Depression and anxiety after divorce

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. SAMHSA’s 2020 National Survey on Drug Use and Health reports that approximately 19.3 million people aged 18 or older had a substance use disorder in the past year.



  • 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)
  • The 2019 National Survey on Drug Use and Health reports that 139.7 million Americans age 12 or older were past month alcohol users, 65.8 million people were binge drinkers in the past month, and 16 million were heavy drinkers in the past month
  • About 2.3 million adolescents aged 12 to 17 in 2019 drank alcohol in the past month, and 1.2 million of these adolescents binge drank in that period (2019 NSDUH)
  • Approximately 14.5 million people age 12 or older had an alcohol use disorder (2019 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)
  • Data from the 2019 NSDUH reports that 58.1 million people were current (i.e., past month) tobacco users. Specifically, 45.9 million people aged 12 or older in 2019 were past month cigarette smokers (2019 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:

  • 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 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)
  • An estimated 745,000 people had used heroin in the past year, based on 2019 NSDUH data
  • In 2019, there were 10.1 million people age 12 or older who misused opioids in the past year. The vast majority of people misused prescription pain relievers (2019 NSDUH)
  • An estimated 1.6 million people aged 12 or older had an opioid use disorder based on 2019 NSDUH data
  • Opioid use, specifically injection drug use, is a risk factor for contracting HIV, Hepatitis B, and Hepatitis C. The CDC reports that people who inject drugs accounted for 9 percent of HIV diagnoses in the United States in 2016
  • 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



  • 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)
  • 2019 NSDUH data indicates that 48.2 million Americans aged 12 or older, 17.5 percent of the population, used marijuana in the past year
  • Approximately 4.8 million people aged 12 or older in 2019 had a marijuana use disorder in the past year (2019 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: 04/27/2022

Life after divorce: 12 steps to happiness


Man and woman

Psychological observations suggest that a painful divorce can cause psychological trauma. If you do not notice it in time and do not start taking action, then after some time it can grow into post-traumatic stress disorder. The person may have intrusive thoughts about the traumatic event, nightmares, anxiety, and emotional outbursts in response to the breakup trigger. nine0003

In order not to end up in such a state, it is important to assess the risks of its occurrence in a timely manner.

Risks and consequences of divorce

  • The decision to leave was made by the partner, although you would like to continue the relationship. Moreover, the news of this decision came as a surprise to you. This situation hurts your self-esteem.
  • Your whole life has been built around relationships. You do not have your friends, apartment, work, interests. In this case, you have no one to rely on. nine0014
  • This is not the first time a relationship has ended with the departure of a partner. It begins to seem to you that something is wrong with you, you are cursed, not created for a family.
  • You got married very early, and the baton for making decisions and taking care of you, your husband practically took over from your mother. In this situation, you may start to feel like a helpless child.
  • You broke up, but you have to spend a lot of time together (shared apartment, job, business). In this situation, you cannot separate from your partner and start first healing from grief, and then building a separate life. nine0014

In all of these cases, you need to understand that you are at risk of psychological trauma and need support.

What is happening in the brain at this time?

Chemistry of emotions

Our thoughts do not define, but only explain the emotions caused by the hormonal cocktail.

Mood is formed mainly by dopamine and serotonin. Moreover, we can say that every trait of our character is associated with hormones - testosterone, dopamine / norepinephrine, estrogen and serotonin. nine0003

Serotonin is the hormone of joy. If you have a consistently high level of serotonin, then you can be called a calm, patient person with a long-established circle of friends. Strong and stable relationships, traditions are very important to you, you are a supporter of social norms. This means that your good mood system built into the brain is actively working in a stable and reliable family system with a single man for life. Accordingly, any loss of stability, destruction of relationships, violation of traditions primarily hit the leading system of obtaining joy from life. nine0003

This important step will help you reach the very bottom from which you can push off.

When there is nowhere to draw joy from, life becomes difficult. Heartache turns the world into a solid "Black Square" by Malevich. Success at work, achievements in fitness, an evening with friends, and even more so, the beautiful weather on the street cease to please.

Dopamine is the pleasure hormone. If you like novelty, you easily change hobbies, places of work, social circle, then you are more like a dopamine addict. It would seem that in this case, divorce should not negatively affect you. Indeed, it is easier for you to adapt to change. Unless you consider the breakup a personal failure that cannot be explained and changed. If the situation turned out to be uncontrollable, then dopamine drops, and with it the desire to do something. nine0003

How can I help myself?

