MENTAL HEALTH DURING TIMES OF CRISIS
More and more researchers are warning that the anxiety and fear associated with the Covid-19 pandemic, together with recent violence in the country as well as the economic fallout from these, will have a detrimental impact on mental health and leading to increased levels of depression and substance abuse.
Alcohol and over-the-counter medication have become a crutch in the wake of both the Covid-19 and political crises in the country, says Andre Brink, a psychologist at Riverview Manor, a specialist clinic in the Southern Drakensberg that is dedicated to the professional treatment of drug and alcohol addiction and dependence, eating disorders, anxiety, depression, trauma and stress.
Like many of his fellow medical professionals, he is already seeing first hand evidence of this disturbing trend.
He says that there has been a definite increase in the number of people who are seeking help at Riverview Manor in the wake of Covid-19.
DOING THE NUMBERS
Although there are still no over-arching statics or local studies available, a number of preliminary studies from the United States indicate cause for concern over people’s reaction to the Covid pandemic.
The impact of recent political violence in KwaZulu-Natal and Gauteng on mental health may never be quantified.
An American study, entitled Loneliness, Mental Health and Substance Abuse Amongst US Young Adults during Covid-19 (authored by Viviana Horigan, Renae Schmidt and Daniel Feaster (link: https://www.tandfonline.com/doi/full/10.1080/02791072.2020.1836435) points to elevated levels of loneliness, depression, anxiety, alcohol and drug use among young adults during COVID-19. 49% of respondents reported a great degree of loneliness. 30% disclosed harmful or dependent levels of drinking and 44% reported binge drinking at least monthly.
In a study conducted by Ralph DiClemente, professor of Social and Behavioral Sciences at the New York University School of Global Public Health, nearly 30 percent of respondents said they were drinking more during the pandemic. People who said their alcohol consumption had increased were more likely to report symptoms of anxiety or depression associated with COVID-19.
A study by researchers at NYU School of Global Public Health published in the journal Preventive Medicine, suggested that drinking grew the most amongst younger people during Covid-19, although older adults with anxiety and depression saw a sharper increase in their risk for harmful alcohol use.
THE DANGERS OF SELF MEDICATION
According to Andre, the abuse of alcohol as well as prescription and over the counter medication is definitely on the increase. The greatest challenges faced by his patients are the loss of loved ones and the financial implications associated with closing down a business or losing a job.
“People are struggling. Many people who are being admitted here are simply not coping. They feel overwhelmed and they turn to substances, mostly alcohol,” he points out.
Andre says that the substance most frequently abused by men who are struggling to cope with the fallout from the Covid-19 pandemic in South Africa appears to be alcohol. This continues even during times when alcohol sales are completely banned as people have either stocked up ahead of such shut downs or have devised a means of obtaining alcohol through illegal channels.
“People are finding ways to get their hands on alcohol so bans are not stopping them from continuing their abuse of alcohol. It is just forcing them to find other avenues,” he says.
Another aggravating factor, he notes, is the frustration of staying at home due to Covid or violence which can also escalate both stress and the drinking problem itself.
Whilst it is well documented that large scale consumption of alcohol at home is directly linked with gender based and family violence, there is also a positive side, he points out.
Substance abuse problems often become more apparent to other family members when a person who is abusing alcohol is confined to their home rather than able to go out to indulge. When a spouse or family member who was not aware of the severity of a drinking problem because it was not happening under his or her own roof, can now see first-hand what is happening, that person can then help that person to seek help.
People are able to see what is happening more clearly and identify a drinking problem that they did not know existed. That often leads to families staging interventions. During this period, I have seen more family members putting pressure on clients to seek help.”
“That doesn’t mean that the person is not wholeheartedly invested in his or her recovery but just that a spouse or a parent has initiated the process,” Andre adds.
THE DANGERS OF PRESCRIPTION MEDICINES
Women, on the other hand, tend to use other substances to cope – including prescription medication (sedatives and sleeping pills) as well as over-the-counter medicines such as painkillers.
He says that codeine based syrups and pain killers are of particular concern with a growing number of young people mixing codeine based syrups with cool drink.
“Older people seem to have discovered that, when they are stressed, an over-the-counter painkiller provides them with a sense of relief. They are starting to use this painkiller not just for headaches or migraines. But, unfortunately, these medications are habit forming.
Often people have been using these painkillers for a long time for headaches. They develop a tolerance and start using more and more. Now, we are seeing people using this as a crutch. Codeine based pain medication then becomes an escape from reality in a way.”
Andre adds that it is not always clear whether the pandemic and lock downs have intensified existing problems or created a whole new set of problems.
“I think that what often happens is that people who are struggling with other issues like depression or anxiety or stress, which are exacerbated when they lose a loved one or are anxious about their own health or financial welfare when the business they are trying to run is struggling to keep its head above water or they face possible retrenchment, try to self-medicate the anxiety or depression and turn to alcohol or prescription medication. “
He says that the dual diagnosis approach used at Riverview is particularly helpful here. “We recommend that people get help for their depression, anxiety or stress. At the same time, if they have been abusing a substance, it is important for them to also get help with that as well. We often see that there’s a bleed over of one into the other. Someone who is depressed or stressed or anxious tends to abuse a substance and that has a negative effect on their mood or anxiety. On the other hand, greater stress or anxiety can escalate an existing addiction. That’s why we suggest that people address both at the same time, in parallel rather than individually.”
His advice to individuals or to family members who have identified an emotional or substance abuse problem is to go for professional help as soon as possible rather than resort to “self-medication. A professional – a psychologist or psychiatrist – can provide help either on an outpatient basis or refer a patient to a facility such as Riverview.
“If you are a family member, try to engage with your loved one. Be honest with them, be upfront and tell them that you are concerned and that you would like them to get help,” he says.