Intimacy and Alcohol

My EX-WIFE WAS the only person I was ever intimate with in the absence of alcohol. She was the only person that I trusted and loved so completely that I felt free being me. But when alcohol and its destructive aftermath reached its limit, she left me and my world went to pieces.I don’t blame her. I was difficult to be with. A recovering alcoholic can be a handful.One year after my divorce, I started dating again. I thought I was ready to deal with life and seek out new relationships. It became increasingly clear that alcohol was my shell, my protection from having to be the true me, whoever that was. I had to face new relationships without alcohol in my system.I felt like a hermit crab that just outgrew its shell and felt totally exposed.On the dating scene I felt cheated. I couldn’t sip wine over romantic dinners or laugh easily at light moments. I felt defective, as though I didn’t fit the mold my date was looking for. Sex was so easy drunk. you could be or act any way you wanted, and then blame it on the alcohol.I entered into several relationships and found myself pulling away. I was scared. I was unable to successfully achieve intimacy. I was so embarrassed. The questions swirled. how do I let myself get close to someone that I don’t completely trust—knowing it’s just me, myself and I, with no buzz, no protection? If the woman I date drinks alcohol but seems to accept me, how do I know it will last? Will she get tired of me like my ex? If I date someone who doesn’t drink alcohol, how do I open up? how do I enjoy myself knowing it’s just us? If I give in and drink alcohol, I know I will die.I am now nearly nine years into sobriety, and it’s been four years since my divorce. I am starting to learn to love again. It took time, self-care, therapy and patience. No magic formula. I can’t tell you that I still feel entirely comfortable. Sometimes I want to get drunk and just let loose. But that’s my problem. Those are my hang-ups and they come from lack of self-love. I am a work in progress. I am so happy I don’t give in and drink again. Sobriety is a journey with many chapters.I sometimes feel like I am missing my shell. I am coming to the realization that hermit crabs need shells for survival. I am not a hermit crab. The only thing hiding in a shell will accomplish is keeping me from being the man I am supposed to become.Excerpted from Through a Sober Lens: A Photographer's Journey by Michael Blanchard, available at Amazon or Michael Blanchard's website.

Treating an Opioid Use Disorder Is Difficult. A Pandemic Doesn’t Help.

