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Depression and marriage issues


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.

  • Suggested Resources

    What Is Substance Abuse Treatment? A Booklet for Families
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    It's Not Your Fault (NACoA) (PDF | 12 KB)
    Assures teens with parents who abuse alcohol or drugs that, "It's not your fault!" and that they are not alone. Encourages teens to seek emotional support from other adults, school counselors, and youth support groups such as Alateen, and provides a resource list.

    After an Attempt: A Guide for Taking Care of Your Family Member After Treatment in the Emergency Department
    Aids family members in coping with the aftermath of a relative's suicide attempt. Describes the emergency department treatment process, lists questions to ask about follow-up treatment, and describes how to reduce risk and ensure safety at home.

    Family Therapy Can Help: For People in Recovery From Mental Illness or Addiction
    Explores the role of family therapy in recovery from mental illness or substance abuse. Explains how family therapy sessions are run and who conducts them, describes a typical session, and provides information on its effectiveness in recovery.

    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. 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.

Alcohol

Data:

  • 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

Programs/Initiatives:

  • 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

Tobacco

Data:

  • 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

Resources:

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

Links:

  • 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

Opioids

Data:

  • 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

Resources:

  • 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

Links:

  • 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

Marijuana

Data:

  • 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.

Resources:

  • 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.

Resources:

  • 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

Can marriage undermine your health?


Irina Balmanzhi

Is there hostility in your marriage that oppresses you? Does your spouse have a chronic disorder? Then be careful! Despite the fact that married people are generally healthier than others, studies have shown that in these two situations, partners may face an increased risk of developing obesity and cardiovascular disease. nine0004

Janice Kickoult-Glazer, director of the Ohio State University Institute for Behavioral Medicine Research, and Dr. Stephanie Wilson explored—and discussed in this interview—how relationships affect our health.

Is it true that in general marriage has a good effect on well-being?

Janice: A number of studies show that marriage generally reduces disease rates, improves recovery from surgery, and reduces the risk of cancer. At the same time, loneliness can be almost as damaging as smoking, high blood pressure, obesity, or a sedentary lifestyle. nine0004

Stephanie: A recent analysis found that quality relationships in marriage are almost as beneficial to health as daily exercise or proper nutrition.

But there is another side. Studies show that the risk of developing obesity, diabetes or metabolic syndrome increases dramatically (for example, in the case of obesity - twice) if a partner has one of these diseases. How to explain such influence?

Janice: If your partner leads a less healthy lifestyle, you begin to adopt his habits, experiencing mild social pressure.

Constant disagreements in the family cause stress, which also leads to health problems. What does it express?

Janice: Cardiovascular disease, hypertension - the entire group of diseases associated with metabolic syndrome. Family conflicts double the risk of its occurrence.

Stephanie: Many of the chronic diseases seen in unhappy couples are caused in part by underlying inflammatory processes.

In addition, family troubles and depression often go hand in hand. An unhappy marriage is a very fertile ground for depression, and depression is known to be destructive to health.

It sounds like most ailments are related to inflammation.

Janice: This is one of the main causes of disease, although of course there are others. Inflammation is associated with many different diseases. And stress can speed up inflammation. nine0004

Do behaviors also change as a result of stress? How is this related to poor health?

Janice: Most of us don't tend to eat more broccoli when we're stressed. As well as follow the rest of the rules that our mothers usually insist on: stick to a healthy diet, do physical exercises, do not abuse alcohol. Under the influence of stress, we begin to neglect all this.

Stephanie: Sleep is especially important for health, and it is also disturbed if you experience marital stress. nine0004

Can all this contribute to inflammation?

Janice: All of the behaviors we've talked about set the stage for inflammation. When you eat fatty foods and eat an unhealthy diet, it can cause inflammation. If you abuse alcohol, smoke, lead a sedentary lifestyle, then all this can be the cause of inflammation. Symptoms of depression can also trigger inflammation.

Stephanie: Sleep disturbances are also associated with higher levels of inflammation. nine0004

How can we prove that marital disagreements affect physiology?

Janice: In early studies, we brought couples into the lab, inserted catheters into their arms, and asked them to discuss any disagreement. We tracked how the level of stress hormones in the blood changes depending on the degree of irritation. When people were angry and hostile, stress hormone levels increased significantly.

Can you give an example of what behaviors you tracked? nine0011

Janice: Bad marriages often have similar symptoms. The classic sign is the harassment-rejection pattern, where one person expresses dissatisfaction and the other does not want to discuss it. Another sign is a negative escalation: one person says something bad, another responds in the same tone, the conflict escalates more and more and more.

Do men and women react differently to family problems?

Janice: There is a lot of psychological literature that says that women remember both positive and negative events in much more detail than men; women think about what's going on in a relationship much more than men. So it would be surprising if disagreements did not affect women's health more.

On the other hand, when a couple has a good relationship, a person may have health problems if his partner is sick. What exactly is going on?

