Dr. Bizzell shares his journey from physician to a businessman in a new Washington Business Journal series, “My Story,” in which business executives share their personal and professional backgrounds and journeys, their challenges, and their successes. Dr. Bizzell discusses how as an established business leader in the Washington, D.C. metro community and President/CEO of The Bizzell Group, he has defined mentorship as one of the company’s core values. He believes it is his responsibility to build a new generation of leaders, given his past experiences of overcoming racial inequity. Dr. Bizzell encourages future generations to see mentorship as their responsibility and as a solution to fight the racial injustices that too many people continue to face today.
Maintaining Recovery from Substance Use Disorders During the COVID-19 Pandemic
Maintaining Recovery from Substance Use Disorders During the COVID-19 Pandemic
Written by: Anton Bizzell, MD
The global COVID-19 pandemic has had a profound impact on health care delivery systems and on patterns of social support worldwide, creating an unprecedented set of challenges for individuals in recovery from substance use disorders (SUDs). In addition to managing the situational anxiety many people are facing with the unknowns of the pandemic, the social distancing that is vital to reduce the spread of the virus and protect vulnerable people, leaves individuals in recovery physically isolated from their health care providers and support system. Some people with SUDs may be at higher risk of relapsing with extended periods of time at home, uncertainty about work or finances, added stress on family relationships, or social isolation.
With this extraordinary situation, new resources and solutions are emerging to help people struggling with SUDs gain access to treatment in order to maintain their path to recovery.
New treatment access and guidelines during COVID-19. Health care and treatment of individuals with SUDs is evolving to meet the challenges of social isolation during the global pandemic:
- Telehealth: Most insurance companies are now covering telehealth services at the same rate as traditional in-person visits with health care and behavioral health providers. Providers use secure virtual platforms to conduct a confidential video assessment, and to provide any necessary prescriptions or referrals to additional virtual or in-person treatment.
- Take-home Medication-Assisted Treatment for Opioid Use Disorders: The Substance Abuse and Mental Health Services Administration (SAMHSA) has issued Opioid Treatment Program guidance for states to be granted an exception to administer 14 to 28 days of take-home medication to individuals in an Opioid Treatment Program. This new guidance improves access to evidence-based Medication-Assisted Treatment for individuals with opioid use disorders (OUDs).
- Treatment for Alcohol Withdrawal: The American Society of Addiction Medicine (ASAM) has issued a Clinical Guideline on Alcohol Withdrawal Management. Some states have closed liquor stores as part of COVID-19 restrictions, resulting in limited access; at the same time, individuals experiencing alcohol withdrawal may also have limited access to treatment and withdrawal management programs. The ASAM Guideline advises clinicians in decision-making and treatment, improving care for these individuals struggling with alcohol use and alcohol withdrawal.
Virtual support during COVID-19. Many new resources are available to help individuals in recovery access support virtually:
- SAMHSA Virtual Recovery Resources: SAMHSA notes that during the social distancing and isolation of COVID-19, it is still vital to continue social connections when recovering from SUDs and mental health conditions. This Tip Sheet describes resources for individuals in recovery and gives guidance for setting up a virtual recovery meeting.
- National Alliance for Mental Illness (NAMI) COVID-19 Resource and Recovery Guide: Mental health support is a vital component of recovery. NAMI provides helpful tips for managing concerns about the virus, accessing virtual support, developing healthy daily routines, maintaining social support, and prioritizing self-care.
- Alcoholics Anonymous Options for Meeting Online: During COVID-19, many Alcoholics Anonymous groups are exploring alternate ways to continue the community of support for recovery. This may involve phone calls, email, social media, and virtual meetings on digital platforms. Alcoholics Anonymous encourages groups to decide what will work best for them and provides information for groups making this change.
- Virtual Narcotics Anonymous: This collaborative resource helps people find online and phone meetings of Narcotics Anonymous around the world. Narcotics Anonymous is for people who have any SUD and want support in their recovery.
Healthy habits to support recovery during COVID-19. Some people in recovery have found it helpful to take this time of social distancing to focus on healthy habits that will support recovery. These can include:
- Manage News Consumption
- Check only established, reliable news sources. Set a timer to limit the amount of time you are reading the news. Avoid checking the news within one hour before bedtime, and instead focus on relaxing activities.
- Get Ample Rest
- Get at least 7-8 hours of sleep each night. Make sure that your sleeping area is used only for sleep. Use calming routines at night such as reading, taking a bath, or talking with a friend.
