The force of habit
For some, recovery has equipped them with the skills to adapt to lockdown, while others are feeling the grip of addiction tighten more than ever before. By Emily Goddard
“Addicts are prone to extremism,” says PJ Smith, as he reflects on the “wobble” he experienced at the start of the Covid-19 lockdown. The 39-year-old was showing coronavirus symptoms – no taste, no smell, feeling ill and achy – and had to self-isolate for 14 days.
“It was sheer panic about everything,” he explains. “Will I have a job? Am I going to die? Is my family going to die? … I went to the other end of the scale, I’m usually calm and well-balanced, but I had a couple of days of full-on anxiety.”
Smith has survived testing times before. Alcohol addiction resulted in a four-month stay at a Liverpool City Council-funded 12-step treatment centre in 2007. The intervention was the beginning of a remarkable turnaround. “That gave me the foundation of everything I’ve got now,” he says.
Being in recovery during the coronavirus pandemic, Smith says, has not been a hindrance – quite the
opposite. Years of involvement in recovery communities have equipped him with the tools to help him stay strong during difficult situations.
Although few challenges can be compared to living through the global outbreak of a deadly virus, Smith has been able to apply his experience and adapt, especially during those first few anxious weeks of lockdown. “When I’m feeling like that I tend to ask myself the question: ‘What would you say to someone else?’ Your mate, your family, whoever is in this position and the answer is usually talk to someone, connect, go to a meeting, share it. But in this instance, that wasn’t possible,” he says. “What I did was just get vulnerable [on the phone] with two people close to me, who were both in recovery, and my girlfriend, who understands. They gave me a reality check.”
From that moment, Smith started looking at things through different eyes. He focused and held onto the things that made him feel good: routine, completing jobs around the house that he had been putting off, daily walks with his mum’s bedlington terrier and connection – however unusual that looked during this time of social distancing. “I’m trying to treat lockdown in the opposite way to how I treated my addiction,” he says. “My old life was all about short-term gain, long-term consequence. The lockdown requires me to see the bigger picture: short-term consequence, long-term gain.”
For those people who usually find comfort, connection and a sense of belonging in recovery groups, the dawn of the lockdown on 23 March could have signalled a time of great uncertainty. As the nation was told to practise social distancing and stay at home, recovery groups were forced to abandon conventional meetings.
However, the uncertainty never materialised for some people. Megara Furie – who stopped drinking for the last time when she hit rock bottom on 28 august 2018 – was confident the recovery community would find a way to navigate the challenges so that vital support could continue. “Everyone I know in recovery is pretty resilient,” the 36-year-old from Glasgow says. “We found some of the most ingenious ways to drink and hide booze so I had no doubt in my mind that we’d be just as ingenious and crafty at finding a way to still have meetings. We didn’t disappoint.”
Within a day of meetings starting to close, Facebook groups emerged sharing details of virtual meetings, including Furie’s local recovery group, which she helps to run. “We can’t meet up physically so we’re at least doing it virtually,” she says. “That connection is so important because alcoholics are notorious for isolation. That’s one of the reasons people end up going back out the door.”
Even the closing of the physical doors to these community groups has not hampered the connection Furie speaks of – it is, in fact, growing stronger. Thirteen people logged on for the first meeting; now anywhere between 40 and 70 are joining, with newcomers almost every week. “We were saying when we go back
after lockdown, with the number of people whose alcoholism has escalated and people who want to start getting into recovery, we can maybe ask to see how much it is to hire the Hydro,” Furie jokes.
Smith has also teamed up with some friends to hold a virtual meeting every evening for a group of people they know who have recently left treatment. “We just thought it must be awful for them,” he says, “being in that recovery bubble and all of a sudden you’re locked in your home, with no meetings to go to. It’s more of a check-in for everyone but it’s proven to be really useful for them.”
Smith has found solace in helping other people during the lockdown. This is especially true in his job as the recovery community lead at the abstinence-based recovery centre at Damien John Kelly House, which is named after his friend who passed away last year. The supported-accommodation hub has become the very example of a beacon of hope during these tricky times. Its residents decided to stay in lockdown together to support each other as they continue therapy and rebuild their lives. “It’s been mutually beneficial,” Smith explains. “I’m there in a paid role to help the guys but I don’t know whether they realise it, they’ve really helped me.”
Smith and Furie appreciate they are among the fortunate ones to be able to view the situation with such pragmatism. This extraordinary time, which has turned our world upside down in ways few people could have truly understood even just months ago, is exposing polar experiences when it comes to people whose lives have been touched by addiction and recovery.
