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Maintaining Recovery from Substance Use Disorders During the COVID-19 Pandemic

Maintaining Recovery from Substance Use Disorders During the COVID-19 Pandemic

Written by: Anton Bizzell, MD

The global COVID-19 pandemic has had a profound impact on health care delivery systems and on patterns of social support worldwide, creating an unprecedented set of challenges for individuals in recovery from substance use disorders (SUDs). In addition to managing the situational anxiety many people are facing with the unknowns of the pandemic, the social distancing that is vital to reduce the spread of the virus and protect vulnerable people, leaves individuals in recovery physically isolated from their health care providers and support system. Some people with SUDs may be at higher risk of relapsing with extended periods of time at home, uncertainty about work or finances, added stress on family relationships, or social isolation.

With this extraordinary situation, new resources and solutions are emerging to help people struggling with SUDs gain access to treatment in order to maintain their path to recovery.

New treatment access and guidelines during COVID-19. Health care and treatment of individuals with SUDs is evolving to meet the challenges of social isolation during the global pandemic:

  • Telehealth: Most insurance companies are now covering telehealth services at the same rate as traditional in-person visits with health care and behavioral health providers. Providers use secure virtual platforms to conduct a confidential video assessment, and to provide any necessary prescriptions or referrals to additional virtual or in-person treatment.
  • Take-home Medication-Assisted Treatment for Opioid Use Disorders: The Substance Abuse and Mental Health Services Administration (SAMHSA) has issued Opioid Treatment Program guidance for states to be granted an exception to administer 14 to 28 days of take-home medication to individuals in an Opioid Treatment Program. This new guidance improves access to evidence-based Medication-Assisted Treatment for individuals with opioid use disorders (OUDs).
  • Treatment for Alcohol Withdrawal: The American Society of Addiction Medicine (ASAM) has issued a Clinical Guideline on Alcohol Withdrawal Management. Some states have closed liquor stores as part of COVID-19 restrictions, resulting in limited access; at the same time, individuals experiencing alcohol withdrawal may also have limited access to treatment and withdrawal management programs. The ASAM Guideline advises clinicians in decision-making and treatment, improving care for these individuals struggling with alcohol use and alcohol withdrawal.

Virtual support during COVID-19. Many new resources are available to help individuals in recovery access support virtually:

  • SAMHSA Virtual Recovery Resources: SAMHSA notes that during the social distancing and isolation of COVID-19, it is still vital to continue social connections when recovering from SUDs and mental health conditions. This Tip Sheet describes resources for individuals in recovery and gives guidance for setting up a virtual recovery meeting.
  • National Alliance for Mental Illness (NAMI) COVID-19 Resource and Recovery Guide: Mental health support is a vital component of recovery. NAMI provides helpful tips for managing concerns about the virus, accessing virtual support, developing healthy daily routines, maintaining social support, and prioritizing self-care.
  • Alcoholics Anonymous Options for Meeting Online: During COVID-19, many Alcoholics Anonymous groups are exploring alternate ways to continue the community of support for recovery. This may involve phone calls, email, social media, and virtual meetings on digital platforms. Alcoholics Anonymous encourages groups to decide what will work best for them and provides information for groups making this change.
  • Virtual Narcotics Anonymous: This collaborative resource helps people find online and phone meetings of Narcotics Anonymous around the world. Narcotics Anonymous is for people who have any SUD and want support in their recovery.

Healthy habits to support recovery during COVID-19.  Some people in recovery have found it helpful to take this time of social distancing to focus on healthy habits that will support recovery. These can include:

  • Manage News Consumption
    • Check only established, reliable news sources. Set a timer to limit the amount of time you are reading the news. Avoid checking the news within one hour before bedtime, and instead focus on relaxing activities.
  • Get Ample Rest
    • Get at least 7-8 hours of sleep each night. Make sure that your sleeping area is used only for sleep. Use calming routines at night such as reading, taking a bath, or talking with a friend.
  • Develop and Maintain a Daily Routine
    • Keep a routine of getting up and getting dressed on a regular schedule each day. Set your alarm and start your day with a walk outside or your favorite breakfast. Take a shower, get dressed, and write out a plan for how you will spend your day.
  • Exercise Daily
    • Get daily exercise, even if it is just a gentle walk or simple stretches. If you usually go to a gym, look for online exercise programs such as yoga, dance, chair exercises, or even a boot camp routine. Start a virtual exercise routine with a friend so that you can encourage and support each other.
  • Schedule Time to Connect with Loved Ones
    • Schedule time for social connections each day, whether by phone, video, email, or text. Look for shared activities such as a book club, art activities, virtually movie night, or cooking that you can enjoy together remotely. Focus on connections with the people you can have honest conversations with about your feelings and struggles.
  • Other Mental Health Exercises
    • Choose activities that will support your mental health, including breathing exercises, journaling, or meditation. Look for online books and workbooks on Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and Mindfulness, to help you manage your thoughts, worries, and behaviors during this challenging time. Notice what feels relaxing and restful for you, and intentionally choose those activities.

