The COVID-19 pandemic is causing an increase in relapses. Here are signs to look for.

Being aware of this issue is a big first step in helping vulnerable communities (such as those struggling with addiction) combat relapse during this pandemic.

Loneliness and isolation can trigger a relapse in those struggling to stay sober during this difficult time.

Photo by Sasha Freemind on Unsplash
  • Many mental health and addiction professionals are worried that the lockdown, quarantine and isolation caused by the COVID-19 pandemic will cause a surge in relapses of individuals who are struggling with sobriety at this time.
  • Stress, loneliness, isolation, boredom and a lack of support for the addiction community are the biggest triggers for relapse right now.
  • However, being aware of these triggers and supporting those in your life struggling with addiction through the help of online platforms can be a way to combat relapses during the COVID-19 pandemic.

According to the National Survey on Drug Use and Health, 19.7 million Americans (aged 12+) struggled with a substance use disorder in 2017 alone. That same year, statistics show 1 in 8 adults struggled with both alcohol and drug-use disorders at the same time.

Now, in 2020, we're dealing with a global pandemic, and many health care professionals worry these numbers will rise, as the stress and negative mental health impact of the pandemic could potentially trigger relapses in people who have reached sobriety.

    COVID-19 and addiction: why are relapses more common during a pandemic?

    sad woman thinking COVID-19 addiction relapse potential

    Stress, declining mental health, lack of community support and boredom can all trigger relapse - being aware of this can help prevent it.

    Photo by Monster e on Shutterstock

    Stress and declining mental health can contribute to relapse potential

    Dayry Hulkow, the primary therapist at Arete Recovery Center in Pembroke Pines, Florida explains, "We have already seen relapses happening, moments of crisis, obviously a lot of mental health issues associated with the addiction and all the stresses that are going on in the world right now."

    Hulkow, like many other addiction specialists, fears the pandemic will grow the rate of relapse of those struggling with addictions all around the world.

    Community supports sobriety, isolation triggers relapse

    The idea that community is a large part (maybe the most important part) of maintaining a sober lifestyle has been proven - and with many areas of the world on lockdown with orders not to attend gatherings or support groups, the fear of relapse is a well-placed one.

    Licensed mental health counselor Denny Kolsch explains the issue with lockdown orders and addiction recovery, "The message we are receiving is to stay away from people. Isolate. Don't be around people - and for people that are in recovery, that's a recipe for disaster."

    Boredom and limited access to the outside world can cause negative feelings that often lead to relapse

    "Also, there is boredom," explains Hulkow, "having to stay at home with very limited access to the outside world, hobbies, meetings, and employment can be triggering as well."

    Adding to that being quarantined in close-quarters with family members or friends, there could be family disputes or arguments that are also triggering for people who are recovering from addiction.

    Relapses are common throughout the journey to sobriety from drugs and/or alcohol - in fact, Addiction Center states that up to 60% of individuals struggling with addiction will have at least one relapse before reaching sobriety.

    This is especially more likely during a time where people may be isolated at home, feeling anxious by the news or fearful for their health or the health of their loved ones.

    Family members and friends of loved ones who struggle with addiction should be particularly mindful during stressful times such as a pandemic, as there may be signs that your loved one is struggling and nearing a relapse.

    Some signs of relapse during a pandemic can include:

    • Change in eating or sleeping habits
    • Declining hygiene
    • Lying or manipulative behavior
    • Glamorizing past drug/alcohol use
    • Bottling up emotion and/or mood swings that are unpredictable
    • Feelings or messages of hopelessness ("I just don't see a point in…")

    How to cope with the relapse potential during a pandemic

    concept of online support group AA/NA meeting during COVID-19 pandemic

    Online support groups, AA/NA meetings and virtual coffee dates can be a great way to stay in touch with members of the community and support each other during this stressful time.

    Photo by Nadia Snopek on Shutterstock

    The COVID-19 pandemic has raised a lot of problems for the general population, and these problems can be amplified and magnified by at-risk populations such as people struggling with addiction.

    The shock of going through a pandemic can cause confusion, loneliness, panic, stress, and fear - all of which can be triggers for relapse. Adding to that being isolated or quarantined in your home (either by yourself or with others) can bring on boredom, irritation, and feelings of inadequacy, again - all of which can be contributing factors to a relapse.

    How to cope with addiction during quarantine:

    • Alternative self-care methods (meditation, reflection, journaling) can help you find a new perspective and stay in tune with your feelings, which makes it much easier to spot (and prevent) a relapse.
    • Maintain contact with your outside supports for sobriety - attend virtual AA/NA meetings, phone hotlines, or keep in regular contact with your sober friends to support each other. An entrepreneur based in New York City has launched an app called Loosid, which is dedicated to providing hotlines and online services to assist those struggling with addiction during this time. As of April 2020, the app has seen over 60,000 users - the app creator, M.J Gottlieb, tells ABC News that there has been a 93.8% increase in active users during the pandemic.
    • Create a routine for yourself to occupy your mind and body, preventing boredom which can cause overthinking and stressful thoughts.
    • Staying active or creating an exercise schedule in your home can provide you with a rush of feel-good hormones (endorphins, dopamine, adrenaline) that can help your body stay healthy during the quarantine.

    Awareness is key in preventing a relapse and maintaining positive mental health

    While social distancing and lockdown measures have been put into place for very valid reasons, we simply cannot ignore the massive impact this has on our more vulnerable populations (people struggling with homelessness, addictions, and mental health conditions). The best way to support each other during this difficult time is to use online platforms to stay in contact and reconnect, keeping in mind that this is a very difficult time for some people.

