The Kusnacht Practice Podcast #18 Interview with Dean Gustar on the COVID-19 pandemic, the year in summary

Interviews Podcasts Podcast 18 V1

“Many people are going to feel long term effects. I expect for, maybe around 15 to 25% of the population, life will not return to normal when we come through the other side of this pandemic. If and when that happens.”– Dean Gustar, Relapse Prevention Specialist.

In the latest podcast from The Kusnacht Practice with Relapse Prevention Specialist Dean Gustar discuss the fallout from the COVID-19 pandemic and reflect on the year gone by.

Dean analyses the increase in alcohol consumption, illegal and prescription drug use, and the ripple effects of the escalation. He addresses the rise in cases of depression and anxiety, the fear of infection that’s preventing many from seeking treatment, and the preparations required to better cope in the future.

Presenter: Hello, today we’re here with Dean Gustar.

Dean Gustar: Hi.

Presenter: Good afternoon. Dean, as you’re in charge of our psychology and psychiatric services here, I’d like to ask you a few questions today regarding COVID-19. As it’s been one year since we spoke in our last session – reviewing where we were in COVID-19 – we thought it would be a good time now to actually sit down again and discuss what happened over the last 12 months.

As the Relapse Prevention Specialist here at The Kusnacht Practice, and being aware that we are now one year on from the first full impact of the coronavirus crisis across Europe, with repeated lockdowns and restrictions of movement and socialising, is there, in your opinion, clear evidence of a psychological pandemic following in the wake of the virus?

DG: For sure. I’ve seen lots of evidence that’s been published about the effects of COVID-19 on the psychological health of the population globally. Some of these are specifically related to COVID-19, but there’s also a kind of ripple effect of the impact of lockdown and economic downturns. I saw one study that showed one month after the UK lockdown there was a rise in population prevalence of clinically significant levels of mental distress. It had gone up from 18.9% to 27.3%. So that’s a big increase after just one month of lockdown.

Also, I was reading some studies about the impact of economic downturns. For instance, generally speaking, and this has nothing to do with COVID-19, but generally speaking, if there’s a 1% increase in unemployment, there’s evidence to show that there’s a 1% increase in suicides, as well. So I think the effect of this pandemic is being felt everywhere.

Presenter: I understand that the mental health effects of the virus will be more far-reaching and longer-term then, from what you’re saying, right?

DG: I mean, many people are going to feel long term effects. I expect for, maybe around 15 to 25% of the population, life will not return to normal when we come through the other side of this pandemic. If and when that happens.

This could include people, let’s say, with alcohol and drug issues, depression, increased anxiety, increased social anxiety, maybe people with exasperated obsessive compulsive disorder issues. I mean, the list could go on. There’s definitely going to be a ripple effect of long term effects.

Presenter: And then it’s pretty much in line with the recent figures from the UK and Office of National Statistics, the ONS, which has revealed that there were 5460 deaths related to alcohol specific causes between January and September last year. And it indicates as well that many are self-medicating their way through the crisis. That is up from 3732, the year before, an increase of more than 16%.

The ONS says the alcohol-specific death rate in England and Wales reached 12.8 deaths per 100,000 people from January to March, its highest level since 2001, when the figure was 9.5 deaths. The ONS annual report was published as the European Commission reported that about 800 people in Europe now die from alcohol-attributable causes every day.

So these figures, plus the ones you’re sharing with us today, show a clear correlation between our codependency and the pandemic, or do they not? Is this something you have witnessed yourself at The Kusnacht Practice?

DG: I mean, there’s definitely a link to an increased alcohol consumption during the pandemic, especially as time has gone on. A lot of the research that involves people reporting on their own levels of alcohol consumption has shown that people are drinking more, maybe up to a third more than pre-pandemic levels. And perhaps this drinking may have shifted as well to people using drinking as a coping strategy for all the other issues that we recently talked about.

It will be interesting, I think, to look at the drinking patterns by examining what alcohol people have actually been purchasing. I think the retail research showed a marked increase in purchasing, in bulk purchasing, right at the start of the pandemic. My instinct tells me that as time goes on we will have found a decrease in people drinking their very expensive wines, and mainly an increase in the purchasing of higher strength alcohol products, such as spirits. And maybe an increase in lower price, lower quality, alcohol products.

I think one would also expect, with more alcohol being purchased and drunk, that we will see an increase, not just in deaths, but in other alcohol-related incidents. Obviously, an increase in health-related incidents, and things like domestic violence – let me just mention that men who drink are six times more likely to abuse their partners or children. So domestic violence has been labelled within the pandemic.

Resolving these kinds of issues is complicated enough, without lockdowns, and all the other things associated with COVID-19. And we also know that there’s been a reluctance for people to access health care for fear of risk of infection, and this may have added to the death rate as well.

I mean, at The Kusnacht Practice, I would not say that we’ve seen a remarkable increase of clients coming in for alcohol related issues. But for sure, we have definitely seen an increase in cases of depression and anxiety reported to us by clients that can be attributed to the situation that’s going on at the moment.

Presenter: And then we see the use of methamphetamine and fentanyl also shot up after the pandemic hit the US with a particularly sharp spike for the latter, according to a news report by drug testing company Millennium Health. The adjusted positive rate of urine drug screens was up 78% for fentanyl and 29% for methamphetamine during the first nine months of the pandemic, compared with the same period in 2019, according to the report.

