Coronavirus and the Threat to Those Recovering From Addiction
Maintaining connections – at a distance – to stay sober during the pandemic
For people in recovery from substance use disorders, group meetings can be a foundational aspect of maintaining sobriety. They offer a space where someone just coming to grips with their addiction can feel accepted by a community that understands intimately the challenges the disease poses.
Groups can help a person in recovery gain tools to work with to maintain sobriety when the ups and downs of life make the urge to use even greater. They can also just be a place to vent about how much getting sober sucks, and how it would be nice to be able to just casually use without being consumed by the cycle of depression and dependency that accompanies a battle with addiction.
Most of all, what group meetings offer a person in recovery – whether one day sober or with many years under their belt – is connection. Support meetings draw people out of the isolation of substance abuse, helping them let go of the false notion that addiction is a problem they caused and that they alone can fix. Recovery involves making changes to one's own life and behaviors that require an often uncomfortable level of introspection. But the idea that that work must be carried out completely alone is detrimental to the freshly and long-term sober person alike.
When the places that house in-person recovery meetings began closing their doors in March, to adhere to local orders restricting the number of people allowed to gather in public, people who depend on those meetings to live in sobriety were left in a lurch. On March 20, just a few days after the city of Austin and Travis County issued orders banning gatherings of 10 or more people anywhere, the distressing reality could already be seen in the online directory of support meetings maintained by Hill Country Intergroup – the local Alcoholics Anonymous chapter.
Of the 469 meetings in the directory – available every day of the week, at all hours of the day, at locations throughout the Austin metro area – 319 were listed as suspended, along with others that had yet to announce their status online. By that point, the move to virtual recovery – both among the various recovery groups and clubs and in the clinical help offered at rehab facilities – was already underway, but the sudden loss of in-person meetings was a huge hit for the recovery community.
"At first, it was a shock for everyone," Alex Coffman, who has owned and operated the sober living house Absolute Recovery since November 2019, told the Chronicle. "Especially for the people who were going into treatment and entering recovery for the first time. Getting out to these meetings can be their only connection to the kind of support and fellowship meetings provide."
It's Both Good and Bad
The shift to virtual meetings – like other parts of society that were forced to move online abruptly to slow the spread of COVID-19 – has been a mixed experience for people in recovery. For some people, meeting online through Zoom and Google Hangouts has provided a way to gain the support and maintain the connections that group meetings offer, without the barriers attending in person can pose.
Meetings can now be attended by people who had trouble finding transportation to facilities that host them. The additional layer of anonymity virtual meetings can offer – people can join with their cameras and mics off, allowing them to listen in on what a meeting is like without being identified whatsoever – allow some a less anxiety-inducing way of experiencing fellowship that they may have found daunting in person. And, for some, talking through a screen makes it easier to share one's experiences more authentically, allowing for deeper connection with people in the group.
But the transition has not been a revelation for everyone. Online video meetings are only more accessible if you have stable access to broadband internet – meaning that for some people living in poverty, the new world of virtual recovery is much less accessible than showing up to a church or a rehab clinic for an in-person meeting. That's made more troubling by the fact that recovery meetings are sometimes the only dependable avenue to sobriety for people who can't afford a treatment clinic, especially since funding treatment as a social service through the nonprofit model has become increasingly difficult.
For others, virtual meetings just aren't the same. As Gary H. – a local with 18 years of sobriety who asked us not to use his last name – put it: "Recovery works better in a knee-cap-to-knee-cap setting. The tools that I've picked up in sobriety and that I continue to learn, I picked up talking with other sober people face-to-face."
Being in the room with others, away from the distractions and stressors of home life, hearing the emotion expressed as someone shares a vulnerable experience, seeing clearly the nonverbal cues given off by body language – all of those aspects of in-person fellowship are lost in a virtual setting. The tension between the need to physically distance to slow transmission of a deadly virus and the need for intimacy has been agonizing for people in early recovery, for those who maintain their own sobriety by helping others achieve theirs, and for the professional clinicians who devote their lives to helping them. Should people in recovery put their physical health at risk to better maintain mental health?
The Power of Social Life
People who aren't living with addiction already experience anxiety or restlessness during quarantine. Those feelings, felt in forced isolation, can be deadly for someone dealing with substance use disorder. That's why recovery work has and must continue by any means necessary. Some groups have continued to meet outdoors, spaced six feet apart, to allow for in-person support. Others have fully embraced the virtual recovery ecosystem.
Chris Marshall, sober 13 years, knows well the importance of maintaining social connections while in recovery. Prior to opening Sans Bar in 2017 – a sober bar on East 12th Street – Marshall was a substance abuse counselor at Integral Care, Travis County's local public mental health agency. He left that work to open Sans Bar and to help propel forward the "sober-curious" movement by creating a space for people in recovery, those interested in becoming sober, or those looking to just enjoy social time without drug use.
