We know that illegal drug use increases during recessions and deaths from drugs, alcohol and suicide skyrocket during periods of economic distress. While finances are a large part of stress, social isolation can contribute to added risks for those struggling with current or previous substance use disorders.
“Heightened anxiety is a near-universal trigger for drug use, and it is difficult to think of a more stressful event — for all of us — than this pandemic. Users who adopted harm reduction techniques and had been using drugs with a friend are now using them alone, and there is no one nearby who could administer naloxone or call 911 in the event of an overdose,” primary care physician Dr. Peter Grinspoon wrote in Harvard Health.
According to ABC News, some communities are reporting a “spike in overdose deaths.” Columbus, Ohio experienced a surge in overdose deaths, including 12 overdose deaths in one 24-hour period in April. In Jacksonville, Florida the fire and rescue department saw a 20% increase in overdose emergency calls in March.
It’s unclear whether this is part of a national trend.
“The problem that we are facing is that with the shutdown our researchers cannot go into their communities, and so it is hard to obtain data,” Nora Volkow, director of the National Institute on Drug Abuse, told ABC.
Isolation Makes Addiction Recovery Much Harder
Chicago journalist KT Hawbaker, 29, is a recovering alcoholic quarantining with their partner. Even though they have security and support, KT told MedTruth that “quarantining is a total drag” on their mental health. Originally, Hawbaker felt energized and optimistic “in spite of the federal government's haphazard management of the pandemic.”
However, after a few weeks, Hawbaker began to feel exhausted.
“I am not sure how to recharge my energy. A total extrovert, I want to hug my friends and have real-life conversations more than anything, but for now I will treasure my weekly trips to the Jewel [local grocery store],” they said.
Hawbaker isn’t just dealing with addiction recovery. In the fall they suffered from two miscarriages, one after another, and their due date is coming up in the near future.
“The quarantine gives me ample room to ruminate and mourn and feel all sorts of jealousy. It feels nonstop and it's ugly,” they said.
Hawbaker has been sober for three months and is grateful that they decided to do so when they did.
“I am certain I'd otherwise be dead during this pandemic. Isolation? Scattershot online socializing? Empty stretches of free time? It's an alcoholic brain's dream. There would have been cases of Trader Joe's Big Churn Chardonnay lining my apartment,” they said.
Extended Isolation Increases Substance Misuse and Relapse Risks
The siege of COVID has ripped through the world and created obstacles for all types of people and especially those within the recovery community. Overcoming an addiction is already a tough feat and with the unforgiving nature of COVID, people are struggling to cope.
The U.S. Centers for Disease Control and Prevention states that people who have high stressors due to the COVID-19 crisis may have difficulty sleeping, increase their intake of drugs, tobacco, and drugs, change their eating patterns, and see a deterioration in health.
According to the 2018 National Survey on Drug Use and Health, nearly half of American adults with substance use disorders have a co-occurring mental illness, with nearly one in six by a “serious mental illness”—a mental, behavioral or emotional condition that impairs one or more major life activities.
When feeling mentally or emotionally unwell during isolation, folks may tend to lean on substances to alleviate the pain and discomfort of stressors. The pandemic triggers dark thoughts and while many of us might distract ourselves by baking bread or watching Netflix, “an addict might look for distractions in drugs or alcohol,” Miami-based serial entrepreneur Kevin Sullivan told MedTruth. Sullivan is a recovering alcoholic with more than 30 years of sobriety, including a four-year period of relapse from which he came back. Sullivan has also “dabbled” with other addictive substances.
“Isolation is the enemy of someone with addiction, not just because support systems can give you the encouragement you might need, but also because they keep you accountable. While we’re stuck inside, many of us only have to physically report to ourselves,” Sullivan said. “I’m disheartened to say that I know people who have been sober for years but then relapsed and overdosed in part due to the coronavirus.”
Addiction Recovery Goes Digital
For many individuals with addiction—whether active or in recovery—reliance on essential services such as syringe exchange programs, medication treatment, psychotherapy, or group meetings, has been disrupted since the pandemic started. These changes can contribute to increased substance misuse, relapse, or overdose.
“COVID-19 has forced the recovery community, like all other communities, to adapt to a world on lockdown,” as clinics, group meetings, and treatment facilities are being closed or moved to online meetings, Sullivan said.
“Many people don’t have access to devices to get online and attend meetings or have the luxury of having addiction medication delivered to them. Those struggling with addiction are being forced to choose between adhering to quarantine or sticking to a routine that has helped keep them sober,” Sullivan said.
Groups are offering teleconferencing services and 12-step services through Zoom or other online video chats. In the Rooms, for instance, hosts a virtual coronavirus support group and virtual addiction recovery meetings such as Alcoholics Anonymous and Narcotics Anonymous. Meanwhile, psychotherapists are trading in couches for screens as social distancing continues and cuts off in-person meetings with clients.
In Chicago, Hawbaker has been attending 7 a.m. virtual Alcoholics Anonymous meetings every morning and meeting remotely with a therapist weekly.
“But nothing can replace AA meetings. While I am super privileged to have access to mental health care right now, I find refreshment and comfort listening to other women and queers speak truth to their recovery. My sponsor is also a huge support; we talk over FaceTime once a week, and it keeps me accountable and level-headed in this testy moment,” they said.
Many of Sullivan’s addiction recovery meetings have moved online to Zoom. However, he’s opening up his front yard for a way for people to come over at a safe distance and chat.
“The silver lining of this whole ordeal is that many people's support systems have gotten a lot bigger. My community now has members from all over the world including Germany, France, Tel Aviv, and Mexico. I probably would have never had the opportunity to hear these people’s stories without having been forced to look online for support,” he said.
Restricted Access to Life-Saving Medications
Some folks in recovery need refills of medication, such as suboxone, to treat their addiction. Individuals with a heroin or opioid addiction typically visit a clinic daily for methadone treatments, and may be vulnerable to COVID exposure while waiting in crowded rooms.
On March 16 the Substance Abuse and Mental Health Services Administration (SAMHSA) enabled opioid treatment programs to give 28-day take-home supplies for “stable patients.” Patients who are considered “less stable” but deemed able to safely handle an at-home supply are potentially eligible for a 14-day supply.
“These drugs are often administered in minimal doses to avoid overdoses of the medicine (which are often less potent opioids themselves). More research must be done to determine whether these methods are safe, yet the alternative now is to have hundreds of people break social distancing orders to meet at treatment facilities to receive the medicine they need,” Sullivan said.
Easing the Transition to the New Normal
It’s anything but normal.
The global COVID-19 pandemic is shifting everyone's lives in addition to the lives of those struggling with or recovering from an addiction. The U.S. healthcare system—providers, researchers, institutions, and policymakers—will have to work towards developing more effective virtual resources for those in need of support.
If you are struggling, call SAMHSA’s hotline at 1-800-662-HELP (4357) or 1-800-487-4889 which is a free 24-hour information service for individuals or family members.