Social distancing policies threaten the cornerstone of addiction recovery

  • An artistic rendering of Cindy M., who is a member of Alcoholics Anonymous and a lead trainer at the Western Mass RLC. Staff illustration/Andy Castillo

  • An artistic rendering of Cindy M., who is a member of Alcoholics Anonymous and a lead trainer at the Western Mass RLC. Staff illustration/Andy Castillo

  • The Recover Project on Federal Street in Greenfield, which was closed Thursday per a mandate from Gov. Charlie Baker. Staff Photo/PAUL FRANZ

  • The Recover Project on Federal Street in Greenfield. Staff Photo/PAUL FRANZ

Staff Writer
Published: 3/28/2020 7:00:16 AM

Editor’s note: The last names of Alcoholics Anonymous members included in this article have been intentionally withheld for privacy reasons. As a rule, AA members refrain from showing their faces or revealing their last names publicly in order to foster a culture that welcomes all who are in need of help in a non-judgemental way. The Greenfield Recorder does not typically publish information based on anonymous sources and the editorial decision to withhold last names was not taken lightly. For more information on AA’s media policy, please visit aa.org.

There came a point in her life when the drinking and the drugs didn’t work anymore. Nothing she ingested or injected was strong enough to keep the demons at bay. Not even time could bury the still-raw emotion of childhood trauma.

“I would wake up and say, ‘I’m not going to drink, I’m not going to use,’ and I would be sincere. But by the end of the day, I would be so messed up and I wouldn’t even know how it happened,” recalled Cindy M., 60, of West Springfield, a lead trainer at Western Mass Recovery Learning Community (RLC) and a member of Alcoholics Anonymous (AA).

In her darkest days, Cindy crashed on couches, hid in basements and wandered the streets of Greenfield, which she sometimes called home. She was saved about five years ago by “small acts of kindness” from strangers and by the encouragement of peer-mentors who gave her a reason to live. “I found a group of people within AA with whom I could be my whole self; I could talk about my dreams, nightmares, thoughts of wanting to kill myself,” she said.

These days, in recovery, Cindy lives in a sunlit third-floor apartment with a lot of windows. She speaks at conferences, leads training sessions and hosts 12-step meetings for the Holyoke-based Western Massachusetts agency. In her job, “All of my struggles, all of my tragedies become treasures — to sit with somebody and say, ‘ yeah, I was sexually abused as a kid,’ it gives me purpose,” Cindy said.

In part, she attributes the success in her journey to the region’s recovery community, which has become fractured in recent days by social distancing requirements. The COVID-19 pandemic has quickly overshadowed the decades-long opioid epidemic, which has taken the lives of some 750,000 people nationwide since 1999. During this time of government-ordered social separation, which public health officials have deemed necessary to stop the spread of the novel coronavirus, Cindy and other area health care professionals say they’re greatly concerned about the welfare of others who aren’t as far along the (never-ending) recovery journey.

“Addiction is very much a disease of isolation. This is playing right into the devil's hands, in many ways,” said Levin Schwartz, a licensed clinical social worker and assistant deputy superintendent of the Greenfield-based Franklin County Sheriff’s Office’s Clinical and Reentry Services. “One of the main points of resilience is sticking together and being together as people. That’s how people in recovery get by. Now, we are having to isolate. The question is, how do we stick together in isolation?”

Building remote community

Community is an incredibly important aspect of recovery, according to Kara Cavanaugh, president of the board of directors of The Grapevine, a community meeting space in downtown Greenfield intended for recovery groups including 12-step programs like AA and Narcotics Annonymous.

Addiction is “physically and emotionally isolating,” Cavanaugh said. Regularly scheduled meetings like those organized through AA, an international support group with 1,361,838 American members, provide “a huge sense of community. One of the first steps is to get out of isolation.” Likewise, “All that structure gives you a sense of purpose, which is critical. When that gets ripped out from under you, that can be really jarring. Especially for people in early recovery.”

Already, the impact of social distancing on the recovery community has been profound. Noticeably, the majority of AA gatherings have moved online. Gov. Charlie Baker’s recent business lockdown order forced the closure of service organizations funded by the state including The RECOVER Project in Greenfield and The North Quabbin Recovery Center in Athol, which plans to reopen April 8, according to Heather Bialecki-Canning, executive director of the North Quabbin Community Coalition. The Grapevine, which is classified as a public meeting space, is also closed. Notably, methadone clinics continue to operate with restricted access.

