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 clients 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.
