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Rising Addiction During COVID-19
Christina Boulet, a nurse practitioner discusses addiction, the rising rates, and how they are related to COVID-19.
Featuring:
Christina Boulet, NP
Christina Boulet, NP is Lead Nurse Practitioner. Transcription:
Prakash Chandran (Host): This Healthy Takeout COVID-19 podcast was recorded on April 12th, 2021. Since the onset of the COVID-19 pandemic, with all the restrictions and stay at home orders, stressors are amplified and some of those struggling with addiction may be turning to substances to cope. We're going to talk about it today with Tina Boulet, Nurse Practitioner in the Addiction Immediate Care Clinic at Harrington Hospital.
This is Healthy Takeout, the podcast from Harrington hospital. My name is Prakash Chandran. So, first of all, Tina, it's great to have you here today. I want to start just by recognizing that COVID-19 has really amplified a lot of the stressors that we currently have, and we all, I think know that however, it's been especially challenging for people struggling with addiction. Can you speak to why you think that is?
Tina Boulet, NP (Guest): The strain that the pandemic has caused on individuals has been multifactorial. There've been many stressors that have been added on to people during this time, including economic stress, a lot of people have lost their jobs, lost income. People have been isolated, so there's a lot of loneliness and not being able to see friends and family like they have in the past or would like to. We've also seen an exacerbation or an increase in mental health issues. So, increase in anxiety, depression, and not really great ways to always manage that stress. They may have had difficult times getting to doctor's appointments or, not being able to get into treatment when they've wanted to. There's less that we can do in general, there's less physical activities.
You can't go everywhere that you used to go, things that you used to be able to enjoy doing. You can't do those things anymore. And then as well as like spiritual interactions, we haven't been able to go to church. So, all the activities and things that people were used to doing, they haven't been able to do to the extent or at all anymore. And that's led to people resorting to substance use or increasing their substance use or relapsing.
Host: Yeah. It's one of these things where when you take away all of the things that provided consistency and structure in a person's life, regardless if you're struggling with addiction or not, when you take all of those things away, if there's an alternative that you're used to and you're comfortable with, it feels like a very natural thing to turn to wouldn’t you say?
Tina: Unfortunately, that is the reality for some people. It's all about what their coping mechanisms are and what their availability to those coping mechanisms that have worked in the past. So, if they've had success with going to church or going to meetings or interacting with others and that's been their safety and that's what's kept them engaged in their treatment. Not, taking that all away and taking it all away pretty much all at once, creates a huge stress for people. And those who maybe haven't used in the past, just having these. We've never experienced a pandemic in our lifetime. So, this has been a huge stress for a lot of people. And this may have been a time that people have started to use because of that.
Host: Now I want to unpack a little bit about the types of substances that you've seen this increase of usage. And can you maybe speak to some of the things that people typically have been turning to during COVID?
Tina: Well, I would say the substance that people tend to use the most because it is the most available is alcohol and you know, I'm sure you're aware, even during the pandemic, the alcohol stores or the liquor stores were able to remain open. So, that's our top substance that people use, just because it's so socially acceptable, it's so readily available. And people can get their hands on it and it's relatively cheap. But we've also seen an increase, like I said in the usage of opiates, which have led to an increase in the overdose. Part of that with the overdoses, they feel maybe related to the increased use of fentanyl.
So, as the pandemic has kind of run its course and people have more limited access to people that they've talked to or connections that they've had, they've sometimes needed to go to other connections. And instead of using heroin, now they're using fentanyl and now that fentanyl is a lot stronger than heroin. So, now you're seeing more overdoses related to that. But in general, in the clinic that we have here at Harrington, we've seen an increase in pretty much any substances. Like people come in with cocaine use and illicit benzo use and amphetamine use. And it's just sort of across the board that I've heard anecdotally from patients increasing their use and that's what we're reading in the media and in the literature as well.
Host: So, there's going to be people listening to this who might have someone in their family or a close friend that had struggled or is currently struggling with addiction. So, maybe talk a little bit to how they can, number one, understand what addiction looks like a little bit more and number two, how they might best support them.
Tina: So, when you're concerned that somebody in your family or a friend of yours is struggling from addiction, some of the things that you're going to see will be changes in their presentation, changes in their hygiene, changes in their sleep habits. If they're in school, you may notice a difference in their grades. If they're working, you may notice there's a decline in how well they do on the job. You may notice, like I said, they're either, sleeping a lot, they're sleeping during the day, or they're not sleeping at all, depending on what substance they're using, will depend on what presentation that they're going to show.
