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Depression and the Use of Substances

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Depression is not just an emotion or the feeling of sadness; it is a brain and mood disorder that can affect a person’s daily life and routines. The illness can be treated with antidepressants and other prescribed medications. However, some people suffering from depression turn to illegal substances in attempt to alleviate the symptoms. Depression can also be brought on by the use of illegal substances. Substance abuse alone is a disease and is the cause of millions of deaths in the United States each year. The term addiction is also used to describe substance abuse. The use of opioid drugs has been labeled an epidemic within the U.S. Most commonly addressed in the news and else where are street drugs such as heroin, Fentanyl, cocaine, marijuana, and many more. The purpose of this paper is to look at the prevalence of depression and substance abuse, how it affects people, the stigma associated with depression and substance use, and how nurses can help patients suffering with depression and/or substance use.

The National Institutions of Mental Health (NIMH, 2016) describe depression as a mood disorder that affect the person in multiple ways such as cognitively, emotionally, and physically. Depression can cause sleep disturbance, decreased appetite, and loss of focus. The NIMH (2016) indicates that in order for the patient to be diagnosed with depression the symptoms must occur almost all of the time if not all of the time for at least two weeks. The cause of depression is related to multiple factors and is continuously studied throughout the world. The factors believed to be involved in depression include environmental, biological, physiological, and physical (NIMH, 2016).

Substance use disorders are explained by the Centers for Disease Control and Prevention (CDC, 2018) as when a person repetitively uses substances, such as drugs or alcohol, and that substance causes significant problems to the person whether that is health problems or the inability to complete everyday duties. According to NIMH (2016) substance abuse changes a person’s priorities, behavior, and relationships. The National Institute of Drug Abuse (NIDA, 2014) explains that substance abuse is commonly seen with a person who also suffers from a mental illness. When people suffer from two different problems this term is called a comorbidity (NIDA, 2014). Depression specifically can be caused by the use of substances and on the other hand depression can lead to the use of substances.

The instance of depression and substance use as two separate problems is wide spread throughout the United States. “In 2014, 20.2 million adults in the U.S. had a substance abuse disorder and 7.9 million had both a substance abuse disorder and another mental illness” (NIMH, 2016). The United States is currently facing the ongoing fight against the opioid epidemic and use of other illegal drugs. According to the NIDA (B, 2018) data shows high prevalence between substance abuse and depression disorders. Depression alone affects over nineteen million teenagers and adults in the United States according to a page on MedLine Plus (2018). People who suffer from depression may be hesitant to seek help from a healthcare professional due to many factors. According to statistics from NIMH (2017), thirty-seven percent of individuals who suffered from depression in 2016 did not receive treatment. People suffering from these diseases may choose to avoid medical treatment for numerous reasons including: lack of insurance, stigma of mental illnesses, and lack of education about the disease/symptoms.

Depression and substance abuse sufferers often end up needing acute care as well as long-term treatment of the disorder. Patients suffering from depression may be put on anti-depression medications, psychotherapies, brain stimulation therapies, as well as complimentary and alternative medicine (CAM). The patients suffering from substance abuse may need to be placed in a rehabilitation program or detox program in order to rid the body of any substances before beginning other long-term treatments. Not only do patients who abuse drugs have to detox the body, but also they have to be concerned about the health consequences that come with the use of drugs.

According to the NIDA (2017) the health consequences users may face depend on the type(s) of drugs used as well as the amount of time used. Many drugs come with the risk of overdosing and death; which the United States is seeing a large amount of overdoses annually. According to multiple charts on the NIDA Overdose Death Rates page (2018), approximately 29,406 people died in 2016 from synthetic opioids such as Fentanyl. The number of overdose deaths from all drugs was approximately 72,306 in 2017 (NIDA, 2018). People who do not overdose and die from substance abuse can suffer long-term damage to different organ systems in the body. Depression and substance use both cause changes in lifestyle, mood, relationships, and physical health. These diseases can be life altering to those suffering and loved ones of those suffering. Patients who suffer from depression or substance abuse may be famous, homeless, military/veterans, parents, or children. People of all ages, ethnicities, backgrounds, and life styles can suffer from these diseases.

