Loneliness poses a public-health threat, prompting a rare advisory from the surgeon general, with a plan to rebuild social connections

By Melissa Patrick

Kentucky Health News

The physical and societal harms that come from loneliness are so bad that America's top public-health official has issued a rare advisory with a framework to rebuild social connection and community in the U.S. 

"Loneliness is more than just a bad feeling," Surgeon General Vivek H. Murthy writes in an opinion piece for The New York Times. "When people are socially disconnected, their risk of anxiety and depression increases. So does their risk of heart disease (29%), dementia (50%), and stroke (32%). The increased risk of premature death associated with social disconnection is comparable to smoking daily — and may be even greater than the risk associated with obesity."

Social disconnection was worsened by the pandemic. 

“What Covid did is really pour fuel on a fire that was already burning,” Murthy told Fenit Nirappil of The Washington Post. “I want the entire country to understand how profound a public-health threat loneliness and isolation pose.”

Murthy's opening letter in the public-health advisory, titled Our Epidemic of Loneliness and Isolation, adds, "The mortality impact of being socially disconnected is similar to that caused by smoking up to 15 cigarettes a day . . .  And the harmful consequences of a society that lacks social connection can be felt in our schools, workplaces, and civic organizations, where performance, productivity, and engagement are diminished." 

To further this point, the advisory says, "Data across 148 studies, with an average of 7.5 years of follow-up, suggest that social connection increases the odds of survival by 50%." 

In the Times, Murthy tells the story of his own experience with loneliness after his first term as surgeon general and how, with the help of others, he found his way out of it. Research shows he was not alone in this feeling, he reports: "About one out of every two Americans is experiencing measurable levels of loneliness. . . . Its invisibility is part of what makes it so insidious." 

Murthy goes on to say that loneliness and isolation have led us to a place where we "are less invested in one another, we are more susceptible to polarization and less able to pull together to face the challenges that we cannot solve alone." And this, he says, "has fueled other problems that are killing us and threaten to rip our country apart." 

For all of these reasons, Murthy writes, "rebuilding social connection must be a top public-health priority in our nation." To do this, he offers three key suggestions in the op-ed, which are outlined in greater depth in the 68-page advisory. 

First, Murthy says we must strengthen our social infrastructure, such as school-based programs that teach children about building healthy relationships and workplace design that fosters social connection.

Second, we must figure out how to create space in our lives without our electronic devices so that we can be more present with each other, with a commitment to promote conversation that amplifies understanding. 

Third, we need to take steps to rebuild our connections to each other, reaching out to people we care about, talking to our neighbors, checking in with co-workers who may be having a hard time, and seeking opportunities to serve.

Murthy has long advocated treating loneliness as a public-health issue wrote a 2020 book, Together: The Healing Power of Human Connection in a Sometimes Lonely World.

Research cited in the advisory shows that nationally, social connection decreased between 2003 and 2020 as time alone increased: Isolation increased by 24 hours per month and social engagement with friends dropped 20 hours per month.

Research also shows that loneliness and isolation are most prevalent in people with poor physical or mental health, disabilities, struggling financially or living alone, says the advisory. It adds that younger and older populations struggle the most. 

"For example, while the highest rates of social isolation are found among older adults, young adults are almost twice as likely to report feeling lonely than those over 65," it says. 

The advisory provides a national strategy to advance social connection that involves six pillars and the report goes on to lay out a detailed plan for how to support them. They include: strengthening social infrastructure in local communities; enacting pro-connection public policies; mobilizing the health sector; reforming digital environments; deepening our knowledge; and building a culture of connection. 

Graphic from Our Epidemic of Loneliness and Isolation public health advisory 

The report says, "We can choose, in short, to take the core values that make us strong—love, kindness, respect, service, and commitment to one another—and reflect them in the world we build for ourselves and our children. This strategy shows us how to create the connected lives and the connected world we need."

Murthy talked to Christina Caron of the Times about how to build meaningful social connections in an increasingly lonely world. He offered five tips: 

• Reconnect with people: "To get started, take 15 minutes each day to contact a friend or a relative. Put a reminder in your calendar, if needed, so that it remains a priority. Your relationships cannot thrive unless they are nurtured," she writes
• Minimize distractions: For a more satisfying quality time, put the devices down and give your full attention.“Focus on the conversation,” Murthy told Caron. “Listening is as important as what we say.”
• When people call, pick up the phone: Even if you are busy, he said. Pick it up, make a time to talk later, and do it. "That 10 seconds feels so much better than going back and forth on text," he said. 
• Serve others: Studies show that volunteering can ease feelings of loneliness and broaden our social networks, she writes. “When we help other people we establish an experience or a connection with them — but we also remind ourselves of the value that we bring to the world,” he told her. 
• Get help: Murthy said to tell someone if you are struggling with loneliness, whether that be a relative, a friend, a counselor or a health care provider. And, if you are having thoughts of harming yourself, call the 988 crisis hotline.

Surgeon general wants health warnings on social-media platforms, which he blames for mental illnesses among youth

Surgeon General Vivek Murthy (AP photo by Susan Walsh)

By Michelle Chapman
Associated Press

The U.S. surgeon general has called on Congress to require warning labels on social media platforms and their effects on young people’s lives, similar to those now mandatory on cigarette boxes.

In a Monday opinion piece in the The New York Times, Dr. Vivek Murthy said that social media is a contributing factor in the mental-health crisis among young people.

“It is time to require a surgeon general’s warning label on social-media platforms, stating that social media is associated with significant mental health harms for adolescents. A surgeon general’s warning label, which requires congressional action, would regularly remind parents and adolescents that social media has not been proved safe,” Murthy said. “Evidence from tobacco studies show that warning labels can increase awareness and change behavior.”

Murthy said that the use of just a warning label wouldn’t make social media safe for young people, but would be a part of the steps needed.

Social media use is prevalent among young people, with up to 95% of youth ages 13 to 17 saying that they use a social media platform, and more than a third saying that they use social media “almost constantly,” according to 2022 data from the Pew Research Center.

“Social media today is like tobacco decades ago: It’s a product whose business model depends on addicting kids. And as with cigarettes, a surgeon general’s warning label is a critical step toward mitigating the threat to children,” Josh Golin, executive director at Fairplay, an organization that is dedicated to ending marketing to children, said in a statement.

