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The Impact of the COVID-19 Pandemic on Behavioral Health in Indiana
As of January 2021, the Johns Hopkins Coronavirus Resource Center has confirmed more than 20 million SARS-CoV-2 cases and over 350,000 deaths in the United States alone and 100 million cases and more than 2 million deaths globally. As of December 31, 2020, over half a million Hoosiers had tested positive for COVID-19 and more than 8,000 had died as a result of complications from the disease. This report is a review on the impact the COVID-19 pandemic had (and has) on the mental and behavioral health of Hoosiers. Specifically, we reviewed pandemic-related stress on children, parents, and the elderly; substance use, misuse, and overdose deaths; mental health concerns; suicide; domestic violence; and child abuse and neglect.
The current report is a summary of findings. It provides a snapshot in time. Data and conclusions were relevant and timely at the time the report was produced.
Marijuana Use in Indiana: A Look at Cannabis Laws in and around Indiana
Though under federal law marijuana is still considered an illicit drug, many states have enacted policies decriminalizing and/or legalizing marijuana to some degree. In 14 states (including Indiana), possession, use, cultivation, sale or distribution of marijuana is illegal. Indiana is bordered by states with varying marijuana policies: Kentucky (illegal), Ohio (medical use), and Michigan and Illinois (medical and recreational use). One emerging trend of concern is the use of marijuana products (THC) in e-cigarettes, especially among young people.
Vaping Among Indiana Youth
The U.S. Surgeon General and other public health officials have described the use of e-cigarettes, or vaping, by young people as an epidemic. E-cigarettes are electronic devices that heat a liquid (called e-liquid) typically containing nicotine, flavoring, and other chemicals to produce an aerosol that is inhaled by a user. Although nicotine is the most common drug that young people vape, vaping marijuana is also increasing in popularity.
Although the long-term health effects of vaping are not currently known, e-cigarettes do pose a number of risks to young people. First, the use of e-cigarettes serves as a gateway to future combustible cigarette use. Second, because most e-liquid contains nicotine and because the adolescent brain is particularly sensitive to nicotine, the use of e-cigarette products places young people at heightened risk for nicotine dependence. Third, the chemicals contained in e-liquid have never been approved by the Food and Drug Administration for inhalation.
Suicide, or intentional self-harm, is one of the leading causes of death in the United States. Suicide rates among Hoosiers have increased from 12.6 per 100,000 in 2008 to 16.3 per 100,000 in 2017, a nearly 30% increase over the 10-year period. One in ten Indiana high school students attempted and survived suicide; those who identified as gay, lesbian, or bisexual had significantly higher rates of suicide-related thoughts and behaviors compared to students who identified as heterosexual. A variety of factors contribute to a person’s likelihood to engage in suicidal thoughts and behaviors. Though anyone can be affected by suicide, there are some groups within the population that are at a particularly high risk due to the stresses they experience.
The purpose of this report is to provide an overview of suicide risks, trends, and current interventions in Indiana. To accomplish this, we (1) reviewed the literature and existing data, (2) conducted key informant interviews with state experts, and (3) synthesized the information to provide recommendations for suicide prevention.
Social Determinants of Health and Their Impact on Mental Health and Substance Misuse
Health and wellbeing are shaped by many factors beyond healthcare and behavioral choices, including conditions that make up our social, economic, and physical environments. These factors are often referred to as social determinants of health (SDoHs). SDoHs not only affect our physical health, but they also can have an impact on a person’s mental wellbeing and substance use. These social determinants of health can be grouped into five major categories:
- Neighborhood and built environment
- Health and healthcare
- Social and community context
- Economic stability
To address SDoHs effectively, a “health in all policies” approach that integrates health considerations into policymaking across sectors is essential.
Drug Use in Indiana: A Regional Perspective
Indiana consists of 92 counties, which can be divided into 8 service regions. The prevalence of substance misuse can differ between the individual regions. Compared to the state’s average, rates of underage drinking, smoking, and illicit drug use were particularly high in Indiana’s Western region. The most frequently used substances among Indiana students in grades 8, 10, and 12 were alcohol, electronic vape products, marijuana, traditional (combustible) cigarettes, and prescription drugs. Understanding each region’s unique needs is a vital component to designing programs dedicated to improving overall Hoosier health.
Medicated-Assisted Treatment in Indiana
Opioid misuse and addiction continues to affect many Americans. Medication-assisted treatment (MAT) using methadone, buprenorphine, or extended-release naltrexone in combination with behavioral therapy is the most effective intervention for opioid use disorders (OUDs). Despite its effectiveness, methadone to treat OUDs is not widely available. Buprenorphine is more accessible, as it can be prescribed by medical doctors, nurse practitioners, and physician assistants who have received specialized training and obtained a waiver from the DEA. Naltrexone is a non-narcotic and can be prescribed by any healthcare professional who has prescription privileges.
