The mental health situation in the US has taken a bleak turn since the onset of COVID-19 earlier this year. Fear of infection, dramatic and isolating lifestyle changes, record-setting unemployment, political unrest, and sheer loss of life have all weighed heavily on the minds of people across the country. One group in particular is especially vulnerable to the conditions we’re now living in, and they’re up against the greatest odds for getting through the pandemic: those in recovery from substance use disorders (SUDs). To ensure the wellness and safety of this group, new solutions are needed to reinforce recovery and avoid the pitfalls that COVID-19 has created.
One of the most important factors for recovery is connection with other people. Support groups around the country exist for this purpose; prior to the pandemic, regular meetings were held in person. However, in an effort to meet social distancing regulations, nearly all in-person support meetings have been canceled. According to a May 2020 academic paper, social distance, isolation, and quarantine are essential measures to help prevent coronavirus transmission. However, these strategies—and the pandemic outbreak itself—are also associated with negative emotions such as irritability, anxiety, fear, sadness, anger, or boredom (Ornell et al., 2020). These conditions are known to trigger recurrence of substance use even in long-term abstainers, or intensify drug consumption for those who are actively using (Serafini et al., 2016; Sinha et al., 2009).
Adding to this, in an interview with the director of the National Institute of Drug Abuse, Dr. Nora Volkov on May 12, 2020, she stated that:
Based on these impacts of COVID-19, it’s little wonder why searches for terms like “online therapy,” “unemployment benefits,” and “alcohol” all peak during the onset of layoffs, fear, and desperation as the pandemic stepped into the spotlight in mid-March 2020:
“Online therapy,” however, is the only term with a lastingly high search intensity, which indicates an enduring change in the demand for this type of service in a pandemic-stricken world.
Why does substance use increase during crises?
Increased alcohol consumption during economic crises is a well-researched phenomenon with causes linked to psychological (depression, anxiety, stress, and isolation) and somatic symptoms (insomnia, trembling, and fatigue). One of the most important causes of these symptoms is unemployment and the associated reduction in income.
In a 2015 systemic review of the literature on alcohol consumption during economic crises, two theories explain how this distress can lead to increases in alcohol consumption. The stress response dampening theory argues that individuals consume alcohol to reduce the intensity of their response to anxiety and stress, which results in higher levels of alcohol consumption during economic crises. This largely aligns with the self-medication theory, which argues that alcohol-related health problems increase during economic crises due to consumption of alcohol as a coping mechanism for stressful situations. In both cases, what we have are direct links between our current crisis and increased alcohol consumption.
Past crises—such as the Great Recession of the late 2000s—have particularly impacted more vulnerable populations, increasing substance use (de Goeij et al., 2015; Dom et al., 2016). It is therefore expected that over the course of this pandemic, vulnerable and at-risk individuals will develop SUD and that subjects with mild SUD could progress to more severe forms of the disorder.
During the post-2007 Great Recession in the US, economic stressors led to an increase in frequency and volume of drinking as well as problem drinking through psychological distress (i.e., depression, denial, anger, and anxiety) (Blau et al., 2013; Brown and Richman, 2012; Kalousova and Burgard, 2014) and through somatic symptoms (e.g., sleep problems, stomach problems, migraines, and fatigue) (Vijayasiri et al., 2012). At this time, reduced hours of paid work was associated with more negative drinking consequences and alcohol dependence (Mulia et al., 2014).
According to the first mechanism in the table above, people may drink more when they feel anxious, depressed, and frustrated. These presentations of psychological distress can be triggered by unemployment, income reductions, or altered work situations (e.g., underemployment, and lower wages). At that time, drinking as a coping mechanism to relieve distress was observed predominantly in men, and to a lesser degree in women. In addition, evidence showed that distress in men primarily increased harmful drinking, including alcohol dependence, negative consequences of drinking, binge drinking, hazardous drinking, and intoxication. This is in line with the “self-medication theory,” which suggests that drinking to cope with stressful situations may increase alcohol dependence in certain people (Bolton et al., 2009; Khantzian, 1997).
COVID Complications
Social distance, isolation, or quarantine are essential measures to help prevent Coronavirus transmission—however, these strategies (and the pandemic outbreak itself) have been associated with negative emotions such as irritability, anxiety, fear, sadness, anger, and boredom (Ornell et al., 2020). These conditions are known to trigger relapse even in those long-term abstainers, or intensify drug consumption (Serafini et al., 2016; Sinha et al., 2009).
The CDC published a survey gauging the impact of COVID on mental health and substance use among Americans in late June of this year. The data reports that 13% of adults either increased or began using substances as a direct result of emotional turmoil experienced during COVID. In comparison to a study from the same time a year prior, there was a 3x increase in anxiety disorder symptoms and a 4x increase in depressive disorder symptoms. On top of this, 10% of adults surveyed reported suicidal ideation as a result of stress related to COVID.
A national survey on drug use and health from 2018 by SAMHSA shows that nearly 50% of all Americans with substance use disorder also have a mental health illness. Given the crossover between individuals in the US who have a co-occuring mental health disorder alongside substance use disorder, the CDC survey demonstrates the critical importance in addressing mental health and substance use during quarantine.
The CDC concluded their survey with discussion around potential solutions and actions that might help to mitigate the risks associated with increased levels of substance use and mental health symptoms. Telehealth is among the suggested calls to action for the US to pursue in efforts to create accessible care. During quarantine, telehealth can provide care options for an array of mental health and substance abuse difficulties in a unique and sorely needed manner.
The Path Forward
To get through this pandemic with as little suffering as possible, it’s important that we—as a nation—show compassion to each other, and realize that some groups will encounter higher risk and more severe negative consequences. Those with substance use disorders are having a relatively rougher time, and making solutions available to them (especially solutions which promote connectedness) will be paramount to easing this hardship.
As recovery communities and mutual aid groups have largely transitioned to an online space, we encourage anyone in need of support to come to our online meetings. They are open to any and all paths of recovery, as well as those experiencing mental health difficulties. Please take care of yourself, and please offer this as a resource to others who are struggling to find the support they need during this challenging time.
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