As an attorney managing a stressful caseload you may result in coping strategies to help manage your stress. One of the most common coping strategies is substance use. If you feel like you have begun to use negative coping strategies therapy is a great option to help you get back on track.
It’s no surprise that people are feeling anxious right now.
Workers are worrying about how they’ll pay the rent as hours are cut back. Young parents are trying to do their jobs remotely while watching their children who are home from school. Older people are weighing the health risks of making a quick run to the grocery store.
Most people’s lives have been turned upside down by the coronavirus.
As Congress takes action to keep our economy strong and our people healthy, we can’t forget those who far too often have been left behind – people who are living with mental illness and those struggling with addiction.
It’s estimated that 1 in 5 people in our country are living with mental illness or substance use disorders. Sadly, people with mental illness and people with substance use disorders may fail to get the treatment they need in a typical year. And as we know, this year is anything but typical.
We know that people who misuse opioids are at high risk for coronavirus. According to the National Institute on Drug Abuse and other health experts, opioids impact the respiratory and pulmonary health of users and make them more susceptible to respiratory infections, including coronavirus.
People who are living with a mental illness or addiction often have other health conditions that make them more likely to suffer severe complications from the coronavirus.
Responding to the coronavirus pandemic requires a comprehensive health care strategy, including increasing access to community mental health and addiction treatment services. And the best way we can do that is to include the expansion of Certified Community Behavioral Health Clinics in the next emergency package passed by Congress.
Six years ago, we worked together to pass our Excellence in Mental Health and Addiction Treatment Act. It created quality standards of care and funding to open community clinics that are transforming mental health and addiction treatment.
After only two years of operations, communities that have CCBHCs are providing life-saving services. They work closely with law enforcement and our schools and coordinate with hospitals to dramatically reduce emergency room visits.
According to the Department of Health and Human Services, they’ve led to a 60% decrease in time spent in jails, a 41% decrease in homelessness and a 63% decrease in emergency department visits for behavioral health. That’s a big deal when every hospital bed matters right now.
CCBHCs also are well-positioned to support those struggling to cope with the stress of coronavirus, whether it’s anxiety, depression, loneliness brought on by social isolation or even trauma faced by front-line health care workers. And many CCBHCs provide telemedicine services, allowing people to access help without increasing their potential exposure to the virus.
As our nation confronts COVID-19, we must not leave those with mental illness and addiction disorders behind. And the good news is, by working together, we can make sure that doesn’t happen.
Opioids and other substances that alter how we feel, think and act have overtaken our culture, and have been declared a public health epidemic. We are losing our loved ones, friends, co-workers and neighbors to these substances. But we have yet to implement the solutions that will beat back this epidemic, as we have so many others, like HIV/AIDS, polio, smallpox and tobacco.
Substance use and abuse—of opioids, heroin, cannabis, stimulants, alcohol, etc.—is universal and the casualties of drug addiction affect all classes, races and regions of the U.S. These substances are too frequently used as an answer to pain, mental and physical, and have become a cure-all for people who’ve fallen on hard times. That’s why so many people use them and that’s why so many people become addicted.
Substance use disorders commonly co-occur with mental health conditions, especially serious mental illness like schizophrenia, bipolar disorder, depression, eating disorders, PTSD and other forms of trauma. People with mental illnesses often turn to drugs and alcohol to quiet their symptoms, and drugs and alcohol can adversely affect our nervous system and increase risk for mental illness.
We are failing with this epidemic because of this country’s dogged attachment to policies and programs that have never worked for addiction. Vast sums of money continue to be wasted on campaigns of drug control and on public messages, especially for youth, that rely on scare tactics. We can and must do better. We can beat this epidemic with three public health approaches.
- Prevention. This includes school-based programs that provide youth with decision-making skills and methods of controlling their moods and impulses. One proven program is called the Life Skills Training. Prevention also extends to the family, such as “positive parenting,” or actively modeling and teaching children about positive behaviors. Big Brother/Big Sister programs—where an older youth of the same background takes on a younger, high-risk child—is also highly protective. These prevention programs work, and we have hardly started to apply them.
- Screening. Early identification of a problem means early intervention, before the substance use disorder becomes more firmly rooted. We have good screening instruments, (such as the Alcohol, Smoking and Substance Involvement Screening Test), and need to make them standard practice in schools, pediatric and family medicine offices.
- Treatment. Families and people affected by addiction should advocate for the strong, comprehensive treatment approach they need. Effective treatment means first detecting the presence of a co-occurring mental (or physical) condition and assuring it’s also treated. Treatment for a substance use disorder should then combine:
- Cognitive therapy that focuses on reducing the triggers of relapse
- 12-Step programs like Alcoholics Anonymous and Narcotics Anonymous
- Family education and support
This public health epidemic that is seizing our country can be beaten. And by following these steps, we save lives, help families and restore communities.
