4 Things You Should Know About Resilience

In the year or two before the pandemic, a new word started popping up in my writing about addiction, mental health and wellness: resilience. All of a sudden, the word seemed to be everywhere, from my reporting on childhood traumas to my discussions about what can help people succeed in recovery.The more I learned about resilience, the more interested I became. When the pandemic hit, and continued to drag on and on, it seemed that resiliency was more important than ever.At this point, most of us have heard the buzzword, but we might not really understand what resilience means. Here are 4 things that you should know about resilience, according to the team at Sunshine Coast Health Centre in British Columbia.What Resilience IsOftentimes, words get tossed around without people really taking the time to think about or understand their true meaning. So it’s important to start by defining our terms. Resilience is defined as the ability to recover shape and size after being compressed. With time, a second meaning has emerged: the ability to recover from, or adjust to, misfortune or change.From a psychological perspective, the American Psychological Association defines resilience as “the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress.”Just like a physical item that is put under stress, the mind can get bent out of shape by stress or worry. But, like a putty that returns to its original shape, the mind also has the ability to rebound and recover from stressors and trauma that it encounters.Resilience Is ProtectiveAs we go through life, we encounter all sorts of adverse experiences that may cause mental and emotional pain or suffering. These can include adverse childhood experiences (ACEs) like divorced parents or abuse. But adversity doesn’t stop during childhood: as adults we experience deaths, the loss of dreams, financial strain and other causes of stress.Resilience can help protect us from the impact of these negative events. Resilience doesn’t mean that you won’t experience circumstances that cause you pain or suffering — it just means that you’ll be able to deal with them better than someone who has less resilience. For example, resilient people are living through the same pandemic as people who are less resilient, but the changes and adjustments that we all have to make have a lesser toll on people who are resilient.Everyone Has The Potential For ResilienceMental health professionals believe that everyone has the potential for resilience. However, there’s no doubt that people have different levels of resilience. That’s why some people are able to recover from even the worst tragedies, like the death of a child, while others struggle to regain a level of normalcy after these events.In general, people are resilient. However, you can take steps to foster resilience in your life, even as an adult.Resilience Is A Learned SkillIt’s important to recognize that resilience can be developed. Many people have learned that firsthand this year, as they’ve had to build more resilience than they ever expected to need.The following can help develop resilience:Building connections: Connections are important to recovering from adversity. This can be a personal connection, like the relationship with a loved one, or a societal connection, like being in touch with organizations that can help support you during adversity.Focusing on wellness: Taking time to indulge in self-care including exercise and mindfulness can ensure that you’re in a healthy state and able to “bounce back” from life challenges.Finding meaning: People who are connected with their personal definition of a meaningful life often have the self-determination and drive to be resilient.Accepting change: Simply accepting that change and adversity are part of life can make them easier to cope with.Since resilience takes effort, it’s not surprising that sometimes we get tired of being resilient. This is common a year into the pandemic, with vaccines still months away for many people. In moments where you struggle to feel resilient, look at the progress that you’ve already made. The last year has presented an enormous amount of challenges. Just surviving that, let alone doing it sober and with a desire to continue improving yourself, is an accomplishment worth celebrating.Sunshine Coast Health Centre is a non 12-step drug and alcohol rehabilitation center in British Columbia. Learn more here.

Abstinence-Supported Addiction Treatment

The Fix: What is Abstinence-Supported Addiction Treatment (ASAT) and how does it work?Last Door: Many people entering recovery say if they just stop using substances--or the substance that is resulting in negative consequences--then everything will be okay; it’s the alcohol, it’s the heroin, it’s the meth, it’s the food.However it’s never just about treating the acute substance use disorder; it’s helping someone experience an environment that’s conducive to their own recovery and wellness process -- however that looks.When we look at the research and practice-based evidence of what types of environments support recovery, it points to abstinence supported addiction treatment recovery residences. People who are initiating their recovery process are seeking environments that are conducive to their primary goal of abstinence.[The goal is to provide] environmental enrichments like human connection, meeting basic needs so that people feel safe enough to stop using old coping skills like substance use, crime, and unhealthy attachments to people to survive the reality of their lives. This process often includes grieving losses of exiting that culture and transitioning into a culture of recovery.How does ASAT support recovery?People get to a point where they think, okay so I stopped the coping behavior, now what? If just stopping substance use or stopping something that was causing negative effects in my life was adequate, I wouldn’t be thinking about what my New Year’s resolutions were going to be this year. So once you’ve gone through withdrawal management, you’re stabilized, you’re no longer using a substance in a negative way, what does your recovery look like? And that’s where abstinence supported environments come in. You have this period of life where you can practice recovery-based skills and competencies and get the basic life skills of growing up.When you look at group living and treatment or recovery programs [that foster an abstinence-supported environment] you get to experience what recovery feels like, looks like on a day-to-day basis, minute-by-minute, with your peers, preferably being able to engage in the community in which you’re living. Whether it’s short-term or long-term, you get good at practicing those recovery-oriented skills in a supported way.[We know that when] housing is accessible and quality food, quality supports, are implemented into someone’s life and they are able to access them on a consistent basis, that their well-being improves, that their addiction can be arrested at some point and their recovery can be sustained. Dr. Best’s research shows that people who are provided access and utilize supports in their first five years of recovery go on to sustain long-term recovery for well over 20 years.An abstinence-supported environment helps increase quality of life areas by building Recovery Capital.  