Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, USA.
Kent State University at Stark, School of Communication Studies, North Canton, OH, USA.
J Subst Abuse Treat. 2021 May;124:108270. doi: 10.1016/j.jsat.2020.108270. Epub 2020 Dec 28.
The COVID-19 pandemic created a number of rapidly emerging and unprecedented challenges for those engaged in substance use disorder (SUD) treatment, forcing service providers to improvise their treatment strategies as the crisis deepened. Drawing from five ongoing federally funded SUD projects in Appalachian Tennessee and hundreds of hours of meetings and interviews, this article explores the pandemic's impact on an already structurally disadvantaged region, its recovery community, and those who serve it. More specifically, we note detrimental effects of increased isolation since the implementation of COVID-19 safety measures, including stakeholders' reports of higher incidences of relapse, overdose, and deaths in the SUD population. Treatment providers have responded with telehealth services, but faced barriers in technology access and computer literacy among clients. Providers have also had to restrict new clients to accommodate social distancing, faced delays in health screening those they can accept, and denied family visitations, which has affected retention. In light of these challenges, several promising lessons for the future emerged--such as preparing for an influx of new and returning clients in need of SUD treatment; making arrangements for long-term housing and facility modification; developing a hybrid care delivery model, taking advantage of new regulations enabling telemedicine; budgeting for and storing personal protective equipment (PPE) and related supplies; and developing disaster protocols to withstand threats to intake, retention, and financial solvency.
新冠疫情为从事物质使用障碍（SUD）治疗的人带来了许多迅速出现的、前所未有的挑战，迫使服务提供者在危机加深时即兴发挥他们的治疗策略。 本文从田纳西州阿巴拉契亚地区的五个正在进行的联邦资助的 SUD 项目中汲取灵感，借鉴了数百小时的会议和访谈内容，探讨了疫情对一个已经处于结构性劣势的地区、其康复社区以及为其服务的人的影响。更具体地说，我们注意到自 COVID-19 安全措施实施以来，隔离增加带来的有害影响，包括利益相关者报告 SUD 人群中复发、过量用药和死亡的发生率更高。治疗提供者已经通过远程医疗服务做出了回应，但面临着客户在技术获取和计算机素养方面的障碍。提供者还不得不限制新客户的数量以适应社交距离，对他们能够接受的健康筛查延迟，并拒绝家庭探视，这影响了保留率。鉴于这些挑战，未来出现了一些有希望的经验教训——例如，为需要 SUD 治疗的新客户和回流客户的涌入做好准备；为长期住房和设施改造做好安排；开发混合护理交付模式，利用允许远程医疗的新法规；为个人防护设备（PPE）和相关用品预算和储存；并制定灾难协议，以抵御对摄入、保留和财务生存能力的威胁。
