Adjusting to a Stressful COVID-19 World   

Adjusting to a Stressful COVID-19 World

COVID Command Center
Clinical Contributors to this story:
Ramon Solhkhah, M.D.
When COVID-19 first hit New Jersey, many of our fears were focused on staying safe from the virus and adjusting to challenges associated with family care, job loss and financial instability.

Now, we are more than seven months into the pandemic, and for most of us, those fears and isolation remain, compounded by the lack of normalcy in many aspects of our lives. Personal hobbies, gathering with friends, shopping, dining, going to the gym and other activities that help reduce stress are either unavailable or have to be done with extreme caution.

All of this creates a heightened level of anxiety, stress and depression, and an increased possibility of substance abuse or self-medicating. If you are experiencing any of this, you aren’t alone, and help is readily available.

“The behavioral health challenges associated with COVID-19 are a marathon, not a sprint,” says Ramon Solhkhah, M.D., co-chair of the Department of Psychiatry at Hackensack Meridian Health. “We each need to focus on our mental health, so that we can then focus on our physical health, work and families. Think of the airplane analogy: In the case of an emergency, put on your mask first before helping others.”

What History Tells Us

After natural disasters and mass-casualty events like Superstorm Sandy and 9/11, increased mental health and substance use issues followed. But many people were reluctant to seek behavioral health care following these events. Some may have ignored red flags, thinking the feelings would go away on their own, while others may have delayed seeking care because of other priorities or concerns about cost and access to care.

“We’re seeing similar trends with COVID-19, where people are struggling but may not be seeking care at the moment,” Dr. Solhkhah says. “Tragic events like Superstorm Sandy or 9/11 spanned a day or a few days—although, of course, we dealt with the consequences for a long time. With COVID-19, it has gone on for months with no sign of letting up. So this is a behavioral health crisis like no other in our lifetime.”

Barriers to Stress Relief

In this unique time, we often can’t rely on typical coping mechanisms like getting together with friends and family and having a clear separation of work and home.

“This health crisis has tremendous ramifications on every person’s overall well-being,” says Juliet Caldwell, M.D., director of Addiction Medicine at Hackensack Meridian Health. “We are being confronted daily with fear of getting sick, fear of close physical contact with those we care about and fear of losing loved ones to this devastating disease. Many are experiencing economic uncertainty, unemployment, and possibly the loss of a home or difficulty getting essential items like food—enormous stressors that cannot be overstated. At a time when we want and need to reach out to those we love to provide and obtain support, we are held back by very real fears. These uniquely challenging circumstances provide fertile ground for increasing self-medication with over-the-counter or illicit drugs, and it is the perfect environment for those already in recovery to suffer a full-blown relapse.”

Dr. Caldwell points out that people may struggle with substance use disorder and mental health challenges that are influenced by both genetics and the environment. The current circumstances with the pandemic create challenges for everyone. “When a person’s environment becomes stressful or unstable, those with genetic tendencies will be more susceptible to addiction, depression or anxiety,” she says. “However, this pandemic and prolonged isolation have a negative impact on almost everyone’s overall psychological health.”

Your First Line of Defense

If you have feelings of anxiety, stress, isolation, depression, changes in mood, appetite or sleep—or if you are struggling with alcohol or drug use—a first, trusted source of guidance can be your primary care doctor.

John Gumina, M.D., a primary care doctor at Hackensack Meridian Medical Group who has practiced for 44 years, has seen an increase in patients experiencing these behavioral health challenges over the past few months. “As a primary care doctor, I’m not just concerned about my patients’ physical health—their diabetes or hypertension, for example,” he says. “I also care about their emotional and mental well-being—their family dynamics or whether someone has lost their job.”

During appointments, he asks general questions to assess patients’ mental and emotional health, such as: How are you feeling with everything going on? Are you feeling extra anxious about anything specific? “I keep my questions open-ended, so patients can feel comfortable bringing up concerns or questions, and I can provide support,” Dr. Gumina says.

If you don’t have a primary care doctor, he suggests asking friends or family members for a recommendation. Or find a doctor near you.

When starting a conversation with your primary care doctor, Dr. Solhkhah recommends coming prepared with a list of mental health or addiction issues you’re having. “That way, you don’t forget your feelings or experiences when you speak with your doctor,” he says.

For substance use disorders specifically, Dr. Caldwell suggests it’s best to seek professional help to determine how much care you need and understand available care options.

“Making a commitment to change can seem overwhelming, and many people avoid the topic or would prefer to delay treatment until ‘a better time.’ So we suggest exploring types of treatment to get a better understanding of the process and what a personalized recovery plan would look like,” Dr. Caldwell says.

She adds that if you aren’t emotionally ready for that, and don’t have an imminent need for medical attention, peer-recovery groups are a good starting point. “You can get the recovery ball rolling simply by hearing from people who struggle from the same disease as you,” she says. “For many people, being understood and accepted is an important step on the road to treating the medical condition of substance use disorder.”

She points to peer-recovery groups such as Alcoholics Anonymous and Narcotics Anonymous as good resources.

More Support Than Ever Before

Support for behavioral health challenges is often misunderstood or misperceived. It doesn’t have to include checking into an inpatient center. A full range of treatments and services is available to provide relief and manage these medical conditions, from telehealth video visits with physicians, to outpatient services and programs, to integrative health and medicine therapies and urgent care centers with behavioral health services.

“Many highly effective medications have been proven to dramatically decrease overall mortality and relapse if used appropriately, particularly for those who suffer from opioid use disorder,” Dr. Caldwell says. “Reaching out to an addiction-trained doctor who can discuss these options with you can be crucial to your chance of recovery.”

In addition, many behavioral health services are available by telehealth, so people can get treatment in their own home. Peer recovery groups like AA and NA are meeting virtually. “Fortunately, many of the barriers to care have been removed, and there is increased availability and accessibility like never before,” Dr. Solhkhah says.

Adds Dr. Caldwell: “You are not alone, though you likely feel alone. There is help available on so many levels, and supportive, nonjudgmental, exceptional care is available close to home. Making the decision to discuss your feelings may be the hardest part of getting better. You will feel better, day by day, if you do.”

­­The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.


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