Depression acceptance stages

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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    For additional resources, please visit the SAMHSA Store.

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

Denial - anger - bargaining - depression - acceptance. Edition 66.RU in five stages of mental quarantine — news about health in Yekaterinburg

Marina Shuleva, PR director:

— I walk through the stages like in a large amusement park, each time bypassing denial. Apparently, there is still too much queue for this attraction. Most of all, of course, I like the carousel " Acceptance" . But the ticket for it is too expensive, and the ride is too short.

That's why my subconscious mind drags me more and more often to the attraction " Depression" . It is somewhat similar to the “Engine from Romashkovo” in the TsPKiO: a rusty little train, painted with bright colors, creaking, slowly drags in a circle to the same song, from which after 10 minutes it starts to feel sick. Cheap. Angrily. Seasick. And getting off on the go is difficult.

Dima Shlykov, editor-in-chief:

Stuck in anger stage . I can't help myself. Infuriates. All. From the outside, it's probably not very noticeable. But the demons of malice and destruction rage in me. Sometimes they break out. I am very ashamed of myself afterwards. Sounds like some kind of hormonal imbalance. Or is it just the result of daily suppression of emotions. But now it will not work to not press them. Too much has accumulated.

I caught myself really wanting to grab things and throw them at the wall. While I restrain myself and even try to direct my demons in a peaceful direction. I thought that I was not the only one, and together with the demons I figured out a cool (no) business idea in the elite segment. For a lot of money, based on the photographs of the customer in a conditionally empty room, we accurately reproduce the interior of his apartment. And then we launch him there for two hours and let him do whatever he wants: beat, tear, crush, break, kick and torment. I think it will be in demand. And the longer the quarantine, the higher the demand will be.

Sasha Morozova, journalist:

— A week ago I wrote to my sister that I have depression . It is in the context of the five stages of acceptance. A week later, acceptance seems to have begun. In any case, I'm glad that I still have a job that pays, and there is a fear of losing it. Hmm… judging by how gloomily I described it all, and by the fact that I enjoy my work, I still have depression.

Olya Koryukova, SMM guru:

- All I experience during self-isolation is relief . Seriously. As the comedian Idrak Mirzalizade rightly noted: “Finally, I am not the only one standing still.” No need to worry anymore about the fact that the passport is gathering dust on the shelf, and for a whole year I have not reached the pool. I legitimately waste my life

Dasha Nemchaninova, journalist:

— My entire regime of self-isolation consists of three stages — anger, depression and acceptance . And most often I am chatting throughout the day from state to state. Right now, I'm in the acceptance phase. It seems that she is used to what is happening around. Found some positives. I even like that the day follows the same schedule: get up at the same time, have breakfast, work, do exercises, go to the store, go to bed. Everything is clear and calm. But it is now.

Depression sets in from time to time, when you don't want anything at all. Such apathy that you have to force yourself to do something. And sometimes I feel angry: “Oh my God! Yes, how this coronavirus and quarantine shook me! Why can't I go and go where I want? How terrible it is to wear a mask in the store when your nose itches terribly!” At such moments, I just wait for everything inside me to calm down again and that very calm “acceptance” of the situation will come.

Lesha Zemlyakov, journalist:
— I had no denial, much less anger. It was immediately acceptance of . Probably, this is the case when I treat what is happening philosophically. I won’t say that I feel eschatological delight, but I’m not 100% sure that I want the quarantine to end as soon as possible. A unique and very interesting situation (primarily in terms of people's behavior), despite all its horror. And, I am sure, we will remember and analyze it for a long time. You say I'm crazy? It seems not. Yes, it's definitely acceptance.

Kirill Zaitsev, journalist:
- This is definitely acceptance of . True, with the message: “Well, […] (a synonym is used for the word what, - approx. ed. ) to do.”

Polina Dikushina, SMM guru:

— I started with accepting . When it became clear that we were going remote and self-isolating, I took it absolutely calmly. I understood the inevitability and saw how it all works in other cities/countries. I prepared and tried to make the most of it for myself. I started cooking more, exercising at home more often and pretending that nothing had changed at all.

And then it dawned on me that all this was hard and scary, and most importantly, that he would be with us for a long time. And immediately flew into the stage " depression ", which is very close to me. Despair and horror, loss of interest in life - it's all about me now. Other stages were not even touched on a tangent. This is bad? Just awful. I don’t know how all this would have ended for me if work hadn’t taken up most of my life.

Polina Pavlova, managing editor:
— I go through these five stages every day. New day, new circle.

Denial is the morning, from the first alarm until the moment I sit down at my laptop. Anger is before noon, when plans are made for the day and it becomes clear how much pain and suffering there will be in this day. Bargaining is the shortest stage. It's a moment of tiny enlightenment and hope that things won't be so bad. The main part of the day is depression . And closer to 18:00, when it is already quite obvious that no work will end for a few more hours, comes the acceptance of .

Artem Ocheretin, editor of special projects:
- In order not to go through the second circle, I decided to bring comfort in the stage of " Acceptance" . Catch a few life hacks.

  • Exactly 60 minutes of a lunch break is saved due to the fact that the food is ready and just waiting behind your back (or seven steps from the workplace - whatever). Spend 10 minutes eating and 50 minutes walking around the house. It doesn't matter how many laps. An antiseptic in your pocket and a mask on your face are important.
  • Exactly at 18:00 we change the office chair for a hard stool. Guaranteed not to stick to the computer before midnight.
  • Oh, it's already 20:00 and your butt has become uncomfortably square? Turn off your computer, you are no longer friends. Look what he did to you, oh-oh-oh!
  • I read somewhere that any new task will gladly wait five minutes while I do the bar. Expectation: “Problem — Plank — Problem — Plank — Problem — Planck.” Reality: "10 tasks - a sandwich."

