In mid-April, recovering heroin addict Willy S. hosted his first virtual 12-step recovery meeting. The state's stay-at-home order issued as the pandemic picked up speed had put a halt to in-person support meetings, made popular by 12-step fellowship programs such as Alcoholics Anonymous, where people could share their stories and solutions to overcoming addiction. Willy S., like the rest of Denver's recovery community, was forced to adapt.
“I was almost riding a natural high at the beginning of this because [virtual meetings] were new and exciting," he recalls. "I was meeting people all over the world. I got to meet some of the co-founders of the 12-step fellowship I’m in and have conversations with them on a weekly basis.”
Willie S. held meetings every night. One man joined from the U.K., and the group saw him celebrate six months of sobriety — all over Zoom.
Still, the novelty of online meetings wore off after a while. Fortunately, Willy S. was able to attend several outdoor, socially-distanced meetings this summer. But as COVID-19 cases climb, he and much of the recovery community have returned to virtual meetings. And so much screen time seems to be wearing on people.
"Recently, it seems like a lot of people are Zoomed out,” Willie S. notes. “It’s been a rough year for everybody due to the isolation and not having their normal access to the human connection that is a vital part of recovery.”
The toll of the pandemic on addiction is apparent. Denver's Department of Public Health and Environment reported 294 drug-related deaths between January 1 and December 18, easily surpassing 2019's total of 225 — with two weeks still left in the calendar year. Fentanyl-related overdose deaths skyrocketed from 56 in 2019 to 123 so far in 2020. The biggest monthly overdose spikes came in April, June, July and August, after the COVID-19 pandemic hit Colorado.
“With the overdose rates being so high right now, we know that vulnerable populations are even more vulnerable because of the pandemic," says Holen Hirsh, director of public and behavioral health at the OMNI Institute, a local, nonprofit social-science consultancy. "I don’t think that telehealth can necessarily solve all of those problems. The challenge for the field [of addiction treatment services] is how to reach the most vulnerable people in times of crisis."
OMNI released a report on COVID-19's impact on addiction treatment at the end of August. The report surveyed 534 individuals receiving substance-use disorder treatment across the U.S., including in Colorado, during April and May — at the height of the initial lockdown.
"When the pandemic first began to hit and lockdowns were starting to happen, all businesses were making rapid adjustments," Hirsh says, noting that those businesses had been slow to move to virtual platforms before the pandemic. "Treatment providers were rapidly moving to telehealth therapy services and making changes to residential treatment settings.”
The report determined that telehealth therapy services were viewed as more helpful than telehealth recovery services, such as virtual recovery meetings, which some survey respondents said often feel impersonal. Technological challenges proved a significant barrier to others. Still, survey respondents noted more positive experiences with telehealth than negative ones. For many, telehealth proved a critical connector to addiction recovery support.
The shift to telehealth "has provided a level of access to people that they didn’t have previously," explains Hirsh. "For example, people who live in remote settings have been able to attend meetings that they otherwise wouldn’t have been able to.”
On average, respondents attended more virtual recovery meetings each week during the pandemic than they did in-person meetings before the pandemic, averaging 3.5 virtual meetings per week rather than the 3.1 in-person meetings earlier. Some respondents even expressed being able to be more open and vulnerable online than at in-person meetings. And, crucially, telehealth treatment services allowed people to maintain their continuity of care.
"It's really hard to put words to how important in-person connection is," says Willy S. "It's safe to say that was something I took for granted before the pandemic. But I will say that overall the positives [of virtual meetings] have absolutely outweighed the negatives."
Steve Sarin, a representative for AspenRidge Recovery, which has several addiction treatment centers in the Denver area, worries about isolation. The company's rehab centers still offer in-person treatment options, but they have had to adapt to the recent surge of COVID-19. Participants in the program's intensive partial-hospitalization program aren't allowed to attend in-person meetings or go to the gym, for example.
“Isolation is always a problem for people in addiction," says Sarin. "We can be great at isolating ourselves when we’re in our act of addiction. COVID-19 is forcing all of us inside and to withdraw from our friends and sober support groups.”
The organization's telehealth treatment options have seen a recent surge in interest — and Sarin says they've received positive feedback on these services so far. Still, he notes that nothing can replace in-person treatment and recovery meetings, and the outlook for those struggling to stay sober this winter — and beyond — remains unclear.
"Every time I read my newsfeed, there’s a story about a ridiculous percentage increase in alcohol sales," Sarin notes. "I think that we’re going to find out sometime in the future that COVID-19 has had a pretty substantial effect on substance-use disorder across the country. Addiction is a chronic and progressive disease. We’re probably not going to know the full effects of the pandemic on addiction for the next year or two. We’re going to see the effects for years to come.”
Willy S. is focused on the short-term effect of the holidays, which will look different — and more socially distant — for everybody this year.
“The holidays are typically associated with families getting together and everyone being happy," he says. "For a lot of addicts, that’s not necessarily the picture that we associate. I can really only speak for myself. There have been a couple of times I’ve been able to visit my family when I was still using. Even during those times, I was not focusing on my time with them because I was always focused on getting high again.”
Willy S. adds that during this time of year, he has a lot of "death anniversaries," marking the day when friends lost their lives to addiction. Still, he remains remarkably positive.
"The daily routine I’ve been able to establish so far this year has gotten me this far, you know? I’m still alive," he says. "I’m still sober. I’m going to just keep trucking along with the hope that one day things will start to open up again.”
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