YOUNGSTOWN, Ohio – Addiction treatment professionals say they are fighting a crisis within a crisis during the coronavirus pandemic.
While inpatient hospital treatment and extended stay medical assisted detoxification centers remained open, Ohio’s six-week Stay-At-Home order caused by COVID-19, the disease spread by the coronavirus, meant that people in recovery for substance abuse lacked the ability to attend 12-step meetings, group sessions at mandated intensive outpatient programs or even see counselors in person.
The “new normal” lifestyle of avoiding large gatherings, social distancing and avoiding handshakes is taking away foundational methods of fellowship and group meetings for people in recovery.
“I’m interested in seeing the numbers at the end of the quarter because my fear is there is going to be a spike in overdoses during this time,” said Carolyn Givens, vice president for Neil Kennedy Recovery Centers, with worry in her voice.
Givens’ fears are becoming reality.
Statistics show drug overdoses have spiked, people in recovery are relapsing, alcohol sales have skyrocketed and addiction treatment experts say they are seeing more people for alcohol abuse.
There were 698 overdoses and 92 overdose deaths last year in Trumbull County. As of June, there have been 344 overdoses, 17 confirmed overdose deaths and 15 suspected deaths.
In June, 107 overdoses came to emergency rooms, making it one of the highest months since the height of the opiate epidemic in 2017, when Trumbull had 135 overdose deaths.
In Mahoning County, the number of overdoses in emergency rooms stands at 295 as of May. And 41 people had died from accidental overdoses. In 2019, there were 780 emergency room visits for overdoses and 103 accidental overdose deaths.
“We’ve seen relapses, overdoses, deaths; it’s sad,” says Cindy O’Keefe, chief operating officer for Travco Behavioral Health. “Everybody is focused on one epidemic when we still have another epidemic that’s been here. And then we pull away all of those resources. They weren’t able to go to meetings. There was no face-to-face contact and people are really struggling out there.”
Alcohol is one of the most abused substances. Because it is legal to buy, consume and isn’t tarnished by the same stigma as other abused substances, it is misused by millions of Americans who become dependent on alcohol, statistics show.
Shelter in place orders have had an inordinate effect on online sales of alcohol. According to Neilsen, when the COVID-impacted period ended April 18, online sales of alcohol had skyrocketed by 234%.
Besides buying more alcohol, consumers also are purchasing larger sizes. Neilsen reports during the COVID-19 impacted period, growth in percentage points was nearly 10 times higher for boxed wine and 23 times higher for 1.75-liter of spirits.
“We’ve seen an increase in admissions for alcohol,” says Cindy Woodford, executive director at First Step Recovery in Warren. “It [alcohol] is a legal drug and everyone has access to it.”
Gary Seech, regional director of operations for Glenbeigh, points out there is national recognition of the high number of people, whether they have been in short- or long-term recovery, who have relapsed during the pandemic.
“We’ve seen an increase in the number of patients coming in with their drug of choice being alcohol,” Seech says. “More people are working from home or are unemployed and they are lacking the stability of meetings and alcohol is legal and available.”
The director of recovery and youth programs at the Trumbull County Mental Health and Recovery Board, Lauren Thorp, explains the pandemic has also brought more social normality around the use of alcohol to cope.
“Alcohol is legal and it doesn’t have the stigma around it like shooting up with fentanyl,” Thorp says.
Glenbeigh’s Seech says the urge to make the use of alcohol normal as a COVID coping mechanism comes as people are more isolated, are working remotely and have less accountability.
“I have an actual case where the guy said, ‘My alcoholism kicked in the day I started working from home,” Seech says.
In 2017, alcohol proved to be even more deadly than illicit drugs, including opioids. That year there were some 70,000 drug overdose deaths – about 2,300 fewer than those involving alcohol, according to the Centers for Disease Control and Prevention. Only cigarettes killed more people.
Oftentimes, professionals say alcohol isn’t perceived to be a problem until someone else perceives it a problem for an individual or a legal ramification occurs because of alcohol.
COVID escalated some anxiety and depression in people. Many did not seek help. They self-medicated with alcohol, they say.
“With all we have endured so far with the pandemic, some people may have crossed over from recreational use to misuse to abuse,” Woodford says.
New Normal for 12-Step Meetings
Seech remembers being on vacation in Florida and returning to the office March 11, only to realize the world had changed.
In-person 12-step meetings were canceled at treatment centers and in church halls. Some small groups met in participants’ houses. But the fellowship of 12-step meetings turned to a virtual presence.
Some meetings recently reopened under health guidelines of social distancing, limitations on crowds, wearing facial coverings and not serving coffee or snacks.
Earlier this month, many of the outpatient treatment centers began to bring back their group meetings. Preparations to return to meetings are underway for others. The process is being done slowly and cautiously following health guidelines of temperature checks, masks, newly installed plexiglass barriers, separate entrances for group members and the general public and floor markings to show social distancing of six feet.
Travco’s O’Keefe says groups that normally had 12 people have no more than six.
