How to fight addiction in the season of Covid-19

Obviously the impact of lockdown and social distancing has been serious for many of my readers, and I’ve struggled to think of what I could share that might help. Finally I think I’ve got something to say. Even as the world closes down around you, you have to stay open!

In my last scientific article on addiction and recovery, I set out a new and improved model of addiction (described in more detail here). I looked at addiction as a “narrowing” of the brain — a setting and solidification of neural networks focused on drug rewards — paralleled by a narrowing of the (available, meaningful) social environment.

This is not rocket science, or even brain science.

The main trouble with the “brain disease model” of addiction is that it ignores the massive impacts of the social environment. Yet we know that emotional challenges create the predisposition to later addiction. We know that the social environment (including one’s family history) matters hugely. We know that abuse (including emotional abuse) and neglect during our growing-up years are by far the best predictors of addiction in adulthood. The brain disease model simply can’t make sense of these facts. How could a brain disease develop from hard times growing up?

So in my model I emphasize that harmful social experiences have a shrinking or narrowing effect. If caregivers or peers make you feel off or wrong or insecure, or unable to trust, unable to just be, then you ingest what gives you the next best thing. Something that soothes you and defines you. And then, as time goes by, you connect with people more shallowly, you connect with fewer people, you connect with fewer people who might actually love you — family, friends, lovers. That’s the outer garment of addiction: the thinning, the contraction, of the social world. And it parallels the “contraction” of available neural networks in the addict’s brain.

The social shutdown isn’t just in the words and deeds you receive from people you know. It’s also a reduction in the places you go, activities, walks in the park, the freedom to be buffeted by babbling crowds shopping, living, watching, listening. When drink or drugs seem all that’s available to provide what you need, you let go of other possible sources of pleasure and satisfaction, energy, and identity. They were never that reliable to begin with. And before long you forget about them, you forget how to find them, you forget they even exist. That’s what locks addiction in place.

It’s what Johann Hari wrote about in Chasing the Scream: the opposite of addiction isn’t sobriety; it’s connection.

So living through this pandemic, here’s the main problem. The impact of social distancing on many people is increased loneliness, greater contraction of the social world, an accelerated plunge into being by yourself. For people with addictions, that’s the opposite of what they need most, the opposite of what they need in order to forget about getting high, at least for awhile.

Maybe it’s obvious, but it’s also what I’ve been told by my psychotherapy clients, especially those who haven’t quite found their way back to a drug-free (or drug-reduced) existence. The four walls feel more like concrete barriers than dividers in a lively hive. The doors and windows start to feel like relics of an existence that’s no longer possible. You can’t go out, you can’t mix, you can’t meet up, except online. And that’s just not quite the same. All you’ve got left is your addiction…or so it seems.

For those who are taking care of kids who are also stuck at home, the increased contraction of possibilities is laced with stress. You have to attend to these little buggers all day long. You love them, okay, but they’re kids. They’re not there for you. You’re there for them. So, infused in your isolation are the toxic currents of stress, not only boredom but frustration and anger and a sense of inadequacy. All of which derive from the situation, but it feels like they derive from you, from your own shortcomings. There you are, trapped inside your bunker, with heightened demands and anxieties that would be hard enough to deal with if you were free to get out and mix with other parents and relatives and the world at large. Forced captivity with junior cell-mates is nothing like being free to wander and connect.

So here’s what you should do. If you’re trying to quit or control substance use (or other addictive activities — porn, online gambling, whatever), get your ass out of the house! Social distancing doesn’t mean solitary confinement. Here in my city in the Netherlands, I’ve seen more and more people strolling over the last two or three weeks. People walk, and when they’re about to pass by, either they or you or most likely both of you move aside, so there’s a good two meters (six feet) separation. That separation doesn’t prevent, in fact it seems to enhance, people’s tendency to smile at each other, say Hi, wave, even utter a few words of greeting.

