Why People Don’t Get Help for Alcohol Use

Alcohol misuse is common – more than 16 million US adults (about seven percent) have alcohol use disorder. Yet many people don’t get help.  Less than one in 10 people with alcohol use disorder receiving treatment, according to the 2013 National Survey on Drug Use and Health.



Many people with alcohol use disorder don’t think they need treatment, yet even among people who believe they need treatment, only 15-30 percent receive treatment.  Researchers looking into why people don’t get treatment found barriers related to beliefs and attitude the biggest obstacle.



Among people who believe they need treatment, their attitudes are the most commonly reported barriers, according to research reported  in Psychiatric Services in Advance on August 3, 2015  Financial barriers (e.g., couldn’t afford it) and structural barriers (e.g., didn’t have time, didn’t know where to go) were cited much less frequently.



The top barriers to seeking help for alcohol problems were

• I should be strong enough to handle it alone -  42%

• The problem would get better by itself - 33%

• Not serious enough to seek treatment  - 21%

• Too embarrassed to discuss it - 19%



Previous research has identified some characteristics that make if more or less likely that people will seek treatment: unmarried people are more likely to get treatment than married people and men are more likely to get treatment than women.



One ongoing problem, the researchers note, is that many doctors are still uncomfortable asking about alcohol use.



Concerned about your own drinking?  See an online assessment from NIAAA and learn more problem drinking and getting help in Rethinking Drinking. Find help with SAMHSA’s Behavioral Health Treatment Locator or 24-hour toll-free Referral Helpline at 1-800-662-HELP (1-800-662-4357).





By Deborah Cohen, Senior Writer, American Psychiatric Association

Celebrities Take on Roles as Mental Health Advocates

Actor Jared Padalecki, known for his roles in “Supernatural” and “Gilmore Girls,” has become the latest in a long list of celebrities who are speaking out about mental illness. These famous people are talking about their personal experiences and using their popularity to help raise awareness, fight stigma, and encourage people who are struggling to reach out and get help. Padelecki has talked about his struggles with depression and initiated the #AlwaysKeepFighting campaign to raise awareness and support.



Musician Demi Lovato has been outspoken and public about her experience with bipolar disorder and has become an outspoken advocate for mental health.  She recently joined with several organizations, including the Depression and Bipolar Support Alliance, the Jed Foundation, and others, as part of the  Be Vocal: Speak Up for Mental Health initiative. The campaign encourages individuals to speak up for themselves in asking for help and to learn how to speak out for others in the community.



Actress Glenn Close has been outspoken and active in bringing national attention to the issue of mental illness. After seeing her sister cope with a mental illness and the stigma associated with it, Close founded the nonprofit advocacy organization of Bring Change 2 Mind.  



Actor Joey Pantoliano, has also been active in talking about his personal struggles with depression and substance use. He is raising awareness and fighting stigma through his No Kidding, Me Too! foundation.  Among its many activities, NKM2 promotes messages of empowerments and acceptance through an award-winning documentary of the same name and a series of public service announcements.



Brooke Shields has publicly shared her experience with postpartum depression and written her story of despair and recovery in a memoir, “Down Came the Rain: My Journey Through Postpartum Depression.” Carrie Fisher (Princess Leia of “Star Wars” fame) has taken her advocacy to the stage with her autobiographical one-woman play “Wishful Drinking,” where she tells her story of bipolar disorder and substance use with openness and humor.


As Jeffrey Borenstein, M.D., president and CEO of the Brain and Behavior Research Foundation, noted in a recent interview with CNN, "When celebrities speak publicly about their own experiences with depression or other psychiatric conditions, it's very helpful. It opens up a conversation about these issues. If someone you admire is going through the same thing you might be going through, it makes a difference with people, it causes people to seek help."


Borenstein is also host of a PBS series on mental health issues called Healthy Minds.  You can view past episodes on topics such as bipolar disorder, autism, schizophrenia, and more online at WLIW – Healthy Minds.



By Deborah Cohen, senior writer, American Psychiatric Association

Stigma: Changing the Conversation and Changing Lives

Renee Binder, MD
APA President

I was reminded recently of the death of an acquaintance who was at the top of her career when she died suddenly after complications from surgery, according to her obituary. I later learned that she had died from suicide, possibly in response to her struggle with chronic pain and resulting depression. 


Stigma serves as a barrier to seeking treatment often because of fears of discrimination. A few years ago, a patient requested that I not keep any records and wanted to pay me in cash. He was concerned that if his psychiatric records were ever discovered, his career could be negatively impacted. Were this man’s concerns legitimate? In a more public incident Sen. Tom Eagleton was forced to withdraw as a candidate for vice president in 1972 after it became public that he had suffered from depression and undergone ECT (electroconvulsive therapy). 


According to the Merriam-Webster Dictionary, the definition of stigma is a set of negative and unfair beliefs that a society or group of people has about something; it is a mark of shame or discredit. 


