How has lockdown affected addiction, rehabilitation and recovery?

Animation by James Sandifer – jimsandifer.co.uk

For many people lockdown has been an unpleasant experience, spurring negative emotions from boredom to loneliness to despair. Even if we enjoy solitude, few of us like to be forcibly isolated from the social groups that bring us support and companionship – especially during uncertain times. 

But what if your mental health absolutely depended on being able to sit with like-minded people and discuss your feelings? What if the absence of such facetime could cause you to spiral back into destructively negative behaviors that you already knew from experience could threaten your life?

Such has been the situation facing those with addictions. Many have sought help through rehabilitation and achieved a much more contented new way of life free of their previous compulsions. A great number of these have successfully maintained such equilibrium, often for years and decades, through 12-step programs such as Alcoholics Anonymous (AA) – but these are ongoing methods, requiring regular self-monitoring through attendance at "meetings" in which recovering addicts honestly share their experiences to help each other through whatever life may throw at them. 

Suddenly, as society closed down – and with it, the churches, school halls, scout huts, back rooms and rented areas where 12-steppers gathered in self-support – those meetings abruptly ended, just as the people who needed them most were being asked to adapt to an uncertain future in which a lethal new plague was straddling the globe. Would this create a perfect storm of relapse and spiralling addictions?

Increasing use and misuse

Doctors now recognize a perhaps surprisingly wide range of addictive behaviors. Misuse of alcohol and drugs (prescribed and illegal) are perhaps the most well-known, but gambling addiction is an increasing problem, while people may also have problems with shopping, overeating, workaholism, internet use, pornography, sexual relations, codependency, self-harm and a host of other issues. 

These behaviors can be coping mechanisms, from "a drink to calm the nerves" and on into patterns that can cause serious harm for the sufferer or those around them. These coping mechanisms may seem more necessary under upsetting conditions such as pandemic and lockdown, which can therefore increase their use and abuse. In the UK, alcohol sales rose 30 percent in March. 

The tragedy is that those coping mechanisms are often self-defeating. "People will often take alcohol to take the edge off their anxiety in the short term," said Michael Farrell of the National Drug and Alcohol Research Centre at the University of New South Wales in Sydney, but "the paradox of it is, if people are taking it for that, instead of reducing their anxiety over the medium term, it actually makes the anxiety worse. It's like a bounce-back effect."

Those who have trodden that path and sought help eyed lockdown warily, worried for others. Tim Morgan said his drinking dependence had "crept up on him" until he was drinking a bottle of whiskey a day and sought help. After 12 alcohol-free months, he worried for those who found themselves in a similar position: "If this outbreak took place a year ago, I'm not sure how I would have coped. That's why I worry for people choosing to continue in the same vein, instead of reaching out at a time like this."

Alcohol sales shot up in March – in the UK, by 30%. /James Sandifer/CGTN

One problem is that reaching out becomes much harder during lockdown, partly because the rules of engagement change. Michele Morphitis, a psychotherapist at the Bond Street Practice who also works for the Cottonwood Tucson treatment center in Arizona and previously spent seven years working with addicts at the world-famous Priory hospital in London, told CGTN there was "no question" that the use, misuse and abuse of addictive substances had boomed during lockdown.

"Alcohol and drugs are something to do if you're bored, if you're shut down on your own," she said. Even though only a percentage will have an addiction, increased consumption can have a knock-on effect: "Moderate drinkers are drinking more, so people who are more prone to addiction can get caught because the people around them, who normally wouldn't be drinking, are drinking more."

In the world of illegal drugs, things got murky quickly. By April, addiction charity We Are With You was warning that users may be at risk of overdosing or ingesting dangerous chemicals cut into impure drugs to maintain supply levels. 

"Some of the people we work with here in Scotland have been telling us that they're stockpiling drugs," said the charity's Andrew Horne. "But we're also hearing about supply difficulties, too, and that the purity of many drugs is decreasing as dealers cut them with different substances to increase their bulk."

"Drug dealers haven't stopped," Morphitis told CGTN. "Deliveries go on as normal with all sorts of things going on – in parcels, you know. If your addiction is to that sort of a substance, your supply is even better organized than it was before."

Lockdown – and, for some people, unemployment or furlough – sped up the spiral. As Morgan put it: "For those already struggling with alcohol, I'd be very surprised if they weren't drinking more during lockdown. Dealing with difficult or new situations can definitely make you reach for the bottle."

