Stay-at-home orders issued during the COVID-19 pandemic interrupted many facets of our lives and created many barriers, particularly for those in recovery from substance use disorder.

But a study by Indiana University faculty found that despite these challenges, those with substance use disorder were largely resilient and employed effective coping mechanisms. The findings, published in PLOS ONE, can help inform the prevention and treatment of substance use disorder amid disaster preparedness, they said.

"Through this study, we not only identified barriers and stressors to those in recovery, but it helped identify ways to help those with substance use disorder maintain their recovery during devastating events such as the pandemic," said Katherine Shircliff, research study coordinator for the Long Term Recovery Project at IUPUI. "Should substance use treatments be interrupted in the future, our study found that prioritising treating mental health and encouraging self-care would be important points of planning and prevention."

Researchers conducted personal interviews with 48 individuals, ranging from 26 to 60 years old, and measured pandemic-related barriers for recovery, methods used to cope with cravings and how these barriers and methods would predict substance use frequency. The participants were also involved in a multi-year, longitudinal study of substance use disorder recovery. These interviews were held within the first six weeks of the original stay-at-home order given by Indiana leadership and a follow-up interview was held within 12 months.

Some of the reported barriers included cancelled support meetings, changes in job format (being fired or furloughed), and lack of social support. Worsened mental health was also reported as a barrier, with those who reported this barrier demonstrating a stronger relationship between baseline cravings and subsequent substance use than those who did not face this.

Patients who struggled with worsened mental health during the early days of the pandemic had a stronger relationship between substance cravings at the start of their recovery and subsequent use, compared to those who did not report having poor mental health, according to the study.

The stress of contracting COVID-19 also played a role, with 58 per cent of participants perceiving themselves as at greater risk of becoming infected with COVID-19, as opposed to 30 per cent in a general adult sample.

Likewise, though following health guidelines was reported by participants as a facilitator to recovery, findings suggest that following these guidelines may have kept them physically safe but may have had inadvertent negative effects on mental health, therefore leading to cravings and substance use. "Although isolation may have served as a coping mechanism in that it kept individuals physically safe, doing so may have also distanced individuals from integral supports and worsened their ability to cope with substance cravings," Shircliff said.

Despite the challenges faced, most participants showed resiliency and made use of effective coping strategies such as participating in self-care, leisure activities/hobbies, taking caution against exposure and strengthening personal relationships. This self-care proved to be an effective protective factor for study participants, as no one who reported self-care as a coping mechanism reported substance use during follow-up interviews.

"Amid future large-scale interruptions to treatment, self-care strategies, such as reflection/prayer, journaling, and positive self-talk can be particularly effective in that they can be engaged regardless of external circumstances," said Melissa Cyders, professor of psychology at IUPUI and co-author of the study. "Should substance use treatments be interrupted in the future, prioritising treating mental health and encouraging self-care would be important points of planning and prevention."