What to tell a depressed friend
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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Suggested Resources
What Is Substance Abuse Treatment? A Booklet for Families
Created for family members of people with alcohol abuse or drug abuse problems. Answers questions about substance abuse, its symptoms, different types of treatment, and recovery.
Addresses concerns of children of parents with substance use/abuse problems.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. 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).
Alcohol
Data:
- 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
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)
- 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
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 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
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:
- 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.
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: 01/05/2023
How to Help a Depressed Person - Such Things
Every week, Such Things answer questions from readers. Today we will talk about depression, or rather, how to be a good friend for a person who finds himself in this state.
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Approximately one in four has experienced depression at least once in their life. Although sometimes we, wringing our hands, call depression just an attack of bad mood. It is necessary to distinguish between blues, a mild depressive state (minor depression, subdepression) and a real clinical depression, which can drag on for several months.
Clinical depression is characterized by three main symptoms:
- Bad mood. But not the kind that usually happens after a hard day or week. With depression, a person loses the ability to rejoice, does not enjoy the usual things - food, communication with friends, sex, music, films. This condition is called anhedonia.
- Violation of thinking. It is difficult for a depressed person to think, it seems that thoughts are “like jelly”. Work is slower.
- Motor retardation. Depression is always accompanied by a constant feeling of fatigue. Forcing yourself to go somewhere in this state is extremely difficult.
If these symptoms are observed for more than a month, then this is a reason to see a doctor, but you can cope with mild depression on your own, with the help of relatives and psychotherapy. But relatives should remember a few simple rules - what to do, and what should never be said. That's what psychologists recommend.
Let the person experience this state
Let's say your loved one experienced a failure, his expectations were not fulfilled, his plans were not realized.
He is very upset, he is not happy with what he usually loves. Don't rush him. Say phrases: “Yes, stop thinking about it!” or “We need to move forward!” - it is forbidden. The state of sadness is not so bad for a person. Sadness allows you to relax a little after the race that was before, to come to your senses, to rethink, so that after that you can smoothly get out of this state.
Be honest
“Yes, you failed to achieve the goal, but let's take a break and try again if you want, no - then try yourself in something else.”
Do not discount failure
Phrases: “Forget it”, “Stop it”, “Your failures mean nothing” will only make things worse. A person can and should learn from his failures a lesson. It just takes time.
Recognize the importance of this situation
“Yes, you tried, it didn't work, but it's important that you did it! The feelings you are experiencing right now are very important.
Sadness, loss of strength - all this is natural, but I am there and will help you.
Be careful with jokes
Do not joke rudely, scoff, ironically over the situation. Of course, it’s hard when a person close to you is in a bad mood, you want him to smile, and not go gloomy. It may seem that if you joke and make fun of the situation, then he will immediately cheer up and everything will immediately go smoothly. But it will most likely only get worse. Any rude intrusion, criticism will prevent you from getting out of a depressive state.
Do not force
It is strictly forbidden to forcefully drag a person to parties and walks in a depressed state. The mistake is that when we see a depressed person, we want to give him the energy of life. We say: "Look how great it all is!" But a person is simply not physically able to appreciate it. When he sees how people enjoy life, this only worsens his condition, he begins to wonder: "Why can't I do that?"
No aggression
Seeing that a person closes even more, in no case should one speak aggressively: “Why are you still in anguish?”, “Why are you sitting and being sad?”, “Pull yourself together, rag!” Such phrases are forbidden even as a joke.
Be patient
Do not do anything excessive, be more restrained and calm. But if the condition of a person close to you does not improve within a month, this is a reason to contact a psychotherapist or psychiatrist. Perhaps we are talking about clinical depression, which must be treated with medication.
Help get rid of the fear of specialists
Many patients with clinical depression are afraid to go to a psychotherapist or psychiatrist. They think: “What if this is something worse than just depression, what if I’m going crazy” or “I can handle it myself”. Close people at this point should gently and carefully explain: “You know, it seems to be depression, and I read that it is completely curable. We will find a way out. Let's go to the specialist together. It seems to me that this will help you get out of this state.
Stay close
Stay close or nearby so your friend always knows that if they need help they will have someone to turn to.
