In this episode we have Dr. Sarah Johnson, the Chief Medical Officer at Landmark Recovery, on to discuss COVID-19. Dr. Johnson will be going over how to stay safe, how this impacts those currently going through recovery, and what you can do to manage your anxiety during these uncertain times. We hope Dr. Johnson can answer some of your questions about COVID-19’s impact and offer some safety tips for you and your family.
Welcome to Recovery Radio by Landmark Recovery with your host, Zach Crouch. In this program we’ll discuss the root causes and treatments of alcohol and substance addiction, speak with experts in related fields, and help navigate the road to recovery.
Now, here’s the host of Recovery Radio, Zach Crouch.
Zach: Hi, folks and welcome to Recovery Radio. I’m your host Zach Crouch and today we have a special episode for you. As I’m sure you’re all aware the COVID-19 virus has been spreading around the world and most recently the United States. At Landmark Recovery we are taking the spread of this virus very seriously.
I want to invite on our Chief Medical Officer Dr. Sarah Johnson today to talk with us about the virus, how people can stay safe, how this impacts those going through recovery, and what you can do to manage anxiety during these uncertain times. My hope is that Dr. Johnson is able to calm your fears and share some important safety tips. With that said, Dr. Johnson thanks for coming on the show with us today.
Dr. Johnson: Thank you for having me. It’s always, always a pleasure.
Zach: Let’s get into this. What is all the hype about coronavirus?
Dr. Johnson: If you’ve been anywhere near a TV or newspaper in the past couple of weeks I’m sure you’ve heard of this COVID-19 coronavirus. It’s a new virus that has emerged really in the past six months or so that was first identified during outbreak in Wuhan, China.
It is a virus which is in the same family as colds and flus. It spreads from person to person and people who have it generally have mild to severe respiratory issues like fever, cough, and shortness of breath. Some people have also reported diarrhea symptoms.
Zach: Got it.
Dr. Johnson: It’s presenting much as other cold and flu-type viruses.
Zach: Question, how did it start? It seems to me there’s some confusion about how it actually began.
Dr. Johnson: Anytime there’s an outbreak of a new disease, epidemiologists who know much more about this than I do will do very intensive studies to try to determine where it came from. This one is hypothesized to have come from animals as many viruses do, possibly from bats. I believe they are still trying to determine exactly where it came from, but it mutated and became contagious to humans. Now we have it spreading around much of the world.
Zach: Got it. How do national crises like this, like the COVID-19, how does it in your estimation impact mental health and addiction for that matter?
Dr. Johnson: Oh wow. When there’s a national crisis like this going on it is the perfect storm of trouble brewing for people with any sort of mental health disorder or addiction or even for people who don’t have diagnosis of mental health conditions. It’s very difficult to watch the news that has been constantly covering this.
Yes, it’s important to be informed and concerned, but it seems like in the past week, definitely in the past week, probably for the past couple of weeks it’s really been ramping up with non-stop state of emergency addresses from governors, from the president, from people that we really look to for guidance.
From that standpoint it can be very anxiety-provoking for people. There are other issues really into this particular epidemic that could put lots of people in our recovery community at risk because the best way that we have identified to stop this is something called social distancing.
Dr. Johnson: If you’ve been anywhere near a TV it would also be hard to not be aware of that term. We know that one of the things that is so important in recovery especially in early recovery is building community, is having connections with others, and building support, networks. It’s really important to think strategically about how to maintain those networks and those connections, but stay home so that you don’t spread disease.
Zach: Sure. I want to come back to what you mentioned at the beginning about how it impacts anxiety in people who have addiction especially and the news can be overwhelming for a lot of people as you pointed out. How much is too much? How much is even too little? What would you say is just right in terms of staying informed?
Dr. Johnson: That’s going to differ from person to person.
Dr. Johnson: Obviously because I’m Chief Medical Officer of a health care company I’ve spent quite a bit of time staying up-to-date on the different states that we have facilities in and also staying up-to-date with CDC recommendations and talking to epidemiologists who are here in Kentucky and other states leading the way to make sure we’re doing what we need to do to protect our patients.
For the average person who doesn’t work in health care I think a daily check-in is important to make sure that you know what’s going on in your community, maybe the morning news and the evening news. I think it can start to be detrimental when you’re spending a significant amount of time in front of the TV.
Zach: Hours and hours, right?
Dr. Johnson: Hours and hours and not doing other things because that can make it really difficult for you to pull yourself out of that and think about other things. This weekend I had the joy of being contained in our home, social distancing with my two-year-old and I was trying to watch some of the governor press conferences. He was a great interruption because he was pulling on my arm the whole time reminding me that the lawn game was a lot more fun to watch than the press conference.
It’s obviously going to vary depending on people’s jobs and what they need to know, but a check-in a couple of times a day with the hot points from state authorities is probably enough for most people.
