The computerized dial tone pulsed repeatedly, but my patient did not appear on my screen. Although we had met only a couple of times by video after more than a year of in-person meetings, my thoughts immediately raced past possible technological problems to worries that she had relapsed after eight months of hard-fought sobriety from alcohol. Working with patients with substance use disorder, clinicians grow accustomed to suspecting a relapse when a patient does not show up for an appointment.
My fears were confirmed a few weeks later when my patient told me that she had begun drinking again after she was laid off from her server position at a local restaurant. It has been a bumpy ride ever since, complicated by anxieties about health, job security, and social isolation caused by the coronavirus pandemic. But she is not drinking now and, with considerable effort, she found another job. Still, we have yet to be able to achieve the stability she enjoyed prior to the onset of the pandemic.
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People with substance use disorder have been hit especially hard by COVID-19. Recent studies show that addiction increases one’s chances by 8.7 times of getting COVID-19 and also worsens the course of the illness, making hospitalization and even death more likely. The stress and worry that came with the pandemic have proved to be a stern test of the coping strategies of those with substance use disorder.
While always a possibility before the pandemic, relapse has been thrust into the forefront of the thoughts of all affected by addiction — patients, their families, and those who treat them. For those affected, there is a heightened state of alertness and fear of relapse and death, a constant weariness that can be tough to escape. Several of our patients have died during this grim period, and patients who have worked desperately to stave off relapse have been forced to do this for almost a year, with no clear end in sight.
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The Division of Addiction Psychiatry at Beth Israel Deaconess Medical Center is doing two things to address this problem. First, we are providing evidence-based care with an emphasis on more frequent interactions by telehealth or phone. We aim for our program to be “high touch,” meaning that we work hard to communicate with patients clearly, often, and with a focus on a patient’s particular needs. If a patient misses an appointment, a clinician will call the patient to make sure they’re OK. This helps us build a strong alliance with patients who may feel marginalized, in part by stigma against substance use disorder. We make it clear that they are not alone; we are on their side as strong advocates in a lifelong fight.
Second, we are trying to improve our care by adapting to current conditions. Treatment programs were not developed with COVID-19 in mind — innovation and adaptation is urgently needed. In response to the unique conditions created by the pandemic, we designed the Launch Early Abstinence Program, which features multiple telehealth groups each week. The program is novel because it creates a level of care below intensive outpatient programs and above standard outpatient care. LEAP groups meet fewer times weekly than IOP groups but for more weeks. Special focus will be placed on issues like isolation, depression, and anxiety, which have been exacerbated by the uncertainty of the past year.
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Like many things that have become more difficult due to COVID-19, it has been harder to help our patients stay sober. A hard job has become harder. Our work has required more time, effort, and energy. As clinicians committed to treating those with life-threatening SUDs, we recognize that this is a challenging time, and we must rise to meet this moment.
Dr. Kevin P. Hill is director of the Division of Addiction Psychiatry at Beth Israel Deaconess Medical Center and associate professor of psychiatry at Harvard Medical School.