Dean, do you think users are more willing to take risks with these highly dangerous drugs and maybe break the law because of the feelings of helplessness and fear and hopelessness brought by the pandemic? Is this more of a problem in the US or have you seen the same uptick in Europe?

DG: I mean, I haven’t seen the full research from the States, but I can give you a possible theory regarding the figures you’ve quoted. In America, a lot of the methamphetamine is either manufactured within the country or imported through Mexico. And the usual channels for cocaine smuggling have become more restricted because of the pandemic. So it doesn’t surprise me to see an increase in the use of methamphetamine, as I believe it’s linked to supply. It’s easier to get hold of, probably less expensive than cocaine.

Opiates in the States, also are generally imported through Mexico. Now the tide has shifted in the prescribing of opioid medication in America, it’s almost impossible to get opioids prescribed through legal means. Many groups in Mexico are now manufacturing their own counterfeit versions of the tablets that many people were addicted to in America, for example, things like Oxycontin.

Many of these counterfeits, in fact, most of them, probably have fentanyl as their core ingredient, and the same goes for the heroin being produced. Heroin comes to the States, mainly via Mexico, and often fairly low grade Mexican heroin is cut with fentanyl to increase potency. This makes for a very dangerous situation all around.

Now you asked about risk-taking. Risk-taking is synonymous with drug taking. And if usual channels of supply are limited or access to particular substances are limited, then people will take alternatives and will take bigger risks when purchasing and taking these drugs.

Personally, I believe the main issue is supply. And when a drug user has a problem with supply a sense of desperation may creep in that affects their behaviour. Also remember that the lack of access to supportive services can also leave drug users isolated and without support and care.

Regarding the comparison between the States or in Europe, I think you probably need to widen it out a little bit. Methamphetamine use in Europe is, on the whole, focused within a small niche of drug takers, and often associated with compulsive sexual behaviour. There have been minor increases in fentanyl showing up in drug tests, but nothing on the levels experienced in the States. This may increase however, as I think money talks, and fentanyl is an incredibly potent substance that can be purchased for a fraction of the cost of heroin.

Presenter: Now in terms of prescription drugs, more than 3.2 million antidepressant items were also legally prescribed by GPs in Wales in the six months after the COVID-19 pandemic started, which is an increase of 115,660 compared to the previous year. Yet, the therapy referrals were said to have dropped by a third. This figure is likely repeated across Europe.

So how worried are you about the long-lasting effect of this pandemic and the incredible scar it’s leaving across the world’s mental health? It is a perfect storm where sufferers are relying on the crutch of illegal and legal drugs while seeking less in-person treatment, aren’t they?

DG: The increase in prescription of antidepressants shows that we’re struggling to manage the impact on an individual level. I mean, overall, in general terms, even before the pandemic, there was an increase in the level of prescriptions, but it’s shot right up. And the lack of therapy referrals shows that there’s either a reluctance for people to be referred, or for the GPs to refer others; perhaps there may be also a drop-off in a provision of services. So maybe lots of traditional sites where people could go for counselling are closed up.

Presenter: You mean health centres?

DG: Exactly. The particular research that you quote there is specific to Wales. And actually, there’s a difference between accessing talking therapies in Wales than in England. In Wales, the referral has to come from the GP. In England it is possible to self-refer to talking therapies. But even in England, people haven’t been self-referring, and it just may be a reluctance to meet face to face with someone or an inability to be able to do that.

So with limited options available, the antidepressant is a fairly quick and easy fix for doctors. But we have to remember that finding the right antidepressant for somebody is a fairly arbitrary hit and miss process. So it’s a difficult situation. The antidepressant doesn’t necessarily fix the problem, and it definitely doesn’t have a long-term solution to what’s going on.

Even in England, where there is the chance to self-refer, there’s been a massive drop off in referrals, at least a third as well. I think the more we can do to promote a broader approach to the treatment of depression and anxiety, the better. And having good access to talking therapies and promoting them. I mean, there’s a lot we can do with Zoom and Skype and these kinds of software solutions to connect people. I know it’s not the same as face to face, but we’ve become much more familiar with these strategies.

Presenter: So this is a lot of what you’ve been doing over the last 12 months to address most of the patients that we couldn’t physically get in touch with, for instance?

DG: For sure, yeah. I think there’s hope in the air now, as the vaccinations are being rolled out, obviously quicker in some parts than others, but they’re being rolled out. At least there’s a sense that we’re at the beginning of the end. And I think people can feel this.

But there’s a lot of future planning now to mitigate these long term impacts. So we need to take into account, as the world opens up, how we can mitigate the harms and plan better for the future. And we have to start building healthcare systems that can cope in the future if something similar happens. We have to be prepared.

And we have to learn from what we’ve experienced now and use the research to do so. We have to design and put in place continuity plans for healthcare, so there’s not just this huge drop off and suddenly services end for people. We have to do what we can to make sure that we don’t fall into this, kind of, huge psychological hole again.

Presenter:Thank you so much Dean for sharing this with us today. We’ve been talking 12 months after the spark of the crisis of the pandemic and we’re learning a lot of lessons here. Thank you for sharing your views on this. We are here at The Kusnacht Practice, reinventing the experience of care. Dean, thank you very much for this.

DG: Thank you.