Key recovery capital domains include social support networks, access to material resources (i.e.: housing, food and financial supports), improving a sense of well-being and skill development and cultural values, beliefs, and identities that all help build connection and safety. Life areas such as becoming gainfully employed in employment that allows you to continue on your recovery journey, your physical mental health, your relationships, what your aspirations are, or having enough safety to have hope that a better quality of life is available to you.Can you talk a little bit about ASAT as treatment for non-substance-related disorders? Yes, ASAT is beneficial for a variety of different health disorders. We know, for instance, that when people who have disordered eating issues are provided environments that enhance their well-being and promote health, they are less likely to utilize their old coping skills or be triggered to indulge or binge or purge.What I’ve found through the change process and unpacking the identified problem, whether it’s a person, a substance, or a behavior, is that oftentimes the solution is not linked to the identified problem. The solution is practicing the life skills or the competency or the capability or whatever fosters connection to people in their life.People who enter bed-based addiction services need to have a sense of safety. They’ve often experienced traumatic events, they’ve been the giver or receiver of acts of violence and abuse, they have a history of feeling unsafe and traumatized, and they may have complex health needs both physical and mental.So when you live in the same household with someone [with similar experience], there’s a sense of safety in the shared social norms of a culture of recovery.There’s the art of knowing each other. So, if the identified goal or the cultural norm in a program is to get up and go for a walk every day or write in a journal every night or maintain abstinence, then that’s an identified cultural goal that has developed in that program.What if someone has the goal of not abstaining permanently?As far as being required to abstain for the rest of your life, it’s like telling me I have to eat one specific thing for the rest of my life or else I’m going to die. No amount of negative consequence is going to make me eat that thing for the rest of my life...that’s a decision that we make based on the quality of our life and what our goals are, long-term.Whereas in treatment you may have an experience of being abstinent from things--or some things--in your lifetime and recovery process, it’s yours to own. And some people may decide to resume their identified problem substance or other substances (and when I say resume, I want to be mindful of language, because if we say someone relapses, that’s a judgment). For some people, resuming a behavior has no negative effects in their life, but it’s a choice and it’s a conversation that they have with their peers and significant people. They make a plan and follow through on it. Sometimes it’s a substance, or sometimes it’s a behavior or process.Sometimes people come back to treatment, and they’re like, seemed like a good idea at the time, didn’t go so well. I thought I could start watching porn with my intimate partner, turns out my emotional and physical intimacy went down the drain. I’m not someone who can socially indulge or socially use that thing in my life. Or, I’m no longer going to work overtime because when I do I get obsessed with money, and the thoughts and the triggers start happening, payday happens and I impulsively go on a binge of substance use. So, part of that is really developing and practicing recovery in all areas of our life before those opportunities show up in our life. It’s that gradual return to work, it’s the knowledge that working overtime and picking your kid up from daycare and getting them fed and to bed is a difficult, that amount of stress in your life may cause you to resort to negative coping skills and it’s not going to go well.But when you build a life that’s conducive to your identified goals, whether it’s abstinence or managed use, that’s what can sustain you over time. And that’s not something someone can necessarily make a decision on early in the recovery process, but I think you can have a conversation well in advance of doing it.Rather than talking about where you’re going to land when you’re huffing off from treatment because you had a conflict with your roommate or the staff, you have a conversation ahead of time about where you think you’ll go if the program is not a fit for you.Same goes for substance use. Resuming substance use at a seriously stressful point in your life is going to be a different experience than planning out resumed substance use. From my experience working in a bed-based program, many of our clients have chosen to remain abstinent for substances long term-- there may be times in life showing up where medications become a necessity (injuries, surgeries, mental health, chronic pain). So when we’re looking at abstinence I think that if our residents identify with some mutual support groups, you know, according to the literature, you’re always welcome to attend meetings, but with the personality dynamics found in the rooms of specific meetings, you may feel unwelcome or judged.Part of the responsibility and role of treatment centers is to help people have those difficult conversations about what we really want to have in our lives, our goals, our dreams and our feelings. As a person in recovery, we get to choose who we have or don’t have in our lives. We must choose who is going to be meaningful and a value in our recovery journey.Any final thoughts?It’s quite fascinating to me to find out where we came from as people in recovery, how did our movement evolve into what it is today (Books such as Slaying the Dragon, how did we start researching people in recovery, how did people start recovering out loud in a way that they are key stakeholders with a seat at the table that includes a voice; that there is actual research and science being conducted about the populations in recovery, that it’s not just a one-size-fits-all.When I look at the key messages that are promoted across the world (i.e.: Canada, UK, USA, Australia’s Life in Recovery Surveys), that there are multiple pathways to and in recovery, that recovery is not just possible, it’s probable -- there is science behind those statements, and 20 years ago it just simply wasn’t readily available.There are also a lot of terrible stories and case studies that happen within treatment centers and happen within communities and looking again at the science of abstinence-supported environments, we know that providing meaningful environments for people helps them thrive and carry hope. Last Door Recovery Centre provides abstinence supported, licensed and accredited addiction treatment services for youth, adults, and families in Canada's most vibrant and successful recovery community. For more information, visit lastdoor.org or call 1-855-465-2851.This interview has been edited for length and clarity.

