A loved one falling ill. Kids unexpectedly out of school with no childcare. Coping with physical distancing. Daily routines interrupted. Life milestones cancelled. Adjusting to working from home, or worse, not being able to work at all. These are the crises we’re all facing as the COVID-19 pandemic continues.
At Shatterproof, we are bracing for how all these awful circumstances will come together to impact the addiction crisis in America. We must recognize the scope of the problem and start moving urgently to prevent future tragedy.
To understand how COVID-19 may compound the addiction crisis in America we must examine healthcare, economic, and social factors.
COVID-19 is taxing all areas of our healthcare system, including treatment and recovery services.
Necessary coronavirus containment measures, like physical distancing and closures of public spaces, are making it harder for people with substance use disorders to seek help, keep up their treatment regimen, or access social supports. Groups such as AA or SMART Recovery have been shown to increase members’ ability to cope with risky social contexts and negative emotions, reduce impulsivity, enhance well-being, among other positive effects. While they’re often coupled with individual therapy, medications, and other interventions, many people do rely solely on groups. With in-person gatherings cancelled, millions of Americans in recovery are now without a crucial lifeline.
On a positive note, more and more virtual meeting options are emerging as the coronavirus outbreak wears on. While this is an exciting test of telehealth capabilities, we must be aware that the switch to virtual groups was not made voluntarily, and many in recovery may be struggling.
It’s also important to remember that, amid all of this, individuals with addiction could face greater risks related to COVID-19, particularly those who smoke tobacco or marijuana, vape, or use opioids or methamphetamines, because of the negative effects these substances have on respiratory and pulmonary systems.
When it comes to addiction, life-saving treatments are subject to overly burdensome restrictions that are rooted in stigma and would be abhorrent, even criminal, if applied to other chronic health conditions. In the context of COVID-19, we see clearly that those suffering from substance use disorders are not granted adequate access, protections, or support by the healthcare system—specifically when it comes to access to medications for addiction treatment (MAT).
Access to these medications, which have a demonstrated efficacy to treat addiction, are limited in the quantity dispensed and prescribed to patients. For some, daily visits to opioid treatment programs (OTPs) is required. While recent guidance from The Substance Abuse And Mental Health Services Administration (SAMHSA), allowing states to request blanket exceptions for all stable OTP patients to receive 28 days of take-home doses, is a step in the right direction, it is critical that states take action to make programs aware of this change immediately. Moving forward, more broad strokes adjustments to these policies must be considered.
Not only from the virus itself, but also from the consequences of physical distancing on access to necessary treatment and recovery resources. We should anticipate potential relapses and dangerously reduced access to addiction treatment for those actively using who are ready to seek care for the first time.
The economic impact of COVID-19 is already proving to be disastrous. While many employers, like Shatterproof, have been able to go remote, this is simply not possible in other industries. Servers, workers in the travel industry, and many other occupations are simply out of work. Hourly workers and those without sick leave are already in crisis. For others, the tanking stock market is resulting in layoffs and depleting retirement plans.
Deaths from drugs, alcohol and suicide, often called deaths of despair by the media, are highest in regions with economic distress. Studies show that drug use increases in recession times because unemployment increases psychological distress. Remember, not only is unemployment already rising, but the mechanisms typically available for coping with psychological distress are less readily available, as community support groups are cancelled and healthcare providers are diverted to treat COVID-19 patients.
Just last week, 70,000 Americans filed for unemployment. Treasury Secretary Steven Mnuchin warned that COVID-19 could drive up unemployment to 20%. We know unemployment and recessions are associated with higher drug and alcohol misuse, which have a multiplier effect of consequences to productivity, the healthcare and criminal justice systems, and families. But another concerning factor is the impact on the food services industry specifically.
The latest SAMSHA report examining substance use and addiction trends by industry showed that individuals in the accommodations and food services industry had both the highest illegal drug use in the past month and the highest rate of substance use disorder in the past year.
Thousands of restaurant and hotel workers are out of work or being laid off due to closures or coronavirus containment restrictions. While some of these workers will be able to return to work when the immediate threat of the virus passes, others will not have a business to return to. Connecting these workers to psychological support to deal with the immediate distress of being out of work and to deal with the potential long-term consequences of this crisis is critical to prevent a surge in drug use and related deaths.
Physical distancing is a new phenomenon for many, and even those without mental illness are struggling to adapt to this new way of life. While an abundance of resources are peppering the internet with tips on how to cope, some people may need professional medical help. But these undeniable social triggers and lack of access to treatment are not the only concern here.
The COVID-19 response has resulted in school cancellations for nearly 30 million children. For those that rely on school lunches this means food insecurity, for others this may mean being quarantined with a potential abuser, while others are missing milestone events like graduations and proms and instead facing boredom or perpetual screen use.
Decades of research shows that there are both risk and protective factors for drug use. For example, lack of parental supervision, drug availability, and poverty are risk factors, while parental monitoring, academic competence, and strong neighborhood attachment are protective factors. It is highly concerning that the COVID-19 response could tip the scale, increasing risk factors for so many of American’s youth. What’s more, families were not anticipating the need to monitor school-age children around the clock, and the increased free time may increase drug experimentation.
Childhood trauma is linked with future substance use disorders and other negative mental health effects. COVID-19 may increase exposure to potentially traumatic childhood experiences, like harassment, abuse, loss, disasters, and even medical trauma, which can be caused when children or their families experience single or multiple medical events.
Addiction is a chronic disease. It can be prevented, and it can be treated. It is critical that we do not forget about the nation’s addiction crisis in our response to COVID-19, and instead build a comprehensive approach that will prevent the spread of addiction and ensure access to treatment for all those in need.
At a systems level, reform is needed to ensure every American has access to treatment for substance use disorders, and that psychological support is widely available not just in times of crisis, but all the time. Shatterproof is working tirelessly to drive these changes, and we need your support.
At a personal level, we must be vigilant to the struggles of those around us—mental, physical, emotional, economic. Everyone is struggling in their own way and we may be physically distant from each other, but we certainly are not struggling alone. Check in on your friends, family, co-workers and neighbors. We must work even harder to build community in times of COVID-19 containment.
Stay safe and healthy.
Samantha Arsenault is Shatterproof's Vice President of National Treatment Quality Initiatives.