People With Intellectual Disabilities May Be Denied Lifesaving Care Under These Plans as Coronavirus Spreads

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Advocates for people with intellectual disabilities are concerned that those with Down syndrome, cerebral palsy, autism and other such conditions will be denied access to lifesaving medical treatment as the COVID-19 outbreak spreads across the country.

Several disability advocacy organizations filed complaints this week with the civil rights division of the U.S. Department of Health and Human Services, asking the federal government to clarify provisions of the disaster preparedness plans for the states of Washington and Alabama.

The advocates say the plans discriminate against people with intellectual disabilities by deprioritizing this group in the event of rationing of medical care — specifically, access to ventilators, which are in high demand in treating COVID-19 cases. More than 7 million people in the U.S. have some form of cognitive disability.

Some state plans make clear that people with cognitive issues are a lower priority for lifesaving treatment. For instance, Alabama’s plan says that “persons with severe mental retardation, advanced dementia or severe traumatic brain injury may be poor candidates for ventilator support.” Another part says that “persons with severe or profound mental retardation, moderate to severe dementia, or catastrophic neurological complications such as persistent vegetative state are unlikely candidates for ventilator support.”

Other plans include vague provisions, which advocates fear will be interpreted to the detriment of the intellectually disabled community. For instance, Arizona’s emergency preparedness plan advises medical officials to “allocate resources to patients whose need is greater or whose prognosis is more likely to result in a positive outcome with limited resources.” Between a person with cognitive difficulties and a person without them, who decides whose needs come first?

Medical triage always forces hard decisions about who lives and dies. For instance, older people with shorter life expectancy or those with severe dementia are often deemed less deserving of scarce medical resources than younger, healthier individuals. The state plans make clear that the fate of those with intellectual disabilities is part of the wrenching debate.

HHS officials said they were opposed to rationing care for people with any kind of disability.

“Persons with disabilities should not be put at the end of the line for health services based on stereotypes or discrimination, especially during emergencies. Our civil rights laws protect the equal dignity of every human being from ruthless utilitarianism,” said Roger Severino, the director of the agency’s civil rights office.

“What we’re seeing here is a clash between disability rights law and ruthless utilitarian logic,” said Ari Ne’eman, a visiting scholar at the Lurie Institute for Disability Policy at Brandeis University. “What this is really about at the end of the day is whether our civil rights laws still apply in a pandemic. I think that’s a pretty core question as to who we are as a country.”

Advocates and families of those with intellectual disabilities say their community is especially vulnerable to the disease because many of those with significant impairments live in group homes or other congregate settings.

It can sometimes be difficult for people with intellectual disabilities to understand the pandemic and its demands, such as the need to wear masks and heightened protocols for social distancing and hand-washing.

The death of Emily Wallace, a 67-year-old with Down syndrome in a group home in Georgia, was an early warning sign of the dangers facing the community, advocates say.

Wallace was a woman of firsts. She and her husband, Richard, were the first couple with intellectual disabilities to marry in the state. They were the first to live independently in their own home in Albany, a small town in the southwestern part of the state. In mid-March, Emily was the first person with an intellectual disability in her community — and possibly one of the first in the nation — to be diagnosed with COVID-19.

She was taken to a local hospital where she died alone.

“Mrs. Wallace is once again the first, but this isn’t what we wanted to celebrate,” said Stacey Ramirez, state director for The Arc of Georgia, a nonprofit advocacy group that serves people with intellectual disabilities.

Emily and Richard Wallace were married for 18 years. A 1992 story in the Albany Herald depicted their life as happily domestic, mentioning that Richard hated to vacuum, while Emily didn’t like to dust, and that she did most of the cooking while he raked the leaves. They made payments on their home and both held down jobs. After Richard, who also had Down syndrome, died in 2018 at 65, Emily moved to a group home operated by The Albany Arc.

After a caregiver apparently brought the coronavirus into the home, Wallace fell ill. So did another resident, who was hospitalized.

Emily Wallace had a do not resuscitate order, so a ventilator would not have been an issue even if care were being rationed, said DeAnna Julian, executive director of The Albany Arc.

But as more people are getting sick, Julian said she worries that not enough testing for the virus is being done in Albany. She’s seeing individuals — both with and without intellectual disabilities — who appear to have mild symptoms of COVID-19.

“They’re just turning them around and sending them home, they’re putting them on” antibiotics, she said. “We live here in southwest Georgia where right now, all the cars are covered in yellow pollen and everyone has some kind of seasonal allergies. … Is it just your springtime cold or is it COVID-19?”

Julian doesn’t have masks, gloves or other safety equipment. She doesn’t have enough staff.

“It’s a difficult and critical situation here,” she said.

But no, Julian said, she didn’t see Wallace or the other group home resident receive treatment any different than anyone else. She said she wouldn’t stand for it.

“I’d take it all the way to the top, to the governor! They have every right to be treated like human beings,” Julian said.

