Answer Addiction

Tag: isolation

  • Kids Already Coping With Mental Disorders Spiral as Pandemic Topples Vital Support Systems

    When states and communities fail to provide children the services they need to live at home, kids can deteriorate and even wind up in jail.

    A bag of Doritos, that’s all Princess wanted.

    Her mom calls her Princess, but her real name is Lindsey. She’s 17 and lives with her mom, Sandra, a nurse, outside Atlanta. On May 17, 2020, a Sunday, Lindsey decided she didn’t want breakfast; she wanted Doritos. So she left home and walked to Family Dollar, taking her pants off on the way, while her mom followed on foot, talking to the police on her phone as they went.

    Lindsey has autism. It can be hard for her to communicate and navigate social situations. She thrives on routine and gets special help at school. Or got help, before the coronavirus pandemic closed schools and forced tens of millions of children to stay home. Sandra said that’s when their living hell started.

    “It’s like her brain was wired,” she said. “She’d just put on her jacket, and she’s out the door. And I’m chasing her.”

    On May 17, Sandra chased her all the way to Family Dollar. Hours later, Lindsey was in jail, charged with assaulting her mom. (KHN and NPR are not using the family’s last name.)

    Lindsey is one of almost 3 million children in the U.S. who have a serious emotional or behavioral health condition. When the pandemic forced schools and doctors’ offices to close last spring, it also cut children off from the trained teachers and therapists who understand their needs.

    As a result, many, like Lindsey, spiraled into emergency rooms and even police custody. Federal data shows a nationwide surge of kids in mental health crisis during the pandemic — a surge that’s further taxing an already overstretched safety net.

    ‘Take Her’

    Even after schools closed, Lindsey continued to wake up early, get dressed and wait for the bus. When she realized it had stopped coming, Sandra said, her daughter just started walking out of the house, wandering, a few times a week.

    In those situations, Sandra did what many families in crisis report they’ve had to do since the pandemic began: race through the short list of places she could call for help.

    First, her state’s mental health crisis hotline. But they often put Sandra on hold.

    “This is ridiculous,” she said of the wait. “It’s supposed to be a crisis team. But I’m on hold for 40, 50 minutes. And by the time you get on the phone, [the crisis] is done!”

    Then there’s the local hospital’s emergency room, but Sandra said she had taken Lindsey there for previous crises and been told there isn’t much they can do.

    That’s why, on May 17, when Lindsey walked to Family Dollar in just a red T-shirt and underwear to get that bag of Doritos, Sandra called the last option on her list: the police.

    Sandra arrived at the store before the police and paid for the chips. According to Sandra and police records, when an officer approached, Lindsey grew agitated and hit her mom on the back, hard.

    Sandra said she explained to the officer: “‘She’s autistic. You know, I’m OK. I’m a nurse. I just need to take her home and give her her medication.’”

    Lindsey takes a mood stabilizer, but because she left home before breakfast, she hadn’t taken it that morning. The officer asked if Sandra wanted to take her to the nearest hospital.

    The hospital wouldn’t be able to help Lindsey, Sandra said. It hadn’t before. “They already told me, ‘Ma’am, there’s nothing we can do.’ They just check her labs, it’s fine, and they ship her back home. There’s nothing [the hospital] can do,” she recalled telling the officer.

    Sandra asked if the police could drive her daughter home so the teen could take her medication, but the officer said no, they couldn’t. The only other thing they could do, the officer said, was take Lindsey to jail for hitting her mom.

    “I’ve tried everything,” Sandra said, exasperated. She paced the parking lot, feeling hopeless, sad and out of options. Finally, in tears, she told the officers, “Take her.”

    Lindsey does not like to be touched and fought back when authorities tried to handcuff her. Several officers wrestled her to the ground. At that point, Sandra protested and said an officer threatened to arrest her, too, if she didn’t back away. Lindsey was taken to jail, where she spent much of the night until Sandra was able to post bail.

    Clayton County Solicitor-General Charles Brooks denied that Sandra was threatened with arrest and said that while Lindsey’s case is still pending, his office “is working to ensure that the resolution in this matter involves a plan for medication compliance and not punitive action.”

    Sandra isn’t alone in her experience. Multiple families interviewed for this story reported similar experiences of calling in the police when a child was in crisis because caretakers didn’t feel they had any other option.

    ‘The Whole System Is Really Grinding to a Halt’

    Roughly 6% of U.S. children ages 6 through 17 are living with serious emotional or behavioral difficulties, including children with autism, severe anxiety, depression and trauma-related mental health conditions.

    Many of these children depend on schools for access to vital therapies. When schools and doctors’ offices stopped providing in-person services last spring, kids were untethered from the people and supports they rely on.

    “The lack of in-person services is really detrimental,” said Dr. Susan Duffy, a pediatrician and professor of emergency medicine at Brown University.

    Marjorie, a mother in Florida, said her 15-year-old son has suffered during these disruptions. He has attention deficit hyperactivity disorder and oppositional defiant disorder, a condition marked by frequent and persistent hostility. Little things — like being asked to do schoolwork — can send him into a rage, leading to holes punched in walls, broken doors and violent threats. (Marjorie asked that we not use the family’s last name or her son’s first name to protect her son’s privacy and future prospects.)

    The pandemic has shifted both school and her son’s therapy sessions online. But Marjorie said virtual therapy isn’t working because her son doesn’t focus well during sessions and tries to watch TV instead. Lately, she has simply been canceling them.

    “I was paying for appointments and there was no therapeutic value,” Marjorie said.

    The issues cut across socioeconomic lines — affecting families with private insurance, like Marjorie, as well as those who receive coverage through Medicaid, a federal-state program that provides health insurance to low-income people and those with disabilities.

    In the first few months of the pandemic, between March and May, children on Medicaid received 44% fewer outpatient mental health services — including therapy and in-home support — compared to the same time period in 2019, according to the Centers for Medicare & Medicaid Services. That’s even after accounting for increased telehealth appointments.

    And while the nation’s ERs have seen a decline in overall visits, there was a relative increase in mental health visits for kids in 2020 compared with 2019.

    The Centers for Disease Control and Prevention found that, from April to October last year, hospitals across the U.S. saw a 24% increase in the proportion of mental health emergency visits for children ages 5 to 11, and a 31% increase for children ages 12 to 17.

    “Proportionally, the number of mental health visits is far more significant than it has been in the past,” said Duffy. “Not only are we seeing more children, more children are being admitted” to inpatient care.

    That’s because there are fewer outpatient services now available to children, she said, and because the conditions of the children showing up at ERs “are more serious.”

    This crisis is not only making life harder for these kids and their families, but it’s also stressing the entire health care system.

    Child and adolescent psychiatrists working in hospitals around the country said children are increasingly “boarding” in emergency departments for days, waiting for inpatient admission to a regular hospital or psychiatric hospital.

    Before the pandemic, there was already a shortage of inpatient psychiatric beds for children, said Dr. Christopher Bellonci, a child psychiatrist at Judge Baker Children’s Center in Boston. That shortage has only gotten worse as hospitals cut capacity to allow for more physical distancing within psychiatric units.

