Quality & Science

Addiction Clinicians Can Help with the Vaccination Effort by Nora D. Volkow

by | October 11, 2021

by Nora D. Volkow, MD, Director, National Institute on Drug Abuse

In 2019, even before the COVID-19 pandemic, the World Health Organization had identified vaccine hesitancy as one of the top threats to global health. The prescience of this assessment is now made clear by the resurgent numbers of hospitalizations and deaths in many parts of the U.S. from COVID-19, especially in communities where vaccine hesitancy remains high due to mistrust of government and the spread of misinformation about COVID-19 and vaccines, particularly on social media.

For their own distinct set of reasons, some people with substance use disorders may also resist becoming vaccinated, despite evidence showing that SUDs put them at higher risk of contracting and experiencing worse outcomes from SARS-CoV-2 infection. Previous experiences of being shamed or discriminated against in healthcare settings may make some people with SUDs wary of a voluntary clinic visit.

People in one’s community, employers, and personal physicians—trusted messengers—are increasingly important as persuaders. Research shows that, when it comes to health-related information, people most trust their own doctors, and a survey conducted last year by the Addiction Policy Forum showed that people with SUDs are no exception. Specialists in addiction medicine thus have an important role to play in helping dispel fears and overcoming hesitancy around the COVID vaccine in their patients.

The key to changing minds is meeting people where they are. For people with SUDs who have experienced mistreatment by healthcare and other authorities, distrust of those authorities during the current public health emergency is understandable. Some may reasonably worry that they could have to divulge their substance use when receiving a vaccine. You can assure them that no one will ask them to disclose that or most any other kind of health information.

Patients may also have medical concerns about getting the vaccine or about its efficacy given their other health issues, including SUD. You can let them know that the vaccines do not interfere with whatever SUD treatment they may be receiving. And while there is evidence that people with SUDs may have a higher likelihood of breakthrough infection—likely a function of other comorbidities—you can also assure patients that remaining unvaccinated places them at much greater risk from COVID-19.

Another positive message is that vaccinated individuals can gather in person more readily. This may alleviate the isolation that can lead to substance use or exacerbate the risk of relapse in those who are recovering from a SUD.

Besides respectful listening, one of the most powerful tools of persuasion is simple repetition. A single encouragement to get vaccinated may not have the desired effect, but when the patient hears that message on every visit, its importance in the eyes of their trusted doctor may gradually sink in and become more likely to influence their decisions.

For more about increasing COVID vaccination among people with SUDs, see this NIDAMED resource.