Coping with dysthymia

SAMHSA’s National Helpline | SAMHSA

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  • SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.

    Also visit the online treatment locator.

SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

Also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

The service is open 24/7, 365 days a year.

English and Spanish are available if you select the option to speak with a national representative. Currently, the 435748 (HELP4U) text messaging service is only available in English.

In 2020, the Helpline received 833,598 calls. This is a 27 percent increase from 2019, when the Helpline received a total of 656,953 calls for the year.

The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs. In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.

The service is confidential. We will not ask you for any personal information. We may ask for your zip code or other pertinent geographic information in order to track calls being routed to other offices or to accurately identify the local resources appropriate to your needs.

No, we do not provide counseling. Trained information specialists answer calls, transfer callers to state services or other appropriate intake centers in their states, and connect them with local assistance and support.

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Last Updated: 08/30/2022

Alcohol, Tobacco, and Other Drugs

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Misusing alcohol, tobacco, and other drugs can have both immediate and long-term health effects.

The misuse and abuse of alcohol, tobacco, illicit drugs, and prescription medications affect the health and well-being of millions of Americans. NSDUH estimates allow researchers, clinicians, policymakers, and the general public to better understand and improve the nation’s behavioral health. These reports and detailed tables present estimates from the 2021 National Survey on Drug Use and Health (NSDUH).



  • Among the 133.1 million current alcohol users aged 12 or older in 2021, 60.0 million people (or 45.1%) were past month binge drinkers. The percentage of people who were past month binge drinkers was highest among young adults aged 18 to 25 (29.2% or 9.8 million people), followed by adults aged 26 or older (22.4% or 49.3 million people), then by adolescents aged 12 to 17 (3.8% or 995,000 people). (2021 NSDUH)
  • Among people aged 12 to 20 in 2021, 15.1% (or 5.9 million people) were past month alcohol users. Estimates of binge alcohol use and heavy alcohol use in the past month among underage people were 8.3% (or 3.2 million people) and 1.6% (or 613,000 people), respectively. (2021 NSDUH)
  • In 2020, 50.0% of people aged 12 or older (or 138.5 million people) used alcohol in the past month (i.e., current alcohol users) (2020 NSDUH)
  • Among the 138.5 million people who were current alcohol users, 61.6 million people (or 44.4%) were classified as binge drinkers and 17.7 million people (28.8% of current binge drinkers and 12.8% of current alcohol users) were classified as heavy drinkers (2020 NSDUH)
  • The percentage of people who were past month binge alcohol users was highest among young adults aged 18 to 25 (31. 4%) compared with 22.9% of adults aged 26 or older and 4.1% of adolescents aged 12 to 17 (2020 NSDUH)
  • Excessive alcohol use can increase a person’s risk of stroke, liver cirrhosis, alcoholic hepatitis, cancer, and other serious health conditions
  • Excessive alcohol use can also lead to risk-taking behavior, including driving while impaired. The Centers for Disease Control and Prevention reports that 29 people in the United States die in motor vehicle crashes that involve an alcohol-impaired driver daily


  • STOP Underage Drinking interagency portal - Interagency Coordinating Committee on the Prevention of Underage Drinking
  • Interagency Coordinating Committee on the Prevention of Underage Drinking
  • Talk. They Hear You.
  • Underage Drinking: Myths vs. Facts
  • Talking with your College-Bound Young Adult About Alcohol

Relevant links:

  • National Association of State Alcohol and Drug Abuse Directors
  • Department of Transportation Office of Drug & Alcohol Policy & Compliance
  • Alcohol Policy Information Systems Database (APIS)
  • National Institute on Alcohol Abuse and Alcoholism



  • In 2020, 20. 7% of people aged 12 or older (or 57.3 million people) used nicotine products (i.e., used tobacco products or vaped nicotine) in the past month (2020 NSDUH)
  • Among past month users of nicotine products, nearly two thirds of adolescents aged 12 to 17 (63.1%) vaped nicotine but did not use tobacco products. In contrast, 88.9% of past month nicotine product users aged 26 or older used only tobacco products (2020 NSDUH)
  • Tobacco use is the leading cause of preventable death, often leading to lung cancer, respiratory disorders, heart disease, stroke, and other serious illnesses. The CDC reports that cigarette smoking causes more than 480,000 deaths each year in the United States
  • The CDC’s Office on Smoking and Health reports that more than 16 million Americans are living with a disease caused by smoking cigarettes

Electronic cigarette (e-cigarette) use data:

