Psy-Q: True or False? You can consider addiction treatment finished after a short-term detox program.

Answer: False. Addiction treatment can start with detox but that is just the beginning of an ongoing process of recovery through counseling, behavioral therapy, medication, and support groups, depending on each patient’s needs. Continued treatment for addiction can help prevent deaths due to substance abuse and deaths of despair (from overdose, suicide, and liver disease).

George F. Koob, PhD, director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) at the National Institutes of Health, is the lead author of a recent study that looked at alcohol use during the pandemic and examined how the factors of the pandemic could add to deaths of despair. (See other perspectives on his team’s findings and insights into “deaths of despair.”)

“Our hypothesis is that since alcohol contributes to a significant part of the deaths of despair in general, through suicide, overdoses, and liver disease, that any increased drinking that we see with the pandemic combined with, of course, the dystopia that the pandemic is inflicting on all of us, is probably going to drive this even further,” he told Psycom Pro.

Whether people have developed new drinking problems, their existing problems have gotten worse, or their recovery has slowed, these developments are among the challenges faced by healthcare professionals as COVID-19 rates continue to climb. Treating alcohol use disorders is essential as is the understanding that treatment takes time.

“It’s not a simple detoxification; treatment requires a long-term commitment, behavioral therapies, and sometimes medication help,” he says.

Dr. Koob points to an important shift in the philosophy of treatment, with the old model of the 28-day rehab stay now replaced with an acceptance that treatment is often a lifelong exercise that takes work. “As with any mental illness, it requires building up a resilience and retaining that resilience through the rest of your life,” he says.

“If there was a silver lining to the opioid overdose epidemic, it’s been that treatment is now increased across the United States,” Dr. Koob says. He hopes that the “treatment culture that’s evolving will evolve even more,” and that the growth of telehealth during the pandemic will remain and expand, particularly in rural communities where there may not be a treatment facility, or even a physician, within 100 miles. He looks forward to a time when people can return to in-person groups, which can supplement and support telehealth and telemedicine approaches.

Dr. Koob pushes for more recognition of the effects of addiction on society and our healthcare system. “When we realize the impact of addiction on our healthcare services, on deaths of despair, on comorbidities with other mental illnesses, I think we really need to give a high level of priority to addressing it,” he says. “We often forget how much of an impact alcohol and addiction have on our healthcare and the cost of it. If we treated addiction as well as we treat heart disease, we could save a lot of money on healthcare.”

Dr. Koob recommends these resources:

  • The NIAAA Treatment Navigator has a section for healthcare providers and for patients to learn about treatment for alcohol use disorder
  • Rethinking Drinking from the NIAAA educates people on things like the size of a standard drink and how to see signs of a problem.
  • The American Society of Addiction Medicine has guidance on how patients can find virtual support groups.
  • The national helpline from the Substance Abuse and Mental Health Services Administration (SAMHSA)

Of note, Case and Deaton (who coined “deaths of despair”) have a new book – Deaths of Despair and the Future of Capitalism – that hit the NY Times 100 Best Books of 2020.

 

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Last Updated: Nov 20, 2020