The catastrophic impact of a pandemic on addiction
2020 has brought the greatest public health catastrophe of our times and caused a huge spike in stress on our societies and on our fellow human beings.
This year, most of us have experienced a tremendous amount of new psychological and social stresses. These stresses can increase the risk of low mood, anxiety, panic, fear and obsessional thoughts of contracting infection, and more.
Prolonged stress can trigger addiction or substance misuse in people who were already at high risk of it, but can also trigger a spike in substance misuse in the general population who would not normally have been at risk. Some people will “self -medicate” with alcohol or drugs to try to cope with stress.
Others who are already addicted to drugs or alcohol may struggle to get their usual supplies, due to social distancing and disruption to medical supplies. Some people will be cooped up with family or loved ones who will suddenly realise they are addicted to drugs or alcohol and throw out all their current supplies.
All of these factors have combined together to create a crisis in addiction.
How do I spot signs and symptoms of addiction?
Each person’s experience of addiction will be slightly different, but they usually share common features to be aware of.
Common signs of addiction:
- Unexplained outings, often at very short notice and with urgency
- Drug taking equipment such as unusual pipes, small weighing scales and sometimes needles and syringes
- Small packages such as in plastic, paper or foil packaging.
- Changes in social groups or circles, new or unusual friends
- Secretive phone conversations
Common symptoms of addiction:
- Changes in mood such as being unusually happy, sad, or anxious
- Changes in energy such as being very tired or equally being unusually energetic or “hyper”
- Changes in weight
- Changes in sleep such as sleeping a lot more or a lot less than usual
- Looking unwell at certain times but rapidly looking better soon after, in a repeating cycle
- Pupil size can change and look different to normal
- Unexpected persistent cough without having a cold or flu
In general, if someone is addicted to something, they tend to:
- Always think about the addiction
- Change their lives to fit around the addiction; it seems to “rule their life”
- Experience difficulty controlling the addictive behaviour, even when the addiction is hurting them or their loved ones
- Need to do more and more of the addictive behaviour
- Feel withdrawal effects when they cannot engage in the addiction
Be cautious though: Both symptoms and signs can be due to other causes. Therefore, it is much more useful to look for groups of lots of these symptoms and signs rather than just one or two in isolation.
What types of addiction should I look out for?
- Cocaine (or crack cocaine)
- Benzodiazepines (diazepam, lorazepam etc)
- Opioids (heroin, opioid based painkillers such as cocadamol, codeine, morphine, dihydrocodeine, methadone, buprenorphine)
- Sleeping pills
- Hallucinogens such as LSD or ecstasy
And don’t forget legal substances which can lead to addiction, including:
- Computer use (video games, online gambling)
- Console gaming
What do I do if I suspect a loved one has an addiction issue?
Family members and loved ones are more likely to be able to spot these signs since lockdowns have resulted in a huge increase in the time that people spend together at home.
If you think that someone may have a problem with addiction, it is important to seek professional advice. There are also a number of different online websites which can provide free information and support:
How do I know which treatment option is right?
Everyone is different and people suffering from addiction have choices in how to respond to it. Some will not be ready to acknowledge there is a problem. This is a tough situation for loved ones.
Others are keen for treatment. For addictions, the main goal is to reduce harm to the person and also to all those around them, as well as to society in general.
For alcohol and non-opioid drugs, the two main approaches are abstinence or harm reduction by reducing use as much as possible if the person is not willing to stop yet. Abstinence means stopping the drugs/alcohol/behaviour completely. For opioid addictions, there are two main options:
- Substitution therapy
Opioid addiction causes harm to people and society. There is much evidence to support reducing this harm by replacing the opioid with an alternative prescribed opioid that is less harmful overall, such as methadone or buprenorphine. These don’t give the same highs as other illicit opioids such as heroin or fentanyl and stay in the blood stream for longer.
Choosing this route can help to reduce the use of illicit/illegal opioids and can allow the person a chance to work on psychological and medical treatment for their addiction, as well as trying to improve their social health through rebuilding family life or getting back to work. The majority of UK services provide substitution therapy for opioids. Substitution therapy can aim for abstinence in the longer term or for “maintenance” therapy where the substitute is continued long term to reduce harm. The main risk of substitution therapy is that a person stays on it long term or just misuses it to supplement their addiction.
The option of abstinence means a person will undergo a “detoxification” from the opioid and then embark on a programme to help them stay off the drugs. Some people are highly motivated towards abstinence rather than longer term substitution, and with the help and support of a professional team, this is another valid option in UK guidance. Some people will have particular reasons for pursuing abstinence such as being able to work in certain jobs, to drive and so on. Any option needs to be chosen by using a shared-decision making process between the specialists, the individual and their loved ones / family. This requires mutual respect and honesty if it is to be successful, and any decision must be patient-centered.
Any person wishing to become abstinent from opioids in particular must be made aware of the risks if they go back to using drugs. Once the body has come off opioids, it gradually becomes more sensitive to them again and if a person takes a previously used higher dose of opioids, there is a risk of that dose being too high and too strong. Therefore, it is particularly important for abstinence-oriented treatment to include education on the risks of overdose if a person relapses and the body’s sensitivity to opioids after a detox.
Our unique holistic approach to help you get back to life
At the BONDS™ Clinic, we operate an abstinence and supported recovery programme which helps the individual get back to life.
Shared decision-making is at the centre of our approach.
First, a holistic assessment is an essential foundation to getting the diagnosis right and helping to come up with a comprehensive treatment plan. The majority of the patients we see have a combination of addiction and a mental health disorder such as depression, anxiety, PTSD or even bipolar disorder. This is called a “Dual Diagnosis”.
The BONDS™ assessment and treatment protocols use what we call a Bio-Psycho-Social model. This means assessing three areas:
- Biological/medical features – Including addressing any co-existing mental health disorder and relapse prevention
- Psychological features – Including talking therapies, MDT reviews and other support throughout recovery
- Social – Re-integration back into the patients’ social and professional world as part of recovery, rather than lengthy period of rehabilitation
When coming up with a treatment plan, we encourage the following three principles, in order of importance:
- Cost effectiveness
The results of an early version of the BONDS™ protocols were published in the year 2000 in the journal Addiction Biology and showed:
- Around 50% of opioid patients being abstinent at 12 months
- 97% of patients not reporting pain during the 1-week detox period
Patients often tell us that a fear of pain during a detox is a big barrier to seeking abstinence and we feel it is very important to discuss this.
The challenges of 2020 have resulted in significant barriers to delivering traditional residential detox and treatment programmes, due to the rules on social distancing and personal protective equipment (PPE). This has resulted in more people seeking outpatient treatment such as that offered at the BONDS™ Clinic. The BONDS™ Clinic’s newly expanded outpatient service – situated in Bradford – offers people a way to work at freeing themselves from their addiction in their own home – reducing the need to travel during the pandemic. The treatment is complemented by support from an experienced clinical team who are available on the phone and via video consultation, ensuring the individual feels supported every step of the way.