Actually getting the labels on social media platforms would take congressional action — and it’s not clear how quickly that might happen, even with apparent bipartisan unity around child safety online. Lawmakers have held multiple congressional hearings on child online safety and there’s legislation in the works. Still, the last federal law aimed at protecting children online was enacted in 1998, six years before Facebook’s founding.

“I am hoping that would be combined with a lot of other work that Congress has been trying to do to improve the safety and design and privacy of social media products,” said Dr. Jenny Radesky, a developmental behavioral pediatrician at the University of Michigan and leader at the American Academy of Pediatrics. “Those two things would have to go hand in hand, because there’s so much that Congress can do to follow the steps of the United Kingdom and the European Union in passing laws that take into account what kids need when they’re interacting with digital products.”

Even with Congressional approval, warning labels would likely be challenged in the courts by tech companies.

“Putting a warning label on online speech isn’t just scientifically unsound, it’s at odds with the constitutional right to free speech,” said Adam Kovacevich, CEO of the tech-industry policy group Chamber of Progress. “It’s surprising to see the U.S. surgeon general attacking social media when teens themselves say it provides an important outlet for social connection.”

Last year, Murthy warned that there wasn’t enough evidence to show that social media is safe for children and teens. He said at the time that policymakers needed to address the harms of social media the same way they regulate things like car seats, baby formula, medication and other products children use.

To comply with federal regulation, social media companies already ban kids under 13 from signing up for their platforms — but children have been shown to easily get around the bans, both with and without their parents’ consent.

Other measures social platforms have taken to address concerns about children’s mental health can also be easily circumvented. For instance, TikTok introduced a default 60-minute time limit for users under 18. But once the limit is reached, minors can simply enter a passcode to keep watching.

Murthy believes the impact of social media on young people should be a more pressing concern.

“Why is it that we have failed to respond to the harms of social media when they are no less urgent or widespread than those posed by unsafe cars, planes or food? These harms are not a failure of willpower and parenting; they are the consequence of unleashing powerful technology without adequate safety measures, transparency or accountability,” he wrote.

In January the CEOs of Meta, TikTok, X and other social media companies went before the Senate Judiciary Committee to testify as parents worry that they’re not doing enough to protect young people. The executives touted existing safety tools on their platforms and the work they’ve done with nonprofits and law enforcement to protect minors.

Murthy said Monday that Congress needs to implement legislation that will protect young people from online harassment, abuse and exploitation and from exposure to extreme violence and sexual content.

“The measures should prevent platforms from collecting sensitive data from children and should restrict the use of features like push notifications, autoplay and infinite scroll, which prey on developing brains and contribute to excessive use,” Murthy wrote.

Sens. Marsha Blackburn (R-Tenn.) and Richard Blumenthal (D-Conn.) supported Murthy’s message Monday.

“We are pleased that the surgeon general — America’s top doctor — continues to bring attention to the harmful impact that social media has on our children,” the senators said in a prepared statement.

The surgeon general is also recommending that companies be required to share all their data on health effects with independent scientists and the public, which they currently don’t do, and allow independent safety audits.

Murthy said schools and parents also need to participate in providing phone-free times and that doctors, nurses and other clinicians should help guide families toward safer practices.

While Murthy pushes for more to be done about social media in the United States, the European Union enacted groundbreaking new digital rules last year. The Digital Services Act is part of a suite of tech-focused regulations crafted by the 27-nation bloc — long a global leader in cracking down on tech giants.

The DSA is designed to keep users safe online and make it much harder to spread content that’s either illegal, like hate speech or child sexual abuse, or violates a platform’s terms of service. It also looks to protect citizens’ fundamental rights such as privacy and free speech.

Officials have warned tech companies that violations could bring fines worth up to 6% of their global revenue — which could amount to billions — or even a ban from the EU.

Murthy’s focus is on teens and social media, but Radesky noted that adults could use a warning label too.

“What we’ve heard from teens is that they want their parents to be on social media less and on their devices less,” she said. “That’s another behavior change we hope that parents will reflect on and think about — ‘where could I cut down or create some boundaries to create more family time or sleep time?’ — and not only hyper-focusing on what teens are doing, but really what all of us as a society are doing in terms of healthy relationships with technology.”

UPDATE, June 19: "Some scientists who study youth mental health say the evidence does not support the notion that social media is harmful per se," The New York Times reports.

Op-ed looks at ways to address loneliness, which is linked to a number of health conditions; Ky. is above average for loneliness

Kentucky ranks in the top 20 states for loneliness, which can involve far more than feelings of sadness from being alone. Research shows it is linked to strokes, heart disease, dementia, inflammation and suicide.

"It breaks the heart literally as well as figuratively," opinion columnist Nicholas Kristof writes for the New York Times as part of a series titled "How America Heals," aimed at finding ways to fix this problem. 

The physical and societal harms that come from loneliness are so bad that America's top public-health official, Surgeon General Vivek H. Murthy, issued a rare advisory with a framework to rebuild social connection and community in the U.S. in May.

Graph from surgeon general's advisory,
"Our Epidemic of Loneliness and Isolation" 

Loneliness is as deadly as smoking 15 cigarettes a day and more lethal than consuming six alcoholic drinks a day, according to Murthy. It is also more dangerous than physical inactivity, obesity and air pollution, he says. 

Research also shows America has been growing lonelier. A majority of adults (58 %) report experiencing loneliness, according to a Morning Consult survey commissioned by The Cigna Group, a health-insurance company.

An Aging In Place study found that Kentucky tied with Arkansas for loneliness at 18th among states, with scores of 5.16 on a 10-point scale. Maine was first at 7.6, and Utah was best off, at 0.72. The study noted that more than half of Utahns identify as Mormons, which "may contribute to the low numbers of divorce and single-person households."

The study looked at a range of factors, including the percentage of single-person households, number of people widowed, number of people divorced, searches for dating apps per 10,000 people and searches for friendship apps per 10,000 people, to determine which states struggle the most with loneliness.

Kristof writes that there are ways to build connections that bind us together and writes about some of those approaches taken by the United Kingdom, which he says "is the pioneer of these efforts, having established the post of minister for loneliness in 2018. Britain oversees public-private partnerships that collectively knit millions of people together with programs like nature walks, songwriting workshops and community litter pickups." And, he adds, other countries have followed suit.  

"That’s because if the researchers are correct, social isolation probably kills far more people in the West each year than terrorists and murderers, and it costs the public enormous sums in unnecessary health costs," Kristof writes. "Countermeasures can make a huge difference: One review of 148 studies concluded that social connections increase the odds of an individual’s surviving over roughly the next seven years by about 50 percent." 