12 steps to a happy life


Accept the fact of parting

If you were told a firm “no”, and even more so your ex-partner has a new one, you must accept the fact that in this story you have reached the epilogue. This important step will help you reach the very bottom from which you can push off. If you maintain hope for a continuation, you will not be able to help yourself, because why do something if everything will soon return to its place, you just have to wait a bit. Remember, this wait can take years. nine0003

2. Ground yourself

If you feel that the pain is unbearable, and black thoughts are running in circles in your head, then this exercise will help to shift the focus of attention from the head to the body. Place both feet on the floor, feet flat on the floor. Feel your feet, close your eyes and imagine that you are a tree that grows into the ground with its powerful root system. Stay in this state until a feeling of peace arises. Perhaps you can focus on contemplating the clouds, or a river will begin to glisten in front of your inner eye. Consider the details of this picture and learn how to supplement it with some new details. Over time, you can easily learn to calm yourself in any stressful situations by going to this safe place. nine0003

3. Reduce the pain

Remember, the main rule of dealing with mental pain is the same as with physical injuries. Diagnose the causes (in your case, we are talking about divorce), take painkillers and begin treatment. So diagnostics. Go through the list of risks that are listed at the beginning. What exactly hurt you the most? This is what we will fight against.

Painkillers at the initial stage are people who love you. Call friends and family, but only those who are ready to listen and support you. The key word is support. There is no need to communicate with people who will aggravate the emotional state with phrases from the series: “I told you, it’s my own fault.” nine0003

Remember, alcohol is not a resource. Moreover, temporary relief will lead you to aggravate the condition the next day. The pain, anxiety, depression and self-flagellation that you feel will increase exponentially when you are hungover.

4. Cry and grieve as much as you need

Unswept and unexperienced grief turns us into knights in iron armor, effectively blocking all emotions. In this case, not only sadness, heartache, despair will be blocked, but also joy, happiness, inspiration and the possibility of falling in love again in the future. nine0003

5. Understand your hormones

Find a source to support your serotonin and dopamine levels. The best helpers will be sports, the sun and proper nutrition.

Serotonin is most effectively raised by antidepressants, but they should be used if you are already depressed and have been prescribed them by a doctor. If, like me, you are a supporter of natural methods, then consult a nutritionist. He will advise the appropriate nutrition to help in the delivery of the amino acid tryptophan, which is responsible for the synthesis of serotonin. nine0003

In a situation of struggle for joy, there is no need to wait for motivation - you will not wait for it.

As for the benefits of the sun, its sufficient amount reduces the production of melatonin, an antagonist of serotonin. Lower melatonin, higher serotonin.

Dopamine rises when you set goals and achieve them, so do not give up on creative, work, sports ambitions. On the contrary, set yourself every day at first small, and then more and more complex, but achievable goals. In a situation of struggle for joy, there is no need to wait for motivation - you will not wait for it. The dopamine reward system works in such a way that joy overtakes after solving the tasks, and with it comes the motivation to complete the new plan. The main thing is to keep moving. nine0003

6. Limit any contact with your ex

Rent an apartment, split your business, go away often to friends, if right now you are still connected by a common job or living space.

Do not follow social networks (it is better to unsubscribe from your ex-spouse everywhere), do not ask your friends about him, do not look for reasons to meet. No need to give him secret (as you think) signals about yourself. Do not post photos, statuses, quotes like "I'm hard to find and easy to lose." Realize that the more time and energy you spend on an ending relationship, the longer you will be stuck in it. There is a wonderful story on this subject. nine0003

“An old man revealed to his grandson the truth of life:

— There is a struggle going on in man, similar to the struggle of two wolves, black and white. The black wolf represents evil: envy, jealousy, regret, selfishness, ambition, lies. The white wolf represents goodness: peace, love, hope, truth, kindness and loyalty.

The grandson thought about it and asked:

— Which wolf wins at the end?

- The wolf you feed always wins.

