Opioid Misuse as a Coping Behavior for Unmet Mental Health Needs Among U.S. Adults

Opioid Misuse as a Coping Behavior for Unmet Mental Health Needs Among U.S. Adults

Published: Aug 01, 2021
Publisher: Drug and Alcohol Dependence, vol. 225

Gracelyn Cruden

Ruchir Karmali

Key Findings
  • Self-medication theory posits that experiencing mental health distress can lead to opioid misuse.
  • Having unmet mental health treatment needs was associated with likelihood of opioid misuse.
  • Individuals potentially experiencing social isolation were at particularly high risk.
  • To prevent opioid misuse, strategies should address mental health distress.


Self-medication theory posits that opioids may be misused to cope with mental or emotional distress, especially if distress is not treated. Opioid misuse may lead to opioid use disorder, overdose, and death. We estimated the risk of opioid misuse associated with unmet mental health treatment needs (UMHN).


We used 2015–2018 data on U.S. adults from the National Survey of Drug Use and Health (n = 165,767). UMHN was the perceived need for mental health services in the past year without service receipt. The primary dependent variable was past year prescription opioid misuse (POM). Secondary analyses estimated POM and/or heroin misuse risk. Logistic regressions estimated the predicted probability for POM, controlling for demographics, social factors, a major depressive episode (MDE), and overall health. We also tested whether the association of UMHN on the predicted probability of POM varied by MDE.


UMHN was associated with a 4.6 percentage point higher predicted probability of POM (p < 0.001; 95 % CI 0.04–0.05) and a 4.9 percentage point higher predicted probability of POM and/or heroin (p < 0.001; 95 % CI 0.04–0.06) compared to adults who accessed mental health services. MDE was associated with a significantly greater risk of POM (p < 0.001). POM risk was greater for adults potentially experiencing social isolation.


Targeted mental health support strategies may reduce the likelihood of POM initiation and episodes. Future research should investigate the relationship between unmet mental health needs and initiation of POM episodes.

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