    “The whole system is really grinding to a halt at a time when we have unprecedented need,” Bellonci said.

    ‘A Signal That the Rest of Your System Doesn’t Work’

    Psychiatrists on the front lines share the frustrations of parents struggling to find help for their children.

    Part of the problem is there have never been enough psychiatrists and therapists trained to work with children, intervening in the early stages of their illness, said Dr. Jennifer Havens, a child psychiatrist at New York University.

    “Tons of people showing up in emergency rooms in bad shape is a signal that the rest of your system doesn’t work,” she said.

    Too often, Havens said, services aren’t available until children are older — and in crisis. “Often for people who don’t have access to services, we wait until they’re too big to be managed.”

    While the pandemic has made life harder for Marjorie and her son in Florida, she said it has always been difficult to find the support and care he needs. Last fall, he needed a psychiatric evaluation, but the nearest specialist who would accept her commercial insurance was 100 miles away, in Alabama.

    “Even when you have the money or you have the insurance, it is still a travesty,” Marjorie said. “You cannot get help for these kids.”

    Parents are frustrated, and so are psychiatrists on the front lines. Dr. C.J. Glawe, who leads the psychiatric crisis department at Nationwide Children’s Hospital in Columbus, Ohio, said that once a child is stabilized after a crisis it can be hard to explain to parents that they may not be able to find follow-up care anywhere near their home.

    “Especially when I can clearly tell you I know exactly what you need, I just can’t give it to you,” Glawe said. “It’s demoralizing.”

    When states and communities fail to provide children the services they need to live at home, kids can deteriorate and even wind up in jail, like Lindsey. At that point, Glawe said, the cost and level of care required will be even higher, whether that’s hospitalization or long stays in residential treatment facilities.

    That’s exactly the scenario Sandra, Lindsey’s mom, is hoping to avoid for her Princess.

    “For me, as a nurse and as a provider, that will be the last thing for my daughter,” she said. “It’s like [state and local leaders] leave it to the school and the parent to deal with, and they don’t care. And that’s the problem. It’s sad because, if I’m not here …”

    Her voice trailed off as tears welled.

    “She didn’t ask to have autism.”

    To help families like Sandra’s and Marjorie’s, advocates said, all levels of government need to invest in creating a mental health system that’s accessible to anyone who needs it.

    But given that many states have seen their revenues drop due to the pandemic, there’s a concern services will instead be cut — at a time when the need has never been greater.

     

    This story is part of a reporting partnership that includes NPR, Illinois Public Media and Kaiser Health News.

    View the original article at thefix.com

  • Opinion: The Opioid Crisis + COVID-19 = The Perfect Storm

    How can the addiction treatment community continue to assist people who are now being left even more isolated and desperate?

    Addiction – a chronic relapsing brain disorder, and a disease that gets deeply personal. It gets low-down and dirty, too.

    If you’re not an addict yourself, you surely know someone who is.

    You know someone abusing their opioid prescriptions, not because it’s a barrier to their pain, but because it’s a potent way to make them feel happier. You know someone whose alcohol consumption is dangerously high and verging on alcoholic – if they’re not already there, of course. Your kids will certainly know someone who abuses recreational drugs like they were going out of fashion. They’ll also know other students who swallow ADHD prescription tablets (as a study aid) because it makes them get their grades, and keeps their parents, people like you, happy.

    Among the people who are in your extended family, among your circle of friends, or someone within your workplace – at the very least, one, probably several more, will be a secret drug addict or an alcoholic. At the very least.

    It doesn’t discriminate. It certainly doesn’t care where you live either, just like most other diseases, and now this new coronavirus – COVID-19.

    Arizona & The Opioid Crisis

    Over the last 3 years, in Arizona alone, there have been more than 5,000 opioid-related deaths. Add to that the 40,000-plus opioid overdoses that have taken place during the same period, and you realize that COVID-19 has never been the only serious health issue the state continues to face, or the rest of the U.S., for that matter.

    In our “new reality” of social distancing and masks, more than 2 people every single day die from an opioid overdose in Arizona. Nearly half of those are aged 25-44 years old – in their prime, you might say.

    Opioids are not the only addictive group of substances that is costing young Arizonan lives right now either.

    From the abuse of “study aid” drugs, like Adderall and other ADHD medications, to the “party drugs,” like cocaine and ecstacy, and so to opioid prescription meds, and, if circumstances allow, a slow and deadly progression to heroin – addiction is damaging lives, if not ending them way too soon.

    These drugs did so before anyone had ever heard of COVID-19, and they’ll continue to do so after, or even if the world ultimately finds another drug – the elusive coronavirus vaccine – it is hoping for.

    Opioids + COVID-19 = The Perfect Storm

    We now live in this time of coronavirus. With the ongoing opioid epidemic, the question arises:

    How can the addiction treatment community continue to assist people who are now being left even more isolated and desperate, still with their chronic desire to get as high as they can, or drunker than yesterday?

    Furthermore, coronavirus has raised questions itself about the ongoing mental health needs of our population as a whole, and drug addicts and alcoholics continue to feature heavily in any statistics you offer up about those in the U.S. living with a mental health disorder.

    In fact, around half of those with a substance use disorder (SUD) or an alcohol use disorder (AUD) – the medical terminology for addiction – are simultaneously living with their own mental health disorder, such as major depression, severe anxiety or even a trauma-related disorder like PTSD.

    How are these predominantly socially-disadvantaged people able to receive the treatment they really need when they have been directed to isolate and socially distance themselves even further?

    This is why I believe the conditions for a “perfect storm” of widespread deteriorating mental health and self-medication through continued substance abuse are here now, with overdoses and fatalities rising across the addiction spectrum.

    There will be many drug or alcohol abusers living in Arizona who will be lost to us, and the majority will be young people in the age group of 25-44 mentioned previously, left isolated and unnoticed by an over-occupied medical community.

    The U.S. opioid epidemic plus the global coronavirus pandemic.

    A deceitfully isolating disorder in a time of generalized social isolation. For some, there will be no safe harbor from this, and it will wash them away from the lives of their families and friends without any chance of rescue whatsoever. The perfect storm – our perfect storm.

    Today, the truth is that successful addiction recovery has become exponentially more difficult. Apart from ongoing isolation to contend with, there exists an unfounded but very real distrust of medical facilities per se, and a real personal problem in maintaining good physical and mental health practices, eg. through nutrition and physical activity.

    Innovation: The Ideal Recovery Answer for Isolated Substance Addicts?

    Digital technology has advanced far further than its creators and financial promoters ever envisaged – or has it? We have become a society where it doesn’t matter where you are in the world, you’re always close by to loved ones you wish to talk to, friends you want to have a laugh with, and colleagues you need to share information with.

    Communication anywhere with anyone is as simple as the proverbial ABC.

    However, if you think that innovation and digital technology – sitting in front of your laptop or tablet, in other words – can provide the answers to the questions raised earlier about the timely provision of professional addiction or mental health treatment to those that need it, then you’re wrong. If only it were all that simple and straightforward.

