Addiction, hope, and recovery in the time of COVID-19
New York recovery coach Jen Cutting urges meeting people where they’re at. “I feel like the mom on the sideline, cheering for them,” she says of her “recoverees.”
“I just want them to be successful and happy and sober and alive.”
Why We Wrote This
Recovery is about reclaiming a life. Many have proved that treating an addiction is a pandemic possibility, even as they uplift their peers.
Amid concerns of increased anxiety and isolation during the pandemic, technology has helped many in recovery from addiction hold onto social support and treatment, through an expansion of online mutual support groups, telehealth, and apps.
Privacy and access issues remain, and more research is needed to understand the efficacy of telehealth and other digital tools. But for some who need help, their willingness to adapt underscores a message advocates have pressed all along: Recovery is possible.
“I just want to give a message of hope,” says Sarah Rollins, a Michigan social worker.
In April, West Virginia’s Office of Drug Control Policy launched its Connections app, whose features include digital cognitive behavioral therapy. An effort to roll it out failed five years ago, as the number of fatal overdoses in the state continued to rise.
As the department’s Executive Director Robert Hansen says, “It may have been because it was way ahead of its time.”
Four summers ago, Frederick Shegog ate a bag of donuts from a dumpster. Homeless and hungry in downtown Philadelphia, he says the sweets replaced a meal he’d have to buy with the last of his cash.
“I wanted that money to save, because I wanted to drink and hopefully I wouldn’t wake up,” he says. Living with an alcohol use disorder, Mr. Shegog had tried 20 different rehabs without success.
Passed out three days later on the street, he says a man woke him with a cup of water.
Why We Wrote This
Recovery is about reclaiming a life. Many have proved that treating an addiction is a pandemic possibility, even as they uplift their peers.
“You’re not dying today,” he recalls the stranger’s words.
Mr. Shegog celebrated four years sober last month. He graduated from Delaware County Community College in May with high honors and straight A’s. The motivational speaker credits his success to his faith in God, and the man who “saved my life” with a call to 911. Virtual resources have helped sustain his recovery during the pandemic, he says, as he joined remote 12-step meetings and therapy for the first time.
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“I gotta be honest – I don’t want to get back to in-person meetings,” says Mr. Shegog, who likes logging on from the comfort of home.
“I can be in a meeting in New York, and I’m in Philadelphia. … It’s opened the world up to be in places I never would’ve been in, to meet people I would’ve never met.”
Amid concerns of increased anxiety and isolation during the pandemic, technology has helped many in recovery hold onto social support and treatment through online mutual support groups, telehealth, and apps. Overcoming the disease of addiction is never easy, and relapse is common. But for some who need help, their willingness to adapt affirms advocates’ message from all along, pandemic or not: Recovery is possible.
“I just want to give a message of hope,” says Sarah Rollins, a Michigan social worker. “This is not something that has to be a life sentence.”
Need predates pandemic
Stigma persists, but substance use disorder (also called addiction, when severe) is a treatable disease. Even before the outbreak, more Americans required help for substance use than received it. An estimated 20.7 million people over the age of 11 needed treatment for substance use in 2017, according to government data. Within a year, only 4 million people received treatment.
Health experts warn the pandemic may lead to increased substance use and mental health issues.
“The concern is that we may then see an increase in overdoses, an increase in alcohol withdrawal, an increase in active substance use disorders,” Yngvild Olsen, vice president of American Society of Addiction Medicine’s board of directors, said in April. Reported spikes in opioid-related overdoses across several states confirm this concern.
The Substance Abuse and Mental Health Services Administration estimates nearly 58 million Americans were already living with a mental or substance use disorder, or both. Well Being Trust, a mental health foundation, projects the pandemic will cause up to 75,000 “deaths of despair” from alcohol, drugs, or suicide.
While for many, physical distancing has impeded access to resources, some service providers credit an expansion of telehealth – and insurance coverage of it – as lowering barriers to treatment during the pandemic. Emergency government deregulation of access to treatment medication has helped, including relaxed rules on reaching clinicians remotely.
While common, relapse doesn’t mean treatment has failed – around 40% to 60% of people with substance use disorders relapse, says the National Institute on Drug Abuse. But relapse can be dangerous. Jen Cutting, a certified recovery peer advocate in Walton, New York, says she’s lost several acquaintances to fatal overdoses in recent weeks, including “recoverees” she personally mentored.
Besides her cat, Thumbelina, Ms. Cutting has lived in lockdown alone. She says she learned to cope with isolation while incarcerated on drug charges – especially those 65 days in solitary. Ms. Cutting has spent over a decade in recovery from heroin, nearly four years from methamphetamine. Recovery has bloomed a relationship with her 8-year-old daughter, whom she had in prison.
As a recovery coach, Ms. Cutting urges her recoverees to reach out day or night.
“I love all my people. I feel like the mom on the sideline, cheering for them,” she says. “I just want them to be successful and happy and sober and alive.”
