COVIDcast

Dr. Jacqueline Smith (JS): Addiction is like a disease of isolation, whether you call it a disease but it is one of isolation so for those who are seeking treatment often it is to pull them together with other people and for support. And so because we're doing social isolation again incredible disruption of the support system that's required for these people who are needing that.

Corey Hogan (CH): That was Jacqueline Smith, an assistant professor in our Faculty of Nursing. And this is UCalgary COVIDcast. I'm Corey Hogan.

Nuvyn Peters (NP): And I’m Nuvyn Peters. Thanks for joining us. The coronavirus pandemic has deeply changed our lives. Unemployment is skyrocketing, social connections and support networks are being disrupted and daily routines are being upended. People are worried about money, childcare, school, jobs and isolation. They're stuck at home with their families or alone. One of the dangers of physical distancing and self-isolation is that people can develop substance use disorders. They also make it more difficult for recovering addicts to access treatment and services.

CH: And certainly, having a tendency towards addiction, and having all these triggers toward addictive behaviour, is a bit of a powder keg situation. And it's something that both we need to be aware of as human beings who could fall prey to these impulses but we also, we have family members, we have friends, who might also be dealing with substance abuse issues in their own right, and sitting down with Jacqueline was quite eye-opening in that some of the triggers, some of the behaviours that we can view in others and some of the ways we can intervene or otherwise stop ourselves from going off the rails, or stop people around us from going off the rails.

NP: It's a combination of a lot of challenges at once. And for many people that can be overwhelming. And how you navigate through this health crisis, this economic one, this interruption in daily life and routine can be very challenging. and without knowing what resources are available, or even what signs to look out for within yourself or your friends and loved ones, it can be very difficult to navigate this journey that we're all on.  

CH: For this episode of COVIDcast, we talked with Dr. Jacqueline Smith, PhD, an assistant professor in our Faculty of Nursing. Jacqueline is also the director of mental health and wellness for the Faculty of Nursing. Her research specializes in families, addiction and mental health as well as middle school drug and alcohol education for youth and families. Jacqueline sat down with us to talk about how the coronavirus pandemic is affecting people with substance abuse disorders and their ability to access treatment, as well as some strategies people can use to take care of their mental health. So Jacqueline, thanks for joining us here really happy to have an opportunity to sit down with you and talk a little bit about your research.

JS: Great to be here. I'm always happy to contribute to this type of conversation around addiction, emotional wellness so again happy to be here.

CH: So tell us a little bit about your research.

JS: Okay. Well I am an assistant professor in the Faculty of Nursing and my doctoral research that really informed my program of research was the impact of addiction on the family and I did that through the lens of a mother. I had been working nonprofit prior to coming to the university and really saw how addiction impacts a family so that was really intriguing for me. So really the bottom line is I came to understand that families do play a critical role in supporting family members with substance use disorders or addiction and that there was little research being done really to investigate how we can support families. So that was when I started at the university back in July, 2017 as an assistant professor and I really decided to, so they always give you a bit of seed money at the beginning to start a project, and I decided to go right after that family to see how we could explore some interventions. And we started with mindfulness based stress reduction and we measured that on family members who had supported, actually it was youth through longterm treatment for drug and alcohol addiction, and we found that the capacity to be mindful, meditation, a lot of self-care practices really did impact, positively impact the wellness of family members so that was exciting research. And then I've done a little bit around, we did the UCalgary campus experience with cannabis. So we did this pre-legalization and we explored how our students by nature of their age are vulnerable because the brain doesn't develop up to about 26 years old. So, we just wanted to know how the students were interacting with cannabis and we did find that we had a high percentage rate in the survey that we sent out and bottom line is that 50 per cent of those students had used cannabis at least once in their lifetime. And there was a lot of students who were using for medicinal reasons for things such as anxiety, depression, sleep and pain which was a concern for us at that time because it was contra-indicated in the science and basically the students were self-medicating and they were finding cannabis to be helpful for that. So it's been very, very interesting. We're continuing to explore that as well and we actually just incorporated a world cafe style cannabis cafe education and harm reduction series so we're really wanting to now that it's a legal substance we're wanting to introduce safe options if students are choosing to use. So Canada has some lower risk cannabis use guidelines, we've been introducing those to the students. So, I'm a real educator and I think the more education we can provide then people have options to make choices for their wellness. So, and now I'm the director of mental health and wellness in the Faculty of Nursing and that's really about how we can support psychological health and safety in the workplace. So, we're doing a lot of really neat things like a wellness dog. We have Jack, one of our faculty members purchased a dog, a labradoodle actually and created a partnership with the Faculty of Nursing so it's been interrupted now because of COVID so but we will be bringing Jack in to help support stressful experiences for our students, staff and faculty. We're also looking at mindfulness and we're piloting some suicide assist training. So lots going on in the way of emotional wellness and psychological health and safety.