    Online meetings of 12-Step organizations, like Alcoholics Anonymous, Narcotics Anonymous, and others, have been available for many years. However, all of these support organizations realize that an online or virtual 12-Step meeting is not the real thing. They are a temporary substitute and no more.

    In fact, they are a poor substitute when compared to the face-to-face and hands-on meetings that continue to be held successfully all over the nation and all year round.

    The various “sober aware” and “sober curious” communities that are present online do not provide a realistic treatment option to any substance addicts whatsoever, whether their SUD or AUD has been clinically diagnosed or not. Furthermore, the current crop of online addiction treatment and recovery programs available are currently statistically unproven in terms of successful outcomes, and with no official accreditation.

    That said, there is limited evidence that “telemental health care” does have several benefits in terms of more timely interventions in those with mental illness generally, particularly when these people are located in isolated communities.

    I honestly wouldn’t know, as there is no official patient outcome data for these services. In fact, by the time that data is able to be impartially and officially collected, these groups and so-called programs may have already lost their internet presence.

    Online “help” (you honestly couldn’t call it an actual treatment) with addiction is severely limited and nowhere near approaching the answer. Here’s exactly why…

    Substance addiction is an utterly isolating disorder. It can obliterate close family bonds, destroy what keeps us close together as friends, and will happily rampage unabated through any social life you may still hold onto, accepting no prisoners. Bleak isolation like you’ve never known before.

    Corona has little on addiction.

    Addiction is the catalyst behind premature death, the end of families and their marriages, long-term unemployment, and endless legal issues. It costs financially too – countless billions of dollars every year are lost to this disorder, over double that of any other neurological disease.

    Let me be absolutely clear and concise – there exists no replacement whatsoever for your hand held by another when lying in an intensive care bed, scared you’ll become just another coronavirus statistic, and there exists no replacement for the smiles, warmth, and openness of fellow recovering drug addicts meeting in a daily support group, especially on those days when you came so close, so very close, to using or drinking again.

    There’s little difference between the two either.

    The online addiction treatment industry is still in its childhood. It truly is an industry too, as you’ll only buy the brand and the product; you’ll never actually meet those telling you how to best change your life.

    At present, it falls woefully short.

    Really, what would you prefer? A mask-wearing addiction professional, clinically qualified to assist with your detox, your medication if needed, and your psychological needs, located in an accredited treatment facility (formally certified as being coronavirus-free), among peers, fellow addicts, and trained medical staff?

    Or a video image on a computer screen of someone you will never meet, who is telling you to do things you’ve never done before? At least, successfully?

    As society moves towards a more home-orientated existence, with WFH (working from home) the new norm, consider this:

    Would a specialized medical professional treating your disease ask you to consider “getting better from home,” as an alternative to the hospital?

    All we can hope for – the best that we can hope for – is that coronavirus soon leaves the state lines of Arizona, and that can continue all of our recoveries as successfully as before. Until then, the advice is simple – take the best help you can from wherever you can get it. Sadly, you are yet to find it on a computer screen.

    One last thought before I sign off…

    Protective masks may well become standard attire in our unknown future. So why, oh why, can they not make these transparent? Just take a moment… We’d be able to see each other – our friends, our colleagues, even complete strangers in the street – smile again.

    View the original article at thefix.com

  • Isolation, Disruption and Confusion: Coping With Dementia During a Pandemic

    The pandemic has been devastating to older adults and their families when they are unable to see each other and provide practical and emotional support.

    GARDENA, Calif. — Daisy Conant, 91, thrives off routine.

    One of her favorites is reading the newspaper with her morning coffee. But, lately, the news surrounding the coronavirus pandemic has been more agitating than pleasurable. “We’re dropping like flies,” she said one recent morning, throwing her hands up.

    “She gets fearful,” explained her grandson Erik Hayhurst, 27. “I sort of have to pull her back and walk her through the facts.”

    Conant hasn’t been diagnosed with dementia, but her family has a history of Alzheimer’s. She had been living independently in her home of 60 years, but Hayhurst decided to move in with her in 2018 after she showed clear signs of memory loss and fell repeatedly.

    For a while, Conant remained active, meeting up with friends and neighbors to walk around her neighborhood, attend church and visit the corner market. Hayhurst, a project management consultant, juggled caregiving with his job.

    Then COVID-19 came, wrecking Conant’s routine and isolating her from friends and loved ones. Hayhurst has had to remake his life, too. He suddenly became his grandmother’s only caregiver — other family members can visit only from the lawn.

    The coronavirus has upended the lives of dementia patients and their caregivers. Adult day care programs, memory cafes and support groups have shut down or moved online, providing less help for caregivers and less social and mental stimulation for patients. Fear of spreading the virus limits in-person visits from friends and family.

    These changes have disrupted long-standing routines that millions of people with dementia rely on to help maintain health and happiness, making life harder on them and their caregivers.

    “The pandemic has been devastating to older adults and their families when they are unable to see each other and provide practical and emotional support,” said Lynn Friss Feinberg, a senior strategic policy adviser at AARP Public Policy Institute.

    Nearly 6 million Americans age 65 and older have Alzheimer’s disease, the most common type of dementia. An estimated 70% of them live in the community, primarily in traditional home settings, according to the Alzheimer’s Association 2020 Facts and Figures journal.

    People with dementia, particularly those in the advanced stages of the disease, live in the moment, said Sandy Markwood, CEO of the National Association of Area Agencies on Aging. They may not understand why family members aren’t visiting or, when they do, don’t come into the house, she added.

    “Visitation under the current restrictions, such as a drive-by or window visit, can actually result in more confusion,” Markwood said.

    The burden of helping patients cope with these changes often falls on the more than 16 million people who provide unpaid care for people with Alzheimer’s or other dementias in the United States.

    The Alzheimer’s Association’s 24-hour Helpline has seen a shift in the type of assistance requested during the pandemic. Callers need more emotional support, their situations are more complex, and there’s a greater “heaviness” to the calls, said Susan Howland, programs director for the Alzheimer’s Association California Southland Chapter.

    “So many [callers] are seeking advice on how to address gaps in care,” said Beth Kallmyer, the association’s vice president of care and support. “Others are simply feeling overwhelmed and just need someone to reassure them.”

    Because many activities that bolstered dementia patients and their caregivers have been canceled due to physical-distancing requirements, dementia and caregiver support organizations are expanding or trying other strategies, such as virtual wellness activities, check-in calls from nurses and online caregiver support groups. EngAGED, an online resource center for older adults, maintains a directory of innovative programs developed since the onset of the COVID-19 pandemic.

    They include pen pal services and letter-writing campaigns, robotic pets and weekly online choir rehearsals.

    Hayhurst has experienced some rocky moments during the pandemic.

    For instance, he said, it was hard for Conant to understand why she needed to wear a mask. Eventually, he made it part of the routine when they leave the house on daily walks, and Conant has even learned to put on her mask without prompting.

    “At first it was a challenge,” Hayhurst said. “She knows it’s part of the ritual now.”

    People with dementia can become agitated when being taught new things, said Dr. Lon Schneider, director of the Alzheimer’s Disease Research Center at the University of Southern California. To reduce distress, he said, caregivers should enforce mask-wearing only when necessary.

