MHM Magazine

Issue 4 | 2021 | MENTALHEALTHMATTERS | 33 MHM By Dr Hemant Nowbath Psychiatrist hemant@saol.com T he last 18 months has been an unprecedented time. We have been thrust into a new, very different world. A world of quarantine, lockdown, sanitising, masks, and social distancing. A world marked by fear and uncertainty, the tracking of morbidity and mortality statistics, loss of control, and one in which the normal rituals of grief and mourning have been disrupted. At a very different time, in 2016, I wrote “Tales of woe continue to occupy columns of newspapers and popular magazines as the gloom surrounding the seemingly lost war on addiction spreads. The human-interest stories reflect the pathos and the tragedy of the horrific consequences of addiction… individual lives destroyed, families struggling to cope, communities suffering as addicts engage in criminal behaviour to fund their habits”. Little, therefore, has changed in the arena of addiction. Addiction remans a complex, chronic medical condition contributing significantly to the burden of other medical diseases. The COVID pandemic has added a new dimension and exacerbated the challenges. BARRIERS Barriers to treatment persist. Resources are woefully inadequate. Serious shortages of trained personnel and facilities bedevil care. Suitable rehabilitation facilities are beyond the reach of most of the population. Medication is expensive and drugs like methadone and buprenorphine, though on the World Health Organisation (WHO) essential drugs list, are not available in most State facilities and not reimbursed by many medical aid schemes. Our Gini coefficient, which marks the disparity between rich and poor, is the highest in the world. Widespread poverty sows the seeds of discontent and helplessness. This, compounded by rampant unemployment and despair, increases the risk of psychiatric illnesses like depression, anxiety and psychosis and contributes to an increased incidence of addiction. LOCKDOWN The lockdown during the peaks of the pandemic was necessary to prevent spread of illness as numbers escalated. There was a need to preserve resources and limit morbidity and mortality. Experts advised that the sale of alcohol and cigarettes should be prohibited during the hard lockdown. However, alcohol was available on the black market and the sale of illicit cigarettes boomed. The decision was probably ill-informed and guided by political shenanigans and well-connected lobbies. The estimated loss in in taxes in the first month was R1,7 billion. The lockdown was never meant to be punitive, was never intended to create a nanny state or to perpetuate the human rights abuses that were seen in the name of the lockdown. Reports of a man being killed at home for breaking lockdown restrictions, the attempted ‘arrest’ of a 4-year-old and people being harassed by overzealous members of the police and SANDF made newspaper headlines. IMPACT These were difficult times for people with addiction. The cigarette smokers suffered nicotine withdrawal with irritability, anxiety, craving, dizziness, headaches, and constipation amongst other symptoms. On a positive note, some were able to quit smoking during this period. Those with alcohol use disorder had greater difficulties. Alcohol withdrawal is a medical emergency marked by confusion, agitation, hallucinations, seizures, and delirium tremens. There are many, who are not problem drinkers, but may drink regularly to mark the transition from work to home, to relax, to socialise and to promote good sleep. These people would have been frustrated and felt that they were being unnecessarily punished by the ban. These frustrations must be seen in the context of the challenges TWIN PEAKS: ADDICTION AT THE TIME OF COVID