This week’s lead article correlates substance use disorders (SUD), serious mental illness (SMI), and suicidal ideation (SI) with the COVID-19 pandemic.  Similar findings have been remarked in the military population, during wartime, by medical thought leaders in stress disorders and suicide since before the time of Harry Stack Sullivan, in the hope of devising reliable screening instruments. Dr. Robert L. Koffman’s & colleagues’ comparative study of Army and Marine units following the Operation Iraqi Freedom incursion (OIF-1) in 2003 described stress responses among the traumatically-exposed that may have been predictable, but nonetheless largely escaped intervention  (https://www.nejm.org/doi/pdf/10.1056/NEJMoa040603; and Rozanof V & Carli V, Suicide Among War Veterans https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407917/ ). 

We would appear to be in an analogous circumstance, with respect to SUDs.  Confirmation that SUD and SI frequencies are increasing is an argument for preserving - and even increasing - funding for SUD treatment efforts, rather than diversion of treatment funds toward other pandemic response efforts.  Reduction in SUD morbidity is a system-wide form of harm reduction, in responding to the predictable longer-term psychological consequences of the pandemic.

- W. Haning, MD