With the Americans with Disabilities Act celebrating its 30th birthday this year, activists are questioning whether policymaking has come far enough in what some consider to be the final battle in the fight for civil rights.

In a March 18 letter to Wisconsin Gov. Tony Evers, the Survival Coalition, a group of advocacy organizations, wrote, “‘Quality of life’ has long been a pretext for denying treatment, including life-sustaining treatment, to vulnerable populations, particularly people with intellectual disabilities.”

Michael Bérubé and his wife, Janet, live in state College, Pennsylvania, with their son Jamie, who is 28 and has Down syndrome. Bérubé, a professor of literature at Pennsylvania state University and the author, most recently, of the book “Life as Jamie Knows It,” studies disability. He was not surprised to learn about state rationing plans that single out people with intellectual disabilities and other cognitive conditions.

“It would be a very rare person who sees a person with Down syndrome as innately as valuable and as able to contribute to society as anybody else,” Bérubé said.

Pennsylvania is among those states now scrambling to write up guidelines to determine who will have access to ventilators in case of medical rationing, according to media reports.

“In two weeks, when the resources get truly stressed out, we’ll see how much of this draconian stuff goes into practice,” he said.

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By: Amy Silverman, Arizona Daily Star
Title: People With Intellectual Disabilities May Be Denied Lifesaving Care Under These Plans as Coronavirus Spreads
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Published Date: Mon, 30 Mar 2020 07:45:56 +0000

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Long Term Effects of Overdoses on the Brain

Drug overdoses are a leading cause of preventable deaths in the United states. We know the dangers of overdoses; generally, they can kill. Opioids make up a large percentage of these deaths. In 2016, opioids made up 69 percent of drug overdose deaths. For people ages 25 to 64, drug overdoses cause more deaths than car accidents. Overdoses caused by opioids can be reversed if quickly countered with naloxone, an opioid antagonist.

In states like Massachusetts, opioid overdose deaths are on the decrease, but overdose emergency calls are on the rise. More people are surviving, but only 3 out of 10 people are receiving medical treatment for substance use disorder. What is happening to the other 70 percent of individuals?

Non-Opioid Overdoses

It is technically possible to overdose on nearly any recreational or medicinal drug available.

Cocaine overdose can involve seizures, heart attacks, strokes, and/or stop a person’s breathing. Amphetamine overdose can lead to seizures, cardiac arrest, and/or a huge spike in body temperature. Psychologically, high doses of stimulants can cause severe psychosis. MDMA overdoses have some similarities to stimulant overdoses, including increased body temperature, kidney failure, and hypertension. Alcohol overdoses most often occur when a person engages in binge drinking which can lead to breathing problems and interfere with cardiac functioning. 

The Mechanics of an Overdose

Heart problems and oxygen deprivation are two common symptoms of an overdose that we see in many drug-related deaths. But what happens to the brain during an overdose? Are there lasting effects? Can an overdose cause permanent brain damage?

The body is being poisoned during an overdose, and it’s usually not obvious to the person who ingested the substance. Someone who has just taken a lethal amount of opioids is unlikely to recognize what’s happening, although others may. As described by Maggie Ethridge for Vice, signs include “extreme drowsiness, cold hands, cloudy thinking, nausea and/or vomiting, and especially slowed breathing (fewer than ten breaths per minute).”

Once ingested or injected, an opioid makes a beeline through your heart and into your lungs. While in the lungs, your blood gets a dose of oxygen and that “now opioid-rich blood is pushed out to the rest of the body, where it plugs into the system of opioid receptors all over your body.” As the opioids enter the brain, they cause the neurotransmitter dopamine (the feel-good chemical) to overflow. That’s where the feeling of euphoria comes from. After repeated use, reaching that blissful state becomes harder, requiring increasingly larger doses of the same drug.

If you’ve overdosed, the next thing that will happen is that your brain’s basic systems that control breathing will be affected and your breathing will slow before stopping entirely. Circulatory functioning is next to be affected; your heart rate will slow as the opioid dampens neurological signaling in the brain. As your oxygen levels reduce, your heart begins having irregular rhythms and this can lead to a cardiac arrest.

Opioids are a depressant, decreasing heart rate and breathing. Overdosing on opioids essentially causes the central nervous system to go into such a depressed state that the body forgets to breathe. Without enough oxygen (hypoxia), the brain can become severely damaged. The longer someone goes without oxygen, the worse the damage can be.

Certain parts of the brain are more sensitive to the immediate effects of oxygen deprivation. The frontal lobe is particularly at risk of damage when experiencing anoxia (zero oxygen reaching the brain), resulting in problems with executive functioning. Executive functioning refers to a set of mental skills in the areas of working memory, inhibitory control, and cognitive flexibility. If a person experiencing an overdose has a seizure, this can cause further damage to the brain.

