Harm Reduction Strategies for Surviving A Pandemic

Blog authored by Dr. Jessica Katzman, Clinical Psychologist and Co-Founder of Healing Realms, on April 21, 2020.

We’ve all struggled in our own ways to adjust to the unfolding global crisis. Though the severity of the impact varies widely, humanity is generally contending with not only the tangible disruptions in every domain of our lives, but also the loneliness and isolation in being cut off from nourishing social contact and our various communities. Video chat burnout may leave us with shrinking connection options. We may be in intense grief after losing a loved one; we may be overworked or furloughed, bored or overwhelmed, checked out or completely frazzled, anxious or depressed.

We are trying our best to cope, and coping can look a lot of different ways.

There are some preliminary reports and observations that alcohol use has increased significantly during this first month of quarantine (42% more than usual in the Bay Area!). Legal cannabis sales in five states similarly increased, and some cities designated dispensaries as essential businesses. Virtual happy hours have rushed in to replace our after-work socializing opportunities.

TL; DR: attending to your mental health and extending yourself compassion is a legit change to make!

Quarantine has additionally disrupted access to treatment. AA meetings have been moved online, (which has its pros and cons); this impacts those in sober living environments who are required to attend weekly meetings to maintain their housing but might not have reliable internet access.

There is an outsized impact on people being treated for opioid use with medication-assisted treatments (especially those on daily dosing on-site protocols), due to disruptions in access to services, which may result in an uptick in relapses, and consequently, fatal overdoses.

(For more on that topic, see Harm Reduction Coalition’s suggestions for safer drug use to minimize transmission risk of COVID-19--such as not sharing supplies and other hygiene practices--as well as the City of San Francisco’s suggestions for medical providers who work with substance users, encouraging sufficient take-home prescriptions for opioid replacement therapies. Even the APA just released an statement encouraging providers to use harm reduction strategies!)

Though I agree with harm reduction-oriented neuroscientist Carl Hart that we don’t need to panic about a huge surge in addiction following quarantine, I still feel called to discuss how we might minimize the harms of our current situation.

Most of us are wrestling with the deleterious effects of losing the structure of our daily routines. Some have shared that as the line between "work" and "not-work" blurs, they’ve found that their alcohol or substance use has crept slowly into earlier hours of the day; those who are out of work may feel at a loss with what to do with their time.

Additionally, just as our levels of psychic stress escalate, our other methods of emotional regulation may be unavailable, and often we are left with the paradoxical reliability of substance use as a handy coping tool.
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Let us also not forget the enormous implications of the Rat Park study: social creatures forced into isolation will seek to numb with substances, when given the chance, as a way to escape a painful reality, but will then turn down so-called "addictive drugs" when placed in enriched, stimulating, social environments.

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Given all of this--our grief, fear, rage, isolation, and deep uncertainty about the future--the changes we see in our habits are totally understandable. (As the above linked articles and stats illustrate: you are not alone.) My efforts to bring this into conversation are meant never to shame, or to nag with unwanted advice, but to illuminate some potentially viable paths forward.

This may not be a time to take on drastic self-improvement projects, but perhaps to work towards more holistic, compassionate self-care. If you are interested in making some shifts in how you're using alcohol or other substances, or just wanting to use in a more mindful manner, I hope some of these tactics might be helpful for you.

I've written a blog series about the harm reduction approach to substance use, and today I’ll use my Menu of Change Options post to walk through some potential ways to manage one's habits and patterns:

You can reduce the AMOUNT you use each time

• Example: Having five drinks a day instead of six​

You can alter the FREQUENCY of your use

• Example: Using edibles every other day instead of every day

You can change the number or types of substances you MIX together

• Example: Using alcohol and ketamine on different days (a super good idea for several reasons!)

You can change HOW you take your substance (route of administration)

• Example: Switching over from smoking weed to edibles (as COVID-19 causes respiratory illness, smoking and vaping could worsen symptoms)

You can change the SITUATION that you use in (setting--perhaps the most challenging variable right now)

• Example: Invite some friends online to chat with you to keep you company as you use

You can put more effort into PLANNING your use

• Example: Cleaning your works and making sure you obtain fresh supplies regularly

You can try SUBSTITUTING a less harmful drug for a more harmful one:

• Example: Discuss initiating buprenorphine treatment to replace opiates with your medical provider

You can focus on OVERDOSE PREVENTION

• Example: Never Use Alone is a hotline that you can call when you have no choice but to use alone; if you become unresponsive, they will notify emergency services of your location to prevent overdose

If you decide that you are going to keep using just as you are now, you can still engage in SELF-CARE while using

• Examples: Eat regularly, drink water, engage in gentle movement, sleep as much as you are able, get medical treatment for any other conditions, and extend yourself gentle compassion as you work with this extremely challenging situation

You can attend to other MENTAL HEALTH and wellness variables (again, without changing your use at all)​, with an emphasis on decreasing isolation

• Examples: Enroll in a virtual support group, call your sponsor, find a therapist, or reach out to a friend (who can accept you without judgment)

Finally, though I might caution against big drastic changes right now, some are inspired to move towards ABSTINENCE, via different methods

• Examples: Cold turkey, “warm turkey,” tapering, trial moderation, sobriety sampling

• Note: if you have physical dependence/tolerance and have been using daily for some time, please use great caution in modifying your intake, and involve your medical provider with your plan so as to stay safe, as some of the greatest harm can arise from rapid detox!

Again, for a deeper dive into these strategies, you can check out my Menu of Change Options post, review my whole blog series on harm reduction, or pick up the excellent book Over the Influence: The Harm Reduction Guide for Managing Drugs and Alcohol for more detailed self-help strategies.

You may also desire professional assistance in designing an individualized harm reduction plan to meet your specific needs. The compassionate, skilled practitioners at Healing Realms offer harm reduction therapy, as well as multiple other modalities to assist in treating any underlying mental health conditions being exacerbated by current stressors.

Please don't hesitate to reach out to us if you have any questions, and, as always, I am available as a resource if you need assistance with appropriate referrals for care.

Take good care of yourselves, everyone!