  • In 2021, 13.2 million people aged 12 or older (or 4.7%) used an e-cigarette or other vaping device to vape nicotine in the past month. The percentage of people who vaped nicotine was highest among young adults aged 18 to 25 (14.1% or 4.7 million people), followed by adolescents aged 12 to 17 (5.2% or 1.4 million people), then by adults aged 26 or older (3.2% or 7.1 million people).
  • Among people aged 12 to 20 in 2021, 11.0% (or 4.3 million people) used tobacco products or used an e-cigarette or other vaping device to vape nicotine in the past month. Among people in this age group, 8.1% (or 3.1 million people) vaped nicotine, 5.4% (or 2.1 million people) used tobacco products, and 3.4% (or 1.3 million people) smoked cigarettes in the past month. (2021 NSDUH)
  • Data from the Centers for Disease Control and Prevention’s 2020 National Youth Tobacco Survey. Among both middle and high school students, current use of e-cigarettes declined from 2019 to 2020, reversing previous trends and returning current e-cigarette use to levels similar to those observed in 2018
  • E-cigarettes are not safe for youth, young adults, or pregnant women, especially because they contain nicotine and other chemicals


  • Tips for Teens: Tobacco
  • Tips for Teens: E-cigarettes
  • Implementing Tobacco Cessation Programs in Substance Use Disorder Treatment Settings
  • Synar Amendment Program


  • Truth Initiative
  • FDA Center for Tobacco Products
  • CDC Office on Smoking and Health
  • National Institute on Drug Abuse: Tobacco, Nicotine, and E-Cigarettes
  • National Institute on Drug Abuse: E-Cigarettes



  • Among people aged 12 or older in 2021, 3. 3% (or 9.2 million people) misused opioids (heroin or prescription pain relievers) in the past year. Among the 9.2 million people who misused opioids in the past year, 8.7 million people misused prescription pain relievers compared with 1.1 million people who used heroin. These numbers include 574,000 people who both misused prescription pain relievers and used heroin in the past year. (2021 NSDUH)
  • Among people aged 12 or older in 2020, 3.4% (or 9.5 million people) misused opioids in the past year. Among the 9.5 million people who misused opioids in the past year, 9.3 million people misused prescription pain relievers and 902,000 people used heroin (2020 NSDUH)
  • According to the Centers for Disease Control and Prevention’s Understanding the Epidemic, an average of 128 Americans die every day from an opioid overdose


  • Medication-Assisted Treatment
  • Opioid Overdose Prevention Toolkit
  • TIP 63: Medications for Opioid Use Disorder
  • Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings
  • Opioid Use Disorder and Pregnancy
  • Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants
  • The Facts about Buprenorphine for Treatment of Opioid Addiction
  • Pregnancy Planning for Women Being Treated for Opioid Use Disorder
  • Tips for Teens: Opioids
  • Rural Opioid Technical Assistance Grants
  • Tribal Opioid Response Grants
  • Provider’s Clinical Support System - Medication Assisted Treatment Grant Program


  • National Institute on Drug Abuse: Opioids
  • National Institute on Drug Abuse: Heroin
  • HHS Prevent Opioid Abuse
  • Community Anti-Drug Coalitions of America
  • Addiction Technology Transfer Center (ATTC) Network
  • Prevention Technology Transfer Center (PTTC) Network



  • In 2021, marijuana was the most commonly used illicit drug, with 18. 7% of people aged 12 or older (or 52.5 million people) using it in the past year. The percentage was highest among young adults aged 18 to 25 (35.4% or 11.8 million people), followed by adults aged 26 or older (17.2% or 37.9 million people), then by adolescents aged 12 to 17 (10.5% or 2.7 million people).
  • The percentage of people who used marijuana in the past year was highest among young adults aged 18 to 25 (34.5%) compared with 16.3% of adults aged 26 or older and 10.1% of adolescents aged 12 to 17 (2020 NSDUH)
  • Marijuana can impair judgment and distort perception in the short term and can lead to memory impairment in the long term
  • Marijuana can have significant health effects on youth and pregnant women.


  • Know the Risks of Marijuana
  • Marijuana and Pregnancy
  • Tips for Teens: Marijuana

Relevant links:

  • National Institute on Drug Abuse: Marijuana
  • Addiction Technology Transfer Centers on Marijuana
  • CDC Marijuana and Public Health

Emerging Trends in Substance Misuse:

