Abstract
This study explored how the COVID-19 pandemic impacted drug-use and treatment-seeking for females in an outpatient treatment program. The authors adapted and administered a COVID-19 stress scale to 15 females receiving outpatient treatment in a gender-specific clinic in Southern Arizona. Results indicate ambivalence about virtual recovery practices, although access to treatment was not greatly affected. Women felt more stressed and disconnected but reported more time to focus on themselves during the pandemic. Notably, the data indicated a positive increase in sobriety during the pandemic in this group of women. Results of this research suggest the pandemic served as a drug-use disruptor of significant duration, which provided the impetus for self-reflection leading to a desire to seek treatment despite increased relapse determinants. This study is clinically relevant for informing intervention strategies at known points of drug-use disruption, such as emergency departments, initial incarceration for non-violent drug-related arrests, and first-responder interactions.
TopIntroduction
In 2021, nearly 21.9 percent of the population in the United States age 12 and older used illicit drugs in the previous 12 months and 16.5% meet the DSM-5 criteria for a substance use disorder (SUD) (Substance Abuse and Mental Health Services Administration [SAMHSA], 2021). During the COVID-19 pandemic, reports indicate that among alcohol drinkers and other drug users, there was a 31% and 29% increase in consumption, respectively (Lifeworks, 2021). During the pandemic, from 2019 to 2021, there was a reported 30% increase in opioid overdose deaths (Centers for Disease Control and Prevention, [CDC] 2021) and the age group most affected by accidental overdoses was 25-34 years (National Safety Council, 2023). There is global consensus that the COVID-19 pandemic had a significant impact on the mental well-being of many individuals (Haider et al., 2020; World Health Organization [WHO], 2022, 2021). Some groups were disproportionately vulnerable to the effects of the economic, healthcare, and social limitations that abruptly occurred at the onset of the pandemic, such as those with mental health and SUD (Chacon et al., 2021; NYU, 2022) and women (Kempler, 2022). Behavioral healthcare was forced to pivot how they provided care, seemingly overnight, which exacerbated existing health disparities within low-income and underserved communities (Chacon et al., 2021). Access to treatment and evidence-based approaches were suddenly curtailed or suspended altogether (WHO, 2020). Many treatment support groups went from in-person to virtual. Therapy and case management sessions were moved to a telehealth format, and many were cancelled indefinitely. Mandatory social distancing regulations were implemented, even among parents and children in the foster care system (Schlosser & Harris, 2020). Medically Assisted Treatment, such as methadone, was impacted both in supply and quality (Aldabergenov, 2022). Reports indicate a sharp increase in overdoses and visits to the emergency rooms very early on in the pandemic for several types of substances and mental health crises (Chandran et al., 2021; Holland et al., 2021). The stressors precipitated by the COVID-19 pandemic induced a high-risk environment for those with SUD and increased common internal and external drug use recurrence determinants, such as isolation, loneliness, decreased self-efficacy, hopelessness, inability to remove oneself from unhealthy environment or relationships, and loss of support system (Menon & Kandasamy, 2018).
Gender Differences in Substance Use Disorder
Gender differences related to substance use disorder is still a relatively understudied topic, and how the COVID-19 pandemic impacted women with SUD who were not yet in treatment is still largely unknown. Interventions and treatments for SUD have historically focused on addiction in men (Covington, 2008, 2013; Stoner, 2018). Consideration of sex as a biological variable in SUD is necessary for understanding the neurobiological and hormonal impacts as well as responses to environmental and cultural pressures for different stages of SUD and treatment outcomes and to develop gender-appropriate interventions. The COVID-19 pandemic was an unanticipated, sudden environmental pressure that impacted women and men differently (Kempler, 2022). Animal models and studies on humans reveal central socio-environmental and biological differences between males and females that increase female vulnerability across the trajectory of addiction, from first-time drug use to drug dependence, reasons for drug use, drugs of choice, brain chemistry dysregulation as a result of drug use, and remission and rates of recurrence (Anker & Carroll, 2010; Clayton & Tannenbaum, 2016; Covington, 2008; Hilliard, 2023; National Center on Substance Abuse and Child Welfare (NCSACW), 2019). Studies indicate women were disproportionately impacted by the COVID-19 pandemic in ways that increase risk for substance use or drug use recurrence (Devoto et al., 2022; Kempler, 2022), elevating the need to investigate the pandemic’s impact on women with SUD.
Key Terms in this Chapter
COVID-19 Pandemic: Officially began March 11, 2020, with the World Health Organization declaration of a global pandemic caused by a novel corona virus. This pandemic is widely characterized as a time in which across global, national, and local communities, individuals and families experienced heightened emotional, financial, and in some cases physical distress.
Recurrence (Drug Use): Is a person-centered term that describes a lapse in remission from drug use by a person who has substance use disorder (i.e., relapse).
Substance Use Disorder: Is a chronic, relapsing disorder or disease that affects a person’s brain and behavior. It is accompanied by impaired decision-making skills and the ability to control urges to seek out, use, and misuse drugs and other substances, even at the detriment of one’s own physical, emotional, and financial health.
Intrapsychic Change: Refers to a shift in one’s internal psychological processes or beliefs often precipitated by an incident or incidents that lead to internal conflict resulting in a change within the internal psychological processes or beliefs.
Drug-Use-Cycle Disruptors: Include actions, behaviors, or incidents that disrupt the cycle of drug use in those who have substance use disorder.
Compulsory Drug-Use-Cycle Disruption: Includes any disruptor to the cycle of drug use that is not brought about intentionally by a person with active substance use disorder and is outside the control of the person using drugs (i.e., incarceration, overdose, medical emergency, pregnancy).
Intrapsychic: Is a belief system or psychological processes that exist within one’s mind.