Staying away from one another is critical to stopping the coronavirus. But this distance also risks keeping people away from life support.
"It's a real danger," said Mike Marshall, executive director of Oregon Recovers, a coalition of addiction recovery groups. Recovery people, he said, rely on group meetings to provide community and responsibility. Introducing yourself regularly to say "I'm Mike, I'm an alcoholic" is one way of defining his problem while asking for help from people in the same room.
"I don't have it anymore" because of the coronavirus, he said. "And then, moreover, our whole life has also changed," accumulating financial and family pressures on people who are already struggling.
The problem goes beyond 12-step groups and ranges from people treated for depression to couples working to repair their relationship.
Matt Mishkind, deputy director of Helen and Arthur E. Johnson Depression Center at the University of Colorado School of Medicine in Denver, is concerned about families learning to juggle work and school at home. "We will begin to see many more parenting issues, and probably more need for family services," he predicted.
Needy people can find different ways to reach. Marshall said that the problem with those seeking to recover from addiction is urgent.
"It's a matter of life or death," he said. "Already in Oregon we lose five people a day from alcohol-related deaths and one or two from a drug overdose. I have no doubt that that number has increased since it happened."
Mutual aid meetings, like anonymous alcoholics, operate independently. This makes it difficult to coordinate the change.
Many meetings closed, while others moved online, Marshall said. His organization quickly gathered a list of online dating and other resources on oregonrecoverynetwork.org.
He sees them as a fixed point. "Being in a room and listening to someone's story or challenges or solutions is a very different experience than watching it online or being on the phone," he said.
But video therapy is by no means new. And Mishkind, who helped develop telehealth programs, said research and clinical practice show that they can provide mental health care on a par with face-to-face meetings.
In some cases, video can be an advantage, he said. The removal effect can make some people more willing to disclose information. Particularly relevant at the moment, he said, is that it can reach people who cannot reach a therapist's office.
Research shows that patients initially tend to be happier than suppliers. After Mishkind's own clinic went completely online due to social distancing, a colleague said that customers almost immediately started saying, "Wait a second. Could I have done it all the time?"
But he acknowledged that groups can be difficult to manage online. Organizers may miss those "subtle things that happen out of the corner of an eye". But technology also has advantages. The teaching materials are easy to share, for example. And organizers can use the mute feature "so you don't have people talking to each other."
Julie Kubala of Superior, Wisconsin, is a fan of the type of support she found online.
After a heart attack in 2016, he participated in various online forums and cardiac rehabilitation, which includes in-person counseling. He also just completed an outpatient program, which included group sessions, to help with post-traumatic stress disorder after an almost fatal car accident.
She is usually averse to technology but she is a fan of her online community, which she compared to a "beacon in the night" when she discovered it. And, he said, everything that got there was as good as what he got from his group in person.
Convenience, even before social distancing, was a big factor for someone in a small community. "I could access it after work," he said. "I could access these things at four in the morning when I couldn't sleep at night."
For people without Internet access or who are not comfortable with computers, telephone therapy is another option, said Mishkind. Research shows that so-called asynchronous therapy, such as text messaging with a licensed professional, can also help.
People who need mental health care should start by contacting their existing provider, if they have one, and the insurance company to confirm which services are covered, he said. A doctor can decide if the problem is something that can be managed through telemedicine, he added.
An employee care plan can also guide people to help.
Marshall suggested that people who are dealing with addiction first seek help by calling someone they know in recovery. In addition, each state has an addiction help line. Alcoholics Anonymous provides a list of online meetings on aa-intergroup.org.
People with pre-existing mental health conditions must continue their treatment during the crisis, according to the Centers for Disease Control and Prevention. Refer people to the Disaster Distress Helpline of the Administration of Substance Abuse and Mental Health Services at 800-985-5990.
"If you know someone in the healing phase, talk to them," he said. "Even if they seem to have it together. They are really difficult times."
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