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Preventing mental health disorders may be key to thwarting the opioid crisis

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What constitutes mental illness is widely misunderstood. Many people immediately think of schizophrenia or other forms of psychotic or dissociative diseases (e.g., multiple personality disorder), as portrayed in the movies. Sufferers of these illnesses are relatively easy to detect, given obvious alterations in thinking, emotion and behavior. Other disorders such as depression and anxiety, however, are not often readily apparent, even though they are much more common. 

Regardless, the opioid crisis has raised our consciousness about the role of these disorders in addiction; science tells us that one begets the other. Given that there are more overdose deaths each year than the number of homicides and suicides combined, we must invest in policies that promise to prevent addiction, not simply treat it after it rears its ugly head. Prevention policies imbedded into national strategies promise to ensure that these problems do not continue to become entrenched, unabated, costing countless lives and precious dollars.

I grew up in a low-income neighborhood outside of Washington, D.C., that was riddled with child abuse, violence, and crime. 

I watched as my best friend, Gloria, was beaten down by both physical abuse and neglect by her parents. In her mind, Gloria believed she was defective, unworthy of her parents’ love. She was confused and angry. She was severely depressed. As a teenager, she turned to drugs to cope and alleviate her pain. Eventually, Gloria became addicted and, in adulthood, overdosed.

Gloria is representative of just one of the many people I knew who traveled along a pathway from trauma to depression, including subsequent attempts to stem the pain through drug use, and in far too many cases — debilitating addiction. And because it was so clear to me that these pathways to addiction could be avoided, I decided to devote my career to the field of prevention, which has documented the ability to avert these pathways toward more positive outcomes using science-informed strategies

Today, it is well established that adverse childhood experiences, such as those Gloria endured, significantly increase the likelihood of a person developing mental illness, addiction, or both. People exposed to early adversity such as child abuse, poverty, or caregiver addiction disproportionately develop opiate use problems at a rate twice that found in the general population. 

The use of painkillers is 50 percent higher in middle and high school students who grow up in toxic environments. And once teens start misusing prescription painkillers (oxycodone and morphine), approximately 80 percent will transition to opiate dependence. 

Although a healthy mix of both prevention and treatment has been recommended by scientific experts to tackle the opioid crisis, treatment has been vastly underfunded and prevention has been virtually ignored.

Scientific evidence from prevention science, amassed over the past 50 years, shows that the most effective approach to promoting behavioral and mental health is comprehensive, and involves a collaboration between child- and family-serving agencies, community organizations, health care providers, and schools. 

Effective prevention practices are substantially more cost-beneficial than treatment alone over the long haul. Economic studies consistently report the cost-effectiveness of early, sustained prevention efforts embedded in public health systems. 

Noteworthy examples include PROSPER (middle school programs in rural Pennsylvania) shown to reduce opioid use by 10-35 percent, suicide prevention programs targeting Native American Youth (for every dollar spent, $10.67 are saved), and programs to reduce youth risk factors for mental illness such as the Good Behavior Game (for every dollar spent, $81 are saved) by addressing underlying problems before it is too late. 

Current policies, however, prioritize the treatment of mental disorders after they have taken root. An example of this reactive policy-driven approach is that insurance coverage is not generally provided until the individual qualifies for a specific diagnosis. 

Our health care systems are geared towards medical models of diagnosing “diseases” and only treating them after they manifest as full-blow disorders. 

In contrast, prevention strategies can reduce or avoid the development of problems altogether by systematically incorporating them into practices and services routinely offered by government agencies, in classrooms and households (e.g., life skill training; family interventions; socio-emotional learning). 

The National Research Council and the Institutes of Medicine state that schools and communities afford opportunities to support healthy youth development and prevent mental illness. Currently, in the United States, there is just one school counselor for 482 students in public schools on average, woefully inadequate if we are to detect problems before they become compounded.

The power of prevention is at your disposal. 

This is a call to action. It’s time to back policies that integrate evidence-based prevention practices into existing systems of care, ensure adequate training of the workforce, and provide access to services for those in need. A preventive approach secures help for individuals showing early signs of despair, like my friend, Gloria, and perhaps keep thousands of people from sliding down the road to addiction. 

As the founder and co-director of the National Prevention Science Coalition to Improve Lives, I, along with my colleagues, urge policymakers to take advantage of the extensive knowledge accumulated in the field of prevention to adequately address the nation’s mental health issues. 

Early, effective preventive intervention for mental illness is a vital ingredient to thwart the opioid use epidemic for this and all subsequent generations.

Diana H. Fishbein, Ph.D., is the president of The National Prevention Science Coalition to Improve Lives (NPSC).


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