Kids Already Coping With Mental Disorders Spiral as Pandemic Topples Vital Support Systems

A bag of Doritos, that’s all Princess wanted.Her mom calls her Princess, but her real name is Lindsey. She’s 17 and lives with her mom, Sandra, a nurse, outside Atlanta. On May 17, 2020, a Sunday, Lindsey decided she didn’t want breakfast; she wanted Doritos. So she left home and walked to Family Dollar, taking her pants off on the way, while her mom followed on foot, talking to the police on her phone as they went.Lindsey has autism. It can be hard for her to communicate and navigate social situations. She thrives on routine and gets special help at school. Or got help, before the coronavirus pandemic closed schools and forced tens of millions of children to stay home. Sandra said that’s when their living hell started.“It’s like her brain was wired,” she said. “She’d just put on her jacket, and she’s out the door. And I’m chasing her.”On May 17, Sandra chased her all the way to Family Dollar. Hours later, Lindsey was in jail, charged with assaulting her mom. (KHN and NPR are not using the family’s last name.)Lindsey is one of almost 3 million children in the U.S. who have a serious emotional or behavioral health condition. When the pandemic forced schools and doctors’ offices to close last spring, it also cut children off from the trained teachers and therapists who understand their needs.As a result, many, like Lindsey, spiraled into emergency rooms and even police custody. Federal data shows a nationwide surge of kids in mental health crisis during the pandemic — a surge that’s further taxing an already overstretched safety net.‘Take Her’Even after schools closed, Lindsey continued to wake up early, get dressed and wait for the bus. When she realized it had stopped coming, Sandra said, her daughter just started walking out of the house, wandering, a few times a week.In those situations, Sandra did what many families in crisis report they’ve had to do since the pandemic began: race through the short list of places she could call for help.First, her state’s mental health crisis hotline. But they often put Sandra on hold.“This is ridiculous,” she said of the wait. “It’s supposed to be a crisis team. But I’m on hold for 40, 50 minutes. And by the time you get on the phone, [the crisis] is done!”Then there’s the local hospital’s emergency room, but Sandra said she had taken Lindsey there for previous crises and been told there isn’t much they can do.That’s why, on May 17, when Lindsey walked to Family Dollar in just a red T-shirt and underwear to get that bag of Doritos, Sandra called the last option on her list: the police.Sandra arrived at the store before the police and paid for the chips. According to Sandra and police records, when an officer approached, Lindsey grew agitated and hit her mom on the back, hard.Sandra said she explained to the officer: “‘She’s autistic. You know, I’m OK. I’m a nurse. I just need to take her home and give her her medication.'”Lindsey takes a mood stabilizer, but because she left home before breakfast, she hadn’t taken it that morning. The officer asked if Sandra wanted to take her to the nearest hospital.The hospital wouldn’t be able to help Lindsey, Sandra said. It hadn’t before. “They already told me, ‘Ma’am, there’s nothing we can do.’ They just check her labs, it’s fine, and they ship her back home. There’s nothing [the hospital] can do,” she recalled telling the officer.Sandra asked if the police could drive her daughter home so the teen could take her medication, but the officer said no, they couldn’t. The only other thing they could do, the officer said, was take Lindsey to jail for hitting her mom.“I’ve tried everything,” Sandra said, exasperated. She paced the parking lot, feeling hopeless, sad and out of options. Finally, in tears, she told the officers, “Take her.”Lindsey does not like to be touched and fought back when authorities tried to handcuff her. Several officers wrestled her to the ground. At that point, Sandra protested and said an officer threatened to arrest her, too, if she didn’t back away. Lindsey was taken to jail, where she spent much of the night until Sandra was able to post bail.Clayton County Solicitor-General Charles Brooks denied that Sandra was threatened with arrest and said that while Lindsey’s case is still pending, his office “is working to ensure that the resolution in this matter involves a plan for medication compliance and not punitive action.”Sandra isn’t alone in her experience. Multiple families interviewed for this story reported similar experiences of calling in the police when a child was in crisis because caretakers didn’t feel they had any other option.‘The Whole System Is Really Grinding to a Halt’Roughly 6% of U.S. children ages 6 through 17 are living with serious emotional or behavioral difficulties, including children with autism, severe anxiety, depression and trauma-related mental health conditions.Many of these children depend on schools for access to vital therapies. When schools and doctors’ offices stopped providing in-person services last spring, kids were untethered from the people and supports they rely on.“The lack of in-person services is really detrimental,” said Dr. Susan Duffy, a pediatrician and professor of emergency medicine at Brown University.Marjorie, a mother in Florida, said her 15-year-old son has suffered during these disruptions. He has attention deficit hyperactivity disorder and oppositional defiant disorder, a condition marked by frequent and persistent hostility. Little things — like being asked to do schoolwork — can send him into a rage, leading to holes punched in walls, broken doors and violent threats. (Marjorie asked that we not use the family’s last name or her son’s first name to protect her son’s privacy and future prospects.)The pandemic has shifted both school and her son’s therapy sessions online. But Marjorie said virtual therapy isn’t working because her son doesn’t focus well during sessions and tries to watch TV instead. Lately, she has simply been canceling them.