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Covid-19, stress, and substance use disorders: Tips to help us all destress

The Covid-19 situation is causing unprecedented levels of stress worldwide and may be a particularly challenging for individuals with a current or former substance use disorder.

fizkes / Shutterstock
fizkes / Shutterstock

As the cases of COVID-19 continue to rise around the world, so does our level of anxiety. This is an unprecedented stressful situation, something that most of us have never experienced before. We have been ordered to shelter in place, self-isolating from family, friends, and co-workers. Many people have lost their jobs and are without steady income. If you still have a job, you are now working from home with extra responsibilities. Our work days consist of cooking, cleaning, taking care of our children, teaching them, and providing them with the enriched experiences they get at school while attempting to work at the same time. This means that some of us are fitting in those work hours during our normal sleep hours.

Our schedules are completely rearranged, and we are out of our normal routine including eating, sleeping, and physical activity. The contents of stores have changed and many of us are not going shopping. Fresh foods are becoming scarce, and we are eating more processed, high calorically dense foods. We are also snacking ALL the time. All of the gyms have closed, and many of us are finding it difficult to exercise at home. Some of us might also just be bored. On top of this, we are now worried about acquiring a disease to which of none of us have immunity and has wildly different effects from person to person – the science on why this occurs is still unknown.  

Putting all of this together, many of us are suffering from a loss of a job, unexpected changes to our daily routine, altered sleep patterns, lack of exercise, overeating, and excess worry over personal and others safety. This is a perfect storm for STRESS AND ANXIETY, and if you suffer from a preexisting condition such as chronic pain, depression, anxiety, or a substance use disorder, this is an even more challenging time.

So, how you are dealing with this new level of stress?       

Was one of your answers making a mean Manhattan at the end of the day? Grabbing a beer or glass of wine as soon as 5:00 pm hits? It’s 5:00 pm somewhere- right? I certainly have seen several alcohol-related Covid-19 memes pop up on my social media. One message even said,

That moment when you’ve hoarded enough wine and vodka (and tequila 🤫) to last 3-6 months after an apocalypse only to discover liquor stores have been included on the list of life sustaining businesses to remain open. 🤗

That’s right, liquor stores have been included as an essential business, and drinking alcohol is certainly an easy way to deal with this uncertain stress that we now wake up to every day.

So, if you are someone with either a current or former substance use disorder, this time is especially difficult. The reason for this is all about the brain and how the brain adapts to alcohol and drugs.

WHAT IS SUBSTANCE USE DISORDER (SUD)?

The DSM (Diagnostic and Statistical Manual) previously used the terms addiction, substance abuse, or substance dependence, but now we use the term substance use disorder (SUD) to classify this serious clinical issue. SUD is a chronic and relapsing brain disease that leads to the inability to control the use of legal or illegal drugs. SUDs are measured on a spectrum from mild to severe, with the level of severity based on the number of criteria that a person meets. These criteria include 11 categories based on impaired control, social impairment, risky use, and pharmacological indications, such as tolerance and withdrawal. SUDs may result from the use of substances including nicotine, alcohol, cannabinoids, opioids, depressants (e.g., benzodiazepines and barbiturates), stimulants (e.g., cocaine, amphetamine, methamphetamine), or hallucinogens (e.g., LSD, mescaline, MDMA).

In America, approximately 20.3 million individuals (aged 12 and older) suffer from a SUD, with the majority of those (73%) being addicted to alcohol. Polysubstance use or the use of more than one substance is also a common occurrence (2.7 million). SUDs often co-occur with other mental health issues including anxiety and depression, making treatment of this disorder particularly challenging.

Take home message: SUDs are chronic, relapsing brain disorders characterized by an inability to control the use of substances.

SUDs AND STRESS

Research demonstrates that during heightened stressful situations, cravings for alcohol and drugs significantly increase. In fact, stress increases the risk of drug and alcohol relapse. This is because the neural circuits that are involved in stress and emotion are connected to the neural circuits that regulate the reward and motivation circuits – the circuits that directly respond to drugs and alcohol. Chronic use of drugs and alcohol lead to both structural and functional changes in these systems including areas such as the hypothalamus, amygdala, hippocampus, prefrontal cortex, ventral striatum, and ventral tegmental area. In turn, these changes cause the individual to have a heightened response to drug- and alcohol-related cues, which lead to increased cravings and use.

Once alcohol and drugs change the brain in this way – the individual then responds to other daily acute stress in a completely different way. First, individuals with SUDs show higher physiological baseline levels of stress (e.g., increased heart rate and salivary cortisol level). Second, the individual then has a heightened response to other stressors in life, such as loss of a job, challenges at work, or home responsibilities– the exact struggles we are all facing with Covid-19. Because of these physiological changes, individuals with SUDs report high levels of daily stress and the inability to manage their stress in adaptive ways. In response to these stressors, they demonstrate increased blood pressure, subject levels of anxiety and distress, and increased drug and alcohol craving. These individuals then choose to deal with this heightened perceived level of stress through drug and alcohol use.

Take home message: Individuals with SUDs have a dysregulated stress response, which causes them to crave, seek, and use substances.

