In a new podcast, Dr. Nzinga Harrison addresses the challenges of diagnosing, treating, and living with addiction when the isolation of Covid-19 and trauma of racial injustice put the vulnerable at even more risk.
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As people shelter-in-place all around the U.S. to prevent the transmission of the highly contagious, novel coronavirus, COVID-19, this forced isolation is correlated with an alarming increase in substance use and abuse.
Such indicators include a surge in alcohol sales by 55 percent in mid-March, shortly after the earliest shelter-in-place announcements were made in the U.S.; parts of the country already struggling with opioid abuse, such as Appalachia, are seeing significant opioid relapses; and other regions are reporting spikes in drug overdoses.
These statistics don’t just affect those with existing substance use disorders, either; in a time of extreme social isolation, everyone is at an increased risk for substance misuse and abuse, according to Dr. Nzinga Harrison, M.D, an addiction medicine specialist. Harrison is Chief Medical Officer and co-founder of Eleanor Health, a value-based provider of comprehensive, outpatient addiction treatment.
Social isolation can increase our risks of all manner of diseases, from heart disease to dementia in the best of times. In a pandemic, when many are isolating who normally would not, the consequences on substance use are staggering.
Moreover, recent protests erupting over the murder of George Floyd, a Black man, at the hands of a white police officer in Minnesota, has triggered immense pain and trauma for Black communities. Trauma is highly correlated with the risk of substance abuse.
Drawing upon her personal and professional experience with addiction, Harrison has recently launched a podcast called In Recovery, a Q&A style show that airs every Monday, in which all aspects of addiction are discussed with compassion and education.
Raised by an activist father who was a leader with the Black Panther party, and an empathetic grandmother who took an unconditional love approach to those with substance abuse issues in the family, Harrison says her roots set her up for her work in addiction treatment. Her journey through medical school started with pediatric surgery, inspired by the doctors who treated her scoliosis as a child. But during her psychiatry rotation, she was drawn to addiction medicine. The specialty allowed her to pair her love of research and data with the ability to relate to and advocate for people in complex situations.
Dr. Harrison spoke with DAME about her podcast, her approach, and how people can access resources for addiction support for themselves and loved ones.
You talk about addiction as a chronic medical illness, but it’s not often framed that way. Do you think this has caused some of the problems in treating it?
The idea that addiction is not a mental health disorder doesn’t make any sense. It arises in the brain. The brain’s responsibility is thinking, feeling, behavior, impulse control. Because the symptoms come in those four domains, we have this false belief that we have control of them.
There is not one person in the U.S., probably the world, that hasn’t somehow had their lives touched or affected by addiction. Addiction is a chronic medical illness—that’s what the evidence shows. There is neurobiological evidence, genetic evidence. When we look at how chronic illness behaves, for instance, diabetes—it’s relapsing/remitting. You get diabetes, you enact a treatment formula including meds and lifestyle interventions. One year after that, the relapse rate is about 55 percent but no one says treatment for diabetes doesn’t work. You look at addiction, you develop the symptoms, what you get is a bio-psycho-social formula that includes medications and interventions. You look one year down the road and, guess what, the relapse rate is: 55 percent. Same as diabetes, high blood pressure, and asthma.
Wow, that’s shocking when you put it in that context.
Right? Yet we look at addiction and say treatment doesn’t work, or people say “relapse is just part of the disease.” That phrase drives me crazy! Can we not throw hope in the trash? Do you say to a breast cancer survivor, “relapse is part of the disease?”
The risk for developing addiction is coded in your DNA. There’s a 40 to 60 percent genetic risk for addiction and a 30 to 40 percent for Type 2 diabetes, hypertension, and asthma. Addiction is even more heritable than those physical health conditions but it’s easier to conceptualize physical health symptoms being out of our control than the brain.
Do you think there’s a shift in the treatment approach since addiction has begun to be considered a medical condition?
There is a shift in the thinking around addiction as a chronic medical condition that is starting to happen but we are very much at the beginning of that shift. As far as that flowing through to a change in treatment, that has not yet begun to happen in an industry-wide way.
If we accept that addiction is a chronic medical condition that is relapsing and remitting that means we should treat it the same as high blood pressure, diabetes and asthma. What percentage of people with diabetes do you think get discharged from a hospital without any medication for their diabetes? None! On the flip side, what percentage of people with opioid use disorder—for which we have FDA approved medications and evidence that those meds prevent death and predict remission at one year—are coming out of in-patient units with a diagnosis of opioid use disorder without a medication? As high as 98 percent. That would be medical malpractice for diabetes.
