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Scott Webb (Host): Sierra Tucson recently conducted its Self-Medication Nation Survey and found some stunning results. Some of the results demonstrated, that during the pandemic employees viewed alcohol and drug use as a benefit of work from home and the concern is, they may very well bring those drug habits back to the workplace and employers need to be prepared. To find out more about the survey results and what it all means, we have Sierra Tucson's, Chief Medical Officer and Director of the Mood Program, Dr. Jasleen Chhatwal on today's podcast. This is Let's Talk Mind, Body, Spirit by Sierra Tucson. Sierra Tucson ranked number one best addiction treatment centers, 2020 in Arizona by Newsweek. I'm Scott Webb. Doctor it's so great to have your time today. We've got a lot to get to. I want to start here when you received the results of Sierra Tucson's Self-Medication Nation Survey, what was one of the first things that you noticed?

Jasleen Chhatwal, MD (Guest): Scott, thank you for having me on the podcast today. And this Sierra Tucson Self-Medication Nation Survey was very interesting. Many different things jumped out, but some of the most standout ones included the total amount of alcohol that was being consumed. It was surprising even for me as a medical professional, who works in this sphere to notice that almost 60% of people said that they had been using alcohol and in greater quantities during the pandemic.

And then also the fact that one in five, almost 20%, said that they were using marijuana during the pandemic. Another thing that stood out was the fact that three fourths of people who were using alcohol during the workday. So while they were working, said that if they were asked to come back to work in-person, they would really miss using alcohol. And that for me became one of those points that's fairly concerning that there was a chunk of people, almost 20% of people who are using alcohol and other substances during the workday. And then on top of the fact that three-fourths of them said that they would be concerned about going back to work because they wouldn't be able to use the substance.

And that, I think, was one of those shocking findings that you can only read and reread and try to look back at the data to make sure that you read it correctly.

Host: I see what you mean, and that is concerning, three-fourths of the people, you know, would find it difficult to go back to the workplace because of their consumption during the day. So, let's dig into this some more, you know, because during the pandemic people needed to make that transition to working from home.

What does the survey really demonstrate about the usage, as we're saying about alcohol and other recreational drug use, you know, while at home? I was thinking people were doing these types of things, you know, after work, when the work day was done, but we're finding out from this data that folks are doing it during the day. What kind of sense can you make of that?

Dr. Chhatwal: One of the ways that I looked at the data and our team has been going over the data and surveying it further. We really think that it could have started almost as an opportunity, sort of a fun thing to do, like, oh, I can use during the day, or I can use at a different time than just using in the evening, but there's also the piece that there was boredom, there was stress. There was worries that may have contributed. And what we noticed was that same number, that 20% were saying that they had actually participated in a virtual call or a Zoom meeting while under the influence. And we'd also had that 20% say, so not the same 20%, but a 20% in the survey said that they had also witnessed a colleague at work who was under the influence of alcohol or other recreational drugs.

Again, when you're observing somebody, you can't really say what they're using, but it appeared that these people were noticing their colleagues using. And when we in the survey asked what they thought about this use, it seemed like at least a quarter of people thought that this was an added benefit of being able to work from home that they could use substances during the day. And it wasn't going to raise a red flag. So for me, that raises a red flag, that drug use is being seen as an added benefit of working remotely, because we know that people shouldn't be working under the influence. I mean, I'm specifically in an area, work healthcare, where we would lose our licenses and not really be able to work or, you know, have some negative consequence to our job, to our ability to work and make good decisions if we were using. So, we don't have the data, what type of professions these people belong to but it was a concerning factor in general.

Host: Yeah, there's a lot of layers here and now we're thinking about, okay, so for employers who have allowed their employees to work from home because of the pandemic, and even if they can come back to work, maybe offering to let them stay at home. And now we're wondering, well, do those employees want to stay at home because they can use during the day, and nobody's the wiser? This, this is really interesting. This is a lot to take in. So what sort of alcohol use are you seeing?

Dr. Chhatwal: In the survey, we noticed that close to 40% of people had said that they had increased their consumption of alcohol. And out of that group, 85% had said that they increased it by one to three drinks a day. And then another 22% actually overall, said that they increased their consumption between one to five drinks a day.

And it's really important to look that these are the number of drinks people are increasing by not just a week, but a day. And then you can multiply that by seven. So, that can be seven to 35 more drinks a week. And we really don't know what their baseline consumption was like, how much were they consuming before if they're now consuming at least seven to 35 drinks more each week.

