A recurring theme among the responses to the Covid-19 pandemic has been reconstruction and “normalization,” specifically of the national economy.  Folks who work in the field of addictions have ample experience with unstable environments, both the worldly one and the internal milieu. In the latter case, it is wiser to not have great and brittle expectations when helping someone deal with their addiction.

But I mention this not to describe the difficulty of treating this illness category but to emphasize an analogy. We are accustomed to dealing with endemics and epidemics, and arguably some of the greater and longer waves of addiction incidence can be construed as pandemics. So that gives us some measure of the pressure for normalcy, as in, “when is he going to be able to return to work, when can I start to sleep through an entire night, when will he be trustworthy enough to return to work?”  - that sort of thing. But the practice of addiction medicine teaches us that there is little likelihood of recovery in the longer sense without attention to the acute phase of the illness, including intoxication.  Insight-oriented therapy is poorly-received in a hangover.

Those accustomed to disaster management will recall that in Advanced Disaster Life Support (ADLS) and similar training curricula, we are taught that there are differing phases and differing levels of response to an event. The two most obvious phases are the acute, ongoing disaster; and the recovery phase.  The recovery phase cannot begin until the still-developing acute event has subsided.    If it is a hurricane, it will be a matter of hours to a day.   If, as in Hawai`i, it is an erupting volcano, it may be months, or never. Tsunamis rarely occur as a single event but generally involve a succession of waves. Similarly, those who have experienced earthquakes know very well not to assume safety when the first shock is done.

And yet we hear many voices, some strident, some furious, some plaintive and fearful requesting a return to normalcy.  In the establishment of recovery for the actual pandemic, we in the world of addiction treatment – addiction recovery - do have something to offer, to teach.  Until the initial event is done, initiation of the recovery, even if it involves attempting to have a conversation with one who is intoxicated, will be a waste of both parties’ time. On a larger scale, those taking care of a population damaged by infection, by alcohol use, by famine, by hurricane and all other sources of mass misery recognize the need for patience at a time when patience is in pretty short supply.  We are at a better point than any historically to survive a mass disaster.

[ASAM Members, please note that Officer elections have begun as of 0800 ET today.]

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