NASW Social Work Talks - EP55: Treating Substance Use Disorder During the Coronavirus Pandemic

Episode Date: June 30, 2020

We speak with Carla Monteiro about how the coronavirus pandemic is changing how social workers approach treatment for substance use disorder. Carla is a member of NASW's Massachusetts chapter, and is president of the Cape Verdean Social Workers Association. Visit the show notes for resources and a transcript.

From the National Association of Social Workers, I'm your host, Aaliyah Wright, and this is Social Work Talks. Thank you so much for joining us for this episode, which focuses on how the coronavirus pandemic is changing how social workers approach treatment for substance use disorder. Today, we're chatting with Boston-based social worker, Carla Montero. Carla is a member of NASW's Massachusetts chapter. She is also the founder and president of the Cape Verdean Social Workers Association Incorporated and a member of the Greater Boston Chapter of the Association of Black Social Workers. She also engages in various volunteer activities in the African American community. Welcome, Carla.

Thank you for having me. I really appreciate the invitation. So, Carla, tell us about your role and how that has changed. So, I'm the founder and president of the Cape Verdean Social Workers Association in Boston, and our mission is to raise awareness and provide psychoeducation about mental health, mental illness, and substance use disorder in the Cape Verdean community and connecting community members to Cape Verdean clinicians. so typically what we would do in our organization is go out and do presentations in person at workshops and things like that to educate people about the symptoms of mental illness but since the pandemic we haven't been able to do that so we've been able to post something some tips on our social media sites and then also I have been doing a lot of community panels and podcast interviews on Zoom and volunteering, delivering food and essential items to community members.

As for my other role, I work in a local substance use clinic in a hospital in the Boston area. The clinic was designed to fill in the gap in care for patients with substance use disorder. The clinic provides rapid access to services so that patients can see psychiatrists, medical doctors and have access to medication, therapy, recovery coaches, and other resources. Our patients are an extremely vulnerable population, and so they have a lot of underlining mental illnesses, and in addition to the substance use disorders. Some of them are also experiencing homelessness and lack of transportation and access to meals. So when the pandemic initially began, we reduced clinic hours and rotated staff members to decrease

the risk of infection, but quickly transitioned to virtual visits. We eliminated toxicology screens so that the patients wouldn't have to come into the hospital. And we also identified patients who were at higher risk for relapse and that would need more support during that time. And so we were prepared to give that added support. We were also scheduled to be in the clinic a couple times a month to provide injectable medications like Sublocate and Vivitrol to support patients with recovery. What were some barriers to care prior to COVID? Some of the barriers, as I mentioned earlier, were lack of transportation, and so patients would miss appointments at a higher rate. Most insurance companies didn't compensate for telehealth visits at the same rate as in-person

visits, or they didn't cover it at all. And in addition to that, doctors could not prescribe medications if the patients were not seen in office. But a lot of that has changed post-COVID. Insurance companies are a little bit more flexible. Medications can be prescribed after virtual visits. And telehealth has been widely used since COVID and has been deemed an effective and sustainable solution for treatment during the pandemic. So do you see that becoming the norm now? I definitely see it becoming the norm for therapy.

Our lives are becoming more and more chaotic. And so signing in with telehealth just makes things just so much more convenient. There are many other factors to consider that create barriers to care. For example, not everyone is tech savvy, nor do we all have access to hardware and technology needed to have access to telehealth services. Are patients still able to access services such as detoxes? And can you explain what that is for our listeners who may be unfamiliar? Sure. Detox generally refers to the process of removing toxins from the body.

And so in most cases, people use a detox facility when they are detoxing from substances like opiates or alcohol. It's a little bit safer to be somewhere where you can be monitored. And are patients still able to access those services? Yeah, so they do still have access to detoxes, but many of them are not accepting new patients or are closed. And some require COVID clearance, meaning that the patient would have to go to the testing site, get tested, and provide a letter to the detox facility stating that the results were negative. Some of the challenges that have emerged post-COVID is that people cannot meet in person. And so people who are in recovery, you know, it can be very difficult for them when they heavily rely on AA meetings or other recovery support groups. There are online options, but again, not everyone has access. This disease is very isolating,

and it can exacerbate when proper supports aren't in place. And the pandemic is just not making it any easier. So are people able to detox at home and maybe get advice over the phone or through those telehealth options because of what's going on? So people often will consult their providers and they can do that. And then the provider can determine whether or not they need to go into an inpatient detox. But typically it depends on what their risks are. So it depends on the person's age, if they have other pre-existing conditions. So there's a number of different factors that would help a provider determine whether or not a person needs to go in for a detox or if they could detox at home. We're living in unprecedented times. Is there

