People with a dependency a hidden cost of lockdown

I have been worried about the health of a number of my patients with problematic alcohol and other drug use during lockdown.
 
Long days at home can increase the chances that people rely more heavily on alcohol and drugs.
 
This includes Mary, a 73-year-old whose multiple medical issues include long-term opioid and benzodiazepine use at risky levels for her age.
 
It was during lockdown that she finally hit the point of saying, ‘I need help’.
 
Ideally, it would have been possible for Mary to be admitted to hospital for a short period of stabilisation – to rationalise her medications in a safe environment.
 
But this just couldn’t happen, as putting an elderly person in hospital was too dangerous due to the risk of exposure to COVID-19. As a result, we’re slowly trying to cut down Mary’s doses while she remains in her home.
 
She fortunately has some family who are helping with dosing, as I was reluctant to ask her to attend the pharmacy in person for supervised dosing. 
 
I have also been worried about Cassie, a 27-year-old woman who has been severely alcohol dependent for three years. I’m currently doing telehealth with her, as she is terrified of leaving her house to attend appointments. During lockdown, she discovered that her local bottle shop home delivers.
 
Cassie would also benefit from a hospital admission for medication-assisted withdrawal, but she hasn’t felt safe to take this step. 
 
During our consultations over the phone, I can hear the top of the vodka bottle being unscrewed and the unmistakeable sound of swigs from the bottle. When I ask her if she’s drinking she replies, ‘Gawd, Hester, how did you know?’
 
The pandemic has been hard on many of us. For Joe, the loss of his job due triggered a relapse. He is once again dependent on the bottle, after working hard to overcome his reliance. 
 
‘I feel defeated and so miserable. And the wine is such a good friend,’ he tells me.  
 
Joe is likely to fall hard back into his old habit. I fear he may end up in crisis in the emergency department, looking for an inpatient admission to help him stop. 
 
These stories are not outliers. I’m seeing an increase in drinking in groups who have not traditionally come forward for help. Drug and alcohol services are busy, emergency departments are seeing more of these patients, and the fallout is extending to general practice.
 
What else am I seeing?
 
Parents of adult children who have lost their jobs calling me to raise the alarm. They had no idea about how much drinking their sons or daughters were doing until they returned home.
 
Relationships, too, are feeling the strain. Men, in particular, seem to be finding it hard to cope with the new constraints coupled with job losses. They’re drinking more, earlier in the day.
 
A recent Foundation for Alcohol Research and Education (FARE) poll found 20% of people reported buying more alcohol than before lockdown, with 70% of those drinking more than usual and a third of that cohort drinking daily compared to ‘BC’ – Before COVID-19. This cohort also reported being more likely to drink alone, earlier in the day, and more than planned.
 
Even though this first wave of the pandemic looks to have passed in Australia, our most vulnerable are still at risk.
 
Those without homes, those without the right kind of visas, those with existing mental health or alcohol and other drug issues, those at risk of family violence and those in financial hardship.
 
For some patients, those issues converge.
 
My patient, Lucie, is 24 years old. She is also 30 weeks pregnant and has been unable to get into a women’s detox and rehab service, as all the services closed in March.
 
She needs the support of an inpatient service because she knows she can’t stop her drug use on her own at home. She does not have stable housing. There is an abusive ex-partner in the house she does have.
 
My hope is that we do not forget about people like Lucie as we consolidate our successes against the coronavirus.
 
If we can make health systems more durable and extend services to the most vulnerable, we can ensure this group is not left out in the cold if there is a second wave. And ,for that matter even after this health emergency is over.
 
We have a chance to rethink how we support this vulnerable group.
 
* All names have been changed.

alcohol and other drugs coronavirus dependency lockdown