Substance Use Disorder Recovery

May 19, 2020

Everyone has been impacted by the COVID-19 pandemic, but some populations, like those with substance use disorder, are particularly affected by social distancing and the closure of “nonessential” businesses.

Melissa Cyders, associate professor of psychology at IUPUI, along with Katie Shircliff, the study coordinator for the Long Term Recovery Project at IUPUI; Melissa Fry, director of the Applied Research and Education Center at IU Southeast; and Kevin Ladd, professor of psychology at IU South Bend have been studying people experiencing opioid use disorder and other forms of substance use disorder as part of IU’s Responding to the Addictions Crisis Grand Challenge. The team is now studying how individuals are attempting to manage their substance use disorder recovery during the pandemic in the hopes that they will better understand what kind of assistance is needed during this unique time.

“In normal times, successful recovery efforts require regular healthcare, stable housing, personal purpose and community,” said Cyders. “COVID-related shutdowns jeopardize those elements by disrupting consistency of schedules and support networks, as well as key medical and psychological care. The question is, how can we continue to provide stability in this time that is notably not stable?”

Prior to the coronavirus pandemic, the spotlight was on a different crisis, the opioid epidemic, which is now happening in conjunction with the pandemic. Between 1998 and 2018, almost 450,000 people died from an opioid overdose. In 2018, approximately 20.3 million people age 12 and over had a substance use disorder.

The team has so far gathered first-hand reports from 45 adults with a substance use disorder (half with an opioid use disorder), ages 28 to 73, about the early effects of the COVID-19 pandemic on their recovery. They have found that while there are significant challenges, many in recovery are showing great resilience in the face of the pandemic, overcoming challenging obstacles to maintain their recovery. They also found that flexibility in treatment services and keeping people connected are key to supporting long-term recovery during the pandemic.

“It is on us all to intentionally care for each other during this pandemic and to be fully alert to ways in which we can actively support people in recovery who need access to healthcare, stable housing, and community to ensure sustained sobriety,” Ladd said. “It is also our collective responsibility to remain mindful of those same needs after the pandemic becomes a memory.”

When it comes to concern over contracting COVID-19, people in the study rated their chances of becoming infected as 63 percent, almost double the rating from the general public, which is around 30 percent. Of those interviewed, 63 percent reported a pre-existing condition such as chronic respiratory illnesses in themselves or in someone in their household, placing those in the study in the higher risk category.

Those with substance use disorder may also be at a higher risk of contracting COVID-19 due to drugs’ general adverse effects on respiratory and pulmonary health and the likeliness of social factors such as homelessness or incarceration that could contribute to their risk. Furthermore, the virus may worsen the impact on breathing caused by opioids, benzodiazepines and alcohol. 

Not surprisingly, 78 percent of people in the study reported a higher level of stress during the pandemic. Heightened stress levels are likely related to increases in job or family life responsibilities, which 42 percent of participants reported, and job losses or reductions, which 30 percent reported. 

Changes in routine and unstructured free time have made recovery more difficult for some, contributing to increased feelings of loneliness, hopelessness and frustration.

“Increases in stress are related to increased risks of substance use,” said Fry. “These increases, combined with changes in access to supports and treatment, can become a perfect storm for relapse.”

Although stress can exacerbate substance cravings, a large contributor to relapse, only about 20 percent of those interviewed reported increases in cravings and 17 percent reported using substances since the start of the pandemic.

Participants also reported a decrease in access to treatment and support as recovery houses closed, in-person support meetings stopped or went online, and treatment centers prematurely released patients out of concerns about spreading the virus. Though the majority of study participants reported attending support meetings online and/or via phone, some reported no longer attending meetings.

Although new guidelines have been developed to help those experiencing opioid use disorder maintain treatment, the use of overdose reversal medications by first responders is no longer happening in some municipalities due to concerns about spreading COVID-19.

Despite all of these barriers, 80 percent of those surveyed reported no craving increase and 83 percent have maintained sobriety. Some participants have used social distancing as a way to better connect with friends and family and to spend more time engaging in hobbies that support their sobriety.

“Although there are a lot of things working against people in recovery right now, I’m inspired by the resilience our participants are showing,” said Shircliff. “Our participants tell us about how their treatment has prepared them for adversity. They tell us about how they are continuing to reach out for support and to support others. It’s a silver lining in this difficult time.”

As our country continues to navigate a new world focused around COVID-19, it is important, Cyders said, to have flexibility in treatment services such as reducing monitoring requirements and allowing for extended take-home doses of opioid replacement medications. Health care providers should also explicitly discuss stressors and barriers to recovery at this time, Cyders said, and should heighten awareness of blood-borne diseases related to sharing or re-using needles, as access to syringe exchange programs will remain limited.

Support is key to recovery and while groups have pivoted online to help provide some type of support, interpersonal connections, Ladd said, remain key to long-term recovery. 

“Although it may seem old-school, phone calls and letters may have more personalized meaning for our friends and family in recovery,” he said.  

Initial findings from this work were recently published by The Conversation.

The team will continue to follow their participants to track changes in these trends over time and to identify ways we can all help support those in recovery.

The project is also supported by Mary Jo Rattermann, a PhD community partner who works with Fairbanks; Misty Gilbert, a PhD community partner who works at LifeSpring; Wei Wu, a PhD in the Department of Psychology at IUPUI; Jeff Johnson, a community partner with Pam's Promise; and Christiana Prestigiacomo and Melissa Liu, graduate students in clinical psychology at IUPUI.