- Develop and Maintain a Daily Routine
- Keep a routine of getting up and getting dressed on a regular schedule each day. Set your alarm and start your day with a walk outside or your favorite breakfast. Take a shower, get dressed, and write out a plan for how you will spend your day.
- Exercise Daily
- Get daily exercise, even if it is just a gentle walk or simple stretches. If you usually go to a gym, look for online exercise programs such as yoga, dance, chair exercises, or even a boot camp routine. Start a virtual exercise routine with a friend so that you can encourage and support each other.
- Schedule Time to Connect with Loved Ones
- Schedule time for social connections each day, whether by phone, video, email, or text. Look for shared activities such as a book club, art activities, virtually movie night, or cooking that you can enjoy together remotely. Focus on connections with the people you can have honest conversations with about your feelings and struggles.
- Other Mental Health Exercises
- Choose activities that will support your mental health, including breathing exercises, journaling, or meditation. Look for online books and workbooks on Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and Mindfulness, to help you manage your thoughts, worries, and behaviors during this challenging time. Notice what feels relaxing and restful for you, and intentionally choose those activities.
The COVID-19 pandemic has created new challenges for individuals in recovery; it has also fostered creative new approaches to treatment and support, many of which are reaching people in new ways that may continue beyond the end of social distancing. With continued integration of treatment, virtual support, and healthy habits, recovery can continue.
The Bizzell Group (Bizzell) was founded by President & CEO Anton C. Bizzell, M.D., a leading substance use disorders (SUDs) expert and former Medical Officer for the U.S. Department of Health and Human Services (HHS). Dr. Bizzell was selected as Maryland’s 2020 Small Businessperson of the Year by the U.S. Small Business Administration (SBA). Bizzell’s recent work includes systematic, integrated approaches designed to effect lasting change in the field of SUDs through work with the National Institute on Drug Abuse (NIDA), the National Cancer Institute (NCI), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), and the United States Chamber of Commerce Foundation (USCCF). Learn more about how we develop data-driven, research-informed, innovative solutions to SUDs and other complex-real-world challenges: https://BizzellUS.com/
Alcohol Use Disorder: Hope for Recovery
Alcohol Use Disorder: Hope for Recovery
Written by: Anton Bizzell, MD
Alcohol use disorder (AUD) is often referred to as the hidden substance use disorder (SUD). With alcohol use legal and socially acceptable in many settings, the symptoms of AUD may initially go unnoticed. Yet individuals with AUD may experience significant difficulties in their relationships, work, and health.
In a newly released analysis, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) at the National Institutes of Health (NIH) found that over 70 percent of the adult population drank alcohol in 2017. Alcohol-related deaths more than doubled from 1999 to 2017. Overdoses of alcohol alone or in combination with other drugs accounted for 18 percent of the deaths in 2017; 31 percent of the deaths resulted from alcohol-related liver disease. Researchers note that the since this study examined only death certificate data, the actual number of lives lost may be significantly higher.
The death rates increased higher for women than for men, and gender differences persist in risks for alcohol-related cardiovascular disease, liver disease, and cancer. In addition, while prevalence of alcohol use and binge drinking remained stable for men, the prevalence of alcohol use increased by over 10 percent for women and binge drinking increased by over 23 percent among women.
The NIAAA screening tool for AUD includes questions a provider can use to diagnose whether an individual may have an AUD. Individuals who are struggling with their drinking, or families and friends concerned about their loved ones, can start by considering the following questions.
In the past year, have you:
- Tried to cut down or stop drinking more than once, but couldn’t?
- Found that drinking or being sick from drinking got in the way of you taking care of your home or your family, or caused problems at work or school?
- More than once gotten into situations while drinking that could be dangerous, such as driving, having unsafe sex, using machinery, walking in an unsafe neighborhood; or had a memory blackout?
- Kept drinking even though it was making you depressed or anxious, or adding to other health problems?
- Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating?
In addition to peer-led support models such as Alcoholics Anonymous, there are many options for professionally-led treatment. Treatment for AUD often involves a combination of talk therapy and medication. Therapy can be for individuals, groups, or families, under the direction of a licensed counselor trained in substance use disorders. Medication to help individuals stop drinking and avoid relapse can be administered under the care of a licensed primary care provider or a board-certified addiction medicine physician. In addition, different levels of care and care settings are available to meet the needs of each situation, including outpatient, partial hospitalization, residential, or intensive inpatient.
