An “epidemic hidden in a pandemic”.
1(np) That is what Andrea Raby, D.O. of Bayless Integrated Healthcare, calls the threat
to our youth who are now at increased risk of substance use disorder and overdose
in the wake of the COVID-19 pandemic.
“This is always a vulnerable time during this period in their growth, in their development,
in their growth of their identity, and often times what helps our adolescent population
is structure and predictability and of course with COVID, this renders everything
the opposite”.
1(np) Transitioning to remote or hybrid classes, social lives put on pause, canceled
athletics, and extracurricular activities leave some teens looking for ways to numb
the pain.
Dr. Raby is not alone in her concerns. Many experts believe the pandemic could lead
to a nationwide spike in substance use disorders as people struggle with the anxieties
and uncertainties borne of the pandemic. As much as we would like to believe that
our young people are somehow protected from these temptations, in truth, no group
is more vulnerable.
Left unchecked, addiction and substance use among young people can accelerate poor
health outcomes and lead to even worse behaviors as adults. Youth who are desperately
in need of care may not get the services they need if no one identifies the problem
early.
We know little about the emerging threats of COVID-19 on our youth. As I write this
in late September 2020, we are experiencing the phenomenon of “COVID fatigue” and
with it, some people are demonstrating a more cavalier approach to wearing masks and
social distancing. A new school year is being defined by remote learning and hybrid
classes, businesses are feeling the financial pains of prolonged restrictions, and
we are facing the advent of the annual “flu season”.
Much of the insight we do have about this issue is based on observations of previous
disasters. A Dutch study tells us that, in the long run, the negative behavioral and
emotional problems for adolescents decrease with time, but the effects regarding alcohol
use remain.
2
In the aftermath of Hurricane Katrina, “survivors were smoking cigarettes, consuming
alcohol, and experiencing alcohol consumption-related problems at a substantially
higher rate”.
3(p.1)
A Canadian study on adolescent substance use pre- and post-COVID-19 found that, “For
most substances, the percentage of users decreased; however, the frequency of both
alcohol and cannabis use increased. Although the greatest percentage of adolescents
was engaging in solitary substance use (49.3%), many were still using substances with
peers via technology (31.6%) and, shockingly, even face to face (23.6%)”.
4(p.1) To be sure, this is just one study that focused on a relatively small universe
of 1,316 Canadian high school students over a limited time of just three weeks, but
the implications are profound.
The impact of COVID-19 can be overwhelming, and it would be easy to become paralyzed
at the thought of this emerging threat to our youth, but complacence is not an option
when the stakes are so high.
To address this growing threat, we must be armed with more than good intentions. We
must empower and build the capacity of community mental health and addiction recovery
organizations to respond to and prevent future youth substance use during the current
pandemic and in future disaster scenarios.
Recognizing the National Council’s leadership role in community health, the Centers
for Disease Control and Prevention (CDC) entrusted us with a $2 million grant to assess
the current situation and develop and disseminate youth substance use prevention,
training, and capacity building resources: Youth Substance Use and Message Development
During COVID-19.
It is not our goal to create a campaign of glossy images and empty catch phrases with
no grounding in reality. There is already an abundance of such well-intentioned, but
ineffective material available. We aim to create an evidence-based campaign of effective
messaging and materials that will affect lasting change and build the capacity of
organizations, states, and local partners working to prevent youth substance use,
particularly during COVID-19, future disasters, shelter in place orders, or infrastructure
disruption challenges that may impact prevention, practices, and policies. This will
be a plan, not just for today, but for the future.
Because of the urgency of our current crisis, this ambitious undertaking will be completed
in an accelerated timeframe of just 10 months. It is a tremendous responsibility and
a formidable task, but I know our efforts can lead to real change, enduring change...
one step at a time.
As I reviewed the articles in this issue of JBHS&R, the work we are about to embark
upon with the CDC was never far from my mind and I find myself, once again, in awe
of our community of organizations; providers dedicated to the entire scope of mental
health and recovery from addictions. I am reminded that our project is just one small
part of a rich and diverse community dedicated to healing the mind and spirit.
Our project is just one point on the continuum of the journey to mental health that
begins with prenatal and infant care (the Weiss-Laxer et al. paper in this issue)
and continues as we find new ways to identify and address childhood and adolescent
trauma (the Donisch et al. paper in this issue); while supporting the transition-to-adulthood
process to help youth between 18 and 25 who are at risk of “aging out” of the system
(the Klodnick et al. paper in this issue) and examining the impact of caretaker attitudes
toward prevention of pediatric behavioral health problems (the Zimmermann et al. paper
in this issue).
5–8
We are living in an unprecedented time of uncertainty. The ramifications of the COVID-19
pandemic are emerging and will continue to emerge for the foreseeable future. Many
clinics that treat our most vulnerable people are fighting to keep their doors open.
The political landscape is in flux and we will continue our work with both sides of
the aisle to ensure that quality health care, with the hope of recovery, is available
to all people.
However, I only need to look as far as the members of the National Council, organizations
like the CDC that are making meaningful investments in our future, the futures of
those we care for, and those who are reading the pages of this journal to know that
we have the determination and the capacity to protect the health of our youth and
the next generation. It is our collective responsibility to reverse this growing trend
that is endangering our future and, together, we will.