Pandemic of Dependence

Managing addiction during Covid-19

On March 19, 2020, an Executive Order and Public Health Order from the California state government directed all Californians to stay home except “to go to an essential job or to shop for essential needs.” Labeled an “essential business,” the liquor store BevMo! on San Pablo Avenue stayed open on March 19 and never closed. In fact, a BevMo! employee stated that the store now has more customers than since before the start of the Covid-19 pandemic. BevMo! has also added an alcohol delivery option at all of its locations. Since March, many East Bay residents have developed a new relationship to substance abuse.

Angelito Kemp is the program manager for the Fremont office of Center Point, an Alameda County–supported referral center that places people into substance use programs.

“The program is taking less clients because of Covid, because they want to social distance,” Kemp says. “We have what we call a ‘pending services list’…  We’ve had it as long as 95 clients who need to get into a program.” 

Center Point is contracted with about 15 Alameda County programs with different care levels. Generally, the programs test clients for Covid-19 and bring them into the general population if the test is negative, but if the client tests positive, they are not allowed in. Kemp emphasizes that Covid-19 has in no way stopped substance abuse, but has in fact hindered programs in place for helping addicts, including homeless people, who make up a substantial amount of Center Point’s patients.

The Bay Area’s homeless population has grown quickly in recent years, and suffers significantly from substance abuse. Now, with many recovery services going online, the East Bay homeless population is blocked from the regular in-person meetings they previously relied on.

“This has affected the homeless population’s ability to stay sober and off alcohol,” says James Raggio of East Bay Intergroup, which supports Alcoholics Anonymous Fellowships in Alameda County. “Because we’ve had a certain percentage of our members who are homeless who would come to in-person meetings that don’t have access to technology and who are not able to attend zoom meetings … .  I’m certain it has affected their sobriety.”

Another East Bay recovery program is Options Recovery Services, an agency with outpatient treatment services as well as housing for people in recovery. Justin Philips is an operations officer at Options Recovery Services Center in Berkeley and confirms that many Options clients are homeless.

He adds that they expect the homeless population to increase soon, “With people that have pre-existing health conditions, mental health conditions, addiction, and so on. That is going to create a critical situation for them. Then you have people that are obviously impacted by not having stable employment or losing their jobs or not being able to afford their rent or their mortgage or what have you.”

Philips points out that homelessness is entwined with substance abuse.

“With the current nature of Covid and all the stress that comes along with that it reactivates trauma, it creates a sense of instability and unsafety,” he says. “People go to what works for them. Unfortunately, for millions of people alcohol is what works for them, nicotine is what works for them, methamphetamine is what works for them; and that reignites a vicious cycle of dependence that is deadly and leads to more and more and more problems.”

Although it may have seemed like the world shut down on March 19, drug dealing never faltered and access to addictive substances was not stopped.

“If you ask just about any addict, they’ll say, if they need a drug, they’re going to find it,” says Edward G., who works for the Northern California Region of Narcotics Anonymous, a 12-step fellowship and sister-program to Alcoholics Anonymous. As per the group’s foundation of anonymity, his last name is not included in this article. “Addicts will go to any length to get what they think they need … I think that the business still carried on. It’s an illicit business, is it not? So why would they be hindered by any public order?”

NA has not seen any significant decrease in relapses or lack of access to narcotics from Covid-19, and Edward compares the virus to the disease of addiction in its ruthlessness.

According to the National Institute on Alcohol Abuse and Alcoholism, around 88,000 people die in the United States each year from alcohol-related causes alone, and according to the Centers for Disease Control and Prevention around 46,900 people died from opioid-related causes in 2018.

“As many Americans that have died from Covid, we lost that many Americans last year from substance abuse and alcohol, if not more, and I still think there’s a huge stigma attached,” says Josh Zeises, founder of the Facebook group Quarantine Conference: Mental Health & Substance Abuse, and chief marketing officer of Enlightened Solutions drug and alcohol addiction treatment center in New Jersey. “People don’t want to admit it, they don’t want to admit they have a problem, they don’t want to admit that their family members are suffering.”

Zeises founded the Facebook group on March 20th and used it to host a digital conference on substance abuse with hundreds of attendees from all around the world. He worries that without in-person services, addicts are struggling.

“People that have found themselves addicted or relapsed or into a drinking habit are going to have a very difficult time [going back to work] without the help of a detox center,” he says.

In order to ensure that as many clients as possible retained access to their services, Options created a new admission process.

“We bring people in, we check their temperature, we look for warning signs, we do a medical screening, we have an on-site medical doctor,” Zeises says. “She’s doing it through telehealth now, but every person is screened.”

Newcomers from the outside community enter a quarantine house where they can wait for a few weeks until they get a Covid-19 test and remain separate from general population housing.

Philips has seen the number of clients at Options increase.

“Our doors remain open no matter what, so we view ourselves as an essential service,” he says. “People are suffering and dying from addiction every day, and we thought it was critical to remain open during that time. As a result, we’ve actually seen more parts of the system refer to us, and we’ve seen an increase in our numbers overall because of that availability. There are a lot of agencies that were worried about how to provide services safely. We ultimately transitioned completely to telehealth so people are able to access our services in person, at least initially in our Berkeley location.”

Telehealth is defined by MayoClinic as “the use of digital information and communication technologies, such as computers and mobile devices, to access health care services remotely and manage your health care.” Since the start of Covid-19, telehealth has expanded rapidly due to the Coronavirus Aid, Relief, and Economic Security Act (or CARES Act), which was signed into law at the end of March. The CARES Act expanded telehealth services in Medicare, and waived the requirement that medical services must include in-person meetings with a medical professional.

