The physical toll of the COVID-19 pandemic is well-known to every physician. At this writing, Arizona alone has had 1.4 million total cases and 24,616 deaths from the coronavirus, impacting virtually every medical professional in our state. Psychiatrists and other behavioral health professionals are now seeing a secondary and less obvious aspect of the pandemic – accelerating mental health issues generated by the anxiety, stress, isolation, loss, and trauma related to the pandemic.
To assess the breadth of these mental health issues, Arizona-based Sierra Tucson surveyed 1,000 individuals across the country about the mental health impact of the coronavirus. The survey, which we titled, “Self-Medication Nation,” shows a disturbing trend and contains implications for physicians who may be among the first healthcare providers to see the signs of a mental health crisis in their patients. Three categories of data were of special concern for physicians:
Alcohol and Marijuana Consumption Soaring
The total amount of alcohol that our respondents admitted to consuming was staggering. As a medical professional who works in the sphere of addiction it was concerning to note that almost 60% of people said they had been using alcohol during the pandemic.
Perhaps more disturbing, 85% of those in this subset increased their alcohol use by one to three drinks a day. That works out to seven to thirty-five additional drinks per week. Let’s put this in perspective.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines heavy drinking as follows: For men, consuming more than four drinks on any day or more than 14 drinks per week. For women, consuming more than 3 drinks on any day or more than 7 drinks per week.
The increase in alcohol consumption noted in our survey goes well beyond NIAAA’s definition of heavy drinking. This unhealthy trend has the potential to increase the morbidity and mortality associated with alcohol use.
Marijuana use followed a similar trend for increased use, with individuals using to manage anxiety, depression, and feelings of loneliness, as well as for enjoyment. This increase was seen across the nation, without much regional variation.
Workday Drug Consumption Has Been Normalized
When our team reviewed the survey data, it became clear that the consumption of marijuana, alcohol, and other drugs that might have typically taken place recreationally after work or on weekends, was now also occurring during the remote workday.
One in five (21%) respondents admitted they’ve used alcohol, marijuana, or other recreational drugs while employed remotely this year, even joining a remote meeting intoxicated. Of those who used, three out of four (73%) stated that if their employer insisted that they return to the office, they’ll miss the opportunity to use marijuana, alcohol, and other recreational drugs during their workday.
As a physician, I’m concerned that this pattern of use through the workday increases the risk of developing a substance use disorder. Given that many school-age children were also often at home doing distance learning, the increasing use of alcohol and drugs by their caregivers through the day elevates the level of concern.
Mental Distress and Self-Medication
Addiction treatment providers recognize that there are underlying causes leading to this worsening epidemic of substance use. Often a response to depression, trauma, and anxiety experienced due to the pandemic, along with grief due to loss of loved ones, financial stressors, a loss of freedom and way of life.
I urge physicians to monitor their patients for this type of mental distress – many patients are dealing with co-morbidities, where alcohol and marijuana use is only part of multiple issues that mandate clinical attention. Our goal as physicians should be to intervene early with our patients, so they don’t fall further into their illness in an attempt to cope with their anguish.
Sierra Tucson’s Self-Medication Nation Survey revealed that most people are not seeking help from clinicians because they think they can manage on their own. Only 13% sought out a therapist for their mental health challenges. When a patient enters our office for care, we are in position to make a real difference.
Ultimately, the survey findings highlight the need for universal screening for depression, anxiety, and substance use in all physician offices. Patients struggling with mental health issues often do not make it to a mental health professional. It’s not enough to know that our patients may be trying to cope by use of substances; rather, we as physicians have an opportunity to evaluate, treat, and help these patients return to their pre-pandemic level of functioning.
Note: Sierra Tucson has prepared an e-book for physicians and other healthcare providers based upon the data in the “Self-Medication Nation” Survey, downloadable from this link.