I’m trying to treat lockdown in the opposite way to how I treated my addiction. My old life was all about short-term gain, long-term consequence. The lockdown requires me to see the bigger picture: short-term consequence, long-term gain
There are an estimated 586,780 dependent drinkers in England but far fewer people – 268,390 – are receiving support from both drug and alcohol services. At one end of the spectrum, there are those who are taking steps to manage problematic consumption. More than one in three drinkers are reducing how often they drink or stopping altogether, and hundreds of people are attending alcohol and drug recovery meetings around the globe, some for the first time in years or ever as they feel this is the time for change, and the lockdown has allowed them to pause and reflect.
Then there are those who are feeling the grip of addiction to substances tighten more than ever before. For many, the stress and anxiety caused by the pandemic can be a trigger for relapse. Kerry Parsons, 35, is in recovery from addiction to prescription opiates and alcohol and has co-existing mental health problems. For her, managing through the lockdown “has not been easy at all”.
Things were already tough, then tragedy struck in April – Parsons lost a pregnancy and required surgery. It was more than she could endure. “I had four bottles of wine over two days, which probably doesn’t sound much but I didn’t eat and my body reacts differently to alcohol to other people,” she says. “I just spent two days in bed.”
Parsons credits the love and support of her boyfriend with getting her through the relapse. “If we weren’t in lockdown then it would have been much easier [to avoid],” she explains. “The thoughts have been there, but luckily I have Gary.” She is also far from alone in struggling during the pandemic.
More than one in five adults who consume alcohol are drinking more often since the beginning of the lockdown on 23 March and nearly one in five people who drink daily have increased the amount they drink, according to research commissioned by the charity Alcohol Change UK . Data gathered from the charity’s website are also telling. The number of visits to the “Get help now” section was up 323 per cent between
the start of lockdown and 31 May when compared with the same period in 2019, from 7,568 clicks to 31,985.
The impact of increasing alcohol consumption is being felt in households across the country and data from the National Association for Children of Alcoholics shows young people can be particularly vulnerable to the fallout. The charity saw calls to its helpline double over a two-week period in May and it experienced what it calls “the Christmas phenomenon”, where calls typically fall in the lead up to the holidays before being followed by a steep rise. Overall, the number of calls and emails it received during the month of May represented a 75 per cent surge when compared with 2019 – from 515 contacts in May last year to 899 in 2020.
Dr Richard Piper, the chief executive of Alcohol Change UK, says: “It is concerning that one in five of us are drinking more frequently since lockdown, especially as those who were heavier drinkers before lockdown seem to be more likely to be drinking more. This can cause all sorts of problems further down the line. So it’s important that anyone struggling with their drinking takes determined action to take control, which they can do themselves by using the Try Dry app, or with extra support if they feel they need it. You can ask your GP about accessing extra support, or directly contact your local alcohol service. Treatment services across the country are making their support available remotely, so there are lots of great options online or over the phone.”
The use of other substances is changing too. A survey by Scottish drug treatment charity Crew found more than half (52 per cent) of respondents are taking drugs more often, and the same proportion of people reported taking a larger quantity of drugs. Interestingly, almost a third of people say they are now taking different drugs from those they would typically use.
This development could be expected, suggests Ian Hamilton, an associate professor of addiction at the University of York. “Unsurprisingly, there has been a general trend of moving away from stimulants, such as cocaine and ecstasy, towards sedatives, such as alcohol and cannabis,” he explains. “That makes sense during lockdown and restrictions on movement. Why would you deliberately use a drug that fills you with energy and enhanced cognitive functioning when you’re trapped in your flat or house? Far better to use something that allows time to drift and complements a more sedentary way of life.”
Hamilton warns, however, that the situation could create additional risks and could see some people exposed to drugs they would not usually contemplate using. “If you’ve lost hope, feel lonely, are anxious etc, then your judgement and risk threshold will change and you may try using more potent drugs in an attempt to mitigate those feelings and thoughts. Drugs can be an effective
586,78 0 dependent drinkers
short-term way of alleviating these feelings and as the traditional mental health and specialist drug treatment services are under pressure and unable to see people face to face this adds to the appeal of the more readily available, appointment-free attraction of drugs.”
