There’s a pandemic devastating the United States and countries abroad, one largely unchecked with no signs of relenting. It kills quietly and threatens the future of generations to come. It claimed the lives of nearly 72,000 Americans in 2019, a death toll accelerating rapidly in 2020.
Its presence does not permeate social media or the nightly news like COVID-19, yet it cripples families and impacts communities—the young and the old, the rich and the poor—just as tragically.
It is the opioid crisis, and 175 Americans die every day because of it. Combined with alcoholism and other forms of substance abuse, it is part of a more subtle pandemic of addiction that former United States Surgeon General Vivek Murthy claimed must be treated with the same urgency as heart disease, cancer, or diabetes.
Although Murthy’s words did not fall on deaf ears—U.S. health officials allocated more than $1.8 billion in state funding last year to combat the crisis—burgeoning problems persist. Overdose mortality rate and suicide continue to reduce average life expectancy in the United States, a trend seemingly bolstered by the mandated isolation and ubiquitous fear from the coronavirus.
Indeed, as the world awaits a vaccine—a drug to serve as a panacea for global panic and uncertainty—more addicts return to their own familiar remedies. It is a step backwards that many will make only once, as families are forced to bury a loved one gone too soon.
This article is an attempt to illustrate the unique challenges—physically and psychologically—facing those with substance abuse disorder during Covid-19. Furthermore, it is meant to offer strategies to combat these challenges, strategies borrowed from Centers for Disease Control and Prevention (CDC), the National Institute on Drug Abuse (NIH), and scholarly journals published via the National Center for Biotechnology Information (NCBI).
COVID-19, otherwise known as coronavirus disease 2019, is a previously unidentified virus that affects the lungs and airways. It spreads via droplets in the mouth and nose when one coughs or breathes out.
The majority of people who contract the virus will experience mild symptoms—including dry cough, fever, or loss of taste and smell—that typically subside with rest and home treatment.
However, the virus seems to pose greater dangers to those classified as “high-risk” members of the population. According to the CDC, these risk factors include age (generally, those over the age of 65) and the presence of certain underlying health conditions.
Unfortunately, many addicts may fall under the at-risk category. According to the National Institute on Drug Abuse (NIH):Because it attacks the lungs, the coronavirus that causes COVID-19 could be an especially serious threat to those who smoke tobacco or marijuana or who vape. People with opioid use disorder (OUD) and methamphetamine use disorder may also be vulnerable due to those drugs’ effects on respiratory and pulmonary health. Additionally, individuals with a substance use disorder are more likely to experience homelessness or incarceration than those in the general population, and these circumstances pose unique challenges regarding transmission of the virus that causes COVID-19.
The emphasis is on respiratory health, which could be compromised for many addicts who smoke cigarettes, vape, abuse opioids, or have a history of methamphetamine use. While the impact of smoking and vaping on the lungs may seem more obvious, opioid abuse can potentially be just as threatening to warding off a respiratory illness like COVID-19. According to NIH:
People who use opioids at high doses medically or who have OUD face separate challenges to their respiratory health. Since opioids act in the brainstem to slow breathing, their use not only puts the user at risk of life-threatening or fatal overdose, it may also cause a harmful decrease in oxygen in the blood (hypoxemia). Lack of oxygen can be especially damaging to the brain; while brain cells can withstand short periods of low oxygen, they can suffer damage when this state persists. Chronic respiratory disease is already known to increase overdose mortality risk among people taking opioids, and thus diminished lung capacity from COVID-19 could similarly endanger this population.
In relation to methamphetamine use, NIH states that the constriction of blood vessels can lead to pulmonary damage and pulmonary hypertension. Frequent users of methamphetamine are at risk for such disorders, and thus may face added risk if positive for COVID-19.
Alcohol abuse may pose dangers as well. A scholarly article posted to NCBI states:
A similar health-risk might be imposed by alcohol consumption, although there is lack of systematic data regarding alcohol consumption and COVID-19 risk. Dysfunctional immune system, vitamin deficiency, heightened risk of aspiration pneumonia, associated liver and cardiometabolic diseases, increased risk of thrombosis-all can act synergistically to cause worse health outcome.
Apart from bodily factors, other risks include decreased access to adequate health care, housing insecurity, and greater likelihood of homelessness or incarceration. Currently, drug offenses account for 46.2% of incarcerations in the United States, according to the Federal Bureau of Prisons. Such close contact potentially exposes inmates to infection from other inmates.
Before directly addressing the psychological implications of COVID-19 on addiction, it may be useful to first look at a decades-old experiment to better one’s understanding of the nature of substance abuse disorder.