One recovery service that made the decision not to move online was Intervention Works, a California-based company that facilitates interventions between substance abusers and their loved ones. Intervention Works focuses on the emotional connection between people, and their process seemed impossible to replicate in a virtual environment. Interventions Works therapists Cassia Bloom and Shawn Smith believe that substance abuse, and particularly alcoholism, has increased in quarantine, even though Intervention Works has interacted with fewer clients. Bloom says that she has noticed a trend of self-medicating in clients who are experiencing depression and anxiety in quarantine.

“I think that locking people in their houses for three months has led to a lot of things happening right now, substance abuse being one of them,” she says.

“Cabin fever and isolation is a big piece of it,” Smith says. “We know that isolation and substance abuse kind of go hand in hand.”

Luckily, ordinary 12-step meetings translate more successfully to a digital setting.

“We’ve had some people who have joined our meetings that are more curious, because it’s easier to go to a Zoom meeting and be anonymous than it is to walk in a door,” says Raggio, about East Bay Intergroup. “So, because of that we’ve had people come and join meetings with less inhibition.”

Although they scrambled to set up online meetings and even dealt with “Zoom bombing,” his organization is one of many that intend to make online resources a permanent feature. Another organization that will take this step is Narcotics Anonymous.

Edward says, “Exponentially, our fellowship grew in terms of people meeting and getting to know each other in a way that we never could before, so it was a very positive fallout.”

Both programs still intend to bring back in-person meetings as soon as possible.

As Raggio says, “AA is completely about connection and helping one alcoholic work with another, and part of that connection in the past has definitely been more face to face and in-person.” 

Options will retain both online recovery services and in-person services in a Covid-19-free future, because some Options clients have found online meetings less stressful.

“As opposed to having 12 people in a circle and one person is trying to speak in front of 12 people, it kind of lessens the stage fright in a telehealth type of venue because the people aren’t directly physically in front of you,” Raggio says. “From the facilitator’s standpoint, they’re starting to see a lot more honesty and information sharing in their groups by people that didn’t traditionally do that in an in-person setting. The social pressure is kind of lessened with telehealth, and we’re looking at that as a real benefit.”

Staying at home affects people’s sobriety in a variety of ways. Larry V. Moore, Jr. has been sober for five and a half years, but at a difficult time in quarantine, he commented on Facebook that he was considering drinking again.

“With all of this stuff happening, it really did come to the point where I thought ‘Gosh, how nice would it be to just go out to the liquor store, buy a bottle of Jameson, come home and just get completely tore up when the kids were at their mom’s house,” he says. 

Moore lives in Florida, and since March, he has not seen his brother, sister-in-law, niece, mother or father in person because his family is concerned for the niece’s health. Moore’s dog died recently, and with the absence of his family and beloved pet, Moore found himself struggling.

“I’m stuck at home and you can’t go anywhere and you can’t do anything, you’re alone and the whole world is kind of collapsing and it’s just kind of an implosion,” he says.

Moore says that maintaining sobriety requires filling one’s time with engaging activities that do not involve substances.

“If you’re sitting around and you’re literally home at night, it’s 11 o’clock at night, you’re bored to death, you haven’t spoken to or seen anybody in weeks, and you’ve got a bottle of Jack Daniels sitting in your cabinet and it’s calling your name. What’s to stop you from going to get hammered?” Luckily, Moore has found a special way to keep himself occupied: a rabbit. “Now that we’ve got the bunny in our life, it’s kind of filled the void of the loss of my 13-year-old best friend [dog] and so quarantine or not, I’m not having an urge right now, because to be honest I don’t have the time to sit around and think ‘I really could use a drink.’ Instead, I’m sitting around and thinking, ‘Gosh I can train her [the rabbit] to jump through hoops and to fetch,’ and I read about rabbits … I know that sounds silly, but that’s exactly what I’ve done. And it’s just taken my mind off of, not just losing the animal that I loved so much, but being so down.”

Unfortunately, not everyone has been able to achieve sobriety.

“A lot of people who were living a clean-and-sober lifestyle, either early in recovery or further into recovery, were able to maintain it for the first few weeks, were able to maintain their sobriety, but everybody has a breaking point,” says Bloom. “So, I think during the middle of the quarantine, a lot of people hit a lot of breaking points. So you have your people who were already using going into the crisis and the people that were sober who relapsed during the crisis.”

An anonymous source says that when quarantine first started, she became less reliant on her addiction to Adderall, but has been drinking and smoking marijuana more often.

“I haven’t seen memes about doing meth because you’re bored, but you see memes about getting drunk because there’s nothing else to do,” she says. “Drinking is probably the worst thing that I do for my health. I use Adderall less … but the thing that has been getting worse is the drinking.”

She attributes this to boredom, and says the lack of stimulation people experience when staying at home is a much stronger cause of stress than it gets credit for. 

Substance abuse is not deterred by anything; certainly not by a pandemic. Covid-19 has resulted in a lack of in-person services, and stress, to addicts.

As Edward says, “It [addiction] doesn’t care if you’re red. It doesn’t care if you’re blue. It doesn’t care if you’re Black. It doesn’t care if you’re straight. It doesn’t care if you’re LGBTQ, gender non-conforming, whatever it is. It does not care. It is the exact parallel of the Covid-19 virus. It does not care.”

SUBSTANCE ABUSE RECOVERY RESOURCES FROM THIS ARTICLE

East Bay Intergroup (AA) 24 Hour Hotline 510.839.8900 

Options Recovery Services (Berkeley) 510.666.9552

Northern California Region of Narcotics Anonymous 707.422.9234

Intervention Works 831.332.0047

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