Managing Addictions During the Pandemic: Insights from Prof. Shaoli Lev-Ran

Understanding the Impact of Isolation and Stress on Substance Use

A few days ago, we watched "The Wolf of Wall Street" with our teenage daughter. In the film, Leonardo DiCaprio's character declares, "I love drugs. Every day I take an amount of drugs that could mestilize Greater Long Island. I take Quaaludes for back pain, Xanax to stay focused, Ambien to sleep, marijuana to chill, cocaine to wake up, and morphine because it's cool."

The point of this monologue is that the hero's true addiction is money, but it made me reflect on how different I am from him. Although I don't use Quaaludes, Xanax, Ambien, or morphine, I do take something for pain, something to stay focused, something to wake up, and something else because it's just cool. These days, I smooth the edges of my life with various substances—some from a medicine box and some from a bottle of cognac—not always following the labels or heeding the warnings.

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To understand how slippery the slope I'm on is, I asked Prof. Shaoli Lev-Ran, co-founder of the Israeli Center for Addictions and chairman of the Israeli Society for the Treatment of Addictions, to explain how the current crisis affects users, addicts, and those in recovery in Israel.

My first assumption was that detoxification for many people relies on a supportive environment, like 12-step meetings. The connection with others contrasts with the increasing isolation faced by active addicts. One of my first questions was whether quarantine makes it harder for those who have quit to stay clean and worsens the addiction of those still struggling.

"There is definitely such a concern," says Prof. Lev-Ran. "The factors that contribute to anxiety and stress in all of us—lack of a support system, loneliness, and boredom—are doubly difficult for those with addiction. The attempt to self-treat anxiety, stress, and depression creates a brutal cycle of hard feelings and devastating results."

Managing Addictions in Isolation

Prof. Lev-Ran adds a note of comfort: "It's exciting to see the availability of treatments, including online groups. 12-step groups, Alcoholics Anonymous, Addicts Anonymous, and others have moved to Zoom meetings, and at the Israeli Center for Addictions, group treatments continue online. It's important and possible to continue treatments during this period."

Are there benefits to social distancing for people whose substance use is social?

"Simple logic says yes, but loneliness is not good for anyone, certainly not for long and not by choice. The harder and longer this struggle is, the greater the chance that socially-contextual use will fill another need and become a more personal and lonely habit.

"This question raises an important issue: the problem of thousands undergoing forced detoxification due to the circumstances. This means enormous suffering without the tools to deal with it and sometimes physical danger. Treatment providers are looking for ways to make treatments available to help with detoxification and offer basic recommendations for remote assistance. Today's technological means don't require disconnecting from the support system and friends. It's not exactly the same, but it's very good that it exists."

Risks and Support for Addicts During COVID-19

In more serious addictions, especially with certain substances and methods like injection, a prominent risk group is created for contracting COVID-19 and other serious diseases. Most people suffering from addiction are part of the general population, says Prof. Lev-Ran.

How can the lockdown affect people in the community with mild addictions, those who drink too much or smoke too much marijuana?

"Sometimes it is precisely these people who have the hardest time dealing with the crisis. Before the routine changed, they managed the addiction alongside work, children, or other regular activities. Suddenly, they are locked in the house all day, without a routine but with anxiety about the future and a lot of available alcohol, weed, or porn for temporary sedation.

"Instead of developing coping tools, a growing dependency is created. Every encounter with difficulty leads the brain to automatically seek the substance or behavior. It is crucial for such people to create a schedule and maintain regular online connections with others. This might be the first encounter with problematic behavior, leading them to realize something is wrong and try to set goals for controlled behavior."

The Role of Family in Managing Addiction

Prof. Lev-Ran explains that the role of family members and partners is complex, depending on the relationships and dynamics within each family. "Sharing and openness allow family members to support and understand the triggers for certain behaviors in the person with addictions, and to set norms at home for this period," he says, noting that help is available even during this time.

Dealing with Substance Shortages and Withdrawal

How do addicts manage without access to their substances, and what are the consequences?

"It is difficult, and they suffer a lot. There are solutions, but they are not yet widely available or known. For example, contacting a family doctor for medical support during detoxification can help with sleep and physical pain. Online counseling is also an option. Some withdrawals, like those from alcohol and sedatives, can be dangerous and require medical supervision.

"Often, an existing addiction is replaced by a new one. If someone can't get cannabis, they might drink more alcohol. The same happens with addictive behaviors like pornography and gambling. It's essential to pay attention not only to what is left behind but also to what is taken up."

Prof. Lev-Ran emphasizes that Israel is still figuring out how to support addicts dropped from the system. "Other countries face similar struggles, and in many places, people with addiction are not a top priority. In Israel, the Ministry of Health allows prescriptions for drugs treating opiate addiction to be redeemed for longer periods, reducing the need to leave home. But counseling for withdrawals, crisis intervention, and support for family members are not sufficiently available."

Future Implications of Increased Substance Use

I wondered about the long-term effects of increased substance use during the pandemic. Will people return to normal, or will new problems emerge?

Prof. Lev-Ran warns that after the current crisis, there will likely be an increase in various addictions and misuse of prescription drugs, as seen in past periods of stress. "It's important to pay special attention to children and young people who have been thrown into chaotic routines with excessive screen time and access to addictive substances. The long-term consequences can be devastating, and parents need guidance to manage this before it worsens."

Preparing for Post-Pandemic Challenges

"Regarding the future, most U.S. soldiers who developed heroin addictions during the Vietnam War stopped using when they returned home without intervention. Changing the environment helped them recover. However, in this case, we're changing the period, not just the place. Many triggers will remain, and when restrictions lift, there will be a surge in substance use and behaviors.

"It's essential to raise awareness of the risks and develop strategies to prevent addictive habits from persisting. The longer this period lasts, the more we must prepare for a flood of problems. Providing information and treatment now can mitigate damage in the present and future."