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APBAM 2020 : Tobacco Harm Reduction – Myths & Reality

APBAM 2020 : Tobacco Harm Reduction – Myths & Reality

According to the World Health Organisation, tobacco kills more than 8 million people worldwide each year, and is one of the biggest public health threats the world has ever faced. But contrary to popular belief that smokers are “uneducated regarding it’s harmful effects”, or are simply “not bothered to make an effort to quit”, studies have shown that 70% to 80% of smokers do hope to quit smoking. The only thing holding them back is that they can’t

Nicotine is widely known to be a highly addictive substance. It is the chemical in tobacco that makes it hard to quit and nicotine withdrawal symptoms that smokers experience can be extremely unpleasant physically and mentally. Apart from the intense craving for nicotine, withdrawal symptoms may also include sweating, increased irritability, difficulty in concentrating, as well as difficulty in sleeping. However, nicotine dependence is causing the compulsion to smoke, it is other chemical substances that cause physical damage to the body. Chemicals such as tar can paralyse the hair-like structures in the lungs (also known as the cilia), contributing to diseases such as chronic bronchitis. Moreover, smokers are also vulnerable to the development of lung cancer. Cigarette smoke contains a cancer-causing substance, benzopyrene, which can attack and damage the p53 gene. When the tumour-suppressor gene is damaged, cancer cells have a higher chance of proliferating due to uncontrolled cell division, hence increasing the risk of tumour growth. 

Ideally, quitting smoking and nicotine completely would be the best, but it’s proven to be tough for addicted cigarette smokers to stop all at once. As such, a harm reduction strategy would be switching to a less harmful nicotine alternative for smokers, and ideally would result in them ultimately quitting nicotine use altogether. This is all about lowering the health risks to individuals and wider society associated with tobacco smoking. Some of the more commonly known alternatives include electronic cigarettes and heated tobacco products (also known as heat-not-burn or HnB). Although these may not be accessible in Singapore, other countries have legalised these smoke-free nicotine products that generally deliver far lower levels of toxic compounds. 

E-cigarettes are battery-operated electronic devices that mimic the act of regular smoking by heating a liquid to generate an aerosol, which is inhaled by users through the mouthpiece and exhaled as a visible vapour. Often, the usage of e-cigarettes is also known as “vaping”. Not to be confused with e-cigarettes, HnBs work in a different manner. In some way, HnBs are a hybrid of traditional cigarettes and e-cigarettes.  In HnBs, the tobacco is heated to 350℃, compared to traditional cigarettes that combust and burn at a temperature of up to 900℃. On the other hand, e-cigarettes heat nicotine-containing liquid to approximately 250℃, causing it to be vapourised and then inhaled.

Although not risk-free, what makes e-cigarettes and HnBs a better option compared to conventional, combustible cigarettes? Cigarette smoke is pretty much the main cause of harm, with thousands of toxins released in high concentrations upon the combustion of tobacco. Unlike traditional cigarettes, its alternatives are smoke-free – this means that smoke-induced health effects are significantly reduced. When smokers make the switch to using e-cigarettes or HnBs, these devices also have the added advantage of replicating the ever so familiar hand-to-mouth ritual of smoking. However, it is crucial to note that both e-cigarettes and HnBs still contain nicotine, so while smoke-induced health effects are reduced, the effects of nicotine consumption is still prevalent, for as long as these products are used. 

It must be acknowledged that many health professionals, tobacco-use control professionals and policy-makers who recommend the harm reduction alternatives have very good intentions. They advocate reduction in conventional cigarette smoking as a pragmatic way of reducing the devastating health effects associated with nicotine dependency. However, good intentions must always be supported by strong evidence. 

This year, the Asia Pacific Behavioural and Addiction Medicine Conference (APBAM 2020) will be a socially distanced online conference. Focusing on “Tobacco Harm Reduction – Myths and Reality” for it’s first forum, the speakers will examine the use of new ways to overcome nicotine dependence, as well as the various policies that different countries have taken in their approaches and their effects on reducing the harms caused by cigarette smoking. Speakers will include Prof Alex Wodak (AUS), Dr. Jeremy Lim (SG), Dr. Takao Ohki (JP), Dr. Rusdi bin Abd Rashid (MY), Dr. Ben Cheung (HK), Dr. Munidasa Winslow (SG), Andrew da Roza (SG) & Dr Sivakumar Thurairajasingam. Do join us on 26th September 2020, we hope to see you there!