And these are excessive levels because that really falls into that category of what we would call excessive drinking in clinical speak.

Host: Yeah, I was going to ask you about that because I think that that's one of the biggest concerns there, as you say is we don't really know what the baseline is. So, if people are increasing their usage from seven to 35 drinks. But they were already drinking too much. It's pretty alarming. And as you say, we get into that excessive drinking. Can you define that for us? What is excessive drinking?

Dr. Chhatwal: Per the National Institute on Alcohol Abuse and Alcoholism, the definition of heavy drinking for men is consuming either more than four drinks in a setting on a day or more than 14 drinks per week. And for women, it's a little bit lower because of our physiology, which is slightly different and it can be consuming more than three drinks on a day or more than seven drinks per week.

Host: Yeah, I'm just trying to process all of this and does Sierra Tucson's Self-Medication Nation Survey provide insight as to why people are drinking more? I mean, we're sort of chalking it up to the pandemic, which we've all been through and has been difficult for all of us, but is it possible that it's the pandemic and perhaps more?

Dr. Chhatwal: That is the million dollar question, right. To really figure out why this is happening and what is the underlying cause. We know that there has been increased rates of depression, increased rates of trauma, just overall increase in mental distress, due to the pandemic, and also increase in grief due to the various losses, loss to the type of life people were living, loss of family members, loss of freedom. And then what we also notice is that there is reduction in the amount of connection people have, which is something that we already know underlies addiction often, and underlies also overall mental distress. That connection is sort of the antidote to mental distress, at times.

And these are really those pieces where we can't quite tell through just our survey, why people were drinking more. There were some reports of the fact that there was boredom. It felt good. Others had said it was because of stress. But because the data numbers are not as high as we would want them to be to really be able to speak confidently about the reasons for it, it does seem to be a mixture of all the issues I mentioned above.

Host: Yeah, I, that sounds logical to me that sure the pandemic may have been the biggest part of it. But when you add in the isolation, boredom, the fact that, you know, they're working, but nobody's really looking over their shoulders, so to speak. And now, as we're saying, people are returning to the office and what can managers and HR Directors expect after people have been at home for so long and possibly drinking while they've been working? It's probably a real concern, I'm sure.

Dr. Chhatwal: In the role of a human resource director or a leader in any organization, this would be a survey finding and a piece of information that should cause a lot of concern, because those of us who are in the addiction treatment field, wonder how these employees will return to work in a healthy way. Will they want to continue using substances or will the things that they were self-medicating with, substances start to become an issue?

So, I think really for human resources directors and others who are involved in working closely with people in their fields should be doing some sort of assessment and really checking in with employees as they come back from remote work as to how they're doing in the new setting and what expectations are in the workplace.

Like I had mentioned earlier on, in our discussion, about 20% of people were saying they were using during the work day. And about, more than a third of them said that they did not believe their employer had the right to test them for alcohol or other recreational drugs while they were working remotely.

And my thought would be, you know, what do they really think about working back on campus or in the office? And so businesses would need to prepare as to how they will re-onboard people to working in the office or in the workplace. And then maybe if they continue to do the remote work, because it works for their organization and works for their business structure, then I would also really hope for the sake of their employees' health, that there can still continue to be some sort of oversight and setting up of expectations so that people's health and wellbeing can be addressed in a more helpful way through an employee assistance program or asking them to get referred to treatment rather than continuing down this path, which is a slippery slope.

Host: Yeah, I think you're so right. Lot to work out here. And specifically, I wanted to ask you, what are you seeing at Sierra Tucson, as a result of the pandemic?

Dr. Chhatwal: Here at Sierra Tucson, we're seeing that the overall amount of distress that individuals are coming in with has increased many fold since last year. Most of us in the mental health and addiction field talk about how individuals who are coming in are sicker than before, are dealing with a lot more. There's more comorbidities, which is our way of saying, you know, multiple issues that are ongoing that need clinical attention.

We've also seen that there are individuals who are coming in because of their employee assistance program or their work place being involved, both for addiction treatment as well as for treatment of mental health issues. And we want to continue supporting our patients, but we also realize that getting this information out, may help some people in a way that they can get intervention early and they don't have to go so much further into their illness, that it takes that much longer to get out of it.

I'm really a strong proponent of early intervention and even better than that, prevention of issues, if it's possible. And that's really part of the reason that we wanted to get this information out there, that if individuals can get treatment early or get intervention early, such that they're able to get back to their prior level of functioning or even better than their prior level of functioning, that is really the hope.