SUDs AND RECOVERY

SUDs share many features of other disorders such as diabetes, asthma, and hypertension in that it is chronic, subject to relapse, and influenced by genetic, developmental, behavioral, social, and environmental factors. SUDs are also treatable, but because individuals with SUDs have difficulty in the ability to make decisions and regulate actions, emotions, and impulses, the afflicted individuals may have difficulty complying with the prescribed treatment regimen. That is, SUDs can be managed but not cured.

Enter the idea of recovery. About 10% of the US population is estimated to be in recovery. The most common treatment programs for SUDs are 12-step recovery programs, but others exist as well. Recovery is a broad term that encompasses not only abstinence from substances, but improvements in overall physical and psychological health and wellbeing, increased quality of life, engagement with family and friends, participation in school or work as well as other recreational activities – gaining back a fully functional and fulfilling life that is substance free. Recovery does work, and it is linked to distinct brain changes.

Dr. Warren Bickel and his team at the Addiction Recovery Research Center at the Fralin Biomedical Research Institute at Virginia Tech have established a new tool to help research addiction recovery –  The International Quit and Recovery Registry (IQRR). Individuals who are in recovery can join and become a Recovery Hero. As a member, you can take surveys, earn rewards to redeem for money, and participate in an online recovery community. This is especially important now as many weekly recovery meetings have shut their door for in person meetings.   

You can find a variety of recovery resources or join the IQRR at www.quitandrecovery.org.

Take home message: Recovery from SUDs is possible, and is a process that not only includes abstinence from substances but improvements in many aspects of life.

10 TIPS TO HELP US ALL DESTRESS

No matter our history with substances, the psychological stress that we are all experiencing can make us anxious, sad, depressed, or just feel overall lousy. Often, we deal with this stress by eating fatty foods, sitting on the couch and binge-watching Netflix, or just pouring an extra drink. I think we can all relate to this – these things are just too easy to do and make us feel good in the short term. The problem is that over the long term, these maladaptive health behaviors will lead to higher levels of stress and a worsening of mood. During this difficult time, we need to be proactive to make sure that we are taking care of ourselves. Here are some things you can all do to decrease your stress levels and make you feel better.

Try destressing through these 10 techniques:

  1. Be sensitive with yourself: This is an unprecedented time. Things are not normal, and that is ok. Be kind to yourself. Avoid negative self-talk and instead, say kind, sensitive things to yourself. Do not feel that you need to be extra productive or extra creative. Do not feel badly if you did not accomplish much during the day. Make sure your priorities are taking care of yourself and the others immediately around you.
  2. Breathe: Try a deep breathing exercise. In times of stress, we often hold our breath without even knowing it. Try inhaling slowly to the count of 1, 2, 3, 4, then exhaling slowly to the count of 1, 2, 3, 4. Breath first into your belly and then your chest, then release from your chest and then your belly. Repeat.
  3. Exercise: Now that all of our gyms are closed, we need to find alternatives to our normal exercise routine. Try an online yoga or dance class or try going for a walk around the block or in the forest if you have access to one close by. Even a few minutes of exercise at a time (~10 minutes) has been shown to decrease stress levels and cravings for food and alcohol.
  4. Play games: Take out an old board game that’s been sitting around. Take up video games and get into a gaming adventure. Start a puzzle or Lego set that will take you some time to complete.
  5. Eat whole, fresh foods: Eating unhealthy, high calorically dense foods make you lethargic and not feel well overall. Nourish yourself with healthy, fresh fruits and vegetables. Try to incorporate at least one fresh fruit or vegetable into every meal.
  6. Get enough sleep: Now that are schedules are all out of sorts, finding time for sleep is difficult. Try to get at least 8 hours of sleep. If this is impossible, try to find some time during the day to nap. If you have a child that still naps, try cozying up and enjoying that rest time too.
  7. Reach out to friends and family: Though we are all alone in our own homes, you can still reach out to family and friends by text, phone call, or video chat. Especially with the holidays approaching, you can even think about sharing a meal or a family tradition while video chatting.
  8. Meditate: Try to find some time for real rest and relaxation. Try meditation, even for a few minutes a day. Apps like Calm or Headspace can help you to integrate this practice into you daily routine.
  9. Listen to music: Listen to music while you work, play, cook, or clean. Research has shown that listening to music that you find enjoyable can increase your happiness and decrease your levels of stress.
  10. Get creative: Art therapy is a proven effective method to help decrease levels of anxiety and enhance pleasurable mood states. Pick up some art materials and paint or draw something in your surroundings, even out in nature if possible. Try coloring an adult coloring book for some additional relaxation.

As an additional tip, use the internet constructively. Avoid excess use of social media as there is a heightened sense of panic on social media these days along with streams of fake news. Check in once (or twice) a day, and then let it go. If you are in recovery and normally participate in weekly or daily recovery meetings, seek out an online recovery resource. For example, www.intherooms.com provides 130 weekly online meetings. If you are in recovery, join us at www.quitandrecovery.org and help us help others!

If you or your loved one need immediate help, call 911 or dial SAMSHA’s National Helpline at 1-800-662-HELP (4357). Recovery from addiction is possible – just keep trying – sobriety is worth it – you are worth it!

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