Let’s talk a bit about COVID-19’s impact on addictions. Are you seeing that social isolation is leading to spikes in all kinds of addictions?
Yes. We’re seeing it anecdotally through the news but at Eleanor Health we quantify and score everything. We’re measuring our data pre-COVID and post-COVID. Our depression and anxiety and substance cravings scores are up, recovery capital scores are down (losing jobs, can’t access loved ones, lost routines that were tethering them). People are needing more and still feeling the effects of COVID.
A lot of treatment providers couldn’t successfully navigate this environment so people couldn’t access their care. A lot of AA meetings had to close for a while, though they’ve moved online. We share pheromones when we’re in the same space, an actual chemical exchange happens in the same space and some of that is definitely lost. People are struggling.
Take the healthiest person and isolate them socially and their health will degrade but take someone whose health is already not optimal, they are already more vulnerable.
COVID is also posing so many unknowns—we don’t know when things can re-open safely, we don’t know when/if we’ll have a vaccine—can these kinds of psychological stressors exacerbate addiction issues?
Yes, you’ve put your finger on what is quite possibly the most stressful part of the pandemic. If the pandemic came and they said it’s going to be bad for three weeks but on the other side of three weeks you’ll get your normal routine back and be fine, people can hang on. Homeostasis (keeping things in a normal range) is a way our brain identifies safety: it’s predictable, you know what’s coming next. So when it’s not predictable, you can even tolerate that if you know when it’s going to end, but if you add on not knowing when it will end, that represents a dangerous situation to your brain. That manifests in anxiety.
What are some warning signs of distress that individuals and their loved ones can look out for, and what resources do you recommend?
We talk about this concept of rising risk. There are levels of risk: The first level of risk is any family history of addiction. Remember addiction is 40 to 60 percent inherited. The next level for that same person with biological risk or raised in an addictive environment is that you drink or smoke or use weed, a pain or sleep medicine prescribed to you, etc. Even if you do so in a regular pattern. The third level, even if you can’t say it aloud to another person, is that you feel any concern about how you’re using: drinking, smoking, or other.
If people are seeing any of that in themselves what I ask is to reach out for help. One thing that is a silver lining is all of the resources that have come online, on-demand at your fingertips. One of my favorites is: wethevillage.co, for family members and loved ones who are concerned. You need a village, to be able to talk to some people where you can not have to worry about hurting feelings so you can come to your person later and talk to them in a way that doesn’t hurt feelings. Eleanor Health offers free online group therapy right now. You can drop into any group for free. I also like the I Am Sober app.
In recent weeks, the world has erupted in pain and outrage over the murder of George Floyd. And though it isn’t strictly related to addiction, I wonder if you could say anything about why some people appear to have empathy for what the protestors are going through and some do not. Is there a clinical explanation for why some people may lack that empathy?
This is a difficult question. There are some people that just don’t have empathy, and some who have a difficult time recognizing that there are life experiences outside of their own, and a third group who are in a way of protecting themselves from guilt that may have benefited from racism. So it’s easier to claim that it doesn’t exist and not open your eyes to it then to be a part of it.
So I think those three different groups of people have different reasons why we’re not seeing their display of empathy. Then there’s a fourth group that feels threatened by the rise of brown and Black people—that what they have is threatened. As if there’s not enough pie for everyone, which is how slavery developed in the first place—that we have to have it and we have to keep it from you. I would say just because you feel like a person doesn’t have empathy, or even if that person is straight-up acting in ways that tell you they are not empathizing, still raise your voice, but don’t let yourself be used up by it.
How can those engaging in protests best protect and prioritize their mental health?
It’s excruciatingly important during these difficult times to make sure we’re protecting our mental health. What’s extremely difficult about George Floyd and Christian Cooper’s stories is that they come on the heels of us being emotionally depleted because the coronavirus has stolen our routines and access to self-care. One thing I’d say is don’t feel any guilt if you have to take a moment away. This is very painful, triggering our own personal traumas and wounds, personally, with racism. And our friends who are not Black are experiencing that pain with us right now. It’s completely and utterly okay if you need to take a break. Go do something that generates some joy, makes you feel closer to your family. Some people will feel, “I don’t have the right to step away from this pain,” but you do and we need you to because you can’t be an effective activist on an empty cup. Spend time with those who love you, if not in person, then on video. So you can fill your cup and raise your voice for anti-racism.