How is the pandemic affecting substance use disorders? We ask Parkview Behavioral Health Institute

For more than two years, the COVID-19 pandemic has dominated headlines. In its wake, a less visible—but also deadly—pandemic has gained momentum in the form of substance use and addiction.

While substance abuse and the ongoing opioid epidemic pre-date COVID-19, the number of overdose-related deaths in the U.S. increased by nearly 30 percent between 2019 and 2020, according to the CDC. In the early months of the pandemic, 13% of Americans reported starting or increasing substance use as a way of coping with stress or emotions related to the pandemic. The long-term impacts of COVID-19 extend beyond the physical ramifications of the virus, and the mental and emotional toll is a rising cause for concern.
Dr. Timothy Kowaleski, D.O.
Dr. Timothy Kowaleski, D.O., a family medicine doctor at Parkview Physicians Group, specializes in addiction medicine and works closely with patients struggling with addiction and substance use disorders (SUDs). He completed a year-long addiction medicine fellowship in Houston before joining Parkview Behavioral Health Institute (PBHI) in 2020. 

“In the midst of COVID, you had people who were right on the brink of developing a substance use disorder and were laid off, or people who had recovery experience, but their support system fell out from under them,” Dr. Kowaleski says. “Those types of events can lead to more use or going back to prior use.”
 
As substance use increases, the risk for addiction grows with it—and addiction doesn’t discriminate based on age, gender, or socioeconomic status. Anyone is susceptible to its pitfalls. 

“Statistically speaking, 10 to 20 percent of a population, which is about 30,000 people in Fort Wayne, will meet the criteria for substance use disorder,” says Dr. Kowaleski. “Addiction is all around us, but we often choose not to look at it.”
 
Exterior of the building at Park Center, 1909 Carew St. Fort Wayne, IN.While the national drug crisis can call opioid addiction to mind, other substances can be just as addictive—and people may not even realize they have a problem. In addition to seeing a spike in the use of opiates, like heroin and fentanyl, Dr. Kowaleski has seen patients with SUDs relating to alcohol and cannabis. 
“There aren’t as many negative consequences associated with cannabis, so people often overlook it,” he says. “But I see a lot of patients who experience withdrawal symptoms if they go without marijuana.”
 
To combat the recent rise in SUDs, PBHI is taking proactive steps in Fort Wayne and its surrounding communities to provide accessible support and resources at various levels. According to Dr. Kowaleski, withdrawal symptoms are a strong indication that it’s time to pursue addiction treatment, and for many substances, withdrawal effects can be deadly. Specialized, formal programs can provide medical detox services that protect patients’ health and reduce the likelihood of a relapse. Parkview LaGrange Hospital and Parkview Wabash Hospital both have inpatient medical detox programs. (All Parkview ERs are also equipped to handle detox emergencies.)
 
“After continual substance use, people often use just to feel normal,” says Dr. Kowaleski. “They don’t get a rush or a high anymore. It’s just so they can function. In those situations, medical detox is crucial because we can lessen the symptoms of withdrawal and monitor how they’re responding to the detox. It keeps them alive.”
 
A room is set up for IOP (Intensive Outpatient Program) group sessions at Park Center.Inpatient facilities provide safety for people struggling with SUDs—but for many people, substance use doesn’t require the intensity of a medical detox. Counseling and therapy can provide some support, but results often require long-term commitment and consistency. Until a few years ago, this was a significant gap in support services. Then, in 2018, a Medicaid bulletin announced new coverage for intensive outpatient programming, which serves as acute, short-term treatment for people who need more resources and accountability than traditional therapy might offer.
 
Caroline Braun, LCSW, serves as the clinical programs manager for PBHI, where she oversees all intensive outpatient programs (IOPs) in the institute. PBHI has IOPs in Allen, Whitley, Huntington, and Wabash Counties, with plans to establish IOPs in other counties as well, and offers a program specific to substance use. IOP treatment occurs in a group setting, which creates a sense of safety and community for participants. The typical schedule involves minimum of three meetings per week, each three hours long, for a total of nine hours.
 