Kristof says he writes from troubles he's witnessed: "More than one-quarter of the children who rode the No. 6 school bus with me in Yamhill, Oregon, have died from drugs, alcohol, suicide and other so-called deaths of despair. These pathologies are linked to social isolation." 

However, he notes that despite the economic devastation of during the Great Depression, mortality then didn’t rise but actually fell." He attributes this to the "strength of community institutions -- like churches, men's and women's clubs and extended families -- that existed during that time." 

Ninety-odd years later, "Those community institutions have frayed," he writes. "Now we’re on our own, and perhaps that’s why so many are also dying alone." 

Kristof says he recognizes that it's not easy to rebuild such networks, but says we have to try, and offers some suggestions. 

"The steps to tackle loneliness aren’t grand, high-tech or expensive. In fact, one of the strategies is simply to get people back into old-fashioned patterns like eating meals together, holding parties and volunteering to help one another out," he writes.

He notes that the U.K. ministry has spent "some $100 million" to address loneliness since 2018, often to support local initiatives. One of those is a local, weekly family-style luncheon for women and children, many of them immigrants who struggle with English. 

He says decline of religious attendance has left a gap in community building, but "church buildings can still provide a physical architecture for connections, even if the faith architecture has eroded." 

He also points to several community-wide events to combat loneliness, including an event held for King Charles's coronation in May called “The Big Help-Out” to encourage people to come together and volunteer, and 6 million people, almost a tenth of the nation's population, did so. "The response was so impressive that this may become an annual event," he writes.

Why did loneliness increase? Kristof says the trends toward larger homes and longer working hours has left less time to share meals, and he notes studies that show social media has led to people being more lonely. Pets and talking robots have been suggested as solutions, he writes, but "It seems that there’s something to be said for friends who are living, breathing human beings." 

In his advisory, Surgeon General Murthy offered a strategy to address loneliness that begins with building up infrastructure that enables social connection: physical infrastructure such as parks and libraries, and social infrastructure to weave together volunteers or enthusiasts with similar interests.

Britain can serve as a model for this, Kristof writes. He points to a town that has has trained more than 1,100 volunteers to be “community connectors" who engage people and encourage them to join events or participate in programs. He also points to the idea of a "chatty bench" adopted in the U.K., Sweden and Australia, a bench with a sign encouraging strangers to talk to each other. 

"Solutions to loneliness are like that — little nudges to encourage us to mingle the way we evolved to," Kristof writes, suggesting that government do more: "President Biden, how about creating a senior government post analogous to a minister for loneliness? And mayors and governors, how about some chatty benches in American parks, along with volunteers deputized to bring us out for nature walks and sing-alongs?"

Youth-led study reveals mental-health, social challenges of Covid

Teachers gathered as students ate at socially distanced tables in Medora Elementary School in Louisville on March 17, 2021, the day Jefferson County Public Schools re-opened for in-person learning with new Covid-19 procedures. (Photo by Jon Cherry/Getty Images)

By Sarah Ladd
Kentucky Lantern

A new study on how Kentucky’s youth have coped with Covid-19 reports mental-health challenges, negative views toward remote learning, and more.

The report was published Wednesday by the Kentucky Student Voice Team, a youth-led nonprofit with a goal of creating “more just, democratic Kentucky schools and communities as research, policy and advocacy partners.”

Researchers interviewed 50 Kentuckians and conducted a survey. It was analyzed by the Student Voice Team and University of Kentucky researchers.

They found that many students felt “heavily negative” about online learning. Students felt like their opinions did not matter enough to administrators. Youth experienced strained mental health during the pandemic. Finally, many reported they struggled with loss of social interactions and milestones.

They described “shock and grief at the loss of the social aspects of learning,” which ranged from jokes in a group project to prom. And, students praised their teachers for helping them cope.

Still, challenges brought on by the pandemic were relentless.

‘Give them options’

One student said they felt that in Zoom classes, a lack of requirement that cameras be on was a barrier to learning. Another said they needed better instruction and didn’t get much out of watching videos.

“Give them options,” the report quotes one student as saying. “That’s what I would have liked last year, that’s what I would have liked this year, and that’s what I would have liked or will like for every year that we’re dealing with something like this.”

Students expressed “almost universal frustration” with administrators, who they said made them feel like their opinions did not matter when they were difficult to reach.

One student described contradicting guidance on masking in schools from the principal and superintendent: “It was just very messy and everyone chose sides and it affected our education.”

Students described mental-health fallout from studying in the same place they slept. That caused at least one student to form an obsession with school. It was the one thing they could control, they told researchers.

The student said, “I would spend just hours at a time without going to the restroom or eating or anything, just working on schoolwork. And it was really unhealthy. And so that wasn’t necessarily just because of Covid. But I think it definitely did enable me to feed into those bad habits a lot more.”

The Centers for Disease Control and Prevention reported last March that 37% of high-school students reported poor mental health in 2021. Additionally, 44% “reported they persistently felt sad or hopeless during the past year.”

The National Suicide Prevention and Crisis Lifeline is 988 – and anyone can call or text it for mental health help.

“Students almost felt ‘stranded’ in a sense where online schooling was not set up in a comprehensive way meant to stimulate learning,” said researcher Esha Bajwa. “Instead, it was mostly an afterthought to sending people home with many feeling that there was no real way of feeling connected and/or engaged with school.”

Researchers said the long-term effects of mental-health fallout should continue to be studied: “Whether the pandemic was the inciting event or merely an amplifier, its effects on mental health for students were devastating and deserve to be studied for years to come.”

Amid all the concerns, one student said, “But in the meantime, it's those small moments, those memories, that laugh, that joke, that little small project that you had with your classmates, that class project that we had, that is what makes school meaningful and important right now. It's those moments. It's those moments that make school what it is. It always has been.”

 
Policy and practice recommendations

Researchers made policy and practice recommendations for the future:

• Prioritize students’ mental health by adapting workload and class structure.
• Advocate for better awareness and access to mental health counselors.
• Add mental health days, check-in surveys and mindfulness opportunities.
• Allow for more transparency in understanding material and provide additional support for students, such as reviewing material and adding peer tutoring.
• Demonstrate care for students’ vast and varied circumstances, including being aware of equity. Humanize the struggles during and after the pandemic.
• Consider health precautions through a new perspective, clearly communicate exposures and accommodate those who are immunocompromised.
• Actively seek to involve students in the decision-making processes by adding voting student members to school boards.
• Implement equity-oriented positive reinforcement systems to celebrate student achievements and foster supportive school climates
• Create an environment where students can connect with each other and teachers and prioritize social connection in the classroom.
• Challenge the normative notion that a students’ value is tied to academic successes. Celebrate student achievements beyond a solely academic context. Also, diversify grading methods.
• Utilize more interactive teaching practices and focus on group work.