Janice: The most revealing data comes from observing extreme situations where spouses cared for partners with Alzheimer's disease. A few years ago, we proved that the immune systems of such spouses react worse to vaccination; their wounds heal more slowly; they have higher levels of inflammation. Today, there is other evidence (from studies of less dramatic cases) that confirms that the partner’s illness really matters. nine0004

Older couples in happy marriages face greater health risks than younger people if one of the partners is sick. Why?

Janice: Older couples have longer, stronger relationships. At the same time, the older a person is, the more vulnerable he is psychologically. Stress at 20 most likely will not lead to illness or serious health consequences, but at 65 or 70, a noticeable decrease in the immune response begins and the level of inflammatory processes in the body increases. nine0004

Stephanie: Generally, as people get older, their social connections decrease. Therefore, the psychologically elderly are more dependent on marital relationships.

Is there a way to protect your health when marital problems arise?

Janice: Family problems are well resolved through marital therapy (as opposed to individual therapy). It helps to form the right view on specific problems.

Stephanie: She also forces you to make an effort to look at the situation through the eyes of a partner, and helps to approach the problem as a team. We have only a few studies on this topic. But they show that if the therapy is effective, stress hormones are produced less intensively.

How to reduce stress when one of the partners is sick? The most obvious advice is “support your spouse.” But how can you not be too pushy or picky?

Stephanie: If you support a person without infringing on their independence (for example, saying: "I believe in you; it's a challenge, but you can handle it"), you will help him feel confident in himself. Empathy, as observations show, is also effective: you need to listen carefully when a partner wants to share something, and in general, show warmth and love.

Has anything you learned in your research changed your own attitudes? nine0011

Janice: Yes - the idea of ​​paying attention to relationships; what matters is how you talk and think about them. And yet, if a partner is sick, it is very important to take care of yourself no less than about him.

My husband has Alzheimer's disease. When he was first diagnosed with mild cognitive impairment, I felt like a train was coming towards me. Our lives are very closely intertwined. My husband was my main research assistant. And we have a really good, close relationship. nine0004

I tried to make sure that I had a busy life outside of marriage (for example, communication with friends plays an important role), and I began to take care of my own health more. I know all too well what happens when people don't take care of themselves.

Can separation also cause anxiety, depression and stress? And what is worse for health - to live in a non-ideal relationship or to be left alone?

Stephanie: Data is ambiguous. One study found that single people have lower blood pressure than those in unhappy marriages. And in another study, single people and people living in unhappy marriages experience equally severe pain with rheumatoid arthritis. At the same time, in both cases, happily married people felt better than the rest. nine0004

When it comes to divorce, many do well and recover quickly, but a minority (10 to 15 percent) face increased health risks.

When it comes to loneliness, you can also feel lonely in a marriage. Well, if you are single, then you need to communicate more with friends and family - this is really very important.

Interviewed by Ricky Rusting

Original text: www.washingtonpost.com
Translation: MIF publishing house
Post cover from here

If you want to build harmonious relationships, reduce the number of quarrels with your partner and create a truly happy family, we recommend reading the book by clinical psychology professor Sue Johnson "Hug Me Tight" .

When your marriage is a source of stress. How to avoid stress and depression in the family

Until recently, psychotherapists focused only on the problems of a person suffering from depression: symptoms, personality and emotional make-up, cognitive style of perception, etc. And not enough attention was paid to its impact on family relationships . Psychotherapist and psychologist Michael Yapko pioneered the study of how depression affects marriage and family. nine0165

A good marriage contributes to a better quality of life. It has been proven that people who are happily married:

  • are generally happier and less likely to suffer from mood swings than ordinary people;
  • are in good physical shape and suffer from serious diseases less than ordinary people;
  • recover better from illness or injury;
    • 90,188 are generally more satisfied with their lives.

On the other hand, people who are dissatisfied with their family life are ten (or even twenty-five) times more likely to suffer from depression than people who are happily married. An unhappy marriage is practically a guarantee of the development of depression in one of the spouses. Research also shows that at least half of all people who seek help from a therapist and are married cite their marriage as a major source of stress. nine0004

To summarize:

  • There is a clear link between unhappy marriages and the development of depression.
  • An unhappy marriage increases vulnerability to depression.
  • An unhappy marriage can cause depression.
  • Depression can cause family quarrels and conflicts.
  • Family therapy helps save a marriage and get rid of depression.