Recovering from Substance Use Disorders: A Case for Peer Recovery Coaches
Peer recovery coaches (PRCs) are resources that are being increasingly utilized in the treatment of substance use disorders (SUDs). The role of a PRC is to act as mentor, guide, and role model to those with an SUD by providing a range of support services. The overall body of evidence suggests that PRCs can be effective; however, barriers to the widespread utilization of the peer-recovery approach still exist.
The Impact of Parental Incarceration on Children’s Health & Development
The incarceration boom in the United States has resulted in high rates of parents serving time. According to recent estimates, one in ten Hoosier children has a parent who is or has been in prison or jail. Though incarceration is often treated as a discrete event, it is important to note that the time period extends both prior to and beyond the incarcerated phase (pre- and post-incarceration). Evidence on the relationship between parental incarceration and various children’s outcomes is inconsistent across the literature and often disappears when controlling for demographic and family characteristics. However, whether the relationship between parental incarceration and children’s health and development is causal or simply correlational, this population is at high risk for adverse outcomes and should be the target of interventions.
Opioid Overdoses in Indiana: A Closer Look at Opioid Type
The misuse of prescription and illicit opioids remains at epidemic proportions, costing the United States billions of dollars annually. Overdose deaths in both the U.S. and Indiana have seen a dramatic increase over the past ten years. Until recently, prescription opioids were responsible for the greatest number of overdose deaths, but now have been surpassed by fatalities involving heroin and illicitly manufactured narcotics, primarily fentanyl.
Mental Health, Substance Misuse, and Suicide: Shared Risk and Protective Factors
Mental illness, substance misuse, and suicide are complex conditions with serious public health implications. Evidence suggests that these disorders often co-occur and share many of the same risk and protective factors. Additionally, certain populations are at an increased risk of developing substance use disorders, mental illness, or engaging in suicidal behaviors. Nationally and in Indiana, several factors, including stigma, an undersized mental health workforce, and limited treatment options, inhibit the effective identification and treatment of these conditions.
Community Conditions Favorable for Substance Abuse
The probability of whether an individual engages in substance use is associated with several risk and protective factors. Effective prevention requires understanding these factors. The social-ecological model considers the complex interactions between individual, relationship, community, and societal factors. This can help us understand substance use in a public health context and design strategies to address the problem across multiple levels.
Adverse Childhood Experiences (ACEs) and their Impact on Substance Misuse & Overall Health
Adverse childhood experiences (ACEs) encompass a wide variety of distressing events, including emotional, physical, or sexual abuse; witnessing maternal domestic violence; or living with a household member who has a substance use disorder, is mentally ill or suicidal, or is currently or was ever incarcerated during the first 18 years of a child’s life. According to most recent estimates, nearly half of Indiana’s youth have experienced at least one ACE in their life. ACEs are linked to many risk behaviors, including substance use, which can adversely affect health outcomes.
Polypharmacy Among Prescription Drug Users
Polypharmacy, i.e., the misuse of multiple prescription drugs or prescription medication with other substances, is highly problematic. Whether unintentional or deliberate, misuse of multiple drugs can lead to adverse effects including addiction; drug-drug interactions; and overdose, potentially resulting in death. Polypharmacy is not uncommon; almost 84 percent of prescription drug misusers receiving substance abuse treatment in Indiana reported using at least one additional substance, most commonly alcohol or marijuana.
The Impact of Substance Use on the Developing Brain
Most peoples’ first exposure to alcohol, tobacco, and other drugs typically occurs during adolescence, a time when the brain changes rather dramatically. The maturation process of the adolescent brain is reflected in a greater propensity to take part in risky activities such as unprotected sex, reckless driving, and substance use. Alcohol, nicotine, and marijuana, the most commonly used substances by teens, have all been tied to disruptions in normal brain development. These structural changes are associated with higher rates of cognitive impairments and academic difficulties, higher rates of future substance use and substance use disorders, and higher rates of mood and psychotic disorders.
Substance Abuse in Indiana - An Urban-Rural Perspective
The use of alcohol and drugs is a significant public health problem in the United States. Indiana, like many other states in the nation, is lacking in substance abuse treatment services and rural areas are particularly underserved. Rural residents may encounter additional barriers to receiving substance abuse treatment, including stigma, fear that they may know their treatment providers, a lack of access to specialized services, inferior quality of care, and having to pay more for treatment.
Substance Abuse Trends in Indiana: A 10-Year Perspective
Substance use is a significant public health problem in the United States. Excessive use of alcohol and drugs has been linked to increased morbidity and mortality from cardiovascular conditions; injuries and motor vehicle crashes; sexually transmitted and blood-borne illnesses, including HIV/AIDS and hepatitis B and C, resulting from risky sexual behaviors and/or injection drug use; pregnancy complications and neonatal abstinence syndrome (NAS); and drug overdoses [5, 6].
Treatment & Recovery for Substance Use Disorders in Indiana
Substance abuse is a significant public health concern. When drug or alcohol use regularly causes a person substantial life consequences, he/she has likely transitioned from occasional, potentially problematic, use to having a substance use disorder (SUD). In 2014, almost half a million Hoosiers (8.5%) met the criteria for SUD.
