Isolation, economic insecurity, and lack of routine are just a few of the ingredients in a toxic blend of issues that those battling substance use disorders have faced during the COVID 19 pandemic. Jeremy Thueson, MD, medical director at the Huntsman Mental Health Institute's Recovery Clinic, has had a front-row seat to the unique set of challenges his patients had to tackle during the shutdowns and restrictions on face-to-face treatment over the past 16 months. Thueson said, "It would be hard to overstate the impact on our services."
As a psychiatrist, Thueson uses a variety of methods to treat his patients. He emphasized that a lot of therapy and counseling is delivered in group settings and during the pandemic it immediately went away. "Instead of us having a discussion with 8 or 10 patients about their struggles and different ways to move forward, different ways to deal with the kind of challenges that people have when they're suffering with a substance use disorder, that just went away overnight," said Thueson.
The pandemic presented a series of logistical puzzles for Thueson, and others treating people with substance use disorders, to solve. "It was clear we were going to need to change how we were approaching the treatment of patients who had lost jobs, lost insurance, had transportation issues, and fear of being in public places," said Thueson.
The first hurdle the team at the Recovery Clinic had to clear was to find ways to reach out and bring patients back into the treatment fold. Initially, Thueson and his colleagues faced technology barriers. He recalls "patients not having Wi-Fi or not having devices that could support it or they didn't know how to navigate the internet. So, we were doing things on the phone, and we were able to stay in touch with people that way."
Eventually, the team at the Recovery Clinic got virtual platforms up and running and helped their patients troubleshoot "pilot error kinds of problems," as Thueson described them. He also discovered a silver lining to this type of patient treatment. "A lot of our patients can now do virtual visits and send us messages. They know how to look up their lab results and employ other skills that many of them might not have learned how to do if the pandemic did not force them to," said Thueson.
The preferred form of treatment is still "in community" with others and in-person with doctors and therapists. Thueson suggests it is much easier to "establish rapport with somebody and really get a feel for what is going on with them by observing their body language and the informal stuff that happens from the waiting room to the parking lot."
The pandemic has forced professionals and patients to try and accept new strategies like doing group work outdoors in a bring your own lawn chair setting. "It's a resilient bunch and they've been creative—whether you are talking about formal treatment or some of the informal stuff that people do on their own," said Thueson.
Nationally, multiple data streams are now suggesting an increase in substance use and a rise in hospitalizations and deaths associated with drugs and alcohol. Thueson admits, "It tends to look more like signal than noise, so there's probably something happening there now." He believes pandemic isolation has allowed "some people to get further into their use and in more trouble before that is detected because of the isolation. So, we are certainly seeing people showing up on average sicker, in some cases." The positive flip side could be more eyes on the problem with spouses and roommates working from home, first observing, and then alerting family and friends to potential substance use issues.
My hope is that this will normalize asking for help for people that might not have thought they need it. They have not lost their job or no longer have housing or had a partner leave them. These people are not waiting for that proverbial 'rock bottom' to seek help.
–Jeremy Thueson, MD
Individuals are also recognizing and self-diagnosing their own substance use disorders. "We have just seen a number of people who have come in and said this just kind of crept up on me and it got away from me, and these are folks who are highly functional and not used to having to access treatment," said Thueson as he described a type of pandemic patient the clinic is seeing more often.
Looking forward, Thueson believes there is the potential for positive change in the important work he and others at the Huntsman Mental Health Institute are doing. "My hope is that this will normalize asking for help for people that might not have thought they need it. They have not lost their job or no longer have housing or had a partner leave them. These people are not waiting for that proverbial 'rock bottom' to seek help."
The flexibility the pandemic has forced upon providers, insurers, and patients is another positive development from Thueson's perspective. "It has sparked a lot of creativity in how we deliver care, so we can get it to more people," said Thueson and that is the goal of those treating substance use disorders.