The entire concept of Sans Bar is that it's not only possible but vital to maintain a social life among others while living sober. The pandemic has blunted the momentum building behind Marshall's business and the broader philosophy that inspired it. He has decided to close the doors at Sans Bar for the time being. But losing that space – along with all the other spaces where sober people can find community – "is having a profound impact," he told us. "Never in my sobriety have I seen so many people posting about overdose or relapse." If friends aren't posting on social media about COVID-19, he said, they're talking about people they've known who succumbed to relapse, or worse, died from overdose.
Behind the philosophy that inspired Marshall to open Sans Bar – and what led him into substance abuse counseling – is the acceptance that not many people can achieve sobriety independently. "Truthfully," Marshall observed, "[sobriety] is a marathon you run with others, but on your own at the same time. We are a collective, but we are also individual stories."
Why Wouldn't You Drink?
A recession-inducing pandemic almost seems specifically designed to threaten sobriety. The transition from in-person group support – which research has shown is among the most effective ways of treating substance use disorder – to a virtual setting has itself destabilized people trying to maintain sobriety. But job loss and economic precariousness are obvious stress inducers, which can drive someone teetering on the edge of sobriety off the cliff into relapse.
It's those factors, folded into the need for social distancing – which can morph into social isolation – that are most troubling to the academics who study addiction and the medical and social service professionals who treat it. "Being vulnerable and connecting with people is important to sobriety," Irek Banaczyk, director of youth services at Austin Recovery Network, told us. "We know depression, anxiety, and other disorders are increased in isolation, so it's not surprising that human interaction is the primary mode of supporting a person with behavioral health issues."
Banacyzk said that the young people he helps achieve sobriety at University High School and the Keystone Alternative Peer Group have been able to maintain a consistent school schedule and connect to other sober youth throughout the country. That's something that wasn't happening much before the pandemic, but is now a semiregular occurrence thanks to the adoption of virtual meetings. But he is also seeing quarantine begin to wear on some students. After the first two weeks of learning from home and meeting over video, student engagement began to decrease. Some began reporting stronger depressive feelings stemming from the loneliness and frustration with forced isolation.
Increases in anxiety and loneliness during quarantine are common for those in recovery and those who aren't. An April survey conducted by the Kaiser Family Foundation found that 47% of people sheltering in place reported "negative mental health effects resulting from worry or stress related to coronavirus" compared to 37% of people not sheltering in place.
The survey also found coronavirus-driven losses of income caused negative impacts on mental health. For someone with behavioral health issues that include a substance use disorder, the increased stress can form a toxic mix that leads to relapse. And without access to the support groups that may have steered someone in recovery away from those habits, the risk is even greater.
In April, CARMAhealth, a substance abuse treatment center with locations in Austin and Dripping Springs, moved about 90% of its services to a telehealth platform, as it tried to find a way to both provide critical support to people in recovery and protect staff and clients from COVID-19. The decision was not easy for Dr. Carlos Tirado, CARMAhealth founder and chief medical officer. He compared a person in recovery losing access to those kinds of services and supports to being separated from family members.
"Just think of what that does to a person psychologically," Tirado said, "if they feel they've been cut off from their families, the people they've shared affection with, the people they've shared highs and lows with. It can really be a huge strain."
Lower Barriers to Using
Just as stress and isolation make it harder to live sober, it's now easier than ever for alcoholics to obtain their drug of choice. Gov. Greg Abbott first authorized alcohol-to-go sales on March 18 – a change he has shown interest in making permanent, if the Texas Legislature is willing – allowing restaurants to sell alcoholic beverages for takeout or delivery along with food.
Liquor stores had already remained open, even under the strictest shelter-in-place orders, for public health reasons. People with alcohol dependency can suffer intense withdrawals that can prove debilitating or fatal without emergency medical care. So even physicians who treat substance abuse have advocated to keep package stores open to reduce the burden on overtaxed medical resources during the pandemic.
On top of this ease of access, casual drinking has become even more widely tolerated and even celebrated than it was before quarantine. It's a way to escape the monotony of sheltering in place and the anxieties of living through the pandemic, and people stuck at home have a lot more time for drinking.
Off-premise alcohol sales throughout the country saw a year-over-year increase every week from March 7 through April 25, according to Nielsen data. Online sales – which many breweries, wineries, and distilleries in Austin are doing – have exploded. In the week ending in April 25, for example, online alcohol sales increased 477% over the same week in 2019 (in-store sales were up 26%).