And it’s springtime! (at least in the northern hemisphere) The bushes and trees are budding and leafing like crazy, the flowers are coming out. My mood improves about 300% after I’ve walked around for awhile. And when you get home, call or zoom someone you care about. Ask about them. They’ll ask about you too. It’s easy to imagine that our isolation is some kind of penance for imagined wrongdoings. It’s not! The world is still full of people. And you still have an instinctive need to connect with them, in whatever way you can.

Getting out of your home is going to make you feel like you’re a part of the world rather than a prisoner on Rikers Island. And that’s going to help you feel like you don’t need to get loaded, or maybe have two drinks instead of eight, or maybe watch a movie, read a book, and fall asleep gently, wondering about the mysterious mix of chance and destiny that’s landed us in this crazy time. Together.

………………………..

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25 thoughts on “How to fight addiction in the season of Covid-19

  1. Mark April 24, 2020 at 7:06 am #

    And possibilities for when we’ve accomplished “Herd Immunity” – https://blogs.scientificamerican.com/observations/the-coronavirus-and-post-traumatic-growth/

    • Marc April 24, 2020 at 1:12 pm #

      This is great, Mark! Thanks!

    • Joanna NicciTina Free April 25, 2020 at 1:05 pm #

      When I saw this article on herd immunity and PTG, I knew which Mark on this planet had sent it!

      Hi Mark;) xox
      Our weekly call is part of the nourishment and relative sanity in my life.

      As a fellow traveler on the path of post-traumatic growth, both of you are inspirations for me on mine.

      And, I’m walking twice as much as I had been pre-pandemic, because I can, living in a small town, and it makes a difference. I usually make calls when I’m walking, or plan the walks around calls that can go mobile. Others have told me that I’d inspired them to do the same, hearing the benefits. Hearing another’s voice – and birdsong or traffic sounds – while walking is enormously comforting, even enriching. I walk regularly with a friend in Los Angeles, often sharing the contrast in our observations as we go.

      I’m also fortunate to be part of a 12 Step fellowship that has a wealth of telephone-based meetings in which I was already rooted for several years before this sheltering in place happened.
      Thank you, timing, and ALL of the Higher Powers!
      ; – )

      As someone who hasn’t always made great decisions on behalf of my overall health and well-being (goodness, that’s an understatement;) I’m grateful to have had the guidance, support (and years of adversity and sh*t experiences;) to do differently this time.

      I absolutely NEED connection with others.

      Without it, I’m more liquid than solid, and not in a good way.

      I’m a people who needs people, and finally feeling lucky about that fact. I used to see myself as weak for needing others, but that’s the bullshit you learn when you grow up in a family and culture like mine, or ours.

      I’m also a people who needs to move my ass.

      As Mark has reminded me, about 90% of our neurophysiology is dedicated to movement.

      A phone call and a walk, twice a day, is now a part of my go-to response in these strange times.

      Thank you both, Marc and Mark.

      Grateful for this connection we share, too.

  2. Nicolas Ruf April 24, 2020 at 9:50 am #

    Sigh. Sometimes I wonder why I even bother. Peoples’ brains can shrink around their beliefs too, and close down. All that confirmation bias stuff. So here you go: the bad experiences in childhood, trauma, ACE’s create a vulnerability to finding addictive behaviors/substances negatively reinforcing. And that brain vulnerability, like vulnerability in any other organ, can predispose it to dysfunction/malfunction/disease. Stay well everyone.

  3. Denise April 24, 2020 at 9:58 am #

    Hi Marc,

    I relate to what you’ve said about the world’s current situation and addiction. I have one question. Your comment “How could a brain disease develop from hard times growing up?” – Wouldn’t repeated responses such as extreme despair, sadness, terror, etc. that a child might experience have an impact on the brain and its development?

    • Janice April 25, 2020 at 1:59 pm #

      I had the same Q Denise, and look forward to Marc’s response.

      Yes, repeated experience as you describe will certainly have an impact on brain development. Not as “disease” but as “dysfunction”. Specifically and primarily, of the nervous system.

