No matter the weather, the sweeping porch at the Uptown Club, a majestic brick mansion on the corner of Hamline and Summit Avenues in St. Paul, is usually filled with people. A popular AA recovery club where individuals facing the disease of addiction go for meetings, community and support, the building is now shuttered until further notice, thanks to COVID-19. The porch stands empty, with nothing but the lingering smell of cigarettes to remind you that anyone was ever there at all.
Social isolation, while an important tool in fighting a pandemic, has been rough on the Minnesota’s recovery movement. A central feature of most addiction treatment programs is community, and for decades, community has meant face-to-face meetings, often in large groups.
Statewide restrictions placed on the number of people who can gather together have meant that Minnesota’s many recovery programs have had to rethink the way they work.
William Cope Moyers, Hazelden Betty Ford VP of public affairs and community relations, explained that because addiction is an illness of isolation, community — like the Uptown Club meetings — is an important antidote that can help keep a person from relapsing into substance use. In an age of shelter-in-place and social distancing, he and other leaders in the state’s addiction recovery community are planning as they go, working to create options that can help keep people healthy and sober.
“We all know that community is about engagement — one alcoholic talking to another, one group interacting with each other and all those other things that are about smashing the silence and the secrecy of this illness,” Moyers said. “In this time, with this pandemic, we all know that community is being redefined and how we as people in recovery engage our community is not the way we would’ve done it even two weeks ago.”
Because addiction and mental illness are so closely intertwined, Moyers added that the stressful times we are living in can be particularly triggering for people struggling with addiction.
“This is a time that is unprecedented in recovery, in the field of addiction and mental illness,” he said. “It is a time where people are being asked to be counterintuitive around the way we typically recover — and yet it is also a time where we must continue to take care of ourselves, despite the uncertainties, the stresses and the pain of it all.”
While no one is immune to the psychological stress of COVID-19, Moyers continued, people with substance use disorder (SUD) are particularly vulnerable: “Those of us who have chronic illnesses like substance abuse and mental illness, we need to do what we need to do to take care of ourselves.”
In other times of national crisis, like the 9/11 terrorist attacks, people with addiction were able to gather together in community to find support, Moyers said. But this is different.
“This is not like 9/11, because back then we all rushed off to our recovery meetings or churches or yoga or sat on our front porches and talked to our loved ones about that horrible moment. This is not that. it is fundamentally different because we as a society can’t come together and physically hold on to each other. Yet somehow we must learn how to hold on to each other differently.”
‘We have to continue helping people to be sober’
While he is as concerned about the spread of COVID-19 as anyone, John Curtiss, president/CEO of The Retreat, a comprehensive addiction recovery program based in Wayzata, believes that even with the threat of a pandemic hanging over their heads, he and his colleagues can’t step away from their work. Too many lives hang in the balance.
“Addiction is still one of the largest killers in our country,” Curtiss said. “We have to continue helping people to be sober and help them to stay on the right side of this problem or they are going to end up overloading our emergency departments, especially when those departments might be needed for coronavirus patients.”
Earlier in the month Minnesota Gov. Tim Walz ordered the closure of schools, and asked that non-essential employees work from home when possible. Essential services, including health care, child care and residential care facilities, were allowed to stay open.
This means that the state’s residential treatment programs are considered essential, and they can keep operating, after making changes to meet CDC infection-reduction criteria. Last week’s “stay-at-home” order [PDF] further expanded statewide rules and requirements around social isolation, but continued to allow for the operation of residential addiction treatment facilities.
Though some might consider inpatient addiction treatment optional, like elective surgery, recovery advocates including Curtiss and Moyers explain that for many people in the throes of addiction, access to inpatient treatment is a matter of life or death.
Even though COVID-19 is rightly claiming our collective attention, Moyers said, it is important to remember that addiction remains a deadly epidemic of its own. “In 2020, 70,000 people in America will die of accidental overdoses. Another 88,000 people will die from alcohol-related issues. The pandemic of coronavirus is real, but so is the epidemic of addiction and mental illness. We cannot afford to pay attention to one at the expense of another.”