The first part of the study came out in Spring 2020. It found, among other things, that students felt the meaningfulness and manageability of their schoolwork declined during the first semester of pandemic-induced remote learning.

At upcoming holiday celebrations, focus on social connections, not on the food; eat mindfully to avoid celebration guilt

Photo by iStock from "How to eat healthy during a holiday celebration," by Hola 

By Patty Craig
Beech Tree News, Morgantown

We will soon enter the holiday celebration season. Our culture promotes celebrating with food – despite staggering obesity statistics. Anticipating those celebrations, how might health-minded people celebrate?

First, carrying extra weight is a real problem. The Centers for Disease Control and Prevention website reports: “The obesity prevalence was 39.8% among adults aged 20 to 39 years, 44.3% among adults aged 40 to 59 years, and 41.5% among adults aged 60 and older.”

Obese children may have to deal with psychological problems such as anxiety and depression, low self-esteem and lower self-reported quality of life, social problems such as bullying and stigma, and obesity as adults.

Obese adults face high blood pressure and high cholesterol, Type 2 diabetes, breathing problems, joint problems, gallstones and gallbladder disease. Additionally, “adults with obesity have higher risks for stroke, many types of cancer, premature death, and mental illness such as clinical depression and anxiety.”

Patty Craig

Why, then, is food a part of life’s celebrations? The Cultural Awareness International website says: “Conceivably it (food) is the most significant commonality that humanity shares. Whatever shape, form, flavor, or seasoning food may take around the world, people eat. More than that, across the world, people enjoy eating.”

Food is a way to show hospitality, and it provides an opportunity to make connections. Food is generally provided with celebrations throughout the life cycle – from birth to death, including many holidays.

How can we find a healthy balance? In a Film Daily article by Samantha Williams ("Healthy Celebrations: Striking a Balance between Indulgence and Wellness"), the author discussed how to be mindful and still savor a celebration. Two of her points resonated with me:

“Set Realistic Expectations: Understand that celebrations are exceptions, not the norm. Don’t expect to maintain your usual dietary and fitness routines during every celebration. Instead, aim for balance over time.

“Focus on Social Connection: Celebrations are about connecting with others and making memories. Shift your focus from food to the people and experiences around you.”

By eating mindfully, a balance between indulgence and wellness can be achieved, ridding us of celebration guilt.

I’ve read that health is an investment, not an expense. The Roman poet Virgil said, “The greatest wealth is health.” And I agree.

So what about those holiday celebrations on the horizon? I say yes, let’s provide the food, but not push anyone to eat or drink what’s being served. After all, we may not understand their situation, and we don’t want to be stumbling blocks to their health goals.

Patty Craig of Morgantown is a mother, grandmother and retired educator.

As more people get vaccinated, the opportunity to reconnect with others increases; experts talk about why touch is so important

ColoradoBoulevard.net photo

By Melissa Patrick

Kentucky Health News

After a year of pandemic-forced isolation, when the simple act of touching became dangerous almost overnight, the arrival of highly effective vaccines means it's OK for fully  vaccinated people to touch again — and experts say it's important we do. 

That's because touching is how we show each other compassion and love, and because it is necessary for our physical, mental and emotional health, said Joe D'Ambrosio, a licensed clinical social worker in Louisville.

"Weighing the responsibility that we have to not increase Covid in this pandemic against human needs, I think that is the balance that we have to make," said D'Ambrosio, who is also a licensed marriage and family therapist, a lawyer and an assistant professor at the University of Louisville School of Medicine.

D'Ambrosio said he has encouraged his clients throughout the pandemic to put on a mask and hug the people to whom they are regularly exposed. "I think that we have to be wise, we have to assess each situation and maybe even risk a bit to care for yourself and care for one another," he said. "We can't always live in a bubble. That's not going to work." 

Other opportunities for touch

D'Ambrosio acknowledged that many people are still scared to touch each other, even if they are fully vaccinated. For them, he advises finding other ways to get that tactile experience. For example, he encouraged them to regularly hug their pets, get a massage or take a warm bath and sleep under a weighted blanket.

There is even value in simply hugging yourself, said D-Ambrosio and Jill Cole, massage therapy coordinator at UK HealthCare's Integrative Medicine and Health. As we wait on restrictions in touch and social distancing to be lifted, and "are able to come back together, I think it's important that we think about opportunities for touch," she said. "The first thing we can do is just simply give ourselves a hug. I know that may sound a little hokey, but that is a form of touch." 

Healthline has reported the benefits of giving yourself a hug, including research showing it can relieve pain, help you feel safe and secure, improve your mood and increase self-compassion. The article also offers instructions on how to do it, titled, "Self-Hugging 101." 

Cole also encouraged people to seek out safe, therapeutic massage as part of their self-care during the pandemic. Information about whether a massage therapist is licensed and in good standing with the state can be found on the Kentucky Board of Massage Therapists website, she said. 

"Touch is important because it's inherent to who we are as humans. We have a significant need to receive and to give touch," she said, later adding, "Touch helps us physiologically, it helps us emotionally, it helps us spiritually, it definitely helps us physically."

Technology can also help seniors stay connected to their loved ones. Sheri Rose, CEO of the Thrive Center, a nonprofit senior-innovation center in Louisville, said it has a pilot program with Louisville's Nazareth Home that uses larger than normal tablet devices that can connect Facebook to Alexa, with the goal of increasing social connectedness between residents and families.

But while such things as artificial intelligence and robotics can help seniors age in place and stay connected, she said, "Nothing will replace the person being there, and that human touch." 

Why touch is important

Touch is required for human survival, just as food and water is, Tiffany Field, director of the Touch Research Institute at the University of Miami, told The Economist, which summarized: "It is the first sense to develop and the only one necessary for survival. We can live with the loss of sight or hearing. But without touch, which enables us to detect such stimuli as pressure, temperature and texture, we would be unable to walk or feel pain. Our skin is the vehicle through which we navigate the world."

As for living in a world where we never shake hands again, as Dr. Anthony Fauci suggested early in the pandemic to slow the spread of the coronavirus, D'Ambrosio said he hopes it never comes to that. 