Toxic Brain Injury

Substance use disorders and brain injuries go hand in hand. An estimated 25 percent of people who enter brain injury rehabilitation have had problems with drug use and half of people entering substance use treatment have experienced a brain injury. Each of these conditions makes the other worse. 

Toxic brain injury is a term that has been coined to encapsulate the type of injuries that occur after an opioid overdose. It is also referenced under the category of acquired brain injuries, which include instances of brain damage that occur after someone is born but are not connected to degenerative or congenital diseases. 

The white matter of the brain can sustain damage from repeated oxygen deprivation. The consequences of toxic brain injury increase if someone experiences multiple non-fatal opioid overdoses. Despite what we know about how overdoses can kill, there is scant literature regarding chronic health outcomes for people who have survived multiple overdoses. What research does exist focuses on brain injuries due to hypoxia/anoxia.

From what we do know, certain areas of the brain are most likely to be harmed and can “lead to the development of severe disability.” These areas affect neurological processes; short-term memory loss, disorientation, even acute amnesia have been observed. Survivors may develop physical problems such as loss of control over bodily functions, lack of coordination, nerve damage and subsequent reduction in the ability to use a certain limb or body part, or even paralysis. Less severe but still serious symptoms include slower reaction times, motor skill disturbances, memory problems, and overall “diminished physical functioning.”

Medical Treatment

Only 3 out of 10 people who overdose on opioids and survive seek medical treatment for addiction. For every reported overdose death, there “may be five nonfatal overdoses, many of which go unreported.”

This isn’t to say that anyone who has ever survived an overdose has brain damage, but rather that more research and advocacy needs to focus on surviving overdoses and how to best move forward with healing and increasing rates of recovery.

NASHIA (National Association of state Head Injury Association) recommends that substance use disorder treatment services should be available and accessible for people who have sustained a brain injury. They also recommend that medical providers regularly screen patients for a history of brain injury and to ensure that people can receive treatment for any cognitive, behavioral, and/or physical disabilities due to a brain injury.

Reducing overdoses is a critical aspect of preventing these kinds of chronic injuries. Once a person has one overdose, they’re more likely to have another, and that likelihood increases with each overdose. When available and implemented, harm reduction principles work to reduce this likelihood and improve outcomes. There is no one-size-fits-all approach to recovery from substance use disorder that will work for everyone. Harm reduction strategies like widespread use of naloxone improve the long-term health effects of an overdose.

By: Kristance Harlow
Title: Long Term Effects of Overdoses on the Brain
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Published Date: Thu, 30 Jan 2020 07:12:47 +0000

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OxyContin Maker Explored Expansion Into “Attractive” Anti-Addiction Market

Not content with billions of dollars in profits from the potent painkiller OxyContin, its maker explored expanding into an “attractive market” fueled by the drug’s popularity — treatment of opioid addiction, according to previously secret passages in a court document filed by the state of Massachusetts.

In internal correspondence beginning in 2014, Purdue Pharma executives discussed how the sale of opioids and the treatment of opioid addiction are “naturally linked” and that the company should expand across “the pain and addiction spectrum,” according to redacted sections of the lawsuit by the Massachusetts attorney general. A member of the billionaire Sackler family, which founded and controls the privately held company, joined in those discussions and urged staff in an email to give “immediate attention” to this business opportunity, the complaint alleges.

ProPublica reviewed the scores of redacted paragraphs in Massachusetts’ 274-page civil complaint against Purdue, eight Sackler family members, company directors and current and former executives, which alleges that they created the opioid epidemic through illegal deceit. These passages remain blacked out at the company’s request after the rest of the complaint was made public on Jan. 15, 2019. A Massachusetts Superior Court judge on Monday, Jan. 28, 2019 ordered that the entire document be released, but the judge gave Purdue until that Friday to seek a further stay of the ruling.

The sections of the complaint already made public contend that the Sacklers pushed for higher doses of OxyContin, guided efforts to mislead doctors and the public about the drug’s addictive capacity, and blamed misuse on patients.

Citing extensive emails and internal company documents, the redacted sections allege that Purdue and the Sackler family went to extreme lengths to boost OxyContin sales and burnish the drug’s reputation in the face of increased regulation and growing public awareness of its addictive nature. Concerns about doctors improperly prescribing the drug, and patients becoming addicted, were swept aside in an aggressive effort to drive OxyContin sales ever higher, the complaint alleges.

Among the allegations: Purdue paid two executives convicted of fraudulently marketing OxyContin millions of dollars to assure their loyalty, concealed information about doctors suspected of inappropriately prescribing the opioid, and was advised by global consulting firm McKinsey & Co. on strategies to boost the drug’s sales and burnish its image, including how to “counter the emotional messages” of mothers whose children overdosed. Since 2007, the Sackler family has received more than $4 billion in payouts from Purdue, according to a redacted paragraph in the complaint.