“I was paying for appointments and there was no therapeutic value,” Marjorie said.The issues cut across socioeconomic lines — affecting families with private insurance, like Marjorie, as well as those who receive coverage through Medicaid, a federal-state program that provides health insurance to low-income people and those with disabilities.In the first few months of the pandemic, between March and May, children on Medicaid received 44% fewer outpatient mental health services — including therapy and in-home support — compared to the same time period in 2019, according to the Centers for Medicare & Medicaid Services. That’s even after accounting for increased telehealth appointments.And while the nation’s ERs have seen a decline in overall visits, there was a relative increase in mental health visits for kids in 2020 compared with 2019.The Centers for Disease Control and Prevention found that, from April to October last year, hospitals across the U.S. saw a 24% increase in the proportion of mental health emergency visits for children ages 5 to 11, and a 31% increase for children ages 12 to 17.“Proportionally, the number of mental health visits is far more significant than it has been in the past,” said Duffy. “Not only are we seeing more children, more children are being admitted” to inpatient care.That’s because there are fewer outpatient services now available to children, she said, and because the conditions of the children showing up at ERs “are more serious.”This crisis is not only making life harder for these kids and their families, but it’s also stressing the entire health care system.Child and adolescent psychiatrists working in hospitals around the country said children are increasingly “boarding” in emergency departments for days, waiting for inpatient admission to a regular hospital or psychiatric hospital.Before the pandemic, there was already a shortage of inpatient psychiatric beds for children, said Dr. Christopher Bellonci, a child psychiatrist at Judge Baker Children’s Center in Boston. That shortage has only gotten worse as hospitals cut capacity to allow for more physical distancing within psychiatric units.“The whole system is really grinding to a halt at a time when we have unprecedented need,” Bellonci said.‘A Signal That the Rest of Your System Doesn’t Work’Psychiatrists on the front lines share the frustrations of parents struggling to find help for their children.Part of the problem is there have never been enough psychiatrists and therapists trained to work with children, intervening in the early stages of their illness, said Dr. Jennifer Havens, a child psychiatrist at New York University.“Tons of people showing up in emergency rooms in bad shape is a signal that the rest of your system doesn’t work,” she said.Too often, Havens said, services aren’t available until children are older — and in crisis. “Often for people who don’t have access to services, we wait until they’re too big to be managed.”While the pandemic has made life harder for Marjorie and her son in Florida, she said it has always been difficult to find the support and care he needs. Last fall, he needed a psychiatric evaluation, but the nearest specialist who would accept her commercial insurance was 100 miles away, in Alabama.“Even when you have the money or you have the insurance, it is still a travesty,” Marjorie said. “You cannot get help for these kids.”Parents are frustrated, and so are psychiatrists on the front lines. Dr. C.J. Glawe, who leads the psychiatric crisis department at Nationwide Children’s Hospital in Columbus, Ohio, said that once a child is stabilized after a crisis it can be hard to explain to parents that they may not be able to find follow-up care anywhere near their home.“Especially when I can clearly tell you I know exactly what you need, I just can’t give it to you,” Glawe said. “It’s demoralizing.”When states and communities fail to provide children the services they need to live at home, kids can deteriorate and even wind up in jail, like Lindsey. At that point, Glawe said, the cost and level of care required will be even higher, whether that’s hospitalization or long stays in residential treatment facilities.That’s exactly the scenario Sandra, Lindsey’s mom, is hoping to avoid for her Princess.“For me, as a nurse and as a provider, that will be the last thing for my daughter,” she said. “It’s like [state and local leaders] leave it to the school and the parent to deal with, and they don’t care. And that’s the problem. It’s sad because, if I’m not here …”Her voice trailed off as tears welled.“She didn’t ask to have autism.”To help families like Sandra’s and Marjorie’s, advocates said, all levels of government need to invest in creating a mental health system that’s accessible to anyone who needs it.But given that many states have seen their revenues drop due to the pandemic, there’s a concern services will instead be cut — at a time when the need has never been greater. This story is part of a reporting partnership that includes NPR, Illinois Public Media and Kaiser Health News.

6 Important Truths About COVID-19 Vaccines

One of the biggest barriers standing in the way of ending the pandemic isn’t medical or logistical. It’s the misinformation about the COVID-19 vaccines.Demand for vaccine currently exceeds supply, but there are many people who are either unsure whether they should take the vaccine or staunchly against it. This is often because they have heard incorrect information about the vaccine or its effects.Many experts estimate that between 70% and 90% of the population must be vaccinated to block the spread of the virus and reach herd immunity, which occurs when enough individuals are immune to a disease that it prevents its spread. If the American population is to achieve herd immunity, it is important to start dispelling myths so that when there is widespread access to the vaccine, people will not hesitate to get their shot.We are an immunologist and pharmacist. Here are some of the facts behind some of the common myths that we have heard about the COVID-19 mRNA vaccines from patients, friends and family members.Fact: Vaccines were rigorously tested and found to be safeThe mRNA technology that was used in the Pfizer/BioNTech and Moderna vaccines has existed for more than a decade and is not new in the vaccine development field. Moreover, the approved mRNA vaccines have undergone rigorous testing and clinical trials demonstrating safety and efficacy in people.More than 90,000 people volunteered for these vaccine trials. The Pfizer-BioNTech vaccine reduced disease by 95% and the Moderna vaccine reduced disease by 94% after volunteers completed two doses. The development, clinical trials and approval