References:

https://www.who.int/news-room/fact-sheets/detail/tobacco (Accessed 06/09/2020)

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/about-e-cigarettes.html (Accessed 07/09/2020)

https://www.athra.org.au/what-is-tobacco-harm-reduction/ (Accessed 07/09/2020)

Treat Smokers with Compassion – Why Quit Smoking is so tough

Treat Smokers with Compassion – Why Quit Smoking is so tough

Written by: Andrew da Roza, Addictions Therapist

To non-smokers and those who have an occasional cigarette at a party or outside a bar, it is baffling why smokers just can’t simply quit. What’s the big deal?

If you think this, then the conclusion may be: “well they just don’t want to quit”; or “they are uneducated, and don’t know how much damage they’re doing to themselves and those around them”; “they have no conscience” or “they have no self-control”. 

The problem with these conclusions is that the scientific evidence doesn’t support them. 

70% to 80% of smokers want to quit – and many of them desperately want to quit – and most smokers fail.  

A majority have tried to quit multiple times – and about 40% are still drawn to smoking -even after losing fingers and toes to gangrene, or lungs to cancer and COPD, as a result of smoking. Many suffer heart attacks, mouth, throat and colon cancer, or labour under serious diabetes problems; some even lose their close relationships with their families. 

They wish that if only they could quit, their lives would be so much better – yet they continue to smoke. 

So, there is more to the compulsion to smoking than meets the eye. 

Perhaps kindness and compassion for smokers may be a more rational reaction – than dismissal, frustration, irritation, anger or contempt?    

There are very good reasons why the chemicals in cigarette smoke are so compelling – and it’s to do with our brains and our bodies. It’s not a mystery.  

Although nicotine in the smoke is a comparatively benign substance, and it doesn’t cause the damaging effects of the other harmful substances in the smoke – it is highly addictive. It is the nicotine that causes the addiction – but it is the tar and other substances that cause the damage. 

In addition to nicotine, there is another substance, in smoke, that creates a potentially “pleasant” psychoactive effect.  It is a monoamine oxidase inhibitor – which results in chemicals in the brain staying longer in the space between neurons and firing those neurons.

And the effect the smoker feels? Well, there can be numerous combinations of “positive” effects. 

Those smokers who feel down, moody and unmotivated, may feel a pleasant “lift” or “boost”. Anxious, fearful and nervous smokers, may feel calmer, and more able to think straight. Smokers who are tired, sleepy or lethargic, may be able to focus, concentrate and pull themselves out of their procrastination.  

Smoking helps some people become more energetic, have better reactions times and become more effective or efficient. Smoking enables people who are mentally tired with work or constant rumination, to feel like they are taking a break and “relaxing” from their thoughts. They can just let their minds gently wonder. They may even feel that after their “reverie” with a cigarette, they have managed to solve a problem that they have been grappling with.

Some people use smoking as a bonding experience. Ironically, all the community stigma that surrounds smokers makes some feel like a “band of brothers and sisters”, as they stand outside in smoking areas or in smoking rooms. It enables instant connection and the sense of “belonging”.

In short, the effects of smoking depend on how you are feeling in the moment. 

Insidiously, mental illness and other addictions result in many becoming vulnerable to smoking – either to cope with: their illness; the difficult side effects of their medication; and the social stigma against mental illness addiction that so oppresses and shames them. 

By way of examples, ADHD, schizophrenia, bipolar disorder, anxiety and major depressive disorders, and personality disorders, can all result in life-long suffering – that smoking may appear to “take the edge off”.  

There is now persuasive research that some people are more genetically susceptible to being addicted to cigarette smoke. They may get more of a “buzz” from it, they may be more tolerant to its side effects, the effects may wear off faster, and they may feel the withdrawal effects (when not smoking) more keenly. They may have more trouble starting to quit – and staying quit. 

