Isolated is bad place for addicts
Recovery specialists turn to online sessions, but still fear wave of relapses
Like the shops and restaurants shuttered by the coronavirus pandemic, the Lehigh Valley’s drug and alcohol rehabilitation centers have been eerily quiet the past few weeks.
New admissions for addiction treatment are down 50% or more at some facilities. The number of warm handoffs, in which people who are rushed to a hospital with a drug- or alcohol-related emergency are met by a counselor and coaxed into rehab, have been cut in half. Police requests for addiction counselors to visit people revived from opioid overdoses are down across the Valley.
Addiction specialists wish they could say this was good news. Instead, they are deeply afraid of what comes next.
“I would love to say that people have stopped using controlled substances and alcohol, but we know that’s not realistic,” said Layne Turner, Lehigh County’s drug and alcohol administrator. “Instead we’re wondering, how are they getting by?”
The isolation prescribed by federal and state officials is exactly the opposite of what people grappling with substance use disorder often need.
“Addiction is an attachment dysfunction,” explained Betsy Martellucci, clinical director at the Mid Atlantic Rehabilitation Services treatment facility in
Bethlehem. “Being socially isolated completely exacerbates any addiction features.”
Virtual rehab
For some, technology is helping.
For the 50 people whose faces appear as thumbnails on a new Lehigh Valley Alcoholics Anonymous virtual group, being stuck at home doesn’t mean going it alone.
Connecting through Zoom each night, they laugh, talk and listen together.
As the group celebrated its two-week anniversary April 2, The Morning Call was invited to observe the meeting, with the condition that participants would not be identified. Members were made aware that a reporter was present.
Singles, couples, dog pictures, and icons with mere initials dotted the screen, some playing with virtual backgrounds like fields of grass and the northern lights. Like any other AA meeting, members observed a moment of silence, recited the serenity prayer and the organization’s responsibility statement, and shared with others.
The towline through every testimony was unity, with a nod of gratitude to the medium that makes unity possible during a socially isolating pandemic. For some, it was their second virtual meeting of the day, and others were skeptical of the effectiveness at first. The very structure of the virtual meeting, many reflected, is a mark of resilience.
There are more than 100 AA groups in the Lehigh Valley, about 80 of which are connected through the ABE Intergroup. They’ve all had to shut down in-person meetings during the pandemic, but within days, most of them transitioned to virtual platforms.
“The vast majority of us have, by necessity, adapted,” said Scott F., chairman of the Intergroup’s public information committee. “There’s not a whole lot of fellowship that’s lost.”
Necessity, he says, because addiction is isolating, and the only solution — and a core tenet of AA — is reaching out.
“The solution is not isolating,” he said. “The solution is getting connected.”
But the ripple effects of a shut-down economy are leaving folks with an elevated state of stress.
“There’s a lot of people truly suffering,” said Freddie M., the Intergroup’s chair. “People laid off from jobs, people who haven’t seen their kids because they can’t leave mom’s house. There are people who are crying in meetings. It’s no different than when we’re in person.”
He even believes virtual meetings could open new doors for Alcoholics Anonymous, and perhaps draw in newcomers for whom stepping foot into a physical meeting is just too much. It’s usually one of the toughest parts of recovery, he explained — walking into that first meeting.
But inevitably, technology can’t reach everyone.
Counselors at Martellucci’s clinic in Fountain Hill only saw half the usual participation in their group therapy sessions the first week they went online. Now about 50 groups, each week, use a HIPPA-compliant version of Zoom.
Martellucci’s staff set up six computer stations at the clinic, equipped with webcams for clients who otherwise don’t have access at home.
“Some people are super frustrated with it, feeling like it’s difficult to connect,” she said. “Other people are saying this is a lifeline, that this is the only connection they have with the outside world.”
Even online meetings run the risk of disruption, in the form of menacing hackers and trolls. Suzanne Corbin, a manager at a Catasauqua residential treatment facility who is four years into recovery from opioid addiction, experienced this at her group meeting last Thursday.
More than half the participants were hackers who filled the thumbnails with pornographic images, racial slurs and videos of kids drinking.
It was already a bad week. She lost a friend from an overdose. She just wanted to be with her group.