occurred faster than seen with previous vaccines. There are several reasons.First, mRNA technology has been studied for other viral diseases – Zika virus, rabies virus, respiratory syncytial virus – for the past few years. Scientists were able to apply this familiar technology to the SARS-CoV-2 virus immediately after its discovery.Second, funding and partnerships from government and private firms allowed many of the clinical trial phases to occur in parallel, rather than in series, which is typical testing design. This significantly sped up the process.Third, most of the costly and time-consuming part of vaccine development is scaling up manufacturing and commercial production, and ensuring quality control. This typically happens after phase 3 efficacy trials have been completed. Because of the urgency of the COVID-19 pandemic, manufacturing and commercial-scale production of these vaccines started at the same time as the human safety clinical trials. This meant that once the vaccines were proved safe and effective there was a large stockpile ready to distribute to the public.Fact: Vaccines have no effect on recipients’ genetic materialDNA is located inside the nucleus of a cell. The messenger RNA, or mRNA, delivered from the vaccines enters the cell but not the nucleus. The mRNA instructions are used to manufacture the spike protein, which the body recognizes as not belonging, and this evokes an immune response. After being read, these mRNA vaccine molecules degrade quickly through normal cellular processes.COVID-19 mRNA vaccines produce only the spike protein and can’t produce the enzymes that facilitate the host-cell integration. Therefore, chances of altering host DNA are highly unlikely.Fact: The mRNA vaccines cannot give you COVID-19The mRNA vaccines cannot cause disease because they do not contain a live virus.Most people have mild side effects like arm pain, aches, chills and fever after vaccination. These symptoms are the expected and healthy reactions to the vaccine and often subside in few days.There have also been some reports of more serious side effects. As of Jan. 18, rates of anaphylaxis – a potentially life-threatening allergic reaction – were 1 in 212,000 in those who received the Pfizer vaccine and 1 in 400,000 in those who received the Moderna vaccine. No one has died from anaphylaxis. There have been reports of death but they do not appear to be due to the vaccine. These deaths have occurred mainly in elderly individuals, a population with higher mortality rates. These deaths are all being investigated, but at this point they are being attributed to underlying conditions.One thing to keep in mind is that as more individuals are vaccinated, there will be more cases of incidental illness. These are illnesses that would be expected to occur at a certain rate in a large population, but may not be related to receiving the vaccine.Fact: Pregnant or breastfeeding women can safely choose to be vaccinatedThe CDC states that pregnant or breastfeeding patients may choose to be vaccinated if eligible.Women who were pregnant or breastfeeding were excluded from the initial trials, which prompted the World Health Organization to initially recommend vaccinating only in high-risk pregnant or breastfeeding individuals.This controversial stance was reversed after pushback from major maternal health organizations, including the American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine, which pointed out that risk of COVID-19 is greater in pregnant populations.Because the data is limited, professional societies and organizations have been slow to make a clear recommendation despite experts agreeing that the risk of COVID-19 infection outweighs any potential and theoretical risks of vaccination.Preliminary animal studies showed no harmful effects and, to date, there have been no reports of harm to the fetus or issues with development]from either mRNA vaccine. Individuals who have questions should speak to their health care provider, but a consultation or approval is not required for vaccination.Fact: COVID-19 vaccines have no effect on fertilitySome individuals are concerned that the COVID-19 vaccinations may cause infertility, which is not true. This myth originated because a short sequence of amino acids that make up the spike protein of SARS-CoV-2 – necessary to infect human cells – is also shared with a protein called syncytin that is present in the placenta, a vital organ in fetal development.However, the sequence similarity is too short to trigger a dangerous immune reaction that will give rise to infertility, according to experts who study these proteins.Additionally, there are records of successful pregnancy after infection with SARS-CoV-2, with no evidence of increased miscarriages occurring in early pregnancy. The immune response to the virus doesn’t appear to affect fertility. While pregnant people were excluded from the vaccine trials, 23 Pfizer/BioNTech trial participants became pregnant after receiving the vaccine and there were no miscarriages in those who received the vaccine. Although a small number compared with the more than 40,000 individuals enrolled in the study, it adds to the evidence that there is no need for concern about infertility.Fact: Those who’ve had COVID-19 will benefit from vaccinationAntibodies from COVID-19 infection are estimated to last approximately two to four months, so those who have had a previous infection should still get vaccinated.The CDC states that individuals who have had COVID-19 infection may choose to wait 90 days after infection because it is expected that they will be protected by the natural antibodies for that three-month period. However, it is safe to get the vaccine as soon as the quarantine period has ended. Those who received monoclonal antibodies, which are synthetic antibodies manufactured in a lab, should wait for at least 90 days before getting the vaccine.With new information being released daily and recommendations changing rapidly, it is difficult to keep up. It’s critical that accurate facts about the COVID-19 vaccines are circulated widely so that anyone can access the information needed to make an educated decision. [Research into coronavirus and other news from science Subscribe to The Conversation’s new science newsletter.]This article is republished from The Conversation under a Creative Commons license. Read the original article.