Portrait of Caroline Braun, Clinical Programs Manager for Parkview Behavioral Health Institute at Park Center.“Inpatient treatment is for patient safety—when a person poses a risk to themselves or others,” says Braun. “IOP treatment is for stability, and it can last anywhere from two to 12 weeks. It’s like an outpatient boot camp, where participants can do a lot of hard work in a short amount of time to see marked results.”
 
Typical IOP groups consist of about six to eight patients and one therapist. Through IOP treatment, patients build connections with both counselors and peers. Rather than receiving feedback exclusively from a therapist, they participate in a community where they get to receive input from group members who understand their struggles and challenges. They also get to provide feedback to others. 

“When you have people on your side encouraging you, it provides an added layer of healing,” says Braun. “The therapists in our IOPs are passionate about the treatment, and they create a sense of security and purpose for patients. People keep showing up because they know they’re in a room full of people who want them there.”
 
Caroline Braun, Clinical Programs Manager for Parkview Behavioral Health Institute, shows what a normal 1-1 therapy session would look like with a client during a mock session at Park Center, 2710 Lake Ave.Substance use can impact anyone, and IOPs allow people to step into a treatment program before addiction reaches an emergency level. 

“I think there’s a perception that because this therapy is an ‘intensive’ program, you have to be really sick to be in it,” says Braun. “But that’s not what the program is structured for. If you’re already in a place where substance use affects your life, now is the time to get involved in an IOP. IOPs create a safe environment for managing substance use and hopefully preventing the need for medical detox later.”
 
One of the primary methods of IOP treatment is harm reduction, which meets clients where they are and seeks to reduce the negative consequences of substance use. 

“Science shows us that a harm-reduction approach is better than an abstinence approach when it comes to substance use,” says Braun. “An abstinence-based approach stigmatizes people with SUDs and isn’t very trauma-informed. We have a lot of clients who have experienced extensive trauma, and their substance use is a coping mechanism. Abstinence tells them they can’t use that coping mechanism anymore, while harm reduction focuses on removing risk factors and educating clients on how to deal with an overdose if they experience one—for example, keeping Narcan on hand for an opioid overdose.”
 
The sign on the front door at Park Center, 2710 Lake Ave.“I have one patient who I’ve been seeing for four years, and we’ve been walking through his active addiction the entire time,” says Braun. “The one thing that created change for him was IOP. He felt so alone, so stigmatized, so ostracized from his family and support—but he found a safe space in his IOP group. It saved his life.”
 
The work of PBHI—through both medical detox programs and IOPs—goes beyond providing treatment for people with SUDs. Instead, it’s opening the door to a wider conversation about who struggles with substance use and how it impacts Fort Wayne’s communities. 

“It’s a common misconception that addiction only affects people with a low socioeconomic status,” says Braun. “But substance use impacts all ages, all income levels, and all walks of life. It’s easier to think it’s not close to us, but it’s right in front of us.”

Caroline Braun, Clinical Programs Manager for Parkview Behavioral Health Institute, shows what taking notes looks like after a mock therapy session at Park Center, 2710 Lake Ave.By responding to the national drug crisis with innovative, community-based treatment programs, providers like Caroline Braun and Dr. Kowaleski hope to reframe the stigma surrounding substance use and addiction. 

“Culturally, we know substance use disorder is a disease, but people treat it differently,” says Dr. Kowaleski. “We don’t get mad at asthmatics when they have asthma attacks, or diabetics when they have low blood sugar. It’s important to start looking at SUDs from a chronic disease standpoint—without the stigma.”

Learn more
 
To learn more about PBHI’s IOP treatment for substance use, visit the Parkview website.

This story is made possible by underwriting from Parkview Health.