Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

COVID-related stressors and increasing instances of substance abuse

Samoon Ahmad, MD
Conditions
August 9, 2020
370 Shares
Share
Tweet
Share

Throughout 2020, the United States has been playing catchup against the coronavirus. As several well-researched articles have noted, lack of appropriate and timely response has been at the forefront and can be attributed to numerous factors including the highly contagious nature of the virus and, simultaneously, a delay in formulating an adequate medical management and containment strategy. Unfortunately, this catchup game has led to one of the greatest losses of human life during a pandemic in recent years. While there are few, if any, silver linings with respect to eradicating this pandemic, the same does not have to be true when we look back years from now and examine how we began mobilizing to stem what is likely to become an increasingly serious public health crisis: psychological/emotional stress and skyrocketing rates of substance abuse.

Though data remains preliminary, 2020 has seen a rise in the number of opioid-related overdoses, with more than 35 states reporting increases in opioid-related mortalities. The aggravating circumstances behind this disturbing trend are still unknown. It could be due to a rise in the number of people in recovery who had fallen into despair due to the COVID crisis. It could also be because individuals who were already struggling with substance abuse disorders were forced to resort to stronger and often deadlier forms of opioids (i.e., fentanyl) because of financial issues or an inability to procure drugs with which they had greater familiarity.

Opioid-related abuse may not be the only form of substance abuse on the rise. Since states began locking down in March, there have been record sales of alcohol and cannabis (in states where usage is allowed). Given that the increase in use is occurring in conjunction with social isolation, prolonged confinement, and the additional environmental stressors of living through the pandemic, it is reasonable to assume that abuse of these substances will become common.

Though alcohol use is normalized in our culture, heavy drinking is estimated to have resulted in the premature deaths of 93,296 Americans between 2011 and 2015. The average amount of time that was shaved off an individual’s life due to excessive alcohol use: 29 years.

Acute stress disorder and post-traumatic stress disorder

Without question, COVID-19 will inflict lasting trauma on many people in the U.S. This is especially true of those who are on the frontlines of the pandemic, those who have suddenly lost a loved one, or those who have had to undergo lifesaving but invasive medical procedures like intubation.

Depending on the nature of the traumatic experience and a host of other factors that can influence resilience, between 5 and 20 percent of those who experience such trauma may develop acute stress disorder (ASD). ASD is characterized by five symptom categories, including: intrusive symptoms, negative mood, dissociative symptoms, avoidance symptoms, and arousal symptoms. ASD is diagnosed when nine or more symptoms from these categories persist for one month or less starting three days after the traumatic event. If the symptoms persist for longer, the diagnosis will likely become post-traumatic stress disorder (PTSD), which affects as many as half of those who initially suffer from ASD. If treated, the average time for PTSD to remit is approximately three years. If untreated, it may persist for up to 64 months, if not longer.

Self-medicating with drugs and alcohol is extremely common among patients with PTSD, with an estimated 46% of such patients developing a concomitant drug or alcohol use disorder. Conversely, research has shown that early intervention and support directly following the traumatic event can substantially improve prognosis.

Allosteric overload

A more insidious element of the pandemic has less to do with trauma and more to do with lower levels of stress that do not reach the threshold of ASD or PTSD, but can, over time, do serious damage. While there will certainly be thousands of patients who will develop PTSD during or following the COVID pandemic, a far larger number of people are experiencing a steady diet of daily stressors: troubling headlines, worries about infection, the inability to travel freely, and the threat of financial ruin. These individuals may be experiencing what Bruce McEwen described as allosteric overload.

Briefly put, McEwen’s research revealed that there is a body-wide network that is hardwired not simply to maintain homeostasis, but to constantly respond and adapt to environmental factors. McEwen called this allostasis. Additionally, he wrote that, “Allostasis also clarifies the inherent ambiguity in the term ‘homeostasis’ by distinguishing between the systems that are essential for life (homeostasis) and those that maintain these systems in balance (allostasis).”

When these systems become overly stressed, this can result in allosteric overload. Most germane to this post, allosteric overload pertains to protracted physiological changes that occur following the activation of the hypothalamic-pituitary-adrenal (HPA) axis—the hormonal/neurological cascade that springs into action when we feel threatened—which is characterized by the release of stress hormones, the most well-known of which is cortisol (appropriately known as “the stress hormone”). If allosteric overload is chronic and the systems designed to maintain balance cannot correct themselves, this can lead to allosteric states like hypertension and a host of other inflammatory diseases. More importantly, these allosteric states often lead to symptoms like sleep disturbances, anxiety, and mood disorders. These are the kinds of conditions for which people around the world self-medicate.

Steps forward

While the rise in substance use disorders during COVID will become more apparent as the pandemic eventually ebbs, the silver lining is that this is not a novel problem. We understand substance use disorders far better than we understand COVID-19, and we also know that one of the largest obstacles to treatment is the shame associated with admitting that one has a problem. Furthermore, we also possess lifesaving drugs (such as Naloxone) that can prevent those with opioid use disorder from dying of an overdose.