“The payments were the motivation for the Sacklers’ misconduct,” the complaint says. “And the payments were deliberate decisions to benefit from deception in Massachusetts, at great cost to patients and families.”

In 1998, two years after OxyContin was launched, Dr. Richard Sackler, a son of Purdue co-founder Raymond Sackler, instructed executives in an email that its tablets were not merely “therapeutic” but also “enhance personal performance,” like Viagra. Fifteen years later, he complained in another email that a Google alert he set up for OxyContin news was giving him too much information about the drug’s dangers.

“Why are all the alerts about negatives and not one about the positives of OxyContin tablets?” he asked a company vice president. Staff immediately offered to replace Sackler’s alert with a service that supplied more flattering stories, according to the complaint.

The redacted paragraphs leave little doubt about the dominant role of the Sackler family in Purdue’s management. The five Purdue directors who are not Sacklers always voted with the family, according to the complaint. The family-controlled board approves everything from the number of sales staff to be hired to details of their bonus incentives, which have been tied to sales volume, the complaint says. In May 2017, when longtime employee Craig Landau was seeking to become Purdue’s chief executive, he wrote that the board acted as “de-facto CEO.” He was named CEO a few weeks later.

In a statement in response to questions about the redacted material, the company said that Massachusetts “seeks to publicly vilify Purdue, its executives, employees and directors by taking out of context snippets from tens of millions of documents and grossly distorting their meaning. The complaint is riddled with demonstrably inaccurate allegations.”

Purdue acknowledged in the statement that it was considering acquiring the rights to sell drugs that combat addiction or reverse the effects of an overdose. It criticized the state for “casting in a negative light” the company’s exploration of a potential acquisition of an addiction treatment that was already on the market, “even though the company never actually made the acquisition.”

Purdue also pointed out that OxyContin is approved by the Food and Drug Administration. It said that most opioid overdoses “now result from heroin and illicit fentanyl.”

The Sackler family was once best known for its philanthropy. Its name is engraved on museums and university buildings across the world. A group of activists has called on organizations to stop accepting Sackler donations and for the family name to be stripped from some institutions. Aggressive marketing of OxyContin is blamed by some analysts for propelling the crisis that has resulted in 200,000 overdose deaths related to prescription opioids since 1999.

After its 1996 launch, OxyContin rapidly became a top seller. But reports of patients abusing the drug soon followed. OxyContin contained more pain relief medication than older drugs, and crushing and snorting it was a simple way to get high fast. In 2007, Purdue pleaded guilty to federal charges of understating the risk of addiction and agreed to pay $600 million in fines and penalties. Still, the company argued publicly that OxyContin has “done far more good than harm,” and it sought to place responsibility for the bad acts on “certain of its supervisors and employees.”

Privately, the complaint suggests, the Sacklers were concerned about alienating two executives, then-CEO Michael Friedman and then-legal counsel Howard Udell. Friedman and Udell each pleaded guilty in 2007 in U.S. District Court in Abingdon, Virginia, to a misdemeanor charge of misbranding OxyContin, as did a former executive. The board signed off on the three executives’ decisions to plead guilty. No member of the Sackler family pleaded guilty.

Purdue paid $5 million to Udell in November 2008, and up to $1 million in November 2009, the complaint states. In February 2008, the company paid $3 million to Friedman. The complaint doesn’t mention any payments to the former executive.

“The Sacklers spent millions to keep the loyalty of people who knew the truth,” the complaint alleges.

Udell died in 2013. A person answering a phone number listed to Friedman declined comment.

The plea deals did little to hinder OxyContin sales or the Sacklers’ hands-on management. At the direction of the board, Purdue repeatedly increased its sales force, which pushed doctors to prescribe higher opioid doses.

In 2008, the same year that Purdue paid Udell and Friedman, Richard Sackler advised other family members that it was important to select a new chief executive who was loyal to the family. “People who will shift their loyalties rapidly under stress and temptation can become a liability from the owners’ viewpoint,” he allegedly wrote. A defendant in the Massachusetts lawsuit, Richard Sackler served in a number of different positions at the company before being named president in 1999 and then co-chairman of the board in 2003.

The company did install five new, non-family board members in the wake of the federal investigation. But in hundreds of board votes, the new directors never opposed the family, according to the complaint. Although Purdue does not operate outside the U.S., board meetings took place at a castle in Ireland as well as in Bermuda, London, Portugal and Switzerland.

When sales results disappointed, Sackler family members didn’t hesitate to intervene. In late 2010, Purdue told the family that sales of the highest dose and most profitable opioids were lower than expected, according to the complaint. That meant an expected quarter-end payout to the family of $320 million was at risk of being reduced to $260 million and would have to be made in two installments in December instead of one in November.

That news prompted a sharp email question from Mortimer D.A. Sackler, whose late father, also named Mortimer, was a Purdue co-founder. “Why are you BOTH reducing the amount of the distribution and delaying it and splitting it in two?” he asked. “Just a few weeks ago you agreed to distribute the full 320 [million dollars] in November.” The complaint doesn’t say how much was ultimately paid.

