Recovery In The Time Of The Coronavirus

What happens when face-to-face meetings, a lifeline for people with addiction, are banned?
Many people in recovery from substance use disorders rely on in-person meetings.
Many people in recovery from substance use disorders rely on in-person meetings.
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SEATTLE ― “Keep coming back, it works if you work it, and we’re all worth it!”

That’s the chant at the end of most meetings of Alcoholics Anonymous in the Seattle area, done while everyone is still holding hands after saying the Serenity Prayer. It’s an affirmation that a program rooted in mutual, in-person support can keep people sober, as long as they keep coming back to meetings.

But here at the epicenter of the coronavirus crisis in the United States, where county officials have officially banned all gatherings of more than 50 people and imposed strict requirements on smaller gatherings, mutual support groups like AA, Narcotics Anonymous and Smart Recovery are struggling to cope.

Meetings that were once held in churches, hospitals and retirement homes have been canceled or moved online. Those gatherings that continue to take place are sparsely attended as residents hunker down. Several regional events for AA and NA members have been canceled or postponed.

Brian, an AA member in Snohomish, Washington, just northeast of Seattle, said he hasn’t gone to his usual weekly meeting since the outbreak hit the area a few weeks ago, and he’s feeling the effects.

“Anytime I don’t get to go to meetings, it impacts me, whether I think so or not,” said Brian, who asked that we use his first name only. “The meeting where I usually go is in a hospital, so that’s canceled.”

Amir Islam, a Seattle NA member who works in the music business, said he’s still going to meetings despite warnings to stay away from groups. On Friday, he said he had just chaired a meeting where people tried to avoid touching at the beginning but ended the meeting with their arms around each other — the NA equivalent to AA’s hand-holding ritual.

“People were doing the elbow bump and the fist bump at the beginning, and then it goes from that to everyone hugging at the end,” he said. “It was like, ‘Really? Are we avoiding each other or not?’”

The structure of AA is nonhierarchical. Decisions are mostly made at the level of individual groups, not by the organization itself. Because of this, AA as an organization is making no formal recommendations to members about whether to meet or how to modify meetings in response to the pandemic. A spokeswoman for AA’s New York-based General Service Office, the closest thing the organization has to a coordinating body, said the office has heard from individual groups that they are “making changes to their formats, adapting when and how they meet, and developing alternative plans in case they are temporarily unable to meet in person.”

The Greater Seattle Intergroup of AA, which maintains lists of meeting times and locations and runs a 24-hour hotline, has created an online list of canceled or suspended meetings. As of Sunday night, more than 125 weekly meetings, out of more than 1,000, had been officially canceled. A member who answered the phone at Seattle Intergroup last week said the group was trying to update its list of meetings that have moved online, but many online meetings that were independently verified by HuffPost had not been posted publicly as of Monday morning.

AA’s lack of formal top-down organization means that information about most online or phone meetings is spreading by word-of-mouth, which can leave out people who aren’t close to others in AA or aren’t members of a particular group. Alysse (who asked that her last name not be used in accordance with AA’s policies on anonymity), the director of marketing at a local television station, goes to meetings frequently but has been staying home because of underlying health conditions. She said she worries about newcomers and those who aren’t regular attendees of any AA group.

“My concern is that we can still be there for the newcomer, so they can find us,” Alysse said. “For people who are either at their bottom or near their bottom, this is going to cripple them.”

“We’re hardly getting any calls from people seeking treatment.”

- Andrea St. Clair, client care coordinator of A Positive Alternative

Brian said he doesn’t consider online meetings a substitute for in-person interaction, especially with people from different backgrounds than his own. “It just doesn’t feel as real to me,” he said. “I go to meetings with people from pretty diverse backgrounds, people from all different walks of life,” Brian said — a contrast from his professional and personal life in the Seattle suburbs. “It’s nice to go to meetings where everyone is not just in my little socioeconomic bubble.”

Islam pointed out that meeting online, using software like Zoom Meetings, is “pretty privileged. Not everyone has access to the Internet and laptops.” Meeting halls that cater to diverse, low-income, and older people — “the old dusty, crusty places that have been around forever” — are “a blessing,” he said. “Those are the places that people gravitate to as the newer places shut down.”

AA members frequently describe addiction as a disease of isolation. “The most dangerous place for an alcoholic to be is alone in their head,” Alysse said. Professionals who work with people with substance use disorders say that as the number of opportunities to meet with others in recovery goes down, the risk of relapse and life-threatening behavior — overdosing or drinking to dangerous excess — goes up.

Andrea St. Clair, the client care coordinator of Seattle-based A Positive Alternative, a non-12-step treatment program that includes in-person support group meetings, said stress and isolation often lead to relapse. This is especially true for people struggling to stay sober while worrying about their next paycheck and taking care of kids at home. “I think it’s kind of a perfect storm,” she said.

Her group is now holding meetings online or by phone. Over the past few weeks, St. Clair said, she’s noticed that “we’re hardly getting any calls from people seeking treatment” — a sign, she worried, that people who need help with addiction are delaying or deferring at exactly the point when they are most vulnerable.

Another organization with a recovery support program that relies heavily on in-person meetings, Seattle’s Recovery Cafe, shut down one of its two physical locations on Monday and is trying to decide whether to keep its main program office open. The organization ― which director David Coffey said caters to “people who’ve been traumatized by homelessness, addiction, and other mental health challenges” ― requires members to attend weekly accountability sessions called “recovery circles” to retain membership benefits, which include access to hot meals, classes and a computer lab, along with connections to resources like case management and medical care.

During a visit last Thursday, the Recovery Cafe’s usually bustling headquarters seemed hollowed out. About a dozen people sat at individual tables spaced six feet apart in a large front room, attempting to shout conversation across the distance. Nearby, a staffer dished up food from a steam table that ordinarily operates as a self-serve buffet.

Coffey said he’s trying to stay open as long as possible for people healthy enough to keep coming in. “Whenever there’s a crisis in this country, the people who suffer the most are the people who live on the margins,” he said. “As we debate whether or not to stay open or what to do, we’re really asking, ‘What’s the least worst option?’”

Islam considers addiction itself more dangerous to his health than the coronavirus. “The ultimate weapon for recovery from addiction is other addicts,” he said. “The way my disease works, it’s always a matter of life and death for me.”

Keep up with the latest updates on the coronavirus at our live blog.

Need help with substance use disorder or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.

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