  • Methamphetamine—In 2019, NSDUH data show that approximately 2 million people used methamphetamine in the past year. Approximately 1 million people had a methamphetamine use disorder, which was higher than the percentage in 2016, but similar to the percentages in 2015 and 2018. The National Institute on Drug Abuse Data shows that overdose death rates involving methamphetamine have quadrupled from 2011 to 2017. Frequent meth use is associated with mood disturbances, hallucinations, and paranoia.
  • Cocaine—In 2019, NSDUH data show an estimated 5.5 million people aged 12 or older were past users of cocaine, including about 778,000 users of crack. The CDC reports that overdose deaths involving have increased by one-third from 2016 to 2017. In the short term, cocaine use can result in increased blood pressure, restlessness, and irritability. In the long term, severe medical complications of cocaine use include heart attacks, seizures, and abdominal pain.
  • Kratom—In 2019, NSDUH data show that about 825,000 people had used Kratom in the past month. Kratom is a tropical plant that grows naturally in Southeast Asia with leaves that can have psychotropic effects by affecting opioid brain receptors. It is currently unregulated and has risk of abuse and dependence. The National Institute on Drug Abuse reports that health effects of Kratom can include nausea, itching, seizures, and hallucinations.


  • Tips for Teens: Methamphetamine
  • Tips for Teens: Cocaine
  • National Institute on Drug Abuse

More SAMHSA publications on substance use prevention and treatment.

Last Updated: 01/05/2023

How to cope with dysthymia on your own

Many of us know what depression is at least by hearsay, and much less people know about dysthymia. So what is dysthymia? Dysthymia is the younger brother of depression. If during depression it is difficult or almost impossible for a person to lead a normal, active, full-fledged lifestyle, then one can live with dysthymia for years and even tens of years. Moreover, it is not easy to find any signs of the disease. And even doctors find it difficult to diagnose, because it is not always possible to discern dysthymia. nine0005

How dysthymia is expressed, its symptoms: firstly, it is a chronically depressed mood, when a person has little or nothing really happy. There are practically no reasons for this bad mood, rather, on the contrary, there is a lot to feel happy, but there is no feeling of happiness. Paradox. Someone can say that a person is “mad with fat” or does not appreciate what he has. But the causes are actually much deeper and more serious, and the symptoms too.

These are problems with falling asleep, with appetite, low self-esteem, feelings of hopelessness, lack of energy, indecision and other related disorders, such as increased anxiety, panic attacks, somatic diseases, excessive drinking, use of psychotropic drugs and others.

So, a little test for dysthymia.

Give yourself one point for each positive answer:

  1. Is it hard to make you happy?
  2. nine0015 Do you often have a bad, depressed mood?
  3. Do you rarely smile when you feel real joy?
  4. Is it difficult for you to have fun without cares, disconnecting from all problems?
  5. Do you live without much expectation of any joy in life?
  6. Do you evaluate life in general in pessimistic terms?
  7. Does life seem rather difficult to you?
  8. Do dark thoughts often come to your mind?
  9. nine0015 Does life seem meaningless to you?
  10. Do you quickly fall into despair?
  11. Do you often feel remorse for past mistakes?
  12. Are you often haunted by guilt for various reasons?
  13. Do you have a sense of self-doubt?
  14. Do you feel ashamed when you confess your failures?
  15. Are you not very talkative in conversation?
  16. You don't like jokes? nine0016
  17. Do you feel uncomfortable around happy, successful people?
  18. Do you remain indifferent to good sunny weather?

Add up all positive answers. Here's what happens: 15 or more positive answers indicate the presence of dysthymia, which can develop into depression if active measures are not taken in time. From 14 to 11 points - you have a borderline state with dysthymia. And less than 11 points - dysthymia does not threaten you.

For the treatment of dysthymia, drugs alone are not enough, and often they can only harm, worsen a person's condition after drug withdrawal. nine0005

Dysthymia manifests itself as a feeling of hopeless gray everyday life, everything seems to be flooded with routine. Everything has been going on knurled for a long time, without any changes, bright glimpses. And there are no real signs of these possible changes in the near future. By the way, the diagnosis of dysthymia is made if the symptoms described above and, first of all, the main one - chronically depressed mood have occurred over the past two or more years. Do not take temporary bad mood and the presence of only a few of the symptoms described as signs of dysthymia you have! nine0005

A tendency to dysthymia can be hereditary, as a rule, people whose parents did not encourage their good mood, equating fun with frivolity, irresponsibility and even stupidity, are more likely to be affected by dysthymia. And they themselves lived according to the same principle, considering it also not permissible to smile once again, rejoice at the successes and happy events of life in view of their “shortness, fluctuation and transience”.

Treatment of dysthymia or how to cope with dysthymia on your own, preventing it from developing into depression. nine0011

1. Dysthymia is more prone to those who live in an environment of pessimistic people who indirectly or directly dictate their rules of life to them: to live like everyone else, not to stick out, not to dream and not to strive for the fulfillment of their desires. Therefore, it would be logical in this case to conduct an “inventory” of your acquaintances with the subsequent exclusion of the most gloomy, hopelessly minded from among them, or at least filter the information that you receive from them.

