In his TED Talk entitled, “Everything You Think You Know About Addiction Is Wrong,” British journalist and writer Johann Hari says, “The opposite of addiction is not sobriety, it’s connection.”
Before the COVID-19 pandemic, substance use disorders and addiction were two of the most shamed social conditions. In fact, the World Health Organization says addiction is the most stigmatized social condition. Addiction and substance abuse also constituted an enormous social problem in the United States.
Environmental stressors such as housing insecurities, unemployment, emotional pains, and isolation often lead to new substance use, or relapse for those in recovery and addiction. The COVID-19 pandemic exacerbated the situation by escalating environmental stressors and creating a high demand for substance use disorder treatment.
Shame and Myths
According to the American Society of Addiction Medicine, addiction is a treatable, chronic, relapsing and remitting disease of the brain that causes compulsive drug-seeking and use despite harm to the person using or to those around them. It is not a sign of moral weakness or failure.
While 23.5 million Americans struggle with substance use disorder, only 10% of those receive treatment. Moral judgments and stigmatizing vocabulary fuel shame around substance use disorder and validate myths associated with it.
Some of the myths include the idea that prison or treatment can fix people living with addiction. However, the COVID-19 pandemic has proven that these spaces are not always safe for people who use substances. Faced with these cruel moral judgments, people who use substances will often feel guilty and worthless—and numb their pains with more substance use.
Prior to the Pandemic
Substance use disorders and addiction were a huge problem before the COVID-19 pandemic. According to the National Institute on Drug Abuse, 128 people in the United States died every day after overdosing on opioids in 2018. Drug overdose, suicides, and alcohol-related diseases are some of the reasons why Americans’ life expectancy is declining.
The situation did not get better with the COVID-19 pandemic—it got worse. The difference is that the media is focused on reporting on the COVID-19 pandemic itself. The Well Being Trust and the American Academy of Family Physicians estimated in May that 75,000 people could die from substance use and suicide during the isolation and economic challenges of the pandemic.
This is how the COVID-19 pandemic has escalated environmental stressors, creating a perfect storm for people with substance use disorder:
Highest Unemployment Rates
The national unemployment rate skyrocketed from 3.5% in February to 14.7% in April, the worst since the Great Depression. The loss of employment came with the loss of health care coverage. As a result, more than 12 million Americans lost their health care coverage.
In addition, in the midst of the COVID-19 global pandemic, the Trump administration is making it hard for states to expand the Affordable Care Act (Obamacare). At the same time, the Trump administration is pursuing to repeal it, even though it provides health care coverage to millions of Americans. Yet the Trump administration is not presenting a health care coverage backup plan to the American people.
Many Americans are unable to pay their rent or mortgage and are at risk of being evicted. The eviction moratorium provided by the CARES act expired by the end of July, putting many Americans at risk of losing their homes. As a temporary fix, the Centers for Disease Control and Prevention has imposed a temporary eviction moratorium order to prevent the further spread of COVID-19. This order is not providing financial relief, and renters are expected to pay all the missed rent payment plus late fees.
The images of long lines of Americans driving bumper to bumper for hours waiting for food donations have dominated the TV. Americans are more than ever experiencing food insecurity. For the first time, UNICEF will be assisting children in some cities of the United States. In the wake of a global pandemic, the Trump administration has tried to cut 700,000 Americans from food assistance and limit access to food aid to 3 million Americans.
Economic pains are causing an increase in mental illnesses and anxiety. Stay-at-home orders have increased cases of domestic violence. And, given some life-altering natural disasters like fires in different parts of the country, more Americans than ever are at risk of developing depression. While quarantine has helped stop the spread of COVID-19, it has cut people off from the social networks they rely on.
Lipi Roy, M.D., M.P.H., a clinical assistant professor at New York University specializing in addiction medicine and substance use, told NPR’s Jane Clayson that public health officials tell people to stay away from others socially, but asking them to stay away from substance abuse counselors and meetings or health care professionals poses “unique challenges.”
Meanwhile, Joseph Lee, M.D., medical director of the Hazelden Betty Ford Youth Continuum also told NPR that stigma could stop people from getting help.
“The stigma leads to a lack of resources, both in terms of access and insurance,” he said. “First for people who want to get help, but also just the infrastructure is not well supported. So people aren’t finding a lot of venues to get the help. These times are making it hard for a lot of people in the community, and the demand is huge.”
COVID-19 is creating a shortage of PPE and medical resources, depleting resources to help treat substance-abuse disorders in communities around the country. Small organizations treating substance use disorder were underfunded before the COVID-19 crisis, and they are struggling to adjust to the new normal of providing virtual services and hire more therapists to meet the growing need.
Stress, isolation, and depression during the COVID-19 crisis have increased the vulnerability to drug overdose. People who are strong in their recovery are already connected to social networks and have been resilient in this COVID-19 pandemic. According to Lee, the pandemic has created new substance use cases and has caused many people to relapse.
“There are a lot of people who are new to recovery, and they have to access virtual services, which are hard to get. They are people in the warning zone for developing substance use disorder, and they relied on their jobs or exercise routine or other social clicks to stave off serious addiction. With COVID-19, those supports are now falling apart,” Lee told NPR.
Lee continued on to say that he hopes that the lack of connection experienced during the pandemic underscores just how important it is for people, especially for those living with addiction.
“I hope that at the end of this, we don’t take for granted how important connection is and how important we are to each other, because I think we have taken that for granted—and it’s reflected in our social discourse and all the issues that we talk about. But these things are so vital,” he said.
In the midst of COVID-19, let us safely reestablish connections with people who use substances and make sure they access the treatment they need.