Our Patients Need In-Person Treatment: Here’s Why and How Encore Is Returning to It Safely

By Kim Ragan, LCSW, LSATP, CSAC

In the spring of 2020, as the coronavirus swept across the country, we were forced to stay home. For most of us, it was a difficult and often anxiety-provoking adjustment, but we found ways to deal with it. For many in recovery from addiction, it was traumatic and sometimes fatal. The CDC reported that 81,003 people died from drug overdoses in the 12 months between June 2019 and June 2020, the highest number of fatal overdoses ever recorded in the United States in a single year.

At the same time, hospitals were dealing with a significantly higher number of alcohol-related readmissions for diseases like alcoholic hepatitis and liver failure. For example, an article in Modern Healthcare noted that hospitals affiliated with the University of Michigan, Northwestern University, Harvard University and Mount Sinai Health System in New York City reported up to a 50% rise in admissions for alcoholic liver disease since March 2020.

This is not surprising to those of us who provide addiction treatment. The core component of a successful recovery is community and expert support in a trusting environment. At Encore, we offer programs, from a partial hospitalization program to intensive outpatient programs, that give people coming out of inpatient treatment critical guidance and assistance as they adjust to their new lives in recovery and create a new and healthier life. We answer the question, “How do I do this?” with a range of support services. Helping them answer that fundamental question was much more difficult when we could not be sitting in the same room together, building trust and confidence.

What’s Missing When Face-to-Face Interaction Isn’t Possible

When the pandemic forced us to shut our doors, we pivoted quickly to virtual services to ensure our patients could continue their healing and growth. At the same time, we had to acknowledge that virtual services will never be able to accomplish what face-to-face treatment can.

It’s harder to engage, to learn the skills, and, most importantly, to build relationships with others and a connection to the therapist when what you see are one-dimensional faces inside squares on your laptop screen. We have noticed less engagement and more distraction in our patients when in virtual sessions. It’s true for all of us, from students attending school virtually to their parents trying to work from home and attending Zoom meetings. Human beings are easily distracted, and we have plenty of those distractions in our homes.

It’s also difficult for therapists and counselors who pay close attention to nonverbal cues. From the moment a patient walks in the room and throughout the time we are with them, we note and interpret their energy levels to understand their emotional state. Are they anxious? Depressed? Hostile? Shut down? Are they making eye contact? Fidgeting? Is their leg jiggling up and down? Is their body stiff or relaxed? Virtual treatment limits our ability to notice and make use of those nonverbal cues.

Virtual treatment can also make it harder to spot a crisis in the making. We can’t smell alcohol on someone’s breath when we see them on a screen. We can’t always notice clues like hygiene, weight loss, and clothing, to know if someone may be in a crisis or at the beginning stages of relapse. It’s easier for them to convince us they are fine when they are anything but.

Getting Back to In-Person Treatment Safely

There is a lot of discomfort and anxiety when a person moves from in-patient treatment back home. Coming out of treatment into the shutdown or, even now, a restricted environment, can increase that sense of anxiety and unease. We have put many protocols in place to ensure the safety of both patients and staff:

• We limit how many people come into the office.
• All visitors must fill out a COVID screening form upon entering our offices.
• Patients and other visitors must call us from the car so we can let them know when it’s okay to come in.
• Everyone must wear masks inside.
• Before someone enters our office, we take their temperature and make sure they use hand sanitizer.
• We encourage frequent hand sanitizing by putting bottles of sanitizer throughout our offices.
• We limit our group sessions to 10 people, including the therapist and recovery coach.
• We have a thorough cleaning protocol in place for our physical space. Therapy rooms and offices are cleaned after each session.
• Our protocols are emailed to everyone who is coming into our office so they know what the expectations are in advance.
• We communicate regularly with patients and family members about our protocols.

As We Continue to Be Cautious

While we are all breathing a sigh of relief as vaccination rates go up and COVID-19 cases go down, it is likely that we will have to remain cautious for some time to come. These steps can help you, whether you a person in recovery or a family member, find a balance between the need for caution and the need for recovery support:

• Meet with your sponsor out of doors. If you’re both vaccinated, then you can meet regularly in person.
• Go to all the virtual recovery support meetings you can. If you’re vaccinated and have a face-to-face group close by, go. In the Washington, D.C. metro area, some outpatient groups have begun meeting in person again. At Encore, some of our daytime groups have been meeting face to face with guidelines in place to ensure everyone’s health.
• If face-to-face groups aren’t available to you, find out if you can meet face-to-face individually with your therapist.
• Set up regular meetings/visits with a trusted family member or friend to talk about your recovery — what’s going well and what you need help with.
• Get in as much physical activity and outdoor time as possible. Take walks or runs. Find an online yoga or mindfulness meditation class.

Making Virtual Services Work for Our Patients and Families

We have gained a great deal of knowledge about how to make virtual services effective during the pandemic. While it cannot do what face-to-face treatment can, it does offer a lifeline to those for whom it is a necessity.

We learned, for example, that virtual treatment can be a great supplement to in-person programs. People can easily attend, whether they are sick at home, stuck at work, or out of town. If they have a hard time getting to our location, they can still benefit from our expertise and experience via their laptop or even their phone. We can always be there for patients who need us, even if we can’t be in the same room together.

Family engagement programs also benefit from the ability to be virtual. Before the pandemic, families who were out of the area had to have therapy sessions over the phone. Now we offer many of those services online so we can be face to face with family members. That’s a much easier way to have hard conversations. We can offer education, information, and support to many more family members no matter where they are. When the family of one of our patients had to move overseas last year, we could continue working with them without interruption, building on the foundation of trust we had established.