So, keeping an eye out for that and having an open and honest conversation with the person that you're concerned about and pointing out, you know, what it is that you're observing, and not being judgmental about it. Just being very factual about this is what you're seeing and asking them what's going on if they can explain that. And if they do disclose that they're suffering from substance use they're abusing illicit substances, helping them through that process, helping them find treatment. And again, not and doing it in a non-judgemental way is probably the best support that you can give to somebody who's suffering.
Not giving advice. A lot of times we see families and they're very, well-meaning, I'm sure, trying to give advice as to what they should do. And addiction is not a one size fits all medical condition. If it was, my job would be super easy and I could just treat everybody at the same way and they would be on their merry way and everybody would be happy and healthy, but addiction isn't like that.
And what works for one person certainly doesn't work for another person. There are different medication options that we have. Some people need inpatient treatment. Sometimes they need the detox and that very structured environment with sober living and some people need that for a while. And some people don't. Some people do okay with outpatient treatment and it's really a discussion between the person who's suffering from the addiction and their care team to help them come up with a good plan and what's going to work for them. But in terms of family members, if what they can do best is just try to help them get to that treatment and just be there for them and just listen to them and try to understand and try to educate yourself on what disease they're suffering from. Opiate use is different than alcohol use and the treatments are different. And just trying to understand how that looks and understanding that it takes time for us to be able to help people get through this. It's not going to happen overnight. Some family members that I've encountered tend to feel that we're not working fast enough or quick enough, but unfortunately the disease that we're struggling with, everybody's different in how they respond to treatment.
Host: Yeah, that totally makes sense to me. And one of the things that you said is as a family member or friend, one of the most important things that you can do is help them get support in a nonjudgmental way, and everyone is different. But when talking about that support, what does that mean? You know, does that mean take them to their primary care physician or coming into a clinic like yours? Talk a little bit about that.
Tina: So, you can certainly start off with speaking with your primary care doctor, given that we're in this opiate epidemic, you know, if it's opiates or if it's any sort of substance use, most primary care doctors are very open and understanding that there is a problem and can direct you to where you can get treatment. If you're not finding that you're getting results from that, you can always search for detox facilities in your area and you can talk to them and talk to the people at that facility and explain what this person is suffering from because some places are more geared towards alcohol or some places are more geared toward opiates.
And you want to make sure that if you're going to bring them to a detox facility or you're trying to get them into treatment, that you're bringing them to an appropriate place. Here in the AIC, our Addiction Immediate Care at Harrington, patients come in and they can call. And our goal is to try to get them in within 24 to 48 hours. What we find is that when people are ready to get treatment, they really need to have that access quickly, because if somebody has to wait a week or two for an appointment, you may have missed your window of opportunity for getting them into treatment.
So, if you have a friend or a family member who is ready and open to get treatment, it's really important to try to act on that as quickly as you can and seek out opportunities in your areas. There's like I said, inpatient detox facilities, there's outpatient clinics. Patients can also do partial hospitalization programs, intensive outpatient treatments. There are different levels based on what the need of that individual is.
Host: So, Tina, just as we start to close here, we've talked about a lot of things here today about how you recognize addiction, how friends and family can be helpful and why it has been so difficult during the time of COVID. But you know, if someone is listening to this and they're struggling with addiction themselves, what is one piece of advice or a takeaway that you would want to share with them before we leave today?
Tina: I would want them to know that they're worth getting treatment. Their sobriety is important to not only them, but to providers who are out there to treat them. I would want them to know that help is available and you can get treatment with providers who are non-judgmental, who will be there with you every step of the way, guiding you and helping you make informed decisions for your care and what's going to work for you and your life. Because again, not everybody can go to inpatient detox. Some people work Monday through Friday and they're struggling and detox isn't an option for them. But like the clinic that we have here, patients come in, they meet with the provider first, most places, they meet with a clinician first. Here, we have it a little bit different. You meet with a provider first. And we talk about what you're struggling with and then we discuss options and it's a mutual effort. It's not us deciding what's right for you or you coming in here and dictating what you feel is right.
It's coming to a mutual agreement about what we both think would be the best option for you in your life, what you have going on at the moment. We see addiction as a disease. And there are people that disagree with that. And whether you agree with it or not, the reality is that people are dying because they're not getting treatment and people are dying because of the judgment that others put on them, and it's a terrible thing. And there is treatment where you can experience compassion and caring for your addiction.
Host: Well, Tina, I really appreciate your time today. Thank you so much for everything that you do. That's Tina Boulet, Nurse Practitioner in the Addiction Immediate Care Clinic at Harrington Hospital. For more information, head to Harringtonhospital.org or call 508-949-8981. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks for checking out this episode of Healthy Takeout. My name is Prakash Chandran and we'll talk next time.
