Alcohol, tobacco and substance use during Covid-19

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Dr Reddy’s Part Two

This free live webinar on alcohol, tobacco and substance abuse was hosted by the Mail & Guardian and Dr Reddy’s in association with South African Depression and Anxiety Group (SADAG), with psychiatrist Dr Hemant Nowbath, clinical psychologist Neil Amoore and operations director of SADAG, Cassey Chambers.

No other country has banned alcohol and cigarettes. It is common knowledge in psychiatric circles that when people are under stress — such as when they enter rehabs — its best not to deprive them of creature comforts like cigarettes.

The virus and lockdown has left many feeling overwhelmed. It is a difficult time: there is loss of income and fear of unemployment, increased anxiety and depression. And with tobacco and alcohol banned, the stress has been exacerbated.

The government’s intention was to reduce movement of people and the effects of alcohol, and this has resulted in a reduction of drunken driving incidents. If people were locked up and drank excessively, their thinking was that this would result in more gender-based violence or increasing the patient burden at casualty and hospitals that needed to prepare for Covid-19 emergencies. But in spaces where there was alcohol abuse and violence, the violence has not abated.

In addition, smokers are now engaging in criminal behaviour by buying cigarettes on the black market, and there is mounting anxiety for them as their stocks diminish. Some people are buying contraband liquor at R500 a bottle; others are brewing their own alcohol, and some are buying contraband liquor that is actually quite dangerous.

Nicotine withdrawal is not fatal, but is uncomfortable and can heighten anxiety and stress levels. Many former addicts use cigarettes as a default, and now that they are not there, there is a risk of them relapsing. For many people, a drink creates a break at the end of the day. These people stocked up for three weeks, and here we are seven weeks later; they have been caught flatfooted, and it is creating challenges.

Alcoholics go through a range of withdrawal symptoms when having to go cold turkey, including delirium tremens, and often need to be hospitalised — it is a medical emergency. You don’t want to put your relative into hospital right now due to the risk of Covid-19 — some hospitals have been closed — and even if you can get somebody in after proper screening and testing, they are not allowed to have visitors.

There is a vast difference between choosing to voluntarily undergo withdrawal or rehabilitation and having it forced upon you. This creates a lot of anger, and we are worried about a loss of coping skills during this global crisis, which is already adding extra strain, anxiety and stress.

Shadow pandemic

Patients are coming in because of overdoses, relapses, medical emergencies such as withdrawals or suicide attempts. In the US many facilities are overwhelmed and cases of “death by despair” are increasing. Mental health problems are on the increase, and there is a looming problem of a “shadow pandemic” of increased mental problems following the Covid-19 pandemic.


Tips for family members who are helping to manage those who are giving up cigarettes and drinking at home: exercise compassion; stay in contact with professionals; make sure that those who are quitting get exercise, eat well, and stay busy. Also, they must drink lots of water, and if need be, they should consult a doctor. Hopefully some people have received reinforcement from family members, who have told them they are not inhaling second-hand smoke any more, that they look better, they are healthier, etcetera.

Binge drinkers are perhaps the people who are coping best in this period. Many people have quit during lockdown, but as they were forced to stop, will they stay off cigarettes and drink when they are able to buy them again? Relapse rates are high when people leave rehab centres. When the ban is finally lifted, some people may use again at higher levels, which is very dangerous.

This is the wrong time to stop people from smoking or drinking! It doesn’t help to take people off addictions if you don’t treat the underlying cause or provide the necessary support structures in place to help treat them. This lockdown was never meant to be punitive. It is a case of skewed priorities from a nanny state: we should really be worried about other issues, such as who is not getting food.

Helplines

SADAG Helplines providing free telephonic counselling, information, referrals and resources seven days a week, 24 hours a day. Call 0800 21 22 23, 0800 70 80 90 or 0800 456 789 — or the Suicide Helpline 0800 567 567.

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