From 2009 until at least 2014, McKinsey helped Purdue shape its message for selling OxyContin and overcoming concerns about addiction and overdoses, according to redacted passages. The consultant told Purdue in a slide presentation that it could increase prescriptions by convincing doctors that opioids provide “freedom” and “peace of mind” and give patients “the best possible chance to live a full and active life.”

Purdue staff, according to the complaint, told the Sacklers that McKinsey would study “patient pushback” to encourage hesitant doctors to prescribe opioids. In a meeting with Purdue executives, McKinsey planned how to “counter the emotional messages from mothers with teenagers that overdosed in [sic] OxyContin” by recruiting pain patients to talk about the need for the drugs.

In a 2013 report, McKinsey recommended directing sales representatives to focus on the most prolific opioid prescribers because that group writes “25 times as many OxyContin scripts” as less prolific prescribers. Because prescription rates rose in tandem with visits from sales reps to doctors, McKinsey recommended increasing each salesperson’s quota from 1,400 visits a year to closer to 1,700. McKinsey estimated that targeting the most frequent prescribers could boost OxyContin sales by hundreds of millions of dollars. The quotas rose, as did total visits, the complaint states. Purdue said it planned to decrease visits relating to opioid products, and any increase was due to promoting a laxative.

McKinsey also recommended Purdue fight back against efforts by a major pharmacy chain, the U.S. Drug Enforcement Agency and the U.S. Department of Justice to stop illegal opioid prescribing, the complaint states. These new rules were cutting into sales of the highest doses, which were also the most profitable, it says. The complaint doesn’t say if Purdue followed McKinsey’s recommendation. Purdue said the recommendations “actually relate to ensuring continued access to pain medicines for appropriate patients.”

A McKinsey spokesman declined comment.

In September 2014, Purdue embarked on a secret project to join an industry that was booming thanks in part to OxyContin abuse: addiction treatment medication. Code-named Project Tango, it involved Purdue executives and staff as well as Dr. Kathe Sackler, a daughter of the company co-founder Mortimer Sackler and a defendant in the Massachusetts lawsuit. She participated in phone calls and told staff that the project required their “immediate attention,” according to the complaint.

Internally, Purdue touted the growth of an industry that its aggressive marketing had done so much to foster.

“It is an attractive market,” the team working on the project wrote in a presentation. “Large unmet need for vulnerable, underserved and stigmatized patient population suffering from substance abuse, dependence and addiction.”

While OxyContin sales were declining, the internal team at Purdue touted the fact that the addiction treatment marketplace was expanding.

“Opioid addiction (other than heroin) has grown by ~20%” annually from 2000 to 2010, the company noted. Although Richard Sackler had blamed OxyContin abuse in an email on “reckless criminals,” the Purdue staff exploring the new business opportunity described in far more sympathetic terms the patients whom it now planned to treat.

“This can happen to any-one – from a 50 year old woman with chronic lower back pain to a 18 year old boy with a sports injury, from the very wealthy to the very poor,” it said.

Company documents recommended becoming an “end-to-end pain provider.” Initially, Purdue intended to sell one such medication, Suboxone, which is commonly retailed as a film that melts in the mouth. When Kathe Sackler asked staff members to look into reports that children might be swallowing the film, they reassured her. They responded, according to the complaint, that youngsters were overdosing on pills, but not the films, “which is a positive for Tango.”

In 2015, Purdue turned its attention to another potential product, the overdose reversing agent known as Narcan, calling it a “strategic fit.” Purdue executives discussed how its sales force could promote Narcan to the same doctors who prescribed the most opioids. Purdue said in the statement Wednesday that it decided against acquiring the rights to sell Suboxone and Narcan.

While those initiatives appear to have stalled or ended, Richard Sackler received a patent last year for a drug to treat addiction, according to the complaint. The patent application states that opioids are addictive and refers to people who suffer from substance use disorders as “junkies.”

Besides being a defendant in the Massachusetts case, Richard Sackler was deposed in a lawsuit against Purdue in Kentucky, which the company settled. It’s believed to be the only time a member of the family has been questioned under oath about OxyContin and its addictive properties. The Kentucky Court of Appeals has ordered the release of his deposition, in response to a motion by STAT, but Purdue is asking the state Supreme Court to review the ruling. Hundreds of other lawsuits filed by states, cities, counties and tribes against Purdue have been consolidated in a pending case in federal court in Ohio.

The Massachusetts complaint cites multiple incidents of Purdue allegedly sitting on information, sometimes for years, about doctors it had reason to believe were inappropriately prescribing OxyContin. In 2012, a Purdue employee appealed to the company’s head of sales to alert health insurers to data the company collected about doctors suspected of abusing or illegally prescribing OxyContin. The list of doctors was code-named Project Zero.