Host: Yeah, it really is. As you say, early intervention, prevention when possible, perhaps primarily, and then early intervention. And wouldn't that be great if we could all get back to not only sort of who we were before the pandemic, but maybe even better. I like that. Let's set the bar high Doctor. That sounds good. What advice do you have for families who may have a loved one who's struggling with increased substance abuse? Um,

Dr. Chhatwal: Uh, families, I think really get the brunt of someboy's illness, when a loved one is struggling with substance use. So, this is a really great question. Because as a psychiatrist, I often see that families really don't know how to engage with their loved one, when they're sitting on the sidelines watching and seeing that they're troubled.

And especially when it comes to substance use, you know, there can be some judgments that come up, people can have this belief that somehow the person should be able to snap out of it or stop doing the behavior. So, I think the first thing for families is to really recognize that this is a health condition. This isn't something that a family member is just being willful about. Another thing for families to recognize is that before they go in to engage their loved one into a conversation, to really maybe practice with another family member or a loved one, and make sure that the amount of judgment that comes across and especially negative judgment can be reduced.

So, I think assessing one's own biases, anger, flushing that out before engaging in a conversation with your loved one is important. Because when we come at anybody with just telling them what to do and telling them how what they're doing is wrong, we don't have a productive dialogue. And, you know, if your family member is open to even just hearing how their health condition or their substance use is impacting your love and relationship with them, really keeping it focused on how it makes you feel, you, the person who's initiating the conversation, is important.

And I think it becomes important to not say you make me feel this way. Because that can trigger a lot of shame. And we typically know that folks who are struggling with substance use are already beating themselves up and feeling shame. So, we don't need to add to that. And I think with having that type of open conversation, we may be able to encourage our loved ones to seek help, to go have a conversation with a therapist, to go see a counselor, to even maybe initiate the conversation with their primary care doctor. Because to get a specific mental health professional involved, maybe you've not been involved with mental health before. And so you don't have anybody. And then when you call there's a long wait list, but what you can definitely do is engage with your primary care doctor. And then also we at Sierra Tucson, have a really robust admissions department that can help and also help you connect with people in your own area.

We do have a group called treatment placement specialists who are part of our larger company network. And they're also people who essentially just connect individuals within their own communities for treatment and such. So, that can be another step that can be taken. But specially initially, when you're just trying to get the person in the door to see somebody, maybe starting with a doctor or a therapist or any other professional who they already have a relationship with, can be a great start.

Host: Yeah, I see what you mean and such great advice today. This has been really sort of startling in a way that these statistics that came from Sierra Tucson's Self-Medication Nation Survey are a bit alarming. And I can see, I can hear the concern in your voice. So, I'm glad we're talking through some of this stuff today.

As we wrap up here, Doctor, what are your takeaways? What do you most want folks to know about the Self-Medication Nation Survey and really how it maybe is affecting them at home and what they can do about it?

Dr. Chhatwal: One of the biggest takeaways for me from this conversation should be that even though alcohol is legal and it can be sold in our grocery stores, doesn't mean it doesn't cause harm. And just because any other drug gets legalized, like even marijuana in some states, that doesn't mean it doesn't have harm. And so for us to really know that anything that starts becoming the place we go for comfort and start to partake in, or repeat on an ongoing manner, can be a problem. So, really thinking about these substances as not being the solution to the stress, the anxiety, the depression, the loneliness, but realizing that those are true psychological impacts of the pandemic and you're not alone in having those impacts.

So self-medicating is really not the solution and help is available to truly address and work through the psychological impacts that you've had. And to make sure that we don't get ourselves to a place where, you know, people are self-medicating initially to feel better, but then end up adding to their problems.

Host: Yeah, definitely. As you said earlier, you know, prevention, early intervention, just trying to help folks. We've all been through a lot through the pandemic and some of the other stuff, the sort of ancillary things related to the pandemic, social isolation, boredom and so on. So, great to have your time today, we went through a lot of information. You carry the heavy load. I appreciate that Doctor. And you stay well.

Dr. Chhatwal: Thank you so much, Scott. Thanks again for having me. And it's always a pleasure to connect with you.

Host: For more information, visit Sierratucson.com or call 808-842-4487. Sierra Tucson, we work with most insurance. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Let's Talk Mind, Body, Spirit from Sierra Tucson. I'm Scott Webb. Stay well.