth (aged 12 to 17) had a major depressive episode during the past year. In 2014, an estimated 22.5 million Americans aged 12 and older self-reported needing treatment for alcohol or illicit drug use, and 11.8 million adults self-reported needing mental health treatment or counseling in the past year. These disorders are among the top conditions that cause disability and carry a high burden of disease in the United States, resulting in significant costs to families, employers, and publicly funded health systems. By 2020, mental and substance use disorders will surpass all physical diseases as a major cause of disability worldwide.
In addition, drug and alcohol use can lead to other chronic diseases such as diabetes and heart disease. Addressing the impact of substance use alone is estimated to cost Americans more than $600 billion each year.
Preventing mental and/or substance use disorders and related problems in children, adolescents, and young adults is critical to Americans’ behavioral and physical health. Behaviors and symptoms that signal the development of a behavioral disorder often manifest two to four years before a disorder is present. In addition, people with a mental health issue are more likely to use alcohol or drugs than those not affected by a mental illness. Results from the 2014 NSDUH report (PDF | 3.4 MB) showed that of those adults with any mental illness, 18.2% had a substance use disorder, while those adults with no mental illness only had a 6.3% rate of substance use disorder in the past year. If communities and families can intervene early, behavioral health disorders might be prevented, or symptoms can be mitigated.
Data have shown that early intervention following the first episode of a serious mental illness can make an impact. Coordinated, specialized services offered during or shortly after the first episode of psychosis are effective for improving clinical and functional outcomes.
In addition, the Institute of Medicine and National Research Council’s Preventing Mental, Emotional, and Behavioral Disorders Among Young People report – 2009(link is external) notes that cost-benefit ratios for early treatment and prevention programs for addictions and mental illness programs range from 1:2 to 1:10. This means a $1 investment yields $2 to $10 savings in health costs, criminal and juvenile justice costs, educational costs, and lost productivity.
The last part of the substance use behavior chain is the consequences. Consequences refer to emotional effects, physical symptoms, and related effects in other areas of life that result from substance abuse. Immediate or short-term consequences happen right after the
first drink or use of a drug and are perceived as either negative or positive. Negative consequences might include feeling guilty about using substances or fear that someone observed the use. However, immediate seemingly positive consequences reinforce a person’s substance abuse and encourage repeated abuse.
Although some argue that results such as socializing with other people who abuse substances (e.g., getting together with drinking buddies) can be considered positive consequences, CB/SM principles hold that all long-term consequences ultimately are negative. They may include falling, forgetting things, getting into arguments, and even getting arrested. For older adults, chronic substance abuse may have a substantial effect on physical health. However, negative consequences such as liver or neurological damage, hypertension, or diabetes often are too far removed in a client’s mind from the initial substance use and perceived immediate positive consequences to deter future abuse.
The consequences section of SAPE identifies the immediate or short-term results of substance abuse that clients might regard as positive. Client anticipation of these consequences leads to substance abuse, and the actual experience of them reinforces continued substance abuse. It is necessary to identify negative short- and long-term consequences that have deterred substance abuse in the past and that may serve as useful reminders when clients encounter high-risk situations.