Although the consequences of AUD can be devastating, hope for recovery is possible with evidence-based, timely intervention.
Reference: White, A. M., Castle, I. J. P., Hingson, R. W., & Powell, P. A. (2020). Using Death Certificates to Explore Changes in Alcohol‐Related Mortality in the United States, 1999 to 2017. Alcoholism: Clinical and Experimental Research.
The Bizzell Group (Bizzell) was founded by CEO Anton Bizzell, M.D., a substance use disorders expert and former Medical Officer at NIAAA. Our recent work includes systematic, integrated approaches designed to effect lasting change in the field of substance use disorders through projects with the National Institute on Drug Abuse (NIDA), the National Cancer Institute (NCI), the Food and Drug Administration (FDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the United States Chamber of Commerce Foundation (USCCF). Learn more about how Bizzell advances data-driven, research-informed, innovative solutions to solve complex, real-world challenges. www.BizzellUS.com
Integrated Strategies to Address Opioid Use Disorders in Women
Integrated Strategies to Address Opioid Use Disorders in Women
The opioid crisis has a complex set of contributing factors in women and requires integrated strategies and solutions. The Center for Behavioral Health Statistics and Quality (CBHSQ) of the Substance Abuse and Mental Health Services Administration (SAMHSA) reports that 19.5 million females (15.4 percent) age 18 years or older used illegal drugs in the past year, and 8.4 million females misused prescription drugs in the past year (CBHSQ, 2017)Center for Behavioral Health Statistics and Quality. (2017). Results from the 2016 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.pdf. Opioid use and misuse may have a different progression in women as compared to men, due to differences in sex and gender. The National Institute on Drug Abuse (NIDA) at the National Institutes of Health (NIH) defines differences by sex as pertaining to biological differences, and differences by gender as referring to culturally defined roles for women. Research has shown effects on women who use drugs from hormones, pregnancy, menstrual cycle, and menopause. Women have described reasons for using drugs, such as caregiving, depression and anxiety, fatigue, and coping with pain. Women are also affected by adverse childhood experiences, trauma, post-traumatic stress disorder (PTSD), partner stress, and domestic violence (NIDA, 2019)National Institute on Drug Abuse. (2019). Substance Abuse in Women. Retrieved September 19, 2019, from https://www.drugabuse.gov/publications/drugfacts/substance-use-in-women..
In the past, women were not included in research studies at the same rate as men, or the data was not reported separately by sex. The NIH and other federal agencies have made significant efforts to include women, and to research the biological differences in women that are important to understanding how substance use disorders develop and how to treat them effectively.
Researchers know that there are some differences in how substance use disorders develop in women versus men, and continued research will seek to better understand these differences (NIDA, 2019)National Institute on Drug Abuse. (2019). Substance Abuse in Women. Retrieved September 19, 2019, from https://www.drugabuse.gov/publications/drugfacts/substance-use-in-women.
- Dependence: Women sometimes become dependent after using smaller amounts of drugs for a shorter time period, as compared to men.
- Relapse: In addition to developing dependence more quickly, women may experience more cravings and be more likely to relapse following treatment.
- Biological factors: Science has also shown differences in brain changes, effects on the heart and blood vessels, and increased sensitivity to drugs due to sex hormones. Women may have a higher likelihood of going to the emergency room or dying from an overdose from some substances, as compared to men.
- Psychosocial factors: Psychosocial stressors can be a significant factor in opioid misuse and opioid use disorders (OUDs). Women who experience changes in relationships due to divorce or loss of child custody, as well as those who are victims of domestic violence, are at increased risk of developing an OUD. Other stressors such as unemployment, housing instability, caregiving, and untreated mental health conditions can play a role as well.