And though, unlike a virus, addiction isn’t contagious, an untreated alcoholic or drug addict can easily cause harm to others, he said. “A drunk driver is not only dangerous to her or himself. They are also dangerous to everyone else on the road.”
Greg Jones, director of substance use disorder at Turning Point, a culturally specific addiction treatment center based in Minneapolis, said that for many of his organization’s clients, inpatient addiction treatment is a last-ditch effort. That’s why it is important that as many as possible are able to complete their residential programs, even in the face of pandemic.
“When people come in for treatment, they are at the end of their rope,” Jones said. “If something comes up and they are abandoned, that could be really bad.” While Turning Point has decided to not take any new clients for the time being, the program will continue to provide care and treatment for those still enrolled.
“We will stay open,” Jones said. “It’s important to provide care for the people that are here now.”
Walz’s stay at home order means that families will likely be seeing more of each other than usual. Curtiss said he believes that this close proximity will reveal addiction problems that in normal life could usually be kept hidden.
“Families now are all together,” he said. “Some of them are seeing their loved one in full force with their addiction.” That makes it all the more important to get the message out that addiction treatment options are still available in Minnesota. “We do want people to know that we are still there to help people if someone needs to get out of the burning house. We have a safe environment for them to go to.”
Curtiss added he sees signs that COVID-related stress is leading some in the state to increase their dependence on addictive substances.
“There are a lot of people at home drinking themselves into oblivion,” he said. “When I drive by 394 and Wayzata Boulevard, the only store open is a liquor store. Their parking lot is packed. I’m thinking that eventually a lot of those cars are going to end up in our parking lot.”
Because the response to the pandemic is changing so rapidly, Curtiss said that he won’t even try to predict the next big change that’s on the horizon. For now, he said, The Retreat’s residential offerings will go on as usual, with capacity reduced in order to ensure that all guests have a private room. His long history of adhering to 12-step principles informs his approach going forward.
“This is a one-day-at-a-time thing,” Curtiss said. “I’m doing my best to stay comfortable with that. Every day we’re making calls about what to do and how to do it, but for now we are still serving those in need.”
What happens in the next few weeks will be critical to Hazelden Betty Ford’s mission and margin for the remainder of the year, Moyers said. Though he has concerns about how this crisis will impact the viability of his and other recovery programs, his colleagues give him reason to feel hopeful.
“I am a long-time alum, a donor and a colleague,” Moyers said, “and I can say, professionally and personally, that what our employees do every day now is nothing short of inspiring and a reflection on what’s required in these unprecedented, unpredictable times.”
Impact on inpatient treatment
While many inpatient treatment programs remain open and continue to accept new patients, some are seeing a downturn in their numbers that can be chalked up to COVID fears.
At Hazelden Betty Ford in Center City, Moyers said, “We are seeing softening in the census. We are seeing some signs that people are not willing or ready or able to travel to residential treatment right now. It’s not a precipitous drop like it was after 9-11, when the airlines stopped flying. It is not cataclysmic, but it is a steady softening in our residential treatment at most of our sites.”
Still, some Hazelden Betty Ford inpatient programs remain fully occupied.
“In Oregon,” Moyers added, “we have more patients than we’re budgeted for. We’re full. The reason for that is most of our patients that get residential treatment in Oregon are from Oregon. They can still get there in their cars.”
Turning Point’s census is also lower than normal. Jones said that reality makes it easier for the program to keep participants safe. “When there aren’t as many clients, it makes it a lot easier to practice social distancing,” he said.
The building is also maintaining a strict cleaning policy, Jones said: “We have a guy who comes in every hour on the hour and sanitizes the building. The rails and doorknobs are wiped down and sprayed with disinfectant.”
There are also hand-sanitizing stations set up all over the building. “We don’t let people go in to the group rooms without washing their hands and sanitizing,” Jones said. “If they go on a break, the whole group will sanitize before they come back.” Residents and workers also wear gloves, and with the stay-home order, staff will be reduced to essential employees only, including workers who provide 24-hour monitoring for clients.
