By Meaghan Breen
Granite State News Collaborative
Usually, Jason Snook’s team at Aware Recovery Care of New Hampshire would be bringing the services people need, right to their home without a second thought.
But since Covid-19 swept into the world, nothing is usual anymore.
Jason Snook, the clinical outreach manager for Aware operations in New Hampshire, Massachusetts and Maine, at the NH Providers Conference in July 2019. Courtesy photo.
Aware has continued to bring in registered nurses, psychiatric providers, and family clinicians, among other staff. But said Snook, the clinical outreach manager for Aware operations in New Hampshire, Massachusetts and Maine, it is up to the individual provider whether they feel comfortable entering a client’s home. The bulk of them are continuing to engage in-person.
Still, it’s a back and forth battle, Snook said, in his role at Aware in terms of questioning the gradation of potential harm caused, either psychologically due to lack of treatment provided, or by physically exposing a client to the virus.
“I think in the spirit of treatment, we social workers and mental health workers have also taken a vow to do no harm,” he said. “If we are just saying, ‘No, sorry, we’re not taking patients in right now,’ are we harming people that need treatment?”
Snook said he’s seen a variety of emotional responses from clients as they face the strain of social distancing, added stress, and lack of traditional treatment resources.
“If they're in early stages, continuing to use on a daily or consistent basis, Coronavirus isn’t a top priority for them.” he said. “They may understand and acknowledge it, but it is really low on the totem pole of things for them to respond to. These people have been in survival mode for years, so when a pandemic comes, it’s not affecting them much.”
However, Snook said, there tends to be a difference in the emotional response if someone is further along in their recovery and trying to “put their life together.”
Snook said that about 90 percent of people who work at Aware Recovery Care are in recovery, including himself.
He said, “One thing I’ve noticed is that people who have great spiritual foundations are not shaken by this pandemic. I can tell you from personal experience, I am not shaken. This is business as usual. If anything, it strengthens our spirituality.”
Faced with a stay-at-home order as the Granite State struggles to arrest the momentum of COVID-19, many of those seeking help for substance use disorders are encountering some new speed-bumps on their road to recovery.
As society is prompted to take a breath of fear every day, so, too is the addict. But to hold onto that breath can mean death for a person in recovery. To combat this, extra effort is being made by those who are striving to achieve and maintain sobriety as well as by those organizations there to support them. The common thread of success during the pandemic seems to be maintaining a connection to fellows in recovery, and to getting creative with at-home treatment options.
Many rehab facilities are trying to offer as many services as possible while adjusting operations in response to stay in place orders. The number of hurdles one must jump through in order to have access to medication assisted treatment (MAT) such as methadone and suboxone have increased, and recovery support groups and AA meetings are moving online, in whole or in part.
Kristofer Alexa of Salem works across the border in Haverhill, Mass. at Spectrum Health Systems. He is the case manager for 497 clients on medication assisted treatment and additionally fills a side role as a recovery service coordinator. Spectrum has adjusted to the spread of the virus in terms of MAT by altering the criteria for medication “take homes.”
“The more you follow policy and program procedures, the more take-homes you are eligible for. They begin at six take-homes, then thirteen, and twenty. Twenty-seven take homes is the max amount we are allotting,” Alexa said.
This change in medication disbursement has allowed for less traffic at the facility, which has responded to COVID-19 by implementing precautions, such as offering hand sanitizer, face masks, and gloves. There are markers on the floor to indicate social distancing, and the counseling services have been transferred to telehealth.
“We deal with the high risk population and some of them are homeless, but for the most part most people’s concerns are the cleanliness and the spacing,” Alexa said. “They are constantly listening to the media and it’s increasing fear. Most of them have co-occurring diagnoses with substance abuse. Everything is heightened, but we try to alleviate those pressures. For the most part no one wants to leave their house.”
Jared Lafreniere of Bennington is the care coordinator at the Phoenix House in Keene, and his experience in terms of cleanliness precautions mirrors Alexa’s. Staff members are required to get their temperature taken regularly, and no more than ten individuals are allowed in a room at a time.
To maintain that connection that is so critical for those in early recovery, Lafreniere said that they are accessing AA meetings online via Zoom.
“I don’t think I’ve heard anyone say they like them better. It’s not the same,” he said. “I think there are some people that prefer it because of anxiety, and they’re more comfortable being at home, but most of the clients, especially when we first said we couldn't bring them out anymore, were disappointed.”
“Obviously we know that people in early recovery, and to feel welcomed into recovery, have to feel a sense of connection, and that’s really difficult during this time right now. There’s fear of change. None of us like change,” Lafreniere said.