Getting treatment for an opioid use disorder can be complicated, often requiring daily visits to receive addiction medication under the supervision of a provider. While guidelines have been relaxed to reduce barriers for those seeking care, it’s not clear how effective the changes have been.“Their barriers are huge here,” said Kim Brown, the founder of Quad Cities Harm Reduction (QCHR), “and they’ve been exacerbated by the pandemic.” QCHR distributes supplies, including naloxone, the medication used to reverse opioid overdoses, to drug users across Illinois and Iowa.On this episode of the podcast we speak with Brown about how the pandemic is affecting access to opioid treatment as providers navigate a new regulatory landscape.Since January 2020, Direct Relief – through a donation by Pfizer – shipped 863,680 doses of naloxone to harm reduction groups, clinics and health centers across the United States, including Quad Cities Harm Reduction, which received 650 doses of naloxone, as well as personal protective equipment for their volunteer staff.Direct Relief · Treating an Opioid Use Disorder is Difficult. A Pandemic Doesn't Help.Listen and subscribe to Direct Relief’s podcast from your mobile device:Apple Podcasts | Google Podcasts | SpotifyTranscript:Getting treatment for an opioid use disorder can be difficult. During a pandemic it’s even harder. People are navigating a changing landscape with shuttered programs and ambiguous new treatment guidelines. And they’re doing it even as overdoses are on the rise.BRENDAN SALONER: I think what’s really changed is that with the pandemic many programs, frankly, just shut their doors.Brendan Saloner is a professor of health policy and management at Johns Hopkins University. He studies access to treatment for those with opioid use disorders.SALONER: I think, you know, there was a moment of panic back in March when places realized this was spreading very fast and nobody really knew how to contain it. So, in that immediate aftermath of the emergency, there was this move to completely shut off these points of connection with care. And for many patients that was very devastating. People lost one of their main sources of continuity, not only with medication and with treatment, but also with the community of people that was there for them and part of their support network.For many opioid treatment involves taking one of two drugs: methadone or buprenorphine. These are both opioids that act by binding to the same receptors in the brain as heroin or oxycodone, but they don’t have a euphoric effect. They help by reducing cravings and preventing withdrawal symptoms.During the pandemic, the federal government has lifted certain regulations around the prescription of these drugs. The intention is to reduce barriers as social distancing and shutdowns make getting to a doctor’s office more difficult, but it’s not clear how effective these measures have been.RAFANELLI: What regulatory changes have been made around prescribing addiction medication?SALONER: So it’s still the case that patients can only get methadone through opioid treatment programs. What happened under the regulatory changes is that patients can now get more days of what’s known as take-home methadone, meaning methadone that they’re allowed to take out of the clinic and give to themselves at home, so that was a big deal. And that was done very deliberately to try to reduce crowding in the clinical setting. For buprenorphine, right now it’s still is the case that not every doctor or clinician can prescribe buprenorphine. It’s also regulated under a separate set of federal regulations called the X waiver. So to get buprenorphine a doctor has to have this additional credential or license from the federal government. So the X waiver still exists, even though there was some attempt recently to get rid of it. But what has changed is that doctors that prescribed buprenorphine right now are not needing to meet the same kinds of face-to-face requirements around initiating patients and then continuing patients in their treatment. So there again the intention has been to try to limit the number of times the patients actually have to come into their doctor’s office to get their medication.But the new laws are somewhat ambiguous leaving it up to providers to interpret.SALONER: The real tricky thing is that, although there has been some greater allowances of this take-home methadone–you know, allowing patients to not have to take the medicine every day in the clinic under observation–not a lot of guidance is out there about who should be eligible for take-home methadone. The federal regulation is pretty ambiguous about what a “stable” patient is who would be eligible to get up to 28 days of take-home methadone. And that ambiguity has, I think, given rise to very, different kinds of treatment protocols in different clinics. Some clinics are having those patients coming in very often to get their dispensed medication.That’s been the experience of Kim Brown who runs Quad Cities Harm Reduction in Iowa and Illinois. The group distributes supplies to people who use drugs, including Naloxone or Narcan–the medication used to reverse opioid overdoses.KIM BROWN: I founded QC Harm Reduction officially in 2015, but we were out on the streets slinging Narcan from 2012 onward. I’d get my hands on Narcan one way or another and it went to the drug users in our community.She says during the pandemic, many of those enrolled in opioid treatment programs haven’t benefited from the new rules.RAFANELLI: Can you talk about the regulatory changes and how they’re affecting the drug users that you know?BROWN: Folks with an opioid use disorder, who are a protected class under the ADA, were supposed to get take-homes for a month, at the least take homes for two weeks, to keep them safe. They didn’t follow those mandates. If somebody had drugs in their urine, they refused to give them take homes and demanded that they get on the city bus or try to find a ride to get to the clinic every day between 6:00 AM and 12:30 to get their dose during a pandemic. Those are the barriers that have been placed in front of our participants.According to the law providers are allowed to administer urine tests to patients undergoing opioid treatment. When and how frequently is up to their discretion. And because guidelines around what is considered stable and unstable are vague, some providers may use a urine test to decide. As Brown has found, those deemed unstable may not be eligible for multiple weeks’ worth of take-home medication, meaning they need to go to a clinic every day to take their prescription.While the pandemic has made accessing daily treatment more difficult, providers are experiencing challenges of their own.RAFANELLI: Tell me a little bit about how the pandemic is affecting your operations at QC Harm Reduction and the people that you reach.BROWN: In January and February we were really getting up and running over in Rock Island, getting all our services set up and we were paying attention to the pandemic, but I don’t think anybody realized the significance of it, right, until it got significant. So, I think part of the struggles for our drug users is many of them are unhoused. The shelters decided to house all of our unhoused folks–well, as many as they could–in the motels on the outskirts of town. They could be in Davenport, they could have been over here out by the airport, they could be in Bettendorf, but they housed them in motels to help people stay physically distanced from other folks and to try to keep folks safe. Once that happened, it was kind of like everybody scattered. Does that make sense? Once they were in the motels, then they had rules to follow. It was almost like everybody quit moving around in the Quad Cities. And when we went out on outreach to find the folks that were moving around, they were very seldom where they always were before the pandemic started. They were indoors door shut away, following rules and not out engaging with us on a weekly basis.Across the nation, drug overdoses have increased substantially during the pandemic, according to data released by the CDC.Drug related deaths were up 20% in the 12 months leading into spring 2020. While the numbers show death rates rising before the pandemic, the biggest spike occurred between March and May of last year. The CDC attributes these increases primarily to the polluted drug supply.RAFANELLI: I know there’s been disruptions in the drug supply chain. How have these disruptions affected drug users in your community?BROWN: In this area, they’re encountering a lot of adulterated methamphetamines, a little bit of heroin. We don’t have that much heroin here in our area right now. It’s almost all fentanyl. And they were reduced to buying the methamphetamines, a little bit of heroin here and there, but by and large, most of the drug supply that came in through here was adulterated with fentanyl. And if people weren’t testing their dope, they were overdosing and dying because they weren’t familiar with the amount of fentanyl that was present in that particular batch of dope. I know in Illinois overdose death rates went up approximately 19%–those numbers could have changed. And I believe Iowa’s went up to like 35 or 36%. And it was because people were using, they were self-isolating, right? So they were using alone. You never use alone, but they were using alone because they were isolated in motel rooms. They were isolated in housing apartments. They weren’t with people. They were using extremely adulterated dope, not testing it if they didn’t have the strips. But if you’re alone and you’re isolated and you can’t get somewhere, you’re going to do what you do. And what they were doing is using alone with no one there to look after them in the event of an overdose.RAFANELLI: So you think isolation is the main driver behind the national increase in overdoses?BROWN: I think it had a lot to do with it. Don’t you?This transcript has been edited for clarity.

