My Dealer is Quarantined: Coping with Unplanned Withdrawal During the Coronavirus Crisis

We are currently experiencing a crisis unlike any before. The global coronavirus epidemic has brought dramatic changes to all our lives. Given the current circumstances, in which medical professionals are fighting for patients’ lives and the country is sliding into an unprecedented economic crisis, it may seem that addiction is a marginal issue at the moment. Nonetheless, the current crisis presents significant and unique challenges to people who are coping with addiction.

The combination of boredom, isolation, and the lack of a daily routine, together with health and economic anxieties, can lead to an increase in the use of addictive substances (such as cigarettes, alcohol and cannabis), as well as an increase in addictive behaviors (such as gambling, video games, and viewing pornography). See: The Coronavirus Crisis as a Risk Factor for Addiction.

Despite the many reasons why this crisis may increase the likelihood of relapse or lead to more engagement with addictive substances and behaviors, the current circumstances sometimes lead to the exact opposite – that is, to difficulty accessing the desired substance or behavior, which may lead to an unplanned withdrawal. This may result from travel restrictions that prevent someone from obtaining the addictive substance, the stopped activity of the person or entity that provides the substance (for example, a dealer who is under quarantine or sick), financial difficulties that make it harder to purchase the addictive substance, or, in some cases, limitations that arise from the social distancing requirements (such as in sex addiction or certain types of gambling).

There are two main categories of unplanned withdrawal, according to substance type:

1) Withdrawal from substances from which detox is physically dangerous or difficult

Severe withdrawal symptoms can occur when a person suddenly stops using alcohol, sleeping pills or sedatives (such as Clonax, Assival and Xanax), especially if they consumed large amounts over a prolonged period. Advanced age and certain other comorbid health conditions can lead to life-threatening withdrawal symptoms. Withdrawal from heroin or opioid painkillers (such as Tramadex, Percocet, Oxycodone and Fentanyl) can also cause severe symptoms, though while the distress can be great, in the absence of significant background illnesses this withdrawal is usually less dangerous than that from alcohol, sleeping pills or sedatives.

Given the potential for considerable distress and even danger, it is advisable, insofar as is possible, to plan the withdrawal from these substances in advance with medical guidance or supervision. Whether planned or unplanned, you should contact your doctor for instructions in any case of withdrawal from alcohol, sleeping pills, sedatives or opioids. They can sometimes provide medications to ease the withdrawal process and reduce the health risks involved.

2) Withdrawal from other addictive substances or behaviors

Withdrawal from substances such as tobacco, cannabis, cocaine, and stimulant medications, or from compulsive behaviors such as gambling and sex, may be difficult, but is usually not accompanied by severe physical symptoms. Depending on the substance, withdrawal may lead to restlessness, difficulty sleeping, irritability, mood swings, fatigue, and anxiety. These symptoms, together with the general difficulty that many are experiencing during this complex period, can make the withdrawal process even more challenging, and patients may find themselves substituting one addiction for another, depending on the substance or behavior available. For example, a person who has difficulty obtaining or affording the amount of cannabis that they are used to may increase their alcohol use, while a person with a sex addiction may consume more pornography.

What can help with withdrawal?

 

1. In the case of withdrawal from alcohol, sleeping pills, sedatives, and opioids (such as heroin and painkillers), contact your family doctor, psychiatrist, or local addiction treatment clinic in order to obtain the necessary medical guidance for the withdrawal process. Hospitalization may be recommended in some cases, although most health facilities these days are trying minimize hospitalizations due to social distancing guidelines.

2. You should contact your family doctor in the case of nicotine withdrawal because they may be able to provide medications to ease symptoms. Moreover, most health plan providers offer counseling by phone to support people undergoing nicotine withdrawal.

3. A variety of outlets are available to support people undergoing withdrawal from any substance or behavior:

(1) Friends and family members, who may be going through something similar and can be a source of mutual support.

(2) 12-step groups such as AA and NA

(3) Various support groups on the Internet (e.g., cannabis use reduction, cannabis use cessation)

(4) Local mental health clinics 

(5) Addiction treatment centers, many of which offer distance treatment (hotlines, clinics, social services, other treatment options)

(6) Support hotlines (such as the patient hotline operated by the Israel Center on Addiction)

4. There are several medications that can ease withdrawal symptoms from addictive substances and behaviors. Medication treatment can help reduce cravings and the risk of medical complications, as well as alleviate withdrawal symptoms and shorten their length.

5. Many people benefit from writing a pros and cons chart, in which you list the “advantages of using” on one side, and the “advantages of undergoing withdrawal” on the other. The lists should be completed with the utmost honesty. Close friends and family members can help in filling out the chart, but make sure that everything that is written down reflects what is truly important to you. A chart like this can help reflect the reality of continued substance use and build motivation for the withdrawal process.

6. The withdrawal process is often marked by restlessness, stress and anxiety, and these can often lead to difficulty sleeping. In such cases, relaxation and self-observation techniques, such as breathing exercises and mindfulness, can help. You can also get support from therapists in various types of treatment frameworks, as well as from online videos and various apps.

7. Some people prefer to reduce their use gradually, as opposed to others who stop using all at once, whether by choice or circumstance. A gradual reduction can be done by reducing the frequency of use, the amount used during each intake, or the concentration of the substance. It is important to set clear and realistic goals throughout the withdrawal process, and to write them down somewhere that you can see each day. Failing to meet these goals is sometimes part of the recovery process, but instead of giving up, it is important to simply set more realistic goals and continue the process.

8. We can benefit from taking advantage of the changes that were forced upon us in our daily habits and routines by directing ourselves toward adopting positive habits, such as exercise, playing music, studying or engaging in family activities. Here, too, it is important to set clear and realistic goals that can be translated into a weekly schedule and new daily routines.

9. Some addictions are associated with nutritional deficiencies, which in extreme cases can lead to anemia and neurological impairment. It is important to incorporate regular, nutritious meals into your daily routines and, in some cases, to take vitamin and mineral supplements if recommended by your doctor.

 

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