There are many other vulnerability factors as well: adverse childhood events (which afflicts 2 out of every 3 Singaporeans); traumas; family and peer modelling; rebelliousness, isolation and loneliness, financial distress, problems in relationships and at work; and many more factors, may all conspire to lead smokers to smoke daily. 

Once they smoke enough cigarettes for long enough – the brain changes, it becomes “hijacked” by the smoke.  

Smokers experience brain changes as: 

  • Tolerance – the need for more smoking, more often, to get the same effect;
  • Withdrawals – 45 minutes to two hours after smoking, they may feel the exact opposite of what they felt when they smoked – and therefore need a cigarette to feel “normal”;
  • Impulsiveness – in the moment (of smoking), they forget about the harms of tobacco and their resolves to quit, and habitually light up;
  • Smoking triggers – smoking cues are everywhere – and they trigger the urges and cravings – and once these build up, they become overwhelming;
  • Stress – their stress response slowly but inexorably ratchets upwards, daily – so that even things that used to be experienced as minor, now elicit strong and intolerable emotions. If health, relationships, jobs and self-image are all on the line because of smoking – the stress can be intense. 

Luckily – there is a solution. Smokers now have access to psychotherapy, nicotine replacement therapy, quit smoking medication, and any number of other tools to help them on their quit journey. In other countries, new nicotine delivery technologies like e-cigarettes and heat-not-burn are being improved and refined – and they are much safer than smoking. 

Smokers deserve our respect and compassion in their struggle with cigarettes. And they don’t have to do it alone. So that the help-seeking and quit smoking load can be lightened. 

You can also hear more from Andrew at the 7th Asia-Pacific Behavioural & Addictions Conference (APBAM2020: Forum 1 – “Tobacco Harm Reduction: Myths & Realities).

 


 

The link between Anxiety and Alcohol Use; and Implications for Treatment and Early Intervention Especially In Youths

The link between Anxiety and Alcohol Use; and Implications for Treatment and Early Intervention Especially In Youths

Alcohol. A beverage that many people enjoy drinking; be it for socialisation or as an escape from reality. However, it is also a beverage that can harm your health and adversely affect many lives. Indeed, alcohol abuse has become increasingly rampant, where it is one of the leading causes of disease and death, with 5.3% of all global deaths and over 200 diseases and injury conditions resulting from the harmful use of alcohol. Worryingly, it is also a phenomenon that has affected Singapore, with 9.6% of Singaporeans engaging in binge drinking (as of 2016) and an increasing number of Singaporean young adults battling Alcohol Use Disorders (AUD). As such, alcohol abuse has become a growing cause of concern.

There are many reasons why alcohol consumption is increasing. Alcohol consumption has been perpetuated by the media in recent years, with an increase in advertising and marketing of alcohol. For instance, in Australia, people are exposed to about nine alcohol televised advertisements every month. In turn, exposure to such advertisements causes alcohol consumption to be glorified and promoted, where people have unrealistic positive expectations towards alcohol, believing that it boosts one’s mood and invokes cheerfulness and confidence. Additionally, alcohol consumption has also increased due to peer pressure. Be it a work engagement or partying with friends, people often find it hard to say no to alcohol, as that rejection may cause disapproval among colleagues or friends. Thus, many people engage in risky drinking behaviour to socialise and develop their relationships.

However, a more significant reason behind alcohol consumption is feelings of anxiety or having anxiety disorders. People with anxiety disorders have 2 to 3 times the risk of having alcohol use disorders (Smith & Randall, 2012). Many people tend to use alcohol to reduce social anxiety, as they believe that alcohol is an excellent aid to speak up and gain more confidence around others. Similarly, people use alcohol as a form of self-medication to overcome anxiety symptoms and stress, relying on it as a coping mechanism. However, contrary to popular beliefs, alcohol exacerbates rather than alleviates anxiety symptoms. This worsened anxiety makes them drink more and have more alcohol-related problems, which causes further anxiety and stress.

Alcohol abuse also causes anxiety. Drinking alcohol builds a tolerance to de-stressing effects of alcohol. This creates a temporary sense of relaxation but later leads to feelings of depression and anxiety. This is because the prolonged use of alcohol can act as a stressor and activate the body’s stress response system, changing neurotransmitter levels in the brain and causing an increase in stress and anxiety. As such, alcohol can worsen anxiety symptoms.