7. People's energy

Take yourself to exhibitions, fitness, to the pool, to walks. The very fact that you got out of bed without an emergency is already a small victory. They forced themselves to get dressed and put on make-up - another victory. Now the main secret. When you are among people (even strangers and silently), the feeling of loneliness goes away. Moreover, thanks to mirror neurons, you absorb the state of others. In the gym, theater and exhibitions, there are usually a lot of people with an active lifestyle who are working on their body and spirit. Let yourself be infected by their spirit. nine0003

8. Stop self-flagellation

The search for causes and errors at the initial stage is not constructive, and most often they turn into self-flagellation. Track the moments when you begin to mentally torture yourself. How to distinguish constructive analysis from unfair criticism? If you have been asking the same question for many days from the series: “How could I make such a mistake, be such a fool” and come to a state of pain and despair, then this is it - auto-aggression and a dead end. Once you realize you're self-flagellation, go back to the first steps on our list. nine0003

9. Give up plans of revenge

Sometimes the only source of joy is dreams of revenge. Fantasies can be different or one and the same, but in different scenery. The problem is that at some point these illusions become a source of dopamine and, accordingly, joy. Dopamine receptors do not distinguish between real achievement and vivid fantasy achievement, and the difference is very simple. Instead of doing small actions in real life (sports, walking, creativity), you start living in fantasies. Moreover, as a result, the former partner and thoughts about him become a source of reward. As long as he lives a real life with another woman, you lose the chance to meet a new real man. nine0003

10. Divide the boundaries

Start to gradually form your own world, separate from your partner. One in which you have your own meanings, interests, friends and plans. It will become easier for you to accept the individuality of your partner and survive resentment towards him. Of course, working with boundaries is a long-term psychotherapeutic process. Reading the gestalt prayer will help you tune in to it:

“I am doing my job, and you are doing your job.

I do not live in this world to meet your expectations, and you do not live in this world to meet mine. nine0003

You are you.

And I am me.

If we meet each other by chance, it's wonderful.

And if not, so be it.”

11. Open your heart though it hurts

Take advantage of the handicap principle. Amotz Zahavi, the author of the principle, believed that life-threatening signs carry information about the quality of the genome. For example, a large tail size, too bright plumage, loud screams, excessively large horns - all this is a measure of the quality of the genome. With them it is more difficult to hide and run away from predators, only a highly adapted individual will be able to survive with such excessive decorations until the moment of reproduction. nine0003

Only the insanely brave win truly worthwhile prizes

Let your experience of divorce become a handicap principle. After all, to open your heart and continue to believe in love, having survived the pain of betrayal, the collapse of illusions and plans, a drop in self-esteem, depression, fear - this is pure madness.

As absurdly bold as the oversized and flamboyant peacock's tail. But only such crazy brave men win really worthwhile prizes! Any man understands that if you are so fearless and strong, you will not fall into hysterics from every trouble, but on the contrary, if necessary, you can become a reliable support. nine0003

12. Search for meaning

Now that you have gone through all the previous steps, you are ready to have a constructive dialogue with yourself. Remember, I wrote that in the initial stages it is not necessary to endlessly remember the past and look for mistakes in it? When you have come to your senses, shared boundaries, found hobbies, learned to ground yourself, then you can begin to analyze past experiences without self-flagellation.

Psychologist Viktor Frankl wrote about the need for an existential turn: you need to stop asking yourself the question “why am I doing this?” and start asking “what can I take away from this?”. When you put the question in this way, you may find that, thanks to what happened, you became closer to family and friends, found new interests, acquired a dream figure and became, on the whole, a completely different person. Perhaps you already know at least one answer to the question: “Why did this happen to me?” nine0003

Onward to a new life

I believe, and the experience of clients confirms my belief, that divorce is precisely the crisis that turns us inward. For many, before divorce, their whole life was determined by the needs of their partner. There was no time for everything. When life confronted me with a divorce, a huge hole formed in my heart. In the beginning, I just wanted to lie down and die. Then I had to push myself forward through despair and pain, further and further towards new meanings. When your legs gave out, friends came to the rescue, and you learned to lean first on them, and then slowly on yourself. nine0003

A woman who has learned to rely on herself is no longer afraid to turn her face to the mirror, look into her eyes, wink and go outside. She is ready to carry out plans, dreams, flirt with attractive men, get married and just enjoy life.

About the author

Sofia Enikeeva — psychologist, member of the Association for Psychoanalytic Coaching, member of a charity project for psychological assistance to chemically addicted people. Her website.

Text: Sofia Enikeeva Photo Source: Getty Images

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