COVID-19 Q&As: Rachel Rabin on coping with addiction during the pandemic

"This new normal, and all the uncertainty that comes with it may elicit feelings of stress, depression, loneliness, anger and anxiety... which are prominent risk factors for the onset and maintenance of addiction"
Rachel Rabin’s research program focuses on developing a better understanding of the neurocognitive and social cognitive dysfunction in individuals with substance use disorders in both psychiatric (e.g., schizophrenia) and non-psychiatric populations.

The COVID-19 pandemic is a time of increased anxiety, uncertainty and loneliness for many. For people dealing with substance abuse issues, the challenges presented by the pandemic can exacerbate their addiction.

Rachel Rabin, an Assistant Professor in the Department of Psychiatry and a researcher at the Douglas Research Centre, is an expert on addiction. In this Q&A, Rabin discusses coping with addiction during these trying times. Rabin is funded by Healthy Brains, Healthy Lives through the New Recruit Start-Up Supplements program.

How is COVID-19 impacting people with an addiction?

The COVID-19 pandemic is a challenging time for everyone. This new normal, and all the uncertainty that comes with it may elicit feelings of stress, depression, loneliness, anger and anxiety. These emotional states are concerning given that they are prominent risk factors for the onset and maintenance of addiction.

Addiction is defined as a chronically relapsing disorder characterized by compulsive drug-seeking and drug-taking despite harmful and even catastrophic consequences. Unfortunately, for individuals who have achieved long-term sobriety, the likelihood of relapsing during this crisis may be exacerbated due to uprooted routines, social isolation, and the lack of access to their habitual treatment practices (e.g., much of their care is currently done virtually if at all).

In addition, there is evidence that individuals with addiction may be “wired” to respond to stress differently than non-addicted individuals which may reflect altered neural circuitry in the frontal lobe and brain reward pathways.1 This dysfunction can contribute to enhanced sensitivity and heightened reactivity to emotional distress, particularly stress that is unpredictable and uncontrollable. These aberrant stress responses can function as conditioned stimuli eliciting strong cravings which can ultimately culminate in a relapse.

How does having an addiction impact the severity of COVID-19?

COVID-19 clearly does not affect all individuals to the same degree. Based on currently available information, older adults and people of any age with serious underlying medical conditions might be at greater risk for more severe complications associated with COVID-19.

For example, co-occurring conditions, including chronic obstructive pulmonary disease, diabetes, hypertension, and other respiratory diseases have been found to worsen COVID-19 prognosis.2 Thus, COVID-19 could pose an exceptionally serious risk to subpopulations of substance users, such as tobacco and cannabis smokers as well as those who smoke crack cocaine or methamphetamine, who may have compromised pulmonary functioning.

Opioids, such as heroin, pose another risk. This class of drugs acts in the brainstem to slow breathing, leading to lower levels of oxygen in the blood. This in combination with the reduced lung capacity common with COVID-19 is a potentially fatal combination.

What signs or symptoms should people be aware of indicating that they may be at risk of developing a substance abuse problem?

The following signs may indicate that problematic substance use is developing. This list is far from exhaustive, so anyone concerned about themselves or others should not hesitate to contact a health professional for support.

  1. The substance is being consumed in larger amounts than was intended or over a longer period of time.
  2. There is a loss of control over substance use such as an inability to stop using the substance, or cut down.
  3. Substance use results in a failure to fulfill major responsibilities, such as work, household/childcare duties, (virtual) social obligations.
  4. Substance use is continued despite harmful consequences.

With people currently working from home, or now unemployed, and social activities being cancelled, changes in behaviours that fit these descriptions may be more difficult to detect.

Additionally, since it is often friends or family who raise concerns about worrisome behaviours, for those isolating alone it is possible that problematic use can go unnoticed.

Anecdotally, we are hearing that sales of alcohol are up over the past 10 weeks and that people are drinking more at home. How concerned should people be if their consummation habits have changed?

Short-term use of addictive substances can provide a sense of relief for individuals experiencing stress, worry, depression or anxiety. Alcohol may be used as a form of self-medication, and this may be one reason that people have increased their consumption.

However, the reprieve one may feel as a result of drinking is temporary. In the long run, however, alcohol can actually have the opposite effect and paradoxically exacerbate these negative symptoms causing one to consume even more alcohol.

Alcohol (like other substances of abuse) acts on the reward centres of the brain, increasing the neurotransmitter dopamine, which plays a major role in reinforcing consumption. Escalating alcohol use is concerning because it increases the risk of developing an addiction. Therefore, it is important to watch the number of drinks consumed as well as the frequency of consumption.

Canada’s low-risk alcohol drinking guidelines, which can be found online, recommends below 10 drinks per week for women and 15 for men, with no more than 2 and 3 drinks per day respectively. Notably, these recommendations may be too high for specific subpopulations, such as the elderly. As we get older, our bodies process alcohol more slowly increasing sensitivity to the effects of alcohol.

Consequently, even if one is below the abovementioned limit, but is still experiencing problems that are caused or linked to one’s drinking (see Q#3), cutting down or remaining abstinent is the safest option. Importantly, genetic factors play a large role in the transition from regular use to addiction. Therefore, if one has a family history of addiction (not just to alcohol), there is greater concern as the risk for developing an addiction can go up eightfold.3

What advice can you offer to people who are worried that the pandemic may trigger or cause an addiction?

If someone is worried about developing an addiction, they should reach out for help to a health professional without hesitation. There are also many smartphone applications which can help identify problematic alcohol and drug use, and many telephone and virtual care options are now offered due to the pandemic. Do NOT delay asking for help, the sooner the better! 

What strategies can people use to help mitigate the stress and anxiety they may be feeling at this time?

Given that it may not be possible to eliminate negative emotions (e.g., worry, depression, anxiety, loneliness, boredom, grief), it is critical that people find ways to process, cope, and manage these feelings. Here are some potential recommended actions:

  1. Stay connected with others. Keep in touch with friends and family via the phone, video chat, or social platforms.
  2. Find ways to attenuate stress such as doing enjoyable activities, exercising, cooking, or practicing mindfulness.
  3. Keep a structured and consistent routine.
  4. Know that the current situation is temporary and accept that feeling anxious and stressed is normal. We are all in this together!
  5. Most importantly, seek out professional help if these feelings become unmanageable.

References

  1. Sinha R. Chronic stress, drug use, and vulnerability to addiction. Ann N Y Acad Sci. 2008;1141:105-130.
  2. Transcript for the CDC Telebriefing Update on COVID-19 [press release]. Tuesday, March 3, 2020.
  3. Merikangas KR, Stolar M, Stevens DE, et al. Familial transmission of substance use disorders. Arch Gen Psychiatry. 1998;55(11):973-979.

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