    That was a lesson Gina Moran of Fountain Valley, California, learned early on. Moran, 43, cares for her 85-year-old mother, Alba Moran, who was diagnosed with Alzheimer’s in 2007.

    “I try to use the same words every time,” Moran said. “I tell her there’s a virus going around that’s killing a lot of people, especially the elderly. And she’ll respond, ‘Oh, I’m at that age.’”

    If Moran forgets to explain the need for a mask or social distancing, her mother gets combative. She raises her voice and refuses to listen to Moran, much like a child throwing a tantrum, Moran said. “I can’t go into more information than that because she won’t understand,” she said. “I try to keep it simple.”

    The pandemic is also exacerbating feelings of isolation and loneliness, and not just for people with dementia, said Dr. Jin Hui Joo, associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. “Caregivers are lonely, too.”

    When stay-at-home orders first came down in March, Hayhurst’s grandmother repeatedly said she felt lonesome, he recalled. “The lack of interaction has made her feel far more isolated,” he said.

    To keep her connected with family and friends, he regularly sets up Zoom calls.

    But Conant struggles with the concept of seeing familiar faces through the computer screen. During a Zoom call on her birthday last month, Conant tried to cut pieces of cake for her guests.

    Moran also feels isolated, in part because she’s getting less help from family. In addition to caring for her mom, Moran studies sociology online and is in the process of adopting 1-year-old Viviana.

    Right now, to minimize her mother’s exposure to the virus, Moran’s sister is the only person who visits a couple of times a week.

    “She stays with my mom and baby so I can get some sleep,” Moran said.

    Before COVID, she used to get out more on her own. Losing that bit of free time makes her feel lonely and sad, she admitted.

    “I would get my nails done, run errands by myself and go out on lunch dates with friends,” Moran said. “But not anymore.”

    Subscribe to KHN’s free Morning Briefing.

    View the original article at thefix.com

  • The Hidden Deaths Of The COVID Pandemic

    A recent analysis predicted as many as 75,000 people might die from suicide, overdose or alcohol abuse, triggered by the uncertainty and unemployment caused by the pandemic.

    BROOMFIELD, Colo. — Sara Wittner had seemingly gotten her life back under control. After a December relapse in her battle with drug addiction, the 32-year-old completed a 30-day detox program and started taking a monthly injection to block her cravings for opioids. She was engaged to be married, working for a local health association and counseling others about drug addiction.

    Then the COVID-19 pandemic hit.

    The virus knocked down all the supports she had carefully built around her: no more in-person Narcotics Anonymous meetings, no talks over coffee with a trusted friend or her addiction recovery sponsor. As the virus stressed hospitals and clinics, her appointment to get the next monthly shot of medication was moved back from 30 days to 45 days.

    As best her family could reconstruct from the messages on her phone, Wittner started using again on April 12, Easter Sunday, more than a week after her originally scheduled appointment, when she should have gotten her next injection. She couldn’t stave off the cravings any longer as she waited for her appointment that coming Friday. She used again that Tuesday and Wednesday.

    “We kind of know her thought process was that ‘I can make it. I’ll go get my shot tomorrow,’” said her father, Leon Wittner. “‘I’ve just got to get through this one more day and then I’ll be OK.’”

    But on Thursday morning, the day before her appointment, her sister Grace Sekera found her curled up in bed at her parents’ home in this Denver suburb, blood pooling on the right side of her body, foam on her lips, still clutching a syringe. Her father suspects she died of a fentanyl overdose.

    However, he said, what really killed her was the coronavirus.

    “Anybody that is struggling with a substance abuse disorder, anybody that has an alcohol issue and anybody with mental health issues, all of a sudden, whatever safety nets they had for the most part are gone,” he said. “And those are people that are living right on the edge of that razor.”

    Sara Wittner’s death is just one example of how complicated it is to track the full impact of the coronavirus pandemic — and even what should be counted. Some people who get COVID-19 die of COVID-19. Some people who have COVID die of something else. And then there are people who die because of disruptions created by the pandemic.

    While public health officials are trying to gather data on how many people test positive for the coronavirus and how many people die from the infection, the pandemic has left an untold number dying in the shadows, not directly because of the virus but still because of it. They are unaccounted for in the official tally, which, as of June 21, has topped 119,000 in the U.S.

    But the lack of immediate clarity on the numbers of people actually dying from COVID-19 has some onlookers, ranging from conspiracy theorists on Twitter all the way to President Donald Trump, claiming the tallies are exaggerated — even before they include deaths like Wittner’s. That has undermined confidence in the accuracy of the death toll and made it harder for public health officials to implement infection prevention measures.

    Yet experts are certain that a lack of widespread testing, variations in how the cause of death is recorded, and the economic and social disruption the virus has caused are hiding the full extent of its death toll.

    How To Count

    In the U.S., COVID-19 is a “notifiable disease” — doctors, coroners, hospitals and nursing homes must report when encountering someone who tests positive for the infection, and when a person who is known to have the virus dies. That provides a nearly real-time surveillance system for health officials to gauge where and to what extent outbreaks are happening. But it’s a system designed for speed over accuracy; it will invariably include deaths not caused by the virus as well as miss deaths that were.

    For example, a person diagnosed with COVID-19 who dies in a car accident could be included in the data. But someone who dies of COVID-19 at home might be missed if they were never tested. Nonetheless, the numbers are close enough to serve as an early-warning system.

    “They’re really meant to be simple,” Colorado state epidemiologist Dr. Rachel Herlihy said. “They apply these black-and-white criteria to often gray situations. But they are a way for us to systematically collect this data in a simple and rapid fashion.”

    For that reason, she said, the numbers don’t always align with death certificate data, which takes much more time to review and classify. And even those can be subjective. Death certificates are usually completed by a doctor who was treating that person at the time of death or by medical examiners or coroners when patients die outside of a health care facility. Centers for Disease Control and Prevention guidelines allow for doctors to attribute a death to a “presumed” or “probable” COVID infection in the absence of a positive test if the patient’s symptoms or circumstances warrant it. Those completing the forms apply their individual medical judgment, though, which can lead to variations from state to state or even county to county in whether a death is attributed to COVID-19.

    Furthermore, it can take weeks, if not months, for the death certificate data to move up the ladder from county to state to federal agencies, with reviews for accuracy at each level, creating a lag in those more official numbers. And they may still miss many COVID-19 deaths of people who were never tested.

    That’s why the two methods of counting deaths can yield different tallies, leading some to conclude that officials are fouling up the numbers. And neither approach would capture the number of people who died because they didn’t seek care — and certainly will miss indirect deaths like Wittner’s where care was disrupted by the pandemic.

    “All those things, unfortunately, are not going to be determined by the death record,” says Oscar Alleyne, chief of programs and services for the National Association of City and County Health Officials.

    Using Historical Data To Understand Today’s Toll

    That’s why researchers track what are known as “excess” deaths. The public health system has been cataloging all deaths on a county-by-county basis for more than a century, providing a good sense of how many deaths can be expected every year. The number of deaths above that baseline in 2020 could tell the extent of the pandemic.