9 Things You Should Know About Women and Addiction

On International Women’s Day (March 8), people from around the world come together to focus on advancing women’s rights and equality. This year the theme is #choosetochallenge, which invites men and women alike to stand up for gender equality.Although addiction can touch anyone, gender differences often influence a person’s experience with both addiction and recovery. Because of that, accessing a recovery program that is focused on women can be beneficial in helping females achieve and maintain sobriety.Here’s what you should know about women and addiction, including how we can create more effective treatment targeted toward females.1. Women are just as likely to develop a substance use disorder. Addiction has typically been thought of as a male problem. Treatment for addiction has focused largely on men, while not recognizing the scale of the issue in women. Although men are more likely to use illicit drugs, men and women are equally likely to develop a substance use disorder as their male counterparts.2. Binge drinking rates are rising among women.When it comes to binge drinking, women are leveling the playing field in a way that is anything but healthy. Binge drinking for women is defined as consuming 4 drinks or more in 2 hours. While binge drinking increased for most groups between 2006 and 2018, the most significant increase was among childless women ages 30-44, whose drinking rates doubled during that period.3. Women use drugs, too. In the U.S., nearly 20 million adult women use illicit drugs each year. Women tend to start using drugs for different reasons than men do, including to fight exhaustion, lose weight, or manage mental health problems. Divorce, the birth or loss of a child, and the pressures of motherhood can all contribute to female mental health conditions, which in turn increases risk for drug use.4. Women may become addicted more easily. Some research indicates that women can become addicted to drugs after using smaller amounts of the drugs, or using for a shorter amount of time. This could be because drugs and alcohol have a large impact on the female body, including the brain and cardiovascular system. Since women, on average, have more body fat than men, their bodies store alcohol, which prolongs the time that their organs are exposed to alcohol.5. Addiction presents unique challenges for women. Women who use and abuse drugs or alcohol might find themselves in unsafe situations. Women with substance use disorder are more likely to be in abusive relationships or to be forced into sex work.6. Substance use affects women’s mental health. Women who use or abuse substances are more likely than those who don’t to experience depression, anxiety, and panic attacks.7. Women’s substance abuse affects generations. Women who use substances face a risk that men don’t: injuring their fetus if they become pregnant. The rates of substance abuse among pregnant women have risen for drugs ranging from opioids to marijuana.8. Women are more likely to die of overdoses. Although more men than women die from drug overdoses, the risk of serious injury or death is higher for women who use drugs than for men who use drugs. Female drug users are more likely to go to the emergency room for overdoses. It’s not just illicit drugs that are dangerous: research indicates that rates of fetal alcohol spectrum disorder are likely higher than previously thought. Up to 5% of American children may have the condition, which can cause lifelong disabilities, including cognitive impairment.9. Recovery can be harder for women. There’s not enough research on recovery from substance use disorder for women. However, the research that’s out there is alarming. It indicates that women are more likely than men to experience cravings, which leads to a greater risk of relapse.Leading medical officials in both the United States and Canada have called for more research to better understand women and addiction. Although substance use disorder has been studied in men for decades, there’s a dearth of research when it comes to females impacted by addiction. Learning more about why women abuse substances, how their bodies are affected by substance abuse, and what treatment modalities are most effective for them can help us provide more equitable, accessible and effective treatment for women.Sunshine Coast Health Centre is a non 12-step drug and alcohol rehabilitation center in British Columbia. Learn more here.

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.