By Sarah Allen Benton, LMHC, LPC, LCPC, AADC
The COVID-19 Pandemic federal public health emergency ended on May 11, 2023. So why are so many still impacted by addiction and mental health aftershocks?
Various phases of the pandemic posed more stress than others. For many, the shutdowns were the most overwhelming, while for others, the reopening was harder to navigate. These stressors put an enormous strain on individuals vocationally, educationally, emotionally, financially, physically and included: social isolation, school closures, temporary and permanent business closures, lack of in-person religious and spiritual services, fears of illness and death, changing and contradictory government mandates, vaccine confusion, masking requirements, job loss, travel restrictions and overall change fatigue.
For the most part, much of daily life has returned to a new normal—externally. There are many substance use and mental health issues that either originated or were exacerbated throughout the course of the pandemic, which individuals continue to struggle with. Key research findings indicate:
40% of U.S. adults in 2020 reported struggling with mental health or substance use, and 13% started or increased substance use to cope with stress.
50% of young adults ages 18-24 reported anxiety and depression symptoms in 2023, 38% ages 25-49, and 29.3% ages 50-64.
Women increased their heavy drinking days by 41% compared to before the pandemic.
The rates of depression tripled from 6.2 million to 17.3 million, with a more significant impact on those with lower economic means. In 2023, 52.8% of those with job loss and 29.6% of those without job loss report anxiety and depression symptoms.
Drug overdoses increased across the total population from 21.6% in 2019 to 32.4% in 2021 and doubled among adolescents.
Alcohol-induced death rates increased by 38% during the pandemic
While the government and media had tunnel vision on the tragic medical component, the mental health and substance use downstream effects were largely ignored. What has followed is an unprecedented behavioral health epidemic that was historically predictable. When an individual experiences mental health symptoms such as anxiety and depression, it can prime the brain for future episodes. When stressors are no longer present, it does not guarantee that the individual will return to their baseline mood, as evidenced by the statistics to follow. There was also a traumatic nature to many of the pandemic stressors and the entire global event. For those who had health anxiety, germ or contamination OCD, anxiety disorders or depression, the pandemic may have validated some of the cognitive distortions associated with these disorders.
While there was certainly tragedy and loss that occurred, the media amplified and capitalized by promoting a culture of fear and negativity that deeply impacted their consumers. Watching the news during and after the pandemic had a telescoping effect that zoomed in on the worst-case scenarios and exaggerated fears about the future. The rates of adults reporting anxiety and depressive disorder symptoms did not subside at the end of the pandemic, showing 35.9% in April 2020, 39.3% in February 2021, 31.5% in February 2022 and 32.2% in February 2023. The highest rates of 52.8% were among individuals who had experienced household job loss and 49.9% among 18-24-year-olds. Even more stunning is comparing these statistics to a 2019 benchmark, which found that only 8.1% of adults 18 and older had reported symptoms of anxiety disorder, 6.5% reported symptoms of depressive disorder and 10.8% reported symptoms of anxiety disorder or depressive disorder.
Those who had substance use issues prior to the pandemic may have developed more acute substance use disorders (SUD), while others may have returned to more normalized drinking or marijuana use patterns. However, it has been a challenge for those who crossed the invisible line of addiction back into low-risk use. SUD and mental health treatment centers and therapists noted the increase in clients and even weight lists that have persisted for several years.
So what are the takeaways? Acknowledging that people are still struggling, decreasing shame around that experience and supporting them in getting help. It is imperative that individuals with addiction and mental health issues have access to appropriate and affordable care. Behavioral health professionals and owners need to take an honest look at the treatment landscape in their area and see what is missing or truly needed. For those who currently own programs at various levels of care, consider adding in tracks or serving populations that are lacking services.
If there is ever a future pandemic, the behavioral health impacts of the event, along with the government responses, must be considered, planned for, and prevention efforts made. This area of impact needs to be considered significant and longer-lasting than the pandemic itself.
Media and social media should be socially responsible for the way in which they report information (i.e., not having daily death counts on the screen, reporting hopeful aspects, discussing the behavioral health impacts, correcting errors and discussing the need to get behavioral health support, warnings surrounding content and balancing focus on the pandemic with other topics, etc.) The World Health Organization and the Surgeon General should not wait until the behavioral health impact becomes so acute and prevalent for the state of emergency recommends and funds behavioral health treatment. The HIPPA privacy telehealth exceptions, telehealth service insurance coverage, and the implementation of the federally mandated crisis number 988 were the most notable and effective legislative actions taken during that time. May innovative and preventative action become the standard moving forward.
M.É. Czeisler et al., “Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020,” MMWR Morbidity and Mortality Weekly Report 69 (2020):1049-1057, http://dx.doi.org/10.15585/mmwr.mm6932a1external icon.
American Psychological Association, “Stress in the Time of COVID-19,” Stress in America, May 2020, Vol. 1, https://www.apa.org/news/press/releases/stress/2020/report.
Nirmita Panchal, et al., “The Implications of COVID-19 for Mental Health and Substance Use,”Kaiser Family Foundation Issues Brief, updated February 10, 2021 and updated March 20, 2023, https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/.
M.S. Pollard, J.S. Tucker and H.D. Green, “Changes in Adult Alcohol Use and Consequences During the COVID-19 Pandemic in the US,” Journal of the American Medical Association Network Open 3, no. 9 (2020): https://doi:10.1001/jamanetworkopen.2020.22942.
C.K Ettman et al., “Persistent Depressive Symptoms During COVID-19: A National, Population- Representative, Longitudinal Study of U.S. Adults,” The Lancet Regional Health- Americas 5 (2022), https://doi.org/10.1016/j.lana.2021.100091.