From Bad to Worse

Local substance abuse treatment providers battle increased demand during the pandemic.

Open Capsules Container Over Colored Background Depicting Drug Addiction

Louisiana was already home to one of the fastest-growing substance abuse problems in the United States. – James Buras, director of business development for Covington Behavioral Health Hospital

As the COVID-19 pandemic continues to rage, its negative impacts on the economy and society — including rising rates of unemployment and evictions, loss of social interactions and disruption of social services — have also spurred substance use problems.

According to a recent study by American Addiction Centers, the largest network of rehab facilities in the nation, out of 3,000 Louisianans who lost their job due to the pandemic, more than 1 in 3 (36%) admitted they have been drinking more than usual.

This would come as no surprise to industry professionals like James Buras, director of business development for Covington Behavioral Health Hospital — a provider of psychiatric inpatient and outpatient treatment for men and women with mental health conditions — who noted that the quarantine’s effects have raised levels of loneliness and depression in individuals regardless of their employment status. The result, he said, has been a spike in alcohol and drug use, as well as self-harm and suicidal behavior over the past months.

“In the state of Louisiana, we have seen liquor sales go up 20% so far this year,” said Buras. “Those who may have used alcohol or drugs prior to COVID-19 as a stress reliever have now found themselves consuming larger quantities more often and not realizing they are becoming addicted.”

Buras said this rise in consumption is only exacerbating what was already a serious problem.

“Louisiana was already home to one of the fastest-growing substance abuse problems in the United States,” he said. “Year over year, we have seen a rise in addiction and treatment in adults and adolescents in the Greater New Orleans area.”

About a month after the stay-at-home order was first enforced, Covington Behavioral Health began to see a significant increase in admissions as hospital emergency rooms, now dealing with an influx of COVID-19 patients, were no longer able to accept psych or detox patients. COVID-19 reached beyond admissions, though.

“The quarantine has created a massive expansion of telemedicine service across all medical fields,” he said. “Medical detox treatment requires patients to be in an inpatient setting for medical observation and treatment by a physician, so we have had to limit access to the facility to essential employees and put in place a strict COVID-19 screening process prior to admission to protect our patients. We have changed our visitation to a telehealth platform.”

The hospital has also moved its intensive outpatient program (IOP) to a larger facility to allow for social distancing, as well as begun to offer IOP groups on telehealth platform for those individuals who don’t feel comfortable attending in person.

Rochelle Head-Dunham, MD, executive and medical director for Metropolitan Human Services District — the local governance entity tasked with service delivery for persons suffering from addictive disorders — said MHSD has also made a big move to telehealth. Before COVID-19, the organization did not provide any services via telehealth. They now offer 70% of their care this way. Walk-in and face-to-face services are now reserved only for medication injections, physician emergency certificates (PECs) and physician determined urgent or emergent services.

Head-Dunham said MHSD has not experienced a drastic shift in numbers of those seeking substance use services over the past few months, but she expects that to change.

“Roughly 17-20% of our services have been for substance use treatment per our historical data pre-COVID,” she said. “The 2020 third quarter (April-June) indicates 17% of the requests for services have been substance related. This time period also aligns with the roll out of our Suboxone office-based opioid treatment program. Numbers have been low and the rollout slow.”

Nonetheless, she said she sees an increase in patients as “very likely, particularly since we plan to continue offering at least 50% of our services using the telehealth platform. Also, with the projected downward turn in the economy due to unemployment and withdrawal of federal stimulus support, coupled with the social unrest around racial issues, these stressors will likely compound the emotional impact.”

Individuals with a history of mental illness and/or substance use issues are particularly vulnerable to increased stress.

“Resiliency is very much the product of our ability to problem solve, exercise good judgement and avoid knee-jerk decisions,” said Head-Dunham. “These abilities are the function of a healthy prefrontal cortex. Without it, as in the case of a history of moderate to severe substance use disorders, even if abstinent, the brain can be hijacked by thoughts and environmental cues, compounded by high stress, to foster substance use to escape.”

Patrick Waring, MD, founder of the Pain Intervention Center in Metairie, specializes in treating spine-related pain without opioids. His concern lies in addiction issues that can result from what he sees as turning to a quick fix for chronic pain.

“Chronic pain is stressful and often leads to chronic anxiety,” Waring said. “If high-quality interventional alternatives to opioids are not offered, not available, or perceived to be unavailable — as often was/is the case during this pandemic—then the easy solution of ‘writing a pain pill script’ is used too often by providers with the unfortunate result of opioid addiction.”

Quarantining is a challenge to everyone’s resiliency and is one of the chief reasons why addiction is rising in the wake of the coronavirus.

“The longer there is uncertainty in the future with COVID-19 quarantine, isolation, social distancing, testing and treatment,” Buras said, “the more likely we will continue to see a rise in people abusing substances to cope with the underlying anxiety and depression.”


Know the Signs of Substance Abuse

According to American Addiction Centers, signs of substance abuse can include:

  • Tremors
  • Bloodshot eyes and constricted or dilated pupils
  • General drowsiness during the workday or falling asleep on the job
  • Being late to work
  • Drop in job performance and increased errors
  • Mood swings and angry outbursts
  • Isolation and withdrawal from the team
  • Forgetfulness and impaired concentration
  • Panic attacks
  • Paranoia