Transcription:
Dealing With Addiction During The Pandemic

Prakash Chandran (Host): According to the National Institute on Drug Abuse, there has been a significant increase in substance abuse, misuse and addiction since the pandemic was declared in March of 2020. But what exactly is addiction? What are the signs to look out for? And what should we do if we, or someone we love is struggling with addiction? To help us answer these questions, we're joined by Dr. Beena Joseph, an Internal Medicine and Addiction Medicine Specialist at Flushing. This is the Flushing Hospital Med Talk podcast. I'm your host, Prakash Chandran.

And so Dr. Joseph, thank you so much for joining us today. Now, before we begin, I was hoping that you could define the term addict for us, because one of the things that I was reading is that not everyone who uses alcohol or drugs is considered addicted. So could you unpack that concept for us?

Beena Joseph, MD (Guest): Yes, of course. So, an addict is a person who is addicted to any particular substance. It can be alcohol, heroin, food, sex, anything that they have no control over and have to use multiple times on a daily basis. That's an addict. So, not everyone who consumes alcohol or uses drugs is an addict. To be considered an addict, there's specific signs. One is severe loss of control. When you're an addict, you cannot stop the behavior even though you know that it's bad for you. Addicts cannot control themselves. They continue to do the same behavior despite the negative consequences. An addict is always preoccupied with using the substance. From the time the patient wakes up, he, all he's thinking about is how to get the drugs. Will he have enough money for the drugs? Will he be sick if he doesn't have the drugs? So, that's very specific for an addict. Number two is an addict has multiple relapses. That means multiple failed attempts to stop the addiction. Every time they relapse, they learn something new about what triggers them to use alcohol or drugs. And every time they overcome their relapse, they learn new coping skills to overcome their triggers, to overcome their addiction. Lastly, an addict develops tolerance and withdrawal. Tolerance is when you need more amount of the drug to create the same sense of euphoria.

So somebody who used to get a feel good on one or two beers, later needs to drink 10 to 12 years to get the same effect. That's called tolerance and withdrawal is the symptoms. They feel sick when they don't get the alcohol or the drugs on time. And this is such a terrible feeling and it makes them so uncomfortable and they will do anything to not feel like that. So these are the main signs that we look for in an addict.

Host: That's really interesting to hear. So, the first interesting point is that it's not just drugs or alcohol as we all traditionally think, but it is any substance or not even a substance, it can be sex or pornography, anything where you don't have that control. There's that loss of control, right? That's correct.

Dr. Joseph: That's correct. And they have negative consequences and they still can't stop.

Host: Right. And oftentimes I wonder, does the addict actually realize that they're addicted because of this loss of control?

Dr. Joseph: Well, you know, in the beginning they feel that it's all under control because they try to hide it from their loved ones. And some of them are successful in doing so. And they think that they don't have a problem. And when they do realize that they have a problem, most of the time, they don't want to disappoint their loved ones and they try to hide it and they don't know where to get help. So, you know, it becomes more complicated for the addict.

Host: Interesting. Yeah, I'm sure we'll talk about that more later in the conversation, but I first wanted to ask, are there certain characteristics or personality traits that make an individual more susceptible to addiction?

Dr. Joseph: Yes, that's a very important question. Everybody wants to know why some people can drink socially and use drugs recreationally while others become addicted. And there are several risk factors. One is genetics plays an important role. It said that genetics plays 40 to 60% in a person's vulnerability to addiction. So it's very important to ask your patients for family history. Number two is underlying or untreated mental illness. A lot of people use drugs to deal with their anxiety or depression rather than see a therapist or a psychiatrist. And this can be due to lack of insurance or there's a lot of stigma associated with mental health. So they prefer to just self-medicate themselves with alcohol or drugs rather than actually seeking professional help. Number three is environmental factors. What type of situation we grow up in, we live in is very important. If we live in a stressful situation or we've undergone a traumatic event and we don't have the coping skills to deal with that, this can also lead to addiction.