      As a somatic trauma therapist informed by applications of Polyvagal Theory in practice, I offer that the brain is affected, and effects behaviors, because the nervous system becomes “dysreguated” due to “hard times growing up”.

      The fundamental operating system (the nervous system) of an infant, baby or child living in conditions of neglect and abuse has no choice, but to operate from a threat-survival state of function. With the biological system in near constant flight/fight/freeze/collapse running the show, and very little to no healthy attunement and social engagement, patterns of brain function become dysregualted and behavioral patterns develop from there.

      I’m offering a very simplistic understanding that
      “All behavior is driven by nervous system state dominance”.
      i.e. Learned behaviors are driven by which state of the nervous system is driving the show. A biological felt-sense experience of safety will express behaviors and experiences very different from those driven by a felt-sense of threat or danger.

      Thanks for the convo!
      Stay well,
      Janice

      • Marc April 27, 2020 at 2:46 am #

        Hi Janice. I’m sure we’re in agreement here: your sketch of nervous system development strikes the nail on the head in biological terms. Thanks for bringing this view of development into the discussion. The contraction of psychological flexibility in response to stress is well known. The fact that this becomes a personality set point is not yet fully appreciated.

        Give my regards to Toronto!

        • Janice April 27, 2020 at 8:49 pm #

          Thanks Marc,
          Yes, still under appreciated that biology begets narrative begets personality.
          Toronto? I will certainly give my regards….. and I live in Oregon! : )
          Ciao,
          Janice

          • Marc April 28, 2020 at 4:12 am #

            Oh sorry, wrong Janice I guess. I know a Janice in Toronto who does trauma therapy and relies heavily on polyvagal (Porges’s) theory. Smail world!

    • Marc April 26, 2020 at 8:23 am #

      Hi Denise. These factors certainly would have an impact on brain development. How could they not? The logical problem is how, when, and why call this brain state “a disease” — which seems to take it out of the realm of developmental change — in response to a challenging rearing environment.

      All psychological outcomes are also biological outcomes. We are biological! That’s why I don’t see any reason to choose between a biological explanation and a psychological explanation. Both can be accurate. The only question is, where can we be of most help. And I don’t think the brain-disease label points us in a useful direction. Unless we’re planning to use neurosurgery with people in addiction.

  4. Jeffrey W Skinner April 24, 2020 at 10:57 am #

    Good point on the narrowing of the addicts social world till ultimately they are alone with their obsession. This state is a Petrie dish that hosts depression, obsessive behavior and paranoia. Anyone who gets hooked into the addict’s world, often by love, is in for a bad surprise: Addiction may not be a disease, but it can be contagious.

    You should post some more on your basic theory. I find it persuasive, even if Norah Volkow does not. (Funny, the spell checker insisted her name is Norah Volkswagen.)

  5. matt April 24, 2020 at 1:21 pm #

    We know an awful lot about the factors that predispose individuals, and make them more vulnerable to addiction. Yet there may be more examples of individuals marinating in these risk factors who avail themselves of mitigating factors that steer them away from addictive behaviors. When I see how people have been motivated collectively to help each other weather the COVID-19 crisis so far, it gives me hope that maybe we can bring this perspective to bear on addiction, hold everything up to the light from all disciplines, and settle on a treatment/prevention model that works.

    • Marc April 27, 2020 at 2:56 am #

      Hi Matt. How nice to read this optimistic vision first thing in the morning. It’s true, the Covid crisis has brought people together in remarkable ways. It seems to extract some level of sympathy and care for others that is usually buried. Holding everything up to the light — great image. When the world suddenly shudders out of the predictable, and reality turns part-way sideways, seems to be when we take a closer and less habitual look at everything. At least that’s the option it affords us.

  6. Steve K April 24, 2020 at 2:30 pm #

    I like your post Marc and it’s well written, but I would question your assertion that the medical/disease model dismisses that impact of social environment etc. Most people, including Dr Nora Volkow, that advocate the disease model also acknowledge the environmental and development origins of addiction.