The COVID-19 pandemic has created new challenges for individuals in recovery; it has also fostered creative new approaches to treatment and support, many of which are reaching people in new ways that may continue beyond the end of social distancing. With continued integration of treatment, virtual support, and healthy habits, recovery can continue.

The Bizzell Group (Bizzell) was founded by President & CEO Anton C. Bizzell, M.D., a leading substance use disorders (SUDs) expert and former Medical Officer for the U.S. Department of Health and Human Services (HHS). Dr. Bizzell was selected as Maryland’s 2020 Small Businessperson of the Year by the U.S. Small Business Administration (SBA). Bizzell’s recent work includes systematic, integrated approaches designed to effect lasting change in the field of SUDs through work with the National Institute on Drug Abuse (NIDA), the National Cancer Institute (NCI), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), and the United States Chamber of Commerce Foundation (USCCF). Learn more about how we develop data-driven, research-informed, innovative solutions to SUDs and other complex-real-world challenges: https://BizzellUS.com/

Categories Insights Tags Alcohol Use Disorder (AUD), Behavioral Health, CEO Insights, Mental Health, National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH), Thought Leadership

Alcohol Use Disorder: Hope for Recovery

Alcohol Use Disorder: Hope for Recovery

Written by: Anton Bizzell, MD

Alcohol use disorder (AUD) is often referred to as the hidden substance use disorder (SUD). With alcohol use legal and socially acceptable in many settings, the symptoms of AUD may initially go unnoticed. Yet individuals with AUD may experience significant difficulties in their relationships, work, and health.

In a newly released analysis, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) at the National Institutes of Health (NIH) found that over 70 percent of the adult population drank alcohol in 2017. Alcohol-related deaths more than doubled from 1999 to 2017. Overdoses of alcohol alone or in combination with other drugs accounted for 18 percent of the deaths in 2017; 31 percent of the deaths resulted from alcohol-related liver disease. Researchers note that the since this study examined only death certificate data, the actual number of lives lost may be significantly higher.

The death rates increased higher for women than for men, and gender differences persist in risks for alcohol-related cardiovascular disease, liver disease, and cancer. In addition, while prevalence of alcohol use and binge drinking remained stable for men, the prevalence of alcohol use increased by over 10 percent for women and binge drinking increased by over 23 percent among women.

The NIAAA screening tool for AUD includes questions a provider can use to diagnose whether an individual may have an AUD. Individuals who are struggling with their drinking, or families and friends concerned about their loved ones, can start by considering the following questions.

In the past year, have you:

  •  Tried to cut down or stop drinking more than once, but couldn’t?
  •  Found that drinking or being sick from drinking got in the way of you taking care of your home or your family, or caused problems at work or school?
  •  More than once gotten into situations while drinking that could be dangerous, such as driving, having unsafe sex, using machinery, walking in an unsafe neighborhood; or had a memory blackout?
  •  Kept drinking even though it was making you depressed or anxious, or adding to other health problems?
  •  Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating?

In addition to peer-led support models such as Alcoholics Anonymous, there are many options for professionally-led treatment. Treatment for AUD often involves a combination of talk therapy and medication. Therapy can be for individuals, groups, or families, under the direction of a licensed counselor trained in substance use disorders. Medication to help individuals stop drinking and avoid relapse can be administered under the care of a licensed primary care provider or a board-certified addiction medicine physician. In addition, different levels of care and care settings are available to meet the needs of each situation, including outpatient, partial hospitalization, residential, or intensive inpatient.

Although the consequences of AUD can be devastating, hope for recovery is possible with evidence-based, timely intervention.

About Bizzell

The Bizzell Group (Bizzell) was founded by CEO Anton Bizzell, M.D., a substance use disorders expert and former Medical Officer at NIAAA. Our recent work includes systematic, integrated approaches designed to effect lasting change in the field of substance use disorders through projects with the National Institute on Drug Abuse (NIDA), the National Cancer Institute (NCI), the Food and Drug Administration (FDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the United States Chamber of Commerce Foundation (USCCF). Learn more about how Bizzell advances data-driven, research-informed, innovative solutions to solve complex, real-world challenges. www.BizzellUS.com

Reference:

White, A. M., Castle, I. J. P., Hingson, R. W., & Powell, P. A. (2020). Using Death Certificates to Explore Changes in Alcohol‐Related Mortality in the United States, 1999 to 2017. Alcoholism: Clinical and Experimental Research.

Categories Insights, Mental Health Tags Behavioral Health, Department of Labor (DoL), Department of Veteran Affairs (VA), Health, Mental Health, Military, Thought Leadership

PTSD Awareness Day

PTSD Awareness Day

The National Center for PTSD promotes awareness of PTSD and effective treatments throughout the year. Starting in 2010, Congress named June 27th PTSD Awareness Day.

