Staying Clean Staying Home

Emily is beginning to take joy in the simple things in life. Her dad had the coronavirus but beat it. Most of her family members are vaccinated, and she is, too. She’s looking forward to seeing her grandmother for the first time in a year and seeing the new Mortal Kombat movie in theaters. She grew up on the video game and still loves the first movie which came out in 1997. “I’m trying to keep a sense of humor about all the things I’ve lost this year, and stay grateful for all the things I’ve kept,” Emily says. “There’s always more reasons to live, big and small.”

Emily is a writer and former insurance examiner for people with disabilities. She’s 32 and lives in Port Richmond, a neighborhood in Philadelphia’s river wards. She’s been in recovery for substance use disorder since 2018. “I grew out of everything,” Emily says, “Except for alcohol.” 

She began to attend Alcoholics Anonymous meetings that year and found a group of people who she could relate to and receive support from, who aided her sobriety. “They’re the most amazing, real people,” Emily says. “You can have a relationship when you’re talking on the phone, but going to a meeting and having something on your chest that normally you would cope with by drinking or taking drugs, and then share it with all these people? People cry and scream, but nobody’s allowed to talk over you. You just get five minutes to pour your guts out. The support you feel afterwards, people will come up to you and they’ll say, ‘I’m so happy you shared that. Let’s talk or let’s get coffee.’ It’s that sense of unity and fellowship that is the saving grace and is, in my opinion, the most important part.”

She felt like she was making a lot of progress. Yet, like the rest of things, that was before the pandemic came along. On March 10, 2020, Emily walked to an evening group meeting in the basement of a church in the Fairmount neighborhood of Philadelphia. On her way there she got an apology text from her boyfriend, David. They had been together at a bar earlier that same night, and had a lot to drink. She wanted to go, and he was trying to convince her to stay. Eventually, they went back to his house together, but things were tense, and they only narrowly avoided an argument. She was disappointed, and frustrated. She knew they couldn’t be together if they kept drinking. The meeting comforted her and gave her space to vent and a little bit of hope that they could overcome their issues and get sober. 

She didn’t know it’d be the last time she’d go to an in-person meeting for more than a year.

Philadelphia’s first documented coronavirus case was confirmed the next day, as treatment centers and recovery groups across the country and world began to close down or move virtual due to strict stay-at-home orders and mandated business closures. That meant no more church-basement meetings for Emily.

On March 12, 2020, David died of a heroin overdose. A few weeks after that, an argument forced Emily to leave the house she had been living in. She didn’t have luck finding somewhere to rent, and couldn’t afford her own place, so she moved up into David’s old house, which one of his roommates had bought from David’s parents after he died. She relapsed again shortly after moving in in April 2020. “I still hang out on the couch where he died,” Emily says. “It’s still there. There was a part of me that was just waiting and expecting him to come home. But after 365 days, it’s like, he’s not coming home and he really is dead.”  

She decided to stop attending her recovery group meetings even after they went online. She felt “awkward, forced, and disconnected” talking about her experiences over Zoom. There was no one there for her to talk to, or hug afterward, and she felt alone when she left the meeting. She succeeded at sobriety for eight months after April, and was feeling good going into the holidays. New Year’s Eve then brought another relapse.

“I was joking with myself that I did it and survived 2020,” Emily says. “Then on New Year’s Eve I had a terrible night. It was like 2020 won and I was defeated by the year. I finally said ‘Uncle,  fuck it.’ It was horrible, and it wasn’t just me reflecting on the year and how shitty it was. My dad was also in the hospital with the coronavirus. I was in this bathtub drunk, bargaining with a higher power like, ‘Break every bone in my body. I don’t care. Just let my father live.’”

Recovery from substance use disorder is a long-term process. Most programs and plans recommend total abstinence managed through some combination of medication and counseling, but relapses along the way are common; the rates across all substances are between 40 percent and 60 percent, according to the National Institutes of Health. 