Dr. Sederer is a psychiatrist, public health doctor and medical journalist. His new book is The Addiction Solution: Treating Our Dependence on Opioids and Other Drugs(Scribner, 2018). www.askdrlloyd.com.
I recently read an interesting article about a Caron Treatment Centers study titled “Many Americans Oblivious to What High-Risk Drinking Looks Like.” Dr. Harris Stratyner was quoted as saying “Alcohol is still the number one cause of damaging behavior at holiday celebrations throughout the U.S”. The information in this article got me thinking… are the holidays a time and excuse for people to abuse alcohol and what are the consequences? The Caron Treatment Centers study found that even non-alcoholics are over-imbibing at these events and experiencing many negative effects such as:
- 50% saw a co-worker/supervisor share inappropriate personal details about themselves or other colleagues
- 45% saw a co-worker/supervisor flirting with another colleague
- 43% saw a co-worker/supervisor drive even though he or she was drunk
- 35% saw a co-worker/supervisor using excessive profanity
- 30% saw a co-worker/supervisor argue, be abusive or engage in sexual activity
- 60% of those who attend family holiday parties also reported that a family member behaved inappropriately after drinking too much alcohol. One respondent shared that alcohol prompted “a knock out drag out fist fight” and another spoke of “emotionally abusive behavior” during a family holiday party. Others said relatives wanted to drive even though they were drunk
I don’t want to be a “buzz kill” but my question is, are we having fun yet? In Pete Hamill’s book A Drinking Life his final drink before getting sober was at a New Year’s Eve party—and he writes: “But once more, I felt as if I were shooting the scene with a camera from across the bar…It was New Year’s Eve. We were supposed to be having a good time. Look: there were balloons. There were funny hats. There were noise makers. Charlie, bring me a vodka and tonic, will you please?…I stared into my glass, at the melting ice and vodka-logged lime. And I said to myself, I am never going to do this again. I finished my drink. It was the last one I ever had.” Hamill took a moment to step back from the festive scene, observed the drunken and insincere behavior and concluded that it felt meaningless. Alcohol is such an integral part of holiday events and this can be a challenge particularly for those who are sober and especially for those in early sobriety.
According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA) low-risk drinking is defined as no more than four drinks per sitting and not more than 14 per week for men and no more than three drinks per sitting and no more than 7 per week for women.
The holidays are notoriously an emotionally “loaded” time for many people as well as a joyous time. They can be especially challenging for those who are sober or choosing not to drink. However, it is possible to be truly present for these holiday events without drinking or abusing alcohol by learning coping skills to tolerate or set limits with more challenging work and social engagements:
• Have an escape plan by bringing your own vehicle or figure out the available public transportation near the holiday event that will enable you to leave if you are feeling tempted to drink or uncomfortable.
• Ask another sober person to be “on call” for you to check in with during the event for additional support.
• Let someone whom you trust at the holiday event know that you may need additional support during this occasion or time of year.
• Find a tasty non-alcoholic beverage you can drink that will give you something to hold and may prevent people from offering you an alcoholic drink.
• Come up with a standard response as to why you are not drinking that may vary depending on the type of holiday event and if you want those in attendance to know you are sober: “I don’t drink anymore,” “I am not drinking tonight,” “I am on medication and cannot have alcohol,” “I am the designated driver tonight,” etc.
• Be choosy about the holiday events that you attend and avoid “people pleasing” by saying “yes” to events that you don’t need to nor don’t want to be at.
• Take care of yourself prior to these events: get enough sleep, eat regularly, exercise, relax, meditate, etc.
• Find new holiday activities and traditions that you may never have tried in the past which do not involve drinking alcohol (volunteer at a soup kitchen, go ice skating, have a sober get-together and gift exchange, see a movie, take a trip, etc.)
• Remember to create structure for yourself if you have time off (volunteer, exercise, make plans, got to mutual-help group meetings, therapy, etc.).
• Work extra hours if needed in order to distract yourself.
• Learn to say “no” if you do not want to attend an event.
• Put your sobriety first and realize that others may not understand what this entails, but that it is your number one priority.
• “Just say no” to rum cake!
• Attend extra mutual-help group meetings during this season (i.e., A.A. has “alcathons” that involve 24 hours of meetings, food, socializing at designated locations on Thanksgiving Eve, Thanksgiving, Christmas Eve, Christmas, New Year’s Eve and New Year’s Day. Contact your local A.A. Intergroup for more information.
• Be honest with loved ones if you are having a hard time and let them know how to support you.
• Remember that “this too shall pass” and there is life after the holidays.
• No matter how you are feeling, you do not have to drink!
For more resources and information about high-functioning alcoholics, visit www.highfunctioningalcoholic.com