As an addiction medicine physician working closely with doctors, dentists, nurses and other healthcare professionals struggling with substance use disorder in Caron’s specialized program, I can already see how the COVID-19 pandemic is taking an overwhelming toll. Our healthcare professionals are devastated – emotionally, mentally and physically.
As healthcare professionals, we are taught to do anything we can to improve the lives of our patients, to the point of saving their lives. COVID-19 is so difficult because, so many times, our best has not been good enough. And because of the contagious nature of this virus, we are sometimes the only ones with patients when they pass away.
The stress and anxiety can be overwhelming. One nurse explained her experience to me. She was working long shifts in the hospital, dealing with COVID-19 patients. Then she would go home. She had isolated herself from her husband for fear of passing the virus on to him, so her time at home was spent alone, watching the news about the pandemic. Her anxiety skyrocketed, and her drinking was quickly out of control.
She described how she would go to work at the hospital but didn’t talk about her anxiety or fears. She would return home and watch the news, drinking more and more over time. She eventually reached a crisis point and reached out to Caron for help.
Fear, anxiety and isolation are a dangerous mix
Healthcare workers treating patients right now will often admit to feeling a lot of fear and anxiety. Every time you interact with a patient, you wonder if the patient unknowingly has this invisible virus.
Healthcare professionals certainly understand these risks when they make the decision to go into this line of work, but the fear of infecting friends and loved ones is real. On a personal note, I have a wife and five children at home. While none of them has said anything to me, I can sense their fear – We don't know what dad has been exposed to. So, it affects both the healthcare professional and their extended families.
Surprisingly, healthcare providers are also under tremendous financial stress during the pandemic. All elective procedures were postponed for many months, so many medical practices and hospital systems resorted to laying off workers. Dentists, ophthalmologists, optometrists, and surgeons are all laying people off. Many independent practices have seen their patient counts down by 75%, because people are postponing doctor appointments for anything not COVID-related. Physicians are taking pay cuts to keep their practices alive. Many practices are not going to survive.
This anxiety around the unknown is unrelenting. No one truly knows where the end is, or what it means, and the sense of constant dread is taking its toll on healthcare workers. The pandemic has also disrupted the normal rhythm of our lives. The outlets we once had for relieving our stress and anxiety and creating connection in our lives are no longer available in the same way.
What to watch for
The change from moderate to problem drinking can at times be subtle. Mood changes, increasing depression, poor sleep, malaise, and physical manifestations may be present. Substance use disorder is a progressive disease, one that may start small and seemingly innocuous but if continued can become progressively worse. This transformation happens at different speeds for different people, but sometimes it can be amazingly quick to develop.
Family, friends, and colleagues of healthcare professionals should be on the watch for signs of problems during this time. These include:
- A tendency to isolate. It is easy to blame this on the need to quarantine, but the need to physically isolate should not be confused with being emotionally and mentally disconnected. Look for ways to actively remain connected.
- No healthy way to manage stress. If the only way someone “lets off steam” is by having a drink, or a sedative, day after day, this is not healthy. Encourage exercise, meditation, and just good conversation. Perhaps talking to a therapist might help.
- A noted increase in drinking or substance use. If someone who only had an occasional drink once a week is suddenly drinking more frequently, that might be a red flag. Similarly, someone might start regularly having a drink or two over lunch, because they are home and “won’t be driving.” Share your concern that they might be drinking more than they realize.
- A focus on drinking or substance use. If they are concerned that they might be running low or become visibly upset to discover that their substance of choice has been used up, that might be a sign. Drinking or substance use might begin to displace other interests. Encourage transparent conversations with a doctor or addiction professional.
- Drinking or using regardless of the consequences. It’s not always the amount of alcohol or other substances that indicates an addiction but rather an all-consuming craving to be drinking or using even at the risk of life, livelihood, or family. This is time to seek outside help.
The earlier the problem is caught and properly addressed, the better.
Many health professionals with substance use disorder consider themselves “high functioning.” The lesson they have taken from their education, training, and professional life is that if they are able to “hold their liquor” and do their job, everything is fine. They work hard, and they deserve to blow off a little steam. The truth of the matter is, while they may not have lost their home or family, there's stress and craziness in the home that is often a direct result of their substance use. And every time, every day, that someone protects that person or just accepts this as normal behavior, the person is getting sicker. It is up to friends, family and colleagues to say something and bring the problem to light. There is no better time than right now.
How to get help for your drinking and substance use
The whole country is under exponential stress right now, and the struggles of healthcare providers are top of mind for everyone. People understand how challenging this experience is for healthcare workers. Now is the time to ask for help. An essential worker is not irreplaceable. Someone else can fill that role because it’s critical to address a substance use disorder before it’s too late.
For physicians in Pennsylvania, for example, we have wonderful programs for both doctors and nurses seeking help. For the physicians it’s the Physicians Health Program (PHP), and for the nurses it’s the Pennsylvania Nurse Peer Assistance Program (PNAP). Both are completely confidential. You can call anonymously and just say, “Here is what is going on with myself, or with my spouse. Do you have resources that might help me?” And they'll help direct you in the right way. The focus of these programs is simply to provide nurses and doctors access treatment when it’s needed.
Stress relief for all healthcare professionals
We must do more to empower and support healthcare professionals to talk about the stress and emotional difficulty they are experiencing. It's been ingrained in so many of us that you don't ask for help, rather you just have to do your job. It’s seen as a weakness if we acknowledge the mental health challenges that we experience – whether it’s a grief, anger, anxiety, fear or depression. And that's something that has to change, or else more people are going to suffer unnecessarily from the trauma they are experiencing in the battle against COVID-19. The truth of the matter is all of us, as healthcare professionals, become stronger and more resilient when we learn how to express and manage our emotions in a healthy and constructive way.
As perhaps a first step, different professional organizations, like the American Medical Association (AMA), are implementing chat rooms where physicians can discuss the emotional impact of their work. There are also many great resources collated by the American College of Physicians.
As physicians, nurses, and other healthcare professionals, we're taught to do anything we can to help others. Just as importantly, we need to learn to take care of ourselves, our health and overall well-being.
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