Jordan: I don’t know about you and I haven’t been keeping track to make sure, but I’d be willing to bet that I’ve been drinking more since I’ve been stuck in my house 99% of the time. And judging by my social media feed and the limited numbers we have seen so far, I’m really not alone. Canadians have self reported an increase in substance use, at least alcohol, since we began social distancing. And no kidding. But here’s the thing. I wonder if in our minds there’s this huge gulf between me kind of laughing and confessing that the whiskey doesn’t last as long as it used to, and the picture that most of us have of someone living with a substance use disorder. Maybe that gap isn’t as wide as we’d like to think. Maybe that gap only exists because some of us really need to believe it does. And maybe a lot of people around the country right now are realizing that it’s not a clear cut matter of abuse or not, and that it’s all a scale. So what has two months and counting of isolation taught us about people who use substances?
What kind of resources have vanished for the less privileged among us during this time? What do we need to help them and what can all of us from the person who no longer has passer-by to panhandle from, to the executive with a wine cellar big enough to sleep in, learn about our behaviour when it’s subject to such a radical shift?
And if we want to do something about that behaviour, whether it’s wine or cigarettes or the way we think about ourselves, what can we do right now?
I’m Jordan Heath-Rawlings, and this is the big story. Gord Garner is the executive director of the Community Addictions Peer Support Association. He is the chair of Recovery Day Ottawa. He is a national public speaker and he is also living well with his own substance use disorder. Hello Gord.
Gord: Hi. How are you doing Jordan?
Jordan: I’m doing well, and one of the reasons we wanted to chat with you is to hear what your work has been like since March. Tell me about the day to day and what’s happening amidst all this.
Gord: On a personal level as an organization, we obviously stopped going into the office in March. We had to cancel four of our peer groups that were running that were in person meetings. So those are some stabilizing things that make us worry about people’s connection. We’re fortunate though in the fact that a lot of our activity is on social media. And we have some content built up. And so some of that’s been receiving more attention because people are able to spend more time, or have no choice in spending more time being on social media, in terms of looking for connection.
Jordan: And when I mentioned that you’re coming at this both as an advocate and as somebody on the front lines, you are living with a substance use disorder. Can you tell me how that’s been different during the time of COVID-19?
Gord: Sure. I think myself, like many people that I know, the change in our lives, and change in the outcomes of our lives, have established these patterns we have around self care, and a lot of that is including contact with others, and finding safe places where we can express that. A person like myself, I also have suicidal ideation. So my thinking hasn’t always changed that much despite the great change in my life, and they need a safe… for myself, I need a safe environment where I can tell someone what my thoughts have been lately without them leaping to conclusions about what that outcome means, and also without leaping the conclusions about what that has to do with my health. They are after all just my thoughts. It only impacts my health when it becomes into my life.
Jordan: What about the people that you work with who also use substances? What I constantly wonder is you know, obviously it varies depending on what they’re using and where they get it, but how the patterns of life change, as all our patterns of lives have changed over the past couple of months.
Gord: So there’s a minimum of four and a half percent of Canadians have a substance use disorder. And then of course, a great many more Canadians use substances. And so we often think of our own substance use disorders in a homeless population, whereas in fact, there’s only, and I say only, I used to be homeless, so it’s not an only sort of thing. Our population of homeless people in Canada tends to be a quarter million a month on average. Whereas our population with people with substance use disorder is about a million and a half. So I guess what I’m suggesting is 85% of Canadians with substance use disorders are actually heading in homes and often leading what appear to be successful lives. So what COVID has done, and isolation has done is several things. It’s brought our homeless population clearly into sight. So there was three homeless people on the street before and a hundred people walking past them. Now you just see the three people.
Jordan: What kind of resources used to be available for people in those situations that aren’t available now because of logistics or, or resources being directed elsewhere or other things?
Gord: Well in a very simple way, things that the Canadians living in privileged lives don’t often think about is, for the homeless population there is often just the resources that you might not think of yourself. So there are no cigarette butts on the street anymore to pick up. Because there’s nobody on the street. And so just that resource has gone. So you’ve got more interactions with strangers, you’ve got less people that got less access, and you’ve got that shared butt thing going on. That leads to greater health risks. There’s no one to panhandle from, there’s nothing in the garbage cans. There’s no half eaten hamburger. There’s no leftover French fries. There’s no public washroom to slide into. And so all those hidden resources that people don’t think of. There is less security in being hidden within the population walking around. There’s a greater visibility. There’s a greater enforcement piece, our own physical distancing.
And yet the homeless community often finds safety within gathering together and with being in a buddy system situation. So all these things have heightened, and driven the level of stress and fear in daily lives of people that are already in incredibly stressful situations.
