Editorial Comment 4/14/2020: Transitions in Treatment

Editorial Comment 4/14/2020: Transitions in Treatment

Baumann and Lee’s article in Bloomberg Law leads, with a discussion of the exacerbating impact of the COVID-19 pandemic on those with substance use disorders (SUDs).  Regardless of the substance or the pattern of addiction experienced, inaccessibility to treatment and support from risk of contagion is universal.  For a month and longer, mutual support groups have been first discouraged, then formally prohibited from meeting in person.  Residential and even outpatient treatment facilities have been trammeled.  The central organizing theme of recovery has always been affiliation and the over-coming of isolation; social approaches now risk acute illness, disability, and death.

But then, that risk is not new.  And the necessity to fashion other mutual supports, certainly in addiction, antedate SARS, MERS, Ebola, and AIDS.  Given that one disaster can feel remarkably like another, if you are caught in its midst, perceived as an existential threat and reckoned-with by ingenuity and compromise, those in recovery will find a way.   The history of Alcoholics Anonymous is one of individuals discovering and examining shared experiences; and finding ways to communicate those experiences widely.  So in World War 2, we have the creation of The Grapevine, “your meeting in print,” exactly to accommodate those in overseas service who were too few in number (and too unknown to one another) to meet together.  The current use of electronic meeting platforms, even with cautions regarding confidentiality, is a logical merging of two approaches: tele-health (or telepsychiatry) and group mutual support.

Parallels may be drawn between this experience and epidemics of drug use, not all of them useful or even accurate, so it is risky to be facile in doing so.   But still, I recall epidemics simmering into endemics even within my lifetime, dating from streptococcal infections in the early days of rationed penicillin, to the poliovirus epidemics of the late 40s/early 50s, to AIDs in the 1990s.  And it was, of course, always the weakest and most compromised who were stricken most severely.  It will be so for this pandemic, which will disproportionately include our addicted patients.  As with tsunami or earthquake recovery, many facilities and many people will be lost.  But the new approaches which emerge need not displace the older, so much as augment them.  We come closer to realizing a cure of addictions by accepting the respective utilities of many approaches, psychotherapeutic and pharmaceutical and somatic, additively.

- Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM