Persons with Substance Abuse Disorders and Other Addictions: Coping with the COVID-19 Pandemic.

Cuba implemented policies mandating social distancing on March 11, 2020, which were still in place at the time of this study. During such periods of isolation, people with psychoactive substance-related disorders and other addictions may be tempted to reduce tension, stress, uncertainty and possible distress by increasing the use of substances or practices they have abused. This can mean relapses and setbacks for patients undergoing treatment. A multidisciplinary team of health professionals specializing in addiction at the Center for Academic Development in Drug Addiction, in Havana, Cuba, cares for people with these disorders and followed their evolution during the initial period of COVID-19 social isolation. With the aim of characterizing strategies employed by patients undergoing treatment for substance abuse and addictions, we conducted a qualitative study from April 2020 through May 2020, using a convenience sample of 37 patients (all students) who had been progressing towards recovery from addictive behaviors when face-to-face encounters were suspended due to COVID-19 restrictions. Contact was maintained through information and communication technologies. The research used telepsychology and focused on understanding patient life experiences. Patients were interviewed using a semi-structured survey, which was then transcribed and coded thematically using a grounded-theory approach. We found that patients' ability to cope successfully with challenges presented by COVID-19 were influenced by: 1) the individual's own methods for maintaining self-control (commitment to studies, projects, and work with therapists) that aided them in their goals concerning abstinence; 2) difficulties faced in addressing specific events and situations (doubts, uncertainties, disagreements, isolation and time use); 3) perpetuation and revivification of myths related to substances and addictive activities (exacerbation of supposed benefits of tobacco, alcohol, marijuana, overuse of social networks); and 4) tendencies toward irrationality and lack of emotional control (fear, sadness, anger, constant worry and self-imposed demands). Our findings suggest that despite the potential negative psychological impact of preventive social isolation during the COVID-19 pandemic, individual coping mechanisms developed by these patients, aiming at improved self-control, allowed most to avoid setbacks that could have affected their recovery. Nevertheless, patients faced challenges to their recovery that were compounded by difficulties in specific situations, myths related to substances and addictive activities, and tendencies toward irrationality or lack of emotional control.

Virtual reality for behavioral health workforce development in the era of COVID-19.

The coronavirus 2019 disease (COVID-19) pandemic emerged at a time of substantial investment in the United States substance use service infrastructure. A key component of this fiscal investment was funding for training and technical assistance (TA) from the Substance Abuse and Mental Health Services Administration (SAMHSA) to newly configured Technology Transfer Centers (TTCs), including the Addiction TTCs (ATTC Network), Prevention TTCs (PTTC Network), and the Mental Health TTCs (MHTTC Network). SAMHSA charges TTCs with building the capacity of the behavioral health workforce to provide evidence-based interventions via locally and culturally responsive training and TA. This commentary describes how, in the wake of the COVID-19 pandemic, TTCs rapidly adapted to ensure that the behavioral health workforce had continuous access to remote training and technical assistance. TTCs use a conceptual framework that differentiates among three types of technical assistance: basic, targeted, and intensive. We define each of these types of TA and provide case examples to describe novel strategies that the TTCs used to shift an entire continuum of capacity building activities to remote platforms. Examples of innovations include online listening sessions, virtual process walkthroughs, and remote "live" supervision. Ongoing evaluation is needed to determine whether virtual TA delivery is as effective as face-to-face delivery or whether a mix of virtual and face-to-face delivery is optimal. The TTCs will need to carefully balance the benefits and challenges associated with rapid virtualization of TA services to design the ideal hybrid delivery model following the pandemic.

Addictive behaviors and craving during the COVID-19 pandemic of people who have recovered from substance use disorder.

Stressors caused by the coronavirus pandemic (COVID-19) contribute to increased addictive behaviors in the general population worldwide. Little is known, however, about addictive behaviors of people who have recovered a long time ago, even years, from substance use disorder (SUD). The goal of the present research was to examine the craving for drug use and addictive behaviors (tobacco and alcohol consumption, viewing of pornography, gambling, and shopping online) of people who recovered from SUD, before and after the outbreak of the COVID-19 pandemic.Methods: During one week of isolation imposed in Israel following the outbreak of COVID-19 in April, 2020, a self-report questionnaire was distributed to a convenience sample of 113 people who had recovered from SUD, aged 22-69, 78% men.Results Fifty-one percent of participants reported craving drugs during the isolation period and engaging in addictive behaviors. Significant differences were found in tobacco and alcohol consumption, gambling, and viewing of pornography online, before and after the outbreak of the pandemic, especially in participants who reported having engaged in these addictive behaviors to some extent before the outbreak. A hierarchical linear regression showed a significant explained variance (R2=44%, p<.001), with stronger feelings of loneliness and shorter length of time free from drug use being associated with stronger craving for drugs.Conclusions: The drug addiction treatment establishment should pay close attention and strengthen communication with people who recovered from SUD. It is necessary to develop real-time anti-craving and anti-replacement addiction interventions to prevent relapses.

COVID-19-related treatment service disruptions among people with single- and polysubstance use concerns.

Individuals with substance use disorders (SUDs), including those in long-term recovery, and their loved ones are facing rapid changes to treatment and support services due to COVID-19. To assess these changes, the Addiction Policy Forum fielded a survey to their associated patient and family networks between April 27 and May 13, 2020. Individuals who reported a history of use of multiple substances were more likely to report that COVID-19 has affected their treatment and service access, and were specifically more likely to report both use of telehealth services and difficulties accessing needed services. These findings suggest that individuals with a history of using multiple substances may be at greater risk for poor outcomes due to COVID-19, even in the face of expansion of telehealth service access.