How can we begin to address mental health stigma? Here are several ideas: We need courageous spokespersons who are willing to come forward and talk about mental health issues that they or their families are experiencing. Former Rep. Patrick Kennedy is one such champion. He has openly discussed his struggles with mental illness and substance abuse and how treatment has helped him lead a productive and rewarding life.

We can learn from the LGBT community and their struggles with stigma and negative stereotypes. They have taught us that “coming out” by public figures and celebrities can decrease stigma.




Another way of combating stigma is for my fellow mental health professions, psychiatrists and others, to take responsibility for examining the language that is used by the media and in our society. Words such as “lunatic,” “crazy person,” or “maniac” convey images of people who are out of control and dangerous rather than people who are experiencing a mental illness and deserve our compassion and support in getting effective treatments. 


Mental health professionals and others can take an active role in drawing attention to language and advocating for more appropriate, compassionate and less stigmatizing language. Mental health care is an essential part of health care. Almost everyone will suffer from a mental health problem at some point in his or her lifetime.. But for people to be willing to access the mental health care they need, we have to continue the fight against stigma.


If we are successful in addressing stigma, and we must be, then not only will we change the conversation, we will also change people’s lives and change the culture. We will finally reach the point where all of us can openly talk about someone’s death by suicide and encourage people with mental health problems to seek the help they need without fear of judgment or harmful repercussions.


By Renée Binder, M.D., APA President 

Know Your Rights: Fair Insurance Coverage for Mental Health

Federal
law is clear that health insurance companies cannot discriminate against people
seeking care for mental illness or addiction. But how do you know if your insurance
company is not complying with the law? What can you do if you suspect a
violation?

The
American Psychiatric Association (APA) created a tool to help answer these
questions. The poster titled, “Fair Insurance Coverage: It’s the Law”
(Spanish-language version), clearly and
simply explains the law and the steps to take if you suspect a violation.

The
poster is intended to help enforce federal law and end discrimination.  Print it out and share the link (www.psychiatry.org/parity).

By
understanding your rights and taking action you can help ensure fair coverage
for yourself and your family, and you can help others by holding insurance
companies accountable.

What Federal Law Requires

The Mental Health
Parity and Addiction Equity Act requires any group health plan that covers more
than 50 employees and offers mental health and/or substance use disorders
coverage to provide that coverage with no greater financial requirements (such
as co-pays, deductibles, annual or life-time dollar limits) or treatment
limitations than the requirements the plan applies to medical / surgical
benefits. 

Also,
under the Affordable Care Act, new individual and small group plans in and
outside of the mandated health
insurance exchanges are required to offer mental and substance use
disorder coverage similar to medical/surgical benefits.

In addition to federal law, 49 states
and D.C. currently have laws relating to insurance coverage for mental health
and substance use.  More information,
including a summary table of state laws, is available from the National Conference of State Legislators.

By Deborah Cohen, senior writer, American Psychiatric Association

Reducing the Stigma of Addiction

Nora Volkow, MD, Director, NIDA

Addiction is common – an estimated 1 in 11 people in the United States experiences a substance use disorder in a given year. Despite significant advances in understanding and treatment, stigma still prevents many people from seeking help.

Nora Volkow, M.D., director of the National Institute on Drug Abuse, speaking recently at the APA’s Annual Meeting in Toronto, talked about some of the recent advances in the understanding of addiction and called on psychiatrists to help reduce the stigma of addiction and “help to eliminate the shame and suffering that accompany the addict who experiences relapse after relapse after relapse.”

Volkow opened her speech with a moving and emotional story of how she learned of her grandfather’s alcoholism and suicide. He had died when she was a girl of 6 in Mexico, but Volkow’s mother did not reveal the truth of her grandfather’s addiction and death until many years later, when her mother was dying and after Volkow had already achieved distinction as an addiction expert.

It was a dramatic illustration of the despair experienced by people who have an addiction and continue to engage in a behavior that they may know is destroying them. She described how it was once believed that addiction was a disorder of hyperactive reward centers in the brain—that people with addiction s sought out drugs or alcohol because they were especially sensitive to the pleasure-inducing effects of dopamine.

But Volkow explained that in recent years research has revealed just the opposite: that those with addiction are actually less sensitive to the effects of dopamine. They seek out drugs because of the very potency with which they can increase dopamine in the brain, often at the expense of other pleasurable natural stimulants that do not increase dopamine so dramatically

Moreover, she emphasized that addiction to drugs disrupts multiple systems in the brain that govern the ability to plan, anticipate, and change behavior in response to changing circumstances. Volkow said it is this phenomenon that accounts for the “craving” experienced by addicts and alcoholics in response to environmental triggers—often leading to what she characterized in the account of her grandfather’s death as that “one last moment of self-hatred.”

Adapted from Psychiatric News