Zach: Got it. Let’s switch gears a minute. I’m curious to know your take on, let’s just pretend that I’m a patient who just graduated from like Landmark, like a residential treatment program as an example. What advice would you give me to stay sober in light of this pandemic?
Dr. Johnson: Wow. That’s a really hard question. On Friday I had to go in and talk to our patients about some things that we were doing as a facility such as restricting visitations to help try to keep everyone well in our community. It occurred to me that I needed to really not mess up that communication because the odds of anyone in that room dying from coronavirus was pretty low but the odds of them dying from their substance use is if they didn’t receive a positive message would be much, much higher. Many of them had history of multiple overdoses.
As a leadership team we decided that we needed to really support our patients especially the ones that were graduating from treatment or leaving treatment for other reasons because there are a lot of things we don’t know about this illness because it’s new. We do know that a lot of them have been close to death from their substance use.
Dr. Johnson: For people that are leaving residential treatment they oftentimes step down to a partial hospital or attend the out-patient program. I would still encourage them to do that. They should check in with more specific programs to make sure that they are also having typical operations. Some programs have decided to cut back on operations and admission of new patients in light of a lot of the community restrictions.
If the program that they are completing doesn’t offer those I would encourage them to ask for referrals somewhere that might be if that’s something that they want to do. Obviously as a health care professional when the governor is encouraging everyone to stay home and not go around groups of people it’s a very individual decision and I think it’s important to support patients in what they want to do.
Those of us in the recovery community still consider ourselves to be doing life-saving work and I would hope that any reputable program would adhere to CDC guidelines. It’s probably not the best time to hold group where people are holding hands or hugging. Social distancing can be practiced in group treatment settings.
Another alternative that many organizations are starting to incorporate are use of tele-health services…
Zach: Yes, absolutely.
Dr. Johnson: For individual and even group treatment. For someone who is in a high-risk category, maybe an older person or someone who has health conditions that could be a very, very good option for them because we do know that this illness has a much higher fatality rate for people who are elderly or who have underlying heart and lung and chronic medical conditions.
Zach: Compromised immune systems, right? Yes.
Dr. Johnson: Yes, yes. Otherwise people can stay plugged in after they leave treatment if a sit-down program isn’t on their agenda would be plugging in to AA. AA is one of the most affordable and accessible supports for people in recovery across the world and they have really strengthened their online presence as a result from this. There are hundreds of virtual meetings that people can attend from a home computer.
Zach: I’m glad you brought that up because I was doing a little bit of research before we talked about that online presence you’re speaking to. Alcoholics Anonymous online meetings directory, you can just Google that. navoices.com, that’s the Narcotics Anonymous online chat room form. To your point there are certainly options that people can utilize during this time.
Dr. Johnson: Sure, sure. For people who may lack computer literacy, during times of I guess community crises and epidemics you can see a lot of people rallying around to help others. It would be a good idea to maybe reach out to a family member or a sponsor or someone who could help you with computer skills so that you would be able to access some of those things. Pre-planning is always good in emergencies.
Zach: I want to come back to this idea of the health system because we keep hearing about the possibility of overwhelming, maybe we’re there right now of overwhelming the health system. Doctors are being encouraged to postpone elective surgeries and people are being encouraged to avoid ER visits unless it’s a life-threatening emergency.
Are substance abuse treatment facilities still open for business? I think our answer’s obvious. Yes. Do these other issues with the health care system affect people seeking substance treatment?
Dr. Johnson: They most certainly can. The colleagues that I have spoken with in our treatment space here in Kentucky and Indiana are all finding ways to implement policies and procedures so that they can stay open. The key with a situation like this is to keep people that are inside your facility well and people who have communicable illness out because once a person comes in to a residential setting it’s much easier to spread illness around. Yes, most substance treatment facilities are still open.
Many of them are doing reduced admissions of new patients and they’re certainly going to be framing and asking some hard questions about travel or exposure to known infected people with COVID-19. It doesn’t mean that those people can’t have treatment but if someone has had a high-risk exposure they’re probably going to recommend that they try to find a way to safely self-quarantine for 14 days and come back so that the whole population isn’t exposed.
Zach: Got it. We’re in the middle or I would say the beginning of this COVID-19 pandemic. What are some of the other ways that people can practice social distancing and still promote good mental health practices? We mentioned online meetings. Are there other things that come to mind?
Dr. Johnson: I think when people hear social distancing they think that they have to be locked in their homes 24/7. That’s just not the reality. Even the most mentally-well person could start to have problems if they were confined to their house for long periods of time.
Dr. Johnson: Good things to do are getting outside when you can. It doesn’t mean going to large mass gatherings outside but taking walks I think. My child and my dog got several walks yesterday that they may not have gotten otherwise.
Zach: That’s never a bad thing, right?