Therefore, anxiety and alcohol abuse tend to fuel each other in a vicious feed-forward cycle of co-occurring addiction and anxiety, which is difficult to break out from. As such, integrated treatment for both anxiety and alcohol use should be readily available.

Treatment

There have been existing parallel or subsequent attempts to treat both anxiety disorder and AUD (i.e. treatment for anxiety disorders first, followed by AUD). However, studies have found that parallel treatments have caused worse alcohol outcomes compared to just seeking one treatment. This is possible because the cognitive load of receiving two separate treatments may be confusing or overwhelming for people, causing them to feel anxious or turn back to drinking as a coping mechanism. As such, these type of treatments causes a “co-morbidity roundabout”, which is a metaphor of mental health problems resurfacing when attempting to tackle substance disorders (and vice versa), thus failing to break out from the vicious cycle of these co-morbid disorders. Therefore, it is clear that both anxiety disorder and AUD are inter-related issues, and an integrated treatment approach is vital to tackle both disorders.

Stapinski et. al. (2015) carried out an integrated treatment for comorbid social anxiety and AUD, where participants undergo both Cognitive Behavioural Therapy (CBT) and motivational interviewing. Moreover, it involves core components such as building coping skills, developing alternative reinforcers and preventing relapse. This provides participants with useful skills such as enhancing social support networks, correcting misconceptions towards the benefits of drinking, reducing avoidance of social situations and developing healthy coping skills to manage triggers for drinking or anxiety.

This study took place over ten 90-minute sessions, where 117 participants with both social anxiety and AUD took part in this study. 61 of the participants received integrated treatment (both AUD and social anxiety) and 56 of the participants received treatment for AUD only. Results showed that both treatments enabled a great reduction in alcohol use and dependency. However, participants that underwent the integrated treatment were observed to have a greater decrease in social anxiety symptoms and a greater increase in overall quality of life. More importantly, these results remained constant even after a 6-month follow-up. This means that integrated treatment has long term effects on overall functioning and quality of life.

Early Interventions

While the above has proven that integrated treatment is indeed useful in overcoming social anxiety and AUD, the road to recovery is a long and arduous journey, where there are a lot of physical and mental challenges suffered by both the clients and their families. Hence, these issues could be more easily overcome or even avoided if there are early intervention and support to at-risk youths.

Over the years, the number of youths drinking alcohol has increased. According to the Avon Longitudinal Study of Parents and Children (2004), the number of youths that engage in binge drinking increase tremendously between the age of 18 and 21 (from 18% to 35% respectively). Furthermore, 18-year-olds who drank alcohol as a coping mechanism or who had anxiety disorders were 1.8-3.8 times more likely to drink. Both groups had a greater risk of transitioning from low-risk alcohol use at age 18 to high-risk alcohol use at age 21.

There are many motives that may drive youths to drink alcohol. A primary reason is that youths are at a phase where they are transitioning to adulthood. Adulthood brings more stress and anxiety due to changes such as new relationships; along with new responsibilities and challenges such as living in a dormitory and budgeting. Additionally, this phase of life also provides youth with more autonomy and drinking opportunities (e.g. clubbing, drinking games). With these drastic changes in life, youths often drink to enhance positive moods, socialise with others, conform to social groups, or as a coping mechanism to overcome stress or anxiety. This causes harms associated with alcohol to peak in early adulthood, emphasising the importance of early intervention to avoid these detrimental consequences.

An ongoing programme called “Inroads Study” (Stapinsky et. al., 2019) aims to provide early intervention to youths with anxiety disorders and AUD. It seeks to enhance anxiety coping skills and address coping-motivated drinking. Moreover, this programme is specially tailored to make it more relevant and appealing to youths. This includes making the programme available online, which is preferred by youths as it is more convenient, affordable and reduces stigma. Participants can freely access online therapy sessions and modules about tackling challenges often faced by youths. Thus, such interventions can address the interconnections between anxiety and alcohol use, as well as reach out successfully to youths in a relevant and appealing manner.