    For example, from March 11 to May 2, New York City recorded 32,107 deaths. Laboratories confirmed 13,831 of those were COVID-19 deaths and doctors categorized another 5,048 of them as probable COVID-19 cases. That’s far more deaths than what historically occurred in the city. From 2014 through 2019, the city averaged just 7,935 deaths during that time of year. Yet when taking into account the historical deaths to assume what might occur normally, plus the COVID cases, that still leaves 5,293 deaths not explained in this year’s death toll. Experts believe that most of those deaths could be either directly or indirectly caused by the pandemic.

    City health officials reported about 200 at-home deaths per day during the height of the pandemic, compared with a daily average 35 between 2013 and 2017. Again, experts believe that excess is presumably caused either directly or indirectly by the pandemic.

    And nationally, a recent analysis of obituaries by the Health Care Cost Institute found that, for April, the number of deaths in the U.S. was running about 12% higher than the average from 2014 through 2019.

    “The excess mortality tells the story,” said Dr. Jeremy Faust, an emergency medicine physician at Brigham and Women’s Hospital in Boston. “We can see that COVID is having a historic effect on the number of deaths in our community.”

    These multiple approaches, however, have many skeptics crying foul, accusing health officials of cooking the books to make the pandemic seem worse than it is. In Montana, for example, a Flathead County health board member cast doubt over official COVID-19 death tolls, and Fox News pundit Tucker Carlson questioned the death rate during an April broadcast. That has sowed seeds of doubt. Some social media posts claim that a family member or friend died at home of a heart attack but that the cause of death was inaccurately listed as COVID-19, leading some to question the need for lockdowns or other precautions.

    “For every one of those cases that might be as that person said, there must be dozens of cases where the death was caused by coronavirus and the person wouldn’t have died of that heart attack — or wouldn’t have died until years later,” Faust said. “At the moment, those anecdotes are the exceptions, not the rule.”

    At the same time, the excess deaths tally would also capture cases like Wittner’s, where the usual access to health care was disrupted.

    A recent analysis from Well Being Trust, a national public health foundation, predicted as many as 75,000 people might die from suicide, overdose or alcohol abuse, triggered by the uncertainty and unemployment caused by the pandemic.

    “People lose their jobs and they lose their sense of purpose and become despondent, and you sometimes see them lose their lives,” said Benjamin Miller, Well Being’s chief strategy officer, citing a 2017 study that found that for every percentage point increase in unemployment, opioid overdose deaths increased 3.6%.

    Meanwhile, hospitals across the nation have seen a drop-off in non-COVID patients, including those with symptoms of heart attacks or strokes, suggesting many people aren’t seeking care for life-threatening conditions and may be dying at home. Denver cardiologist Dr. Payal Kohli calls that phenomenon “coronaphobia.”

    Kohli expects a new wave of deaths over the next year from all the chronic illnesses that aren’t being treated during the pandemic.

    “You’re not necessarily going to see the direct effect of poor diabetes management now, but when you start having kidney dysfunction and other problems in 12 to 18 months, that’s the direct result of the pandemic,” Kohli said. “As we’re flattening the curve of the pandemic, we’re actually steepening all these other curves.”

    Lessons From Hurricane Maria’s Shifting Death Toll

    That’s what happened when Hurricane Maria pummeled Puerto Rico in 2017, disrupting normal life and undermining the island’s health system. Initially, the death toll from the storm was set at 64 people. But more than a year later, the official toll was updated to 2,975, based on an analysis from George Washington University that factored in the indirect deaths caused by the storm’s disruptions. Even so, a Harvard study calculated the excess deaths caused by the hurricane were likely far higher, topping 4,600.

    The numbers became a political hot potato, as critics blasted the Trump administration over its response to the hurricane. That prompted the Federal Emergency Management Agency to ask the National Academy of Sciences to study how best to calculate the full death toll from a natural disaster. That report is due in July, and those who wrote it are now considering how their recommendations apply to the current pandemic — and how to avoid the same politicization that befell the Hurricane Maria death toll.

    “You have some stakeholders who want to downplay things and make it sound like we’ve had a wonderful response, it all worked beautifully,” said Dr. Matthew Wynia, director of the University of Colorado Center for Bioethics and Humanities and a member of the study committee. “And you’ve got others who say, ‘No, no, no. Look at all the people who were harmed.’”

    Calculations for the ongoing pandemic will be even more complicated than for a point-in-time event like a hurricane or wildfire. The indirect impact of COVID-19 might last for months, if not years, after the virus stops spreading and the economy improves.

    But Wittner’s family knows they already want her death to be counted.

    Throughout her high school years, Sekera dreaded entering the house before her parents came home for fear of finding her sister dead. When the pandemic forced them all indoors together, that fear turned to reality.

    “No little sister should have to go through that. No parent should have to go through that,” she said. “There should be ample resources, especially at a time like this when they’re cut off from the world.”

    View the original article at thefix.com

  • Drinking Surged During The Pandemic. Do You Know The Signs Of Addiction?

    While some people may be predisposed to problematic drinking or alcohol-use disorder, these can also result from someone’s environment.

    Despite the lack of dine-in customers for nearly 2½ long months during the coronavirus shutdown, Darrell Loo of Waldo Thai stayed busy.

    Loo is the bar manager for the popular restaurant in Kansas City, Missouri, and he credits increased drinking and looser liquor laws during the pandemic for his brisk business. Alcohol also seemed to help his customers deal with all the uncertainty and fear.

    “Drinking definitely was a way of coping with it,” said Loo. “People did drink a lot more when it happened. I, myself, did drink a lot more.”

    Many state laws seemed to be waived overnight as stay-at-home orders were put into place, and drinkers embraced trends such as liquor delivery, virtual happy hours and online wine tasting. Curbside cocktails in 12- and 16-ounce bottles particularly helped Waldo Thai make up for its lost revenue from dine-in customers.

    Retail alcohol sales jumped by 55% nationally during the third week of March, when many stay-at-home orders were put in place, according to Nielsen data, and online sales skyrocketed.

    Many of these trends remained for weeks. Nielsen also notes that the selling of to-go alcohol has helped sustain businesses.

    But the consumption of all this alcohol can be problematic for individuals, even those who haven’t had trouble with drinking in the past.

    Dr. Sarah Johnson, medical director of Landmark Recovery, an addiction treatment program based in Louisville, Kentucky, with locations in the Midwest said that, virtual events aside, the pandemic has nearly put an end to social drinking.

    “It’s not as much going out and incorporating alcohol into a dinner or time spent with family or friends,” Johnson said. “Lots of people are sitting home drinking alone now and, historically, that’s been viewed as more of a high-risk drinking behavior.”

    There are some objective measures of problematic drinking. The Centers for Disease Control and Prevention defines heavy drinking as 15 or more drinks a week for a man or eight or more for a woman.

    But Johnson said that more important clues come from changes in behavior. She explains that, for some people, a bit of extra drinking now and then isn’t a big deal.

    “If they are still meeting all of their life obligations, like they are still getting up and making their Zoom meetings on time, and they’re not feeling so bad from drinking that they can’t do things, and taking care of their children and not having life problems, then it’s not a problem,” Johnson said. “It’s when people start to have problems in other areas of their life, then it would be a signal that they are drinking too much and that it’s a problem.”

