Addiction, abuse, access to care: Studying secondary health impacts of the pandemic

VCU projects support those facing drug and alcohol abuse, intimate partner violence and cancer in remote areas.

Person with mask looking out window. [View Image] VCU COVID-19 research projects are looking at how the pandemic is having an impact on drug and alcohol abuse, intimate partner violence and cancer in remote areas. (Getty Images)

Other medical crises haven’t taken a break during the COVID-19 pandemic. They’ve taken a back seat. And the four-month-long sidelining has become apparent, as data emerges about delayed medical treatment and death rates that exceed the virus’ reach.

Virginia Commonwealth University researchers want to know more. How has the stress of the pandemic affected people with drug and alcohol addictions? Has intimate partner violence increased or changed, and how can medical providers help support survivors? Are rural cancer patients and their caregivers receiving the care they need? 

Three researchers will soon answer those questions with the help of awards from the COVID-19 Rapid Research Funding Opportunity. The fund, led by the VCU Office of the Vice President for Research and Innovation, with support from the C. Kenneth and Dianne Wright Center for Clinical and Translational Research, awarded nearly $350,000 in funding this spring to 31 VCU research projects that seek to address the impact of the coronavirus.

“VCU School of Medicine faculty and VCU Health providers are leading by example when it comes to clinical research that will inform patient care,” said Peter Buckley, M.D., interim CEO of VCU Health System and interim senior vice president of VCU Health Sciences. “These projects tackle tough issues, and the research that emerges from them will improve treatment for everyone.”

Understanding barriers to rural medical care

Having cancer or caring for someone with cancer in a rural area is a scary enough prospect — with medical centers often hours away. That fear is even more acute during a pandemic. Maria Thomson is assessing wellbeing and access to care in rural communities among those with and without cancer. (Tom Kojcsich, University Marketing) [View Image]
Maria Thomson is assessing wellbeing and access to care in rural communities among those with and without cancer. (Tom Kojcsich, University Marketing)

No one knows that better than researchers like Maria Thomson, Ph.D., an associate professor in the VCU School of Medicine’s Department of Health Behavior and Policy. She has long worked to understand the behaviors, attitudes and needs of cancer patients and their caregivers.  

A few years ago, Thomson, who is also a research member at VCU Massey Cancer Center, worked with a team to survey the cancer community, asking questions about lifestyle, mental health and their relationships with medical providers. The research led to insights on cancer prevention, risk and the long-term outcomes of survivors.

Massey funded the original research, and the Virginia Tobacco Region Revitalization Commission funded community engagement components of it.

“With the advent of COVID, we thought, because we have all these psychological measures from before this happened, we can really look at some of the differences pre- and post-,” Thomson said. “So we’re going back to people who've agreed to be re-contacted and asking them the same questions, but now during the pandemic.” 

Thomson’s team will survey cancer survivors and their caregivers about their psychological well-being — depression levels, anxiety levels — and ask about people’s ability to get testing and treatment for their medical issues during the pandemic.

“What's cool about this is we've been able to really recruit a large sample of people from rural, racially diverse communities, which are often excluded from studies and trials,” Thomson said. 

The second part of the project is a Google Voice account, where participants can call in to leave anonymous messages and share stories about their experience. Thomson hopes the anonymity of the system will yield compelling accounts. 

Thomson’s data will show unique aspects of how the pandemic has affected attitudes toward medical care and health, which will be crucial for understanding how health care can adapt post-pandemic.

Tackling abuse in isolation

Stay-at-home orders mean something different when it’s not safe at home.Nicholas Thomson is looking at how intimate partner violence has been affected by the pandemic. (Courtesy photo) [View Image] Nicholas Thomson is looking at how intimate partner violence has been affected by the pandemic. (Courtesy photo)

Even before the orders, intimate partner violence was increasing globally. Project Empower, founded in 2010 at VCU Health, offers prevention and intervention services to individuals and their families who have or are experiencing intimate partner violence, domestic violence, sexual violence or human trafficking.

And Nicholas Thomson, Ph.D., (no relation to Maria) worried that the pandemic would keep away the very people who needed Project Empower most. Thomson is a forensic psychologist who works at VCU Health Trauma Center with survivors of intimate partner violence, and formerly was in private practice and institutional settings such as prisons and psychiatry hospitals.

“We know that violence can escalate very quickly,” said Thomson, who is also an assistant professor in the School of Medicine’s Department of Surgery and director of research at VCU Health’s Injury and Violence Prevention Program. “Which means that rather than seeing milder injuries in the emergency department, we would likely start seeing more severe injuries and higher rates of deaths." 

This meant an intervention program would need to rapidly adapt to the pandemic to ensure patients were still getting the resources they needed — without putting them at greater risk. Thomson’s research project will evaluate the prevalence and characteristics of intimate partner violence during stay-at-home orders. And it will help Project Empower continue to adapt.

Even as people go back to work and access regular medical care again, Thomson expects rates to remain high. Violence is fueled by family stressors prevalent during the pandemic: job loss, financial difficulties, food insecurities and child care. And it has long-lasting psychological impacts on survivors and any children involved.

“My hope for this research is to inform clinical practice that will help survivors of intimate partner violence recover and live safe and healthy lives,” Thomson said. “And the second hope is to develop effective screening and clinical assessment tools to identify people most at risk for victimization and perpetration — to help stop violence before it occurs.”

Thomson’s work is also funded by the Centers for Disease Control and Prevention and the Department of Justice for injury and violence prevention. 

Understanding drug and alcohol abuse in stressful times

You didn’t have to contract COVID-19 to feel its effects. Whether deemed essential and risking your life for work, or isolated at home fearful of the outside and worried for friends and family, the pandemic has been a stressful time. Albert Arias is examining Stress and drug/alcohol abuse during the pandemic. (Tom Kojcsich, University Marketing) [View Image]
Albert Arias is examining Stress and drug/alcohol abuse during the pandemic. (Tom Kojcsich, University Marketing)

Many people are struggling to cope in healthy ways. Alcohol sales have soared, according to distributor reports. And numbers are beginning to trickle in about a surge in drug overdoses.

“We know that stress is bad for a lot of people when it comes to drinking and drugging,” said Albert Arias, M.D., an associate professor in the School of Medicine’s Department of Psychiatry. “[When the pandemic hit], we had the suspicion that this would be a trigger for a lot of people to use more drugs and alcohol, or to relapse if they were in recovery.”

Arias’ research seeks to uncover the mechanisms behind that impulse and help drug and alcohol abuse treatment evolve accordingly. The longitudinal study will use online questionnaires to examine the relationship between COVID-19, its related stress and their effect on drinking and drug use in 50 subjects with addictive disorders.

Job loss, financial struggles, grief over lost family and friends, social isolation: Arias said these alter people’s existing support systems and curb their ability to access new support. 

“We’re going to see how those factors relate to impulsivity and one’s natural tendency to seek things that are rewarding as a way to deal with unpleasant emotions,” said Arias, who is also a faculty member at the VCU Institute for Drug and Alcohol Studies. “Some people are able to stay steadfast in their recovery, and some people really struggle.”

And stress during a pandemic is applicable to living through similarly traumatic events, Arias added, like wartime and natural disasters. Long term, he thinks the research could lead to targeted treatments of drug and alcohol abuse during uniquely stressful times like these. 

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