"When I heard him say that, I thought, 'No, don't say that. Don't, because touching is probably one of the most important things that we could do in life because our skin is the largest organ that we have and there's so much research that shows what touching does to the body, how the body reacts to it," he said.

 

For example, he said touch decreases cortisol levels, a hormone produced in response to stress. It decreases blood pressure, and it lowers a heart rate. It releases oxytocin, a hormone associated with connection and empathy. He also pointed to studies that show an absence of touch in infants can have a negative effect on their growth and their ability as adults to have proper attachment. 

Cole added that research shows massage helps to calm a person's nervous systems, decreases their pain and anxiety and has had some impact on nausea. 

Social isolation, touch and seniors

The pandemic's forced isolation and the lack of touch have been especially hard on those living in long-term care and assisted living facilities.

Tammy Roberts, a licensed practical nurse at Masonic Home Shelbyville, told the story of a lady in her facility who broke down and said she just really needed to be hugged and when Roberts sat down next to her she leaned over and laid her head on her chest and "wrapped her arms around me really tight."

"I do think that is something that each and every one of them needs, a sense of touch. You know, we all do," she said. "I think there is a sense of isolation when you go so long without that human interaction and touch." 

Roberts said some residents  couldn't understand why their family members quit coming to see them, and felt abandoned. When restrictions on visitation were lifted, she said, "Some were very excited, some just couldn't even believe it. You know, it had been so long they just couldn't even believe it."

Kentucky relaxed some of its visitation restrictions at assisted living facilities and other types of group living homes in mid-February, two months after starting vaccinations and giving priority to residents of long-term-care facilities. A month later, it did the same for federally regulated nursing homes, also allowing them to return to group activities and congregate dining. 

WDRB tells the story of the reunion of  a long-term care 
resident at Nazareth Home in Louisville who was finally 
able to reunite with his wife after spending a year apart. 

Even residents who don't have family members are "reconnecting with their buddies. . . . so we're already seeing just the change in mental status, just incredibly, you can just feel it in the air when you walk through," said Karen Venis, chief executive officer of Sayre Christian Village in Lexington. She said, "It just feels so much more like normal, and that's all we're looking for."

Venis said the last year has been "very difficult on all levels" for residents, families and staff. "The connections that are made with family members, and those hugs, are hard for us to fill in those gaps," she said. "We've done as many things as we could to still let love in. We've done virtual visits and window visits, but that sense of touch, there's really nothing you can do to fill that void."  

Laurie Dorough, executive director of Daisy Hill Senior Living in Versailles, said she considers her staff "physicians of the spirit" whose job is to serve, love and minister to their residents. And because of that philosophy and also because they recognized the importance of touch, "We often suited up in PPE and just gave hugs."

Dorough said the new visitation rules have given her residents back their independence, to have fellowship and leave the facility if they choose. "I can definitely tell that the morale in all the residents is much stronger," she said. All her residents have been vaccinated, she said, but as a precaution they ask everyone to wear a mask when socializing unless they are eating.

D'Ambrosio said he understands the public-safety rationale for denying seniors visitation, but wonders about the long-term effects. 

"I watched a number of my clients that I have that are older deteriorate over the year because of loneliness and social isolation and lack of touch. They did not prosper. They deteriorated," he said. "And it wasn't normal aging, it was different than normal aging. It was from the lack of connection, lack of connectivity." 

18% more Kentucky youth (ages 5 to 19) went to hospital emergency rooms for self-harm injuries in 2021 than in 2020

Ohio Valley ReSource graph from Ky. Injury Prevention and Resource Ctr. data; click it to enlarge.

Kentucky hospital emergency rooms are increasingly becoming the go-to destination for Kentucky youth who have mental-health problems and harm themselves.

The Kentucky Injury Prevention and Resource Center says 1,396 Kentuckians ages five to 19 visited emergency departments for self-harm injuries in 2021, up 18 percent from the 1,182 reported in 2020.

"The data also shows more Kentucky youth died by suicide compared to youth who are killed in homicides," Corinne Boyer of WEKU-FM reports for Ohio Valley ReSource, a consortium of public radio stations in Kentucky, Ohio and West Virginia. "Between 2010 and 2021, a total of 430 suicide deaths were reported and 302 homicides were recorded among Kentuckians ages five to 19."

Lindsay Ragsdale, M.D.

Dr. Lindsay Ragsdale, chief medical officer at Kentucky Children’s Hospital in Lexington, told Boyer that she’s seen an increase in patients seeking mental health treatment.

“Every single day, we have patients that come into our ER for evaluation for mental health crisis, and whether that's suicidal attempts, or thoughts, some more anxiety related diagnoses [and] eating disorders,” Ragsdale said, adding that the pandemic cut off social connection for children.

“There's a lot of fear and concern, and this has really upended a lot of kids' lives.”

The hospital, part of the University of Kentucky, is working on a psychiatric unit that it hopes to have completed by November, Boyer reports: "But Dr. Amy Meadows, the child and adolescent psychiatry director at UK, said the demand for mental health treatment means the new unit won’t have enough beds."

“Not only do we need more inpatient, but we also need a better system of care to help manage kids out of the hospital, keep them at home when it's at all possible,” Meadows said, adding that means many options.

“From schools where kids are doing education about emotions and mental health, to being able to have outpatient therapy,” she said. “We need more psychologists, therapists, social workers, to having available psychiatrists in the community.”

The problem is widespread. The Children’s Hospital Association reported last fall last that self-harm injuries among children rose significantly in the first six months of 2021, with a 45% increase in the number of self-injury and suicide cases in 5-to-17-year-olds, compared to 2019.

CHA President Amy Wimpey Knight "said the numbers indicate a mental health crisis," Boyer reports.

“Basically, if a child presents to the emergency room in a mental health crisis, that cannot safely be discharged home, they often need to be — some can — but many often need ongoing care,” Wright said. “And there's not enough mental health beds right now and/or intensive outpatient programs.”

Eating local: Farm-to-school gaining ground as way to fight childhood obesity and otherwise improve students' nutrition

By Tara Kaprowy
Kentucky Health News

With the faint hue of green appearing in thousands of gardens and farms, the growing season has officially begun in Kentucky. While most of the resulting produce is destined for store shelves and personal pantries, there is growing demand for it to appear in kitchens that haven't seen locally-grown fruit and vegetables for decades but are keys to children's nutrition.