2. As already mentioned, dysthymia often affects people who, in the first approximation, in life, everything is fine, well-established, settled. Analyze your actions and feelings lately, and if you find that you devote yourself too devotedly to some activities, but you don’t even get pleasure, there is reason to think about whether you need them. Sometimes dysthymia is disguised as being too busy, when quantity is not good for quality: you do not have time to feel joy, to feel satisfaction from each of the things done. nine0005

3. Determine your priorities, write down three tasks that you would like to accomplish this (next) year. The only condition is that it should not be material achievements. Not a salary increase, not a new car or apartment. Rather, they are life-forming values ​​that allow you to increase self-esteem. For example, pay more attention to your close environment, your health, find meaning in what you do every day.

4. Communication makes a person happy, but only quality communication. What follows from this? In life, you need to try to maintain a balance: be able to provide assistance, assistance, show sympathy and at the same time ask for help, openly express your feelings, without being ashamed that someone may misunderstand you. Only in flowing reservoirs is the purest and freshest water, but if you only “let in” other people's experiences, or constantly complain to others, or do neither, harmony in communication disappears and the overall quality of life decreases. It is necessary to learn how to equally express yourself in different roles, while correctly choosing interlocutors. But there would be a desire, and the right people will be found. nine0005

5. It is not only the achievement of goals that makes people happy, but also the pursuit of new goals. Therefore, when the main goals are achieved, for example, a higher education is received, a family is created, there is a good job and healthy children, there may be a feeling of inner emptiness. And passive enjoyment of the fruits of labor does not bring joy. We need to constantly strive for something. Therefore, it is worth making sure that you always have some new goals in reserve that meet your internal needs. nine0005

And a few purely practical recommendations to fill your life with bright colors and joyful experiences:

  • Do what you have never done, but wanted to do.
  • Think of your old friends and call them, find out how they are doing.
  • Talk to a stranger on the street, ask about something or give a compliment.
  • Get out to a beautiful place: a corner of nature or an exhibition, a conference, any unusual place that charges you with new experiences. And go there without delay. nine0016
  • Try to touch people with whom you communicate as often as possible. Start with active gestures if the first is not good for you.
  • Repeat this exercise several times during the day: every hour, take a deep breath in through your belly and a long, deep breath out through your mouth.
  • Several times during the day notice the expression on your face and consciously relax your facial muscles. Then, if you wish, smile. Straighten your shoulders, straighten your back. nine0016
  • Fix your attention on the soles of your feet several times during the day. Feel the weight of your body resting on the ground, feel the contact of the foot with the sole, with the floor.
  • Choose a person (one, two or more) and express your admiration for him, tell him how much you appreciate what he does.
  • To heal a past wound, call the person who hurt you and talk to them about it. Or write him a letter - you don't even have to send it if you don't want to. nine0016
  • During the day, try not to make judgments (neither good nor bad) about what you do, say, or what others say and do. Take everything without judgment, just listen to the sensations of your body, notice in which part of it you feel a response to what is happening.
  • Find some time in the evening and look at the starry sky without being distracted by anything. Think back to your childhood dreams. What are you dreaming about now, what do you want?..
  • Hang a note “I have the right to be myself” on the refrigerator door or in front of your desk. When your eyes fall on the note, repeat it to yourself several times. nine0016

Personal experience: a psychologist from St.

Petersburg on how to cope with the constant feeling of fatigue and depression


With dysthymia, you almost always feel tired and quite depressed. These symptoms are not so pronounced as to speak of depression, but they can seriously increase during exacerbations. Cognitive-behavioral psychologist of the Quality of Life Center Victoria Tsebrenko spoke about her personal experience of living with a condition similar to dysthymia and ways to help herself. nine0004

How dysthymia manifests itself and its exacerbations

According to the latest estimates, 3.3% of the population suffers from dysthymia. This disorder is officially included in the ICD-10 (International Classification of Diseases 10th Revision), it can be found in the section "persistent mood disorders". Even if you have not been diagnosed with this by a doctor, but you often feel depressed and tired, it is important to know how to prevent your condition from worsening. For example, I do not have an official diagnosis of dysthymia, but its manifestations are as close as possible to what I feel. nine0005

In a person with dysthymia, a feeling of depression and fatigue in a blurred form is almost always present, and at some moments it becomes more noticeable. This is a fairly constant condition, the symptoms of which may overlap with those of depressive episodes. Their severity is not so strong as to speak of depression. But noticeable enough to impair the quality of life. Due to the blurring of symptoms, a person may consider dysthymia as part of his personality, character, or feature of the rhythm of life. And when, against such a background, even greater declines in activity and mood occur (periods of exacerbations), a person simply cannot understand that something is wrong with him. Although at these moments he needs to take care of himself, seek help. nine0005