Isolation at home can lead to loneliness but also increasing patterns of addictive behaviors, including overeating and internet use. /James Sandifer/CGTN

"People who have existing alcohol issues and are isolating at home will not have the distractions that normal life provides," said Rebecca Harris of the Central and North West London NHS Foundation Trust. "They might be tempted to use alcohol as a way of filling this void, or coping with being cooped up in a stressful environment. Substance misuse services and GPs may also not be able to provide their usual level of support during the current crisis."

As with so many health concerns, GPs are often the first line of help: either the patient or the doctor suspects help might be needed, resulting in a referral to either public or private healthcare providers. But with GPs closed or only interfacing with patients via phone or online, that route quickly dried up.  

Rehab referrals in a pandemic panic

As numbers dropped, some organizations offering help with addictions felt the need to broadcast their continuing services. "With many hazardous and harmful drinkers tending to refer themselves into treatment via their GP, we want to absolutely reassure those wishing to access support that they can get in touch directly with their local service," said Caroline Phipps of the Welsh help service Barod in late April. 

"A drop in new referrals could mean people are unaware that help is available under lockdown conditions, but our services remain open and are ready to support anyone affected by drug and alcohol use in a time of unparalleled change."

Referrals also fell in the private sector. In mid-May, the UK Addiction Treatment Group (UKAT) revealed that admissions to its seven residential rehabilitation centers had dropped by almost a fifth in a month. UKAT treatment lead Nuno Albuquerque felt moved to issue a battle cry – "Addiction won't pause during the coronavirus crisis, and neither will we" – while reminding potential clients that a nice, clean private hospital might be a good place to ride out the pandemic. 

For many in the grip of an addiction, even those who acknowledge they need help, a pandemic is a perfect cover for a few more spins of the wheel: as Morphitis characterizes it, "the idea of 'I may as well drink now or use now and then I'll start my recovery later.'" Others, though, have held up their hands and asked for help. 

A newcomer's story: 'I was drinking all the time' 

Chris is 70, but could pass for a decade younger. With straight steely hair, neatly trimmed white beard, twinkly eyes and ready smile, he could be a poster-boy for the silver generation, an advertising model genially selling retirement cruises or life insurance. But that face wasn't always such a pleasant sight, even as recently as March. 

"I got to the stage where I was literally drinking all the time," he tells CGTN. "And I couldn't even say that there was any ostensible reason. But one Sunday I'd been out for a drink with my friends, and one of them dropped me back. I stumbled getting out of the car and cracked my head on the pavement."

For many with existing addictions, lockdown has increased the likelihood of relapse. /James Sandifer/CGTN

Bruised of face and broken of spirit, Chris knew enough to know he'd had enough. "My wife suggested that this was all getting ridiculous, there was an AA meeting at a church nearby, and it might be a good idea if I went along." Warmly welcomed in a way those with facial injuries rarely are in bars –it's hardly a good advertisement – Chris discovered why many in recovery from various addictions call their 12-step program "the fellowship."

Aware that boredom can encourage the reappearance of old habits, those in 12-step programs (there are several dozen, each adapted to varying addictions and afflictions) gently suggest – nothing is ever enforced – that newcomers try to attend several meetings in their early days. This is partly to keep themselves busy but also to experience that fellowship, and to learn more about how others have stayed clear of the behaviors that once ruined their lives. 

"Someone suggested to me that I do nine meetings in nine days," recalls Chris. "I did my best and I managed to do nine in 10 days. That took me to 16 March... and then social distancing came in."

This, then, was a crucial time for AA and other 12-step programs. Could the fellowships retain contact and remain strong? 

Taking meetings online

As history so often proves, technology provided a solution: hold meetings over an online conferencing platform such as Zoom, Skype or Google Hangouts. A handful of online meetings already existed, but necessity pushed thousands of the now-shuttered "physical" meetings towards the idea of re-emerging online. 

In the expressly non-hierarchical 12-step set-up, nothing was imposed from above, but each individual group's regular members pooled together to decide whether and how to go online. In south-west London, one such group was led by Gerry, a tousle-haired mid-40s man with eight years of sobriety, an affable manner and a gentle Irish accent undimmed by two decades in the UK capital. 

"After a couple of years of fluctuating work patterns, I'd got back to regularly attending my old Friday night meeting," he tells CGTN. "But by their own admission, they didn't have anybody who was tech-savvy enough to host a Zoom meeting. There was talk of just waiting it out until the virus died down, but I knew that could be months and I knew I could help.

