COVID-19 Q&A: Dr. Anna Lembke on Addiction
We’re seeing some signs that substance abuse and addiction is on the rise because of the stressors brought on by the COVID-19 pandemic. Dr. Anna Lembke, Associate Professor of Psychiatry and Behavioral Sciences and Medical Director of Addiction Medicine, is a national leader in the move to “bring addiction into the house of medicine” so it can be treated like any other disease. As Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic, Dr. Lembke is uniquely experienced to discuss this social consequence of COVID-19.
In May, a national survey by The Recovery Village network of addiction treatment facilities showed an increase in both alcohol and drug consumption, and a USA Today report also in May cited an increase in calls to substance abuse programs. Does this fit with what you are seeing and hearing?
Dr. Lembke: We’ve seen a slight uptick in the number of people seeking treatment for addiction, but not necessarily because their problems have gotten worse since the pandemic. Most of our new patient visits are people who have been struggling on and off for a long time, and sheltering in place has given them the time and motivation to seek help. In other words, they’re cleaning house, including taking time to address longstanding mental health problems. Further, visits to our clinic have been made easier by the fact that we’re seeing all patients on Zoom, so geographic barriers have been eliminated overnight. Our no-show rate has decreased as a result, and we’re getting queries from people around the country to be seen in our clinic – the pandemic has loosened restrictions on seeing patients out of state.
For people already working on managing an addiction, or dependence issue, what are the stressors from COVID-19 that might contribute to a reversal in progress or a recurrence in use?
Dr. Lembke: The main stressor is not concern about getting infected or financial worries, as you might think. The main stressor seems to be sudden loss of structure and purpose, and for people living alone, isolation. People don’t have to get up in the morning to go to work or school, so they’re staying up later at night. Their sleep gets phase-shifted to sleeping during the day and being up on the computer at night. They’re at risk to consume more of everything, from food to alcohol to videogames.
Is it possible for virus stressors, like social isolation or financial uncertainty, to create a dependency on drugs or alcohol in someone who had never previously had an abuse issue?
Dr. Lembke: Of course. In this age of consumption, we’re all at risk of getting addicted. I’m terrified to think of all the grandparents out there I’m hearing about who have ‘discovered’ Netflix. There’s no doubt in my mind that one result of this pandemic will be a whole new cohort of people addicted to something.
As people have been confined to their homes, and work from home, there has been an attempt at humor to cope. Plenty of social media posts joke about eating too much and drinking more. For those grappling with a condition of dependence, wouldn’t this be anything but funny?
Dr. Lembke: Not true. A sense of humor is key to recovery from addiction. Some of the funniest stand-up comedy routines you’ll ever hear are Alcoholics Anonymous speaker meetings, where gifted raconteurs in recovery tell their stories in a way that is downright hilarious. We need to laugh to survive. Bring it on.
How do we know if we’re self-medicating to cope with COVID-19 stress? How do we know if it is “situational” or becoming an abuse problem?
Dr. Lembke: Red flags for problematic or addictive use include daily use, out of control use, compulsive use, and continued use despite consequences.
When should someone reach out for professional help, and where should they initially seek help
Dr. Lembke: If you or someone you love is worried about developing an addiction, see an addiction medicine specialist in an outpatient clinic. These are usually psychiatrists with specialized training in addiction medicine, but can often be family medicine or internal medicine doctors, or psychologists and people with other types of training. A trained specialist can let you know whether you’re already addicted and what some of the best resources might be for you. There are growing numbers of medications to help people who are addicted or using more than they want, and many people don’t know about these meds.