Addictions Advisor: How the Pandemic Is Affecting Those With Substance Use Disorders
By Rebecca Gomez, PhD, LCSW, and Erika Hildebrandt, LCSW
Social Work Today
Vol. 21 No. 2 P. 10

It’s a widely acknowledged fact that the COVID-19 pandemic has greatly exacerbated various public health crises in the United States. One of those crises has been the challenges faced by people recovering from substance use disorders. Rates of substance use, overdosing, and relapsing have all been on the rise during the pandemic, prompting questions about what can be done to alleviate the problem.

Social workers have an important role to play in this process, and while the basic approach toward working with people recovering from substance use disorders has not changed as a result of the pandemic, it’s become more important to look out for certain danger signs and potential pitfalls that have become common over the past year and to discuss them with clients in constructive and encouraging ways.

Defining Recovery
The term “recovery” is broad and often lacks clarity when it’s being discussed. That being the case, it’s best to attempt to define it more clearly. While the pandemic has certainly been affecting people in long-term recovery, it also has been impacting early recovery in significant ways. For example, while peer-based recovery support is important for everyone in the recovery community, people in early recovery generally rely on it even more.

“Recovery” in the context of this article includes early, middle stage, and long-term recovery. Anytime recovery is discussed among fellow social workers, clients, or the general public, it should be described as a process and not an end goal or a single event.

The Pandemic’s Effect on Various Risk Factors
One of the ways the pandemic is causing problems for those who are recovering from substance use disorders is by increasing the level of stress and isolation in their lives. Both stress and isolation can be significant risk factors for relapse. People with substance use challenges may be particularly vulnerable because there is a high likelihood of co-occurring mental health conditions such as depression and anxiety, conditions that may also be aggravated by the pandemic.

In the event of a relapse, the damage to close relationships that can occur as a result of associated behaviors—as well as the negative emotions that can occur as a result of that damage—can lead people to further isolate themselves, which can exacerbate the existing challenges and result in a vicious cycle.

The media plays a role in this cycle of stress. Early in the pandemic, a Nielsen study found that online news consumption via mobile devices increased 215% in March 2020 compared with March 2019. Excessive news consumption can be an aggravator of stress; the frequent reporting of distressing news over the past year may have been yet another risk factor for people recovering from substance use disorders.

The presence or relative lack of healthy coping mechanisms is another factor that may have been impacted by the pandemic. People who are in early to mid-recovery may not be actively using a substance, but it was likely one of their main coping mechanisms in the past. This may mean there was not ample opportunity to develop enough healthy coping strategies—which can positively influence the course of recovery—before the onset of the pandemic. This, too, can put them at higher risk for relapse.

The Importance of Peer Support Groups
Peer support group meetings—such as those based on a 12-step program or a SMART recovery program—serve as an important pathway in both early and long-term recovery of substance use. As with virtually every other dimension of the social fabric, however, the pandemic has caused significant disruptions to the support routines that people had in place, mostly in terms of having physical places where they could spend time with other people undergoing the same challenges.

To a degree, phone-based meetings and even online meetings existed before the pandemic, but in-person gatherings were definitely where most people had their “home groups,” or the primary source of support where they could enjoy increased interaction, familiarity, fellowship, and shared accountability.

Recovery support groups have responded to the pandemic the same way other social groupings have—by moving their meetings online and using various platforms and apps. To ease the transition, many recovery support groups attempt to replicate certain aspects of the experience of in-person meetings such as staying on and chatting after the formal meeting has concluded. While participants may miss certain aspects of in-person meetings—and in some cases the drawbacks of virtual meetings may affect the recovery process—these online support meetings nevertheless serve as a lifeline for many.

How Social Workers Can Help Alleviate the Problem
As the largest group of behavioral health service providers, social workers can play an enormously important role for those impacted by substance use disorders during this time.

One way to do so is by validating the very real factors of stress and strain that have been added to whatever preexisting challenges clients may have already been struggling with. This could begin to address some of the feelings of shame or guilt that clients may experience in the event of relapses or near-relapses.

Another important way social workers can make a difference is by encouraging clients to continue attending online peer support group meetings even—or especially—when they don’t feel like it. Depression can make people feel unmotivated and retreat deeper into isolation, which will only make matters worse.

Additionally, it would be helpful for social workers to stay alert for the signs of stress, which is one of the main risk factors for relapse. Irritability, changes in energy level, frequent crying, headaches—look for these and other signs of stress overload that may signal a potential relapse risk. Also, encourage clients to explore healthy coping strategies such as engaging in activities they enjoy, taking breaks from news and social media, reaching out to friends, and just getting enough food, water, physical activity, and sleep.

Finally, social workers should also be on the lookout for the same warning signs in themselves. After all, they are particularly susceptible to burnout during the pandemic. Social workers are notorious for neglecting their own self-care, but at a time of such heightened stress it should be viewed by everyone in the field as a core competency. We will be of the greatest help to clients when we are also looking after our own well-being.

— Rebecca Gomez, PhD, LCSW, is the associate dean for academic and student affairs and an associate professor in the Virginia Commonwealth University School of Social Work.

— Erika Hildebrandt, LCSW, is a PhD social work student at Our Lady of the Lake University.

Resources
• Alcoholics Anonymous Online Meetings
• Narcotics Anonymous
• SMART Recovery
• In the Rooms: A Global Recovery Community
• National Alliance on Mental Health COVID 19 Resource and Information Guide