Question: During the COVID-19 pandemic, I have to admit, I have been drinking far more than I usually do. If this keeps up, my husband warns me, I am going to become a problem drinker. Where can I get help?
Answer: You are certainly not the only person pouring back more alcohol in these troubling times.
“Many of my patients are struggling with the realities of the pandemic, including uncertainties over finances and employment as well as challenges with childcare and schooling,” says Dr. David Gratzer, a psychiatrist at the Centre for Addiction and Mental Health (CAMH) in Toronto.
“Not surprisingly, some are turning to alcohol and other substances. While alcohol can provide short-term relief for mood and anxiety symptoms, it is also addictive.”
A recent CAMH-Delvinia poll revealed 28.5 per cent of men and 22.6 per cent of women report binge drinking.
Even if you consider yourself a casual drinker, there is a risk you may be slipping into a danger zone. It’s worthwhile talking to your health-care provider, whether that’s a family physician or nurse practitioner. “They know you and your medical history so they’re a very good starting point,” says Dr. Mark Greenberg, an addiction-medicine physician at Sunnybrook Health Sciences Centre in Toronto.
Of course, not everyone has a primary-care provider. Fortunately, there are alternatives.
In Ontario, for instance, people seeking help for substance-use issues can go to a Rapid Access Addiction Medicine (RAAM) clinic. “No referral from a doctor or pre-arranged appointment is necessary. It’s a walk-in type of place,” explains Dr. Greenberg.
He notes that when people decide they are ready to make a significant change in their behaviour, any delay can divert them from that path. “What we have found is that if patients can get timely access to treatment, their chances of succeeding are higher,” says Dr. Greenberg
So, the main purpose of a RAAM clinic is to reduce barriers to care – people just show up and they are seen that day, on a first-come, first-served basis.
RAAM clinics, which deal with addictions to various substances including opioids, are still relatively new in Ontario. They first opened in 2015 as part of a seven-site pilot project funded by Health Quality Ontario, a provincial government agency with a mandate to improve health care. After the pilot showed positive results – including a reduction in emergency department visits and hospital admissions – the concept took off.
There are now 65 publicly funded clinics across Ontario, says Kate Hardy, network director of META:PHI, which provides oversight, expertise and support to the province’s RAAMs.
Clinic locations can be found online at metaphi.ca
In the early days of the pandemic, some clinics transitioned to providing care “virtually” through video conferencing and telephone calls. More recently, they have re-opened their doors – giving patients a choice between in-person and virtual visits.
At the first appointment, patients meet with a doctor or nurse practitioner who has special training in addiction medicine. Patients are usually offered a prescription to one or more medications – such as acamprosate and naltrexone – which can curb cravings and ease withdrawal symptoms.
“These medications are really effective in helping people reduce their drinking, whether their goal is abstinence or simply to control the quantity they consume,” says Dr. Jennifer Wyman, associate medical director of the substance-use service at Women’s College Hospital in Toronto.
Aside from using medications to treat the biological and physiological aspects of the addiction, RAAM clinics also provide other forms of assistance.
“Patients are linked with a social worker or case manager who will talk to them about their immediate needs,” says Ms. Hardy. “For some people, that might be access to housing or food.”
Ms. Hardy says the long-term objective of a RAAM clinic is to shift patients to supports in the community. The patient’s own family doctor may take over prescribing the addiction medication. But in places where certain services are not readily available, “they can stay with us as long as they need our support,” she adds.
The RAAM model of treatment has proven to be so successful in Ontario that it is currently being considered or tried in other provinces including Manitoba, Saskatchewan, Alberta and British Columbia.
Addiction is a complex condition and a medication alone may not be enough to overcome the disorder. “I think the best treatment plan includes psycho-social supports which might involve group or individual counselling,” says Dr. Wyman.
She notes there are various types of support groups ranging from traditional 12-step programs to SMART Recovery training, which is growing in popularity. “Different people respond to different things.”
Many of these support groups are now being conducted virtually because of the pandemic – and that’s a good thing. Going virtual increases the options available to those who might find themselves imbibing a bit too much alcohol during what is expected to be a challenging winter ahead.