“At a basic level, it just seems like the right and ethical thing to do,” the employee wrote. “Doing so could help those companies identify those physicians that may be of a concern, not just with respect to our products, but also other” pain medications. “As a result, if it reduces abuse and diversion of opioids then it seems like something we should be doing.”

The idea was rejected and the employee left the company a month later, according to the complaint.

Update, Jan. 31, 2019: The day after this article was published, a judge rejected Purdue’s request for a further stay, and the entire complaint was made public.


This story was originally published by ProPublica on January 30, 2019. ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.

By: David Armstrong, ProPublica
Title: OxyContin Maker Explored Expansion Into “Attractive” Anti-Addiction Market
Sourced From:
Published Date: Tue, 28 Jan 2020 07:21:57 +0000

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7 Science-Based Strategies to Cope with Coronavirus Anxiety

As the SARS-CoV-2 virus continues its global spread and the number of diagnosed COVID-19 cases continues to increase, anxiety related to the outbreak is on the rise too.

As a psychologist, I am seeing this in my practice already. Although feeling anxiety in response to a threat is a normal human reaction, sustained high anxiety can undermine constructive responses to the crisis. People who already suffer from anxiety and related disorders are especially likely to have a hard time during the coronavirus crisis.

The following suggestions, based on psychological science, can help you deal with coronavirus anxiety.

1. Practice tolerating uncertainty

Intolerance of uncertainty, which has been increasing in the U.S., makes people vulnerable to anxiety. A study during the 2009 H1N1 pandemic showed that people who had a harder time accepting the uncertainty of the situation were more likely to experience elevated anxiety.

The solution is to learn to gradually face uncertainty in daily life by easing back on certainty-seeking behaviors.

Start small: Don’t text your friend immediately the next time you need an answer to a question. Go on a hike without checking the weather beforehand. As you build your tolerance-of-uncertainty muscle, you can work to reduce the number of times a day you consult the internet for updates on the outbreak.

2. Tackle the anxiety paradox

Anxiety rises proportionally to how much one tries to get rid of it. Or as Carl Jung put it, “What you resist persists.”

Struggling against anxiety can take many forms. People might try to distract themselves by drinking, eating or watching Netflix more than usual. They might repeatedly seek reassurance from friends, family or health experts. Or they might obsessively check news streams, hoping to calm their fears. Although these behaviors can help momentarily, they can make anxiety worse in the long run. Avoiding the experience of anxiety almost always backfires.

Instead, allow your anxious thoughts, feelings and physical sensations to wash over you, accepting anxiety as an integral part of human experience. When waves of coronavirus anxiety show up, notice and describe the experience to yourself or others without judgment. Resist the urge to escape or calm your fears by obsessively reading virus updates. Paradoxically, facing anxiety in the moment will lead to less anxiety over time.

3. Transcend existential anxiety

Health threats trigger the fear that underlies all fears: fear of death. When faced with reminders of one’s own mortality, people might become consumed with health anxiety and hyperfocused on any signs of illness.

Try connecting to your life’s purpose and sources of meaning, be it spirituality, relationships, or pursuit of a cause. Embark on something important that you’ve been putting off for years and take responsibility for how you live your life. Focusing on or discovering the “why” of life can go a long way in helping you deal with unavoidable anxiety.

4. Don’t underestimate human resiliency

Many people fear how they will manage if the virus shows up in town, at work or at school. They worry how they would cope with a quarantine, a daycare closure or a lost paycheck. Human minds are good at predicting the worst.

But research shows that people tend to overestimate how badly they’ll be affected by negative events and underestimate how well they’ll cope with and adjust to difficult situations.

Be mindful that you are more resilient than you think. It can help attenuate your anxiety.

5. Don’t get sucked into overestimating the threat

Coronavirus can be dangerous, with an estimated 1.4% to 2.3% death rate. So everyone should be serious about taking all the reasonable precautions against infection.

But people also should realize that humans tend to exaggerate the danger of unfamiliar threats compared to ones they already know, like seasonal flu or car accidents. Constant incendiary media coverage contributes to the sense of danger, which leads to heightened fear and further escalation of perceived danger.

To reduce anxiety, I recommend limiting your exposure to coronavirus news to no more than 30 minutes per day. And remember that we become more anxious when faced with situations that have no clear precedent. Anxiety, in turn, makes everything seem more dire.

6. Strengthen self-care

During these anxiety-provoking times, it’s important to remember the tried-and-true anxiety prevention and reduction strategies. Get adequate sleep, exercise regularly, practice mindfulness, spend time in nature and employ relaxation techniques when stressed.

Prioritizing these behaviors during the coronavirus crisis can go a long way toward increasing your psychological well being and bolstering your immune system.

7. Seek professional help if you need it

People who are vulnerable to anxiety and related disorders might find the coronavirus epidemic particularly overwhelming. Consequently, they might experience anxiety symptoms that interfere with work, maintaining close relationships, socializing or taking care of themselves and others.

