“John,” a 48-year-old patient in the Beth Israel Deaconess Medical Center Addiction Psychiatry clinic who works in construction just outside Boston, managed to stay abstinent from alcohol for two years before the pandemic. He was stable on medication for his depression combined with psychotherapy and Alcoholics Anonymous (AA) meetings.
Then came Covid-19 and, for John, a relapse of real consequence:
Chronic migraine pain led him to see a neurologist who recommended ibuprofen. But the pain was difficult to manage so he began to self-medicate with an opioid pain medication he bought from a friend at work. Within weeks, he went from taking the opioids as needed to taking them daily.
He also began using cocaine and drinking alcohol again. His work suffered, money became tight, and his ex-wife no longer let him see his kids on the weekends. John eventually went to detox four months ago and has been trying to pick up the pieces in his recovery since.
The medical staff at the detox facility changed his depression medication. They added three new ones, making it hard to know which was the most helpful. He had stopped seeing his therapist before his relapse because he felt stable, and she could not take him back because her clinic was full.
John’s health insurance was requiring weekly psychotherapy appointments in order to cover buprenorphine-naloxone (Suboxone), the medication for his opioid use disorder. He was paying over $300 a month out of pocket, which he could not afford.
At the same time, he was trying to attend virtual AA meetings but found the technology to be spotty and the remote group work less effective. Despite these challenges, he has remained sober since his detox admission.
Many of our go-to resources for addiction treatment have changed or disappeared since March 2020. The number of detox beds decreased due to Covid-19 regulations. In-person intensive outpatient programs went virtual. AA meetings could no longer meet as a group, moving online instead. The increased need for mental health support has made finding and keeping a therapist challenging.
With stress levels heightened, anxiety and discomfort can lead to the use of poor coping strategies, like what happened to John, contributing to his relapse.
John, and many others, don’t like telehealth for many reasons. It’s harder to connect when you are not in the same room with others. There is a loss of structure, eliminating the benefit of getting out of the house and being with other people. While telehealth is a great idea and it has some advantages, it’s important to acknowledge that the patient experience is not the same.
In our division, we have had to be creative to help our patients stay engaged. We meet with our patients more often. We help our patients work through any technology issues that may arise. We have added brief check-ins to remind our patients that they are not alone in their battles against addiction. We know that Covid has made things harder, but we are in it for the long haul with our patients and we’re confident that we can get through this together.
While accessing care has been complicated during the pandemic, talk with your Primary Care Doctor if you are worried about your drug use. They may be affiliated with a medical center that has a specialty addiction treatment program. If you are worried about a family member, consider the Massachusetts Substance Use Helpline (helplinema.org) for services local to your area.
Denise Studley, a Dorchester resident, is a nurse practitioner and nurse care manager specializing in addiction psychiatry at Beth Israel Deaconess Medical Center.