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Path to recovery gets a detour as 12-step programs go remote

Groups to help people recovering from alcohol or drug use disorders are moving to conference calls and video chats. Experts say they can be effective but might leave some people out.

Pause a While's 12-step meetings are usually in the former dining hall of a sailing camp on the elbow of Cape Cod, Massachusetts. It holds four to five meetings a day for local residents.

On Monday, it met over the phone, and over 300 people called in from around the country.

As the spread of the coronavirus continues across the U.S. and states have taken drastic measures to get residents to practice social distancing, people in recovery from alcohol use and substance use disorders can't go to their regular meetings, like Alcoholics Anonymous. California issued a stay-at-home order Thursday, New York on Friday mandated that all nonessential businesses keep workers at home, and Illinois issued a stay-at-home order Friday, as well. Those are just a few of the states making sweeping changes to limit person-to-person interactions as confirmed cases of the coronavirus were at nearly 250,000 Friday, according to Johns Hopkins University.

Stuck at home, people have turned to video chats and conference calls to find support with mixed effects. But as gatherings of more than 10 people across the country have been banned, meeting places like churches have closed and recommended curfews have been instituted, remote meetings are proving to be people's only option, and one that experts recommend.

Paul Dart, who works at Pause a While, which functions as a meeting space for 12-step programs and a social house for sober events, said the nonprofit decided to have dial-in meetings this month as older participants began staying home amid coronavirus fears.

For the first meeting, on March 2, nobody called in. That continued until March 13, when nine people called in. On March 14, a Saturday, 20 people called. On Sunday, 90. And on Monday, the number ballooned to 330. Most of the callers weren't from Cape Cod or even from Massachusetts.

"We wanted to have a resource for the people in our little community to be connected back into their groups and to hear the voices of the people they knew from their meetings," Dart said. "But we didn't have the heart to say no to others who were calling in."

Information about the call made the rounds on social media. People from Seattle, the first major city in the U.S. badly hit by the coronavirus, dialed in and talked about their experiences in lockdown. Others shared their anxieties about what's to come. Dart described the meetings as "phenomenal" and "emotional."

The pandemic worries him for a number of reasons, but chief among them is how it could affect people in recovery. Isolation is really hard for people with substance use disorders, Dart said, and he knows people rely on meetings.

But the meetings are more than the sit-down parts. They're a space for people to check in with one another or share stories, find someone when it's done and express gratitude for what they shared. Afterward, people often grab a meal or maybe head to a movie. "At a 12-step meeting, that whole group brings you into your arms and helps you rebuild their life," Dart said. He hopes that can continue without in-person get-togethers.

Dr. George Koob, director of the National Institute on Alcohol Abuse and Alcoholism, said much of the reason 12-step programs like Alcohol Anonymous are effective is that social action is "one of the most positive reinforcers" for people in recovery.

Koob said phone calls and video conferences can be effective, especially if you already know the people on the other lines, but he said networks are going to have to make an "extra effort" to ensure everyone is faring OK.

"The social isolation is going to be particularly trying for people who have been getting connected and developing a new net," he said.

People who are just starting their recovery have been a particular focus of Andy, of southwestern Ontario, as he tries to organize online Alcoholics Anonymous meetings.

Andy, who asked that only his first name be used, has been sober for over 30 years and goes to weekly AA meetings on Friday nights.

"Everything's closed but the grocery stores and liquor stores," he said of his city.

Coronavirus is a "trigger" for new participants, Andy said, and he worries how isolating might affect people. Without the draw of the "fuzzy hug and handshake" people are greeted with, he isn't sure whether new people will dial-in.

Dr. Henry Kranzler, director of the Center for Studies of Addiction at the University of Pennsylvania, says Andy's fears are well founded. "To the degree that social support is less accessible and is an important part of recovery, people may be at increased risk of relapse."

It's not inevitable, but it's certainly a factor, he said.

One drawback of the video conference, Kranzler said, is that it's hard to express empathy. How do you show people you care when your connection is cutting out or you're not sure when the right time to unmute yourself is and jump into the conversation?

Andy said there are other problems, such as people not having access to the needed technology, whether because they're elderly or because they can't afford it and rely on somewhere like a public library — now closed — for computer access. And AA's purposefully leaderless structure, which Andy described as "anarchist in a good way," makes it difficult to make big decisions, like moving meetings online.

He's been emailing people in his group, trying to rally people online, but in the meantime, he went to a different online meeting as he self-isolates.

Dart, of Cape Cod, said phone or video meetings aren't perfect but are crucial in-betweens until people can meet up in big groups again.

"My email box is full of people asking me how to do this for their own group in Chicago or Ohio," he said. "I'm trying to tell them. I use a website that provides free conference calls. I just stumbled on it and set it up."