Stressed Out

Substance use is a major problem in the United States.

People with substance use disorders misuse alcohol or drugs in a way that could harm them or others. More than 20 million Americans age 12 or older reported substance use disorders in 2018, according to the National Survey on Drug Use and Health.

During the COVID-19 pandemic, people with substance use disorders are facing greater obstacles.

COVID-19, the disease caused by novel coronavirus SARS-CoV-2, has resulted in millions of infections and hundreds of thousands of deaths worldwide. It also has caused an increase in mental health conditions and substance use disorders.

“We suspected that this would be a problem. The data now shows that this is in fact a problem,” says Jody Glance, MD, medical director, Addiction Medicine Services, at UPMC Western Psychiatric Hospital. “We’re seeing more problems with both mental health and substance use.”

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COVID-19 and Substance Use

World events such as COVID-19 can have an effect on mental health.

More than 40% of Americans reported struggling with mental health or substance use issues in late June, according to a study from the Centers for Disease Control and Prevention (CDC). Symptoms of anxiety and depression more than tripled over the same period in 2019.

About 13% of people said they either started or increased their substance use, says the CDC study. “It’s certainly a combination of factors — a perfect storm,” says Dr. Glance.

Reasons for increased substance use include:

  • Mental health conditions such as anxiety, stress, depression, or trauma. “Increased anxiety can lead people to use substances as a way to cope,” says Dr. Glance. “Substance use is a known coping strategy for depression.”
  • Socioeconomic stressors. Unemployment and other socioeconomic issues also can lead people to use drugs or alcohol to cope. A study in the International Journal of Drug Policy links recessions and unemployment to substance use.
  • Stay-at-home orders. Isolation and quarantine may cause people to turn to substances. “You’ll
    hear it said that addiction is the disease of isolation,” says Dr. Glance.
  • Fewer therapy options. People with substance use disorders may have fewer options for in-person counseling. To reduce COVID-19 spread, many in-person therapy sessions and support groups moved to online video or audio meetings. Some people lack the technology needed to participate in those sessions. “I
    think a lot of people are impacted by not being able to be in their
    recovery activities in person,” says Dr. Glance.

COVID-19 and the Opioid Epidemic

In the U.S., the opioid epidemic is of particular concern among substance use disorders.

Opioids refer to street drugs, such as heroin, and prescription painkillers, such as oxycodone or Vicodin.

Opioid misuse has risen in the U.S. in recent decades. More than 10 million Americans age 12 or older misused opioids in 2018, according to the National Survey on Drug Use and Health. About 2 million people had an official opioid disorder.

The use of opioids appears to be on the rise during the COVID-19 pandemic. More than 40 states reported an increase in opioid-related deaths, according to the American Medical Association.

Dr. Glance says the latest rise may be due to temporary changes in how much opioid maintenance medicine people can receive at one time. For example, someone who previously visited a program daily for medication dosing may now receive enough doses to cover multiple days.

“On the one hand, it’s a benefit because it helps them avoid being exposed on a daily basis to others who might be COVID positive,” says Dr. Glance. “On the flip side, now they’re home with more medicine than they’ve ever been responsible for. This can be problematic because there’s more potential for overdose, especially as we’re seeing increases in anxiety, depression, and suicidal ideation.”

What Should I Do If I Have a Substance Use Problem?

If you are suffering from a substance use disorder during the COVID-19 pandemic, you should seek help from your doctor, a psychiatrist, or a loved one. You shouldn’t try to handle these problems alone.

Dr. Glance recommends scheduling in-person counseling or a video visit with a professional who can help you work through your problems.

“You can gain a lot more information when you’re seeing someone face-to-face, but video is the next best thing,” says Dr. Glance.

UPMC Addiction Medicine Services offers a wide range of treatment options for substance use disorders — including inpatient addiction treatment, intensive outpatient care, medicine management, and mental health therapy.

You can schedule an in-person or video visit with a UPMC addiction specialist. Group therapy sessions are currently conducted online. Call 412-246-5910 for more information.

“You don’t have to do this alone,” says Dr. Glance. “We’re all going through this. Please reach out for help.”

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Sources

American Medical Association, Advocacy Resource Center, Issue Brief: Reports of Increases in Opioid-related Overdose and Other Concerns During COVID Pandemic. https://www.ama-assn.org/system/files/2020-08/issue-brief-increases-in-opioid-related-overdose.pdf

Mark E. Czeisler, et. al, Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020. https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm

Gera E Nagelhout, Karin Hummel, Moniek C M de Goeij, Hein de Vries, Eileen Kaner, Paul Lemmens, International Journey of Drug Policy, How Economic Recessions and Unemployment Affect Illegal Drug Use: A Systematic Realist Literature Review. https://pubmed.ncbi.nlm.nih.gov/28454010/

Substance Abuse and Mental Health Services Administration, Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health. https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf

U.S. Department of Health and Human Services, Opioid Crisis Statistics. https://www.hhs.gov/opioids/about-the-epidemic/opioid-crisis-statistics/index.html

Stacy Weiner, Association of American Medical Colleges, COVID-19 and the Opioid Crisis: When a Pandemic and an Epidemic Collide. https://www.aamc.org/news-insights/covid-19-and-opioid-crisis-when-pandemic-and-epidemic-collide

About UPMC Western Behavioral Health

UPMC Western Psychiatric Hospital is a nationally recognized leader in mental health clinical care, research, and education. It is one of the nation’s foremost university-based psychiatric care facilities through its integration with the Department of Psychiatry of the University of Pittsburgh School of Medicine. UPMC Western Psychiatric is the hub of UPMC Western Behavioral Health, a network of nearly 60 community-based programs providing specialized mental health and addiction care for children, adolescents, adults, and seniors throughout western Pennsylvania.