In our collective attempt to mitigate the spread of COVID-19 through physical distancing and business closures, some folks have found a temporary reprieve from the daily grind. The stress of economic shutdown notwithstanding, a silver lining has emerged for some people: a few are using the sudden break from our normal routines to pursue hobbies, work through stacks of books they’ve been meaning to read, or even to simply catch up on sleep. For others, an even-darker cloud has emerged. Those in recovery from addiction are being tested now more than ever, with stressors and risk factors that threaten sobriety more prevalent than ever. Maintaining sobriety requires ongoing, daily intentionality. It requires preparation, structure, and personal insight of oneself – personal knowledge of what someone finds stressful versus what someone finds rejuvenating. Staying in recovery also requires an engaged and supportive community. Like everyone else, folks in recovery from addiction are now finding their support systems overburdened, their self-care skills challenged, and their vulnerability at a high-point, regardless of past effort invested into personal wellness. Even those without a formal diagnosis of substance use disorder and those who aren’t in active addiction treatment are finding themselves on the edge. Alcohol sales – which have seen a 26% rise in year-over-year overall sales and a 400+% increase in alcohol delivery services – tell the tale. People aren’t buying all that alcohol to hoard in the event of an economic cataclysm – they’re locked in their homes, drinking at never-before-seen rates. Mental health professionals call this behavior “self-medication” – people are using whatever they can get their hands on to alleviate stress and get through this crisis. Unfortunately, that list doesn’t stop with alcohol – it includes opioids like heroin and fentanyl, the use of which leads directly to spikes in overdose deaths, even in communities where tremendous progress was being made in addressing the opioid epidemic. All the pent up stress is coming out in other tragic ways too, with a dramatic uptrend in domestic violence sweeping the world. The worst of it? The fact that while some states are starting the process of reopening, we don’t have a true sense of when everything will go back to “normal.” And the longer we stay locked away – isolated, self-medicating – the greater the certainty that more people will come out of this crisis clinically depressed addicted to alcohol or drugs. So what do we do? We have to start by acknowledging this is already a problem. It is inevitable that more people will come out of the lockdowns – even if they were universally lifted today – with more problems than just unemployment and household cashflow. But “more” doesn’t need to mean “all” – if we each take action now by looking out for ourselves and each other, we can begin working to insulate ourselves from a worse outcome and have fewer folks come out of this pandemic in a mental health crisis. I frequently get questions about what people should do to improve their mental well-being or work through some trauma or crisis. My typical answers direct people to start with what already works and my advice won’t change just because of coronavirus: each of us has some coping skill or network that we can tap into. My advice is to start there. Actively ask for support from family, friends, neighbors, and clergy. Make a schedule on when you will check-in with these folks – or when they will check-in on you. Be creative in connecting by phone, email, text messaging, and video calls. A quick phone call with a supportive friend can go a long way to helping you feel connected to others, that someone else “sees” you and your struggle. And it’s a two-way street – by setting accountability in this way, you can also offer support to someone else who probably also needs it. Then, if you still need more support, look into anonymous, online support meetings. They’re “everywhere” now that virtual options are available and can help fill the critical gap of human connection. Next, create structure for yourself. Again, start with what you had pre-COVID and work from there. Eat meals at your typical times. Exercise at the same time you usually do – and if you didn’t exercise before, it could be a nice opportunity to try something new. If you can’t go to the gym, try a new bodyweight workout at home. Maintain your bedtime and wake time. And if you aren’t sleeping well, pay attention to what the professionals call “sleep hygiene.” Basically, it’s a fancy way of telling you to stay away from screens (TV, phone, tablet) within an hour of going to bed. If the news and social media are stressing you out, reduce your exposure to them so you have fewer anxious thoughts flying through your brain as you go to sleep. Dim the lights, limit noise, take a hot shower or bath before going to bed – and obviously avoid alcohol. It may help you fall asleep if you drink enough of it – but the type of sleep won’t be mentally or physically restorative and will end up leaving you worse off. Speaking of alcohol, keep track of your intake. Count the drinks you have. How much are you drinking every day? The simple act of just tracking your drinking – even by using a paper on your fridge with hashmarks by the date – will reduce your consumption. The act of tracking our behavior directly leads to changes in our behavior. Just be sure when you characterize a “drink” that you’re using the accurate definition of a standard drink. Next, carve off time to make room for purpose and meaning. We can’t control the state of the world. But we can control our inner experience of it. Calming exercises really work – but they require intentional, repetitive practice to be effective. A simple place to start? Control your breath by learning diaphragmatic breathing. Practice progressive muscle relaxation. Listen to music, engage in guided imagery exercises – there are countless apps for this now. Learn mindfulness – in other words, realize that it is understandable to feel anxious about the future. Allow yourself to experience those feelings without judgment – only then will they pass through you. Mindfulness can also build self-awareness – which will help you identify cravings and triggers for alcohol or drug use – or stress-eating, anger outbursts, and other self-destructive behaviors. In other words, it’s something helpful even for those without a formal diagnosis of addiction. Once you notice a craving or trigger, ask yourself why you’re experiencing these thoughts and redirect your attention to something else. Journaling, reading, drawing, exercise, cooking, playing music – all are just examples of activities you can get wrapped up into in a healthy way. As tough as it sounds, we can build a sense of control in an uncontrollable situation. Have enough supplies, yes – but don’t hoard. Be sure you have enough medication you may need – over-the-counter, prescribed, and for children. Stay connected to your healthcare provider – call them if you have concerns and ask about telehealth options for appointments. Most providers, including those providing addiction treatment services, have started offering more telehealth options. At BrightView, we now offer all of our services remotely for patients who can’t physically come into our centers. And do simple things to increase your sense of safety: wash your hands following CDC guidelines. Practice physical distancing. And when you must leave the house, grant other people the grace and patience you wish they’d offer you – they’re just as stressed, after all. Clean and disinfect objects and surfaces that are commonly used – and do so more frequently for high-traffic areas. And make a plan on what will happen and how you will react if someone in your home becomes ill or must quarantine due to COVID-19. Finally, get professional help if you need it. If you’re feeling depressed, are having thoughts of harming yourself or others, or feel like your alcohol use is getting out of hand, talk to a doctor as soon as possible. We are here to help you get back on track and come out of this pandemic better – not worse- than you went into it. Sobriety, recovery – and even your general well-being – must be managed every day. That takes self-awareness, planning, and preparation – all things you can start working on today. Lastly, remember that this crisis will not last forever. And know that you aren’t alone in this. Dr. Navdeep Kang is a clinical psychologist, Obama Foundation Fellow, and the Chief Clinical Officer of BrightView.
May 27, 2020