But while the business ban is intended to halt the spread of the coronavirus, there are unintended public health consequences that are perhaps just as dire.

“Folks in early recovery really need the connection. And, these folks don’t have access to a lot of the online meetings that are going on,” said Peggy Vezina, program director at the RECOVER Project. The nonprofit Federal Street program provides a slew of social services and meets the physical needs of those who have nothing — “Bus passes. Socks. Gloves. Water. Small bottles of hand sanitizer. We’ve taken a giant step backward in terms of stigma. This population has been largely ignored in all of the efforts to keep people safe.”

In a way, the COVID-19 crisis poses a catch-22 for public health professionals: On the one hand, structured meetings are an integral part of the recovery process; on the other, because IV drug use can make users immunocompromised, some are at an increased risk of contracting the coronavirus.

“A lot of people who come through our doors are a part of the high-risk community with underlying health concerns,” Cavanaugh said. Thus, stopping transmission is of utmost importance.

But while those concerns are real and should be taken seriously, Vezina says closing recovery centers is not the solution.

For those most vulnerable who’ve been “Left on their own, either it's going to be putting (meetings) together because you desperately need that connection — and not in the safest way — or not having it at all, and your recovery is at risk,” Vezina said. “What we need are more places where people can connect in a safe environment.”

Meeting the challenges

In the face of this challenge, there are many working hard to overcome it: Healthcare professionals are logging long hours; social workers are hitting the pavement to connect with at-risk drug users; Vezina said Sen. Jo Comerford and Rep. Paul Mark have been advocating for the region’s needs on Beacon Hill; recovery coaches are setting up online meetings; peers are checking in on their friends more often than ever. As connecting becomes more difficult, another AA member, Adam, 30, of Turners Falls, said it’s imperative that those in recovery to actively reach out to others.

“If I’m not around people who are working the program, I’m going to think I don’t need it, my addiction is going to start telling me ‘I’m good,’” he said, noting that in addition to a local group that meets daily via Zoom, a video conferencing app, there’s another group that’s holding 12-step sessions in a parking lot near The Grapevine, practicing social distancing, every morning at 7 a.m., at noon and at 6 p.m.

The online meetings are accessible using a code, which can be obtained by visiting westernmassaa.org.

At first, Adam says he was skeptical of the digital format: “But I’ve tried it and it’s really amazing. It’s a great way to stay connected. It works really well,” he said. “A lot of people who are in those meetings are really compassionate. If they’re working the 12 steps, then they’re compassionate people.”

Anecdotally, Schwartz said he’s heard that many virtual AA meetings have been “packed” with both regulars and “a lot of first-timers.”

Additionally, he highlighted a number of digital apps that have recently become popular for those in recovery such as A-CHESS, a clinically tested game that sends daily messages of encouragement and alerts users based on their GPS location if they’re close to a bar or liquor store they used to frequent, among other things.

“It’s forcing our hand with technology in many ways. It’s forcing us to engage in ways that are important,” Schwartz said.

Increased stressors

Besides the wide-ranging implications of social isolation, this pandemic is bringing with it a swath of stressors that are especially burdensome for those in the recovery community, according to local health care officials.

“People who are in recovery are at an especially high risk right now,” said Dr. Barry Sarvet, chair of the psychiatry department at Baystate Health. American society has come under an enormous amount of stress in recent weeks, he continued, “not only with the isolation and the stress of not being able to go out, but the economic stress, the dread about the risk of getting sick, the worry about their family members — sometimes more than worry — all of that stress contributes to a higher risk of psychiatric risk of depression and anxiety.”

That, in turn, can lead to an increased risk factor for substance abuse.

Logistically, there are emerging barriers that could prevent those who need it most from receiving care: Public transportation has slowed (the Franklin Regional Transit Authority has reduced its schedules in compliance with the state’s Department of Public Health guidelines), making it difficult for people to make medical appointments; public spaces have shut off their Wi-Fi networks, making it tough for those who might not have other options to connect; month-long waitlists have materialized overnight at recovery homes; halfway houses have closed altogether and shelters are struggling to maintain sanitary conditions necessary to stem the coronavirus spread, according to Vezina.

“It’s really hard to follow the recommended protocols in those settings. Folks have no control over that, and then when they leave, they have (nowhere to go),” Vezina said.