Dire Mental Health: A Catalyst for Post-Pandemic Drug Addiction

Did you know that loneliness - the sadness we feel when we’re apart or separated from our loved ones, like parents, siblings, partners and friends, or even from society itself - is affecting more and more adults, and actually appears to worsen with each new generation of Americans?In addition, this loneliness, this sad sense of separation, is a prominent precursor to depression and other mental health disorders, and a major contributing factor in substance use and, later, drug addiction, among its other effects.For decades and decades, and long before “coronavirus,” “social distancing” and “quarantine” became commonplace words and phrases in our daily conversations, the U.S. was experiencing an ever-worsening plague - one of simply feeling alone - and it’s still with us.Unsurprisingly, the COVID-19 pandemic has made this “loneliness epidemic” far more pervasive throughout the nation, and far more concerning to mental health experts, especially as many of them are now predicting a wave of post-pandemic mental health and behavioral issues as a result of both the physical and socio-environmental effects of COVID-19, resulting in a new public mental health emergency on the very near-horizon.“We have supply shortages and economic stress, fear of illness, all of our disrupted routines… There's a real grief in all of that. We don't have a vaccine for our mental health like we do for our physical health.”- Lisa Carlson, MPH, MCHES, renowned public health expert (2020)So, should we listen?...Well, these same expert voices were 100% correct in predicting the rapid spike in fatal drug overdoses as the pandemic and its effects really kicked in across the U.S. In fact, record numbers of drug users died by opioid-related overdose in 2020, as recently acknowledged by the U.S. Centers for Disease Control & Prevention (CDC).Furthermore, they correctly predicted the rise in relapse rates as those in addiction recovery were left to look solely online for their support (from treatment and counseling, to their 12-Step meetings), and, lastly, they were more than proved right when it came to the growing influence across the entire U.S. of the synthetic opioid fentanyl in today’s illicit drug trade.Think about it. It’s a succession of undeniable consequences with severe effects on U.S. public health. It’s only prudent to listen to them now.Loneliness, Depression and Self-MedicationIn 2018, the global health service company Cigna, in partnership with market research firm Ipsos, released the results from their national “loneliness” survey, which utilized the “UCLA Loneliness Scale” - a frequently referenced and acknowledged academic measure for loneliness, involving a 20-item questionnaire developed to assess subjective feelings of being lonely and social isolation.The survey revealed that most U.S. adults should be considered as lonely, and that feeling or sense of loneliness has further increased with each subsequent generation. The survey revealed a number of other worrying findings, too:43% of U.S. adults often or always feel that their relationships are not meaningful, and that they are isolated from othersGeneration Z (adults aged 18-22) is the loneliest generation, and appear to be in worse health than older generationsRespondents defined as “very heavy users of social media” had a loneliness score of 43.5%, only marginally higher than those who never use social media (41.7%)Predictive Factors for Substance AddictionAs we now understand from extensive research on the subject, there is no one single factor that determines the likelihood of an addiction developing from substance use. Moreover, it’s a combination of possible factors that can be predictive when assessing an individual’s risk of addiction.However, the more “predictive boxes” that are ticked, the higher the likelihood of substance addiction, as individuals look to “self-medicate” to deal with their struggling mental health. Predictive factors include:Biology: It is believed that about half of an individual's risk for addiction is solely genetic. Additionally, gender, ethnicity, and the presence of mental disorders will further increase risk.Environment: An individual’s personal environment includes many different factors, such as family and friends, economic status, quality of life, peer pressure, physical and sexual abuse, early exposure to drugs, stress, and parental guidance.Development: Furthermore, these genetic and environmental factors will interact with an individual’s development (particularly in teenagers) to affect addiction risk. Using substances at any age can lead to addiction; however, the earlier the drug use begins, the more likely it will progress to addiction.Loneliness, as we’ve discussed above, can act as both an environmental and a biological factor in addiction risk (especially if it leads to a depressive or other disorder), resulting in a much higher risk for the later development of substance addiction, and, as we’ve mentioned previously, the COVID-19 pandemic has only made this “loneliness epidemic” more pervasive and more concerning in the opinion of mental health experts.Unfortunately, it doesn’t end there.Post-Viral Inflammation and Mood Disorder DevelopmentMedical researchers have long known about the direct link between inflammation, a natural biological response to viruses like COVID-19, and the subsequent development of mood disorders, such as depression. Additionally, they have also demonstrated that inflammation and mood are so intrinsically linked that the presence of inflammation may induce or exacerbate a mood disorder.A “Tsunami” of DepressionAn Irish Journal of Psychological Medicine article, published in May, 2020, and entitled “Fallout from the COVID-19 Pandemic - Should We Prepare for a Tsunami of Post Viral Depression?,” highlights this link, and predicts that 2021 will see a tidal wave of depressive disorders and other behavioral issues.“How is this possible?” you may ask.During the period when an individual has a viral infection, they experience decreased cellular immunity, and their body produces neuromodulators and immunomodulating agents to cope with this. However, these agents can then penetrate the brain when the blood-central nervous system (CNS) barrier is compromised - common during time of stress, infection and inflammation.In short, these neuromodulators inhibit our brain’s neurotransmitters, and so create feelings of depression and other negative responses, such as severe fatigue.COVID-19 Survivors and Mental IllnessFurther and more up-to-date research, in the form of an analysis of existing COVID-19 data by the psychiatry department at the University of Oxford, UK, has shown that around 1 in 8 people (13%) who have had Covid-19 are now being diagnosed with their first psychiatric or neurological illness - this occurs within 6 months of testing positive for the virus.This is a major public health concern because, as of the end of January, 2021, the U.S. had already seen nearly 26.5 million confirmed cases of coronavirus. If that wasn’t enough to create a brand new demographic of “self-medicating” individuals susceptible to substance addiction, it gets worse.The research further concluded that those figures rose to an alarming 1 in 3 (33.6%) when patients with a previous history of psychiatric or neurological illnesses were included. Furthermore, it’s worth noting that the Oxford study used, obviously with permission, relevant data from 236,379 U.S. survivors of the COVID-19 virus.Both of these in-depth studies simply add to the robust body of evidence that stresses the coronavirus pandemic and its consequential effects will lead to many more individuals with mental health disorders, such as major depressive disorder (clinical depression), other neuropsychiatric disorders, and a range of behavioral issues, which will undoubtedly include substance use disorders, and will instigate a rise in illicit drug use.Depression, Drug Overdose and The Dark Spectre of SuicideAs we slowly begin to navigate our way through 2021, still with over 100,000 new cases of coronavirus being diagnosed in the U.S. on a daily basis, we can but hope that the vaccine rollout will soon begin to have a positive effect on the nation’s seemingly futile battle with the pandemic, and that one day, possibly in the summer but far more likely in the fall, the CDC and other major U.S. public health bodies will announce a kind of tentative victory.However, by the time it does finally happen, further extensive and severe damage will have already been done to the collective mental health of the nation. It begs another question:How exactly will this new public mental health emergency manifest itself?Sadly, it will be more of the same of what was witnessed in 2020, with similar record numbers of premature deaths either through drug overdose (predominantly, involving fentanyl and other high potency opioids and their analogs) or the dark spectre that pervades any crisis of the mind - suicide, the ultimate self-medication.Like overdose, in the midst of this pandemic, the issue of suicide has never been far from the legitimate concerns of mental health experts.Finally, as this article has demonstrated, one clear feature of the looming public mental health crisis facing the post-pandemic U.S. will be a significant rise in the use and abuse of illicit substances - from opioids to cocaine, and from counterfeit prescriptions to methamphetamine - all of which are now being cut with the far cheaper product of fentanyl, and its analogs, by America’s perpetual dealer - the Mexican drug cartels.And, just like the coronavirus pandemic, exactly as Dr. Fauci stated, it will “get worse, much worse before it gets better.”