For people who don't have an unhealthy relationship with drugs and alcohol, the prevalence of cues to use – stressors, availability, cultural acceptance – are not a big deal. But for people in recovery, those factors, combined with the loss of traditional in-person support, can be hazardous.
The Next Right Thing
It's unclear at this point if the tools of virtual recovery – video meetings, online forums, Facebook groups, etc. – are any more or less effective than in-person support. It's likely that their effect varies depending on the individual's personality and lived experience, but for the time being, they are the safest way for people in recovery to maintain that aspect of a vital support system. "One thing we're really focused on is not using the term 'social distancing,'" Darrin Acker, executive director of Communities for Recovery said. "It's physical distancing; we need to maintain social connection with people, because isolation is often the enemy of recovery."
Communities for Recovery is one of the physical spaces people in Austin trying to stay sober have lost access to during the pandemic. Like other clinics, social service providers, and support meetings, CFR has made the decision to temporarily shut its doors for the time being, to protect staff and clients. (As a tenant of the Austin State Hospital, CFR's closure was first mandated by the state, but they have decided to remain closed despite those restrictions now being lifted; they are developing a plan to reopen in stages.)
It's important that people in recovery don't lose the connections that have helped them become sober, Acker told us. Sponsors, sober coaches, therapists, a sympathetic friend who can lend an ear – these can all uniquely guide people on the path toward a sober life. Elaine Burgess, a sober coach with CFR who has been sober for three-and-a-half years, recalled how important such a connection was in her own road to a clean life. "At the very end, I became suicidal. I never thought I could be sober, until I talked with another sober person." That relationship led to sponsorship, and that saved her life, Burgess said.
Even though Burgess is now on the other side of addiction, she knows, as does everyone in recovery, that she isn't in the clear. It's common for people in recovery to compare the disease to diabetes; it's a lifelong health condition that can't be cured, only treated. "I haven't felt more tested in sobriety [than] during the quarantine period," Burgess told us, "And there's still a lot of stigma around addiction, so it can be hard to talk about those struggles if you don't already have the confidence to be open about it."
Again: The isolation and loneliness are especially pernicious for someone in recovery. What's more troubling is during a pandemic, isolation is not only acceptable – it's demanded. "That's the scariest thing," Burgess said. "Now we're able to hide ourselves again."
What the Future Looks Like
But it's not all gloom. Few people interviewed for this story had a completely despairing view of life in virtual recovery. Nearly everyone found something to appreciate about their new online tools for sobriety. Jodie Lane – a self-described poster child for AA who has been sober for nine years – said the transition to Zoom meetings has been great. She's someone who bounced around between several in-person meetings regularly before the pandemic.
She even chairs a couple in town and has tried to find creative ways of re-creating the in-person experience. In one of her meetings, she opens up the Zoom room 30 minutes before the meeting officially begins and leaves it open for an additional 30 minutes after the scheduled end time. This allows for a version of the "meeting before the meeting" that occurs at in-person support groups – the more casual discussion with fellow members that strengthen the relationships that make the fellowship during the meeting more powerful.
Irek Banaczyk at ARN said the cross-state peer groups have been inspiring for the students in his programs. And Peggy Robinson, the special programs director at Communities for Recovery, said that even when they reopen to in-person meetings, virtual support won't go away. It's opened up new options for people who may never have envisioned themselves sitting in an AA or other support meeting.
But the mandate to conduct support virtually won't last forever. Already, as the state's stay-home orders loosen, people who lead recovery meetings are contemplating what a return to something approaching normalcy might look like. Could in-person support meetings happen if they're held outside, or in groups of fewer than 10 and everyone wears a mask?
Lane said returning to in-person meetings is an open question for her at this point; she's fine with Zoom meetings, but acknowledged that may not be the case for someone more fragile in their sobriety. "People miss holding hands and closing a meeting together," Lane told us. "Using touch and proximity is an important part of meetings. We're not handsy, but if someone steps toward you, you step toward them and don't let them go."
Obviously, those aspects of support meetings can't be easily created virtually. Many meetings in Austin take place in clubhouses – locations dedicated to that purpose – but others take place at churches, clinics, or nonprofits. Staff and other visitors who may not be in recovery would still be at increased risk of catching COVID-19 with more people utilizing the space. Such concerns are weighing on every person in recovery who depends on support meetings. What's the risk to physical health in meeting in-person with a group, or even a sponsor? What's the mental health cost – the threat to hard-won sobriety – in not meeting in person?
Sober people will have to answer the question, because there is no stopping the marathon that is recovery. The work will continue, in one form or another – amid a pandemic that requires social distancing or not – because it has to continue. As Gary H. told us, "I know the coronavirus is a threat, but I don't have COVID-19 yet. I have the disease of alcoholism, and if I don't treat it, it's going to kill me."