Prevention programmes are also forms of early intervention that may benefit younger youths (i.e. 13- or 14-year-olds) that have a ‘high-risk’ of developing substance disorders, even if they do not currently have a substance disorder. It is vital to identify early onset of problems faced by youths and nipping them in the bud, providing them with early support and teaching them relevant life skills. This prevents problems faced by youths from developing into more severe adulthood problems such as substance disorders, chronic mental health problems and delinquency.

One such prevention programme was organised by Edalati & Conrod (2019), who first identified at-risk youths through the Substance Use Risk Profile Scale; where those with higher levels of certain personality traits (e.g. sensation seeking and negative thinking) were at higher risk of abusing substances before the onset of use. Afterwards, these youths attended coping skills workshops, CBT and motivational interviewing.  Results showed that the programme proved effective in reducing alcohol use, alcohol-related harms and emotional and behavioural problems (i.e. symptoms of anxiety and depression). This shows the importance of early intervention and prevention programmes.

In conclusion, it is apparent that there are interconnection and the longstanding link between anxiety and alcohol use, where this co-morbidity can cause huge effects on one’s physical and mental wellbeing. Thus, this raises the importance of integrated treatment, allowing both conditions to be resolved at the same time. Furthermore, early intervention is extremely vital to offer support to youths and prevent potential disorders from occurring. More importantly, all this shows that alcohol is not the answer to relieve stress and anxiety, and can only serve to exacerbate rather than resolve our problems. Thus, such action could be done to reduce excessive alcohol use in our society, such that harmful usage and effects of alcohol could be prevented.


 

References:

https://www.mentalhealthacademy.co.uk/dashboard/catalogue/the-link-between-anxiety-and-alcohol-use-implications-for-treatment-and-early-intervention

Smith, J. P., & Randall, C. L. (2012). Anxiety and alcohol use disorders: Comorbidity and treatment considerations. Alcohol Research: Current Reviews, 34(4), 414–431.

Stapinski, L. A., Rapee, R. M., Sannibale, C., Teesson, M., Haber, P. S., & Baillie, A. J. (2015). The clinical and theoretical basis for integrated cognitive behavioral treatment of comorbid social anxiety and alcohol use disorders. Cognitive and Behavioral Practice, 22(4), 504–521.

Golding, J., & ALSPAC Study Team (2004). The Avon Longitudinal Study of Parents and Children (ALSPAC)–study design and collaborative opportunities. Eur J Endocrinol. 151, U119-U123.

Stapinski, L., Prior, K., Newton, N., Deady, M., Kelly, E., Lees, B., Teesson, M., & Baillie, A. (2019). Protocol for the Inroads Study: A Randomized Controlled Trial of an Internet-Delivered, Cognitive Behavioral Therapy-Based Early Intervention to Reduce Anxiety and Hazardous Alcohol Use Among Young People. Journal of Medical Internet Research, 8(4), 1-14.

Edalati, H., & Conrod, P. J. (2019). A Review of Personality-Targeted Interventions for Prevention of Substance Misuse and Related Harm in Community Samples of Adolescents. Frontiers in psychiatry, 9, 770.

https://www.who.int/news-room/fact-sheets/detail/alcohol

https://www.straitstimes.com/singapore/alcohol-abuse-worse-among-younger-people

https://www.drugrehab.com/addiction/alcohol/peer-pressure/

Photo by Q.U.I on Unsplash

 

Managing Grief

Managing Grief

There isn’t consensus in the scientific community about whether Kubler-Ross’ five stages of grief is rooted in empiricism. Although much vaunted in popular culture, if you’ve experienced grief and resolved it in your own way, you’ll know that grief is an organic process that is by no means neat or orderly. It’s deeply unique to each individual, and this article is designed to hopefully help you through whatever loss you have experienced in the recent past.

The five stages of grief, which Kubler-Ross first postulated that terminally ill patients experience are: Denial, Anger, Bargaining, Depression and Acceptance. Denial in this context encapsulates a perfectly normal response to a tragedy, and is exactly what you would imagine – it’s simply a refusal to believe that “this bad thing is happening to me”. After reality sets in, and the sobering realisation that the tragedy has occurred is impossible to ignore, Kubler-Ross observed that people often display frustration, which culminates in Anger. Once that Anger has dissipated, people often move on to Bargaining, which is the hope that they can somehow extricate themselves from their dire straits and obtain the balm of a different circumstance. Notwithstanding the success of the earlier bargain, Depression follows, which is self-explanatory. The final stage of Acceptance is the sanguine realisation that nothing will change their situation.

