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The Addiction and COVID-19 Connection
How Is COVID-19 Impacting People with an Addiction?
Coronavirus disease 2019 (COVID-19) is a rapidly spread respiratory disease that has changed the globe in a matter of months. Businesses, schools, churches, and the daily life of individuals have been disrupted financially and socially. Just as the disease has impacted almost everything else in life, it has impacted the world of addiction and recovery. Physical and mental health is a major concern for those currently battling a substance use disorder, as well as those in recovery who are being separated from their social circles. Feelings of fear and anxiety may hold people back from seeking or continuing addiction treatment, when that treatment may be the key to saving their life. The connection of addiction and COVID-19 is being confronted by those in the community so people in need can be provided the safest options.
How COVID-19 Impacts an Addict’s Body
Addiction attacks the body in dozens of ways, destroying internal organs and weakening the immune system. Repeated and long-term alcohol use damages the heart, causing irregular heartbeat, stretching and drooping of the heart muscle, high blood pressure, and stroke. The toxic substances that alcohol creates in the pancreas can lead to pancreatitis, a swelling and inflammation of the blood vessels in the pancreas. Most people are aware of alcohol’s effect on the liver, causing cirrhosis, alcoholic hepatitis, fibrosis, and fatty liver. Alcohol use is linked to several different types of cancer, as well as brain damage. These serious health conditions can make you more vulnerable to the symptoms of COVID-19.
Illicit drug use can quickly deteriorate the body. Long term methamphetamine use causes lung, liver, and kidney damage, damage to blood vessels in the heart and brain, malnutrition, tooth decay, respiratory problems if smoked, and infectious diseases and abscesses if injected. Abusing opioids like hydrocodone, codeine, oxycodone, fentanyl, and heroin impact respiratory and pulmonary health. Smoking any drug, tobacco, or marijuana weakens the lungs, putting smokers at risk for being hit hard by COVID-19. The National Institute on Drug Abuse stated that COVID-19 poses a serious threat to smokers and people with a substance use disorder.
Once someone catches COVID-19, it starts by infecting cells in the lining of the lungs. The first symptoms are a dry cough, shortness of breath, fever, headache, muscle pain, and fatigue. Symptoms worsen as the infection moves from the upper respiratory tract to the lower respiratory tract. A healthy patient’s immune system may be able to contain the disease in the upper respiratory tract, allowing them to recover. In severe cases, COVID-19 can cause bronchitis and pneumonia. In a small number of severe cases, it causes acute respiratory distress syndrome (ARDS). While a healthy person should be able to fully recover from COVID-19, someone with pulmonary abnormalities, chronic disease, or a compromised immune system is at risk for serious illness and death.
Mental Health and COVID-19
The impact of COVID-19 has left many people with feelings of stress, anxiety, and depression. Those with preexisting mental health issues may find that their symptoms are worsening in this time of uncertainty. Substance abuse and mental health have long been linked, with 50% of people with severe mental disorders being affected by substance abuse. When someone has both mental health issues and a substance abuse disorder, it is called a co-occurring disorder or dual diagnosis. When mental health goes untreated, substance abuse typically worsens, and when someone starts abusing more drugs or alcohol, their mental health worsens. Many people use alcohol or drugs as a coping mechanism for their mental health.
While someone might feel temporary relief from their stress and anxiety after using drugs or alcohol, in the long run it will worsen their symptoms and increase negative side effects. Undiagnosed, it is extremely difficult to deal with a co-occurring disorder. Out of all people who have received a diagnosis as mentally ill, 29% of them admitted to abusing drugs or alcohol. A reported 53% of drug abusers and 37% of alcohol abusers have a serious mental illness. Thankfully there are rehabilitation centers available that treat co-occurring disorders. This is an important time to seek treatment, with the stress of COVID-19 increasing substance abuse in many individuals.
The Centers for Disease Control and Prevention (CDC) stated that some people react more strongly to the stress of the crisis. This includes people who are at a higher risk of becoming infected by COVID-19, those who are helping in the response, such as health care workers, and those with mental health conditions including problems with substance use. The stress from an infectious disease outbreak can produce these symptoms:
- Increased use of alcohol, tobacco, or other drugs
- Difficulty sleeping or concentrating
- Deterioration of chronic health problems
- Changes in sleep or eating patterns
- Fear and worry about personal health and the health of loved ones
People with mental health conditions should continue treatment during COVID-19 and pay attention to new or worsening symptoms. The World Health Organization (WHO) released a message on mental health and psychosocial considerations during COVID-19. They advise people to limit their consumption of news on COVID-19 that triggers feelings of anxiety and seek information from trusted sources. It is important to take care of physical health by eating healthy food, exercising, and getting enough rest.
Avoid using unhelpful coping strategies such as use of tobacco, alcohol or other drugs. In the long term, these can worsen your mental and physical well-being.
Responders to COVID-19, like doctors, health care providers, and first responders, may experience an emotional toll and develop secondary traumatic stress (STS). It is important to recognize the symptoms, such as guilt, fear, social withdrawal, illness, and fatigue. Allowing time for self-care and taking a break from media coverage are ways to unwind. Understand that anyone can develop STS in a crisis, and it is okay to ask for help. Developing a buddy system with another responder to monitor each other’s stress, safety, and workload can create a partnership that allows you to maintain support.
Getting Substance Abuse Treatment During COVID-19
The American Society of Addiction Medicine stated that because of social isolation, anxiety, and stress associated with the COVID-19 pandemic response, the risks associated with substance use will likely increase. It is crucial for addiction treatment to remain accessible, while providing a safe and therapeutic environment for patients and staff.