an increase in substance use because of the added stress of job loss or being required to shelter in place? Yes, I mean, I believe that there is an increase in substance use disorder during the pandemic. You know, people have lost family members, jobs, and their social connections. And also people who have lower income status, loss of job security, insecure housing, and people who are post-incarceration often use maladaptive ways to cope with stressors. Therefore, they are at a higher risk for increased levels of substance use. Now, what are some things social workers should be mindful of when it comes to patients with substance use disorders? I think it would be helpful to keep in mind that the COVID-19 pandemic has presented unique challenges for

people with substance use disorders and for those in recovery. Like I said earlier, you know, a vast majority of AA meetings and support groups have been stopped or have been moved virtually. So most patients may need some sort of additional support from their provider. Listeners, we'll be right back. NASW Press is the leading scholarly press in the social sciences. Our publications reach faculty, practitioners, agencies, and researchers in social work and related disciplines. Visit naswpress.org for scholarly books, reference works, brochures, and periodicals. So, Carla, we've talked about your job, but how has your volunteer activity changed?

You know, I'm a self-proclaimed super volunteer, and so I love volunteering in my community. And before, you know, I could go somewhere and we'd be kind of, you know, in close proximity. But now, you know, we're picking up food and essential items and delivering them to families, but not going in their homes, just meeting them on the porch and delivering there. We all, you know, have to wear a mask, have to wear gloves. Do you think that by wearing the mask and interacting with people that you're losing that human connection? We have discussed this when we're out because often I'm smiling and, you know, when I'm talking to people and I'm like, I don't know if they know I am or not or smiles and things like that go a long way for people. And so I think people just really accept the gestures and they are very happy that we're there to provide services. And so I think they they take that as, you know, something that they really appreciate.

And so they they're not you know what I mean? So they're not focusing on them on the mask. So what issues are COVID illuminating that have already existed in your community? I think it has magnified the health disparities stemming from structural racism. it has been reported that Black people have a higher risk of death from COVID. And those results are due to lack of access to testing and treatment in communities of color. We are already experiencing disproportionate economic stressors, food insecurities, and racism. You know, people, Black people are being stopped in the stores for wearing a mask, even though a mask is required. You know, all of these things are contributing factors to mental health issues. And it's just

been really stressful for a lot of people in our community. Unfortunately, because there is just so much stigma around mental health and seeking help from a therapist or taking medication in the Black community, folks are at higher risk for poor mental health outcomes. How can community members support each other? I think that we as a community, you know, those who are interested and are able full-bodied people should be assisting, you know, the elderly, like going grocery shopping for them, you know, just dropping it off on the porch and not having contact. I think we really need to support our loved ones, our neighbors, and we all have to come together to just kind of, you know, to get through this. This is the only way that we're going to get through this safely is by

using the proper precautions, but also supporting each other and, you know, in any way, you know, whether we're just calling to check in, seeing what additional things they need. And people of color have to make sure that they are taking it serious and wearing their mask when they go out, whether they're going to the stores or visiting family members. I think it's important for us all to just take the proper precautions to support each other. In addition to that support, do you think it's important for social workers to maybe pause and take some steps to exercise self-care for themselves? Because you guys are actually seeing a whole lot on the front lines. What do you think about that?

Yeah, I strongly believe that social workers should be getting some sort of mental health support. It is a lot. I know we often talk about nurses on the front lines and watching the death tolls at the hospitals, but we also have hospital social workers who are also delivering the news to people's families that they're dead or holding the phone on FaceTime while somebody's or somebody who is dying and speaking to family members. And so that's really hard to sit with, you know, knowing that this patient's going to die and they're saying their final goodbyes. It definitely takes a toll on social workers. And it doesn't matter how much, you know, you've been trained and how many skills you have. You know, we're human at the end of the day. And so this affects us, too.

And it's very important for us to take deep breaths, for us to stretch, go for walks and, you know, lean on each other and find our own social supports that can be supportive of us. and in validating our experience as well. Do you have any additional tips and what are some other things you think people should know? I think people should not rush this process. I think that we all adjust at a different pace. And so, you know, it may take somebody two weeks to adjust to being home.

It may take somebody a month or two. And so it's important to take breaks from watching the news, also social media, go for walks, you know, eat healthy and get some exercise because we have to take care of ourselves, you know, mind, body, and soul. And so I think those are all really important ways that we can kind of try to stay ahead of the pandemic. And so it doesn't take too much of a toll on us.

Carla, thank you so much for spending the time speaking with us today. Thank you so much. I really appreciate it, Aaliyah. You have been listening to NASW Social Work Talks, a production of the National Association of Social Workers. We encourage you to visit NASW's website for more information about our efforts to enhance the professional growth and development of our members, to create and maintain professional standards, and to advance sound social policies. You can learn more at www.socialworkers.org. Don't forget to subscribe to NASW Social Work Talks wherever you get your podcasts. Thanks again for joining us.

We look forward to seeing you next episode. Thank you.