Although Zoom meetings are allowing the fabric of the established connections between those in recovery to remain intact, many have suggested that the quality of online platforms is lacking.
Lafreniere said, “Just being on Zoom, there’s a lot of people having to get their 24 hours chips. We won’t ever know the number of people who won’t make it into recovery because of this.”
As the emotional response from isolation becomes more acute and overwhelming, people in recovery are forced to adjust to this new normal and embrace what services are still provided.
Joshua Park, manager of Live Free Structured Sober Living in Keene, is now working with what he said has become a common set of difficulties for those in his field.
“The biggest hurdle we are facing is men not getting to meetings, but we have suggested the Zoom meeting application,” he said. “Also, we are doing in-house recovery meetings throughout the week. I want to keep the men engaged in their recovery. I know for me, if I mix fear and complacency without any sort of relief, I am in trouble.”
Park is initiating regular verbal check ins with his residents to gauge how they’re feeling physically, conducting daily temperature checks, and adjusting curfew and restricting overnight passes.
Some facilities, including Live Free and the Phoenix House, are still accepting new residents provided they have transferred from a facility that carried them past the 14-day quarantine period without displaying symptoms.
“Live Free would never force a resident out due to the virus,” Park said. “I personally feel that would be more dangerous not only to the resident that is an addict/alcoholic but also to the community.”
Christina Villa of Swanzey, has a unique perspective in that she is both in recovery and in the medical field. Villa works at Dartmouth Hitchcock in Keene, as a contracted travel RN in the oncology department. She said the virus has added another layer of stress to her job, especially because she works daily with patients with pre-existing weakened immune systems and juggles staff shortages and childcare difficulties because of COVID-19 related call outs.
She said that typically her recovery means “going to about four support meetings per week, regular contact with my mentor, writing and journaling around my sobriety, and prayer and meditation every day.”
Villa said that the change with the biggest impact on her recovery is the elimination of the face-to-face aspect of support groups. “
I rely heavily on hugs,” she said. “I get a lot out of sitting and seeing people’s reactions and facial expressions.”
“It has required us to move groups to a virtual platform,” she said,” which has been really useful, but has been a big adjustment and has been a real learning curve.”
Snook of Aware, said that one of the biggest challenges for peers in recovery is social distancing and the challenges of virtual support systems.
“Every single one of us gets into recovery and the first thing they say is get yourself a support network. That’s literally recovery 101,” he said. “How are new people supposed to get in touch with recovery communities if they don’t have the means to get online? What’s the quality of the connections being made?”
A network of peers is what most addicts cling to for success, both during the pandemic and prior to. For the addict, to harbor consistent fear and overwhelm without talking about it—without sharing the subsequent trepidations with those who are also in recovery—is to risk isolation and relapse.
Although it appears the dynamic and means of achieving connection for those in recovery has taken on a new life, the necessity to nurture those strands of unity is just as important. It may feel uncomfortable initially. It may not feel the same, simply because it is a vastly different mode of interconnectedness, but there are upsides, too.
“As a person in recovery with years of sobriety under my belt I’ve had a positive experience with Zoom,” Alexa said. “It’s benefited me in a way that I’ve been able to connect a lot more outside of my normal fellowship where I can attend meetings all over the world that I never really gave a chance to before the outbreak. It’s pushed me into an uncomfortable zone and uncomfortability is for me my greatest asset, and it makes me move in the direction toward my Higher Power, because I need my Higher Power to get outside of my comfort zone.”
These new trials that each addict and alcoholic faces are real and threatening, and the key to maintaining the link to others and to supporting oneself throughout this societal shift is to integrate every tool in the box. When unable to engage with a person virtually, many of those in recovery work diligently daily to connect with their Higher Power.
Villa said, “Having a Higher Power, prayer, and meditation in my life gave me the tools to handle any challenges that come in my daily life. Regardless of the problem, one of those things is almost always the solution.
Another mode those in recovery are using is continuing to utilize skills that worked for them prior to the stay at home order. Many are turning to literature. Refuge Recovery is a method of recovery based in Bhuddist principles and has a basic text. Alcoholics Anonymous has literature not only aimed at the 12 Steps, but also daily reflections books that provide prompts for meditation, and readings that offer practical advice for those in their early days of sobriety. YouTube provides hundreds of speaker tapes and guided meditations and body scans. Some, thrive in helping others to get outside of themselves.
The worst thing a newly sober person can do is to, “stop asking for help, stop applying for programs, and to stop trying to get into a house, or a detox. The worst thing that they could do is to stop trying,” said Alexa.
These articles are being shared by partners in The Granite State News Collaborative. For more information visit collaborativenh.org.