If you are currently going through your own grief and taken a step back to evaluate how you are processing it, you might have noticed some incongruencies between the model and your experience. That’s perfectly natural because there has been some criticism levelled at the Kubler-Ross model in that there is confusion over description and prescription. This means you shouldn’t take it as a rule, no, or feel inadequate or “bad” that you aren’t “properly” grieving. We hope that what follows in this article will provide you with some breathing room to let your grief take its own course, and helps you handle a tragedy with the right tools.

Grief is a loss. It’s your prerogative to define what grief is to you, and even something as banal as losing a cherished item from your childhood can precipitate feelings of loss. So, you shouldn’t wall up these feelings behind what society has proscribed as appropriate. We’re talking about you here, not anyone else. It bears repeating that your grief is unique because of a multitude of factors, for those of you who don’t want to accept that it is your right to give yourself the breadth to grieve – your upbringing, your culture, your faith, your parents, the list is endless. So give pause and slip into your own rhythm of grieving.

To help ensure that you do not slip into the common fallacies that can disrupt your grieving process, we’re going to list some of the pitfalls that ensnare people and prevent therapeutic processing of grief. 

1) If you don’t show an outward display of grief such as crying, you aren’t “sad”

Just like the shortcomings of Kubler-Ross’ model, while crying is seen as a “socially acceptable” way of demonstrating sadness, it isn’t applicable to everyone. You may have been brought up to avoid tears at all costs, perhaps due to tough parenting or some childhood trauma, or you may not wish to “affect” others with your grief. No matter the reason, you should know that physiological responses to grief vary widely depending on your circumstances. Shock, numbness, anger, even hysterical laughter – just about anything is permissible in the initial, very private stages of your grief. 

2) If you don’t “get over it” within an “acceptable timeframe”, you aren’t good enough

Although your family members or people in your community may react to and resolve their grief earlier than you, you need to know that it is by no means healthy to affect the fragility of such a process by introducing the pressures of comparison. Some people simply have better coping-skills than others or are more inured to unhealthy thought processes that hold them back from the therapeutic management of their grief.

3) You feel like you need to “protect” loved ones from your grief, so you turn inwards

We keep emphasizing that grief is individual to everyone – this should tell you that there is no circumscription to how you handle it. Even though it might feel selfish to display your feelings openly because you think less emotionally able loved ones shouldn’t have to deal with your pain, remember that there is nothing shameful about the old adage, “Shared joy is double, shared sorrow is halved”. 

There are some simple coping mechanisms that you can use to help yourself through the process. Although the low mood is a given after the heartache of a tragedy or loss, and you might not feel willing or able to pick yourself up and carry on, remind yourself of the wisdom of eating and sleeping right. Drugs and drink might seem the most accessible ways to insulate yourself from poor mood, but these indulgences, in the long run, are hindrances to sustaining your mental well-being.

If you feel like the person you have lost needs to be remembered, you can do so in the solitude of creative expression, or you can choose to gather loved ones to laugh about cherished memories. If there’s one scenario where laughter in the face of loss is wholly acceptable – here it is! Whether communal or solitary, there are many ways you can raise someone up in loving memory – honouring them and helping yourselves. 

Find solace in your old routines. If you’re hurting after the failure to gain acceptance into a school of your choice, it may help to remember all the things you did well before that gave your life meaning and structure. At the worst of times, it helps to fall back on old patterns if only to hang on to some stability.

Lastly, know that there is a difference between clinical depression and the normal response to grief. You should be aware of critical signs or symptoms in both yourself and your loved ones that may indicate depression. For example, if you notice that your loved one isn’t eating or sleeping properly after a long period of time, or is displaying reckless tendencies such as driving dangerously or overindulgence in addictions, it may be time to seek professional help. Although many people can get through grief without the help of a mental health professional, when it all gets too heavy to handle, you may consider seeking grief therapy. Some of our clinicians are specifically trained in grief therapy, such as Joachim Lee or Winifred Ling.