How does this smooth transition from a conditionally normal, background state of depression to a more severe one take place? In the background, you almost always feel sleepy, especially if you slept less than 7 hours. There is little interest and motivation in even the most beloved things, but there are flashes of high interest. Ordinary situations can trigger painful thoughts, such as: "I'm not doing well, I'm doing everything wrong." However, in a conditionally normal state, these thoughts are easier to track and stop so as not to plunge into a dangerous, depressogenic thought pattern. nine0005

It happens that a person is a little sad for most of his life, with “beaten” emotions. Against this background, even greater declines in strength and self-confidence occur.

During episodes of dysthymia, you begin to experience physical fatigue and exhaustion, regardless of the amount of rest and sleep. You can lie in bed all day and watch a series that makes you sick. Much more situations cause a painful assessment of yourself and your actions: if you experienced hopelessness, felt weak and stupid in a normal state, then during the period of exacerbation this seriously intensifies, it is much harder to suppress such thoughts. You often experience irritation, it is difficult for you to empathize with other people, even those closest to you. nine0005

When you feel tired and overwhelmed, this inevitably leads to a deterioration in the quality of your work. You negatively evaluate yourself and your work, trying to solve the problem with the help of processing. Symptoms in the form of fatigue and depression add up in a vicious cycle, support each other and reinforce. This cycle looks like this: “Tired and depressed - Fewer tasks done - I don't work well. I'm not doing well. I should do better. - Start working harder. “Fatigue and depression.” nine0005

Workhorse mode, as a rule, is turned on in relation to areas that require you to be as hyper-responsible as possible. You turn a blind eye to everything else - it is dangerous that, first of all, what brings you real pleasure, gives you a feeling of a full life. Communication with loved ones, hobbies, playing sports - all this you sacrifice, trying to make time for "really important things. " Because of fatigue and depression, it begins to seem that you basically don’t like anything. Here is another closed loop. "Fatigue and depression - Leave only the most necessary, reduce pleasant activities - Mood and strength decrease - Negative forecasts increase "I will not like this, I will get even more tired" - Fatigue and depression. In order to help yourself cope with dysthymia, it is important to break the vicious circles: on the one hand, do not overload yourself with tasks, on the other hand, do not refuse entertainment, communication and a pleasant stay. Do not trust too much the feeling of tiredness and sadness: return to life activity and pleasant rest, even if there is less joy from them now. nine0005

In people during depression and exacerbation of dysthymia, mental chewing gum, which consists in painful, unproductive thinking, often turns on. Often a person is too fixated on his well-being, on feelings of fatigue and sadness. This adds even more suffering, leads to the fact that you merge even more into a state of depression. It is important to train attention switching. Yes, you should pay attention to the symptoms of dysthymia, but don't get too stuck in them. Remember that episodes of aggravation end and even with limited strength, we can still do a lot. nine0005

So, here's how to notice the worsening of dysthymia in order to help yourself in time:

  • Irritability appears: everyone wants something from you, but you can no longer and do not want to.
  • More and more often you refuse to meet people you like, you are less engaged in any business
  • Drowsiness accumulates. Spend more hours in bed.
  • What to do

    • The first thing you need to understand is that rest is not a prize for a job well done, not a privilege, but a vital necessity. Our body and in particular the brain cannot fully function without enough sleep and rest. And the sooner we come to terms with this limitation of our body, the less often we will fall into a dangerous trap. You also need to understand that we are all really different. In no case do not focus on the work schedule, the amount of workload and rest from other people. nine0016
    • Do not compare yourself with yourself in more even periods. Yes, a month ago you felt more strength, energy and optimism. Now you can’t live at the same pace, you don’t have to try to “push”. We cannot always rely on the maximum of our capabilities. Stop scolding yourself: you do not choose this state, and in general you can’t influence it that much. Yes, it is normal. No, you are not weak and not a whiner.
    • Do not plunge into the state: notice fatigue in order to balance work and rest, but learn to be distracted from it, switch attention. Mindfulness techniques can help you with this. Don't trust fatigue and bad thoughts too much: you may actually be able to do less and worse right now, but still quite a lot. nine0016
    • Don't play almighty: delegate, refuse work that can be abandoned. Get plenty of rest, but keep it in moderation - if you notice that passive rest makes you feel even worse, it's better to get up and do something simple
    • Recognize the limitation of effort.
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