“Eddie," a patient in our addiction psychiatry clinic, overcame several significant losses in the last few years. First, his mother passed away; then, his partner. His grief was compounded by his underlying depression and anxiety, which, with considerable effort, were mostly kept at bay with medication and psychotherapy. Still, Eddie remained steadfast in his abstinence from opioids and alcohol. He attributed this to his active engagement in his comprehensive treatment plan — weekly group and individual psychotherapy, along with frequent appointments with his psychiatrist and his primary care doctor.
When the pandemic hit last March, many of these sessions disappeared. While group therapy did not resume right away, the appointments with his psychiatrist and therapist were offered via phone or video, which posed significant issues for Eddie, given his poor cell phone reception and lack of experience with video technology. When he did speak via phone with his psychiatrist, Eddie sounded distant and unengaged. He lost his job, and with no family nearby, the increasing isolation got to him. The depression crept back in and his anxiety heightened.
Recent data shows that those with addictions are eight times more likely than those without to get COVID-19.
We referred him for a more intensive level of care, but this program was also virtual, and Eddie didn’t participate. Eddie needed an escape. He found his thoughts returning to the place where they hadn’t been in years — drinking — and he relapsed. Fortunately, Eddie’s trust in his treatment didn’t completely fade, and he reached out to us shortly afterward. We helped him enter a detoxification program — ironically, a type of treatment that can’t be done virtually. While he is doing better today, Eddie is not alone in how the pandemic affected him.
People with addictions have suffered disproportionately during the COVID-19 pandemic. Recent data shows that those with addictions are eight times more likely than those without to get COVID-19. And if they do, they are significantly more likely to be hospitalized and die, in part, because they are also more likely than those without addictions to have other significant medical problems like heart disease, diabetes and cancer. Increased stress and anxiety can lead to the use of poor coping strategies, making those with a history of addiction more likely to relapse. While job loss during the pandemic has undoubtedly created financial stress for many, it has also contributed to feelings of helplessness and unstructured time, both of which can lead to relapse.
Additionally, many addiction treatment programs are group-based. Therapeutic groups, such as group psychotherapy and support groups like Alcoholics Anonymous, are often considered a cornerstone of treatment. Positive peer support, reduction of isolation and a sense of accountability are just a few of the many benefits. Furthermore, there is evidence that therapeutic groups are as effective — and potentially more effective — than individual therapy for those with addictions.
Many who experience virtual treatment feel that it is inferior to in-person treatment.
Due to the pandemic, almost all group treatment programs have gone virtual. Some patients cannot afford the phone or computer required to participate, and others, like Eddie, have trouble navigating the new technology. Many who experience virtual treatment feel that it is inferior to in-person treatment. Virtual groups can feel distant, less supportive and awkward. Furthermore, there is a loss of the behaviors associated with attending group programming -- adding structure to the day and getting out of the house are therapeutic. For many, the value of these behaviors cannot be understated. While we recognize and applaud the enormous time and effort placed into creating virtual group programming, it’s important to acknowledge that the patient experience is not the same.
Worsening mood and addictions in the setting of fewer and less effective treatment options can lead to feelings of helplessness in both patients and their treaters alike. As such, in the Division of Addiction Psychiatry at Beth Israel Deaconess Medical Center, we have found that increasing the frequency of virtual appointments has been essential for helping our patients stay engaged in treatment. The increased contact has allowed us to minimize the “virtual void” left by telehealth and increase our patients’ trust and engagement in treatment. Even brief check-ins can enhance connection to patients and their commitment to treatment. Furthermore, these check-ins can serve as a reminder that our patients are not alone in their battles against addiction.
The COVID-19 pandemic has created numerous challenges for patients and clinicians alike. For all patients, and particularly those with addictions, increased contact and support from providers can go a long way in helping patients to feel less alone and more engaged in treatment.