Altered State
The pandemic has changed the landscape for individuals trying to recover from substance use disorder.
by Bill Donahue

Christopher Gallagher refers to “the lost years” of his late teens and early 20s with a mix of sadness and regret. There’s also the faintest suggestion of pride, in that he survived the most tumultuous period of his life.
“I was a stupid kid, doing stupid things—taking pills at parties, doing other things you’re not supposed to do,” recalls Gallagher, a Montgomery County resident who asked not to use his real name. “It all started as not really a big deal, and then it became more and more. And then we got to the point where we turned to other stuff.”
By “other stuff,” he means heroin. 
“It doesn’t matter who brought it to the table,” he says. “What does matter is that I wasn’t in a position to realize how bad of an idea that was.”
He spent the next six years on a continuing downward spiral, including multiple accidents, arrests, and overdoses. In moments of clarity, he agreed to try inpatient programs—multiple tries, in fact. His attempts were halfhearted, he can now admit, because the disease had its hooks deep into him. He found his path to breaking free of his addiction in a most regrettable place: a jail cell, where he spent more than a year of his life.
“I’m almost glad I went through it when I did,” he says. “I wouldn’t want to go through it now, in the middle of the pandemic. Dealing with [addiction] is hard enough as it is.”

Sobering Trends
The stress and isolation caused by the COVID-19 pandemic have presented challenges for all Americans, but perhaps none more so than those who living with substance use disorder, or SUD. Significant increases in many kinds of drug use have been recorded since mid-March, when the national lockdown designed to stop the spread of the pandemic turned life upside down.  
Christoffel Le Roux, M.D., has seen these struggles firsthand. As an attending psychiatrist at The Retreat at Sheppard Pratt and service chief of Retreat homes and outpatient services, Dr. Le Roux says the increased social isolation has taken a great toll on those in recovery from SUD. He cites an analysis of 500,000 urine drug test results conducted by Millennium Health that reflects some sobering trends. Following the lockdown in mid-March, test results showed steep increases in the presence of cocaine (an increase of 10 percent), heroin (up 13 percent), methamphetamine (up 20 percent), and nonprescribed fentanyl (up 32 percent). 
COVID-19 has delivered a series of devastating blows to those with SUD. Individuals who struggle with opioids and methamphetamines tend to have compromised immune systems or poor respiratory health, according to the National Institute on Drug Abuse. As a result, they are particularly vulnerable to the virus. For those who are in recovery, the increased worry, fear, and loneliness associated with the pandemic may increase the risk of relapse. On the other hand, those who have yet to take the first step toward recovery may refrain from seeking the help they need out of fear of the virus. 
“Everyone is boxed into their house, their car, and their office, so it makes perfect sense that people would be delaying treatment,” Dr. Le Roux says. “What makes it even more difficult is the treatment landscape has changed. We’ve gone from an environment of in-person addiction treatment to one that’s largely remote.”
Dr. Le Roux suggests the health care community’s adaptability has been one of the unexpectedly positive byproducts of the pandemic. He has been impressed by the commitment of the staff helping patients at The Retreat at Sheppard Pratt, a residential treatment program for individuals affected by SUD and other mental health issues that have the potential to upend an individual’s life. Likewise, he has been buoyed by the widespread acceptance of HIPAA-compliant video conferencing as an assessment and treatment tool. 
“It’s almost like medicine has gone online,” he says. “A lot of us, especially in psychiatry, have shifted from in-person care to home-based or office-based telehealth. What I have found is that telepsychiatry is a reasonable substitute for office-based care. Unfortunately, many patients I have worked with, especially those in lower socioeconomic positions, don’t always have access to this technology, in which case we can do assessments over the phone.” 
Unlike other forms of disease, the disease of addiction isn’t something one gets treated for and cured of, never to be thought of again. Rather, genuine recovery requires a lifelong commitment made one day at a time. 
“Treatment starts with containment, meaning you put a safety fence around yourself,” says Dr. Le Roux, who joined Sheppard Pratt in July. “In the beginning that fence is called containment, and at the end it’s called relapse prevention, but it’s the very same thing. The moment you think you’ve graduated, that’s where the trouble begins. You’re never done with working to stay safe if recovery is what you want. Patients often need ongoing professional involvement on an outpatient basis, which provides both monitoring and advocacy. You’re also going to need ongoing 12-step involvement.”
He cites the need for membership in safe fellowship-oriented organizations such as Alcoholics Anonymous, which offer 12-step meetings regularly and helps to reinforce an individual’s vulnerabilities and the need to effectively care for oneself. Such meetings provide a form of continuing emotional education, according to Dr. Le Roux, and help members achieve a broader awareness of their own functioning, their relationships, and their place in the world.   
“People at these meetings historically share in a style of thirds,” he adds. “First is telling some part of your unrecovered experience, which keeps you humble and qualifies you to be in the meeting. Second is sharing what misfortune had befallen you that mandated increased awareness and change. And the third is sharing skills on how to live sober, and that’s the most important part of the share; everyone knows how to get intoxicated, but very few know how to live sober and safely. 
“Gaining sobriety ultimately changes the trajectory of a life and helps to deepen your quietude, if you will,” he continues. “It’s what they call the miracle of recovery, meaning patients start to deeply value and typically would not trade the recovered life for the former unrecovered one.” 
Whereas 12-step meetings used to be held strictly in person, virtual meetings have become commonplace. Chapters of Alcoholics Anonymous across the country, for example, now host virtual meetings daily, multiple times per day. Dr. Le Roux sees such developments as a good thing.
“The pandemic has become so incredibly disruptive to the whole world,” he adds. “I’ve seen an interesting phenomenon in that people used to get sober in 12-step rooms, and now we’re seeing the phenomenon of people getting sober online. It’s going to be interesting to see if the virtual recoverees engage in in-person meetings after the pandemic.” 

‘A Different Person’
Nearly three years after his release from prison, a sober Gallagher has moved forward with his life, with help from the support of his immediate family, as well as the community of others who have endured similar experiences. Now on the cusp of 30, he has been studying for a career in criminal justice. Things had been going pretty well, he says, until the pandemic. 
Life in the time of COVID-19 has been a “mixed bag,” as he puts it. The prolonged stretches of boredom and reflection have been difficult to weather. At the same time, he admits to not shedding too many tears over the fact that he won’t have to gather together with his extended family, trying to pretend that everything is normal.
“My parents and [siblings] have been great throughout everything I went through, probably a lot more than I deserved,” he says. “The rest of the family is a little different. They don’t come right out and say anything, but it’s like they look at me differently, treat me differently. I get it, to a degree, but I’m a different person now than I was then.
“I regret that I lost the years that I did, but the worst part is what I put my family through. No parent should have to find their son or daughter in the kind of shape my parents found me in on more occasions than I can even remember.”   

Taking the First Step
Individuals in the Philadelphia area who struggle with addiction have a number of resources to help them down the road to recovery. These resources include inpatient/residential treatment programs such as the following, devoted to helping people overcome their struggles with substance use disorder.

Huntington Creek Recovery Center

Peace Valley Recovery

Pocono Mountain Recovery Center

Recovery Centers of America at Devon

The Retreat at Sheppard Pratt

Published (and copyrighted) in Suburban Life magazine, December 2020