According to The American Hospital Association: “The pandemic exacerbated the need for behavioral health services while individuals with existing disorders faced additional barriers to care.” The COVID-19 pandemic certainly turned a spotlight on behavioral health challenges, and also worsened many of those issues through isolation and widening disparities in wealth, resources, and support.
Charles Eaton, a former Chemical Dependency and Public Health Consultant involved in New York City’s first needle exchange program says, “There is a lot of attention on mental health right now, and it’s a good time to ask, ‘what is the role of mental health?’”
According to the National Alliance on Mental Illness (NAMI), 21 percent of adults reported suffering from a mental illness in 2020. That is more than one in five adults. However, local funding and resources don’t reflect this need for services. Perhaps the stigma of mental illness that prevails today creates a barrier to compassion and prevents communities from appropriately addressing the behavioral health crisis that has been increasing in our country since pre-pandemic days.
Individuals suffering from addiction seem particularly poorly received by public perception. In the first few months of the pandemic, we saw an increase in alcohol sales,¹ and we heard anecdotal accounts of increased substance misuse as a means of seeking positive shifts in affect and avoiding negative emotional experiences. However, the stigma attached to substance misuse seems to be alive and well. Many view addiction as a choice and lack the same compassion for those suffering from substance misuse as they do for individuals struggling with other behavioral health challenges. People with substance use disorders, in particular, are viewed by the public as weak-willed, although evidence shows that they are as likely to adhere to treatment as people with other chronic medical conditions, such as hypertension or diabetes. Unfortunately, and in spite of efforts to educate the public, this misperception has increased over time, according to the findings from national surveys in 1996 and 2006.²
Charles Eaton says that substance use and mental health are intertwined, and challenges the community to use the term ‘behavioral health’ to encompass both of these things, as well as many issues in between. He says, “To not deal with them together does not make sense.” He goes on to describe how our approach to public health must include behavioral health, and behavioral health must include addressing substance use disorders. “That’s the front line, the thing that would make the biggest difference — a workforce of thousands across the state who could complete mental and behavioral health evaluations and treatment; it would be a tremendous resource. In New York in the late 1990s, they basically made the transition between mental health and substance abuse as two different fields. But we know behavioral includes substance use. Plus or minus half of the people with opiate use problems also had diagnosable mental health problems. Plus or minus 50 percent of people with mental health problems used drugs. You can’t deal with one without the other.”
In order to address behavioral health concerns appropriately, we must work toward addressing both the biases each of us may hold individually and the structural biases that exist within the realm of behavioral health issues. One study³ states that “Public perceptions and beliefs about mental and substance use disorders are influenced by knowledge about these disorders, the degree of contact or experience that one has had with people with mental and substance use disorders, and media portrayal of people with mental and substance use disorders, as well as media coverage of tragic events, notably gun violence and suicide.” This indicates that one way to reduce stigma would be to take the time to listen and learn from the lived experiences of those in our community.
With that goal in mind, I invite you to look and listen to these submissions from your community — from your friends, your family members, and your neighbors.
We need the tools
I’ll never forget the pit in my stomach the day my neighbor called: “Hunny, your mom told us that you admitted to taking the pills. I want you to know I still love you, and I’m here for you.”
I felt the world spin around me as my brain tried to make sense of her statement; my cheeks burned, and my hands shook as my body filled with indignant rage. “My mom would NEVER say that.”
I couldn’t comprehend a world where my mom would tell such a heinous lie about me, and I assumed my neighbor must just be unhinged, a sentiment my mom reinforced with her own incredulous reaction as I recounted the conversation. It would be years before I could reflect on this situation, or the other countless situations that made me question my own reality and recognize them for what they actually were — see the symptoms of my parents’ sickness, infecting our home with lies and trauma.
It would be several more years before I was ready to stop pretending not to see my mom’s drug use, stop contorting the truth to resemble something that offered a smidgen of false hope or safety. It was much more painful and scary to consider that my mom might not be well than to just assume I must be seeing things wrong. I must have misunderstood, I would tell myself, or I must just be a really bad kid. So I spent my childhood and early adult years striving to be ‘good’, attempting to assuage the deeply-rooted fear that I was actually unworthy, bad, and unlovable — the only explanation I had for the things that were happening around me (and to me). I hoped that maybe if I did things just right, life would be okay — for me, for my siblings, for my mom.
