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April 29, 2020

Coronavirus is increasing substance use – and decreasing treatment availability, providers say

The economic and social impacts of the COVID-19 pandemic are raising concerns among Connecticut providers about both increased alcohol and drug use and the capacity of treatment programs to handle a potential rise in addictions.

Social distancing, quarantines, job losses and uncertainty about the future are likely to push more people to rely on or increase their use of alcohol and drugs – and that could result in an increase in addictions and drug overdoses, experts warn.

“It’s always a concern in stressful times that people will turn to drugs and alcohol” to cope with their problems, said Mary Kate Mason, a spokeswoman for the state Department of Mental Health and Addiction Services.

National reports indicate the pandemic has resulted in soaring sales of alcohol, and Connecticut package stores are seeing a big boom in business. One study found that prescriptions for anti-depressant and anti-anxiety drugs are also increasing.

Mason said the state’s addiction support hotline, a resource referral service, actually saw a “slight decrease” in calls for help in March: it received 2,796 calls in February and 2,471 the following month. She declined to speculate about why calls to the hotline may have dropped.

But Connecticut providers worry that increases in prescription rates and alcohol consumption are a combustible combination, colliding just as the state’s financially stressed residential treatment facilities are at or near capacity.

“It’s definitely harder for people to access treatment beds,” said Rebecca Allen, executive director of the Connecticut Community for Addiction Recovery.

Mason downplayed such concerns, saying the state’s addiction services website continues to show rooms available at treatment services. The state’s website showed  Tuesday that 23 of the 38 residential treatment facilities listed had no beds available at present and the rest of those facilities have availability rates ranging from 1.8 to 9.2%.

Allen said she’s heard from state officials in the past that, in Connecticut, about 20% of its approximately 1,000 addiction treatment beds are generally available. Mason said a DMHAS database, which tracks longer-term rather than daily numbers, showed a 93.5% average occupancy rate for all residential addiction facilities – including residential treatment, but also detox programs and recovery houses – between July of last year and February 2020.

Residential facilities are squeezed on both ends
According to several addiction center officials, part of the reason facilities have such high occupancy rates is that COVID-19 infection concerns have forced them to change normal residential practices where two clients share a single room. The result has been a drop in the number of beds available, a situation that isn’t expected to change until state social distancing guidelines are lifted.

Kristie Scott, CEO of Perceptions Programs Inc., a nonprofit treatment network based in eastern Connecticut, said one of her network’s facilities in Willimantic could normally house up to 20 women. “But we’ve had to go to single rooms where possible,” Scott said.

David Borzellino, vice president for addiction services at the Farrell Treatment Center in New Britain, said some patients who would normally come out of short-term detox programs now don’t want to follow the normal route of staying about a month in a residential facility for follow-up care.

“They’re nervous about being in an institution because of the risk of infections, or they want to take care of their families,” Borzellino said. He said one client in the New Britain facility was agonizing over whether to stay or return home to take care of a sick family member or remain for residential treatment. This frees up increasingly rare beds, but it also means many people who need more intense support aren’t getting it.

“He was asking, ‘Can I go home?,’” said Borzellino, “but he was also saying, ‘I need to be here.’”

Another major change for residential facilities as a result of COVID-19 is that most have now banned any visitations from family or friends, Borzellino said. “That used to be a significant part of our program.”

Outpatient services go digital
As a result of the pandemic, outpatient services for people with alcohol or drug dependencies have seen a dramatic shift away from traditional practices such as group sessions and in-person counseling to “tele-health” efforts.

“Our service providers have done a really excellent job of switching to e-platforms,” Mason said.

The Connecticut Community for Addiction Recovery is now conducting computer group meetings on Zoom for outpatient clients.

Officials in some of those treatment programs say staff are doing their best to stay in electronic contact with clients struggling with drug dependencies, but they worry that those long-distance services aren’t as effective as in-person clinical work.

It certainly doesn’t work for many homeless clients who may lack cell phones or – now that libraries are closed – access to computers, noted Mark Jenkins, executive director of the Greater Hartford Harm Reduction Coalition. “We don’t know how many of our homeless are suffering from COVID or are overdosing because of distress from COVID,” Jenkins said.

“Tele-health is great,” Scott said, but she warned that key aspects of many treatment programs simply can’t be conducted over the phone or by computer. Group therapy and in-person counseling provides much more of the support and contact that many addicts need, she said. Without it, counselors worry they are “losing a sense” of what their at-risk clients need and how they are coping with the loneliness and isolation involved with this pandemic.

“Are they getting the care they need if they overdose?” she wondered.

Financial concerns for treatment programs
The current decrease in services – either because it’s online instead of face-to-face, or because social distancing has diminished treatment center capacity – may well outlast COVID-19. Like many other nonprofit social service groups in this crisis, addiction treatment programs are facing rising expenses and declining revenues as a result of the pandemic, officials say.

The inability to conduct intensive group therapy sessions multiple times a week for clients is resulting in a major loss of Medicaid funding, several facility officials said, because reimbursement for tele-health sessions is significantly lower.

Meanwhile, costs for residential treatment facilities have risen dramatically because of the need to purchase personal protective equipment for staff and residents, to buy laptops for staff providing electronic outpatient services from home, and for overtime and bonuses for residential staff, officials said.

Mason said that state officials are aware of the financial difficulties facing treatment centers and have released state payments for the fourth quarter early to help with cash flow problems. She said DMHAS is “reviewing other options that may be available for financial relief” and is asking addiction service providers to document all coronavirus-related expenses.

Borzellino and Allen both warned that their biggest financial worries are that, without additional aid, their programs may be forced to cut back on staff and services in the future.

“I could definitely see us losing not only beds, but some smaller treatment programs aren’t going to be able to survive this,” Allen said.

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