Schools are the newest frontier in sustainable farming, with their collective power not only capable of transforming the agricultural landscape, but also fighting childhood obesity, one of the biggest health crises facing the nation. (Kentucky Department of Agriculture photo: Montgomery County farmer Gayle Arnold picking tomatoes)

This growing trend is called "farm to school," in which school cafeterias serve food grown by local farmers. Across the state, food-service directors in 78 school districts have made their schools Kentucky Proud institutions, meaning they serve local products in their school lunches.

This map shows that nearly 50 counties had some type of farm-to-school program in place in 2010; more have started.

"It's a growing movement," said Tina Garland, coordinator for the Kentucky Department of Agriculture's Farm-to-School Program. "Producers are being added every day. We've got orchards that can turn off their freezers in the fall because the schools buy all of their apples."

John Cain, state co-chair of Kentucky Action for Healthy Kids, attributed the trend to several factors, including efforts to find viable markets for former tobacco farmers, a concern about food security and the obesity epidemic. "We're having to revisit where does our food come from and what does the source of our food have to do with our obesity problem," he said.

This year, 10 school districts will receive $5,000 grants from the Kentucky Department of Public Health's Obesity Prevention Program so they can establish farm-to-school programs. Last year, Jackson, Lee and Owsley counties established their own programs using the grants. Owsley Food Service Coordinator Charolette Thompson served locally-grown watermelons and cantaloupes in her cafeterias. "The students noticed the difference in taste and the better quality in the produce," she said. "They love it."

In Jackson County, in addition to developing ties with farmers, students grew tomatoes, left,  and canned salsa, which will be used in the school cafeteria. They also made jam, which they sold under the label "Jammin' Generals." "Not only did they learn how to grow their own food, they learned how to market it and how to preserve it," said Elaine Russell, nutrition coordinator for the Obesity Prevention Program. (Cumberland Valley District Health Department photo)

This trend is likely to continue, especially since it now has federal support. On April 26, the U.S. Department of Agriculture established a rule that will let schools give preference to local, unprocessed farm products when they buy for the National School Lunch Program and other USDA programs.

While farm to school is gaining traction, it is not a new concept. Julie Tuttle, food nutrition coordinator at Montgomery County Schools, is one of a handful of food-service directors who have been serving locally-grown produce for several years. "We started using apples in 2006," she said. "Now we're up to four producers." (Kentucky Department of Agriculture photo: Students Macy Tabor and Makayla Donathan at Montgomery County High School)

The latest is Marksbury Farms, where Tuttle is buying beef, chicken and pork. Last week, in honor of the Kentucky Derby, Montgomery County High was one of the first Kentucky schools in decades to serve local meat. The students had the option of either burgoo or hot browns, left. "I had one student who came up to me and said, 'I just wanted you to know this is the best school lunch I've had since I've been here,'" Tuttle said. "That's what it's all about, getting those comments from students." (Kentucky Department of Agriculture photo)

Julia Bauscher, director of school and community nutrition services for Jefferson County Public Schools, teamed with Sullivan University to develop recipes, and was able to buy local squash, peppers and zucchini that she and her team processed and froze for year-round use. This year, she is buying local foods from about 12 providers, three of whom have contracts to grow for the schools.

In addition to raising awareness, she's found farm to school improves the reputation of the school cafeteria in general. "This gives everyone something to feel good about and opens everyone's eyes a little more about the program," she said. "And how we really do have to work hard to make this happen."

Farm-to-school programs have been slow to start in many places because they face logistical, legal and other challenges. Many school districts want their suppliers to carry a $1 million liability insurance policy, which they may not be able to afford, and be certified through the Good Agriculture Practices Program, education they may not be able to get.

Farm to school's biggest drawback is that it takes more work. Unlike food delivered to schools by huge providers, locally-raised produce may need to be washed and processed, which takes more staff or volunteers.

"The market has evolved a very convenient system," said Mark Swanson, an assistant professor in the University of Kentucky College of Public Health. He said school food-service directors "have one or two providers they can call and they can get what they need. Farm to school gets a lot more complicated. ... It takes a really motivated person to tackle that on their own."

Swanson said that hurdle can be lowered by social connections in rural communities. He spoke of one farmer who was selling her tomatoes to a Wendy's restaurant. Though she'd had a bad harvest, the restaurant manager was willing to use the product, in part because they went to church together. "He knew that his business arrangement would be cushioned by social ties," Swanson said.

In Owsley County, ties between the school and farmers have become so strong farmers will now host a farmers market on the grounds of the high school there. "It's the social connection with farm to school that gives it the most potential," Swanson said.

Federal procurement guidelines keep schools from paying much of a premium for local products, but "Farmers are pretty uniformly willing to accept a lower price for their produce because of the volume and they can sell it all at once," rather that waiting for single buyers at a farmers' market, Swanson said. "It's a good trade," he said. "It's a whole lot easier."

That was the case for Jeremy Hinton, owner of Hinton's Orchard and Farm Market, and the schools in LaRue County and nearby Elizabethtown, which buy 1,000 of his apples a week.

"It was a cost savings to them over what they were paying at the time," Hinton said. "Even when wholesale apples are available for less, they continue to buy our apples because of the quality and supporting locally grown. . . . Probably the biggest compliment we've gotten is talking to some cafeteria managers who said they're seeing more apple cores in the trash bin instead of apples with one or two bites out of them."

While farm to school is gaining ground in Kentucky, it is more established in the upper Midwest, the Northeast and California. Kelly Crossley, food-service director at Independence School District in Iowa, started her program in 2008. Though she is interested in supporting farmers and shrinking the district's carbon footprint, Crossley's main goal is the same as most food-service directors in the program: healthier eating.

"If you can get kids to eat more fruit and vegetables, hopefully those items will replace something more fattening they would have eaten otherwise," she said. To reinforce the effort, students meet the farmers in the classroom and travel to the farms, and Crossley posts in the cafeteria signs noting where the local foods were grown. Crossley said her staff only casually monitors what students take in the lunch line, not what actually gets eaten, but "The cooks have told me ... that they can tell which kids have been exposed because they're taking more."

Swanson is doing research in Lee County to see if farm-to-school actually improves children's nutrition. He will establish a program and photograph trays of food coming off the lunch line and being returned once the students have eaten. "There's a general assumption that farm-to-school programs work and no one has really studied the effects on nutrition," he said. "The reason I don't sell it on the nutritional benefits is we really don't know."

