Source: MissLunaRose12, CC BY-SA 4.0 via Wikimedia Commons

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 socially, vocationally/educationally, emotionally, financially, and physically. They 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, 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, with which individuals continue to struggle. Key research findings indicate:

• Forty percent of U.S. adults in 2020 reported struggling with mental health or substance use, and 13 percent started or increased substance use to cope with stress.
• Fifty percent of young adults ages 18-24 reported anxiety and depression symptoms in 2023, 38 percent ages 25-49, and 29.3 percent ages 50-64 reported the same.
• Women increased their heavy drinking days by 41 percent 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 fewer economic means. In 2023, 52.8 percent of those with job loss and 29.6 percent of those without job loss report anxiety and depression symptoms.
• Drug overdoses increased across the total population from 21.6 percent in 2019 to 32.4 percent in 2021 and doubled among adolescents.
• Alcohol-induced death rates increased by 38 percent 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 its 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 percent in April 2020, 39.3 percent in February 2021, 31.5 percent in February 2022, and 32.2 percent in February 2023. The highest rates of 52.8 percent were among individuals who had experienced household job loss and 49.9 percent among 18-24-year-olds. Even more stunning is comparing these statistics to a 2019 benchmark, which found that only 8.1 percent of adults 18 and older had reported symptoms of anxiety, 6.5 percent reported symptoms of depression, and 10.8 percent reported symptoms of anxiety or depression.

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 waitlists, 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.

There has been an increase in the number of behavioral health services as well as the ongoing utilization of virtual options. Virtual behavioral health services were a silver lining of the pandemic, as they have allowed individuals with barriers such as living in rural areas of states, having children at home, having busy schedules, lacking transportation, or experiencing harsh weather to benefit from accessible 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 it reports 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, 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 and funding of behavioral health treatment. The HIPAA 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.