Moving forward, we in the mental health community should encourage efforts to eliminate stigmas associated with addiction. More concretely, policymakers should be ready for the increase in opioid-related overdoses and ensure first responders have access to drugs like Naloxone. Secondly, COVID-19 patients and family members should receive easier access to mental health care to improve resiliency and potentially reduce instances of substance abuse disorders that begin as PTSD-related self-medication.

Samoon Ahmad is a professor of psychiatry, NYU Grossman School of Medicine, and founder, the Integrative Center for Wellness. He can be reached on Twitter @SamoonAhmadMD, LinkedIn, Instagram, and Facebook.

Image credit: Shutterstock.com

Prev

Women in medicine: a conversation with my daughter about lessons learned 

August 9, 2020 Kevin 0
…
Next

Flattening the curve of COVID’s emotional impact [PODCAST]

August 9, 2020 Kevin 0
…

Tagged as: Psychiatry

Post navigation

< Previous Post
Women in medicine: a conversation with my daughter about lessons learned 
Next Post >
Flattening the curve of COVID’s emotional impact [PODCAST]

More by Samoon Ahmad, MD

  • Misinformation is endemic in our society, but it is not a new problem

    Samoon Ahmad, MD
  • Your brain and PTSD: biomarkers and high-stress states

    Samoon Ahmad, MD
  • Stuttering: Understanding the neurobiology, psychology, and treatment options

    Samoon Ahmad, MD

Related Posts

  • Stop criminalizing prenatal substance abuse

    Jolene Kokroko
  • Finding happiness in the time of COVID

    Anonymous
  • Birthing in the era of COVID

    Jennifer Roelands, MD
  • How to get patients vaccinated against COVID-19 [PODCAST]

    The Podcast by KevinMD
  • COVID-19 divides and conquers

    Michele Luckenbaugh
  • The ethics of rationing care during COVID

    M. Bennet Broner, PhD

More in Conditions

  • Overcoming the lies of depression: Senator John Fetterman’s struggle with mental health

    Harvey Max Chochinov, MD, PhD
  • Proposed USPSTF guideline update: Advocating for earlier breast cancer screening at age 40

    Hoag Memorial Hospital Presbyterian
  • The rising threat of lung cancer in Asian American female nonsmokers

    Alice S. Y. Lee, MD
  • Urgent innovation needed to address growing mental health crisis among children and families

    Monika Roots, MD
  • The importance of listening in health care: a mother’s journey advocating for children with chronic Lyme disease

    Cheryl Lazarus
  • The unjust reality of racial disparities in pediatric kidney transplants

    Lien Morcate
  • Most Popular

  • Past Week

    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician
    • Unlocking resilience: a powerful journey from trauma to transformation [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
  • Recent Posts

    • Unlocking resilience: a powerful journey from trauma to transformation [PODCAST]

      The Podcast by KevinMD | Podcast
    • Overcoming the lies of depression: Senator John Fetterman’s struggle with mental health

      Harvey Max Chochinov, MD, PhD | Conditions
    • Master the ABIM Certification exam with effective strategies: insider tips for success

      Farzana Hoque, MD | Education
    • A mentor’s legacy in medicine, leadership, and embracing evidence-based care

      Arthur Lazarus, MD, MBA | Physician
    • Breaking free from restrictive covenants to combat burnout

      Raya E. Kheirbek, MD | Physician
    • Fixing the system and prioritizing patient care [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • New Data in NSCLC Bolster Support for Perioperative Immunotherapy
  • Breathing Support Type Matters for Preventing Extubation Failure in the PICU
  • Second-Line Axi-Cel Bests Standard in Relapsed/Refractory Large B-Cell Lymphoma
  • New Agents for Relapsed/Refractory Myeloma Impress in Early-Stage Clinical Trials
  • Kratom Linked to Outsized Proarrhythmic Risks

Meeting Coverage

  • New Data in NSCLC Bolster Support for Perioperative Immunotherapy
  • Second-Line Axi-Cel Bests Standard in Relapsed/Refractory Large B-Cell Lymphoma
  • New Agents for Relapsed/Refractory Myeloma Impress in Early-Stage Clinical Trials
  • CAR-T Tops Standard Care in Heavily Pretreated Lenalidomide-Refractory Myeloma
  • T-DXd Proves Mettle in Multiple Solid Tumors
  • Most Popular

  • Past Week

    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician
    • Unlocking resilience: a powerful journey from trauma to transformation [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
  • Recent Posts

    • Unlocking resilience: a powerful journey from trauma to transformation [PODCAST]

      The Podcast by KevinMD | Podcast
    • Overcoming the lies of depression: Senator John Fetterman’s struggle with mental health

      Harvey Max Chochinov, MD, PhD | Conditions
    • Master the ABIM Certification exam with effective strategies: insider tips for success

      Farzana Hoque, MD | Education
    • A mentor’s legacy in medicine, leadership, and embracing evidence-based care

      Arthur Lazarus, MD, MBA | Physician
    • Breaking free from restrictive covenants to combat burnout

      Raya E. Kheirbek, MD | Physician
    • Fixing the system and prioritizing patient care [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...