The stigma of depression and the use of substances have been researched as recently as this year. In the journal titled Substance Use & Misuse researchers have found a significant link between the stigma behind depression and the use of maladaptive coping mechanisms such as substance use (Wang, Burton, and Pachankis, 2018). The study completed by these researchers found that one of the most common barriers of people suffering with depression is the stigma associated with the disease (Wang, Burton, & Pachankis, 2018). The common belief between people diagnosed with depression is that people will view them as weak and they will struggle finding/keeping a job as well as with keeping friends. The study asked participants with depression how they felt other people viewed their diagnosis and determined how they themselves felt about the disease (Wang, Burton, & Pachankis, 2018).

Nurses play an important role in the care for patients suffering from depression and/or substance abuse. Patients who seek care for these diseases are most often very vulnerable at this time and need emotional support. Not only do patients need emotional support, but they also need medical treatment in many cases. Patients who come into an emergency department setting could have attempted suicide, be withdrawing from substances, or overdosed among many other reasons. Nurses need to remain judgment free towards these patients and provide support. Nurses are advocates for patients and should always take time to listen to the patient, allowing for them to talk about their feelings. Patients who are depressed and/or drug users may feel like people are judging them due to the stigma of mental health. Although nurses help patients who are current drug users or depressed, nurses can and should assess with screening tools to determine if people are suicidal or using substances. According to NIDA (2012) the screening tool for substance use in a medical setting is called the NIDA quick screen.

The screening for suicide, supported by NIMH, is called the Ask Suicide Screening Questions (ASQ) and it takes approximately twenty seconds to ask the questions (NIMH, 2017). The ASQ is not the only screening for suicide, if the patient results are positive from the ASQ it is followed by a brief suicide safety assessment (BSSA). The BSSA is completed by an advanced clinician; they decide if further evaluation will be necessary (NIMH, 2017).

Often time’s nurses educate patients and their family members about different topics in order for them to be successful after leaving the hospital. For drug users, nurses may teach family members and the patient about drug overdoses and how to help in that situation. The drug naloxone, also known as Narcan, has become increasingly important to the Opioid epidemic. Recently, naloxone has become more readily available for people to obtain and programs have been created to distribute naloxone to friends and family members of drug users (NIDA, 2017). Before naloxone was distributed to friends and family it was first responders who administered the opioid reversal drug and often times they arrived to late (NIDA, 2017).

Now that family member and friends can carry naloxone many overdoses that would have once been deadly are now being reversed in time. Nurses can assist in educating patients and the family about rehabilitation programs and different therapies that they can use to treat the disease long-term. Family members may be unfamiliar in resources for them and the nurse could suggest groups for family members with drug users. Nurses can educate patients with depression about coping strategies, therapies, any new medication they will be on, and give them the suicide hotline number. The nurse plays a critical role in ending the epidemic of drugs in the United States.

Depression and substance use are ongoing diseases of interest in the United States. The large prevalence in the United States will continue and the research for treatment will remain ongoing. The known facts about depression and substance use have been beneficial in caring for as well as treating many with the diseases. The CDC, NIH, and other government-involved organizations have large amounts of knowledge about both diseases. Stigmas regarding depression and substance abuse do exist; they create a very large barrier for those suffering with the diseases. Once the stigma of mental health and substance abuse is lessened it may be easier for the diagnosis and treatment of these problems, because individuals will be more willing to seek help. Nurses will continue to play a critical part in helping this large group of people be diagnosed, treated, and better educated so eventually the prevalence of these diseases will be significantly lower. Nurses may be able to reduce the stigma of mental illnesses and substance use by educating the public. Substance use and depression can be a comorbidity of each other or can be seen alone.

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