At Hazelden Betty Ford, anyone entering the buildings has their temperature taken.
“We are a medical facility,” Moyers said. “So we are taking the proper precautions, including taking the temperature of anyone who comes on our campus. That includes person filling the pop machine, the doctors, all patients, any other visitors.”
At The Retreat, residents, as well as everyone entering the facility, also get regular temperature checks. And with non-essential staff working from home, they’ve had no problem meeting recommended spacing requirements.
In normal times, The Retreat has a stand-alone 18-bed retreat center, where family members can stay overnight for special programming. These programs have been temporarily suspended, so the building has been designated as a place that can hold any guests who experience COVID symptoms.
“We are closely coordinating with the CDC and Minnesota Department of Health about the right procedures,” Curtiss said, “depending on the severity of the symptoms.”
Census in The Retreat’s residential side has shifted, Curtiss said: “The women’s side has gone up a bit. The men’s side is a little down. We have capacity for 41 in the men’s side, but we’re in the mid-20s right now. Frankly, I’m happy about that because it allows me to manage a smaller population in terms of distancing and safety.”
For now, Curtiss is still coming into work each day. “I have to be there,” he said. “The guests would not feel as safe if the key staff were not present. We have identified who the key staff are. And if any staff member is nervous about coming in, or has a family member that is not feeling well or has recently traveled, we say, ‘Don’t come in. Stay away.’”
Socially distant alternatives
Now, more than ever, people living with SUD need to come together. Moyers said. He’s encouraged to see the range of virtual recovery meeting options that are popping up everywhere, like hopeful spring buds in a thawing garden plot.
“People still need to recover,” he said. “Online meetings are proliferating like crazy. It’s heartening to see it.” While he thinks that virtual meetings will never replace powerful face-to-face contact, he believes it’s a good option that many will embrace in the coming days.
In an unintended confluence of timing, earlier this month Hazelden Betty Ford announced that it would be making its intensive outpatient programming available in an online format. The program, called RecoveryGo, has been in the works for “months,” Moyers said. The program, also known as Virtual Intensive Outpatient (VIOP), will be available in the seven states where Hazelden Betty Ford’s counselors are licensed to practice.
“We’ve been planning this for a long time,” Moyers said. “It cost us a lot of money, a lot of intellectual capital. We didn’t do it for a moment like this, but it is serendipitous. We can now provide services to people in their living rooms in Minneapolis, just like we can at their cabins in Duluth.”
While Moyers stressed that VIOP wasn’t designed to replace in-person treatment options, he said, “This is just another way to harness the power of technology, the power of social media, to provide licensed clinical care.”
One plus of RecoveryGo is that it can make intensive outpatient treatment available for people who otherwise couldn’t afford the program.
“Not everybody can take time off work or reschedule their lives to go to outpatient treatment in St. Paul,” Moyers said. “This is another way to meet people where they are at — virtually and literally.”
At The Retreat, staff has been working hard to set up large-screen TVs to accommodate virtual talks from visitors and volunteers who can no longer come to the facility.
“We’ll still be hearing from a lot of interesting people,” Curtis said. “We’re keeping the curriculum robust.”
Even with all the planning and innovation that is going into keeping recovery programs healthy in the age of COVID, Moyers admitted that for a time, at least, everything will feel different. “Recovery has to adapt to reality,” he said, “just like everything else. Nothing is the same. It doesn’t mean it has gone away. It is just different.”
While everyday life will change — at least for now — Moyers is convinced that in-person AA meetings will survive this pandemic. When the crisis lifts, he said, they’ll re-emerge, stronger than ever.
“AA has been around since 1935, and wars have come and locusts have come. Those meetings will remain. They’ll come back. I think we will have ignited a new generation with these new virtual options, but the bread and butter will still be here. Just for now, anyway, the bread and butter is going to taste a little different.”