Elaine Traina, CEO of Family Recovery Center, says 13 to 14 meetings a week affecting 325 people held at the Oxford House in Salem resumed July 5 after a nearly three-month hiatus. The house offers transitional living, also known as sober or recovery housing, for men. There are 11 beds for men in recovery, who pay rent, utilities and household expenses.
Meeting sizes are limited to 40 people; temperature checks are performed on individuals as they enter and face coverings or masks must be worn and are made available. Coffee and snacks are not.
The recovery houses operated by Family Recovery Center have a staff member who was holding small internal meetings for some residents once or twice a week as well as Alcoholics Anonymous or Narcotics Anonymous virtual meetings daily.
Sheila Vandergriff, director of development for Glenbeigh, says the outpatient clinic in Niles has allowed groups to use its outside space to hold meetings over the last couple of weeks.
Neil Kennedy’s Fellowship Hall on Rush Boulevard was a familiar site for 12-step meetings before COVID-19 with about 625 people passing through the rooms weekly. Givens says she is working on protocols and hopes to soon get the meetings started again. “But there is nothing stopping people from getting together in a park for a meeting,” she says.
Most treatment centers employ peer support coaches, especially if they offer recovery housing as a step-down from outpatient care.
“A lot of people are struggling with isolation. Human beings are not meant to be isolated. People need to be honest with themselves about how it’s affecting them,” says Larry Moliterno, CEO of Meridian HealthCare.
Meridian, like other treatment centers, turned to virtual 12-step meetings. But Moliterno says people are eager to return to face-to-face encounters for better accountability.
The alumni coordinator for Glenbeigh, Fawley Bernstein, used his background in radio and technology to quickly pivot meetings onto a virtual platform when meetings were canceled.
Bernstein was host of the Maxwell Show radio talk show on WMMS in Cleveland from 2004 until 2009. He later moved to the Chicago radio scene before returning to northeastern Ohio and began to work for Glenbeigh in 2015.
“When the lockdown happened, we needed to stay in touch with people. So I worked with the IT people here and created the online meeting schedule,” he says.
The meetings were hosted seven days a week at first and anywhere from 50 to 75 people were part of the meetings. Now meetings are usually hosted five times per week.
“People have flat out said to me, ‘This has saved my life.’ And I believe them,” Bernstein says. “We’re going to keep doing the meetings regardless moving forward. It’s a good way to stay in touch with people.”
When meetings were suspended at On Demand Drug Counseling, a sister company of New Day Recovery bought pre-paid cellular phones for clients to ensure they had access to counseling, explains marketing director Sydney Metzel.
On Demand Counseling also recently bought vans to take those with addictions to meetings.
“Transportation is a huge issue for some people and we wanted to break down any barrier to recovery that people may have,” Metzel says.
Family Recovery Center’s Traina, who serves people in more rural areas, says some people have found telehealth hard to navigate or experienced a problem with phone or internet access.
Often, the digital divide doesn’t necessarily come down to an area that lacks online or digital service but rather a person not having the funds to pay for the service or able to purchase a device or phone.
Use of telehealth technology expanded during the pandemic as insurance companies and Medicaid relaxed regulations to pay for its use.
Traina says her staff began to use telehealth in mid-March and they were using it exclusively by the first week of May. She is hearing some clients say it has been successful. Still they want to return to face-to-face encounters.
The use of telehealth has been so successful that experts believe it will become a permanent tool for recovery. For many it will be a personal choice in treatment. For others, though, it has allowed people to access help more easily, alleviated transportation issues and has led to fewer cancellations of appointment.
Glenbeigh’s Vandergriff says the use of telehealth at the outpatient clinic in Niles has been a lifeline for many people. “They have been able to move through IOP [intensive outpatient program] to aftercare and get their [recovery] coin from the outpatient center,” Vandergriff says. “They are so proud. And they should be, to have accomplished what they have through all of this hardship.”
Coleman Professional Services is using a hybrid model of both in-person and telehealth for services.
“Telehealth allowed people who are not comfortable, or maybe have never engaged with us or had not addressed issues before, to reach out. It opened up the door for more people to seek help [in the] comfort of their own home,” explains Carmella Hill, director of behavioral health for Coleman Behavioral Health in Trumbull and Mahoning counties.
Hill has been in behavioral health for 21 years. While she has never experienced changes like she has seen with the COVID-19 crisis, she is pleased with how Coleman staff members have responded.
Switching to video or conference calls between patients and health care professionals was new for everyone, Hill says. Coleman had to make changes in infrastructure and technology and buy equipment.
“You have to hone in on your listening skills, especially with no visual cues like looking down or looking away. You need to listen more for pauses, or a raised voice or speaking more rapidly,” Hill says.
Pictured: Sydney Metzel, director of marketing and community outreach, and Audra Olesky, clinical director, for New Day Recovery and On Demand Drug Counseling, set up chairs in an outdoor area at On Demand Counseling in Austintown where outpatient 12-step meeting groups meet.