Post-Traumatic Stress Disorder (PTSD) is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event. PTSD can happen to anyone at any age and includes war veterans, children, and people who have been through physical or sexual assault, abuse, accident, disaster, or other serious events. According to the National Center for PTSD, about 7 or 8 out of every 100 people will experience PTSD at some point in their lives. Women are more likely to develop PTSD than men, and genes may make some people more likely to develop PTSD than others.  PTSD happens after traumatic events that cause people to have painful memories. For many people, the effects of the traumatic fade over time, but others are unable to make the thoughts and feelings go away even months or years after the event has occurred.

PTSD symptoms usually start immediately after the traumatic event:

The U.S. Department of Veteran Affairs has a list of symptoms for PTSD:

  1. Reliving the event (also called re-experiencing symptoms). You may have bad memories or nightmares. You even may feel like you’re going through the event again. This is called a flashback.
  2. Avoiding situations that remind you of the event. You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event.
  3. Having more negative beliefs and feelings. The way you think about yourself and others may change because of the trauma. You may feel guilt or shame. Or, you may not be interested in activities you used to enjoy. You may feel that the world is dangerous and you can’t trust anyone. You might be numb, or find it hard to feel happy.
  4. Feeling keyed up (also called hyperarousal). You may be jittery or always alert and on the lookout for danger. Or, you may have trouble concentrating or sleeping. You might suddenly get angry or irritable, startle easily, or act in unhealthy ways (like smoking, using drugs and alcohol, or driving recklessly.

Below is a list of PTSD screens, that is, brief questionnaires that may identify people who are more likely to have PTSD.

For each measure, a brief description, sample items, versions, and references are provided. Information on how to obtain the measure is also provided.

Categories Insights, Mental Health Tags Autism Spectrum Disorder (ASD), Behavioral Health, Centers for Disease Control and Prevention (CDC), Health, Mental Health, Special Populations, Thought Leadership

National Autism Awareness Month

National Autism Awareness Month

For over 50 years the Autism Society has provided services and programming to support individuals living with autism. National Autism Awareness Month, observed every April, has been an occasion to promote awareness of autism and work to ensure that each person with autism spectrum disorder (ASD) can achieve the highest possible quality of life.  

Autism spectrum disorder is a complex developmental disability that affects a person’s ability to communicate and interact with others. Signs of autism, which usually appear early in childhood, are: delayed learning of language; little or no eye contact with other people; lack of interest in peer relationships; lack of spontaneous or make-believe play; fixation on particular objects; difficulty with executive functioning (which relates to reasoning and planning); narrow, intense interests; poor motor skills; repetitive use of language; repetitive movements (such as hand-flapping); and sensory issues. ASD is a “spectrum condition” that affects individuals to varying degrees. A diagnosis of autism spectrum disorders reflects the number and severity of these behaviors a person shows. 

In 2016, the Centers for Disease Control and Prevention reported that the prevalence of autism in the United States was 1 in every 68 births, and 1 in every 54 boys. The overall prevalence in 2016 was twice the rate in 2004, which was 1 in every 125 births. Autism services cost U.S. citizens $236 to $262 billion annually. Most of this amount is for adult services—$175–$196 billion, compared to $61–$66 billion for children. Cost of lifelong care can be reduced by two-thirds with early diagnosis and intervention.  

Autism is treatable. Studies show that early diagnosis and intervention can change lives. Intervention plans must be unique to the individual, but they usually involve behavioral treatment, medicines, or both. Early behavioral treatment requires intensive collaboration between a child’s family and a team of professionals and may consist of parent training and individual therapy in a special center or classroom. Many people with ASD have other associated medical conditions, such as sleep disturbance or seizures, and improving these conditions can improve attention, learning, and behavior. Different interventions are needed as a child develops and acquires social and learning skills—for example, specialized social skills training may be help children with autism when they enter school. Adolescents with autism can benefit from supportive services that help them transition to employment and independence as adults.  

According to Autism Speaks (www.autismspeaks.org), a small minority of people with ASD progress to the point that they no longer meet the diagnostic criteria for autism. These individuals may have been misdiagnosed, may have “matured out” of some symptoms, or may have responded especially well to treatment. Some individuals have the “best possible outcomes”; their test scores are within normal ranges for IQ, language, functioning, school placement and personality, but they still have mild symptoms on some personality and diagnostic tests.  

This April, the Autism Society also wants to encourage people and groups to become partners in a movement toward accepting and appreciating people with ASD and including them in our schools and communities in a way that reflects true appreciation of the unique qualities of all people. “We want to get one step closer to a society where those with ASDs are truly valued for their unique talents and gifts,” says the Society’s website. 

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