For decades, medical experts have called addiction a “disease of isolation.” Although we’ve changed the way we think about addiction in recent years – we now call alcoholism or alcohol addiction alcohol use disorder (AUD) and call substance abuse or drug addiction substance use disorder (SUD) – that hasn’t changed the fact that isolation and addiction are intimately related.
That makes our current situation in the U.S. a one-two punch for people in recovery from an AUD or SUD.
The first punch: many people who develop an addiction identify isolation and loneliness as contributing factors. Other factors include genetics, family history, the presence of past trauma, or the presence of a co-occurring mental health disorder.
The second punch: stay-at-home mandates, social distancing guidelines, and prohibitions against group gatherings – which includes in-person social supports like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) – result in the very isolation that many cite as a contributing factor to their addiction.
National experts on addiction recognized the dual threat COVID-related isolation poses to people in recovery. In an interview in April, Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA), said:
“Whenever there’s been a catastrophe like this, there is an increase in drug consumption across the board. Our alcohol drinking goes up, smoking goes up, and people relapse. We do know that drug-taking is one of the ways that people try to cope, and unfortunately, this can have very adverse effects. Meanwhile, social isolation is one of the most important factors contributing to drug-taking behavior.”
Let’s explore why social isolation is recognized by addiction professionals like Dr. Volkow as a contributing factor to substance use and addiction.
The Relationship Between Isolation and Mental Health
We’ll connect the dots between isolation and risk of relapse so there’s no doubt in your mind about the challenges people in recovery face. If you’re in recovery, we’ll connect the dots so you understand them, as well. It’s important to know the challenges you face during the coronavirus pandemic are not in your head. They’re very real, backed by evidence, supported by data, and agreed upon by almost any mental health professional you ask.
The first two dots to connect are between isolation and mental health. Dr. Volkow made the connection between isolation and addiction in the quote offered above, but now we’ll explain why isolation increases risk of both addiction and relapse – because she did skip that step.
According to the American Psychological Association, loneliness and isolation have a wide range of negative consequences on emotional, physical, and cognitive health. Here are the adverse consequences of isolation and loneliness they identify:
- Emotional health:
- Physical Health:
- Poor cardiovascular function
- Increased risk of coronary heart disease
- Increased risk of stroke
- Impaired immunity
- Cognitive Health:
- Impaired executive function
- Increased risk of dementia
- Accelerated cognitive decline
That evidence is clear. In addition to increasing stress, loneliness and isolation can increase the risk of mental health disorders like anxiety, depression, and insomnia. Now it’s time to connect the next two dots: mental health and addiction.
The Relationship Between Mental Health and Addiction
The National Institute on Drug Abuse (NIDA) website offers an abundance of information about the relationship between mental health – or mental illness – and substance use disorder. They lead their resource section on co-occurring disorders – the term clinicians use when one person has a mental health disorder and a substance use disorder – with the following simple statement:
“Multiple national surveys have found that about half of those who experience a mental illness during their lives will also experience a substance use disorder, and vice-versa.”
NIDA goes on to list the mental health disorders that may co-occur with SUD:
- Anxiety disorders:
- Mood disorders:
- Bipolar disorder
- Other disorders:
- Attention-deficit hyperactivity disorder
- Borderline personality disorder
- Psychotic illness
- Antisocial personality disorder
While all the disorders above may co-occur with SUD, the most common mental health disorders that co-occur with SUD are anxiety and depression. Research shows that:
- People with depression are approximately twice as likely to have an SUD as people without depression
- About 20% of people with an anxiety disorder also have SUD
When we look back at the mental health disorders that are most often associated with isolation and loneliness, we find that depression and anxiety are at the top of the list. That means that the dots between isolation and addiction now connect in a clear and unmistakable way.
Isolation, Mental Health, COVID, and Relapse
Here’s the simplified version:
- Isolation can lead to anxiety and depression.
- Anxiety and depression commonly co-occur with – and are risk factors for – both addiction and relapse.
- Therefore, isolation can increase risk of substance use and relapse to substance use.
That’s the default situation many people in recovery face right now: they’re isolated because of coronavirus, and this isolation increases and intensifies many of the factors that may have led to their addiction in the first place. And we didn’t mention the additional factors at play at the moment that can also cause significant stress, and increase risk of relapse:
- Fear of contracting COVID-19
- Fear of loved ones contracting COVID-19
- Uncertainty about everything related to COVID-19:
- How it’s transmitted
- Risk of serious illness or death
- How long the pandemic will last
- When therapeutics will be developed
- When a safe and effective vaccine will be developed
- Income instability
When we said one-two punch at the beginning of this article, that may have seemed dramatic, or possibly hyperbolic. Now we can see that it’s the opposite: calling isolation during COVID a one-two punch is understating the situation. In addition to the one-two of isolation, several additional factors increase the risk of relapse during COVID, such as general stress, worry about COVID, income instability, and unemployment.
How to Handle the Isolation
If you’re in recovery and COVID isolation threatens your sobriety, there are two critically important things for you to do: stay on your program and stay connected to your support community. Staying on your program means doing all the things you know support your sobriety. That includes eating healthy food, getting enough sleep, exercising regularly, and participating in activities or hobbies you know are safe, sober-friendly, and life-affirming. Staying connected to your support community means attending virtual AA or NA meetings (visit their websites here and here for virtual meeting information), talking on the phone to your recovery peers, and participating in teletherapy with your counselor or therapist.
If you need more intensive support than you can receive by doing all those things, then it’s important to know that most residential, intensive outpatient, and partial hospitalization programs are considered essential businesses, and are open and ready to help – even during COVID.
Finally, if you’re worried a friend or loved one in recovery is in danger of relapse, you can take action. Reach out to them, remind them to stay on their program and stay connected to their recovery community – as described above – and remind them that if they need intensive support, they can seek professional treatment.