Beyond access to evidence-based treatment, “Social support is incredibly important,” says Quyen Ngo, executive director of the Butler Center for Research at the Hazelden Betty Ford Foundation. “Social support around managing cravings, managing urges, understanding that there may be triggers in the environment that individuals may not be able to get away from at this point because we’re all sheltering in place.”
Connecting with peers can help those trying to hide their addiction and use alone, says Ms. Rollins, senior social worker at University of Michigan’s Addiction Treatment Services in Ann Arbor, who has led virtual therapy during the pandemic.
“One of the biggest reasons for social support is it decreases the shame. It increases accountability,” she says. “No one gets better shaming themselves.”
Though nothing fully replicates meeting in person, stay-at-home orders have made mutual support groups like Alcoholics Anonymous proliferate online. SMART Recovery, a secular abstinence-oriented alternative to 12-Step programs like AA, has also continued meetings remotely.
Gerardo Matamoros, volunteer executive director of SMART Recovery NYC, launched the national organization’s first online Spanish-language meeting during the outbreak after mulling the idea for six years. He says the ease of facilitating Zoom meetings in English, despite a slight decline in local attendance, inspired him to commit.
“I’m telling you – silver lining,” says Mr. Matamoros. “It’s been very exciting to start that, and to grow despite what’s happening.”
These groups aren’t subject to health regulations, however, and privacy issues have surfaced over apps that are insecure. In Philadelphia, Mr. Shegog has witnessed multiple Zoom-bombers invade meetings that weren’t password-protected.
“Why would you not prepare when you know people are in here sharing their deepest, darkest, most painful things they’ve ever been through in their life?” he says.
In response to the pandemic, treatment provider Hazelden Betty Ford sped up its rollout of RecoveryGo early this year to reach more clients with mobility issues or in remote areas. The health-privacy-law-compliant platform is currently used for virtual intensive outpatient and mental health programs in nine states.
Attendance spiked when the remote offering was introduced, “due to the concerns of elevated anxiety and boredom and isolationism,” says addiction practitioner Terry Gerlach in Naples, Florida, who leads virtual counseling sessions on the app. “We’re probably talking a lot more about relapse prevention strategies.”
Still, there are success stories. Ms. Rollins, who runs therapy sessions for adolescents and adults, says it’s been “incredible” watching several maintain sobriety during the outbreak, especially while navigating graduations and job hunts.
“Fully present”
Outside Tacoma, Washington, Clarissa Heneghen relies on her Instagram sober community to stay on track – even as she mutes a mounting number of alcohol-related posts that she finds triggering.
COVID-19 has prompted her to check in more frequently with other friends in recovery she’s met on the app. She says those connections promote accountability and remind her of her progress: one year sober.
Her sobriety has allowed her to better address the emotional needs of her three children – all under the age of 10 – as the crisis adds new stressors to home life.
“I feel like if I had been drinking during this, I would have been more annoyed and frustrated” with the kids, says Ms. Heneghen.
“Now we can have conversations. I can be fully present.”
Certain apps have been developed and rolled out with more urgency during the pandemic, while meditation and mindfulness apps already on the market and designed to help ease anxiety – like Headspace and Calm – are offering some of their content for free.
West Virginia’s Office of Drug Control Policy has been working with app developers CHESS Health, launching the Connections app in April. The evidence-based app provides digital cognitive behavioral therapy, moderated peer discussions, classes, and motivational content for people in recovery.
“We kept thinking, what can we do during the pandemic, and part of recovery is connectedness and social interaction,” said Robert Hansen, the department’s executive director.
They tried to launch a similar service about five years ago, as the number of fatal overdoses continued to rise in the state, the biggest spike being in fentanyl-related deaths. “It just never took hold,” says Mr. Hansen. “It may have been because it was way ahead of its time.”
The time may just be right during a pandemic. Recently released to treatment providers, Mr. Hansen hopes to have the app available in popular app stores for anyone to download.
“It’s not a replacement for group therapy and in-person treatment, but it’s another positive,” says Mr. Hansen.
Limited research on telehealth, which predates the pandemic but has significantly expanded since, suggests benefits like better addiction treatment retention. Experts say more evaluation is needed to gauge what virtual resources have worked.
“As with many telehealth innovations, growth may occur before the evidence base is strong,” comment authors in the Journal of American Medical Association Network.
Still, not everyone has a computer, cellphone, or internet connection to engage, much less stable housing. Access to technology “is an issue for many communities, including rural communities where there are also a number of health disparities because of access to good health care of even proximal health care,” said Dr. Ngo.
With limited internet connection and access to technology, Mr. Hansen similarly struggles to reach people in rural West Virginia and worries about the efficacy of technology-based aids to recovery. “There is no easy answer,” he says.
In whatever way connection is possible, Ms. Cutting in New York urges meeting people where they’re at. “Sometimes it’s just seeing a friendly face, or sharing a joke,” she says.
“You can share something that might save someone else’s life.”
If you or someone you know is struggling with substance use, Substance Abuse and Mental Health Services Administration offers a range of resources. You can also call the national hotline at 1-800-662-HELP (4357).