If this applies to you, please get professional help from your doctor or a mental health professional. Cognitive behavioral therapy and certain medications can successfully treat anxiety problems.

Although you might feel helpless during this stressful time, following these strategies can help keep anxiety from becoming a problem in its own right and enable you to make it through the epidemic more effectively.

[Insight, in your inbox each day.You can get it with The Conversation’s email newsletter.]The Conversation

Jelena Kecmanovic, Adjunct Professor of Psychology, Georgetown University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

By: Jelena Kecmanovic, Georgetown University
Title: 7 Science-Based Strategies to Cope with Coronavirus Anxiety
Sourced From:
Published Date: Fri, 27 Mar 2020 07:03:35 +0000

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Addiction Recovery in the Time of Coronavirus

My roommate finally found toilet paper after weeks of searching and while he was walking home from CVS with 12 rolls in his hands, a homeless guy approached him and said, “You guys found toilet paper. Good job,” and gave him a thumbs up. My roommate, without skipping a beat, said, “Do you need some?” and the guy kind of shrugged yes. So my roommate tore open a package and handed him a roll. He is a normie, by the way. He doesn’t have a program that instructs him on how not to be a selfish asshole which makes the story all the more moving to me.

Unfortunately, this isn’t the type of behavior we’re seeing in general, but it should be. Instead, people are fighting over sanitizing wipes at Sprouts. A woman walked into Erewhon coughing and somebody threw a banana at her–an overpriced organic one I’m sure–and said “Get the fuck out of here.” There is widespread panic and a scarcity mentality which is leading to hoarding, paranoia, and an “every man for himself” mindset. Personally, I find it all really depressing and in a time when I need to feel more connected, I feel less. 

I tweeted something about it and somebody mentioned modeling the behavior I wanted to see in others and that really struck me: Knowing people are scared and on edge, how can I cut them more slack, be more compassionate? Instead of being reactive, how can I be generous and loving toward people who are acting like dicks? As addicts and alcoholics, we know all too well how fear brings out the worst in people.

Ahh, fear. We are naturally fearful people so this pandemic can really ramp up our underlying anxiety. Personally, it has totally freaked me out. I have a shitty immune system anyway and am almost famous for always being sick… without some terrifying virus taking people out all over the world. On top of that, I have 82-year-old parents. One is wheelchair bound with a horrible flu (not COVID-19) and the other is just recovering from chemo. So yeah, I’m scared.

I hear program peeps being all “I choose to have faith and be positive. I’m not worried about it” while they do things that the CDC have warned us not to do. Ummm, okay, magical thinker. I’m all for being positive but let’s wash our fucking hands and not hang out in big groups. As the old Russian sailor proverb goes, “Pray to God, but row to shore.” 

When we get clean and sober, two different mindsets seem to emerge. One is “we’re addicts and alcoholics. We’ve survived a killer disease. Nothing can take us down.” Those people are the ones who still push for live group meetings. “Recovery first!” they chant. “Fuck fear!” I know a few places that have re-opened their homegroups, limiting the number and spreading out the participants, claiming it felt “rebellious.” Is it rebellious or is it just classic alcoholic defiance and selfishness? Let’s say you go to a meeting, catch it from an asymptomatic carrier and then go home and give it to your nana or some old woman at the market and kill her? And Jesus, is that what it’s come to? That having a meeting gets our adrenaline pumping and feels risky? Man, get a hobby.

The other mindset I’ve seen when people get clean and sober is hypochondria, an OCD cleanliness, and an obsession with health. People who shot up with toilet water are now carrying Purell or drinking kale smoothies or doing ozone therapy; that ironic swing from smoking meth to becoming vegan and doing crossfit. These people are like: “I survived all that stupid shit and now I want/need to take care of my body and certainly don’t want to die from a virus.”

Those people, and I count myself among them, are currently flipping out. Even before COVID-19 hit, I thought every headache was a brain tumor, every cramp was pancreatitis. I was never particularly obsessed with germs but now I try to push elevator buttons and open doors with the sleeve of my distressed vintage sweatshirt, only to find myself wiping my nose with said sleeve 30 seconds later. Old habits die hard.

A key to recovery is connection. As meeting halls and churches close their doors, most 12-step meetings have moved online. Although online meetings have existed for those who couldn’t or didn’t want to go to in-person meetings, membership has really jumped since COVID-19 hit the stage. These are great stopgaps during a time when social distancing or quarantine is suggested or mandatory. And sure, it’s wonderful to see the faces of your regular meeting people, all sequestered in their individual little homes. And it’s quite incredible to be in a big online meeting with 200 people from all over the world. There’s a feeling of solidarity that’s very much needed in this time.

