Post-traumatic stress disorder (PTSD) is an anxiety disorder that is caused by a traumatic experience in a person’s life, such as military combat, sexual abuse, violence, disasters, or acts of terrorism. Symptoms often include flashbacks, nightmares, severe anxiety and depression as well as uncontrollable and intrusive thoughts surrounding the events that caused the PTSD. Covid-19 has created so many stressors from strained finances to grieving the death of loved ones to the moral trauma of global leaders mishandling or ignoring the crisis. It is likely that an unprecedented amount of people have and will experience PTSD related to the effects of Covid-19. A recent study demonstrated the prevalence of PTSD in 30.2% of patients after acute Covid-19 infection
This alone is a grave concern as our health systems are not currently equipped to care for and treat such an influx of patients and even access to mental health care remains a convoluted issue. Amplifying the crisis is that PTSD and substance abuse disorders are commonly linked as co-occurring disorders. Research consistently demonstrates that individuals who suffer from trauma or PTSD are more likely to have problems with substance dependence. The U.S. National Comorbidity Survey revealed that 34.5% of men and 26.9% of women who had PTSD at some point in their lifetime also had a problem with drug abuse or dependence. Based on this knowledge, substance abuse and addiction could even be seen as manifesting as a symptom of PTSD.
According to the CDC, as of June 2020, 13% of Americans reported starting or increasing substance use as a way of coping with stress or emotions related to COVID-19. As the pandemic has continued, the crisis has only worsened. In Colorado, overdose deaths were up 20% through the end of last year, and those involving fentanyl doubled. 2020 proved to be the deadliest year of the opioid epidemic on record for Maine with 502 fatal drug overdoses reported.
The latest national data from the CDC shows there were more than 88,000 overdose deaths in the year through August 2020, up from nearly 70,000 in the same time period of 2019. According to a report from the Commonwealth Fund, the final 2020 total in the United States could exceed 90,000 overdose deaths, compared to 70,630 in 2019. That would not only be the highest annual number on record but the largest single-year percentage increase in the past 20 years.
There are many reasons that may explain why the pandemic has facilitated this steep rise in addiction, relapse, and overdoses. Americans have fewer coping and resilience-building strategies available to them in the pandemic, they can’t exercise at a gym or fitness center and they can’t socialize or see family regularly. Isolation makes it easier to hide the effects of addiction from family and friends who might otherwise intervene. People are also more likely to die when they are using drugs alone because there’s no one there to call emergency services or administer naloxone, an opioid-reversal agent. The impact of PTSD related to Covid-19 can also not be underestimated.
During the early stages of the pandemic and even currently, addiction treatment centers have shut down or reduced their in-person services. While clinics and services have shifted to telehealth services, many patients lack access to stable housing and/or the technology to access these services. Some patients feel the intimacy and impact of a group meeting are lost in a virtual setting and stop attending. That’s not to say telehealth can’t be effective in providing greater access to care, particularly in rural areas. But the choice to use telehealth in addiction treatment needs to be voluntary, not inflicted by a pandemic.
Despite the clear and desperate need, many states are cutting addiction programs due to the financial toll of the pandemic. The National Council on Behavioral Health conducted an online survey of 880 behavioral health organizations across the country in April 2020. 61.8% of organizations closed at least one program. Nearly all of the organizations (92.6%) have reduced their operations. 46.7% of behavioral health organizations have had to, or plan to, lay off or furlough employees as a result of Covid-19.
One option to address this disparity in care is Medicaid expansion, which has been associated with positive insurance coverage, treatment access, and mortality outcomes for substance-use patients. With the federal government funding 90 percent of the cost, Medicaid expansion can be a key source of external funding for states to sustain substance abuse care providers and facilitate better access for patients. Florida, South Carolina, and Tennessee, which have high overdose rates, have yet to expand Medicaid. Utilizing Medicaid also decreases the reliance on annual discretionary funding to support siloed treatment programs.
On April 1st, 2021, the Biden administration announced its drug policy priorities for the first year. These priorities included expanding access to quality treatment, enhancing harm reduction services to engage and build trust with people who use drugs, and working to reduce the lethal supply of illegal substances in the U.S, advancing recovery-ready workplaces, expanding the addiction workforce, and increasing access to recovery support services such as safe and stable housing.
While these are critical and long-overdue reforms, there also needs to be a greater focus on preventive mental health screenings and care due to their link with substance abuse disorders. Childhood trauma is also linked with future substance use disorders and will likely be exacerbated by the increase in child poverty during the pandemic. Creating integrated healthcare systems that treat the physical, mental and social health of patients will be critical in fighting the syndemics such as PTSD and addiction that accompany the Covid-19 pandemic.