While the empirical evidence may be short, the anecdotal evidence is strong. Crossley said she witnessed an unforgettable success late last fall in Iowa.

"Brussels sprouts were the only thing left in the garden," she said. "The kids went out and actually harvested them off the trunks. We sautéed them, put a little bit of parmesan cheese on them and we passed them out to the kids. I'm telling you, they ate it up ... That day, we heard stuff like, 'I like Brussels sprouts and I didn't even know it.'"

Bauscher looks forward to the day that happens all over Kentucky. "As more districts become more involved in this," she said, "we ought to be able to create something that's really worthwhile, not only for the students, but for the farmers."

Study cites benefits of telehealth; commentary says mental telehealth services are 'clinically equivalent to in-person care'

As people across the nation have been asked to shelter in place because of the novel coronavirus, never before has the importance of telehealth, especially for mental-health care, become more evident, says a commentary in The Journal of Rural Health. 

The authors assert that mental-health therapy over video platforms "has been demonstrated as clinically equivalent to in-person care." 

Before the pandemic, they write, video-to-home telehealth services for mental-health care was not uniformly offered, but has since gained some traction, especially in rural areas where mental-health provider shortages are great.

The authors note that telehealth visits have ensured continuity of care during stay-at-home orders, all while minimizing physical contact to keep both patients and providers safe.

But they also recognize that this type of care also comes with many challenges, including overburdened networks, poor internet bandwidth, inconsistent internet service, a lack of equipment,  billing and scheduling challenges, and usability issues for both providers and patients. These challenges have resulted in some providers conducting phone-only visits, especially after federal rules were relaxed to allow reimbursement for such visits.

But the authors say that in this time where "the loss of in-person contacts has never been more pronounced," phone-call appointments, while efficient, don't offer the same connection that video-based meetings do.

"During this pandemic, we believe that visual contact remains crucial; thus institutions that work to facilitate the availability of [video-to-home] visits will significantly benefit both patients and providers,"  they write. "Robust telehealth programs require a significant commitment of time and resources, and large health care organizations with the foresight to invest in telehealth are poised to transition [mental health] care from in-person to virtual visits."

The authors say they regularly collect patient input through interviews about virtual appointments, and have found that many patients say the video connection makes it more personal and that seeing their provider during the therapy session is "very important." Further, patients have told them that they are more comfortable getting their mental-health care at home.

"We believe that prioritizing video over phone-only calls will help maintain the integrity of [mental health] care by maintaining important social rhythms, supporting rapport, and offering a more patient-centered care approach," they write.

They add that such visits allow for the re-establishment of "social rhythms" that many patients prefer, and let the patient and the provider see nonverbal communication cues that would otherwise be missed. It also allows the provider a window into their patient's physical space, the authors write.

Video-to-home "may help patients share more with their provider within the context of therapy by enhancing the therapeutic relationship and allowing providers to establish connections that could never be achieved over the phone," they write.

The authors conclude that video-to-home "will become part of the new normal in the post-pandemic period" and say that now is the time to build competency and capacity for it.

In particular, they note that video-to-home care has been quite successful in rural Veterans Health Administration treatment centers.

A study, also published in The Journal of Rural Health and named article of the year, found that over  a six-year period, 2009 to 2015, use of clinical video telemedicine grew from 30 to 124 encounters per 1,000 veterans, with faster growth among rural veterans than urban ones.  It also found that more than 50 percent of the telehealth visits were for mental-health care.

The study adds that in fiscal year 2015, the last year of the study, 3.2% of urban and 7.2% of rural veterans used telemedicine for nearly 725,000 clinical encounters.

The authors said vets were more likely to use telemedicine if they had a "younger age, longer driving distance to VHA facilities," or multiple medical conditions.

The study concludes that the availability of telemedicine "has likely increased access to care for rural veterans, especially for mental-health care."

Annual policy forum will focus on role of education in health

Individual and public health are influenced by many things, including the educational characteristics of people and their communities. Education will be the focus of the Foundation for a Healthy Kentucky’s 2022 Howard L. Bost Memorial Health Policy Forum, to be held virtually from 9:30 a.m. to 4:30 p.m. Oct. 17.

The forum will look at the connection between educational opportunities and health outcomes of Kentuckians, as one of the social determinants of health. Presenters and panelists will consider education as a cornerstone of Kentucky’s health outcomes. It is offred free of charge. Register here.

“Education is more than what happens between the four walls of a school building,” said Ben Chandler, president and CEO of the foundation. “Educational factors that influence health outcomes include everything from life skills — mental health, emotional literacy, financial literacy, and nutritional literacy — to local community programs, such as out-of-school care and workforce training, to equity issues. It’s important we consider all the factors of health to find ways to make a positive impact.”

Looking beyond the K-12 education system, panelists and presenters will discuss programs that can enhance education and provide more equitable access, while leading to better health outcomes for individuals and communities. Attendees will learn about replicable community-oriented collaborations and coordination between sectors that have led to improved health overall.

The 2022 Kentucky Teacher of the Year, Willie Carver, will give the keynote address. Sessions will include:

• Making the Case for Funding, in Education and Beyond: Considering education as a social determinant of health, panelists will discuss school funding, social safety net programs’ impact on education, and real examples from urban and rural schools.
• Literacy for Life (Critical Lessons for Positive Health): They’re lessons most don’t receive in school but can mean the difference between addressing and overcoming life’s challenges or becoming overwhelmed. Panelists will discuss mental health and emotional literacy, financial literacy and navigating systems, and how nutrition education impacts hunger long-term.
• Linked but Addressable; Helping Families Overcome Obstacles: A look at how family income plays a critical role in the academic outcomes of students, and therefore, the lifelong health of individuals.
• Breaking Down Barriers; Real Examples of Kentucky Communities Making Positive Change: Learn how local communities are lifting up families. Panelists will share about connecting families with early childhood intervention services; public schools and public health collaborating on mental health services; and, how a community is working to chart paths for non-traditional career building.

The forum is designed to raise awareness of the health issues impacting Kentuckians and highlights model strategies and policy opportunities to improve Kentucky’s health. The foundation created it to honor Dr. Howard L. Bost, a notable health economist and a founding member of the foundation’s board of directors. It welcomes a range of audiences, inside and outside the health industry – including health care advocates, providers and educators, business professionals, civic leaders, policy makers and more.

Updates on the forum are at Healthy-KY.org/bost-forum-2022.

