Covid Anxiety and Substance Abuse

 By: Brian Murray, LMHC, NCC

 

Covid has created a psychological mind storm since breaking out nearly a year ago. Counseling for anxiety searches on Google tripled in just one-month last March and continues to dominate as one of the leading mental health searches. Anxiety is closely followed by depression as a mental health concern. It shows that after Covid arrived in the United States there was an upheaval in people trying to get a handle on anxiety.

Anxiety is a natural response our mind produces that basically gives us two choices which is fight or flight. When we feel cornered and there is no escape, we tend to fight. If we have options to escape, we tend to flee. Panic which is also a form of anxiety is when we feel like we can do neither and feel trapped with no way out.

Covid has certainly created all three of these types of anxiety scenarios. If we are to flee then we isolate and avoid others and try to shrink ourselves to the threat. To fight may mean we join a cause such as being a volunteer for a vaccine candidate. There have been instances where people went to nursing school to join hospitals in the fight against the virus. People panic as they feel trapped in their homes and experience all kinds of distress with themselves and their families.

Sometimes anxiety becomes too difficult to handle. There are some healthy ways to handle anxiety and some unhealthy ways. Healthy methods of managing anxiety can be counseling, talking to a trusted friend, exercise or getting outdoors in a safe environment. Some people prefer to go to their doctor and get medication if other non-medication strategies are not working.

Unhealthy coping strategies involve eating too much junk food, excessive isolation, and avoidance of others as well as self-medicating through substance use such as alcohol. During the initial phase of the lock downs one of the essential services that were left open were the liquor stores. Sales jumped dramatically. Getting intoxicated, or using drugs, is common with those who are experiencing out of control anxiety. The sufferer flees into the substance to numb out the emotional discomfort. Problems arise when too much consumption begins to create impairment and distress from excessive use.

So how do we know when we are overdoing and leading ourselves into alcoholism? How do we know when we have a problem? The clinical diagnosis manual, DSM-5, states that for a person to be diagnosed with alcohol use disorder they must display at least 2 of the following 11 symptoms within the past 12-months. As we approach a year with Covid it might be wise to do some self-assessment.

1. Alcohol taken in larger amounts over a longer period than was intended.
2. A persistent desire or unsuccessful efforts to cut down or control use
3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol or recover from its effects.
4. Craving, or a strong desire or urge to use alcohol
5. Recurrent use of alcohol results in failure to fulfill major obligations at work, school, or home.
6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
8. Recurrent alcohol use in situations in which it is physically hazardous.
9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
10. Tolerance is defined by either of the following: a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect. b. A markedly diminished effect with continued use of the same amount of alcohol.
11. Withdrawal, as manifested by either of the following; a. The characteristic withdrawal syndrome for alcohol. b. Alcohol (or closely related substance, such as benzodiazepine *Xanax*) is taken to relieve or avoid withdrawal symptoms.

It does not take much to achieve a clinical diagnosis of Alcohol Use Disorder. While some people who have pre-Covid alcohol problems, and suddenly you throw a lot of anxiety and depression on top of the disorder, we now have a very big problem. People isolate themselves at home and try to recover on their own and it does not work. The prospect of going through a rehab facility is filled with fear of catching Covid. There seems to be no way out. Remember that thing called panic when there is no way out?

Alcohol is not the answer as it can also increase anxiety and depression. There are two additional diagnoses called Alcohol Induced Anxiety and Alcohol Induced Depression. So, the very thing that was supposed to help can make the problem worse, and it becomes worse two-fold. Not only is there an addiction issue but now the anxiety and depression have just become elevated. Now it seems hopeless and feeling hopeless is the marker for depression not to mention the possibility of suicide.

Metaphorically, this downward spiral is like driving a car in reverse with no brakes. So, what we must do is take the car out of reverse and put it into neutral and let it coast to a stop. The coasting is down dosing the alcohol consumption or quitting altogether. At a neutral state of mind, we are then faced with our choices and the reality of our situation and what to do next. When the car is put into drive and moving forward that is well within our control and direction of where we want to go. The picture is clearer going forward.

What makes this so hard, to stop the car and go in another direction, is that addiction, desire, and compulsion are found in the survival region of the brain. This also happens to be where our emotions pull from. Think about that for a minute. If a person is experiencing anxiety in the part of the brain where survival resides, then doesn’t it make sense that something that offers an escape become attractive?  We cannot run away from Covid just like we cannot escape our problems. There is a saying that wherever we go, so go our problems. Substance use and alcohol recovery is very hard due to the survival part of the brain demanding it. The brain is like a two-year-old beating the user trying to get its way and the user finally gives in to soothe the two-year-old.

So, what can be done about this conflict taking place in the brain? Think of alcohol as a substitution for real life and relationships. If you struggle with alcohol, then you have bonded to it relationally. You must change the way you look at alcohol and your relationship with it. What the brain needs at the survival level is connection to people. We are social creatures, and we need community to get plugged into, and not a bar. We need a purpose such as something that provides acts of service giving us meaning to life. The science behind trauma treatments show that the brain heals in nature and not in isolation. It’s okay to get out and hike and enjoy something with a view. Bring a loved one along and pack a lunch. We must give our minds what they are really craving as there is no reality in craving alcohol other than the false perception it makes you feel better. Remember, alcohol is a substitution for real life, and when you enjoy real life positive feelings will follow leading to lowered anxiety and depression. 

 

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