Being ‘good’ meant never questioning the actions of those around me; it meant being nice at all costs and prioritizing the needs of others. It meant carrying the weight of enormous shame. It meant not ever knowing what I actually wanted, but being an expert on what other people wanted. I knew how to expertly scan a room for the slightest indication something was amiss, how to assess what was needed from me in any given situation, and how to silence any doubts or dissenting thoughts that could upset those around me. I learned that my value and my safety hinged upon the approval of others, and that often I could not trust my own perception of reality.
I grew into an adult who did not trust myself, who did not feel safe in my own skin — one who was very, very certain that I was worthless — and I was constantly exhausted and anxious. At 19 years old, I had moved into my first apartment, and at 20 I was gifted my first bottle of wine. I had promised myself that I would never, ever drink or use drugs like Mom and Dad. Then, as swiftly as the thought arose, it disappeared, replaced by a fervent voice insisting that I was not like them, that after everything I had been through, I ‘deserved’ the right to drink if I chose.
I filled one glass with water and another with wine and chugged as fast as I could, using the water to rinse the bitter taste from my mouth so I could keep going. Perhaps that drive to ‘finish’ should have been the first red flag, the first indication that drinking wasn’t for me. But as the warmth of the alcohol spread throughout my body, I felt the bondage of my own mind begin to loosen. I felt the expectations, the fears, and the pain slip away until I was buzzing inside a cocoon that provided separation between the world and myself. For the first time in my whole life, the pain, the worry, the shame… didn’t feel so crushing. It all seemed to just float about me, inconsequential whisps, part of the atmosphere, slowly dissipating until I was spinning in nothingness.
For the next seven years, I would seek that feeling again, and again, and again. It was the closest I had ever been to freedom. I was so desperate to escape my reality, to stop feeling all of the things that hurt so badly, that I traded my whole future — everything I ever thought I would do — just to get out of that pain. I woke up ill every morning, anxious, and desperately attempting to recall my actions from the previous night. Running to check that the kids were okay, that my partner still loved me. Only to turn around and spend the day as busy as I could, more determined than ever to be ‘good’, attempting to atone for my nightly sin, planning crafts, outings, and activities… all the while, counting down the seconds until I could get the kids into bed and start the cycle again.
I didn’t recognize who I had become, and the only parts of me that resembled the truth of my soul were nothing but fantasy. I existed, and I drank. I started to recognize that the boundaries and ‘rules’ I had placed around drinking were slipping away. ‘Waiting until the kids were in bed’ started creeping toward dinnertime; ‘Only if my partner was home’ stopped mattering; ‘As long as I’m not lying about it’ had become a series of acrobatics to convince myself omission wasn’t lying. One day, as I sat crying in the living room, watching my children play, guilt consumed me at the realization of all the ways I was putting them at risk for experiencing the same things that had driven me to drink. I realized that the place I had sought solace had become my greatest source of pain.
When I decided to reach out for help, I found tools that taught me a new way to live and addressed all of the things that had made alcohol feel like a solution to begin with. The tools that were offered to me in the program of recovery that I chose showed me how to trust myself, how to receive love, how to set boundaries, how to pause, and how to honor myself.
Addressing addiction, substance use disorder, or substance abuse means addressing trauma, grief, lack of connection, resources, and community. It means addressing a lack of access to coping tools and support. It means addressing poverty, sexual assault, and the toxicity of rugged individualism that tells people facing systemic barriers to pull themselves up by their bootstraps. It means addressing sexism, racism, homophobia, transphobia, and classism. It means teaching children how to navigate emotions, how to regulate their nervous systems, how to speak for themselves, and how to ask for what they need — and then being there to help when they need it. In order to treat substance use in our country, we have to look at people holistically and understand the breadth of experiences and factors that often collude to create the perfect circumstances in which addiction thrives.
A list of the things I wanted to be: caring, kind, reliable, a good partner, a good friend, PERFECT, some kind of revolutionary with a name people knew, HAPPY, appreciated, a good cat mom.
A list of the things I failed to be: see above.
I grew up wanting. Always an idealist. Wanting more. More pleasure, more sugar, more equality. If something was ‘good’, I was already thinking about what would make it ‘better’. Life didn’t fit me and I didn’t fit life. As a teenager, I denied the idea of genetics disqualifying me from experimenting with substances. I was determined to try to find ‘the thing’ that would make me feel satisfied.
So I tried. And tried. And tried some other things.
2011: I’m not a teen anymore. I’m 21 and wrecking my car. After lucking my way out of serious trouble, I decide I’m simply young and inexperienced with the bar scene and obviously need some more practice. (I’m almost certain I was actually drugged that evening by a stranger at the bar; however, blacking out had already become my way of life, so I’ll never know for sure.)
