As the pandemic begins to resolve, the substance use epidemic in the state still needs to be addressed, experts say.

By Kelly Burch, Granite State News Collaborative

On Tuesday, June 1, Keith Howard, executive director of Hope for New Hampshire Recovery was excited. For the first time in more than a year, Howard announced, the Manchester nonprofit would be holding indoor recovery meetings, doing away with COVID precautions like temperature taking, social distancing, and — most significantly — mask requirements. 

“I didn’t know if this day would ever come,” Howard said in a video posted to the nonprofit’s Facebook page. 

With more than 70% of Granite Staters having at least one dose of the vaccine, and transmission rates down in the state, leaders at Hope for New Hampshire Recovery felt it was safe to relax COVID precautions, Howard said. Although some might argue that masks are no big deal, being able to return to a more normal, intimate experience for recovery meetings is important for people who are working hard to maintain their sobriety.

“So much of life in early recovery is about making connection,” Howard said. “Part of that is getting a smile, returning a smile. It’s tough to learn to read a mask.”

The pandemic came at a time when New Hampshire was already struggling with another epidemic: opioid addiction and other substance use disorders. Back in 2015, New Hampshire had the second highest rate of fatal drug overdoses, behind only West Virginia. The state made progress in expanding access to treatment, and by 2019 New Hampshire had the 9th highest rate of overdose deaths. 

However, professionals were concerned that the pandemic would take away from the public health spotlight on substance use. In the first seven months of the pandemic, seven recovery houses closed, making it even more difficult for people to find affordable sober housing in the state. At the same time, the vast majority of 12-step and other meetings to support recovery shut down or went virtual, removing critical support for people trying to stay sober.

Now that the state is beginning to open back up, the recovery community is ready to integrate lessons from the past year, and begin serving people who may be more in need than ever. 

“Addiction isolates people and so has this pandemic,” said Meghan Shea, chief programs officer for Manchester-based Families in Transition, which operates an intensive-outpatient treatment program and sober housing in the state. Now that the COVID transmission rates are down and society is opening back up, “it’s a new phase” of providing recovery services, Shea said. 

Connection in recovery

The culture of recovery communities has long been rooted in connection, which is often referred to as the antidote to addiction by people who are sober. The pandemic, with its social distancing requirements, presented a barrier to connection. That’s why Howard was so happy to return to more normal meetings. 

Hope for New Hampshire Recovery held socially-distanced, outdoor recovery meetings at various points during the pandemic, but the organization shut down from December through April, when the weather was too cold to be outside. Now, being able to welcome people back into the community center is a major turning point, Howard said. 

“That’s one of the most important things we can offer: just being with people in recovery,” Howard said. 

There are small changes —  like a return to serving coffee again. That seems insignificant, but is an important ritual for many people in sobriety. A simple cup of coffee can reduce anxiety by giving people something to do with their hands and an excuse to start talking with a stranger. 

“It’s easy enough to strike up a conversation with someone who has a cup of coffee,” Howard said. “During the pandemic, with everyone masked, you almost needed to declare your intentions before starting a conversation.”

Prior to COVID, Hope for New Hampshire Recovery was serving roughly 1,000 people each week. Right now that number is down by half, but Howard is confident that will begin to rise again now that in-person, indoor meetings have returned. 

“I am just so incredibly… thankful that things can be kind of normalish,” he said. 

Lessons from the pandemic

Building community is one of the key premises behind the idea of recovery homes. In these houses, people who are newly sober live in a family setting with other people who are learning to live without intoxicating substances. The pandemic challenged that, but provided many learning opportunities, said Kim Bock, executive director of the New Hampshire Coalition of Recovery Residences. 

“Isolation can bring on reuse… so living as a family unit together is very important,” she said. 

However, close quarters also makes it easier to transmit diseases like COVID. Recovery houses in New Hampshire received CARES funding distributed through the state to allow them to maintain their mission, while mitigating risk. One home installed partitions in the bedroom, allowing residents to more safely share a room, while others invested in air purification systems. Overall, the precautions worked. 

“I was surprised at the relatively few… positive cases that houses were seeing,” Bock said. 

Now, the people who operate recovery homes have a plan in place for similar events in the future. 

“They know what to do,” Bock said. 

Shea, of Families in Transition, feels the same. 

“It’s taught us a lot about disease and how we manage it,” she said, adding that it could inform responses to events as mundane as flu season. 

Families in Transition is now offering a hybrid approach to its recovery programming. People in intensive outpatient programs can come for in-person group meetings, for example, but complete their one-on-one counseling remotely. That makes treatment more accessible overall, especially for groups like parents who often find it difficult to go through treatment while maintaining their obligations to family and work. 

“We’ve noticed that it’s critical to meet people where they’re at,” Shea said. 

Addressing healthcare disparities

People with substance use disorder are at increased risk for contracting COVID and have worse outcomes if they get the virus. Even people in recovery from addiction are 1.5 times more likely to get COVID than those who have never had substance use disorder. At the same time, many people with substance use disorder lack access to health care. 

With that in mind, all three organizations that spoke with the Collaborative are encouraging people to get vaccinated, and helping facilitate vaccinations for the people they serve. 

“We work closely with the health department and various clinics helping support access to vaccination for folks who have not been able to access it,” said Shea. 

No recovery houses are requiring vaccination, Bock said, but they are having discussions with residents about the shot just like they do about other infectious diseases. 

“There’s counseling on that, just like there would be guidance on hepatitis or AIDS or anything like that,” she said. 

Access to treatment and affordable sober housing remains a big challenge in New Hampshire. Bock said that although no new recovery homes have opened to replace the seven that closed during the pandemic, there are plans underway to open new residences. Counties including Rockingham County are studying recovery houses as part of a comprehensive solution to the addiction epidemic, she said. At the same time, recovery home operators have begun working more collaboratively, with each other and other state organizations to strengthen New Hampshire’s recovery community. 

“It’s become more of a network, which has been gratifying to watch,” Bock said. 

Shea said that Families in Transition has seen a slight increase in people reaching out for treatment, as they become more comfortable being in a communal setting again. Right now, she’s cautiously optimistic about the future, while also acknowledging the successes of providing treatment even when it was difficult during the pandemic.

“What we’ve been able to pull off in the last year has been pretty phenomenal,” she said. 

These articles are being shared by partners in The Granite State News Collaborative. For more information visit collaborativenh.org.