 

Virus creates perfect storm for those with substance-use disorder, but opens the door to online recovery tools that could persist

By Melissa Patrick
Kentucky Health News

Economic struggles and social isolation are well-known triggers for people with substance-use disorders, so the coronavirus pandemic has created a perfect storm for them. But the isolation has prompted an influx of online recovery services that addiction experts hope will continue long after the virus subsides.

Image from Alcohol.org

"Some really great things that are going to come out of this situation is that for folks who really face transportation barriers, especially out in those rural communities, if we allow, continue to have this space for virtual connection, we can really create some better connections with those people to get them the supports that they need," Tara Moseley, program manager at Young People in Recovery said on "Coronavirus: A Kentucky Update," a weekly Kentucky Education Television program hosted by Dr. Wayne Tuckson.

The shift to online care is an opportunity for those who are seeking recovery, but are hesitant to attend an in-person meeting, said Sarah Bell, lead peer specialist at Beyond Birth, a University of Kentucky outpatient substance-use-disorder recovery program serving mothers in recovery.

"I think it is a great time to for anyone who might be exploring getting sober, but they don't want to walk into a meeting in their town," Bell told KET. "There are all these virtual meetings now, which I think is really helping to break down the stigma of people who feel like they might want to stop using a substance."

Addiction experts have long called for more access to online addiction treatment, including the ability to prescribe medications online for opioid-use disorder. About 40 percent of U.S. counties don't have a health-care who is approved to prescribe buprenorphine, an active ingredient in Suboxone, the preferred drug in medication-assisted treatment for substance-use disorder, according to a federal report.

Online prescribing is possible only because the pandemic prompted the federal government to suspend a law that required patients to have an in-person visit with a physician before such a prescription, Phil Galewitz reports for Kaiser Health News. 

The new rules also allow people who are in treatment for addiction and are considered “stable” to take home a 28-day supply of methadone, and those "less than stable" to have a 14-day supply. Beforehand, methadone could only be administered in an opioid treatment program. Advocates say compliance with the new guidelines has been inconsistent, reports Stat, the medicine-and-science publication of The Boston Globe.

Virus creates perfect storm for relapse 

Since mid-March, all non-life-sustaining, in-person businesses in Kentucky have been closed, public schools have ceased all in-person classes, and Kentuckians have been asked to practice social distancing and be "healthy at home" to slow the spread of the coronavirus. Such measures, while saving lives, have wreaked havoc on the economy and thrown people with addictions into a tailspin as in-person recovery supports have shuttered.

"Research shows that job loss is associated with increased depression, anxiety, distress, and low self-esteem and may lead to higher rates of substance use disorder and suicide," according to a recent poll for the Kaiser Family Foundation, which notes, "A broad body of research links social isolation and loneliness to both poor mental and physical health."

The poll found that 45 percent of U.S. adults said their mental health has been hurt by worry and stress over the virus.

A U.S. Department of Labor report shows that Kentucky (except tourism-dependent Hawaii) leads the nation in percentage of workforce that has claimed unemployment benefits. The Louisville Courier Journal reports that about 590,000 Kentuckians, or about 29% of the state's workforce, have submitted new jobless claims in the past six weeks.

"Quarantine and stuff, it causes anxiety, and anxiety is a trigger for a lot of people," Rebekah Bowman, women's group leader at Celebrate Recovery, a faith-driven, 12-step recovery program, said on the KET show.  "And sometimes the alienation, that's a trigger for some people. And the hopelessness of it, some people just get to feeling like it's never going to end."

Alex Acquisto of the Lexington Herald-Leader has reported in detail on this topic, telling the stories of Kentuckians who are working to stay sober while being asked to isolate. One is Jaden Korse, 23, who told her that he normally attends at least three recovery meetings a week.

“For a lot of people, me included, prior to relapse, isolation is sort of a trait you’ll see,” Korse said.  “It’s weird to forcibly be put into that, [since] it was something many of us would do in active addiction.”

Drug use continues

Rob Sanders, commonwealth's attorney in Kenton County, told columnist Salena Zito that even though arrests are down dramatically in his county, he didn't think drug use was.

“I would estimate that we normally would get 20 to 30 felony drug-possession arrests per week in this county,” he said. “Right now we’re averaging five or six, maybe. Short of crashing into a police car, you are very hard-pressed to get yourself arrested for drug possession . . . I don’t think the drug users have stopped using just because of the coronavirus. I suspect there’s a lot of rampant drug use right now and there’s just a lot less police intervention. I’m not faulting the police, because I wouldn’t want them to have any more interaction with strangers than they absolutely had to, but their proactive policing is way down.”

Sanders isn't likely far off in his assumption, since illicit drugs continue to flood into the state, news reports in the past month indicate.

In the past month: WKYT reported May 2 about nine straight days of methamphetamine seizures in Whitley County; WYMT reported April 9 about a meth bust in Johnson County; The Daily Independent of Ashland reported April 7 about a seizure of more than a pound of heroin in Boyd County, an amount the sheriff said was almost unheard of locally.

Meanwhile, drugs continued to reach users. The Richmond Register reported April 24 that the Madison County EMS saw 75% more overdose calls April 1-23 than during the same period 2019.

Paul Brethen, co-founder of SoberBuddy and a certified addiction specialist for more than 20 years, told Dawne Gee of Louisville's WAVE-TV that he believes the supply and distribution of most drugs was being altered because borders closed because of the pandemic: "Drug dealers to keep business going are cutting the heroin and cocaine with fentanyl," which could lead to more overdoses.

Drug shortages can also lead to overdoses, because users will substitute drugs they’re less familiar with, or change their habits, making dosing less reliable and potentially causing a spike in overdoses,
Daniel Ciccarone, a medical professor at the University of California-San Francisco, told Lois Parshley of National Geographic. Ciccarone fears that the pandemic may usher in a fifth wave of the opioid crisis.

Help is still available.

"A big part of recovery is telling on yourself; you are going to always have thoughts about picking up a drink or a drug," Bell, of Beyond Birth, said on KET. "If you say it out loud, and talk to someone else about it, it's going to take a lot of that power away. The more you kind of try to sit in isolation and stuff it and stop thinking about it, or think that you're wrong or guilty for thinking about it, it's going to be a lot tougher to  kind of make it through that craving."

Here is a list of free online meeting options, as well as platforms where individuals can interact virtually with others in recovery, provided to Operation Unite by James Carroll, director of the White House Office of National Drug Control Policy. Kentucky also offers a website to connect Kentuckians to addiction treatment, findhelpnowky.org.