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How to deal with a depressed person. Instructions - Meduza
Depression is one of the most common mental disorders: according to the World Health Organization as of February 2017, more than 300 million people worldwide suffer from it. The scale of the problem in Russia is harder to assess. Experts talk about almost eight million Russians suffering from depression, but specify that, most likely, there are much more of them - people with depression often do not seek help because of shame or unwillingness to admit the seriousness of their condition. Depression can be underestimated not only by the patients themselves, but also by their relatives. At the request of Meduza, the author of the remain_nameless telegram channel about mental health, Daria Chagina, tells how to properly behave with a person suffering from depression, so as not only not to harm him, but also to help.
Recognize the importance of the problem
Pop culture has taught us that depression is a kind of seasonal blues: many of us have heard (or said) "I'm depressed today." Of course, any person experiences bouts of melancholy and depression - due to lack of sleep, problems at work, a quarrel with a loved one, and even bad weather. But as soon as the surrounding circumstances change, everything returns to normal. Depression, on the other hand, is arranged differently: its causes can be deeply hidden, it greatly affects a person’s life, and only in 40% of cases goes away on its own - and even then not completely.
Depression is expressed primarily in a constant depressed state, chronic fatigue and loss of interest in things that used to please. In addition, the disease can be accompanied by various somatic manifestations: a person either suffers from insomnia, or, conversely, constantly wants to sleep. Doesn't want sex. He cannot concentrate on anything and loses his ability to work.
Loses appetite or, conversely, begins to overeat. Depression can also lead to a complete loss of interest in life, a suicidal state and suicide. The diagnosis is made if the duration of symptoms is at least two weeks - but depression can last for months or even years, and it must be treated.
Risk factors for depression can range from psychological shocks or trauma, dysfunctional family situations or lack of parental love, as well as genetic predisposition or various diseases, as well as alcohol or drug use. Moreover, psychogenic depression (caused, for example, by the death of a loved one, divorce or violence) does not necessarily come immediately - people experience difficult events in different ways, and sometimes the reaction to them comes with a delay.
Show that you are there
Depressed people don't just feel lonely, they often feel ashamed and guilty about their feelings and emotions. For fear of being misunderstood, ridiculed, or rejected, they prefer to remain silent about their experiences, do not seek help, or refuse to acknowledge the seriousness of their situation.
Left alone with their feelings, many try to suppress and hide them - and only more convinced of their own "abnormality", worthlessness and uselessness. As studies confirm, it is this feeling of separation from other people that can lead to suicidal thoughts - therefore, the support of relatives and friends is especially important for depressed people. Make it clear that you are there no matter what, the person’s condition does not affect your attitude towards him in any way, you understand the depth of his suffering and are ready to help.
Do not discount the feelings and experiences of a depressed person
If you have never had depression, then you are unlikely to be able to fully understand the state of your loved one. Do not try to compare it to a "bad day" or just a difficult period in life (for example, a session or a job change) and do not offer a person with depression to "pull themselves together" or "tune in to positive." Even if you sincerely want to express support, such advice will only devalue the feelings of a person who is faced with depression, because he knows that everything is not so simple.
People in this situation often hear, “Others have worse problems than you”, “It’s all in your head”, “Do something useful”, but all this only causes more shame, guilt or annoyance due to helplessness in the face of illness. Hearing something like this, a person may conclude that you will never understand him, and close up - then it will be much more difficult to help. If you don’t know what to say in such a situation (and this is normal), just hug, say: “I can’t even imagine what you are experiencing right now, but I see that it is very difficult” - and let the person show feelings in the way he it's necessary.
Don't take the words and actions of a depressed person personally.
People with depression are generally not able to lead the same active lifestyle as before. For example, they stop responding to messages and calls, refuse offers to go out to dinner or to the movies, they may even miss your birthday or wedding. This looks strange and insulting: after all, quite recently everything was in order, and today a person comes up with reasons to avoid a meeting.
And if he nevertheless agrees to it, he can behave indifferently and not even try to pretend that he is interested in listening to you.
It's not about you at all - it's just that in a depressed state, most often there is no strength for anything. Even such simple, ordinary things as getting out of bed, taking a shower and preparing breakfast require a lot of effort. It is all the more difficult to go somewhere where there will be a lot of people. In addition, communication with people itself, even if it is not binding, requires a return, for which a depressed person does not have enough emotional resources. Remember that depressed people feel and appreciate the support of their family and friends, but they simply cannot respond to it in the same way as before.
