A scorecard from the Commonwealth Fund ranked Colorado as one of the worst states for alcohol-related deaths and found that at least 22% of adults with a mental illness in Colorado reported an unmet mental health need.

Lack of access to addiction treatment and support is an issue all over Colorado, but especially in rural parts of the state.

In Durango, we spoke with recovery movement advocate Amanda Lembach about the heightened challenges recovering addicts face in an underserved part of the state during COVID-19.

Our discussion with Lembach, and a recent report from the Well Being Trust, suggest that changes caused by coronavirus may put recovering addicts at higher risk of relapse and make it harder for them to reach out for help.

For many who are battling addiction, or living in recovery, grassroots community support from organizations like Young People in Recovery (YPR), Alcoholics Anonymous (AA), and others, fill critical gaps in what mental health treatment can provide.

Normally, in-person recovery meetings play an important role in supporting those with histories of addiction to build and maintain healthy lives. Now, social distancing guidelines have put most in-person meetings on hold indefinitely, often replaced by sparsely attended virtual meetings.

Additionally, rural Coloradans may be faced with changes in probation enforcement, the existing lack of access to residential treatment facilities, and other complicating factors during COVID-19.

INTERVIEW:

Debbie (RMPBS): What are your concerns for people battling addiction during COVID-19 who live in our area?

Amanda: In a rural area, someone living in recovery from drug or alcohol addiction does not have access to a lot of community resources the way that she would in a larger city. While some people do not consider Durango rural, the truth is that in Durango we do not have a residential treatment center for addiction treatment, or recovery housing for those who are transitioning out of treatment somewhere on the Front Range. We do not even have a low barrier shelter that is accessible for those who are homeless and actively battling addiction. The number of Coloradans cycling through substance use disorder is unfortunately on the rise.

Debbie: You work with a recovery community, as in a community of people who have chosen to build lives independent from drugs & alcohol. What are some of the ways that COVID-19 is affecting those living in recovery?

Amanda: COVID-19 has put addiction into full swing. Without the intervention of law enforcement and probation standards being relaxed, people already struggling are without support of boundaries. While I do not support the criminalization of individuals struggling with mental health disorders, down here, that is sometimes the only recourse.

In rural areas law enforcement is often the go-to intervention for those in need of treatment. As a result of the restrictions that have been put into place as a result of COVID-19, the feeling within our recovery community is that action is not being taken by law enforcement as proactively as before.

Debbie: It sounds like what you are saying is, that although something like probation or jail is certainly not ideal, as it can be hard on someone, and creates barriers of its own, that sometimes it really is the best course of treatment—especially in areas like ours that are lacking resources. Living in recovery when the normal rules of probation suddenly no longer apply sounds like a challenging thing to do.

Amanda: Yes. Another concern is that, if someone from our area does enter treatment at a major treatment facility, then she will be leaving our relatively isolated area for a larger, more populated one, which will pose an additional threat to her when it comes to exposure for COVID-19.

Debbie: Locally, what else are you seeing?

Amanda: The biggest loss we suffered in Durango has been cancellation of recovery meetings. Here in La Plata County I find people to be a little bit more "old school," so to speak. We are having a hard time with people responding to virtual meetings, and I think that is why. For whatever reason, either because they are not tech-savvy, or they lack access to Internet, or just because they do not prefer to spend time in front of a computer, most of our regulars have not been coming to the recovery meetings since they switched to virtual. Whereas YPR’s Durango Chapter used to see between 30 and 40 people in a meeting, now we are lucky to have between 5 and 7.

Debbie: For those who do attend, do you think that virtual gatherings have the potential to be as effective as in-person recovery meetings?

Amanda: There is something to be said for the human connection that meetings provide. Nothing replaces that. Virtually, you get to talk and listen, but there is no fellowship, or informal small talk before and after. For some people, the fact that they are expected to arrive in person at a meeting, and that their absence will be noticed, is a motivating factor that helps them to stay committed when recovery gets hard. Virtual meetings do not allow space for the one-on-one relationships that provide the encouragement and support that our community thrives on. It is also easier to be under the influence and attend the meeting without this being detected by peers. The pressure and expectation of in-person encounters support sobriety.