Like so many other things, the pandemic has made recovery even harder. In a study on the pandemic’s effect on people in recovery for alcohol, National Institutes of Health researchers found that relapse rates had increased during the pandemic; the same study found that isolation had a greater impact on relapse than economic and physiological health factors. Ordinarily, there’s a wealth of support groups like Alcoholics Anonymous and 12-step programs, as well as inpatient and outpatient rehabilitation run through professional centers and private therapeutic practices.

Yet most depend on face-to-face contact — and the isolating circumstances of the pandemic made it necessary for those methods, and the people who benefit from them, to adapt.

Mary is a registered nurse living in West Philadelphia. She aspires to plan one trip each year to explore sites and cities around the country. Glacier National Park in Montana is at the top of her list. “We have so much diversity of landscapes, geography, and culture right in our own backyard,” Mary says. “How much or little that all pans out just depends on the course of the pandemic.” 

Mary has been in recovery for alcohol and benzodiazepines since September 2018. She’s spent quarantine doing whatever she can to interrupt the alienation and boredom of being stuck in the house, where Mary and her fiancé have endured months of social distancing together. That’s included going on short walks — “Going to the mailbox was something that I tried for,” Mary says — as well as going through some of the vanishing motions of everyday life, like taking a shower and putting on makeup each day.

“One of my favorite phrases is, ‘The opposite of sobriety isn’t addiction, the opposite of sobriety is isolation,” Mary says.

But isolation was hard to avoid, not only at home, but in public — even at the hospital. In December, Mary went to the emergency room, suffering from seizures, as well as other symptoms likely related to her diagnosed narcolepsy, and found herself enduring a harrowing stay alone, unable to bring her fiance, Bill, inside under the hospital’s pandemic protocols. Heaped on top of the stress of the pandemic, it proved overwhelming. She relapsed on Christmas Eve.

“It was the perfect setup to lead to relapse,” Mary says.  “Not only is the pandemic making it hard for people to access healthcare for things unrelated to the coronavirus, but accessing care is harder and you’re scared and isolated while waiting for appointments. That plunges people into relapse.”

Over the next month and a half, Mary struggled to access the necessary care. She followed up on referrals to various specialists to see if they could fit her into their programs sooner than the six-week window they promised, but had no luck. Her neurological deficits continued, and doctors instructed her to stay home from work and avoid driving. On top of that, recovery meetings became less available for her to go to. She had been to both outpatient and inpatient services and AA meetings in the past, and always found she got the most out of AA. And while she hadn’t been going to meetings when the pandemic hit and when she relapsed, she knew that they were a resource for help that would always be available if things got bad again.  

“I didn’t realize how nice it was knowing that there would be this group of people that if things got bad again, there would be a place for me to go where people wouldn’t judge me and where they would get it,” Mary says. “They’d instantly welcome you back and try to help you. There’s something really meaningful about the in-person setting for AA.”

Mary looked into attending some online AA meetings, but didn’t end up following through. 

As the coronavirus vaccine continues to be distributed nationwide, more treatment centers are beginning to reopen and offer in-person services once again. 

The American Society of Addiction Medicine released a list of policies and practices to consider for residential addiction treatment facilities in November 2020 which include wearing a mask at all times and social distancing inside the building, working quickly to develop telehealth based treatment and limiting visitation, quarantining patients inside their building if possible, creating clear policies and procedure for patients and employees that have tested positive or have been exposed to the coronavirus, developing standardized screening for the coronavirus once a patient enters the building, and having knowledge of all public health guidance related to the coronavirus. 

Many treatment centers, tagged as essential businesses, have remained open during the pandemic, albeit in a limited capacity. Prevention Point Philadelphia, a nonprofit that provides harm reduction services including Medication Assisted Treatment (MAT), is one of those that remained open. Everything quickly became a lot harder, says Clayton Ruley, who works in community engagement and volunteer services at Prevention Point.

“Normal external resources that you used to be able to have come to the building and serve people were gone,” Ruley says, “and we have to tell people that we were closed with no estimated time of reopening.” 