Conflicts and quarrels in family life are inevitable. But if, in addition to them, anger, cruelty, offensive manipulations, lies and coldness or apathy have crept into your relationship, one of the partners will almost certainly feel out of place. And such a feeling in adverse circumstances increases the risk of developing depression. However, nothing affects you as much as your marriage. It defines your physical (where you live) and personal space (this person is always there, even when you or he is not at home), which is why you have to regularly interact with your other half and react to her words and behavior. nine0004

A marriage does not break down suddenly. Just like depression, which does not come “suddenly” (as a rule, it develops over several years under the influence of certain factors), marriage breaks up gradually. It is extremely important that before you get married, it is good to understand for yourself all the issues raised in this article. You will need to find out what you both think about, how you approach problem solving, how you handle failure, how well you can control your behavior, get along with each other, and how high or low your expectations are for yourself and your partner. In order to build a happy marriage that would not falter under the yoke of problems and troubles in life, you need a certain skill. Ideally, before becoming husband and wife, you meet for a while and study each other to understand where this relationship will lead. nine0004

Meetings take time and require thoughtful decisions that go beyond impulsive actions. Each interaction requires a clear exchange of information about where your boundaries “are” and what this or that action of yours means. If you blindly follow the voice of your heart and focus all your attention on the sweet excitement of a new relationship, everything that you do not pay attention to will most likely return to you a hundredfold. And bad relationships practically guarantee the development of depression in one of the partners. nine0004

Choosing a partner

Relationships require effort and attention, even when they are joined by two healthy optimists. Depression causes people to make one bad decision after another.

  1. People who don't like themselves don't believe they can please anyone else. And if someone suddenly begins to show them the signs of attention that they have always dreamed of, the trap slams shut. By the time they realize that they have been captured by the one who really offended them, they find themselves emotionally stuck in this situation and do not feel the strength to get out of it. nine0189
  2. People who don't like themselves train their partner to agree with this thought. This is what is called "self-checking" - agreeing (and thus confirming) with your partner only when he sees you in the same negative light that you see yourself. If I consider myself stupid, then only when you call me stupid do I believe you, only then do I consider our feedback reliable, because it confirms my beliefs. This is a powerful tool for creating an atmosphere of pseudo-agreement in a relationship. nine0189
  3. People who do not like themselves decide to build relationships only with the same "inferior" people. They may think that this is evidence of tolerance or compassion, when in fact, in this way they only add pain to their lives. Adding to the pain is what scientists call "reconstruction of family relationships": you grow up with the idea that all marriages are the same as between mom and dad, and then recreate this model in relationships with your partner. Depressive marriage as a model serves as a source of new depressive relationships. nine0189
  4. People who don't like themselves believe that no one but a depressed person can understand them. They distance themselves from happy people under the pretext "they will never understand me anyway." Being around someone active, cheerful and positive is hard for them.
  5. Perhaps the most common reason why people suffering from depression choose their partners incorrectly is not that they have a need to suffer more than they already suffer, but that they rely too much on their feelings. And when you are depressed, you rely on depressive feelings. And until you realize that you have what it takes to change relationships, and that you must change those relationships, you will make bad decisions just to "follow your heart" or "go with the flow." nine0189

None of the choices you have to make every day of your life is as powerful as your decision to get married. Carefully evaluating others before becoming attached to them is essential. You need to choose the right person and be the right person to keep your marriage long and healthy.

Similarities and differences between you

We are generally attracted to those who like us—people with similar values, interests, and outlook on life. We like people who support us, who see things the way we do. And while it is the similarities that draw people to each other, how they relate to the differences between them largely determines whether the relationship between them will flourish or die in the bud. Pay attention to how your partner deals with differences of opinion. Does he express his opinion or just make it clear that "if you have even a drop of common sense, you will agree with me"? Does he/she make value judgments like “thinking this way is wrong”? nine0004

All people are different. And if you do not set your own boundaries, which will give you and your partner the opportunity to show respect for each other, at an early stage of the relationship, criticism, hostility and even cruelty will “sneak” into your relationship over time.

Psychologist John Gottman has been studying marriage in his lab at the University of Wisconsin for over a quarter of a century and has a clear understanding of why some marriages survive and others fail. A scientist is able to predict the fate of a couple just by observing their behavior. His predictions turn out to be correct in a colossal 91% of cases. In his book Why Marriages Succeed or Fail, Gottman describes the human skills that hurt a marriage and offers specific solutions for each. He identified four negative relationship patterns that almost always result in a breakup. He called them "The Four Horsemen of the Apocalypse".

  1. Criticism in the form of becoming personal.
  2. Prejudice in the form of insults, ridicule and teasing.
  3. Defensive behavior in the form of excuses, excuses, and hitting back instead of a healthier response to concerns.
  4. Obstacles in the form of refusing relationships and avoiding conversation (silence or monosyllabic answers).

Kindness and fun are victims of depression

People suffering from depression gradually lose their ability to enjoy and withdraw from life. The attention of depressed people turns inward (the "inward orientation" I have repeatedly warned you against) and focuses on problems and negative feelings, adding every hurt, real or imagined, to an ever-growing list of complaints. They stop noticing all the good things that happen to them. nine0004

Gratitude, pleasure and kindness need to be trained to become constant companions of your relationship. In the end, even relationships where both partners are not suffering from depression need to be kept healthy, fresh and fun, and this will require some effort. Depression only makes it harder. Before you feel a downturn in your mood, you should make sure that the illness does not harm you or your relationship.

Your problems will never completely disappear: life will continue to challenge you with difficult tasks.

Learn more