    On the topic of coping during the pandemic, your readers may benefit from a recent blog article of mine titled: ‘Practicing These Principles in All Our Affairs – Even During a Pandemic!’

    https://12stepphilosophy.org/2020/04/02/practicing-these-principles-in-all-our-affairs-even-during-a-pandemic/

    • Dave April 24, 2020 at 8:45 pm #

      The benefits of growing up in a violently toxic alcoholic family.
      Too long for a book title?
      It’s a work in progress.
      It’s also an exercise in, so what?
      #1: you survived.
      #2: always refer to #1.
      It took me over 60 years to decide to change my thinking.

    • Marc April 26, 2020 at 8:10 am #

      Hi Steve. In brief, Nora Volkow and her colleagues at NIDA have paid increasing attention to social-environmental variables over the last 2-3 years. This is certainly progress. But they have yet to address the logical contradiction between addiction as a brain disease and brain change resulting from socially-reinforced learning. Still, it’s good to see this slow convergence of biological and social-developmental thinking. It’s certainly the way to go.

      Thanks also for the link to your blog. I agree that this is helpful advice!

  7. Annette April 25, 2020 at 4:14 am #

    A wise post, Marc. Thanks for this. Johann Hari’s book “Lost Connections” is an even better follow up to “Chasing the Scream.” We all need to remember and focus on being utterly human in this mess. Less stuff, more chat and moments of random happiness!

    I remember my life contracting when I drank: outwardly ‘successful’, but inwardly falling apart, alone, bored and lonely in a family where we all drank. Thanks to sobriety, those dark days are behind me – and in Covid 19 times,we’re all talking and walking more, which is so much healthier. Chatting to strangers in lockdown is a ‘must’ because we’re all feeling weird and somewhat fearful. A joke is even better! Blessings to you and all your followers.

    • Joanna NicciTina Free April 25, 2020 at 1:11 pm #

      Blessings to you, too, Annette, and trudging the road of happy destiny with you, too, fellow traveler;)

  8. Eric Nada April 25, 2020 at 11:49 am #

    Marc, thanks again for a timely and helpful post. I couldn’t agree more that current circumstances require great attention to making sure that I don’t collapse inwardly into a tiny protected existence held together with groundhog day-like routine, most of which surrounds keeping a wildly energetic five-year-old healthy and engaged. Especially as an extrovert, I painfully long for the natural buzz that social immersion easily brings into my life. But it is also an exercise in flexibility and adaptation, both of which happen to areas that I will probably always be able to do some work on. I also note that as someone who has long since given up their traditional addictions, I still tend to use routine and certain activities I enjoy to punctuate my daily experience with things I “look forward to.” It’s not as restrictive as my additions were but it is still in the same vein, at some level.

  9. Percy Menzies April 25, 2020 at 12:48 pm #

    When the lockdown order came and many residential clinics closed their doors, we made a conscious decision to not only keep our two clinics open but significantly expand our virtual clinic. We made a commitment to see patients the same day or no later than 24 hours. It has worked splendidly.

    Loneliness, boredom and isolation don’t mix with drugs and alcohol. Our patients started calling us desperately if they could still receive treatment and we told them, nothing had changed! They could come to the clinic or our medical staff could see them via telemedicine and they could pick up the meds at a local pharmacy. We did not change our policy of prescribing just one week’s medication at a time. Giving patients a month’s supply of abusable drugs is not a good idea. It is hard to describe the gratitude of the patients. The drug we mostly commonly prescribe is buprenorphine and for some opioid patients who had not taken opioids for months were prescribed naltrexone.

    We also had a spate of patients calling for help with intense cravings for alcohol. They were seeing pictures of Zoom drinking parties. Some of these patients had been sober for years and felt vulnerable. Some found themselves drinking a little too much and wanted to cut down. Naltrexone is the perfect drug in a lockdown situation. Our medical staff would see them via telemedicine and prescribe a month’s supply (there is no danger of abuse, overdose or diversion).