Suggest seeking professional help
Depression doesn't often go away on its own—but even if it does, it can come back. According to statistics, 50% of people who have had a depressive episode in their lives have a second one after some time, and 80% of people who have two depressive episodes in their medical history sooner or later have a third.
So if you suspect depression, a person should definitely see a specialist - first of all, a psychiatrist who can prescribe drugs if necessary. True, it is also very difficult for many to take this step: going to the doctor is considered something like a “last resort”, an admission of defeat. Antidepressants are also treated with great apprehension, although now there is a large selection of funds - and a competent specialist will be able to choose the right ones in each individual case. Yes, it doesn’t always work right away, but often you can’t do without medication.
Your loved one may be seriously afraid of going to the doctor because of the fear that he will be labeled “mentally ill”, “registered” or even “put in a fool”. In fact, psychiatric registration was canceled back in the early 90s, and a person can be placed in a hospital against their will only by a court decision - or if a person poses a threat to himself and is not able to take care of himself. But if your loved one is still haunted by the fear of free medicine, advise him to contact a private specialist - if possible.
Tell the person with depression that more and more people are going to therapy and it really helps. After all, with a fracture, your friend would go to the surgeon - so in this case, you need to see a doctor. Offer help in finding a psychiatrist, offer to give a ride to an appointment or just see them off. But in no case do not shame and do not force.
Help with the simplest things (but in moderation)
When a person close to you cannot do some things due to illness, there is a desire to take everything upon yourself. You really can help, but here you need to know when to stop.
If you live together, help with daily activities: waking up and going to bed on time, remembering to take a shower or soak in the bath, eat well, and remember about medicines if they are prescribed. The correct daily routine helps to maintain some kind of balance even in the most difficult condition. You can try to involve a person in physical exercises - studies confirm that sports help in the treatment and prevention of depression.
Moreover, it is the regularity of classes, and not their intensity, that plays the key role - you need to exercise for at least three months and for 45-60 minutes. Workouts on a pulse of 120-130 beats per minute are best suited: running, walking, swimming, cycling, tennis, dancing.
Offer to install useful applications
When depressed, it is useful to monitor how your mood changes over time - there are many paid and free mobile applications in Google Play and the App Store for this. For example, Moodnotes. When creating the application, the developers relied on the method of cognitive behavioral therapy, so in it you can not only note what you think about and how you feel today, but also track what causes certain thoughts and moods. You can also keep a mood diary through the How Are You and MoodPanda apps.
Mindfulness meditation apps can also be useful. It forms the basis of Mindfulness-Based Cognitive Therapy (MBCT), which is now gaining popularity in the United States.
The main goal is to help get rid of the tendency to automatically respond to thoughts, emotions and life events. Perhaps the best mobile app for this is Headspace; it's available on both iOS and Android, but it's a paid subscription for $12.99 a month (I must say it's loved by many who don't have a depression problem, too). A free alternative to it could be Stop, Breathe & Think. But, of course, we must remember that neither meditation nor a mood diary can replace treatment, but can only be a help (well, it doesn’t hurt to discuss these practices with your doctor).
Be attentive and patient
The process of treating depression is long and hard. How much time and effort it will take depends on the severity of depression (mild, moderate, severe), and on the chosen treatment method (only taking pills, only psychotherapy, or both), and on how quickly it turned out to pick up the right pills and their dosage and, finally, whether it was possible to find a suitable psychotherapist.
It also happens that a psychotherapist is good, but not suitable. Even if you have done everything you could and the healing process has begun, you should not expect an immediate result. Don't ask, "Are you feeling better?" - It may seem to a depressed person that progress in his treatment does not meet your expectations.
Instead, ask delicately from time to time if he remembers to take his pills, if he misses psychiatric and/or psychotherapist appointments, and if so, try to carefully find out why. For example, in psychotherapy there is such a thing as "resistance" - the patient's subconscious opposition to the process of psychotherapy. This phenomenon is associated with the fear of change, because it is far from always easy and painless to come to a cure. Resistance in psychotherapy can be expressed in many ways, including just missing meetings or refusing to continue psychotherapy in principle. Dealing with this is the work of a psychotherapist, but a careful, confidential conversation with a loved one can also help.
