Relapse pandemic: Substance abuse treatment is failing due to COVID

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Bill can't be reached at this time, call again later:

Jackie Ré, who runs a substance-use disorder facility in New Jersey, gathered the 12 female residents of her center in the living room on March 27 and told them that the coronavirus outbreak had forced the center to limit contact with the outside world.

There was an immediate outcry: The women already felt disconnected and didn’t want their sense of isolation exacerbated, Ms. Ré said. Within the next six months, nine left the program at Haley House in Blairstown against staff advice, and all but one relapsed.

Routine is important. Group therapy is important. Family visitation is important. Field trips are important. Intimate conversations are important. Take away any one of those things and rehabilitation is jeopardized. Take away all of them, and rehabilitation is virtually impossible:

Addiction is often referred to as a disease of isolation, and overcoming that challenge has only become more difficult during a pandemic that has forced people indoors — in some cases to live lonely lives, with drugs and alcohol as a way to cope with the stress.

Several studies have shown that binge drinking has increased during the pandemic, and a recent report from the Centers for Disease Control and Prevention cited a “concerning acceleration” of opioid-related overdoses last year.

At the same time, many treatment centers have closed down or limited in-person visits.

The New York Times spoke to several residents of addiction treatment facilities who expressed dismay at the loss of in-person counseling. Many of them declined to give their full names as part of the anonymity granted by their recovery programs.

In many ways group therapy is much more difficult than a standard AA or NA meeting. It can be like a damn cage match sometimes, but once the walls come down and sharing begins, progress inevitably follows. Abrading burned skin so it can regrow is a decent metaphor, but of course everybody reacts differently.

But it's not just the treatment programs that are important; changing the environment is also a biggie:

In New York City, the Hazelden Betty Ford Centers, which offer outpatient services, switched to entirely virtual care in mid-March. At first, the organization scrambled to remake a program that had relied so heavily on in-person gatherings.

Staff had to identify a virtual platform compliant with substance-abuse confidentiality regulations. They also had to accommodate patients who didn’t have internet-connected devices or stable Wi-Fi connections.

They worried, most of all, about people who were isolated in their homes relapsing.

“Many of our clients were riddled with fear and anxiety,” said Rose Foley, who runs mental health services for a Hazelden Betty Ford center in Chelsea, Manhattan. “I remember working with clients and hearing the sounds of sirens from outside their apartments. It was a traumatic time.”

Bad habits are like ghosts, they hang around the scene of the crime. And of course the people you used to party with aren't just neutral observers. They will actively try to attack your sobriety, to protect their own denial. Out-patient services are critical for post-rehab folks, and for many who do/did not require a full rehab program (in reality, many in that second group actually do need it, but the cost and lack of beds is a serious impediment). But out-patient treatment cannot replace a residential rehab program. People will die. People are dying.

And we can't wait until COVID is gone to fix this.



I am not a therapist,

or a clinician of any kind. But I have been through rehab myself, struggled with addiction for many years. And I've had family members go through rehab and relapse cycles so many times I've lost count.