Number four is accessibility to the substances. If drugs or alcohol are easily available, it increases the chances of a person to start using the drugs for the first time, especially in young impulsive individuals. It also increases relapses in patients who are trying to stay away from the drug. That's why it's very important that we tell our patients to avoid people, places, and things that remind them of the drug during the recovery process. Certain personalities are linked to addiction, especially people with low self-esteem, impulsive behavior, compulsive behavior, and people who are not able to handle stress or lack coping skills.

Host: Yeah, it's interesting. You mentioned external factors and my dad, I'm hearing my dad play in my head. He always says that environment is stronger than will and you touched on a couple of things there, specifically people, places and things. So just given that, for the last two years, you know, we've been living through a pandemic and that is a lot of pressure during these unprecedented times. And so how does that environment, or how has that environment resulted in someone becoming an addict?

Dr. Joseph: Yes. COVID-19 has caused so much stress and uncertainty in not only us but all around the world. During the pandemic, we have all been isolated and stressed, unable to see our support systems like family and friends, and even our primary care doctors and therapists. And this has caused a lot of people to turn to alcohol and drugs. A lot of jobs have also become remote. And this also decreased the need for people to get help on time, because a lot of people can actually be under the influence of drugs or alcohol at home and still do their work and get away with it. And because you're not going to work and being seen by your colleagues, your need to get better, actually decreases.

And I've seen that with a lot of my patients who now have to get back to work suddenly are coming into detoxes because they can't go back to work in person. We also have been separated from our family and friends because of the pandemic, and this is our support system and they actually notice the changes in us when we are going through an addiction if the patient is going through an addiction. And they help us to realize if the patient is going in the wrong track and when we don't have the support systems, you know, it just gets more complicated during the pandemic. Also during the pandemic, a lot of recreational users started increasing the frequency of how much of drugs or alcohol they were using because they have a lot of time to themselves.

And also during the pandemic, there was a short supply of heroin and fentanyl was very common. And also a lot of the cocaine and Xanax and opioids were actually laced with fentanyl, which actually made patients to become more addicted and they used to get more sick. And this also led to so many overdoses and in 2020, during the pandemic in 2021, we've seen record number of overdose deaths in the United States of America, the first six months in 2021, we hit a record of 53,000 overdose deaths. And that's only getting worse day by day.

Host: Yeah. You know, what's really interesting about what you're saying there is, you know, you touched upon the external factors that people, places and things, potentially spark a remind someone of that substance that they're trying to stay away from, but in the midst of this pandemic, it's almost the lack of people place and things. It's that. And it's the isolation that causes someone to use more. Is that something that you saw?

Dr. Joseph: Yes. And you know, when we're isolated, we try to, we're bored. And sometimes we use the drugs or a person who uses drugs actually starts using more drugs. So, you know, and nobody is there to keep an eye on them or to see how they are doing. And that just complicates the situation.

Host: You know, So Dr. Joseph, let me ask you what signs should we look for if we suspect that a loved one is dealing with addiction and I guess more importantly, how might we go about helping them?

Dr. Joseph: So when you suspect that your loved one is an addict, the most important thing is to look for withdrawal symptoms and a patient who is in withdrawal, maybe because you're watching them, and you want to make sure that they're not using start getting very nervous, irritable. He can be sweaty. He can complain of nausea. He will be vomiting, complaining of stomach cramps, diarrhea. In opioid withdrawal, pupils will be dilated. So these are some of the withdrawal symptoms that we look for in patients and addicts don't want to have conversations, they can be very argumentative. They try to isolate themselves. They ask for money, they miss their appointments or work without giving you a valid reason.

They start being a totally different person than. Addicts also become very emotional. They have crying spells. They cry unexpectedly when you ask them questions and they have bouts of hysteria. They get very hysterical when you try to question them, they can also seem very depressed. They are very anxious. When they are confronted, they can also be very defensive.

