AA to Zoom, substance abuse treatment goes online

Until the coronavirus pandemic, their meetings took place quietly, every day, discreet gatherings in the basements of churches, a spare room at the YMCA, the back of a cafe. But members of Alcoholics Anonymous and other groups of recovering substance abusers found the doors quickly shut this spring, to prevent the spread of COVID-19.

What happened next is one of those creative cascades the virus has indirectly set off. Rehabilitation moved online, almost overnight, with zeal. Not only are thousands of AA meetings taking place on Zoom and other digital hangouts, but other major players in the rehabilitation industry have leapt in, transforming a daily ritual that many credit with saving their lives.

“AA members I speak to are well beyond the initial fascination with the idea that they are looking at a screen of Hollywood Squares,” said Dr. Lynn Hankes, 84, who has been in recovery for 43 years and is a retired physician in Florida with three decades of experience treating addiction. “They thank Zoom for their very survival.”

Although online rehab rose as an emergency stopgap measure, people in the field say it is likely to become a permanent part of the way substance abuse is treated. Being able to find a meeting to log into 24/7 has welcome advantages for people who lack transportation, are ill, juggling parenting or work challenges that make an in-person meeting tough on a given day and may help keep them more seamlessly connected to a support network. Online meetings can also be a good steppingstone for people just starting rehab.

“There are so many positives — people don’t need to travel. It saves time,” said Dr. Andrew Saxon, an addiction expert and professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine. “The potential for people who wouldn’t have access to treatment easily to get it is a big bonus.”

It is too early for data on the effectiveness of online rehabilitation compared to in-person sessions. There has been some recent research validating the use of the technology for related areas of treatment, like PTSD and depression that suggests hope for the approach, some experts in the field said.

Even those people who say in-person therapy will remain superior also said the development has proved a huge benefit for many who would have otherwise faced one of the biggest threats to recovery: isolation.

The implications extend well beyond the pandemic. That’s because the entire system of rehabilitation has been grappling for years with practices some see as both dogmatic and in sufficiently effective given high rates of relapse.

“It’s both challenging our preconceived concerns about what is necessary for treatment and recovery but also validating the need for connection with a peer group and the need for immediate access,” said Samantha Pauley, national director of virtual services for the Hazelden Betty Ford Foundation, an addiction treatment and advocacy organization, with clinics around the country.

In 2019, Hazelden Betty Ford first tried online group therapy with patients in San Diego attending intensive outpatient sessions (three to four hours a day, three to four hours a week). When the pandemic hit, the organization rolled out the concept in California, Washington, Minnesota, Florida, New York, Illinois and Oregon — where Pauley works — and has since expanded to New Jersey, Missouri, Colorado and Wisconsin.

Pauley said 4,300 people have participated in such intensive therapy — which entails logging into group or individual sessions using a platform called Mend that is like Zoom. Preliminary results, she said, show the treatment is as effective as in-person meetings at reducing cravings and other symptoms. An additional 2,500 people have participated in support groups for family members.

If not for COVID, Pauley said, the “creative exploration” of online meetings would still have happened but much more slowly.