The COVID-19 precautions have complicated supports and mental health treatment delivery. In a commentary recently published in the Journal of Substance Abuse Treatment, Dana Sarvey of McLean Hospital and Justin Welsh of Emory University School of Medicine explore considerations unique to the identification and treatment of substance use issues among adolescents in the context of the pandemic.
“While the pandemic has undoubtedly afflicted all sectors of society, there is a growing concern of more persistent, lifelong effects that youth may experience,” the authors write.
Sarvey and Welsh’s piece highlights the complexities of characterizing the pandemic’s impact, addressing context-specific affordances and barriers relevant to care for young people grappling with substance use issues. Opportunities for identifying substance abuse have been significantly limited during the pandemic, making it particularly important for primary care providers and other general practitioners who frequently interface with youth to implement assessment procedures to maximize recognition of issues.
According to Sarvey and Welsh, myriad risk factors for adolescent substance use (e.g., isolation, boredom, and anxiety) have been amplified by social distancing measures. Research in the early months of the pandemic pointed to increases in cannabis and alcohol use among adolescents.
Missed opportunities for development and growth opportunities, such as the celebratory milestones that often went unacknowledged, may also hinder progress and coping. Without explicit celebration of growth, many young people may feel stuck during this time.
“Many of these events serve as developmental milestones and represent a way of marking the passage of time and symbolize increasing independence, achievement, and individuation for youth,” Sarvey and Welsh explain. “Youth who have experienced an arrest in their development during critical time periods are at greater risk of using substances as a perceived way of coping.”
Additionally, the pandemic has placed unique strains on family systems, increasing the potential for abuse and relapse among youth already struggling. Heightened stress experienced by individual family members can lead to relational tension and, in some circumstances, exposure among young people to their immediate family members’ struggles with substance abuse. Sarvey and Welsh note that approximately one in every eight children under the age of 17 lives with at least one family member engaging in substance abuse.
Students may have only limited access to significant adults outside their immediate family circles, such as extended family members and adults with whom they’d historically connected in their school communities. The authors describe research indicating that disconnectedness from one’s school community and academic pursuits can increase substance abuse risks among teens.
However, for some teens, social distancing may also be protective in minimizing exposure to adverse experiences that can happen outside the home leading to initiation or perpetuation of substance use. The extent to which home is experienced as a safe and supportive place may be an important determinant in whether extended time spent at home exacerbates or relieves substance abuse during confinement associated with social distancing measures.
The identification of substance use issues among young people had already been challenging for various reasons pre-pandemic. The authors indicate that only about a thirteenth of young people who meet the criteria for a substance use disorder receive formal treatment.
Further, more intensive, in-person, or residential supports may be necessary for young people with “co-occurring mood disorders, executive functioning disorders, substance use, and/or safety concerns” and those with severe challenges impractical to monitor in the home setting. However, for many, some access to some degree of online community or therapy may be supportive during this time may be supportive.
The shift towards virtual treatment delivery may be increasing access to services previously unavailable to some. Some states have made it possible for licensed psychologists to engage in virtual visits with out-of-state clients. Some insurance companies have relaxed reimbursement standards to facilitate virtual coverage. Whether or not these policies last beyond the pandemic remains to be seen, but these temporary adjustments have opened doors to treatment for some in the short term.
“Creative collaboration efforts and new guidelines might help to overcome some of the current challenges in providing care for this age group through the use of virtual platforms.”
The sudden transition to virtual support has also necessitated unique considerations for assessment procedures, privacy, and monitoring adherence in the telehealth landscape treatment for substance abuse concerns. Accessing treatment from home may pose limitations to both client privacy and engagement. Distractions in the home environment and fears associated with being overheard are among the barriers to which there are limited short-term solutions. Yet, creativity based on necessity may be slowly propelling innovation.
The authors conclude:
“Treatment considerations should focus on adolescents who are most at risk of relapse or of an exacerbation of their use. This includes identifying families who may be at higher risk by virtue of multiple members within the same household having an identified SUD. Practitioners should consider any and all means of accessing and interfacing with these youth and their families, including with virtual programming and addressing other co-occurring psychiatric symptoms, such as depression and anxiety.”
Sarvey, D., & Welsh, J. W. (2021). Adolescent substance USE: Challenges and opportunities related to covid-19. Journal of Substance Abuse Treatment, 122, 108212. https://doi.org/10.1016/j.jsat.2020.108212 (Link)