In AA, COVID’s Sobriety Inequality Gap

As large-scale lockdowns commenced to blunt the spread of COVID-19, members of Alcoholics Anonymous around the world took swift action. In many cases, the same dedicated folks who regularly serve as meeting chairpersons – the glue that binds local groups together even in the best of times – embarked on self-taught scramble drills to fulfill their duties online, typically via Zoom. In mere days, AA went digital.This expedient, comprehensive cyberization of AA was nothing short of remarkable. Among other pleasant surprises, it showed an adaptability that a program whose keystone literature has barely changed in 85 years might seem incapable of mustering. While AA’s traditions and principles are supported by an understandable stubbornness – the program works, so why fix what isn’t broken? – this success can lead to a dearth of malleability. Considering this, the Zoom rooms that promptly sprouted by the thousands have shown an impressive nimbleness, albeit one born of necessity.Nearly a year later… we’re still Zoomin’ along. It was never meant to last this long. And therein lies a distinctive issue the pandemic has inescapably exacerbated: inequality.The uneven impact of COVID-19 has long been evident. Economically, white collar workers who can earn a living from laptops have fared far better than blue collar and service industry workers, who are more likely to lose both jobs and vital health insurance. Communities of color have seen higher rates of hospitalization and death than whites, and children from lower-income families face obstacles to remote schooling that more affluent students do not.But boardrooms and classrooms aren’t the only mission-critical environments Zoom is struggling to replicate. The rooms of Alcoholics Anonymous are also significantly diminished by digitization. And as with other walks of society, a chasm in AA has emerged between the haves and the have nots.Getting Sober vs. Staying SoberWhile inequality in other landscapes typically involves economics – white collar vs working collar, privileged student vs. disadvantaged one – AA’s COVID-caused gap generally goes like this: those with longstanding sobriety remain sober, while newcomers struggle mightily to achieve and sustain sobriety. And every day that Zoom substitutes for in-person gatherings, that gap yawns ever wider.Some of this has been well publicized. Unsurprisingly the added anxiety, fear and isolation COVID-19 has caused lends itself to increased risks for alcoholism and substance abuse. Hard data shows overdoses increasing, and analysts noticed marked upticks in alcohol consumption from the very first week of stay-at-home restrictions.These are, however, mere figures. While it’s easy to track indicators of substance disorders, more difficult is assessing the challenges COVID poses to those ready to leave the bottles and baggies behind. Here, the growing recovery gap birthed by the pandemic lies in two truths: Getting sober is really hard, while remaining so is comparably easy.I have been a sober member of Alcoholics Anonymous for nine years, and can unequivocally state that, as far as getting and staying sober goes, AA’s Zoom rooms are an unworkably far cry from the in-person meetings that have served as lifelines for countless millions. AA works – I am living proof. But Zoom does not – and I fear it’s costing lives.For most addicts, myself included, getting sober is arguably the most arduous endeavor – and most rewarding accomplishment – of our lives. We come in broken and, with the help of others who’ve walked the path before us, slowly emerge stronger, 2.0 versions of ourselves. We accrue wisdom and develop tools we never possessed prior, even before descending into addiction’s depths. We become weller than well.But we did not – we could not – do it alone. AA thrives on the principle that addiction and alcoholism are “takes one to help one” diseases. Those with longstanding recovery pay their experience forward to the next generation of newcomers.And for those newcomers, including me in 2011, there is something magical about an AA meeting – something whose spirituality is tied to physical symbols and experiences. The 12 Steps posted to show our adherence to principles over personalities. The formality of the introductory readings – reverence to a text written in 1935 that remains penetratingly current today. The Serenity Prayer said in unison by dozens gathered for one primary purpose: arresting addiction.Recovery lives and breathes behind those closed church basement doors. The sing-song “Hi Chris” from scores of fellow alcoholics as I identity myself as one of them, at once humbled and empowered. The hoots, hollers and applause received by a newcomer celebrating another day free of drugs and booze. The enraptured silence of a group listening to someone who once drank or drugged like them explain his downfall and ultimate redemption through the 12 Steps, sober mentors and fellowship. And finally, a circle of sober drunks, hands linked, closing the gathering as they opened it: united. Standing together against a common enemy.The best in-person meetings are instructive, inspiring, fortifying. The best Zoom meetings are… well, a heaping pile of meh. If you think teaching a six-year-old arithmetic is difficult online, try teaching a 26-year-old not to drink himself to death during the other 23 hours in his isolated day.Instead of awed silence there is muted awkwardness. Instead of a room full of engaged sober drunks there is a Brady Bunch screen of stacked, often distracted faces. Instead of hugging and handholding there is, simply, nothing.A Temporary Necessity, Not a Long-term Solution AA has an essence that cannot be digitalized and, because of this, many with substantial recovery time have limited their attendance during the pandemic. Others have undoubtedly abandoned it entirely. We’ve worked the Steps, adopted the principles, and have already proven durable through protracted emergencies, alcohol-related and otherwise, We have the luxury of