    But there are signs to watch out for, she says. They include:

    • Big increases in the amount of alcohol consumed
    • Concern expressed by family or friends
    • Changes in sleep patterns, either more or less sleep than usual
    • Any time that drinking interferes with everyday life

    Johnson noted that for many people, living under stay-at-home orders without the demands of a daily commute or lunch break could be problematic.

    “Routine and structure are important to overall mental health because they reduce stress and elements of unknown or unexpected events in daily life,” Johnson said. “These can trigger individuals in recovery to revert to unhealthy coping skills, such as drinking.”

    Johnson explained that while some people may be predisposed to problematic drinking or alcohol-use disorder, these can also result from someone’s environment.

    Johnson said that people who are unable to stop problematic drinking on their own should seek help. The federal Substance Abuse and Mental Health Services Administration runs a 24/7 helpline (800-662-HELP) and website, www.findtreatment.gov, offering referrals for addiction treatment.

    Peer support is also available online. Many Alcoholics Anonymous groups have started to offer virtual meetings, as does the secular recovery group LifeRing. And for people who are looking for more informal peer support, apps such as Loosid help connect communities of sober people.

    Darrell Loo at Waldo Thai said that he has been concerned at times about people’s drinking but that he generally has seen customers back off from the heavy drinking they were doing early in the pandemic.

    Loo and others in the Kansas City restaurant business are pushing for the carryout cocktails and other looser laws to stay in place even as restaurants slowly start to reopen.

    “This will go on for a while. It’s going to change people’s habit,” Loo said. “People’s spending habit. People’s dining out habit. So there’s definitely a need to keep doing it.”

    This story is part of a partnership that includes KCUR, NPR and Kaiser Health News.

    View the original article at thefix.com

  • Flattening the mental health curve is the next big coronavirus challenge

    Some recent projections suggest that deaths stemming from mental health issues could rival deaths directly due to the virus itself.

    The mental health crisis triggered by COVID-19 is escalating rapidly. One example: When compared to a 2018 survey, U.S. adults are now eight times more likely to meet the criteria for serious mental distress. One-third of Americans report clinically significant symptoms of anxiety or clinical depression, according to a late May 2020 release of Census Bureau data.

    While all population groups are affected, this crisis is especially difficult for students, particularly those pushed off college campuses and now facing economic uncertainty; adults with children at home, struggling to juggle work and home-schooling; and front-line health care workers, risking their lives to save others.

    We know the virus has a deadly impact on the human body. But its impact on our mental health may be deadly too. Some recent projections suggest that deaths stemming from mental health issues could rival deaths directly due to the virus itself. The latest study from the Well Being Trust, a nonprofit foundation, estimates that COVID-19 may lead to anywhere from 27,644 to 154,037 additional U.S. deaths of despair, as mass unemployment, social isolation, depression and anxiety drive increases in suicides and drug overdoses.

    But there are ways to help flatten the rising mental health curve. Our experience as psychologists investigating the depression epidemic and the nature of positive emotions tells us we can. With a concerted effort, clinical psychology can meet this challenge.

    Reimagining mental health care

    Our field has accumulated long lists of evidence-based approaches to treat and prevent anxiety, depression and suicide. But these existing tools are inadequate for the task at hand. Our shining examples of successful in-person psychotherapies – such as cognitive behavioral therapy for depression, or dialectical behavioral therapy for suicidal patients – were already underserving the population before the pandemic.

    Now, these therapies are largely not available to patients in person, due to physical distancing mandates and continuing anxieties about virus exposure in public places. A further complication: Physical distancing interferes with support networks of friends and family. These networks ordinarily allow people to cope with major shocks. Now they are, if not completely severed, surely diminished.

    What will help patients now? Clinical scientists and mental health practitioners must reimagine our care. This includes action on four interconnected fronts.

    First, the traditional model of how and where a person receives mental health care must change. Clinicians and policymakers must deliver evidence-based care that clients can access remotely. Traditional “in-person” approaches – like individual or group face-to-face sessions with a mental health professional – will never be able to meet the current need.

    Telehealth therapy sessions can fill a small part of the remaining gap. Forms of nontraditional mental health care delivery must fill the rest. These alternatives do not require reinvention of the wheel; in fact, these resources are already readily accessible. Among available options: web-based courses on the science of happiness, open-source web-based tools and podcasts. There are also self-paced, web-based interventions – mindfulness-based cognitive therapy is one – which are accessible for free or at reduced rates.

    Democratizing mental health

    Second, mental health care must be democratized. That means abandoning the notion that the only path to treatment is through a therapist or psychiatrist who dispenses wisdom or medications. Instead, we need other kinds of collaborative and community-based partnerships.

    For example, given the known benefits of social support as a buffer against mental distress, we should enhance peer-delivered or peer-supported interventions – like peer-led mental health support groups, where information is communicated between people of similar social status or with common mental health problems. Peer programs have great flexibility; after orientation and training, peer leaders are capable of helping individual clients or groups, in person, online or via the phone. Initial data shows these approaches can successfully treat severe mental illness and depression. But they are not yet widely used.

    Taking a proactive approach

    Third, clinical scientists must promote mental health at the population level, with initiatives that try to benefit everyone rather than focusing exclusively on those who seek treatment. Some of these promotion strategies already have clear-cut scientific support. In fact, the best-supported population interventions, such as exercise, sleep hygiene and spending time outdoors, lend themselves perfectly to the needs of the moment: stress-relieving, mental illness-blocking and cost-free.

    Finally, we must track mental health on the population level, just as intensely as COVID-19 is tracked and modeled. We must collect much more mental health outcome data than we do now. This data should include evaluations from mental health professionals as well as reports from everyday citizens who share their daily experiences in real time via remote-based survey platforms.

    Monitoring population-level mental health requires a team effort. Data must be collected, then analyzed; findings must be shared across disciplines – psychiatry, psychology, epidemiology, sociology and public health, to name a few. Sustained funding from key institutions, like the NIH, are essential. To those who say this is too tall an order, we ask, “What’s the alternative?” Before flattening the mental health curve, the curve must be visible.

    COVID-19 has revealed the inadequacies of the old mental health order. A vaccine will not solve these problems. Changes to mental health paradigms are needed now. In fact, the revolution is overdue.
     

    [You need to understand the coronavirus pandemic, and we can help.Read The Conversation’s newsletter.]

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

  • Don't Relapse Now

    Time has paused, life has paused, why can’t sobriety pause too?

    Reader, I will make a deal with you. I will talk to you like an adult and say some uncomfortable things. I won’t be your sponsor and I won’t throw the Big Book at your face. But in exchange, you need to promise me you’ll read this to the end. No skips, no tag outs, no skimmy skims. Okay? Okay, great.

    I understand the urge to relapse right now. I’m feeling it too. A lot of us have severely diminished responsibilities – my work has nearly dried up. I hate the Zoom meetings, which feel like impersonal shadow plays where I have to stare at my new fat face. All our other distractions that can’t be done from the couch have been cancelled. My normie friends are mixing up quarantinis before the 5 o’clock news starts. Most importantly, we are all being treated to a daily blast of death, inequity, and press conferences where a poorly tanned moron tells us to shoot up with bleach. It is so much. It is a daily mental weight that is difficult to bear even on the best days.