Debbie: What else is lost when community is so dispersed?

Amanda: Isolation plays a huge role in addiction. COVID-19 has not only prevented human connection but human contact. I know for me when you're “coming out of it,” the world feels judgmental, and embarrassment flourishes and eats away at you. There is nothing like that first hug received from someone that feels comfortable enough to do so. The impact can motivate someone for days.

Absolutely the normal flow of things is being disrupted and it's causing mental health disorders to flourish negatively. In an area where resources are limited, we depend a lot on each other. Quarantine has taken those little encounters that means so much away.

Debbie: Outside of recovery meetings, how else is COVID-19 affecting access to treatment?

Amanda: This is not just about resources for recovery, but also essential resources for harm reduction, like a needle exchange. Rural areas tend to be in denial about drug use. There is a stigma trapped in perception, "not in my town." With less people walking around on the streets, syringes have become more prevalent in parks and alleyways.

Addiction is often thought of on its own but a lot of times it is co-occurring alongside another mental health issue. COVID-19 has brought many situations like this to the surface. There is no long-term mental health facility nearby—only an acute treatment unit designed to hold those who are at immediate risk of harming themselves or others. So, again, law enforcement is the predominant intervention for mental health crises. If someone with a substance use disorder co-occurring along with a serious mental illness does relapse, then they may also stop taking their medications, or following through with other treatment. I have seen this issue the most among several individuals.

In the news has been talked about the rise of domestic violence. A lot of that stems from alcohol use that happens behind closed doors in close quarters. I know firsthand that La Plata County is struggling with this as well.

Service work of some sort is sometimes a necessary component of successful recovery. It is for me. My personal recovery is lacking in that these days because I am doing a lot of outreach to my peers with no response. It is easier to ignore a Facebook message than it is to blow someone off who runs right into you around town. When I do run into people, a lot of what I hear is: “I can't wait till that meeting gets going again.”

FOOTNOTE: Projected Deaths of Despair During the Coronavirus Recession

A recent report from Well Being Trust (pdf) attempts to predict the increased risk factor for deaths related to drugs, alcohol, and suicide due to the social and economic impacts of COVID-19.

The report states, “the magnitude and scale of social isolation in COVID-19 is unprecedented,” and warns that virtual community may not be enough to hold off the impact of isolation and loneliness.

The Well Being Trust recommends that, “Ideally, local communities and even states can implement measures to mitigate isolation, creating local solutions for their neighbors and friends.”

Amanda Lembach lives in Durango, CO and is from Milwaukee, WI. She is a Navy Veteran and has served in Iraq. Amanda is part of the leadership team for Young People in Recovery’s Durango Chapter and identifies as being in recovery herself. She feels able to relate and identify with others as she too has suffered from mental illness.

Young People in Recovery (YPR) is a national organization with over 50 chapters implementing peer support. YPR chapters engage people in or seeking recovery and their allies in communities across the country to take a stand for recovery. Our vision is a world where all young people have the resources they need to thrive in recovery from addiction to drugs and alcohol. Chapters also advocate on the local, state, and federal levels.

Resources

• Addiction resources for the COVID-19 pandemic from Shatterproof, a national nonprofit dedicated to reversing the addiction crisis.
• Chapter information for Young People in Recovery.
• SAMHSA’s National Helpline – 1-800-662-HELP (4357)
  SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.
• Mental Health Resources from the Well Being Trust

Sources

• Petterson, Steve et al. “Projected Deaths of Despair During the Coronavirus Recession,” Well Being Trust. May 8, 2020. Available at https://wellbeingtrust.org/wp-content/uploads/2020/05/WBT_Deaths-of-Despair_COVID-19-FINAL-FINAL.pdf
• The Commonwealth Fund. (2019) Colorado, Scorecard on State Health System Performance. Available at https://scorecard.commonwealthfund.org/
• United States Congress Joint Economic Committee. (2019). Long-Term Trends in Deaths of Despair. Published online September 05 2019 at https://www.jec.senate.gov/public/index.cfm/republicans/2019/9/long-term-trends-in-deaths-of-despair