Inpatient rehabilitation facilities, also called residential treatment programs, are centers where patients reside for an extended period of time. The average length of stay is 30 days, but some patients stay 60 to 90 days or longer, depending on the severity of their addiction. These programs offer an opportunity for the addict to be removed from their daily life where they had access to substances and focus fully on their recovery. A benefit of these programs is that patients have full time care and a community of recovery around them, but during COVID-19, some people may be afraid of transmitting or becoming infected with the disease.
Residential treatment programs are taking precautions to protect the health and safety of everyone in their facilities. Anyone entering treatment who has symptoms of COVID-19 or has been in close contact with someone who may have the disease should be tested prior to entry into the program. An isolation period of 24 hours may be deemed appropriate for new patients while their health is evaluated. Current patients should be screened for symptoms and be made aware of symptoms to look out for. If any symptoms occur, they should be quarantined and given a face mask and hand sanitizer while waiting for test results of COVID-19. The local health department should also be contacted. If they test positive, a plan to begin temporary virtual treatment should be put together in partnership with guidance from their primary care doctor if possible.
All staff and visitors should be screened for fever, cough, sore throat, shortness of breath, and muscle aches upon entering the facility every time. Discontinuing the entry of visitors or limiting the number of visitors to 1 visitor per patient a day may be necessary. Enhanced facility cleaning should be implemented. Surfaces that are touched a lot, like doorknobs, light switches, desks, countertops, phones, keys, and faucets should be disinfected multiple times per day. Any resident-care equipment should be cleaned after each use. Soap, water, or hand sanitizer should be made available in every room, and gloves should be worn when handling deliveries.
Physical distancing in inpatient rehabs should be implemented, with unnecessary physical contact being eliminated and maintaining a distance of 6 feet in between individuals. Common areas may need to be rearranged, and some groups may need to be altered to keep the number of people below 10. All of these measures are suggested by The American Society of Addiction Medicine to make sure that safe and sanitary treatment can continue to help those with substance use disorders.
Outpatient rehab is a program where those seeking treatment remain living at home but travel to a facility during the day to receive treatment. these programs are often appropriate for someone who has a mild addiction or who has professional or personal responsibilities that they cannot set aside. Before a new patient begins outpatient treatment, they should be screened via phone for symptoms and once more upon arrival. If they have symptoms, they should be tested for COVID-19. If they test positive, they should be isolated from other patients and staff and consider creating a telehealth treatment plan. Substance use disorders take thousands of lives every year, and the risks for each patient should be evaluated on an individual basis.
Patients who show no symptoms of COVID-19 can begin or continue treatment, while following the sanitary and physical distancing standards. Outpatient treatment offers the opportunity to participate in telehealth services, where patients can communicate with counselors via phone or video call. On March 6, 2020, Medicare coverage was expanded to encompass telehealth services furnished to patients in broader circumstances in response to the COVID-19 pandemic. This allows a wider range of services to be offered virtually instead of traveling to a treatment facility. Telehealth has also been implemented for support groups and addiction treatment medication access.
Virtual 12-Step Meetings
For those who are in recovery from a substance use disorder, 12-step meetings like Alcoholics Anonymous and Narcotics Anonymous are an important part of their process. However, many of these meetings across the country have been put on hold because of social distancing measures. Groups that are still meeting are taking sanitary precautions and practicing physical distancing by no longer hugging and shaking or holding hands. Many may be afraid to attend in-person meetings, but there is a plethora of virtual 12-step meeting available. The Substance Abuse and Mental Health Services Administration (SAMHSA) compiled a list of virtual recovery resources to be used during the COVID-19 pandemic. They include:
- Alcoholics Anonymous http://aa-intergroup.org/
- Narcotics Anonymous https://www.na.org/meetingsearch/
- Cocaine Anonymous https://www.ca-online.org/
- Marijuana Anonymous https://ma-online.org/
- In The Rooms https://www.intherooms.com/home/
- LifeRing https://www.lifering.org/online-meetings
These meetings allow for the continuation of support that people in recovery need. There are recovery support apps and podcasts that can be useful in this time. Webinar tools like Zoom make it simple to set up a virtual meeting for free, and many counselors are offering sessions via phone or web cam. If you are struggling with a drug or alcohol problem, it is important to not cut yourself off from supportive friends and family in this time. Reach out through texts and phone calls and set time aside to focus on talking to the positive people in your life.
Addiction Treatment Medications
Opioid treatment programs (OTPs) provide counseling and medication-assisted treatment for people with an opioid addiction. People travel to these facilities, often daily, to receive a dose of methadone, buprenorphine, or naltrexone. These medications keep people from experiencing the unpleasant and painful withdrawal symptoms that come with opioid abuse. These programs offer people a better quality of life, a reduction in criminal activity, and a way to stop using opioids. Because OTPs provide essential medications, they have remained operational during COVID-19, but some at risk people are concerned about traveling to these facilities every day.
Stable patients have been allowed a take-home dose of their medication for 28 days, with less stable patients being able to receive a take-home dose for 14 days. Unstable patients, such as those who are still abusing opioids, will have to continue coming to a facility each day for their own safety. However, OTPs have implemented cleaning standards, as well as isolating patients who may be infected to receive their dose in a separate room. Practitioners are able to treat existing patients through telehealth, but new patients will need to undergo an in person physical examination. The risk of overdose in those who abuse opioids is high, so being able to receive these treatment medications is essential in this time.
Seeking Treatment During COVID-19
Although much of the world has stopped, addictions continue, with many being amplified by the isolation, stress, and anxiety during this crisis. If you or your loved one is suffering from an addiction, a caring treatment provider can help you find the right center for your needs. Don’t wait, reach out today.
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