That’s on top of the national toilet paper shortage and the childcare conundrum that comes with kids staying home from school. With “access to basic supplies” becoming increasingly difficult, said Bialecki-Canning, “It is a very unnerving time for all, (especially) folks in recovery, who are even more vulnerable to the overwhelming uncertainty of our current realities in North Quabbin.”

As the pandemic continues to capture the world’s attention, the health care needs that existed before COVID-19 are immediate as ever, forcing the system as a whole into uncharted territory.

The long term impact

“Even though all you see in the public conversation is COVID-19, Baystate Health providers in every area, in every specialty, are still very, very focused on taking care of their patients,” Sarvet said. “We’re rapidly developing ‘telepsychiatry.’ … We’re doing a lot of telephone outreach with people we’re treating because they can’t come into the office.”

Certainly, there will be systematic changes stemming from this acute public health crisis that will become a new normal, like the ability to attend an AA online meeting and the evolution of telepsychiatry, which Barry noted, “We’ve always needed.” 

But it’s not yet clear whether the region’s ability to respond to the more long-term public health needs of the community will be affected.

“It’s understandable that the COVID-19 crisis is taking up all the attention right now. As long as that’s temporary, I think we can catch up and get back to focusing on all of the other health issues,” Barry said, adding, “I worry, sometimes, because people aren’t paying as much attention to this part of it. When you think about the risk of not being able to breathe, having severe pneumonia, the mental health aspect doesn’t feel as relevant.”

Especially within the recovery community, the repercussions are unknown.

Between 2010 and 2016, Mass. saw a sharp increase in opioid-related deaths, from 547 to 2,097. Since then, that number has hovered around 2,000 statewide. Last year, there were 2,023 opioid related deaths in the state, according to a report released in February by the Department of Public Health. 

Locally, the need is great. From 2010 to 2018, the Department of Public Health recorded 104 opioid-related deaths in Franklin County. The region’s year-over-year number of recorded overdose deaths has risen steadily from six deaths in 2010 to 22 most recently.

While work has been done toward stemming the epidemic, with the state’s health care system suddenly strained and resources increasingly difficult to come by, Vezina says she’s concerned about the future. There are “So many people who are already at high risk (who are) at a higher risk, now, and without supports in place,” she said.

The COVID-19 pandemic “will make things worse,” she continued. “We’re not getting anywhere near the other side of (the opioid epidemic) yet. This is certainly not going to help.”

In a statement, Debra McLaughlin, coordinator for the Greenfield-based Opioid Task Force of Franklin County and the North Quabbin Region, highlighted the record number of opioid-related deaths that occured in the region in 2018. And, as of the most recent data from November of last year, McLaughlin says the rate was on pace to surpass those numbers — even before the current health crisis. 

“We are now working at break-neck speed to manage two public health emergencies simultaneously, which is putting a severe strain on an already under-resourced area compared to other parts of the commonwealth,” McLaughlin said.

Another potential stressor that could arise from the pandemic is that, with slowed production, McLaughlin noted there’s “some long-term concern that the worldwide supply of methadone could be affected.” In an underserved region like Franklin County and the North Quabbin area, where “Access to methadone here has always been an issue,” those supply challenges could further strain a health care system that is already on overload. About this, she said, “The Opioid Task Force is extremely concerned that the required and life-saving measures to prevent the community transmission of COVID-19, which we fully support, will exacerbate the conditions that contribute to fatal and non-fatal drug overdoses."

If there’s a silver lining to it all, Cindy said it’s that, as America’s  broader community experiences what it means to be isolated, perhaps compassion for those in recovery will be fostered.

 “Our ‘using’ usually ends us up in isolation,” Cindy said. “This may sound corny, but this is forcing our community, our country, to re-evaluate itself. It’s an opportunity to do things differently. With all this social distancing, so many of us (who are in recovery) have lived with that. Now, a whole bunch of people are experiencing it. Maybe we’ll be more compassionate. That is what I’m hoping.”

Andy Castillo can be reached at acastillo@recorder.com.

How to connect

While many in-person groups are no longer being held, meetings are being hosted online and over the phone. A full schedule of meetings with code information to access each session can be found at westernmassaa.org.

The RECOVER Project can be reached at 413-774-5489. The Grapevine can be reached at 413-772-0359. The Western Mass. RLC, which is b ased in Holyoke, can be reached at 413-539-5941. The National Suicide Prevention Lifeline is 1-800-273-8255.




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