The COVID-19 pandemic has caused various levels of social isolation since the early stages of the outbreak. People recovering from addiction need therapies that rely on close social networks, so losing those connections can create obstacles to recovery. Fortunately, the UAB Medicine Addiction Recovery Program (ARP) found ways to adapt to the pandemic’s social restrictions.
The ARP provides expert care for people with substance use disorders. A team of providers from multiple medical specialties offers a variety of personalized treatment plans, support networks, and recovery paths for each patient. The staff combines knowledge and skills from a wide range of areas, including spirituality, communication, grief, and trauma. This approach to rehab creates a strong support network for each patient. That network extends to a patient’s family, so the ARP also offers support, education, and therapy to spouses, caregivers, and other family members. Care is individualized, based on expert assessment of each patient’s conditions and needs.
Effective rehab requires one-on-one, in-person communication with the ARP team and/or group therapy sessions with others in recovery. ARP Director Bronwyn McInturff, MSW, LICSW, says the COVID pandemic has made this process challenging.
“Addiction is already a very isolating disease,” McInturff says. “Because of that, a large part of recovery involves re-establishing and maintaining connections with others. What we faced with COVID was an almost immediate move to isolation for everyone. This created a huge obstacle for people who wanted to begin or continue recovery. Most people can relate on some level to the problems of isolation due to COVID. But for people with substance use disorders, that kind of ongoing isolation has far higher stakes. It can be deadly.”
Virtual Support Networks
Patients in recovery must be able to engage with members of the ARP staff, and they also may need to participate in sessions with other patients. They often need to rebuild family relationships, integrate themselves back into the workplace, and re-learn the skills for doing those things. Building a network of support calls for ongoing social interaction, which in turn requires some amount of immediacy and intimacy. The COVID pandemic disrupted those networks.
“There were numerous disruptions,” McInturff says. “In the first year of the pandemic, we saw data that showed entry into treatment was in decline and overdoses were increasing. Sober support groups that meet daily were put on hold. Patients who come in for treatment with us and undergo psychotherapy were put on hold. Other data indicated that people who might not have been drinking to a dangerous level began drinking more than normal, putting them at risk for addiction. So we had to quickly find solutions to those losses of connections due to isolation. We tried meeting in parks and other locations with social distancing, but we settled on using technology. With tech solutions, we could create intimacy and bonds through technology that we couldn’t achieve with social distancing.”
McInturff is specifically referring to Zoom, the software that the ARP now uses for videoconferencing with patients.
“It’s true that videoconferencing never matches the intimacy and energy of meeting in person, but the upside is that participants were no longer limited by geographic, time, or travel constraints. You could now go to a virtual meeting from anywhere, and that meant that ARP could serve patients we never served before.”
McInturff says the ARP team anticipated that younger patients would adopt videoconferencing faster than older ones might. Through innovation and creativity, the staff found ways to make virtual connections easy and effective for patients of any age.
“We did a lot of coaching of those who were not used to this kind of communication, and they took to it quickly,” McInturff says. “As providers, we had to figure out ways to make videoconferencing as personally connective as possible, or at least more intimate than it might be for business meetings or presentations. We break out from the larger meetings into smaller groups, and we sometimes use visual aids to compensate for the lack of body language and cues that you have with in-person meetings. The main success is that we are providing the support networks you need in recovery, even if right now they are virtual networks.”
Unexpected Benefits
Along with making ARP more accessible by extending its geographic range, using videoconferencing provided some new insights for staff and created convenience for families.
“We’ve learned a few small but different ways to assess progress,” McInturff says. “We have videoconferencing guidelines, so that everyone keeps their cameras on, keeps the sound adjusted, and makes sure the camera is aimed properly. Not doing so can sometimes signal that a patient may not be doing well or isn’t fully engaged with the program. We look for those signals to assess the level at which anyone is committed to recovery. We might have someone who wears certain clothing, such as a hoodie, to hide reactions, or may not look directly into a camera in the early stages. As they became more open and stop those behaviors, we can measure that progress. All of those small details were advantages we didn’t know videoconferencing would provide when we first decided to use it.”
Because substance use disorders often affect a patient’s family, ARP offers family workshops, individual family sessions, and weekly support groups. This gives loved ones some sense of connection with the recovery process for patients and helps avoid the disruptions of COVID restrictions.
“We had to adjust some of our timeframes,” McInturff says. “It’s hard to sustain all-day meetings for hours and hours via technology. We moved services that meet three days, all day – for example – to every Monday at noon. What we discovered is that our no-show rate has dropped to almost nothing. Family therapy is often limited by work schedules, and most people can’t show up every day to support a family member who is in recovery. But with videoconferencing, we’ve seen an increase in family participation. That’s definitely been a win.”
Click here to learn more about the UAB Medicine Addiction Recovery Program.