I keep ‘trying’. I finally conclude that alcohol has been ruined for me. I also conclude that I’m not quite enough like my mother to need help setting it aside. So I quit drinking and promptly pick up the two things I always said were my limit — the things I said I would never do. These two drugs plow the last good parts of me into the ground in no time at all.
2014: I’m 24 — a shell of a person disguised as a skeleton. At a treatment center. The one my mom went to. The one my grandpa went to (the grandpa who didn’t die with a drink in front of him at a bar…). I feel like death. It dawns on me that I can be miserable and wallow in it, never to feel good again — OR I can be miserable and push myself to eat, to go to the lectures and group therapies, to go for walks in the sun, and do the step work assigned to me, rather than letting my pride kill me. I become open to suggestions from people who had proved a way of recovery that worked.
Now I’m 31. I haven’t stopped following the suggestions.
A list of the things I am today: caring, kind, reliable, a good partner, a good friend, a growing work-in-progress, satisfied with myself as I am, happy, appreciated for wholesome reasons, a good pet mom, AND a good human mom.
I know who I used to be. I don’t want all the same things she did. That person wouldn’t recognize me today and for that I am grateful.
No one is a hopeless case
“I will never understand why every organ in our body gets support when it is ill, except for your brain.”
I knew there was something wrong for quite some time. I was sad more often than not and I drank a bit too much. However, I was able to maintain a normal life. I woke up early every morning, I got ready for work, paid my bills, and maintained my relationships. It never occurred to me that having this routine was the only thing slowing my downward spiral.
Fast forward a few months to March 2020, when I was sent home from work and told that we would not be returning until the COVID-19 quarantine was lifted. Two weeks turned into two months, and my life quickly began to crumble. I sat alone in my home, waking up around 8 a.m. with nothing to do and nowhere to go, anxiety and pain overwhelming my mind.
I would scroll social media and see so many memes with messages like, “In quarantine, airport rules apply… it’s acceptable to start drinking at 9 a.m.!” Seeing these messages normalized my destructive behavior. It was acceptable to be drinking all day; everyone was doing it! And so I did.
My drinking quickly became an all-day-every-day habit. I remember a time when there were rumors that liquor sales were going to be halted. I quickly ordered a gallon of vodka to hold me over for the next few weeks until the quarantine was lifted. That gallon was gone in less than 48 hours, and I was sicker than I’d ever been. After that day, I woke up every morning making a promise to myself that I would not drink again. But by 10 a.m., I would be so consumed with pain, both physical and mental, and before I knew it, I would be intoxicated again.
I tried everything I could think of to stop, but I was addicted. The only thing I knew would make the shakes, nausea, headache, and mental turmoil cease was another drink. I knew I needed help. I called my doctor and told him I needed to be seen urgently. They could not get me in for another four weeks. So, I lived another four weeks of hell. The only thing that got me through that time was thinking that my doctor would have solutions — I just needed to make it to my appointment.
When the day finally came, I sat in his office and explained that I had a problem and I needed help desperately. I will never forget how he looked at me when he said, “You know drinking is bad for you, right?” I said yes. And he said, “Well, if you know it’s bad for you and you want to quit, then stop drinking.” That was all he had to offer me. I felt like an idiot. Like I should have more willpower. I felt as though there was no hope left. Who could help me if my own doctor couldn’t?
It was hopeless, I decided. So I went back home and continued to drink for another year. I was sure I was going to die. I came close multiple times. After the last of my many hospital stays, I found a recovery group. Here, at last, were people who could help me.
I attended and I did everything that was suggested to me by that group. I sit here with one year of sobriety. I also sit here with the knowledge that help for individuals with substance use disorder is severely lacking, and because of that, many people out there may not end up as lucky as I did. We desperately need more readily available resources to help those who are struggling, so we stop losing so many of our loved ones to this disease. Medical professionals need to be better educated on treatments and programs available for addicts and alcoholics so that nobody else that needs help will be turned away.
3. Swanson JW, McGinty EE, Fazel S, Mays VM. Mental illness and reduction of gun violence and suicide: Bringing epidemiologic research to policy. Annals of Epidemiology. 2015;25(5):366–376.
Ashleigh Rogers is a Tri-Cities artist who wears many hats. One of her latest projects is Looking Up: an investigation into how COVID-19 has changed our world, and uncovering the community’s vision for the future.