CH: Well, speaking of COVID and stressful situations we do seem to find ourselves at a moment where I think many of us who have people in their lives who have struggled with addictions, we start to worry.

JS: And a valid worry, I've been working in the field of addiction for about 15 years now and do have family and friends who have struggled as well. In fact I was speaking to a colleague this morning and we were talking about this and really sadly stress and exposure to trauma and I could say this COVID is trauma, it's crazy. It's unpredictable, we just don't know. Earlier we were talking about that it's so fluid and it's changing and trying to experience this when you can't really predict what's going to happen next. So again, that type of stress is closely linked with drug abuse and addiction because what happens for many people drugs and alcohol can actually provide a temporary respite from reality and everyday life. And again, especially now with the COVID pandemic and you're seeing job loss and again many use substances to enhance pleasure and to decrease inhibition and anxiety. And we are seeing that people are turning and even those who have been in recovery it's like the recovery has been disrupted by this incredible stressor that's changing every day. So, it is a huge concern and I don't know about you Corey but I certainly have been hearing more and more over the past week about the concern around mental wellness and for young, for old, for families, for individuals who are struggling. And what we do know is that the majority of those who have addiction issues also have co occurring mental illness so it's a double edged sword and there is a concern, there is a significant concern with the stress and how those who have substance use disorders whether they're in active treatment or active use or whether they're in recovery exactly what are they doing to cope. And I know the government is looking at putting more supports in place. Because for many as well addiction is like a disease of isolation, whether you call it a disease but it is one of isolation so for those who are seeking treatment often it is to pull them together with other people and for support. And so because we're doing social isolation again incredible disruption of the support system that's required for these people who are needing that. And they're still again I spoke to a colleague this morning who works for CPOPs and there's still opportunities too for those who are using maybe opioid replacement therapy, they can still make appointments, they can still go down to Sheldon Chumir, there's lots of other organizations as well. Metro City, Alpha House, Rim for detox, the Arch Program, there's still organizations available for support it's just not as easily accessed as it used to be. And I think that is again another stressful experience for our families and friends and colleagues who are struggling with addiction issues.

CH: Well, and to your point about not as easily accessible in some cases not as easily "monitored" either. We're all very remote from each other. These are such exceptional times I do worry if people almost give themselves a pass they say, "Well I wouldn't normally but here we are at the end of the world," and COVID is just such a dramatic moment.

JS: Yes, and you bring up a really good point Corey because I think this is really an incredible time for self-reflection because you really, especially those who are struggling with addiction you have to know your personality. So, are you more of an introvert or the extrovert? So the extrovert needs more of that social connection so you would really want to be seeking out the online support groups and the online therapeutic groups as well too. And for the introvert I mean that's someone who may be not so inclined to socialize but then do a lot of just individual self-care practices as well. It's the disruption of schedule and I spoke to a friend a couple of days ago, a psychiatrist, and he said that that is a concern because for many like I said job loss, working at home, maybe children at home, you may be taking care of family members as well too. And for someone who already has this tremendous load of dealing with an addiction there really needs to be a support system in place and being able to somehow maintain some form of scheduling is so important for again those who are struggling with addiction.

CH: Yeah knowing yourself, maintaining a schedule, are there other strategies you would recommend for former addicts to prevent them from gravitating towards addictions?