Prakash Chandran (Host): This Healthy Takeout COVID-19 podcast was recorded on April 12th, 2021. Since the onset of the COVID-19 pandemic, with all the restrictions and stay at home orders, stressors are amplified and some of those struggling with addiction may be turning to substances to cope. We're going to talk about it today with Tina Boulet, Nurse Practitioner in the Addiction Immediate Care Clinic at Harrington Hospital.
This is Healthy Takeout, the podcast from Harrington hospital. My name is Prakash Chandran. So, first of all, Tina, it's great to have you here today. I want to start just by recognizing that COVID-19 has really amplified a lot of the stressors that we currently have, and we all, I think know that however, it's been especially challenging for people struggling with addiction. Can you speak to why you think that is?
Tina Boulet, NP (Guest): The strain that the pandemic has caused on individuals has been multifactorial. There've been many stressors that have been added on to people during this time, including economic stress, a lot of people have lost their jobs, lost income. People have been isolated, so there's a lot of loneliness and not being able to see friends and family like they have in the past or would like to. We've also seen an exacerbation or an increase in mental health issues. So, increase in anxiety, depression, and not really great ways to always manage that stress. They may have had difficult times getting to doctor's appointments or, not being able to get into treatment when they've wanted to. There's less that we can do in general, there's less physical activities.
You can't go everywhere that you used to go, things that you used to be able to enjoy doing. You can't do those things anymore. And then as well as like spiritual interactions, we haven't been able to go to church. So, all the activities and things that people were used to doing, they haven't been able to do to the extent or at all anymore. And that's led to people resorting to substance use or increasing their substance use or relapsing.
Host: Yeah. It's one of these things where when you take away all of the things that provided consistency and structure in a person's life, regardless if you're struggling with addiction or not, when you take all of those things away, if there's an alternative that you're used to and you're comfortable with, it feels like a very natural thing to turn to wouldn’t you say?
Tina: Unfortunately, that is the reality for some people. It's all about what their coping mechanisms are and what their availability to those coping mechanisms that have worked in the past. So, if they've had success with going to church or going to meetings or interacting with others and that's been their safety and that's what's kept them engaged in their treatment. Not, taking that all away and taking it all away pretty much all at once, creates a huge stress for people. And those who maybe haven't used in the past, just having these. We've never experienced a pandemic in our lifetime. So, this has been a huge stress for a lot of people. And this may have been a time that people have started to use because of that.
Host: Now I want to unpack a little bit about the types of substances that you've seen this increase of usage. And can you maybe speak to some of the things that people typically have been turning to during COVID?
Tina: Well, I would say the substance that people tend to use the most because it is the most available is alcohol and you know, I'm sure you're aware, even during the pandemic, the alcohol stores or the liquor stores were able to remain open. So, that's our top substance that people use, just because it's so socially acceptable, it's so readily available. And people can get their hands on it and it's relatively cheap. But we've also seen an increase, like I said in the usage of opiates, which have led to an increase in the overdose. Part of that with the overdoses, they feel maybe related to the increased use of fentanyl.
So, as the pandemic has kind of run its course and people have more limited access to people that they've talked to or connections that they've had, they've sometimes needed to go to other connections. And instead of using heroin, now they're using fentanyl and now that fentanyl is a lot stronger than heroin. So, now you're seeing more overdoses related to that. But in general, in the clinic that we have here at Harrington, we've seen an increase in pretty much any substances. Like people come in with cocaine use and illicit benzo use and amphetamine use. And it's just sort of across the board that I've heard anecdotally from patients increasing their use and that's what we're reading in the media and in the literature as well.
Host: So, there's going to be people listening to this who might have someone in their family or a close friend that had struggled or is currently struggling with addiction. So, maybe talk a little bit to how they can, number one, understand what addiction looks like a little bit more and number two, how they might best support them.
Tina: So, when you're concerned that somebody in your family or a friend of yours is struggling from addiction, some of the things that you're going to see will be changes in their presentation, changes in their hygiene, changes in their sleep habits. If they're in school, you may notice a difference in their grades. If they're working, you may notice there's a decline in how well they do on the job. You may notice, like I said, they're either, sleeping a lot, they're sleeping during the day, or they're not sleeping at all, depending on what substance they're using, will depend on what presentation that they're going to show.