"I owe that group a lot – it's the room I got sober in," he continues, his voice thickening slightly with gratitude. "I'd had various commitments with the group over the years – like greeting people at the door, or being the 'secretary' who chairs the meeting and organizes each week's guest speaker. I was always happy to give back, and I was happy to help out again. The group agreed, so I bought a Zoom subscription and set it up."

As thousands of groups around the world found their way online, attendees realized they could traverse the planet without leaving their chairs. As most groups in any given fellowship are open to all, meetings received visitors from far and wide, including abroad. 

"I've been to real meetings in a dozen countries and I tried a few more in those early weeks," recalls Gerry. "It was liberating to get around so easily. Our little group had visitors from California and Georgia, and there's a woman who lives 200 miles west of here who liked it so much she's come back every week. 

"But you can do that – it's like teleporting. One day I was working from home and my shift ended at 7 p.m., then I immediately joined a New York lunchtime meeting."

Not everybody was as ready to go online. Chris, who had just started to find his way around his various local groups, didn't fancy it. "I'm not a Luddite, I'm quite computer literate, but initially I didn't much care for the idea," he tells CGTN. But after a couple of weeks of phone calls with his new friends, he dipped a toe. 

Many 12-step groups have taken their meetings online – and reached new people. /James Sandifer/CGTN

"I eventually relented to the Zoom meetings in early April. I've had a pretty stable diet of meetings that I've been going to. Because of going to the same set of meetings, I've begun to recognize people, they recognize me and I've had lots of pats on the back and encouragement, and that's kept me going."

To his surprise and delight, Chris has now gone 14 weeks without alcohol. "I'm really pleased that I managed, through what is a very difficult period where everybody is going the opposite way because of the lockdown. I've actually managed to stay high and dry, which is unbelievable. I've never managed that before."

Skeptics and bombers

While Chris went from Zoom skeptic to convert, Julian didn't make the same journey. Closing in on 30 alcohol-free years – although he doesn't seem old enough, due to what Gerry calls "the AA facelift" of rejuvenated body and lightened spirit – he went along with his group's online conversion, but had his doubts from the start. 

"I spend most of my day sat here on this computer and a lot of the day in meetings," Julian told CGTN from his neatly ordered home office. "I couldn't make the transition from this being work to this same seat, same headphones, same screen being the fellowship."

He also found the online vibe very different from offline: as much of the white-collar working world now knows, Zoom meetings can present a distracting gallery. "I found the mix of blank screens, empty screens where people had left the room, people making cups of tea, people lying down and going to sleep or eating – all a bit disjointed." 

On this problem, Chris found a workaround: "I tend to work on Speaker view so I can concentrate on the message that person's trying to impart, just for me to see the similarities. It's a filtering process."

By late April, there were more serious distractions: with much of the world on lockdown, idle hands were wreaking havoc. Zoombombers target unprotected online meetings, lectures and conferences, disguising their identities and disrupting proceedings with noise and imagery, often offensive or pornographic. 

"It was a bad start," Gerry told CGTN. "Some people in 12-step programs are quite nervous anyway, and there was a lot of concern about protecting anonymity. It certainly didn't feel like the safe space it should."

Gerry's geniality was tested when his own meeting was bombed. "Nothing too bad, just literally a kid parroting what everyone was saying and singing 'I love weed,' but it was upsetting for some of the regulars.

"AA suggested a pretty good set of recommended Zoom settings – how to set it so people couldn't share screens, hosts could override and mute everybody, that sort of thing. The bombers dried up after that, and people are a lot more confident now. Most groups have a host as a digital bouncer, but I haven't heard of a bombing in months now."

The absence of contact

Although the aggressive interlopers were run out of town, some still say online meetings lack intimacy. Gerry says that real-world meetings are convivial, congenial affairs: "We laugh a lot, before and after the meeting and even during it. Someone can be sharing a story that seems desperate, but then she'll crack a joke about it and we'll all chuckle along with her – because we've been there, and we've got better.

"Then there's the hellos. You might have seen it in films and it's true – when someone introduces themselves in a real meeting, 'I'm Gerry and I'm an alcoholic' – everyone says 'Hi Gerry.' It might seem a daft little thing but it really roots you in the room. 

