Pulse on the Pandemic: Addiction & Treatment
The coronavirus has affected nearly every aspect of our society. Just as our daily routines, personal habits, and day to day frameworks we use to navigate the human experience have all been disrupted, so too, has the social capacity to help those who are struggling.
To keep a pulse on the impact of the pandemic on addiction and treatment, this article surveyed four experts to get a sense of where we are with addiction and treatment during the coronavirus crisis. This article covers the impact on those seeking treatment, modes of treatment (remote vs. in-person sessions), and the opioid crisis, as well as tips to manage the lifting of restrictions and resources for those who cannot access care.
Post-Pandemic Increase in Intakes/People Needing Treatment
When asked whether there would be a post-pandemic increase in people needing treatment and/or intakes, the consensus is that there is and will be an increased need for treatment. However, it is important to point out that despite the increased need, the ability to pay could affect the number of intakes we see.
On one hand, the pandemic has brought increased isolation, less connection, fewer distractions, and heightened stress – all of which are known risk factors for substance use. “Our world has been experiencing so much trauma collectively that for those with pre-existing mental health issues, people are now even more uncomfortable so they ask for help”, says Dr. Julia Rosengren, a San Diego based psychologist and addiction specialist.
On the other hand, as more people find themselves without employment and/or insurance, “… the capacity to pay will be a primary factor [of intake numbers],” says Dr. Tom Horvath, co-founder of SMART Recovery and President of Practical Recovery, adding, “I can imagine the behavioral health services collectively getting smaller, despite the increased need.”
With an already significant gap between those who need treatment and those who can access that treatment, the pandemic could serve to increase the need – yet widen the gap between those who can get treatment and those who cannot.
An Increase in Telehealth Services
In recent years, telehealth has grown in popularity among the medical and behavioral health communities, but the COVID crisis has made telehealth a necessity, even for those reluctant to embrace the shift toward online care for addiction treatment during a pandemic. While this could be beneficial for both patients and providers, there could be some drawbacks, or at least some issues to remain mindful of.
Dr. Kenneth Leonard, director of CRIA and Professor of Psychiatry in the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, sees this trend continuing. “We have heard anecdotally from psychiatry providers that the “no show” rate has declined dramatically and that the patients prefer [online] treatment.”
The improved efficiency of online care could get more patients to show up at their appointments, but it’s important to explore why. Dr. Leonard offers two possible reasons patients prefer this mode of treatment. On one side, increased efficiency makes it easier for patients to show up for their appointments. Conversely, “they might be able to avoid confrontations about non-compliance with treatment.”
Additionally, there could be issues with the quality of human connection through online appointments. Dr. Donna Marks, mental health counselor and author of the award-winning book, Exit the Maze: One Addiction, One Cause, One Cure, said of online care, “I don’t think it’s passing; I think both sides will want it, but it’s unfortunate. Human contact is important in recovery.”
Telehealth opens a wide range of opportunities, in part due to the improved efficiency of appointments, but those new to this mode of treatment will need to stay mindful of a patient’s motivation to seek online care. There becomes heightened importance of a patient’s in-person support network to offset the reduced in-person contact with their provider.
Impact of Pandemic on Opioid Crisis
The news has extensively covered the impact of the pandemic on substance use, in particular the increase in alcohol and cannabis use. Curiously, there has been little coverage of the impact of the pandemic on the opioid crisis, and there was no real consensus among our experts as to what to make of the current situation. One thing we do know, however, is that overdoses have increased during the pandemic and the shutdowns and physical distancing have created additional issues for those at risk.
“Alcohol and cannabis use has gone up significantly, but I do not know what, if any, change will occur with opiate use,” says Rosengren. Dr. Marks believes the pandemic will “make it worse, more isolation, more drugs.” As with so many effects of the pandemic on everyday life, it can be difficult to predict outcomes during an unprecedented time.
Dr. Leonard, however, offered some intriguing insights. “Anecdotally, I’ve heard that drug seizures are up. With many people in quarantine, trafficking is easier to spot. Also, given the current restrictions on physician appointments, prescribing opioids may decline. So, there may be a decrease in developing opioid use. But, I think that there may be an increase in opioid overdoses and deaths.”
Staying Mindful as We Lift Stay-at-Home Orders
The experts surveyed had a few tips for patients and providers as the US continues to move between shutdowns and re-openings.
Patients and providers alike could benefit from getting back to a routine (or creating a new one) as soon as possible. “Getting back into a routine and reconnecting is very important for stability,” says Rosengren. For patients, routine and connection can help them begin or maintain recovery, while for providers, routine and connection can help the business thrive through referrals and networking.
While reconnection and routine are important for recovery, it would be wise to take things slow and easy. “I’m concerned that some individuals will rush to freedom. They might benefit from detailed discussions about how to manage their transition back to more outside activity,” says Horvath.
For providers, Dr. Marks points out, it is important to meet and respect patients’ wishes concerning “in person [or online] sessions, sanitation, best practices, etc.” Seeking out treatment can be overwhelming, but adding the stress of a global pandemic, office closures, and physical distancing can bring another level of challenge and concern for some individuals, while others may appear to be less emotionally affected by the added barriers. Just as with therapy plans, it is important to meet patients where they are with the pandemic and establish a sense of safety unique to the individual.
For Those Unable to Seek Care
If an individual is unable to seek proper addiction treatment during the pandemic, whether due to shutdowns, quarantine, or financial reasons there are still several options to get help for those seeking treatment or maintaining recovery.
“There are incredibly good options for connection and support through online mutual help groups and similar kinds of activities,” says Dr. Horvath. SMART Recovery, AA (and other 12-step programs), Reddit, or even an online recovery course are good places to start the search for support and connection.
Of course, as in non-pandemic times, “some individuals may not have the energy to seek out support, or they may be afraid to take the first step” Horvath says. “In this case, a loved one might conduct the search for them, and initially attend with the individual to get that process rolling.”
If finances are the issue, Dr. Rosengren suggests contacting a provider to see if they can work with a limited budget for treatment. “Many therapists are offering pro bono cases so they should ask. They also can sign up for insurance through the Affordable Care Act (ACA) and use it to get the treatment they need.”
Closing Words
As we continue to reach for the “new normal” in everyday life, it’s important to keep a pulse on the systems designed to help those who are struggling. Not only do we need to assess the impact of the pandemic on at-risk populations, but we also need to assess the impact on our ability to help those populations and be ready to pivot to continue meeting them where they are with the pandemic and addiction treatment.