How much does environment and a community of support affect addiction—or, more specifically, one’s ability to abstain from drugs and alcohol? American psychologist Dr. Bruce Alexander tried to answer that question in the 1970s with his now famous Rat Park Experiment.
Long before Dr. Alexander came along, researchers concluded two things: first, drugs like heroin and cocaine are highly addictive; and second, if untreated, will most likely lead to death. Researchers developed this theory by studying rats. They placed the creatures alone in a cage with two water spouts: one containing only water, the other containing water laced with either heroin or cocaine. The rats repeatedly drank the drug-laced water, leading to overdose and death.
Dr. Alexander questioned the experiment. He wondered how much the environment—being alone in an empty cage—affected the rats’ decision to drink the drug-laced water.
He then modified the original experiment and created Rat Park—a rat utopia filled with other rats, an abundance of food, and even spinning wheels. The rats, no longer alone, could play, have sex, and socialize all day. The end result: none of the rats drank the drug-laced water. No overdoses.
Dr. Alexander concluded that environment and the presence of a social community play a key role in abstaining from drugs and alcohol. In short, the opposite of addiction may not be sobriety, but perhaps connection and a sense of belonging to the community at large.
Therein lies the crux of the problem faced by many today with substance abuse disorder. The need for social isolation to slow the spread of COVID-19 often creates an environment conducive to relapse. This isolated environment is further complicated by the added stressors of potential job loss, income reduction, or housing instability. A study published via NCBI outlines the biological and psychological process by which an alcoholic is prone to relapse in such an environment:
Acute and chronic stressors have well been attributed to the inception and protraction of many SUDs among general public. Serotonergic modulation of the dopaminergic pathways leads to reduced activation of the mesolimbic reward circuit of brain in people with depression; and addictive substances like alcohol and others produce prolific activation of the reward system bringing temporary pleasure to them. Furthermore, alcoholic beverages when used for prolonged duration result in neuronal adaptations in the stress and reward pathways and flares up the neuroendocrine responses and stress reactivity, which in turn aggravate alcohol-related cravings when a stressful situation arrives.
In short, where there is isolation in a toxic environment of stress and fear, cravings most likely will arise. To borrow from one addicts story of recovery and relapse:
I had three years clean. Then the pandemic hit. I lost my job, I couldn’t afford rent and had relationship problems. I lived alone. No meetings…they were all canceled due to COVID. I felt trapped and everything on the news seemed so depressing. I lasted about a month before using again. Ended up overdosing a couple times. Luckily I bounced back and am a couple months clean today.
This addict’s story is not uncommon. It illustrates some of the many reasons those with substance abuse disorder are driven to use in the first place. A closer look at some of those reasons highlights just how unescapable they can be during a global pandemic.
Psychiatry researchers from West Bengal, India identify six main contributors to substance abuse. They are:
With these factors in mind, it is no wonder so many addicts struggle during COVID-19. Many of the same factors driving them to use in the first place are encouraged, enforced, or unavoidable. Take, for example, an addict predisposed to substance abuse, prone to anxiety or depression, confined to a home where toxic relationships and/or abuse may be unescapable, and left trying to cope with the glum realities so prevalent on the news and social media. It is a perfect storm of dejection where drugs and alcohol may seem the only relief.
Luckily, there is relief in other, healthier forms. The silver lining is that help is still available and there are useful strategies for avoiding relapse during COVID-19.
First and foremost, addiction specialist and creator of the Beacon Program in New York Molly Carmel suggests visiting homepages of local 12-Step meetings (aa.org or na.org, for example). She adds:
Well it’s actually an incredible and very beautiful thing that has happened. The 12-Step community has galvanized in a tremendous way. . . For those who are struggling I would suggest to go to the intergroup homepage of any of the 12-Step communities. You’ll see there are phone meetings, online meetings (via Zoom). It’s different, but it’ll do.
Carmel also suggests getting off devices and getting a plan. She recommends establishing a daily schedule or routine, and setting aside time to reach out to at least three people a day. The less time spent soaking up the often troubling news online, the better.
Finally, Carmel suggests practicing mindfulness and meditation, “Meditation, it’s a biologically-based intervention. And it actually helps us to manage our anxiety.”
Additional pointers can be found at iaff.org, where a detailed plan for recovery during COVID includes the following:
Additionally, many communities are home to sober living housing. Sober living can provide structure, support and a sense of community during these difficult times. A simple Google search of sober livings in your area is a good starting point.
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