KINGSTON — Sitting in a hut behind a live-in treatment facility for men with substance-use disorders, Jim and Nick enjoy a moment of fresh air. “We have specific times we can go out for walks. There’s nothing open anyway,” says Nick, 44. “But they’re letting us out an hour here, an hour there. Just so we don’t go stir-crazy.”
As their facility adjusts to help slow the spread of COVID-19, both men have learned to “accept what’s beyond [their] control,” says Jim. This includes the suspension of in-person Alcoholics Anonymous meetings and the adoption of increased cleaning duties.
“It’s a moment of uncertainty,” the 36-year-old says. “For some of us, the meetings are very important. It becomes our family because they understand us.”
(TVO.org has agreed to use only their first names to protect their privacy.)
The Canadian Mental Health Association estimates that roughly 10 per cent of Ontarians use substances problematically. For the thousands of people in Ontario living with substance-use disorders, the physical isolation and disruption of services brought about by the COVID-19 crisis present another roadblock on the path to recovery.
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Nick and Jim’s facility has suspended the intake of new participants. Nick says that staff have been especially supportive and that counsellors are still available. Some of the men are participating in online meetings. While they’re safely able to, Jim and Nick continue to meet face-to-face.
“Me and Nick here, we’ve known each other for a while,” Jim says. “It only takes two recovering alcoholics to have a meeting. We have enough history and know-how. It’s about sitting down with another like-minded person who is struggling and being able to talk and air some of our problems with each other and support one another.”
When they’ve completed their treatment programs — which last from two to four months — Nick will have a place to call home. Jim, like roughly half of the other men, he estimates, will not.
Nanky Rai, a family physician at the Parkdale Queen West Community Health Centre in Toronto, often works with people who are street-based and use drugs — the health centre operates two supervised-consumption sites, and a “safer opioid supply” program. She says that many people with substance-use disorders are homeless and trying to deal with changes to their usual services. “In the last two weeks, the requests for people wanting to get into the program have gone from one person contacting me every couple of days to multiple people contacting us daily,” she says. “We had to close intake to the program in order to figure out what we’re doing for COVID-19.”
Rai says that current public-health measures aren’t manageable for everyone. “People who are needing to use drugs — whether it’s access to alcohol, opioids, stimulants — they aren’t able to self-isolate, because they’re homeless or they’re couch-surfing or precariously housed,” she says.
In order to ease overcrowding in its shelter system, Toronto has leased hundreds of hotel rooms, making it easier, in theory, to practise physical distancing. But Rai worries that, without a so-called safe supply, people will disregard emergency orders.
She also predicts that the COVID-19 crisis will increase the unpredictability of the illicit-drug supply because it will be harder for lower-level dealers to access drugs. “Now is the time — if not four years ago, when people were dying of overdoses — to ensure that you can also prescribe your patients access to short-acting opioids that they can use in order to meet their daily needs for their opiate tolerance or for their stimulants or for access to managed alcohol programs for those who are relying on alcohol and unable to afford purchasing it, even if LCBOs are open.”
Nikki Bozinoff, an addiction doctor at the Centre for Addictions and Mental Health, in Toronto, has been meeting with patients over the phone and online for the past week. She says the COVID-19 emergency is taking a toll. “Addiction is a disease of isolation,” Bozinoff says. “Not being able to reach out to their usual supports is difficult.”
Adding to the problem, says Gord Garner, executive director of Ottawa’s Community Addictions Peer Support Association, is the fact that the majority of Canadians with substance-use disorders are “hidden” and may not be seeking treatment. Those who are, he says, are also at-risk. “Some of these folks who are doing well — through ongoing counselling activities built to change their lives — well, those activities have ended,” he says. “There’s a break in routine. Uncontrollable events. Isolation leaves one with oneself. It could be seen as a vulnerable place to be if you're someone with a substance-use disorder.”
Garner says that CAPSA is partnering with Breaking Free Online, a computer-assisted therapy tool for addiction treatment, which has been used by 35,000 people in Canada and the United Kingdom. For at least a year, Garner says, access to the program will be free. “It’s a self-activating online program created through evidence-based research. People can check in with themselves, and focus on their wellness and their recovery,” he says.
Nick says he’s willing to use video chat for meetings. There aren’t, after all, many other options. Jim says that, whatever happens over the coming days, he’s determined not to let the COVID-19 crisis get in the way of his progress toward recovery.
“It’s tough being away from the meetings. But, at the same time, we can be here for each other. There’s a lot of strength and resiliency. We’re here because we’re survivors.”
This is one in a series of stories about issues affecting eastern Ontario. It's brought to you with the assistance of Queen’s University.
Ontario Hubs are made possible by the Barry and Laurie Green Family Charitable Trust & Goldie Feldman.