Jordan: What about the people with substance use disorders who are privileged and who do live in homes? How are their lives changing? Are they unable to hide it to family anymore? I’m imagining the day to day of their lives must be pretty different as well.
Gord: Often towns and cities, there’s an area that we all identify as being a privileged area and someone’s there living there today, and there’s cars in the lane way and there’s kids in college, and there’s probably a partner in the house and their totally disconnected from all that. And so they’re comfortable chairs offer them no comfort. And often what was the last piece we’re hanging on to was this purpose of the morning of getting to work and the idea of functioning some way to justify their use. And now, they have this bottomless supply of whatever substance they want. Cause money’s not an issue. Great despair and great isolation. And then who do you ask? And because of stigma, how do you reach out? And because of the, the reduction in what were already inadequate services or greatly hampered despite being declared essential because of the distancing. So there’s just an incredible difficulties out there for everybody.
Jordan: What kind of help do they need and how do you and the people you work with get it to them right now?
Gord: So one of the things that we look at is leverage points in terms of what can we do to make the greatest change and get the resources that are needed for this health issue. And we believe at CAPS that reducing stigma is the pathway forward.
That trying to do something in this instant without a social support behind it is kinda like beating your head against the wall. Mental health has always been underfunded, substance use issues even more so. It’s seen as a moral failing. It’s seen as a personal responsibility rather than as a health condition.
And so the leverage point is around reducing stigma. So we all are pretty aware in Canada that there’s an opioid crisis going on and an overdose crisis going on. And so the irony behind that is we’ve been trying to get people to pay attention to the 5,000 deaths a year taking place in Canada.
And we’ve even seen lately where they started adding the two years together and saying 10,000 people have died over the last two years. We’re trying to find the number where Canadians will care sufficiently to bring resources and make policy changes. But the truth is, 37,000 people died from tobacco this year.
And there’s no headlines. No one’s suggesting we arrest the corner store owners for selling something that’s deadly. No one’s suggesting we close tobacco production down. And the reason behind that is we believe that if people know better, they should do better, and everybody in Canada now knows that tobacco is bad for you, it says it right on the package. And so this disregards what a substance use disorder is all about. That consequences will not stop the behaviour.
Jordan: Well, I wanted to ask you about that, and not necessarily about tobacco, but, but about invisible substance users. Because when we talk about stigma, and to be honest, when I think about talking to you about substance use, you think about the opioid crisis and heroin and fentanyl, and you know, the quote unquote street drugs. But one thing that I’ve seen a ton of, since everybody began staying at home is people referring to how much more they’ve been drinking. And not in a in a serious way, but in a way that implies, ‘of course I’ve been drinking more during this pandemic’. And you know, that is substance use too, obviously. And I guess, how do you fold all those things into the same conversation, if that question makes sense?
Gord: Well, it does, it makes absolute sense, because it’s where we make changes is when we can connect Canadians to the issue in a way that they understand. So if I told you that approximately 14,000 people died last year from alcohol related outcomes, most people would be shocked to find that out. Again with the 37,000 cigarette related deaths, now you’re talking about 50,000 people. Talking about a half a million Canadians grieving over their loved ones from substance use.
And all you hear is silence, and all you hear is people talking about, ‘yeah, no, I’ve doubled the size of my margarita because I’m handling Covid’, right? And this normalization of taking a toxin, and I’m not a temperance movement person. But I think Canadians need to make informed decisions about what is healthy substance use and what is harmful substance use and what the outcomes are of their decisions. In the vulnerable population, and the people… no one ever took an addiction, people was taking a drink, they’d taken a substance, but they never took an addiction. They found out they had an addiction after they took substances. And so we really need to be able to have these conversation, this broad context of the continuum that our people are going to use substances, some will use them without negative outcomes, many people have outcomes that are negative, and some people have what are really brain shifting outcomes and lose the ability to make a choice about substance use, and be caught in an addictive pattern.
Jordan: Do we know, by any measure, if people are using more substances during this time?
Gord: Yeah, Nanos just did a poll on alcohol use, and came out with a 25% increase in ages 35 to 54, a 21% increase between ages 18 and 34 and interestingly, only a 10% increase in 54 plus. But for me, the other thing that’s really interesting is the reasons people give for those increases. So like half of people said it’s because they’ve lost their regular schedule. So that’s interesting. People don’t seem to know what to do with themselves. 49% say it’s boredom, and 44% say it’s stress. And, there’s a lot of research, I think there’s an article in the Lancet that stress is one of the foundational ingredients towards moving towards a toxic use of substances and potential dependence and perhaps addiction.