Dr. Johnson: That’s never a bad thing. Keeping schedules and keeping routines is also very helpful during periods like this. There are hundreds and thousands, if not millions of Americans that have kids out of school and are possibly working from home or if they’re in an education or service industry affected by this pandemic they might be out of work.
Routines can help restore some normalcy. We know that keeping the same sleep/wake cycles it’s beneficial for mood. It’s beneficial for overall health. It’s really important to try to keep regular routines as much as you can during periods like this especially for the children that may be out of school.
Zach: Absolutely. I was just going to mention what came up for me as you were talking about that is we have a pretty large whiteboard in our kitchen and on the whiteboard now is a schedule. It’s everything from when our child, she’s in first grade goes to bed, when she wakes up in the morning, and everything in between from rising to falling asleep.
Everything’s on that board so she knows each day what the schedule looks like because we don’t know how long this is going to last. Getting her in a routine is certainly going to help us our and this stuff is going to help her out.
Dr. Johnson: Oh absolutely. I think one of the biggest factors that cause fear and anxiety during emergency situations like we are experiencing now is fear of the unknown and not knowing what’s going to happen. Are we going to be able to go to restaurants?
Dr. Johnson: Are we going to be able to pay our bills next month if our job continues to be on furlough?
Dr. Johnson: There are a lot of unknowns. One of the best ways to combat that is to keep routines so that you know what to expect at least from the areas of your life you can control; otherwise, they are good to practice social distancing that I made a note here to myself not to forget.
It doesn’t mean shut off your social network. This might be a time when it might be a positive use of social media to share information and certainly telephone or FaceTime and Skype are really good ways to stay in contact with people. It’s important to reach out to elderly parents or neighbors or people who might be home-bound to check in on them.
People in recovery can keep connections going with their sponsors and with people in their support community. Some of them are not completely isolated which could be detrimental.
Zach: Quick question for you, what can I do if I’m a person who’s been struggling with substances and unfortunately the timing’s just terrible but I’ve waited till now to get help for my substance abuse problems? What options do I have?
Dr. Johnson: For most people in that situation the treatment options would remain pretty much the same as they would even without the COVID-19 crisis, but it might be a good time to consider different points of entry in the system. Many people go through ER’s as an entry point into the health care system and we are as a society being asked to stay away from those if we’re not having chest pains, stroke symptoms, life-threatening, life or limb-threatening conditions.
If a person who was seeking substance treatment went to an ER in hopes of being referred somewhere they’re probably not going to get the attention and authority they might get at other times in history. Asking your primary care physician or asking other people that you know in recovery for places that you might call directly. Most substance treatment organizations will have admission centers or admission hotlines that will do admissions 24/7 and they don’t require a referral.
By no means should anyone who has been wanting substance treatment delay it just because we’re focused on another health crisis right now because we still have health crises in areas of substance use in our society and we wouldn’t expect those to go away just because something else has come on the radar.
Zach: Got it. We touched on some of the challenges at least for those people in recovery during this current state of affairs being sort of challenges to their ongoing recovery, going to meetings and staying connected. Are there any other things that come to mind as big challenges for those people in recovery during this time?
Dr. Johnson: I think there are going to be lots of challenges for all people, not just people in recovery. For people in recovery, I would just strongly recommend keeping social networks intact any way that you can that’s still allowed for minimizing exposure to this COVID virus and also reaching out to find places where you can receive treatment if for some reason offices or programs are closed in your area.
I would just not let the substance use take a backseat to the COVID-19 crisis if that is something in your life that you know is an issue. It’s really important to take care of your mental health in addition to your physical health.
For people that are prescribed medication for medication-assisted treatment, I would strongly recommend pre-planning and reaching out to treatment providers and doctors that prescribe those. Most state and federal authorities are enacting some emergency measures so that people who are in opiate treatment programs or who are prescribed using buprenorphine by out-patient doctor can have access to their medication if they end up on a quarantine or their area is in a travel restriction.
That would be something that you should call for now, not late until you run out of medication because we know that those can be really important things to some people in recovery as part of their treatment plan.
Zach: Absolutely. As a closing message, what are the most important things that people can do to maintain mental health during stressful times?
Dr. Johnson: Use existing social networks for support. Try to maintain routines and normalcy. Reach out to support people if you start to struggle with increased feelings of depression, anxiety or cravings if you’re in recovery from a substance use issue. With this current health crisis probably the most important thing that we can all do is to maintain our physical and mental health is just wash our hands and stay home when we can so that we can get back about our normal day-to-day life.
Zach: Fantastic. Dr. Sarah Johnson, I just want to thank you for coming on today and the time to talk about this issue. Thank you so much.
Dr. Johnson: Thank you. We’re going to be doing all we can at Landmark to keep our staff and our patients well so that we can continue providing services.
Zach: Yes we will. Thanks again.
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