 


Photo by Claudia Wolff on Unsplash

COVID-19 AND ADDICTION – RECOVERY USING ONLINE THERAPY

COVID-19 AND ADDICTION – RECOVERY USING ONLINE THERAPY

Author : Andrew da Roza

COVID-19 has posed a challenge to everyone, and those more physically vulnerable in our community clearly need our care and attention. 

There are also people whose mental vulnerability deserves equal care.

Mental illnesses such as depression, anxiety, and addictions are exacerbated by a pandemic crisis in multiple ways. 

Collective family and community fears are (in themselves) contagious; and the constant bombardment of medical and financial bad news, can leave those with mental illnesses lost in a cascade of negative rumination and catastrophising. 

The mentally ill and people with addictions commonly have compromised immune systems, and suffer stress or substance, tobacco and alcohol abuse related diseases – leaving them wide open to severe pneumonia with acute respiratory distress symptoms – and other complications from COVID-19. 

Isolation, separation and loneliness – caused by working at home and social distancing – are perhaps the worst contributors to: low mood; agitation; irrational fears; moments of panic; self-disgust; resentment; anger; and even rage.

People whose ability to pause, use reason and find practical solutions can be severely compromised. They may find themselves bereft of the motivation, and ability to engage in even the simplest tasks of self-care. 

Added to this, listlessness, boredom and frustration can lead to despair. Then self-harm and suicidal thoughts may arise, take hold, and even overwhelm them.

Those in recovery or active addiction may also turn to their compulsive and impulsive behaviours of choice, to sooth and find momentary respite from the moods and thoughts that have hijacked their mind. Triggers, urges and cravings may become relentless and unbearable. 

The solution may begin with finding a way out of isolation. 

Starting the journey out of this darkness can start with talking to people who can demonstrate unconditional positive regard, show kindness and compassion, and help reframe the situation. Such people can assist those suffering to put a name to and validate their emotions. 

In short – therapy can help!

In times of COVID-19, working with a therapist via teleconsultation can be effective using ZOOM, Skype, WhatsApp video and FaceTime. 

Although the calming and soothing sensation of the physical presence of a therapist is absent, for those in isolation – distraught with shame and despair – Internet enabled therapy can prove a lifeline.   

Isolation can be further broken, using similar Internet methods, by attendance in recovery groups such as Alcoholics Anonymous, Narcotics Anonymous and Sex and Love Addicts Anonymous – all of whom now hold Zoom meetings in Singapore. 

These Zoom opportunities in Singapore are supplemented by Zoom, Skype and telephone conference meetings in Hong Kong and Australia (in Singapore’s time zone) and in the U.K. and the US (during our mornings and evenings).             

Having broken the isolation, the second step therapists can provide is guidance and motivation towards self-care. This would include tapering or abstinence from the addictive substances or behaviour. A well thought through relapse intervention and prevention plan, specifically tailored to a person’s triggers, will also assist.

Triggers may be particular places, situations, people, objects or moods. 

The acronym “HALT” is often used by those in recovery; which stands for the triggers of being: Hungry; Angry; Lonely; or Tired.

When these triggers arise, people are encouraged to 

  • HALT their behaviour; 
  • breathe deeply, with long outward breaths;
  • think through consequences;
  • think about alternatives;
  • consult with others; and
  • use healthy tools to self-soothe.      

Daily mindfulness, meditation, exercise, sleep hygiene, healthy eating and following a medication regime are important aspects of self-care – and for some suffering mental illness – these actions – and time – may be all they need to find their footing again.

Luckily, the Internet gives a vast array of possible self-care options, including things to distract us, soothe us and improve us. 

Everything is available from: calming sounds and music; guided meditations; games; home exercise, yoga and tai chi; self-exploration and improvement videos; video chats with loved ones; to healthy food delivery options. They can all be had with a few keystrokes. 

Today we live at a time when suffering from mental illness and addictions is commonplace. But we also live at a time when the solutions are literally at our fingertips – if we only reach out for them. 

For information on teleconsultation for addiction therapy and addiction recovery meetings, contact:  Andrew da Roza at Promises Healthcare by email to andrew@promises.com.sg or by calling the Promises Healthcare clinic at: (+65) 6397 7309