For someone struggling with addiction, fellowship is a big part of the recovery process. Unfortunately, since the coronavirus outbreak began and social distancing became the norm, this process has become more challenging.
This typically means physical meetings with other people in recovery. In the Alcoholics Anonymous (AA) program, members are encouraged to attend several meetings per week, during which they’re invited to share their experiences and connect with others in person.
But since the outbreak, meetings like these have become few and far between, leaving people in the throes of addiction without immediate support.
Sarah, a sponsor for AA in Toronto, has seen this firsthand. Global News has agreed to use a pseudonym to protect her identity.
“AA meetings are a vital part of the program, especially for newcomers who are still building their groups of peers support system among fellow participants,” she said.
At first, it started with less physical touch. Now, in-person meetings are largely cancelled.
“About two weeks ago, most groups stopped shaking hands and holding hands at the end of the meeting,” Sarah said. “In the last week, most meetings have decided to close for the time being.”
As a sponsor, Sarah fears that the lack of in-person meetings will leave newcomers stranded at a critical juncture in their recovery process.
“I’m worried … especially those who are still out there drinking who are on the verge of making it to their first AA meetings, because we won’t physically be there in the traditional way,” she said.
This is especially worrisome because researchers typically see a spike in substance abuse during emergencies like the COVID-19 pandemic.
“ pretty consistent with any type of emergency or disaster — natural disasters like a fire, hurricane or flooding — as well as more localized disasters, like survivors of a ship sinking,” said Michael Chaiton, an associate professor at the Dalla Lana School of Public Health and researcher at the Centre for Addiction and Mental Health (CAMH) in Toronto.
“It’s often people coping by using substances … primarily things that are easily available, like alcohol, tobacco, cannabis and non-prescription medications.”
Substance abuse during crises
CAMH defines addiction as the presence of four things: cravings, loss of control of amount or frequency of use, compulsion to use and using despite the consequences.
Unfortunately, said Chaiton, a situation like the coronavirus outbreak can exacerbate these circumstances.
“People turn to substances to cope with stress and trauma,” Chaiton said.
“One of the real downsides is that it’s not a very good coping mechanism. can actually exacerbate some of the effects.”
For example, although drugs and alcohol may help you feel calm in the short term, they can actually heighten your fear and anxiety in the long term.
“These substances offer an immediate source of control. Having a drink or smoking can make you feel better right away,” Chaiton said.
“But long-term, as you get into addiction, then really the substance itself is driving that cycle of coping and stress rather than the outside environment itself.”
If you feel better after having a cigarette, it’s because you’re managing your body’s withdrawal from the nicotine — not the impact of the disaster that was the cause of the stress in the first place.
There’s little data on the effects of a pandemic on substance abuse, Chaiton said, particularly in the social media age where we are “connected to the sources of information constantly.”
However, there is data on the effects of significant disasters, such as 9/11.
A 2001 survey found that 10 per cent of New York participants reported an increase in smoking, and nearly 25 per cent of respondents consumed more alcohol in the days following the terrorist attack. Roughly three per cent of people reported an increase in cannabis use.
Physicians and harm reduction workers say the need for a safer opioid supply as a way to curb overdose deaths is even more urgent now in the midst of the COVID-19 pandemic.
“If safe supply were something that was readily available to people who use drugs, it would drastically increase their ability to stay put and stay in place, wherever they deem their home to be,” Andrea Sereda, a family physician at the London InterCommunity Health Centre in London, Ont., previously told Global News.
Sereda is part of a growing chorus of front-line workers who say this type of prescribing needs to be ramped up to help people who rely on the street supply, to protect them from the spread of COVID-19 and also mitigate the increased risks of using street opioids alone.
What it means to be addicted
Addiction is an illness, but it’s often portrayed as a choice — a misunderstanding that can further stigmatize people who struggle with substance use and addiction.
“Sure, we’ll make the decision to use , but nobody decides to live that lifestyle,” said Kim Hellemans, chair of the neuroscience department at Carleton University in Ottawa.
The exact science remains unclear, but doctors believe there are a region and a circuit in the human brain “listening for when we engage in highly rewarding events,” said Hellemans.
“When we eat tasty food or have sex, there’s a natural reward circuit because when we engage in these rewarding events, they tend to increase our survival.”
Most addictive substances target this system.
“Whether you shoot heroin or drink alcohol, smoke nicotine or cannabis, they all start to activate that pathway,” Hellemans said. “It translates to us feeling good.”
In people who develop addiction, doctors believe their “baseline reward pathway activation” is low.
“When they engage in heroin or alcohol use, it elevates the activity of that pathway so they feel like … that’s just normal,” she said.
She noted if someone has depression or anxiety and uses a substance to relieve symptoms, the brain notes this particular substance makes them feel good.
The pathway triggered by those substances, traditionally intended to signal survival, is triggered by something that is actually bad for you — but your brain doesn’t know this.
“Your brain starts telling you that engaging in these behaviours is going to mean you’re more likely to live,” she said. “ people who are trying to quit those substances may feel like they’re dying. That circuit isn’t being activated.”
And that’s why substance abuse may rise during times of emergency or disaster: users are looking for a way to feel better — and when they use drugs or alcohol, the reward pathways in their brain are triggered.
New ways to connect
While social distancing can definitely make it harder to connect, Sarah said her community is pulling together.
“I have a sponsee that is currently in a treatment centre … and they’re not allowed to go out to meetings or have visitors, so we connect on the phone more often and share online resources that can be helpful,” Sarah said.
“Our community spirit has deepened in these trying times, in terms of really trying to make sure we all have the best possible information and resources to get through this — not only sober, but emotionally well and in a positive way.”
The COVID-19 outbreak is probably causing people heightened levels of anxiety and stress, and substance use and abuse during this time should be avoided.
According to CAMH, for those at risk, substance use can lead to an addiction or a relapse in those who are in recovery. If you are in recovery and experiencing stress, it is important to reach out for help before a relapse occurs.
The organization recommends that you:
- Reduce or stop using any non-prescribed substance if you can do so safely.
- Take prescription medications as prescribed.
- Try to reduce or avoid caffeine and alcohol.
- Seek out professional help if you cannot do it alone.
The new coronavirus was first identified in Hubei province, China, in December 2019 and spread rapidly. While the outbreak has begun to level off in China, it seems the virus has found a foothold in a number of countries around the world, and it continues to spread.
Questions about COVID-19? Here are some things you need to know:
Health officials say the risk is low for Canadians but warn this could change quickly. They caution against all international travel. Returning travellers are asked to self-isolate for 14 days in case they develop symptoms and to prevent spreading the virus to others.
Symptoms can include fever, cough and difficulty breathing — very similar to a cold or flu. Some people can develop a more severe illness. People most at risk of this include older adults and people with severe chronic medical conditions like heart, lung or kidney disease. If you develop symptoms, contact public health authorities.
To prevent the virus from spreading, experts recommend frequent handwashing and coughing into your sleeve. And if you get sick, stay at home.
For full COVID-19 coverage from Global News, click here.
If you or someone you know is in crisis and needs help, resources are available. In case of an emergency, please call 911 for immediate help.
The Canadian Association for Suicide Prevention, Depression Hurts and Kids Help Phone 1-800-668-6868 all offer ways of getting help if you, or someone you know, may be suffering from mental health issues.
— With files from Rachel Browne
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