    Being aware that the loved one in your life who has struggled with addiction in the past may relapse could be key to helping them stay sober.

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    The surprise reason sleep-deprivation kills lies in the gut

    New research establishes an unexpected connection.

    Reactive oxygen species (ROS) accumulate in the gut of sleep-deprived fruit flies, one (left), seven (center) and ten (right) days without sleep.

    Image source: Vaccaro et al, 2020/Harvard Medical School
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    • When the buildup is neutralized, a normal lifespan is restored.

    We don't have to tell you what it feels like when you don't get enough sleep. A night or two of that can be miserable; long-term sleeplessness is out-and-out debilitating. Though we know from personal experience that we need sleep — our cognitive, metabolic, cardiovascular, and immune functioning depend on it — a lack of it does more than just make you feel like you want to die. It can actually kill you, according to study of rats published in 1989. But why?

    A new study answers that question, and in an unexpected way. It appears that the sleeplessness/death connection has nothing to do with the brain or nervous system as many have assumed — it happens in your gut. Equally amazing, the study's authors were able to reverse the ill effects with antioxidants.

    The study, from researchers at Harvard Medical School (HMS), is published in the journal Cell.

    An unexpected culprit

    The new research examines the mechanisms at play in sleep-deprived fruit flies and in mice — long-term sleep-deprivation experiments with humans are considered ethically iffy.

    What the scientists found is that death from sleep deprivation is always preceded by a buildup of Reactive Oxygen Species (ROS) in the gut. These are not, as their name implies, living organisms. ROS are reactive molecules that are part of the immune system's response to invading microbes, and recent research suggests they're paradoxically key players in normal cell signal transduction and cell cycling as well. However, having an excess of ROS leads to oxidative stress, which is linked to "macromolecular damage and is implicated in various disease states such as atherosclerosis, diabetes, cancer, neurodegeneration, and aging." To prevent this, cellular defenses typically maintain a balance between ROS production and removal.

    "We took an unbiased approach and searched throughout the body for indicators of damage from sleep deprivation," says senior study author Dragana Rogulja, admitting, "We were surprised to find it was the gut that plays a key role in causing death." The accumulation occurred in both sleep-deprived fruit flies and mice.

    "Even more surprising," Rogulja recalls, "we found that premature death could be prevented. Each morning, we would all gather around to look at the flies, with disbelief to be honest. What we saw is that every time we could neutralize ROS in the gut, we could rescue the flies." Fruit flies given any of 11 antioxidant compounds — including melatonin, lipoic acid and NAD — that neutralize ROS buildups remained active and lived a normal length of time in spite of sleep deprivation. (The researchers note that these antioxidants did not extend the lifespans of non-sleep deprived control subjects.)

    fly with thought bubble that says "What? I'm awake!"

    Image source: Tomasz Klejdysz/Shutterstock/Big Think

    The experiments

    The study's tests were managed by co-first authors Alexandra Vaccaro and Yosef Kaplan Dor, both research fellows at HMS.

    You may wonder how you compel a fruit fly to sleep, or for that matter, how you keep one awake. The researchers ascertained that fruit flies doze off in response to being shaken, and thus were the control subjects induced to snooze in their individual, warmed tubes. Each subject occupied its own 29 °C (84F) tube.

    For their sleepless cohort, fruit flies were genetically manipulated to express a heat-sensitive protein in specific neurons. These neurons are known to suppress sleep, and did so — the fruit flies' activity levels, or lack thereof, were tracked using infrared beams.

    Starting at Day 10 of sleep deprivation, fruit flies began dying, with all of them dead by Day 20. Control flies lived up to 40 days.

    The scientists sought out markers that would indicate cell damage in their sleepless subjects. They saw no difference in brain tissue and elsewhere between the well-rested and sleep-deprived fruit flies, with the exception of one fruit fly.

    However, in the guts of sleep-deprived fruit flies was a massive accumulation of ROS, which peaked around Day 10. Says Vaccaro, "We found that sleep-deprived flies were dying at the same pace, every time, and when we looked at markers of cell damage and death, the one tissue that really stood out was the gut." She adds, "I remember when we did the first experiment, you could immediately tell under the microscope that there was a striking difference. That almost never happens in lab research."

    The experiments were repeated with mice who were gently kept awake for five days. Again, ROS built up over time in their small and large intestines but nowhere else.

    As noted above, the administering of antioxidants alleviated the effect of the ROS buildup. In addition, flies that were modified to overproduce gut antioxidant enzymes were found to be immune to the damaging effects of sleep deprivation.

    The research leaves some important questions unanswered. Says Kaplan Dor, "We still don't know why sleep loss causes ROS accumulation in the gut, and why this is lethal." He hypothesizes, "Sleep deprivation could directly affect the gut, but the trigger may also originate in the brain. Similarly, death could be due to damage in the gut or because high levels of ROS have systemic effects, or some combination of these."

    The HMS researchers are now investigating the chemical pathways by which sleep-deprivation triggers the ROS buildup, and the means by which the ROS wreak cell havoc.

    "We need to understand the biology of how sleep deprivation damages the body so that we can find ways to prevent this harm," says Rogulja.

    Referring to the value of this study to humans, she notes,"So many of us are chronically sleep deprived. Even if we know staying up late every night is bad, we still do it. We believe we've identified a central issue that, when eliminated, allows for survival without sleep, at least in fruit flies."

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