time, and don’t want Zoom eroding our esteem for AA. With vaccines on the way, we can wait this thing out safely and soberly. Newcomers, though, cannot. And therein lies the inequality COVID has foist upon recovery. It has significantly diminished the effectiveness of the most prolific recovery program in human history – and those most affected by it are the ones most threatened by active alcoholism and addiction.Is it possible to achieve and sustain sobriety via Zoom AA? Of course. But it is exceptionally difficult. Remote rooms have made an exceedingly challenging, existentially important process exponentially harder. To arrest alcoholism for the vast majority of those struggling with substance disorders, we must first arrest COVID.We’ve been living with this pandemic for nearly a full year. Its protracted nature brings with it a concern separate from the nearly half a million dead Americans: the concern that we start seeing these emergency measures as the new normal.Zooms rooms are not normal. They are a stopgap measure – a backup generator in an only-option scenario. This lack of alternatives is especially evident in the wintertime in cold-weather areas. No one is meeting in a park that just got 30 inches of snow, as much of my home state of New Jersey recently did.We all owe a debt of gratitude to the men and women who so quickly and capably pivoted to hosting Zoom meetings during widespread lockdowns. But we must remember that their sterling examples of sober service are merely making lemonade from lemons. They are keeping the AA ship afloat during a 100-year storm.AA will persevere. We will navigate this storm online for as long as necessary. But once the pandemic subsides, online meetings should return to being the exception rather than the rule.

The Stages of Change Model Shines Light on Recovery

In the common dialogue about recovery and substance use, there are a lot of black and white terms. You’re sober or you’re not; you’re in recovery or out of it; you’ve made change, or you haven’t.But most people who have lived with addiction for any amount of time know that there are shades of nuance and progression involved in making a major life change. Sometimes it’s two steps forward, one step back. If you’ve experienced this, you’re not alone.In fact, scientists have documented this phenomenon. To understand how people go about deciding to make a major life change, researchers developed the Stages of Change Model, also known as the Transtheoretical Model of Change.Familiarizing yourself with this model can help you understand your own behavior, or that of a loved one who is trying to get and stay sober. It can also help you accept that relapse is a normal, even expected, part of recovery.The Stages of ChangeAccording to the Stages of Change model, there are six stages that people go through when they are considering making a major change. They are:Precontemplation. People at this stage don’t see any problem with their behavior, and don’t have plans to change. For the person at the precontemplation stage, like a person who is still using drugs or alcohol, the idea of making a change seems to have more drawbacks than the idea of continuing life how they’re currently leading it.Contemplation. At this stage, a person is beginning to see that their behavior is problematic. They plan to change, but aren’t ready to change quite yet. A person who is using might know that their substance abuse is problematic, but they’re ambivalent about making a change.Preparation or Determination. After contemplating change, a person becomes committed to making a change. They know that their substance use is problematic and that they need to get healthier, and they’re starting to explore ways of getting sober, like researching treatment centers.Action. At this point, a person has decided to make the change that they hope will improve their lives. For people with substance use disorder, that might mean getting treatment. They’re learning about life in sobriety and trying their new skills to cope with challenges without using drugs or alcohol.Maintenance. After taking action, people in the maintenance phase know what they have to do to maintain change. That might mean working an aftercare program and engaging in activities like exercise, volunteering or anything else that keeps them sober and responsible.Relapse. We would like to think that after going through the hard work of recovery, change is permanent. However, it’s well-known that most people who get sober will relapse at some point. Accepting that relapse is part of recovery can help reduce shame and stigma, and encourage people to restart the stages of change as soon as they can.What The Stages of Change Say About RelapseIt’s scary to think about relapse, especially when you’re new in recovery. But putting your head in the sand will not help you stay sober. Being frank about the risk of relapse can serve as motivation to adhere to your recovery program. Understanding relapse risk can help you grasp that relapse is not the end of meaningful change.Consider this: most people have to go through the Stages of Change 4 - 7 times before they make lasting change. Knowing that making change is a fluid and dynamic process can normalize the experiences that you’re likely to have during your recovery journey.Processes of ChangeThe same researchers who identified the stages of change also identified ten processes of change that can be used to help motivate people looking to alter their lives. For example, consciousness raising helps you become more aware of an unhealthy behavior. Environmental reevaluation helps you understand how your behavior can impact the people around you. Forming helping relationships can keep you sober and on track.In order to make lasting change, you have to determine which processes of change resonate the most with you. That way, you can tap into these sources of motivation when you’re struggling.Sunshine Coast Health Centre is a non 12-step drug and alcohol rehabilitation center in British Columbia. Learn more here.