    Sadly, we had several patients who had a severe relapse to alcohol and had to be seen at the clinic. They came to the clinic with a family member and the appropriate detox medications were called in along with naltrexone.

    We went a step further to make a special effort to reach out to patients struggling for help at homeless shelters. The program was called: Treatment for Unhoused. One of the staff member set up shop outside a homeless encampment. Patients were seen via telemedicine and the appropriate medications were delivered to the patient at no cost to them! These patients could also see a psychiatrist and talk to a case worker about housing, bus passes etc.

    I have no interest in the polemics of describing drug and alcohol addiction as a disease or a deep habit or anything else or what caused the problem. I know patients suffer from intense physical symptoms over-layed with psychosocial issues. Effectively treating the withdrawal/craving is the first step towards long-term treatment. The three medications that have worked very well for us are buprenorphine, naltrexone and Antabuse (disulfiram).

    Once the withdrawal symptoms are effectively controlled the patients can take walks, indulge in hobbies, binge watching movies etc. And if they are still struggling, can call the clinic.

  10. Karen April 26, 2020 at 4:06 pm #

    As usual I get a lot out of your posts Marc, although I’ve never had a substance abuse problem, unless you count sugar, or relationships with psychopaths. Maintaining the threads of social connection during the lockdown is good advice for everyone.

    I have one small hole to pick. You say, “We know that abuse (even just emotional abuse) and neglect during our growing-up years are by far the best predictors of addiction in adulthood”. It’s not “just” emotional abuse. My parents started out physically abusing and neglecting my brother and I, but switched to psychological abuse, I think because this was less easy for the social services to detect.

    I think the term “emotional abuse” is inadequate. I call it psychological neglect / abuse. Physical and sexual abuse don’t occur without psychological abuse. Psychological abuse is not just “hurt feelings”; it stunts and damages the developing mind, in the same way that malnourishment, injury or disease can slow and twist a child’s physical growth. A child’s psyche develops on a scaffold of relationship with carers. The mind is our most powerful tool; deliberately neglecting or damaging it should be legally on a par with starving a child, injuring her internal organs or breaking her bones. The worst damage is in the knots that the developing brain has to tie itself into, to maintain the fundamental belief, wired into it from birth, that these adults upon whom he depends, for life and growth, are normal and good: that what these adults are doing, is love.

    • Marc April 27, 2020 at 3:05 am #

      You are so right. I’ve gone back and altered the wording…so anyone reading your comment might wonder what triggered it. Regardless, your sketch of psychological damage is terribly evocative. I was never a victim of ongoing emotional abuse. But my stint in a militaristic boarding school — two years of being unable to reach for home — pretty much did me in for the following decade and a half.

      Parents don’t have to be ill-intentioned to make terribly bad decisions. Often they themselves are damaged. But yes, I agree with you, it’s our responsibility as parents to protect and nurture as much as we possibly can.

      • Karen May 15, 2020 at 12:26 pm #

        Yes – the practice of sending children to boarding school originated in the “good old days”, when men were men, childcare was “just women’s work”, and protecting and nurturing children was deemed to turn them into “sissies”. Those societal attitudes made it easier for my parents to do what they did.

        I think parents should receive a lot more support than they do. It’s a very demanding job, even for someone who isn’t carrying psychological injuries from their own childhood.

  11. Falguni May 13, 2020 at 8:48 am #

    The best drug rehab is that which addresses the individual needs of individual patients. Drug addiction is an intensely personal disease, one that never afflicts any two victims in quite the same way.why counseling is important

  12. carlton May 25, 2020 at 8:08 am #

    Here is an interesting account regarding the lockdown and alcohol, and and socializing in general.

    This line popped out as a generally straight-forward and logical observation:

    “Without alcohol, I could spot red flags early on, rather than guessing if I misinterpreted someone’s words under the influence. Drinking wasn’t providing false sparks or interfering with real ones either.”

    https://www.nytimes.com/2020/05/20/fashion/weddings/no-alcohol-quarantine-couple.html?searchResultPosition=2

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