JS: Absolutely. I mean we look at exercise for one and they say we have to keep the body moving and again we get in a slump and we're again talking about often the co-occurring mental health disorders, the stress, the anxiety and the depression. And we do know that healthy doses of exercise really release endorphins and help to reduce stress, it helps to stabilize moods and improve self esteem. I always call it the feel good neuro receptors. I mean I use my elliptical every morning, that got me through my PhD, that is a daily coping mechanism for me. So, exercise is so important and just that ability to calm the brain. I think again stress, anxiety and someone who is struggling with addiction that constant battle with the brain, should I or shouldn't I. And if you've had a lapse can you make the next day? Being able to calm the brain is so important and I know in a lot of treatment programs they do talk about mindfulness and meditation. And for those who've incorporated yoga into their life as well, I use an app called Calm, a 10 minute app it's guided meditation every morning and it is a useful coping mechanism and it helps to bring forth that self-reflection that we were talking about earlier and it really helps people just to become as well more in tune with their body. I mean that mind-body connection is so huge and I find often when I'm meditating especially guided meditation she'll say, "Just relax your forehead," and I think, "My goodness, my forehead is so tight." "Relax your eyes and your shoulders," and I don't even realize that my body is responding to my stress so it's a really incredible evidence-informed scientific way to really calm the brain and to become in tune with the body so I think that is huge. And just in general, emotional wellness is really about being attentive to both positive and negative feelings and we can take away positive, negative about what's going on right now with COVID. I see an incredible sense of community happening as well and people pulling together. Bauer hockey making, instead of making face shields for their hockey players they're doing it for their healthcare providers and I think and I'm seeing it now more on social media that I think at first everyone was like they just wanted to take it all in what's going on and what's next and now we're realizing that we need to have an appetite for the good that's happening in the world as well too. So it's just being able to balance and know that there's some scary things, unknown things, but there's also some incredibly good things going on as well. So again being mindful of that. And what we're talking about is really just self-care practices, the ability to be able to relax and to balance the TV, the gaming with maybe a puzzle and the word games like the old-fashioned days. My son is home from university from the U.S. And he said to me last night he's 23 he said, "Mom, can we order some more board games on Amazon?" I said, "Absolutely." So tonight we're going to pull up the puzzles and I said, "Let's just see what we have." So things like and not everybody is into this but journaling is another incredibly therapeutic practice and very evidence informed and some people I mean I'm also a family counselor and I always encourage my clients to journal, just to be able to have that creative expression and who cares if it rhymes just get your words down on paper so that it can become a sounding board for you. And so, maybe for those introverts who maybe are not communicating as effectively with another person maybe being able to put words on paper and then possibly sharing it. I do have some of my clients who actually share back and I'm blown away. I had one of our faculty members as the director of mental health and wellness we're asking people to brainstorm different ways of supporting one another and she sent an email and she said, "How about music?" Music is so powerful and I love all the music videos that are coming out on Facebook as well. So we've decided we're going to create a site for people just to put their music selections in and to share it and to talk about what that music is doing for them as well. So just again, these are not new ways of coping or new ideas these have been around for a long time but it's starting to use these ideas really purposefully amid the stress. I mean there's no getting around this this is incredibly stressful so let's just bring in all these wonderful things that are at our fingertips, nothing's complicated we just pull them in. And I think last but not least and although I know there's many more as well but just that giving back to your community again in the science when you can give back and get out of yourself there's something about that almost puts energy back into that positive outlook on life when you are actually helping somebody else and reversing that channel of negative emotion just by way of helping somebody else. It could be as simple as a phone call, sending a note. I noticed on U of C Today we get updates all the time they said, "Send a note to someone, tell them, thank them for being kind and for the way that they're giving back to their community." So, there are just a number of ways that not just those who are struggling with addiction but I mean family members as well who are maybe even supporting those who are struggling with addiction. There's just another level of stress for someone who's watching a family member struggle with addiction so everything that I shared with as far as self-care practices can be translated and transferred to the family as well.

CH: Well, it's wonderful to think you can help yourself by helping others as well. I mean if there's anything more poetic than that I haven't come across it yet. And you have answered my question as to how family and friends can help especially when they're stressed. It's funny when you were talking about you didn't realize that you were holding tension and then you let go I realized every muscle in my upper body was tensed up I didn't even think about it. How do I help family and friends when I'm also going through this and trying to digest it in my own way?