So what I hear in those words, Jordan, is that we’re seeing a lot of people in Canada that are not comfortable with being with themselves and want to alter their personal experience with themselves. And so a self-medication process is taking place here. And it’s not about myself doing something to change my experience, it’s about taking something to change my experience with myself. And that’s always slippery territory when it comes to substances, and dependency, and harms.
Jordan: I mean, that’s speaking to a broader problem than just a substance use, right? When you’re saying that people in the middle of this are finding out they’re not comfortable with themselves.
Gord: Yeah. I think that that’s going to show up in a lot of different behaviors. And of course the one we’re talking about today is substance use. So I really think that you’re seeing sort of, ‘who are we if I’m not what I’m doing’? This attachment to human doings instead of the human beings, right?
Jordan: How do you change that in your work, when you’re working with someone who has a substance use disorder? How do you change that mindset?
Gord: Well, I first try to make it safe for the person to have had the life they’ve had to this moment. To recognize that all human beings have done their very best right up to now to have a good life. And then, so it’s not lack of effort, it’s not lack of desire, it’s not lack of caring. We’ve all tried to have a good life. And in that, there’s often the first decision to use a substance is in the attempt to have a better life. Whether that’s from taking the substance or feeling like I belong because I’m with the others and I took a substance, or whether it’s to soothe my anxiety. And then things happen and people are always… It doesn’t look like it. I mean, if I told somebody that I was trying to have a good life, she would wonder what I was talking about for many, many decades. But I was. I was trying to have a good life. I just didn’t know how. And so we have to be respectful, we have to be compassionate, and it has to be safe not to be okay. And to be respected for having done your best so far.
Jordan: If you could get some aspect of the work that you and those organizations do to stick with the general public as, hopefully we start coming out of our homes in the coming weeks and months, what would it be? And what would you have us take away from this?
Gord: I guess at the heart of all this is to understand that no one chose an addiction. Addiction is about the loss of choice. And that you’re looking at what we’re… When you’re driving down the street, if you look out the window, can you imagine you’re looking at children? And you can imagine that they’ve done their very best up to now, and you wonder what they might have suffered, that this is the outcome. And to realize that when you’re talking in your car about who’s outside, out the window, or who is across the street or who’s in front of the liquor store lined up. There’s someone in your family, there’s someone in your group of friends that you’re talking about. And would you express yourself differently? Would you use person-first language?
People who are using substances, people with a substance use disorder. And when we begin to see people, we can begin to see their suffering. I mean, we still describe people in the most bizarre ways around this issue. It’s unfortunate.
Jordan: If people are just at home without, maybe the support system that they usually rely on, is there anything that they can do themselves to kind of change their thinking and work with their substance use?
Gord: There’s a couple of things that sounds almost too simple to be effective, but they’re actually very beneficial. One is actually exhaling. Exhaling allows us to draw our next breath. And what happens is when we’re stressful or when we’re caught up in our thinking, we stop breathing properly. And that tells my primal brain that I’m in a life threatening situation.
And in fact, I’m just sitting in a chair at home. So when I exhale, I can get more grounded in the reality that I’m okay, I’m just not happy or I’m concerned, and that’s different from being in a life threatening situation. I can think more clearly and make better decisions when I’m not stuck in my primal, fearful brain.
The other thing is journaling is an activity that’s really beneficial. It’s the reverse of substance use. Instead of getting away from my experience, I get connected to my experience and again, I attached into my frontal cortex instead of in my primal brain. And of course the easiest way to start journaling is by writing down, ‘I think journaling is stupid’, and then you’ve started and you can go from there.
Jordan: That’s pretty simple.
Gord: That’s how I start journaling every time, ‘I think this is stupid’, and you know what? Then I have my thinking and I have my emotions connected in my head and nothing bad happens, and I’m more comfortable not being happy than I was before. We often get confused, in my experience, Jordan with happiness. Can I tell you a little story? So when I was young, I used to read these stories and they started in a time long, long ago in a place far far away, and I thought that made them fairytales. It turns out that’s just geography and history. It’s the last line of the book, happily ever after, that’s the fairy tale. See? And I didn’t know that. And so I thought anytime I wasn’t happy that that meant there was something wrong with me, or something wrong with the world and something had to be done.
I didn’t realize that unhappiness, sometimes it’s a great emotional indicator that helps guide me into different behaviours that informs me about the richness of my experience. As Shakespeare said, partying is such sweet sorrow. If I will not experience the sorrow, how will I know the sweetness of the party?
Jordan: That’s a lovely story. Thank you so much for sharing it and thank you for your time today, Gord.
Gord: Appreciate it Jordan, all the best eh?
Jordan: Gord Garner of the Community Addictions Peer Support association.
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