At what stage are you now?

Tell us on social networks: Facebook, VKontakte, Instagram or in our telegtam chat

Stages of accepting the inevitable: what you need to know over which we have no influence. Confirmation is the COVID-19 pandemic and the global crisis, due to which many people lost their jobs, the owners were forced to close both projects and organizations completely. During these drastic and unpleasant changes, we go through the five stages of accepting the inevitable: denial, anger, bargaining, depression, and acceptance.

Since HR is a person whose job is to interact with people, we decided that it would be useful for you to understand both how you feel in difficult situations, when nothing depends on you, and the feelings of employees. Today we'll discuss Elisabeth Kübler-Ross' model for accepting the inevitable and break down each of the five stages.

A bit of history: the Kubler-Ross model

Elisabeth Kubler-Ross is an American doctor and psychiatrist who was the first to reveal and describe all five stages of accepting the inevitable in her book On Death and Dying. Initially, the practice of the five stages was used only to help people come to terms with the loss of a loved one due to a terminal illness.

After the release of Elizabeth's book, this model has been actively used in psychology to help people who are in a state of stress or crisis. Today, this technique is known all over the world. It helps a person to look at the situation from a different perspective, rethink the problem, accept it and move on.

How long each of the stages will last depends on the person's environment, his status in society, and the characteristics of the generation to which he belongs. For example, people of generation Y, when inevitable and unpleasant situations arise, can radically change their lives: move to another city or withdraw into themselves. Thus, they want to start from scratch and escape from problems.

Stage #1. Denial

The first stage in which a person tries in every possible way to deny reality, ignoring both external events and the internal state. At the stage of denial, we feel stupor, shock, pretend that nothing has changed.

The danger of this state is that a person accumulates a lot of negativity and negative energy, because of which this stage can last a very long time. But on the other hand, such detachment and stupor gives a person time to realize everything in proportion and accept difficult information in stages, and not en masse.

How to help a person to pass the stage of denial?

It is very important to maintain contact with a person and gently help him return to reality. Try asking him questions he's afraid to answer. For example, what happened, how does he feel about it, what would he like to change, etc. The answers to these questions will help a person to see the problem from different angles. It is difficult to do this on your own, because the subconscious mind understands that after that it will be very painful.

A person can go through this stage both in a few minutes, and in a few weeks, months or even years. In most cases, the duration of this stage takes about two months. It is important to remember that denial is a normal and inherent reaction of the body to a difficult situation and it is impossible to avoid it.

Stage #2. Anger

After realizing the situation or after unpleasant changes, the stage of anger begins, which is considered one of the most difficult. At this stage, a person experiences bursts of aggression, thinks that no one understands him and is looking for an object with which he will be angry. It can be bosses, neighbors, friends and even the person himself.

The danger of this stage is that a person may try to restrain the negative energy inside, because of which it will not be possible to get out of this state painlessly. There are many ways to release negativity. For example, go in for sports: exercise, jog, fitness, or join the art: draw, write poetry, etc. Sublimating negative energy into some kind of activity will help balance the hormonal background, which will mitigate anger, aggression and tension.

In addition, another danger of the anger stage is that in this state we can lash out at others. Because of this, relationships with people can deteriorate, you can lose friends or even work.

How to help a person to pass the stage of anger?

Help find a way to splash energy into some activity and do not take its negative emissions to heart. Remember that this stage proceeds faster than the others and is delayed only in rare cases.

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Stage #3. Bargaining

When a person realizes that the situation or changes are inevitable and there is no point in looking for the guilty, the third stage begins - bargaining. At this stage, we want to postpone the inevitable, correct the situation by starting to bargain. Psychologists call the trading stage “What if?”. It is in this phrase that the very trades are hidden. A person asks himself questions, what if I change, find another job, behave differently, then maybe everything will change. In this way we bargain with ourselves or even with those around us.

The danger of this stage lies in the loss of authority and reputation when bargaining with subordinates, employees, partners in order to pity them. In addition, at the trading stage, a person feeds himself with the illusion that the problem is about to be solved and everything will be as before. Bidding lasts for several weeks, but in individual cases, it can be delayed for an indefinite period.

How to help a person pass the bargaining stage?

At this stage, little depends on others. All that is needed is time, after which the person himself realizes that attempts to find solutions do not bring the desired result. Then he will move on to one of the most difficult stages - depression.

Stage #4. Depression

The stage of depression is considered one of the most difficult and protracted, and it sets in abruptly, literally in one second. Depressed people behave differently, some can withdraw into themselves, not go out and not take care of themselves, while others, on the contrary, actively communicate with people, work, but suffer at the same time.

The danger of depression is that because of it a person looks negatively at the whole world around him. He can be financially secure, constantly travel, have many friends, but perceive everything in a negative way and not receive positive emotions. According to WHO data for 2018, about 264 million people worldwide suffer from depression.

Another danger of depression is the activation of all addictions. A person begins to smoke, drink alcohol, seize grief, constantly play games. Thus, he is looking for an activity that will help him to forget at least for a while. In addition, during depression, people often experience complete emotional and professional burnout.

The stage of depression is often noticeable in the working environment. Employees who experience depression are extremely demotivated and often absent: they take sick leave, vacations.

How to help a person go through depression?

At the stage of depression, a psychologist is the best help, since this is already a psychological problem. As an HR specialist, you can spend 1:1 with an employee, talk to his manager, perhaps offer a vacation or pay a psychologist. Remember that a depressed person needs the support of a team and loved ones.

Stage #5. Acceptance

At this stage, a person begins to reason rationally and accept the situation. He recognizes that the problem does not allow him to live normally and understands that he needs to step over it and move on. After the acceptance stage, we begin a “new life” with new circumstances.

Learn more