Physical signs that you can look for, especially in heroin addicts are track marks. You will see these bruises on their arms, legs, or neck. And if you're a heroin addict who injects drugs, they try to cover up their neck and they cover up their arms because they don't want people to see those scars on their body.

When we think of a loved one who is suffering from addiction, it's important not to blame them. You have to understand that addiction is a disease and nobody wants to live the life of an addict. They feel helpless and they feel scared and all they want is help. But they're so scared to approach their loved ones because they know that they've disappointed their family and friends. Just like diabetes and heart disease, they need proper treatment to overcome the illness and it takes time. Just, if you imagine a diabetic person, you can tell a diabetic to avoid carbs for the rest of their life. It's just not going to happen. So the important thing to understand whether it be diabetes or whether it be addiction, you know, human beings are not perfect and there will be good days and there will be bad days.

But the important thing is to have more good days than bad days and to get back on track. And that is how you have to approach the situation or approach your loved one.

Host: One thing that I wanted you to expand on is people that are high functioning addicts. So I personally, as a personal anecdote, I have a friend who was an addict and then went to recovery and was, you know, living a very full life. Admittedly like every time he was with us, he struggled from alcoholism. You know, he would always drink, you know, the bitters and soda water.

He, he had no problem talking about it. And he even was talking about the different milestones that he was trying to meet. After a year, he went off seemingly on vacation for a while. Didn't see him for a couple months. When in fact we learned later that he actually went to treatment because he had relapsed, you know, like a lot of the things that you had said, and he came back and he admitted it. That's the only way that I knew about it. And I was actually flabbergasted because he was so high functioning. So you talked about the very clear signs, right? The people that are nervous, irritable they have these signs that are kind of more typical of someone that's not high functioning, but I'm curious, like if you know someone that for example, it's able to hide it really well. What would you recommend for someone who has someone in their life that operates in the way I just described.

Dr. Joseph: So, you know, people are different and you know I have a lot of patients who have very good jobs and have a problem with drugs or alcohol and they're high functioning individuals. So like, the hiding part. I don't agree with, you know, it's like a disease. You can't hide that you're diabetic or you're hypertensive, or you have heart disease or you have any type of disease, you know, hiding it is because you're ashamed of it.

But you know, the addict should understand that this is a disease and not just the addict, the family support. That's very important. So I have patients who are good for months and years and one day or one particular day, maybe they're having a bad day or there is maybe some particular family event that made them relapse. And you know, the important thing that I tell my patients is that, listen, this is a lifelong process and nobody is perfect. And if you relapse nothing to be ashamed of. You just have to come back to treatment on time. Don't wait until you lose everything you worked so hard for your family, your job, your apartment.

Don't lose it before that. In one week, I tell my patients all the time in one week, if you cannot get back on track by yourself, call me, call the unit, get to a detox. Get into treatment. And they will be out of the treatment in shorter number of days and they will be back on track. And that's what family has to understand.

And that is what the addict has to understand. So he should be comfortable to ask for help and, you know, help should be available for him. You know? So that's why we have so many centers in New York. We're very lucky. New York has so many detox centers and rehab centers. And if you go online or you call the national helpline, they will connect you to these centers and it's about getting help. So once they do that, they can get back on track and that's all that we want them to do. And we encourage them to not be embarrassed and to come back to us.

Host: Dr. Joseph. I'm so glad that you expanded on it in that way. I really appreciate it. So you're talking about the importance of reaching out and getting help. Where can we do that? Where can people go to look for help?

Dr. Joseph: So there is a national helpline it's called SAMHSA National Helpline, substance abuse and mental health services administration helpline. The number is 1-800-662-4357. You can go online and look for detoxes. They will give you numbers. There's always somebody that will call you back and take your history and let you know whether you are qualified to come into their facility or not. And Flushing Hospital also is available. The number is (718) 670-5693. And you can call, there's somebody who will always pick up the phone and let you know whether there are beds available, or if you need detox or whether you need a lower level of care.