Prevention Point established its own protocols from the beginning of the pandemic, including mandatory mask-wearing and social distancing inside the building, and offered outdoor services at drop-in facilities in a limited capacity. Making those decisions and trying to figure out how to still provide specific services to their clients was something that Ruley says he wished they had more guidance on from the local government. 

Although Prevention Point has stayed open throughout the pandemic, they haven’t been able to keep all of their services open, and the services they have kept open haven’t been in full capacity. Their drop-in center, which is usually open seven days a week, was closed for the first three months of the pandemic when many clients needed to use that service the most for things such as food, clothing, hygiene products, and mail services.

“For the first three months there were definitely people who would come out, and maybe they hadn’t been around in a couple of weeks or days,” Ruley says. “They were used to being able to come in seven days a week in and out, and that space not being open for three months was like a, ‘What the hell is going on? What do they expect us to do now? Where are we supposed to go get help for this?’ type of moment for a lot of folks.”

In Bala Cynwyd, Jeremy Frank and Associates, which offers treatment programs for substance use disorder, shut down in March 2020 and switched to entirely virtual care. Initially, it was a “scramble” to provide the necessary care for their clients, says Jake Brennan, a therapist at JFA. 

Prior to the pandemic, JFA primarily served clients in the surrounding Bala Cynwyd and Main Line area. But since moving all appointments online they’ve been serving clients all throughout the state, taking on more clients during the pandemic than they had before. That was a surprise to the staff, says Brennan, who expected their caseloads to drop without in-person sessions.

“If anything, we’re getting more calls,” Brennan says.

Brennan also mentions that therapy has become much more accessible for people who might’ve not had the time to schedule appointments when they were only in-person, and they can take “an hour off from their workday to do sessions in their living room.”

“Honestly, one of the benefits of opening up telehealth is that it’s made it a lot easier for people to schedule therapy, so people that would otherwise be on a waitlist because they can only meet in the evenings and there were only so many evening slots available,” Brennan says.

Yet even with those benefits of telehealth, that piece of human interaction was still missing for Jenny. She still felt alone at the few online meetings she went to. She misses meeting people who are struggling like her and connecting with them and working towards the same goal with all of them: inner peace. 

“There was this weird kind of synchronicity where I kept meeting people that just happened to be in recovery,” Emily says. “The thing that you learn from talking to other people who are in recovery is that’s the thing that happens to everybody. It’s very much a power of attraction thing. It’s like the universe decides you’re ready to be sober. You’re nearing or are at rock bottom and then these people appear out of nowhere like angels, and you surrender to it. That’s how you find serenity. Inner peace is the end game for all of it. Everybody is working towards that in recovery.”

For both Emily and Mary, life is starting to look up, even if there’s a long road ahead.

It’s been close to four months since Mary’s relapse, and she’s trying to gain more momentum again to stay sober. She was prescribed and has been taking disulfiram, a drug which converts alcohol into formaldehyde in the body, since February. She’s also going back to work part-time, and is paying attention to her body and how she can better deal with the stress that comes with recovery. 

A year from now, Mary hopes to see herself living sober.

“I definitely just really want to take some time to focus on resting and exercise, and just really letting my body heal from all the chronic stress it’s been through,” she says. “Learning about how stress currently manifests and how to keep an eye on it.”

Emily still lives in David’s old house. As the anniversary of his overdose approached, she went away on vacation to Washington state, where she hiked in Olympic National Park and camped in a van on the beach facing the Pacific Ocean. She went back to AA in early April after in-person meetings resumed in nearby Havertown, commuting and has reconnected with her former sponsor.

“For me the necessity of being sober is clearer than ever,” Emily says. “The person I wanted to marry and have kids with and work with is dead, and things like COVID are going to keep happening. There’s going to be more disasters. Our country isn’t perfect. Sobriety is a very useful thing to have in the midst of a crisis.”

Photos by Colleen Claggett

If you or someone you know is struggling with substance use, you can call the SAMHSA National Hotline at 1-800-662-4357, or you can reach out to the following resources from the Philadelphia Department of Health and these services from the Philadelphia Department of Behavioral Health and Intellectual Disability Services.



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