"That instant auditory feedback isn't there online, because virtual meetings sort of have to be mostly muted or all you hear is creaking chairs and every time someone sneezes their screen pops up. So you just see these people waving at you instead."

Even for the professional online Zoomer Michele Morphitis, who is in recovery herself, this can be a problem. "If there is a problem with Zoom meetings in the fellowships, it's that it's silent, the response is silent. That's the difference – you're talking to potentially a vacuum."

For Julian, that lack of human response was just too much. "I didn't like the fact that we couldn't really speak – even though we don't speak when someone is sharing, we all laugh at something funny and you couldn't even hear that. It just felt anaemic to me. 

"So I was realizing it wasn't working for me after a couple of weeks – it wasn't actually helping. I was beginning to develop resentments – well, not resentments: dislikes about the fellowship, so I thought it's better for me not to do this."

Like Chris, he maintained contact – "I was ringing people, an average of one per day, but I was just really missing being in a circle and the power that exists when we're all there" – and cooked up a plan: the socially distanced meeting in the great outdoors. 

Some group members have been staging socially distanced meetings to maintain their self-support circles. /James Sandifer/CGTN

"A few of us started meeting in quiet corners of the park, but Monday night we were up to 11 people in the sun and we'll be 15 tonight. I have to say I feel so different, I feel so glad to be back. I'm quite an isolator – I don't need daily interaction with lots of people – but lockdown has really made me realize how much I do value the interactions I do have.

"Someone pointed out, and this applies I think to the fellowship and to all work: we're all set up online, it's great, but we're all leveraging mostly existing relationships, which were established offline. It must be quite different for someone who has joined the fellowship online."

The flexible lifeline

Like all the recovering people CGTN spoke to, Julian was at pains to point out his personal opinion was not necessarily representative of all in AA or other 12-step programs. ("We don't tell other people what to do, and we don't speak on behalf of other people... we just sometimes make suggestions, and sometimes we even take them, too.") And he is well aware of the benefits of online meetings – they're just not for him. 

"I'm glad they're there for those who won't risk going out, who can't get out, for newcomers, I'm sure it's a great lifeline. And it's great that there are people willing to provide that service – but it's not been for me."

While recognizing its drawbacks, Michele Morphitis is also keen to emphasize the possibilities of online recovery. "I think that the 12-step fellowships should be really proud of themselves for how they've risen to that challenge and are continuing to put them on. I actually hope that they will continue even after the lockdown, because I think for some people it could be very helpful. 

"If you're very shy or self-conscious, with social anxiety issues, it might be a nice way of first connecting to a fellowship. You don't have to say anything, you can switch off at any time, nobody needs to see you, that kind of thing. 

"If you have a busy life, you can just sit there, click and off you go. That's the flexibility of it, that the timing could suit you: all you have to do is just go to wherever your computer or phone is and just plug it in."

For Chris, who has spent most of his burgeoning recovery in the online realm, the return of real-world meetings will bring a different balance. "I don't drive anymore, I've got grandchildren, my wife, a 90-year-old mother takes a bit of looking after these days – but I'll definitely go to the physical ones near me. I've got a bus pass and some are only a nice walk away. 

"I'll try to get a decent diet, but I'll supplement that with Zoom meetings. I might start to branch out a bit," he says. Like Gerry, he's already started to pay back the warm welcome he was given.

"I've finally managed to suss out using the chat function and one person, a contemporary of mine, gave the impression he was struggling, like I would have been struggling a few months back. I just said 'keep going.' There are a lot of people in a much worse place than me, without a doubt."

Some of them might be drinking or using more heavily than ever in lockdown; they might even be reading this piece. If so, does Chris have a message for them? "I can only reiterate what I was told: that it's never too late and there's lots of good people sitting beside you – or in front of you on a camera – who are willing to help you."

Morphitis insists that "there's absolutely no shame whatsoever in saying that you've struggled. In fact, it's the best time, because even the person who was the most in control has struggled, so you're pretty much in good company. 

"Making your first forays into seeing what the fellowship meetings are like, it's so easy to do it anonymously and not be clocked or watched or seen. Why not give it a go? You don't have to make a full-blown commitment, you can test it out a bit more easily. And I'd say, what have you got to lose? You might lose an hour of your time. But, potentially, it could change your life."

Some names have been changed to protect anonymity. 

Originally published by CGTN Europe, 2 Jul 2020.

Imagery by the quite brilliant James Sandifer.