Host: So talk to us a little bit about the services or treatments that you offer there like, what can an addiction specialist as yourself offer?

Dr. Joseph: So I work in Flushing Hospital Chemical Dependency Unit. It's a medically managed detox, and we have the ability to treat patients with complex medical as well as psychiatric problems. So this is a 24-hour medical, nursing and psychiatrically equipped hospital. And we safely detox patients suffering from alcohol, opioid and benzodiazepine addiction.

We provide behavioral therapy while they are in detox. And patients are seen by counselors who work with them every single day and try to coordinate the next level of care. So by the time they're done with the detox, the counselor will help them to continue their treatment, whether it will be an outpatient or inpatient.

We also provide medication assisted treatment such as we induce patients on suboxone, naltrexone. And if they're interested in methadone maintenance, we set them up so they can go directly to the program after their treatment at our facility. We also have an outpatient program known as Reflections that patients can follow up after detox.

And in Reflections, there is a therapist that talks to the patient mostly on a weekly basis to make sure that the patient is doing okay. And if the therapist feels that the patient is starting to relapse, they can refer the patient back to the detox before things get worse. Reflections also is equipped with a psychiatrist that can assess the patient for any underlying anxiety or depression and give the patient the appropriate medication. So the objective of any clinician is to improve the quality of life for their patients so they can be a productive member in their family and society. So we try our best to do that.

Host: So the last thing that I wanted to ask you is that we still live in a world where there are a lot of restrictions currently in place. So how can you and your team still provide help to those that are maybe unable to get that physical in-person help.

Dr. Joseph: Yes. So COVID-19 has forced all of us to be creative in everything. So our facility, our detox center before we admit every patient, they are tested for COVID-19 prior to admission. And if they are tested positive and require detox, they will be admitted to the medical floor under isolation. But if they are negative, they can come into our unit and be detoxed on the chemical dependency unit.

We provide masks for all of our patients daily and as needed. The outpatient program Reflections started to use Telemedicine more frequently after the pandemic because patients sometimes don't want to come into a hospital. So they also do video sessions for a more personal feeling and to directly observe the patients during the session. If patients also have work and can come to the clinic, we have evening appointments and if they need to do urine test or blood tests, staff there is available until 9:00 PM.

So they can come in and get the appropriate care that they need. We also have a MAP grant program, which is medication assisted program. So in this program we have staff that actually call all the patients that have been discharged from CDU, whether they have taken aftercare or not, and follow up with them, just to make sure that they're doing well.

And if they relapsed, they help them to get the appropriate level of care, whether it's detox, outpatient rehab, and then help them throughout the whole process until they get the help. And we also provide medications for these patients, if they're interested, such as Suboxone now, naltrexone and Vivitrol. So it's very important to tell your patients or tell your loved ones, not to be embarrassed if they have to come back for treatment.

So none of us are perfect and we all have good days and we all make bad decisions. We all have to understand that. So if your loved one, or if your patient you tell them if they cannot stop using drugs in a week, please call whichever detox or their therapist and make sure they go to the appropriate level of care before things get worse. And you know, at this point, if they get treatment, it's only a minor setback in their life rather than a major one.

Host: Well, Dr. Joseph, this has been a truly informative and helpful conversation. I really appreciate your time.

Dr. Joseph: Thank you very much for having me.

Host: That was Dr. Beena Joseph, an Internal Medicine and Addiction Medicine Specialist at Flushing Hospital. Thank you so much for listening to this episode of

Prakash Chandran (Host): Flushing Hospital

Host: Med Talk. For more information about the services Flushing Hospital offers, or to schedule an appointment with an addiction medical specialist at Flushing Hospital's Reflection Treatment Program, you can call 718-670-5693. You can also call the SAMHSA National Helpline mentioned at 800-662-4357. This has been

Prakash Chandran (Host): Flushing Hospital Med Talk

Host: Thank you so much. And we'll talk next time.