Tag: recovery

Addiction Treatment Centers Struggle To Serve Patients As COVID-19 Spreads

This excerpt originally appeared at HuffPost, where you can read a full version of this story.

The spread of COVID-19 has presented a unique challenge to those fighting another life-threatening epidemic: substance use disorders, which affect about 20 million American adults each year. Residential treatment centers, which are based on a model of group therapy and interaction among patients, are scrambling to adapt to the Centers for Disease Control and Prevention’s guidelines.

Those treatment centers are also facing a more existential threat: As potential patients stay away for fear of contracting the coronavirus, many smaller and publicly funded centers could run out of money and close their doors at a time when social isolation is driving many people with addictions to relapse.

“Historically, whenever there’s a crisis in the U.S., alcohol sales and illicit drug sales increase dramatically,” said Dr. Marvin Seppala, the chief medical officer at the Hazelden Betty Ford Foundation in Beaverton, Oregon. “Day-to-day things are suddenly stressful …. In the long run, there’s going to be an increased need for treatment.”

Treatment centers are considered “essential critical infrastructure” under the federal guidelines that most states are using to determine which services are exempt from requirements to shelter in place. But in order to keep people safe, they’re being forced to adapt in ways that go against normal methods of treatment, forgoing things like group meetings, family visits and open-door policies.

Melody McKee, who until last week was the clinical program director for Olalla Recovery Services in Olalla, Washington, said her treatment center made “the difficult decision” to implement a triage system for admissions.

“The way it will work is, like, ‘Is this person literally not going to make it if they do not enter this location?’” said McKee.

A person experiencing homelessness with no ability to access tele-health would rank high on the triage list, as would someone leaving detox who seems likely, based on their medical history, to go out and drink or use again.

Other factors that might push someone to the front of the line: frequent falls, past failure to follow through with opiate replacement therapy, suicide attempts and meth-induced psychosis. Those who don’t rank high on this kind of triage list may be turned away from treatment.

It’s a brutal calculus and a stark shift for treatment providers and advocates who have spent decades arguing for treatment on demand.

“No one can just walk up to a treatment center anymore,” said Dr. Paul Earley, president of the American Society for Addiction Medicine, which put out its own COVID-19 guide for providers. “The overarching issue here is to balance the risks of the two illnesses: the risk of contracting coronavirus and developing COVID-19 versus the risk of not getting treatment for the disease of addiction.”

Inpatient Facilities Make Tough Choices

McKee said the need to implement social distancing — for example, by reducing the number of patients who sleep in the same room — can be hard to balance with the desire to take care of as many patients as possible.

“Do you know what kind of burden it is to say, ’We know this person needs this level of care, but we also have people right here who are sitting ducks [for infection]?” she said.

If tests for COVID-19 were available, she said, her treatment center would be able to admit or reject patients. For now, all they can do is screen for symptoms and hope for the best.

The tight quarters at residential treatment centers and the medically fragile condition of most people with serious, long-term addiction make them ideal breeding grounds for infection. Long-term intravenous drug users often suffer from a heart infection called endocarditis; people who smoke crack, meth or marijuana may have diminished lung capacity; and heavy drinkers may have multiple organ failure and a suppressed immune system.

“These are not healthy individuals,” said Lauren Davis, executive director of the Seattle-based Washington Recovery Alliance. “People whose disease is advanced enough that it would necessitate inpatient treatment are pretty much universally in the high-risk category.”

To keep the virus out, treatment centers are cleaning more thoroughly and often, checking both staffers’ and patients’ temperatures regularly, and implementing social distancing in all group activities. That means putting space between chairs in group therapy, spacing out or canceling mass lectures, discharging some patients early if they seem stable enough to leave without relapsing, banning hugs and eliminating visits from friends and family, among other measures that fundamentally change the nature of rehab.

Read the rest of the story here.

Recovery in the Time of Coronavirus

Image via Pixabay

This piece originally appeared at HuffPost

“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?’”

Read the rest of this piece at HuffPost. 

Five Years

Five years ago today, I made a decision that would change the trajectory of my life, and lead—with many steps along the way—to the creation of the website you’re reading right now.

On February 6, 2015, I called a cab, packed a bag, and checked in to a detox center in Kirkland, where I stayed for five days before returning home and starting over—no job, no prospects, and no real faith in myself, but an ineffable feeling that this time, things were different.

I won’t belabor everything that it took to get me to Fairfax that rainy morning—suffice to say, this wasn’t the first time I’d checked myself in to a place where the doors locked from the outside—but something had clicked. More than six years after I first sought help—thinking, in my ignorance, that detox would be a “reset button”—I was done.

But putting it that way makes it sound like a foregone conclusion, and of course it wasn’t. Most people who struggle with substance use struggle to quit, and most of us relapse before we “get it.” Some of us have loving, supportive families who try to help; some of us lose the support of those families after a stint at treatment doesn’t “work,” and many of us don’t have support from family or friends at all, because we’ve burned every last bridge or never had bridges to support us in the first place. I had every advantage—a decent job, a family who wanted to help even if they didn’t know how, and friends who never stopped showing up for me, even when I was at one of my many “rock bottoms”—a concept, by the way, that is just a story we tell ourselves.

One of the reasons I write about homelessness and addiction with such conviction is that I know what it’s like to be addicted and I know the privilege that prevented me from becoming homeless myself. Another reason is that I want to dispel the myths about addiction that people choose to believe because it’s easier than acknowledging the ways in which we’ve failed people who don’t have comfortable cushions to fall back on.

For every conservative armchair addiction expert who says, “My brother was an alcoholic but he just decided it was time to quit,” there’s someone who tells me that they were doing fine on medication but then their doctor cut them off and they switched back to meth.

For every person who tells me they support a zero-tolerance policy for people who want to live indoors, there’s a guy who was able to quit drinking only after getting stable in a place where people didn’t judge him for having a disease.

For every person who says people live in tents and shoot heroin because they want life to be a nonstop party with no consequences or accountability, there’s me, an alcoholic, telling you that maintaining an addiction from day to day is some of the hardest work I’ve ever done.

The people you see on the street muttering to themselves or committing crimes to feed a drug habit or living in squalid, deplorable conditions didn’t start out that way; they fell farther than I did, and probably farther than anyone you know, because they ran out of resources, and probably didn’t have many to begin with. The job of a just society isn’t to look at people who are struggling with a life-threatening, time-consuming, soul-annihilating disease and shame them for not curing themselves on their own. It’s to ask them what they need and help them get it.

My bias is for compassion toward people that too many others view with contempt and want to sweep away. This isn’t because I’m a better person than anyone else. It’s because I know that the cure for addiction isn’t tough love or making people’s lives harder or forcing them into treatment and then blaming them when a 28-day spin-dry doesn’t “work.” The cure for addiction is realizing that there isn’t one cure for addiction, that recovery looks different for every person, and that some people may never “get it.” That doesn’t make them less deserving of respect and human rights; it just means that they didn’t defeat a life-threatening disease.

It’s hard to fit public policy into a framework of uncertainty, but everything else is a waste of time.

Unlike many of the people I write about, I had resources, and I got sober in time. I could have become homeless. I could have died. But I didn’t.

And here are some of the things I’ve done because I didn’t: I got a job at a nonprofit that fights for reproductive rights. I created this website. I got a book deal, left the job at the nonprofit, and started writing full-time. I moved out of a lousy apartment in a great location and got a place with a view in a better one. I expanded this site into a full-time enterprise, supported by hundreds of readers in Seattle and beyond. I rebuilt my old relationships and built some new ones. I wrote that book. I stayed here, one day at a time.