The administrator of the meeting got a handle on it, and they’ve upgraded the security features of their Zoom platform. So they’ll continue to meet, because they have to.
“The cool part about all of it is the world is at a standstill, and we’re still recovering,” Corbin said.
New stressors
Erica Panella, a certified recovery specialist who works for Lehigh County, is worried that some of her clients are not handling the isolation and disrupted daily routines of the pandemic well. Though she’s working from home most of the week, Panella said she’s busier than ever, reaching out to clients in recovery by phone, Facetime and video conferencing.
“Recovery is hard to begin with, and then you add all these new types of stressors,” she said. “So I’m constantly on the phone, trying to make sure everyone is OK. A lot of people have no other support, and they feel very disconnected right now.”
Alcohol addiction is already the No. 1 issue for Panella’s clients, and she worries about an explosion of new cases as people turn to a bottle to calm their frayed nerves.
Calls to the state Department of Drug and Alcohol Programs hotline have been relatively consistent thus far, Secretary Jen Smith said last week, with no sharp upticks or declines. Interestingly, alcohol-related calls to the hotline decreased in the last week of March, from 58 calls to 36 calls, though she noted a wave could still be coming.
“Under the circumstances we are living in, it is extremely likely that we could see more individuals turning to substances to deal with anxiety, depression, stress,” she said in a conference call with the media. “For individuals who are prone or already have existing mental health conditions, you’re looking for ways to make it easier on yourself, and substances are likely the answer to that question.”
Panella’s other concern is for those who were forced into sudden sobriety by the coronavirus and may relapse the second they’re able to leave their homes. Using drugs, especially opioids, after a period of abstinence carries a high risk of overdosing.
“Everyone is running on fear right now,” she said.
Fear, too, of what a resurgence in the opioid crisis would mean for hospitals already overwhelmed with handling an impending coronavirus caseload, Martellucci said.
Before the COVID-19 pandemic, opioid addiction was considered Pennsylvania’s greatest public health crisis. Though overdose deaths were down last year for the first time in five years, dropping 23%, according to the state’s opioid dashboard, 3,811 Pennsylvanians lost their lives, including 130 in Lehigh County and 69 in Northampton County.
A post-pandemic surge in overdoses would certainly push those numbers higher.
Lehigh County’s addiction helplines barely ring these days, and there are far fewer requests for admission into local treatment centers than just a month ago, said Turner, Lehigh County’s drug and alcohol administrator.
One reason for this is the strict CDC guidelines designed to prevent coronavirus outbreaks inside hospital-type settings such as residential drug and alcohol treatment centers. New applicants are screened over the phone and turned away if they are perceived as a risk.
“If you’re over 60, you’re not getting in. If you self-report an underlying condition, like asthma, you’re not getting in,” Turner said.
This is a concern because the majority of people suffering from the disease of addiction also have medical issues, Turner said.
“A lot of our clients have physical health complexities that, until a month ago, we had no problem treating.”
Facilities are trying to be creative, using telehealth to provide counseling.
Residential facilities like Corbin’s in Catasauqua haven’t allowed visitors in about a month; residents wear masks every day and videoconference with family as much as they can.
Turner said he’s heard of one facility that is only admitting men during the pandemic because that makes it easier to divide people into housing groups.
Twelve-step Zoom meetings are great, Turner said, but he worries about folks who usually go to a library or Starbucks to get internet access.
“A lot of these public places are closed. The less tech-savvy population we serve is being left behind.”
With fewer people seeking help, Turner worries that treatment centers may soon be forced to lay off staff, which could lead to another crisis when the pandemic eases and more need help.
The state has seen some diminishing of the addictionrelated workforce, Secretary Smith said, but she remains optimistic.
“The reality is, our field is no stranger to crises,” she said. “Our field is no stranger to trying to adapt to new circumstances ... to pulling things together when it seems impossible. This is something we’re equipped to handle.”
As the pandemic drags on, the only thing people who help the addicted can do is wait.
“People are afraid to go out. People are afraid to go to the hospital. Does this mean people are going to turn to other substances?” Turner said. “Trying to answer these questions is almost like shaking a magic eight ball — there’s just no way for us to know.”