JS: Again, I go back to the education, it's so important. And what I think and I'm going to go to those who are actually in recovery. There's so many communities support programs and one I know that I'm familiar with is a 12-step program. And what they've done is actually I have a close family friend who has shared with me that there's now she thinks a hundred meetings a week for Alcoholics Anonymous. And then there's also, there's many different forms like Refuge Recovery is another non-spiritual form of self-help groups as well. There's so many, there is Eaters Anonymous, there's Emotional Anonymous, they're all online now. So it's about putting the effort in to be able to tap into that support. I know that this week I was made aware through a community group that Al-Anon as well so Al-Anon is a support group for family and friends of those who are struggling with addiction so they have those meetings online as well too. So I think what's really important is that everyone should take time even every now and then to check in with themselves and I would say there's that balance between there is a time to give and there's a time to take. So we just have to be so aware of checking in with ourself. And mental health and emotional health are really two of the most important things that we sometimes overlook. And I think when we're caring for somebody whether it's addiction or physical illness often caregivers get trapped in just giving, giving, giving and are so exhausted. And like you just said so beautifully that being able to give to another is a form of self care but you also have to give back to yourself and that feeling overwhelmed, worried or concerned or even fear. I mean this is all natural but the best way to respond to that outbreak is to, of all of those mixed emotions, is to reach out for support and sometimes reach inward so you're reaching outward and reaching inward. And that practicing social distancing is the right thing to do but that does not mean that we have to close ourselves off from the world as well. So again, my friend the psychiatrist said yes social distancing is so important right now to be able to flatten that curve but emotional connection is a must amidst the social distancing as well. Now I think I've been posting a lot on Facebook. I think what is a concern and this is not an area I even like to delve into but I know it's a reality because I'm reading it is that domestic violence is starting to go up and again a huge concern. And I can say in particular for those who are struggling with addiction and I was thinking this week as I listened to the news and I think it was eastern Canada a few communities had chosen to shut down their liquor stores and because it wasn't an essential service but that actually was challenged by mental health therapists and those who work in the field of addiction because you cannot cut off alcohol cold turkey to those who are dependent on alcohol to get through their daily lives. And I mean we get into things like life threatening consequences when somebody goes into alcohol withdrawal and goes into things like delirium tremors. And so, because of the barriers that are in place right now there is a disruption to those who are using. And again, my friend who works in CPOPs was saying, "Well we do know that use is alive and present." I'm still downtown with the homeless population and I'm just so grateful that we're now looking at locations to be able to support and to house these homeless people as well to decrease their risk to themselves but also to society. But how about those who quote unquote he can't look at me but I've got the quotation marks up with the two fingers on both sides and it's what about those who are functional alcoholics and who get by and we're doing that in their workplace and now we're at home. And what about the tensions in the home? So I think it's really important that families know that there are 24 hour support lines accessible to all. And we do know of course 911 is emergency services but health link is 24-7, that's the 811 number and there's actually a 24 hour helpline for family violence information line as well. And so, and that's all through myhealth.alberta.ca. So again, I think what's really important is that we need to equip ourselves it's like having the tool belt on of all the resources that we need to access. So again, lots of stress, lots of anxiety especially if you're dealing with a family member who's struggling with addiction. I think to be able to alleviate some of that, not all of it unfortunately but some of it is to know what resources are out there that you can access so telephone distress lines, child abuse lines, addiction services helpline as well, 24 hour help line for those who are struggling with addiction as well. So, I think in times like this we have to know that we are not alone, that there are support services available not like they used to be, not as accessible as they used to be, but they are there and we need to know where they are so we can access them at our fingertips and be able to get the support that we need.

CH: That seems like a wonderful point to leave it off on. Jacqueline, thank you very much for your time today I really appreciate it.

JS: My pleasure. Thank you, Corey. Bye bye.

CH: Thanks to Jacqueline Smith for taking the time to chat with us today. And thanks to all of you for listening. Before we go, I'd like to take this opportunity to remind our campus community that our mental health supports continue to be available. For students, support can be accessed through Student Wellness Services. For after-hours support, or if you're in crisis, call Wood’s Homes Community Support at 403 299 9699 or the Distress Centre at 403 266 4357. For staff, faculty and post-doctoral scholars, supports are available through Staff Wellness. Additionally, Homewood Health is available, and provides 24/7 mental health and crisis support. For domestic violence support, visit ucalgary.ca/sexual-violence-support. For drug and alcohol harm reduction supports, visit the Wellness Services website at ucalgary.ca/wellness-services. You can subscribe to COVIDcast on Apple, Google, or Spotify. You can also find episodes and other community resources including webinars and expert advice at ucalgary.ca/covidsupport. Ideas for future episodes can be emailed to podcasts@ucalgary.ca. COVIDcast is a production of the University of Calgary. Thanks for listening.