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How Shelter-in-Place Affects Those Suffering from Substance Use Disorder

— May 14, 2020

A diabetic who needs insulin is just as vulnerable as someone battling substance abuse needing the social interaction of psychological, behavioral, holistic, and group therapy.

When you consider what is involved in recovering from substance use disorders and any accompanying addiction, it becomes clear that COVID-19 can become much more than a pulmonary disease. True, for the elderly and for those with pre-existing diseases that put them at increased risk from this novel virus, it can become life-threatening. Recovery from substance abuse and addiction, and even their very treatment, however, are designed to save people from another disease just as life-threatening: substance use disorder.

Therapeutic protocols for substance abuse and addiction rely on interactions designed to support the patient through the hardest parts of overcoming abuse and addiction as diseases. As such, there is going to be collateral damage from COVID-19 precautions that won’t be covered in the media with as much emphasis as the risks that health care workers and first responders are taking. Outside of the media attention, it is important to realize that substance abuse/addiction are just as much pre-existing conditions complicating the COVID-19 crisis.

Substance abuse treatment relies on social interaction

  • Behavioral and psychological therapy: Behavioral therapy is, of course, a change in behavior that helps prevent dependence and the triggers that lead to continued abuse. Psychological and even psychiatric care rely on gains made via behavioral therapy. While telemedicine is quickly becoming legitimized as a valid practice of medicine in today’s pandemic world, it is still another degree of separation between therapist and patient. This extra distance may be too far for those too fragile to withstand extra detachment. 
  • Support groups: Nowhere is the void that separates people more noticeable than that isolation away from one’s support group. Support groups are important for a reason—they are crucial for the camaraderie and inclusiveness that boosts one’s feeling that he or she is not in the battle alone, thereby increasing the self-esteem that strengthens one’s resolve. Take that away and the Jenga tower may just fall.
  • Holistic approaches: Among the many holistic approaches are those which rely on person-to-person contact, such as yoga and meditation instruction, art and dance therapy, and massage therapy. 

Substance abuse is only one of many “emergencies”

Man sitting on rock in body of water; image by Keegan Houser, via
Man sitting on rock in body of water; image by Keegan Houser, via

The opiate crisis and its overdose statistics certainly have underscored the necessity of treatment for those suffering from substance abuse. Crises seem only as important as the media attention given them, so when the COVID-19 pandemic came to the forefront, it became easier for a frightened society to sweep the substance abuse emergency under the public-consciousness rug. In the media, out-of-site is out-of-mind; nevertheless, substance abuse is no less dangerous. 

Shelter-in-place = suffer-in-place 

Sheltering-in-place creates obstacles for those who suffer abuse disorders, threatening success:

  • It makes it harder for those on maintenance programs (e.g., methadone programs) to maintain their highly structured treatment regimen.
  • It causes loss or reduction of the aforementioned behavioral therapy and support, removing a big piece of the therapeutic plan. 
  • It causes loss of the support of friends and family—the ones most personally invested in someone’s recovery.
  • Depression and anxiety that normally accompany social isolation become all the more likely in those who rely on socialization for the—suddenly forgotten—emergency of substance abuse. They are traditionally more at risk for mental co-morbidities because of the things that may have made them susceptible to drug abuse in the first place: poverty, post-trauma effects, childhood abuse, and dysfunctional families.
  • It can make more likely the adoption of unhealthy coping mechanisms, such as alcohol and marijuana abuse. 
  • It fosters a misconception that suspension of social life—officially declared by government policy—forgives suspension of abstinence.


A diabetic who needs insulin is just as vulnerable as someone battling substance abuse needing the social interaction of psychological, behavioral, holistic, and group therapy. Using diabetes as an example to compare with substance abuse, each is a disease and each has relied on tailor-made therapeutic approaches. But, while insulin can be mailed to a person who is sheltering-in-place, this is not true for the therapeutic protocols above, needed by those battling abuse disorders, addiction, or who are tenuously engaging in their fragile recovery. It is obvious that we need to keep in mind substance use disorders and addiction and add them to the pre-existing conditions that make COVID-19 concerning, because they present just as much a life-threatening scenario at the personal and societal levels. And, it is just as obvious that the necessity of social isolation complicates substance abuse just as much as it does other co-morbidities. 

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