Substance misuse and OUDs affect millions of women, many of whom are of childbearing age. Most drugs, including opioids, can have serious and harmful effects to a pregnant woman and to an unborn baby. Some substances can increase the risk of miscarriage and stillbirth, in addition to causing health complications to the mother such as high blood pressure and seizures, according to the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) at NIH (2013)Eunice Kennedy Shriver National Institute of Child Health and Human Development. (2013). Tobacco, drug use in pregnancy can double risk of stillbirth. Retrieved from https://www.nichd.nih.gov/news/releases/Pages/121113-stillbirth-drug-use.aspx. Women who are using may be afraid to get help while pregnant, due to fears that they will lose custody of their children, or due to barriers such as stigma, lack of access to treatment programs, or lack of child care. Babies born to women who misuse drugs, especially opioids, can go through withdrawal after birth, a health condition referred to as Neonatal Abstinence Syndrome (NAS). The Office on Women’s Health (OWH) issued Final Report: Opioid Use, Misuse, and Overdose in Women (2017)Office on Women’s Health. (2017). Final Report: Opioid Use, Misuse, and Overdose in Women. Office on Women’s Health. Retrieved from https://www.womenshealth.gov/files/documents/final-report-opioid-508.pdf detailing how the epidemic affects women, and the key prevention, treatment, and recovery issues for women who misuse opioids and who have OUDs. Stakeholders must collaborate to continue to develop relevant research, effective outreach, and evidence-based intervention targeted to the unique needs of women at risk of and affected by opioid use disorders.
Integrated Strategies to Address OUDs Among Women
Integrated strategies are vital to address the complex causes and effects of OUDs in women. The following is list of suggestions for improving health outcomes for women experiencing an OUD:
Research: More research and data are needed on women who have substance use disorders, and the treatment strategies that are most effective for women.
Education: Education should focus on prevention, as well as on early identification and treatment of substance use disorders. Partnerships between organizations such as schools, employers, and community centers are essential to reach women of all ages.
Integration of services: Substance use disorder screening should be integrated into health care, mental health services, and social services. Screen to identify women who are at risk and who need help, and partner with treatment providers to coordinate care across settings.
Whole person care: Coordinated assessment is needed of all aspects of women’s lives that may be contributing to a substance use disorder and may be a barrier to care. Treat the underlying contributors to substance use disorder and the barriers to recovery, including chronic pain conditions, pressures of caring for elderly parents plus young children, emotional distress and mental health conditions, relationship stress, domestic violence, under- or unemployment, and housing instability. Partner with social services to provide child care while a woman is undergoing treatment, and to address other social stressors in addition to opioid misuse and addiction.
Bizzell US’s Experience Addressing OUDs Across the Female Population:
Bizzell US (Bizzell) has advanced national and regional efforts over the past decade to improve prevention, identification, and treatment of opioid use disorders in women. The most recent Bizzell projects include:
- Bizzell partnered with OWH in 2019 to support the meeting Combating Opioid Misuse Among Women and Girls: Prevention Strategies at Work, where 18 grantees and 75 participants discussed projects in 12 states focused on prevention strategies aimed at girls age 10 to 17, women of reproductive age, and older women. Topics included community engagement, pregnant and postpartum women and infants, youth and education, training and capacity building for the clinical workforce, pain management, and health IT and innovation to improve health care delivery.
- Bizzell partnered with SAMHSA in a multi-year contract to provide technical assistance for approximately 1600 opioid treatment programs nationwide, integrating specific strategies to improve outcomes of women with opioid use disorders.
- Bizzell partnered with SAMHSA in a multi-year contract to develop and deliver training to over 1500 clinical staff in 16 states through workshops and web-based interactive education, including modules on effective use of medication assisted treatment for pregnant and breastfeeding women.
Are you interested in learning more about Bizzell’s work to improve health outcomes for those affected by the opioid epidemic, including targeted interventions for women and other special populations? At Bizzell, we provide Management Consultation, Technical Assistance, Training, and Subject Matter Expertise in Opioid and other Substance Use Disorders, addressing complex real-world problems with modern, integrated strategies. Visit www.BizzellUS.com or email us: firstname.lastname@example.org.
Center for Behavioral Health Statistics and Quality. (2017). Results from the 2016 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.pdf.
Eunice Kennedy Shriver National Institute of Child Health and Human Development. (2013). Tobacco, drug use in pregnancy can double risk of stillbirth. Retrieved from https://www.nichd.nih.gov/news/releases/Pages/121113-stillbirth-drug-use.aspx.
National Institute on Drug Abuse. (2019). Substance Abuse in Women. Retrieved September 19, 2019, from https://www.drugabuse.gov/publications/drugfacts/substance-use-in-women.
Office on Women’s Health. (2017). Final Report: Opioid Use, Misuse, and Overdose in Women. Office on Women’s Health. Retrieved from https://www.womenshealth.gov/files/documents/final-report-opioid-508.pdf.