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May 31, 2020
“From our patient experience at McLean, there are many impacts on the population of people who are using substances and in need of stabilization during the pandemic, as well as those just trying to maintain their recovery,” said Connery. She explained that among the greatest challenges are changes in drug and alcohol testing, reduced access to care, and transitions to virtual treatment.
One of the most dramatic changes brought on by COVID-19 involves halting tests for drug and alcohol use. These tests include urine drug screens and saliva samples for drug screening and breathalyzer tests for alcohol use disorder. Because they involve bodily fluids and aerosols, these types of tests raise the risk of spreading the coronavirus. To ensure the safety of patients and health care workers, Connery said, “For the most part, we’ve put toxicology monitoring on hold.”
This hold on testing has implications for patients and treatment teams. “Toxicological monitoring has always been an important part of treatment,” Connery stated. “If you’re a clinician, it’s one of the only objective pieces of data that you have to verify if a patient is using or not.” Also, she said, regular drug and alcohol screenings “serve as a kind of check and can be a real deterrent for the patients,” who might otherwise relapse.
Hospitals and treatment facilities are prioritizing the safety of patients and workers, which has led to changes in the environments where patients get treatment. Connery explained that to help individuals break the cycle of using, it is sometimes essential to take “a patient from their community environment into a contained environment.” This process can involve inpatient hospitalization for detoxification or medical withdrawal management. Treatment can also take place in residential settings, such as short-term residential treatment, and longer-term residential facilities, such as sober housing. With the COVID-19 crisis, many of these facilities have cut back services or closed altogether.
“Because of all that has gone into preventing this very contagious coronavirus, we’re struggling right now,” Connery asserted. “Many places haven’t had the ability to stay open, so that immediately cuts out services,” she said. “Places that have the ability to stay open, like McLean, have had to make a series of intensive changes for the safety of both patients and staff.”
Changes include reducing treatment program capacity so that every patient can have a single bedroom and requiring six-foot social distancing separation for group meetings and regular interactions, like dining together. These changes have had a profound impact on the nature of substance use disorder treatment. “People are not able to congregate in the normal ways that people do,” Connery said. “It throws a wet blanket on what is otherwise usually a really relaxed, informal, and cozy treatment environment.”
Also, social distancing introduces new stress to the treatment experience. “People are worried. ‘Who’s sick? Who’s not sick? Who’s incubating? Am I six feet away? What about that person that just sneezed?’ There’s a lot of tension there,” she said.
To make things safer for patients and staff alike, many addiction treatment facilities have introduced virtual or online support groups and care services. Patients who meet one-on-one with a psychiatrist or therapist can conduct a telehealth session during the pandemic. Some facilities are also able to offer group therapy programming online, with strict privacy settings and procedures. While these new approaches eliminate the need for social distancing, Connery said there are still issues and drawbacks.
“Many types of peer-led support groups have converted to virtual. The conversion has sometimes been difficult,” asserted Connery. Problems stem from the high volume of people joining online meetings and a lack of resources to address technical issues.
Also, virtual peer support groups have had some issues with privacy and security. Some people are “crashing” these calls, Connery reported. These meeting crashers often insult participants or disrupt the flow of conversation. “These people are ruining what would otherwise be a recovery support meeting between people who are humbly working hard, trying to support each other,” she said. “It’s been disruptive.”
Beyond technical and privacy issues, Connery said that virtual support groups simply do not offer the same intimate experience people fighting substance misuse issues are accustomed to and benefit from. “Virtual is a good tool. It’s better than nothing, but it’s very different from the usual experience of being able to go to a group and be hugged by people who care about you,” Connery said.
“There is a communal contact aspect that is very personal and very real. It’s in the moment and face to face,” she said. “And I think people are really missing that piece in the same way that all the rest of us are missing that piece in a variety of different ways.”
Despite the drawbacks, Connery encouraged everyone to embrace new technologies and new approaches to care. “Take advantage of the supports that do exist, including virtual supports,” she said. “Many people say they don’t like it as much as in-person treatment, but it is a treatment support that I encourage people to try to use during these times. And a lot of virtual treatment, especially individual care appointments, has allowed many who otherwise could not access care to experience high-quality addiction care … and this is certainly worth preserving.”
McLean is a leader in substance use disorders treatment. If you or a loved one are struggling with misuse of drugs or alcohol, we are here to help.