So, keeping an eye out for that and having an open and honest conversation with the person that you're concerned about and pointing out, you know, what it is that you're observing, and not being judgmental about it. Just being very factual about this is what you're seeing and asking them what's going on if they can explain that. And if they do disclose that they're suffering from substance use they're abusing illicit substances, helping them through that process, helping them find treatment. And again, not and doing it in a non-judgemental way is probably the best support that you can give to somebody who's suffering.
Not giving advice. A lot of times we see families and they're very, well-meaning, I'm sure, trying to give advice as to what they should do. And addiction is not a one size fits all medical condition. If it was, my job would be super easy and I could just treat everybody at the same way and they would be on their merry way and everybody would be happy and healthy, but addiction isn't like that.
And what works for one person certainly doesn't work for another person. There are different medication options that we have. Some people need inpatient treatment. Sometimes they need the detox and that very structured environment with sober living and some people need that for a while. And some people don't. Some people do okay with outpatient treatment and it's really a discussion between the person who's suffering from the addiction and their care team to help them come up with a good plan and what's going to work for them. But in terms of family members, if what they can do best is just try to help them get to that treatment and just be there for them and just listen to them and try to understand and try to educate yourself on what disease they're suffering from. Opiate use is different than alcohol use and the treatments are different. And just trying to understand how that looks and understanding that it takes time for us to be able to help people get through this. It's not going to happen overnight. Some family members that I've encountered tend to feel that we're not working fast enough or quick enough, but unfortunately the disease that we're struggling with, everybody's different in how they respond to treatment.
Host: Yeah, that totally makes sense to me. And one of the things that you said is as a family member or friend, one of the most important things that you can do is help them get support in a nonjudgmental way, and everyone is different. But when talking about that support, what does that mean? You know, does that mean take them to their primary care physician or coming into a clinic like yours? Talk a little bit about that.
Tina: So, you can certainly start off with speaking with your primary care doctor, given that we're in this opiate epidemic, you know, if it's opiates or if it's any sort of substance use, most primary care doctors are very open and understanding that there is a problem and can direct you to where you can get treatment. If you're not finding that you're getting results from that, you can always search for detox facilities in your area and you can talk to them and talk to the people at that facility and explain what this person is suffering from because some places are more geared towards alcohol or some places are more geared toward opiates.
And you want to make sure that if you're going to bring them to a detox facility or you're trying to get them into treatment, that you're bringing them to an appropriate place. Here in the AIC, our Addiction Immediate Care at Harrington, patients come in and they can call. And our goal is to try to get them in within 24 to 48 hours. What we find is that when people are ready to get treatment, they really need to have that access quickly, because if somebody has to wait a week or two for an appointment, you may have missed your window of opportunity for getting them into treatment.
So, if you have a friend or a family member who is ready and open to get treatment, it's really important to try to act on that as quickly as you can and seek out opportunities in your areas. There's like I said, inpatient detox facilities, there's outpatient clinics. Patients can also do partial hospitalization programs, intensive outpatient treatments. There are different levels based on what the need of that individual is.
Host: So, Tina, just as we start to close here, we've talked about a lot of things here today about how you recognize addiction, how friends and family can be helpful and why it has been so difficult during the time of COVID. But you know, if someone is listening to this and they're struggling with addiction themselves, what is one piece of advice or a takeaway that you would want to share with them before we leave today?
Tina: I would want them to know that they're worth getting treatment. Their sobriety is important to not only them, but to providers who are out there to treat them. I would want them to know that help is available and you can get treatment with providers who are non-judgmental, who will be there with you every step of the way, guiding you and helping you make informed decisions for your care and what's going to work for you and your life. Because again, not everybody can go to inpatient detox. Some people work Monday through Friday and they're struggling and detox isn't an option for them. But like the clinic that we have here, patients come in, they meet with the provider first, most places, they meet with a clinician first. Here, we have it a little bit different. You meet with a provider first. And we talk about what you're struggling with and then we discuss options and it's a mutual effort. It's not us deciding what's right for you or you coming in here and dictating what you feel is right.
It's coming to a mutual agreement about what we both think would be the best option for you in your life, what you have going on at the moment. We see addiction as a disease. And there are people that disagree with that. And whether you agree with it or not, the reality is that people are dying because they're not getting treatment and people are dying because of the judgment that others put on them, and it's a terrible thing. And there is treatment where you can experience compassion and caring for your addiction.
Host: Well, Tina, I really appreciate your time today. Thank you so much for everything that you do. That's Tina Boulet, Nurse Practitioner in the Addiction Immediate Care Clinic at Harrington Hospital. For more information, head to Harringtonhospital.org or call 508-949-8981. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks for checking out this episode of Healthy Takeout. My name is Prakash Chandran and we'll talk next time.