    If you are saying to yourself, maybe I can’t hold out on this, maybe I am going to break, that is a sane response. It is, in some ways, a rational response. Time has paused, life has paused, why can’t sobriety pause too? The other day I found myself telling a friend that I won’t be jobless, locked down, without the beach (my favorite distraction), and sober. In full Scarlett O’Hara mode, I declared, “Sorry, but I won’t do it!” It felt good to say, the way forbidden things sometimes do. Total, unapologetic narcissism has its pleasures.

    I could probably get away with it, too. I could probably go on a few-days bender and maybe my boyfriend would figure it out (he is sharp!), but no one else would. I could even keep my day count! Why not?!? This is the sort of self-dealing I’ve been doing. I am so good at it. I am the Clarence Darrow of fucking my own shit up.

    But it is wrong. I know it’s wrong. If you are having similar thoughts, you probably know they are wrong too. Even now, with life halted and pain and injustice ascendant, there are reasons both practical and metaphysical that it is crucial for you and me to keep our sober time. Even if every word we ever heard at an AA meeting was false, even if the Big Book itself is a decades-long scam to sell us on religion.

    Practically, you are going to regret it. You know you are! Sorry, but you do. You are going to be annoyed, at the very least, that you need to restart your day count, which yes, you eventually will be forced to do because you won’t be able to lie to your support network for that long. Whatever bender you have in mind is going to come to an end, in what will feel like the blink of an eye, and all you’ll have left is regret and likely, a terrible headache or worse. You also, of course, might take it too far and die.

    If things get really bad, as they very well may, people are going to know what you did and that is going to suck for you. Your family and friends are already extremely stressed out right now (just like you!) – the last thing they need is to hear that you relapsed, in your tiny apartment in some faraway city, and no one can travel to you to make sure you get it together. Your mom is going to cry.

    On that note, if you need hospital care because you overdose or can’t stop, great, you are taxing an already overtaxed healthcare system and exposing yourself to COVID19 at the same time. From a million different standpoints, any decision to relapse right now is selfish, even if it feels like the only person being punished is you.

    Okay, who cares, right? I hear that. When I was first trying to get sober and in a relapse cycle, other people’s problems were some theoretical concern that was a not-close second to my immediate ego gratification. I did not give a shit, and honestly I didn’t care much if I died, either. What worked for me, though, was spite – not giving my enemies the pleasure of seeing me fall.

    Spite could be helpful right now. Picture Donald Trump, in all his 300 pounds of dense mass, standing over you as you take that first drink. “I was always right,” he says without laughing, as he never laughs, “You’re weak. Libs like you, weak, lazy.” Do you want Donald Trump to think he’s better than you? How about the maskless crowds begging states to let them kill themselves, and each other? Should these yahoos and sociopaths be allowed to feel morally superior to you? Or picture a little closer to home. Do you want your douchebag ex to hear that you fucked up again? No you do not.

    The time we’ve all spent cooped up indoors losing our gourds has been an achievement which can be measured in days and lives saved. We’ve been doing this for well over thirty days now. In New York and elsewhere, we’ve flattened the curve. Your sobriety is the same. It’s not some fungible commodity that can be lent out and borrowed back at will – it has a character in itself composed in part of a temporal element. Your sobriety after you relapse is not the same as your sobriety before. When you give it up, you give up effort, sacrifice, things you can never get back. That might not feel important now, but it will feel devastating later.

    Look, I am not Mr. Lockdown. I eat loaves of bread as a snack. I stay up most nights until 5 AM and I sleep till 11. I bleached my hair. I play Nintendo Switch and try to get one or two productive hours into a day. My sheets smell like farts. All of this is fine! You do what it takes to make it to the next day. The people doing pilates every morning, learning a second language, making OnlyFans, whatever – they are fine, too. And it’s even fine to hate them!

    “One day at a time” is a relentless cliché in sobriety circles. But right now, it feels appropriate, as all of the stupid sayings eventually do. The world is a miserable place, maybe always, definitely right now. Don’t add to the misery by giving in to the demons you fought so hard to keep at bay. Be strong, stay home, save lives, stay sober. Good luck.

    View the original article at thefix.com

  • A Lesson from Sobriety: You Are Allowed to Feel Hopeful

    Having hope during a terrible situation isn’t the same as false hope. Hope is a fundamental ingredient of human resilience, a mechanism that sets our brains apart from other species.

    Imagine waking up one day and everything has changed. Overnight you’ve lost the ability to go to work. All the places you eat, drink, and socialize are closed. You walk down the street and people cross over to avoid your path. You are living the definition of empty. Void. Vast nothingness. You have no idea what tomorrow will bring, but if it’s more of the same, you might not want to have another tomorrow.

    Welcome to the reality of COVID-19. Many of us are currently living under stay at home orders where the situation feels similar to what I’ve described. Overnight, jobs lost or sent to work from home, daycares and schools closed, the few restaurants remaining open offer take out only, and, for some reason, toilet paper has become the national currency. I’ve noticed life during a pandemic has some clear parallels to life when contemplating going from substance abuser to sober.

    Fortunately, most of us can survive this pandemic if we practice some safety guidelines and weather a storm that has an uncertain end date. Again, the same can be said for sobriety. When I first contemplated sobriety, the uncertainty of what the future would look like kept me from moving forward. Eventually, I had to embrace this. I looked at what my life had become versus what I wanted it to be and I knew even uncertainty was better than the present.

    I made the decision to become sober six years ago. For me, sobriety meant losing a routine I’d become comfortably habituated to. A destructive routine that involved daily consumption of alcohol, often until I couldn’t drink any more on any given night. Right now, we are being told our normal routine could lead to a worsening of the pandemic, the potential to spread the disease and expose those most vulnerable to its fatal effects. We’ve been asked to willingly adjust our routines with the absence of an end date.

    In sobriety, I had to define a new normal. This happened both purposely and organically. Part of what I did was attend counseling and AA sessions. That was on purpose. I also started writing more and performing better at work. That was more organic. I didn’t order alcoholic beverages while out with clients and colleagues. That was on purpose. I fell in love with ice cold seltzer water. That was organic.

    We don’t know what our new normal will look like after this first round of COVID-19. There are some behaviors many of us have adopted that will probably persist: wearing masks, avoiding handshakes, increased hand washing. We will adopt other behaviors or adapt in ways we can’t foresee in the coming months. Many of these will bring us joy, or at least decrease potential future situations like our present condition.

    The Present and the Presence of Hope

    Everyone–sober, drunk, or indifferent–is facing some unexpected hardships right now. We’ve been told by experts we are experiencing loss and should feel permission to grieve. This is true. But we have permission to feel hopeful as well. Hope is what led me to embrace and eventually thrive in sobriety. Hope will get us through this pandemic.