Overview of Suicide Risk Among Adolescent Hispanic Girls in Indiana
Suicide is one of the leading causes of death among adolescents in the United States and in Indiana. Suicide is a complex public health issue, and common risk factors include problems with mental health, substance use, physical injury and psychological trauma. In addition, social and cultural differences can place certain racial and ethnic groups at especially high risk of thoughts and behaviors that may lead to suicide.
Behavioral Health Disparities in Indiana
The burden of illness, premature death, and disability is distributed unequally throughout the nation, leading to vast differences in health status or outcomes between specific groups. Such health disparities are persistent and occur across a wide range of physical and behavioral conditions.
Injection Drug Use in Indiana: A Major Risk for HIV Transmission
Illicit drug use is a significant public health issue. In 2014, approximately 27 million people, or 10.2 percent of the United States population 12 years of age or older, were currently using some type of illicit substance, while 7.1 million people 12 years of age or older could be classified as either abusing or being dependent on an illicit drug.
Substance Use Among Young Adults in Indiana Who Are Not Enrolled in College
The primary purpose of this study was to gather information on patterns and trends of substance use; reasons for using (or not using); and perceptions and beliefs regarding substance use within one’s social circle (peers) from our target population, i.e., Indiana residents ages 18 to 25 who do not attend, nor have graduated from, college.
Indiana Syringe Exchange Program
According to the Centers for Disease Control and Prevention (CDC), “syringe exchange programs provide free sterile syringes and collect used syringes from injection-drug users to reduce transmission of blood borne pathogens, including human immunodeficiency virus (HIV), hepatitis B virus, and hepatitis C virus.” Such an approach falls under the category of public health prevention known as “harm reduction,” which aim to minimize disease spread and injury (to the individual and to others) associated with high risk behaviors.
Indicators of Mental Health in Children and Adolescents in Indiana
Mental health disorders among children and adolescents are an important public health issue across the United States. Many of our youth are suffering from mood, anxiety, behavior, and substance use disorders with onsets occurring as early as age 6; unfortunately, several do not receive treatment until years later.
Ebola Virus Disease - Legal and Ethical Considerations for Indiana
The Ebola Virus Disease (EVD), formally known as Ebola hemorrhagic fever, is a virulent and often deadly infectious disease. Fatality rates for the disease have reported to be as high as 90% following contraction. As of October 14, 2014, a total of 8,914 probable, confirmed, and suspected cases of EVD and 4,447 deaths due to the disease, have been reported to the World Health Organization (WHO) by the nations of Liberia, Guinea, and Sierra Leon.
Using Data to Identify Substance Abuse Prevention Needs - Development of a Substance Abuse Priority Index (SAPI)
Substance abuse continues to be a public health concern in Indiana and nationwide. The abuse of alcohol and other drugs may not only result in negative health outcomes but are often a key issue in the criminal justice system, either directly (e.g., possession or sale/ manufacture of illicit substances) or indirectly (e.g., crimes com- mitted while under the influence of alcohol or drugs, or to support drug-seeking behaviors). The U.S. Department of Health and Human Services declared substance abuse stance abuse can differ by county.
Opioid Treatment Programs in Indiana - The Use of Medication in Addiction Treatment
Addiction to opioids (e.g., heroin, morphine, prescription pain relievers) is a serious health problem with wide-ranging social and economic implications. In 2010, more than 2 million Americans were affected, with 1.9 million U.S. residents addicted to prescription opioids and 359,000 addicted to heroin. Abuse of opioids, particularly heroin, has been associated with unintentional overdoses and transmission of hepatitis, HIV, and sexually transmitted diseases.
Prenatal Alcohol Use and Fetal Alcohol Spectrum Disorder in Indiana
Consumption of alcohol during pregnancy can cause the infant to be born with a fetal alcohol spectrum disorder (FASD). FASD is not a diagnosis, but an umbrella term that describes a group of conditions associated with prenatal alcohol exposure, including fetal alcohol syndrome (FAS) .
The Effects of Tobacco Use on Oral Health in Indiana
Tobacco use is associated with a variety of harmful consequences, including increased risk of numerous cancers; coronary heart disease and other cardiovascular diseases; respiratory diseases in adults and children; and pregnancy complications. In addition, tobacco use imposes a considerable economic burden, accounting for $190 billion annually in healthcare expenditures and productivity losses .
Meth Use in Indiana
Methamphetamine, a derivative of amphetamine, is a synthetic stimulant that affects the central nervous system. It is commonly known as meth, speed, and chalk; in its smoked form, it is often referred to as ice, crystal, crank, and glass . Due to its high potential for abuse, meth is classified as a Schedule II drug and is legally available only by prescription . Abuse of the drug is a serious problem in the United States, often resulting in devastating medical, psychological, social, and legal consequences. According to estimates from the 2008 National Survey on Drug Use and Health (NSDUH), 12.6 million Americans (or 5.0 percent) ages 12 and older have tried meth at least once in their life .