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I recently had the good fortune to have an op-ed published in our local newspaper, the San Diego Union Tribune on August 29 (about the relationship between Covid-19 and Mental Health). In the article, I talk about the fact that pretty much everyone on Earth is currently struggling with intrusive fear. I normalized the sensation of fear pointing out that anxiety is more often about irrational and uninformed worries, whereas fear is the outcome of a real threat. Sadly, Covid has presented us with a very real threat as it is the rare person, indeed, who has not lost a friend or family member of this tragic disease.

As the mother of an adult son currently working hard to maintain two years of sobriety from an opioid use disorder, it pained me to say little in the article about the relationship between Covid-19 and its notable tendency to fuel emotional and physical distress in those struggling to maintain sobriety. Last night, I telephoned my son for a daily check-in and the call went to phone mail. As it was relatively early in the evening, it worried me that my son was not answering the phone and those old, cruel intrusive catastrophic fears reared their ugly heads. Has he relapsed? Is he dead from a fentanyl overdose?  Has he abandoned his new apartment? Is he in jail? Sadly, Covid-19 is finding many families struggling with these same questions wondering if they are being anxiously catastrophic or reasonable in their fears.

The bottom line is that human beings are deeply hard-wired to seek and sustain close social contact with others. As a harm reductionist, I am no huge fan of AA yet I have to acknowledge that AA and the rooms do serve hugely important needs in those suffering from SUDs; the need for close comradery, the need for affiliation, the need for validation and respect and the need for a shared mission. Martin Buber, the renowned Israeli philosopher, argues that “shared suffering” or what is more formally called “communitas” is a form of emotional crazy glue that binds people to one another. The question then remains, is a Zoom AA meeting adequately meeting the needs of its members? I, sadly, fear it is not.

I have noted that my son’s frequent physical attendance at AA meetings over the past two years has been notably impacted by Covid. He now attends the odd meeting but often stays home watching old movies. I fear that the loss of physical connectivity with hugs, back-pats and ‘‘attaboys’ is dampening down the experience of shared suffering. Again, as deeply physical animals, we also pine for those essential human embraces. Where but in an AA meeting or a church service are adult men welcome to publicly demonstrate physical affection for their friends?

Sadly, Covid-19 has caught many of us in the substance use arena unprepared. We fail to fully understand that our entire bio-psych-social world has transformed. Prior to Covid, my son was successfully attending school four days a week to complete his high school diploma. His father and I have been incredibly proud of his decision to work towards a diploma in lieu of getting a GED. He enjoyed and needed the daily structure and the regular feedback from his instructors and was within weeks of taking his final exam. Alas, the school closed its doors with Covid moving to a distance learning format.  For my son, years off the grid homeless and incarcerated found him not very tech-savvy. It has been a very painful stretch for my learning-disabled son to embrace technology without an instructor physically modeling what to do. I strongly suspect that his success at school was an additive in his engine supporting his ongoing sobriety. Without an in-person school experience, I fear that he will once again drop off the grid.

Six weeks ago, my son received a key to his first adult apartment. He was soon to leave his sober living community after 18 months of structured living, planning to move in two weeks. Alas, his sober living manager surprised everyone in the house with a rapid, 2-hour turnaround Covid-19 test. My son called in good spirits in the early afternoon stating that he would join us for dinner but first had to get his test results. Imagine our shock when he called soon after to say that he had tested positive. As it turned out, several members of his community tested positive. The outcome was totally shocking. My son and several of his housemates were, literally, asked to take their belongings and to immediately leave the house.  There were no provisions for sheltering in place. Horrifically, it was far too resonant of times past when our son called in tears from curbside with all his belongings thrown into a black garbage bag, stating that he had been kicked out of his housing because he relapsed. I fear some must have become homeless with this unfortunate lack of preparation. I do know that my husband, son and I felt deeply, negatively triggered informed by waves of memories of confusion, fear, abandonment and rejection. If ever there was an impetus to re-using, there it was.

My psychotherapy practice grows busier by the day because Covid-19 is wreaking havoc on everyone’s mental health. My patients are struggling to find healthy distractions and to stay engaged as best possible. My own mental health is somewhat fragile. I find myself awakening at 2 am worrying about the future and trying my best to challenge irrational fears that my son is going to return to the street. The good news is that my son remains sober and has a supportive, sober, engaged roommate. He was re-tested two days after the positive Covid test and came up negative. He remains close to several of his sober-living friends while enjoying some important adult autonomy. His father and I invite him to dinner twice a week to stay connected. Our health is nothing if our son is not thriving. We feel compelled to take what we see as this essential risk. In conclusion, Covid flies cruelly in the face of all we know that is a corrective experience for those suffering from substance use disorders. This, categorically, is not the time to shame or reject but when possible, to embrace.

Caroline Ridout Stewart recently retired from the UCSD Department of Psychiatry where she was a Clinical Instructor and Psychotherapist for over twenty years specializing in the treatment of anxiety and addictive illness. Caroline continues to be a harm reduction provider in her private practice where she enjoys working with those struggling with opioid misuse. She is the mother of a son who suffers from a co-occurring disorder and leads the local NAMI Co-Occurring Support Group for Family Members whose children suffer from both mental and addictive illness. Caroline has been the President of the board of A New PATH (Parents for Addiction Treatment and Healing) for 17 years promoting community Naloxone distribution. She is an artist and essayist. https://www.anewpath.org/

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