But, let’s be honest, it’s not the same. I’m a very touchy person who likes to hug and these meetings are lacking the physical connection and face-to-face contact that I really crave. But a bigger concern than the lack of physicality for needy fuckers like me is that many older people who have been told to stay home aren’t technically savvy enough to get on Zoom or So are they being left out? And how about the deaf population? Of the 2,000 brick and mortar AA meetings in LA, I believe 12 have ASL interpreters. So let’s imagine how many of the new online meetings have them. Or people who don’t have access to computers or internet connections? Granted, this is uncharted territory for all of us and we’re all learning and adjusting to this new way of life together.

The isolation aspect of this pandemic is deadly for us. We are prone to isolate anyway and now we’re encouraged (or required) to do so. Isolation is the breeding ground not just for loneliness but for depression and negative thoughts to take over like some evil dictator. As I quarantine (when I’m not at the market or pharmacy), sleeping has become a big hobby, as has, I’m embarrassed to say, looking for cat sweaters for the newly shaved Colonel Puff Puff. Don’t judge. It’s easy to spiral out with too much time on your hands. And as mortifying as it is, at least I’m not getting loaded.

I checked in with one of my best friends, former news anchor and certified recovery specialist Laurie Dhue. “The only thing I can really compare this to (and it’s not exactly comparable) is the eeriness of the empty streets and the feeling of desperate helplessness immediately after the 911 attacks in NYC,” she said. “There was so much fear of the unknown, fear of uncertainty, ‘is Al-Qaeda going to attack again? Will life ever get back to normal? Is this the new normal?’ Those of us privileged to anchor the news during this terrifying time felt extra pressure to deliver. Of course I drank more than usual in the immediate aftermath of the terror attacks and during the war on terror for the next several years… we ALL drank more. In THIS crisis, I have 13 years of recovery so of course I can’t fall back on substances. But imagine being newly sober? I feel for the newcomers.”

She brings up two great points. One is that people have a natural tendency to anesthetize during terrifying periods like this. As people get ready to hole up at home, the cannabis dispensaries have lines around the block. Liquor stores are reporting booming sales.

Now that most bars are closed as well as many restaurants (apart from takeout or delivery), you can get alcohol to go as long as you buy it with food. The government is urging people to stay at home and drink. But as sober people, we can’t do that. I admit that I want to vape but I haven’t been. I know some people who have relapsed on cigarettes after years of not smoking and I know people who have already relapsed on drugs. People in recovery are especially vulnerable in these unique circumstances.

Dhue also points to the looming ambiguity and uncertainty that both 9/11 and the COVID-19 pandemic have created. Many alcoholics and addicts, control freaks to the max, loathe uncertainty despite it being an integral part of life. That’s one of the reasons why we drank and used. If we couldn’t control the outcome, at least we could control our feelings. Well, right now we don’t just have the uncertainty of the virus, but we have financial insecurity as well. So many people have lost their jobs as restaurants, schools, and gyms close and companies lay off employees in record numbers. So financial fear is rampant and that’s a big struggle for people in recovery even at the best of times. It’s really easy to let your mind take you to a place where you’re not only sick but homeless as well.

I have a lot of friends in the treatment business and they are working double or triple shifts. Intensive outpatient clinics have closed. Clients in residential treatment aren’t allowed to go to the few outside meetings still happening or have family or friends come visit. Behavioral health care workers are exposing themselves everyday. It’s mayhem. Many treatment staff feel human contact is key to recovery, but that isn’t allowed right now.

Patrick Reilly, program supervisor of LSS Aspen Center and Genesis House in Waukesha, Wisconsin, who has 10 years clean and sober, told me, “I’m fearful for residents currently in treatment because most aftercare has been cancelled and there’s no community support. We have to create a new path for these individuals and it’s going to have to be social media. It’s imperative that rehabs stay connected to their alumni and help guide them into whatever the new normal of community support is.” He continued, “Personally I’m concerned that the overdose numbers will either stay where they are or increase. I’m nervous for the slow creep relapse. Are alcoholics maybe starting to smoke pot? Are junkies starting to drink? Like I won’t do my drug of choice but….As a drug addict and alcoholic when I’m scared, I know the one thing that will make it better. As people in recovery, it’s imperative we reach out to those people whose number we got once a few weeks ago. It’s on us to stay connected. We need to take care of our own. We are the most selfish people in the world and if there was ever an opportunity to challenge or change that behavior and mindset, this is it.“

If you need help, financial, emotional, some dried noodles, whatever, ask for it. Stay on your meds. Do the virtual meetings. Call people. Stay connected. Be empathetic. Getting loaded will not help anything. There is no current escape from this. Do self-care, whatever that looks like. Don’t bang a lot of people. Cut yourself some slack. This is new and terrifying for all of us. Most importantly, be kind. This can either tear us apart or bring us together.

By: Amy Dresner
Title: Addiction Recovery in the Time of Coronavirus
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Published Date: Thu, 26 Mar 2020 06:47:57 +0000

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