Fluctuations have been witnessed in the market too, with 64 per cent of respondents in the Crew study noting changes due to the coronavirus pandemic and 69 per cent reporting drug shortages. Elsewhere, there have been anecdotal reports of an increase in the price of heroin and cocaine and a fall in purity. This was also mirrored in the Crew survey, with 38 per cent of respondents noting higher prices alongside 28 per cent reporting poorer quality drugs.
Dr Emily Finch, an NHS addiction psychiatrist and the vice-chair of the addictions faculty at the Royal College of Psychiatrists, says the impact of the pandemic is being borne out in specialist addiction treatment services with an increase in referrals for support alongside having to adapt the way they work with clients. “I’m also seeing some of the patients I know very well, really having problems, losing forms of support, not getting as much professional support as they’d like,” she adds.
There are likely to be risky patients that are difficult to reach at this time, Finch says, and the pandemic has resulted in “unintended consequences”, with the availability of inpatient treatment dropping as specialist detoxification units have been closed. “The amount of provision was pretty tight anyway,” she explains. “Several units have closed during the pandemic. The problem is that it was such a low base to start with. It’s only made a difficult situation worse.”
Parsons was accessing an addiction rehabilitation service every fortnight before the lockdown began and continues to do so during thanks to telephone appointments – although these are typically less frequent at three to four weeks apart. She feels supported and has a good relationship with her drug worker. “They are very understanding and there is no judgment if I were to relapse,” she explains. “They always check you have the numbers you need in a crisis. It’s not just a quick, ‘you doing OK?’ They spend the time asking questions: what you’ve been up to, how you’re feeling, is there anything they can do for you.”
Having a dual diagnosis makes Parsons a somewhat complex case, but she says her drug worker is considerate of her circumstances and thorough. He asks about her mood, as well as offering guidance on what to do if she feels anxious. She sees a separate psychiatrist for help with a borderline personality disorder, but admits that if there were an option to see one specialist that could look after both her mental health problems and addiction she would “take it in a heartbeat”.
There are fears that the stress caused by the pandemic is plunging people into crisis. Psychiatrists have seen a 43 per cent increase in the need for urgent and emergency care since the lockdown began, according to the Royal College of Psychiatrists. Meanwhile, Alcohol Change UK reports that 5,718 people visited the specially launched coronavirus alcohol and mental health tips section of its website between 23 March and 31 May.
Dr Tony Rao, an NHS consultant who advises people with drug and alcohol addiction problems, highlights that the need for dual diagnosis services has never been more critical. “People who already have problems with alcohol and drug use during lockdown may suffer additional difficulties with their mental health,” he cautions. “Worsening mental health may then put people into crisis. It is essential that there are services that can provide assessment and treatment of mental disorders, such as anxiety and depression. It is equally important that these same services can provide a comprehensive assessment of drug and alcohol problems so that referral to addiction services can be made.”
Beyond the provision of dual diagnosis services, the pandemic is exposing other flaws already existing in a system that is meant to safeguard one of society’s most vulnerable groups. Finch, the NHS addiction psychiatrist, says treatment services are already working as hard as they can to be resilient amid the challenges that come with a pandemic on top of “very significant” funding cuts in recent years. “We keep trying, we’re always working to improve,” she adds.
In addition, Hamilton, of the University of York, says a striking impact of the lockdown on drug use is the way in which it has magnified pre-existing inequalities. He notes: “From access to drugs through to getting support when you need help, the pandemic has seen those with resources, financial and social, more able to adapt to changes in drug supply and choice than those who are poor, homeless or disadvantaged in some other way.”
More worrying still are the reports of people struggling to access the prescription medications – methadone, for instance – they need to keep them on the path to recovery as pharmacies have been forced to implement changes to daily dispensing methods under lockdown conditions. This has already proved to have tragic consequences. The minutes from a Care Quality Commission (CQC) meeting on 20 May reveal the health and social care services regulator took enforcement action against a large national provider of drug treatment, which remains unnamed, after an increase in deaths of patients receiving treatment for opiate addiction. The CQC says it believes the loss of life may have come as a result of some services stopping all daily dispensing of opiates and adds that it is undertaking “risk-based focused visits to high-risk providers” after whistleblowers came forward with information.
Whether living with addiction or not, the ability to survive the coronavirus pandemic is something the world’s population continues to confront. But those who are in recovery can offer an insight into what fighting for one’s life might require.
For Smith, Furie and Parsons, the key is taking things day by day and focusing on what you can control. “I think, because I’ve been in recovery for a while, and I live on my own, I can implement the oldest recovery cliche in the book: one day at a time,” Smith says. “It really helps when I feel fragile or insecure.”