    I could have never imagined the wonderful things waiting for me on the other side of sobriety. A marriage (later a divorce, but hey), a child, Saturday mornings, physical health, mental clarity, reduced anxiety, and vomit-free carpets are only some of the things I wouldn’t have accomplished if I were still drinking.

    Having hope during a terrible situation isn’t the same as false hope. Hope is a fundamental ingredient of human resilience, a mechanism that sets our brains apart from other species. Hope has kept individuals and societies moving forward to better ourselves since the time our external gills disappeared, and our tails fell off. Or we were fashioned from dust. Whatever you choose.

    Hope is what countered the fear and uncertainty I felt initially entering sobriety. Excitement for a future without the shackles of alcohol. We are in the same situation now; there’s no other motivation to go through this if we have no hope the future will bring something better than the present.

    We have some time before this will pass. Spend some of it dwelling on hope. Make a list of things that might be better post-pandemic. Plan your dream vacation (we will travel again). Do something you’ve always wanted to do for yourself. Along with anxiety, fear, or grief, you are allowed to feel hope and excitement in our current situation. Something different is waiting for you. Potentially something better than you can imagine.

    View the original article at thefix.com

  • Addiction Is ‘A Disease Of Isolation’ — So Pandemic Puts Recovery At Risk

    Addiction Is ‘A Disease Of Isolation’ — So Pandemic Puts Recovery At Risk

    “We consider addiction a disease of isolation…Now we’re isolating all these people and expecting them to pick up the phone, get online, that sort of thing — and it may not work out as well.”

    Before the coronavirus became a pandemic, Emma went to an Alcoholics Anonymous meeting every week in the Boston area and to another support group at her methadone clinic. She said she felt safe, secure and never judged.

    “No one is thinking, ‘Oh, my God. She did that?’” said Emma, “’cause they’ve been there.”

    Now, with AA and other 12-step groups moving online, and the methadone clinic shifting to phone meetings and appointments, Emma said she is feeling more isolated. (KHN is not using her last name because she still uses illegal drugs sometimes.) Emma said the coronavirus may make it harder to stay in recovery.

    “Maybe I’m old fashioned,” said Emma, “but the whole point of going to a meeting is to be around people and be social and feel connected, and I’d be totally missing that if I did it online.”

    While it’s safer to stay home to avoid getting and spreading COVID-19, addiction specialists acknowledge Emma’s concern: Doing so may increase feelings of depression and anxiety among people in recovery — and those are underlying causes of drug and alcohol use and addiction.

    “We consider addiction a disease of isolation,” said Dr. Marvin Seppala, chief medical officer at the Hazelden Betty Ford Foundation. “Now we’re isolating all these people and expecting them to pick up the phone, get online, that sort of thing — and it may not work out as well.”

    Emma has another frustration: If the methadone clinic isn’t allowing gatherings, why is she still required to show up daily and wait in line for her dose of the pink liquid medication?

    The answer is in tangled rules for methadone dispensing. The federal government has loosened them during the pandemic — so that patients don’t all have to make a daily trip to the methadone clinic, even if they are sick. But patients say clinics have been slow to adopt the new rules.

    Mark Parrino, president of the American Association for the Treatment of Opioid Dependence, said he issued guidelines to members late last week about how to operate during pandemics. He recommended that clinics stop collecting urine samples to test for drug use. Many patients can now get a 14- to 28-day supply of their addiction treatment medication so they can make fewer trips to methadone or buprenorphine clinics.

    “But there has to be caution about giving significant take-home medication to patients who are clinically unstable or actively still using other drugs,” Parrino said, “because that could lead to more problems.”

    The new rules have a downside for clinics: Programs will lose money during the pandemic as fewer patients make daily visits, although Medicare and some other providers are adjusting reimbursements based on the new stay-at-home guidelines.

    And for active drug users, being alone when taking high levels of opioids increases the risk of a fatal overdose.

    These are just some of the challenges that emerge as the public health crisis of addiction collides with the global pandemic of COVID-19. Doctors worry deaths will escalate unless people struggling with excessive drug and alcohol use and those in recovery — as well as addiction treatment programs — quickly change the way they do business.

    But treatment options are becoming even scarcer during the pandemic.

    “It’s shutting down everything,” said John, a homeless man who’s wandering the streets of Boston while he waits for a detox bed. (KHN is not including his last name because he still buys illegal drugs.) “Detoxes are closing their doors and halfway houses,” he said. “It’s really affecting people getting help.”

    Adding to the scarcity of treatment options: Some inpatient and outpatient programs are not accepting new patients because they aren’t yet prepared to operate under the physical distancing rules. In many residential treatment facilities, bedrooms and bathrooms for patients are shared, and most daily activities happen in groups — those are all settings that would increase the risk of transmitting the novel coronavirus.

    “If somebody were to become symptomatic or were to spread within a unit, it would have a significant impact,” said Lisa Blanchard, vice president of clinical services at Spectrum Health Systems. Spectrum runs two detox and residential treatment programs in Massachusetts. Its facilities and programs are all still accepting patients.

    Seppala said inpatient programs at Hazelden Betty Ford are open, but with new precautions. All patients, staff and visitors have their temperature checked daily and are monitored for other COVID-19 symptoms. Intensive outpatient programs will run on virtual platforms online for the immediate future. Some insurers cover online and telehealth addiction treatment, but not all do.

    Seppala worried that all the disruptions — canceled meetings, the search for new support networks and fear of the coronavirus — will be dangerous for people in recovery.

    “That can really drive people to an elevated level of anxiety,” he said, “and anxiety certainly can result in relapse.”

    Doctors say some people with a history of drug and alcohol use may be more susceptible to COVID-19 because they are more likely to have weak immune systems and have existing infections such as hepatitis C or HIV.

    “They also have very high rates of nicotine addiction and smoking, and high rates of chronic lung disease,” said Dr. Peter Friedmann, president of the Massachusetts Society of Addiction Medicine. “Those [are] things we’ve seen in the outbreak in China [that] put folks at higher risk for more severe respiratory complications of this virus.”

    Counselors and street outreach workers are redoubling their efforts to explain the pandemic and all the related dangers to people living on the streets. Kristin Doneski, who runs One Stop, a needle exchange and outreach program in Gloucester, Massachusetts, worried it won’t be clear when some drug users have COVID-19.

    “When folks are in withdrawal, a lot of those symptoms can kind of mask some of the COVID-19 stuff,” said Doneski. “So people might not be taking some of their [symptoms seriously], because they think it’s just withdrawal and they’ve experienced it before.”

    Doneski is concerned that doctors and nurses evaluating drug users will also mistake a case of COVID-19 for withdrawal.

    During the coronavirus pandemic, needle exchange programs are changing their procedures; some have stopped allowing people to gather inside for services, safety supplies, food and support.

    There’s also a lot of fear about how quickly the coronavirus could spread through communities of drug users who’ve lost their homes.

    “It’s scary to see how this will pan out,” said Meredith Cunniff, a nurse from Quincy, Massachusetts, who is in recovery for an opioid use disorder. “How do you wash your hands and practice social distancing if you’re living in a tent?”

    This story is part of a partnership that includes WBUR, NPR and Kaiser Health News.

    View the original article at thefix.com