The Substance Abuse and Mental Health Services Administration (SAMHSA) recognizes September National Recovery Month. This national observance is held every year to educate Americans that substance use treatment and mental health services can enable those with mental and substance use disorders to live healthy and rewarding lives.
CU Denver professor Candice Shelby discusses what has happened with addiction over the course of the COVID pandemic and why we need to change how we approach addiction treatment.
How does your research look at addiction?
In 2005, I started by research focusing on biological, psychological, social, and economic aspects of addiction. This led me to write my book Addiction: A Philosophical Perspective. In my book, I argue that addiction should be understood not as a disease but as an emergent complex dynamic phenomenon that must be understood on many levels. It’s not just genetic or brain functions, but the result of numerous interacting and changing factors. We need to understand that many elements are involved when individuals undergo addiction.
I believe people can be moved out of addiction through the proper treatment. Addressing this problem is not simple, however, it requires attention at many levels, with many different tools.
How has the pandemic made this year worse for addicts than previous years?
There was a 30% jump in opioid-related overdoses during the pandemic, to over 93,000 Americans. That number includes death from synthetic opioids. This is the largest jump in American history. Deaths from psychostimulants such as methamphetamine also rose dramatically.
Economic and health disparities were exposed over the last year, beyond what we had previously wanted to know to exist. People also saw housing and food uncertainties, which are the kind of risks and stressors that can bring out flight into self-medication. The last year can be seen as one big trauma, but also as very different kinds of individual traumas, depending on an individual’s specific situations.
We also ran into the issue that there was nowhere for addicts to turn during the pandemic. Most help was limited to online services, and harm reduction services were curtailed. While we saw online group services have high attendance numbers, there is nothing like in-person help; and personal contact is exactly what was minimized.
What are the main issues with addiction treatment today?
Instead of providing those suffering from addiction with proper help, including medications for treatment of opioid use disorder, people lost the insurance that could have paid for those, and as a nation we continue to criminalize drug-related behaviors. This is a problem because it takes away every opportunity that might be there to help addicts who are looking for a path to recovery. Fear of arrest and jail create greater fear and stress. If arrested, people are subjected to yet further reasons to want to self-medicate. People who are taken to jail, even briefly, generally lose their jobs, their time to attend to their addictive problems, and often their support systems, as they become isolated from their families. Even undergoing the process of defending oneself in court and then attending all the requisite appointments that probation involves undermines a person’s ability to receive adequate help for their addiction. As a society we’re really putting someone in a deeper hole by criminalizing them instead of giving them the proper help needed.
We have been conditioned for one hundred years that the Al-Anon based “tough love” approach is the right treatment philosophy for families of those who suffer from addiction. According to this advice, we must be selfish and take care of ourselves and cut those suffering from addiction out of our lives. That doesn’t work anymore. It actually never worked. We will all suffer from the ravages to our society from this epidemic of addiction until we realize that we are all in it together.
How can we better deal with addiction recovery during COVID and beyond?
What recovering addicts need is need healthcare, both physical and mental (because they are at root the same thing), social support, and ways to find meaning.
We need to put into place a system in which access to mental and trauma care is widely accessible, as well as opioid therapies, which have been demonstrated to be highly effective. Also, as mentioned earlier, addicts haven’t had access to their support groups because of the pandemic. Online services have not been enough. They need to be touched by other human beings, and to share stories. To bring about the myriad changes that are necessary to overcome this blight, we’re going to need federal, state, and volunteers to help fund these efforts.
I endorse a model of open entropic systems for helping our addicted family members and friends. Rather than closing ourselves down to try to “reserve” our energy, which is impossible, it is much more effective to get support ourselves from healthy sources, so that we have more to use to help those in most need. This is a flow-through kind of model, and it’s essential to switch from “tough love” to this, because with numbers this enormous, we are all affected.