A tough year for mental health, substance abuse
With people facing anxiety, depression, uncertainty and substance abuse problems, treatment providers and patients have had to rapidly adapt to a new landscape of virtual care and support
It’s never easy to overcome drug addiction problems. This year has been particularly challenging for people struggling with substance abuse, and for the people working to help them turn things around.
Throughout the marathon crisis of the pandemic, job losses, financial hardship, isolation, anxiety, depression and uncertainty have all swept across Colorado and communities on the Western Slope, ratcheting up stress levels for everyone.
At the same time, behavioral health and substance abuse treatment providers have been forced to limit in-person contact and quickly pivot to providing virtual services.
It’s been a whirlwind year for treatment providers and clients, agreed Lisa Morton, coordinator of the problem solving court for Colorado’s 5th Judicial District, which works to provide treatment and oversight for offenders struggling with substance abuse issues in Clear Creek, Eagle, Lake and Summit counties.
Statewide, phone calls and text messages to Colorado’s crisis line are up more than 33% this year. They hit a record 24,843 in October, with staff answering more than 800 a day.
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“With the ongoing pandemic, economic downturn, natural disasters and social unrest, it’s been a very challenging year for people across our state,” Robert Werthwein, director of Colorado’s Department of Human Services, said in a Nov. 23 news release announcing the record number of crisis calls. “You don’t have to be diagnosed with a substance abuse or mental health condition to be struggling right now.”
Meanwhile, the internet abounds with memes about people drinking or using drugs to cope with stresses of the pandemic, raising concerns that potentially damaging behaviors are being normalized. Remote work and social isolation have made it harder to tell if people are struggling with addiction, and treatment providers are collaborating and working to find ways to reach out, provide services and help those who need it in a region that has long struggled with mental health challenges and a shortage of treatment providers.
“Across the board, we have seen increases in people seeking services, which is excellent because it shows we have reduced the stigma for the community to reach out for help,” said Dr. Casey Wolfington, community behavioral health director for Eagle Valley Behavioral Health.
Treatment providers are reporting increases in substance abuse concerns, as well as higher instances of relapse for people who already had problems. And there has been a consistent increase in the number of substance abuse cases appearing in the hospital emergency room, Wolfington said.
‘A rather toxic stew’
For people struggling with substance abuse and looking for help, the pandemic has greatly affected the treatment landscape. Many inpatient treatment facilities have had to reduce capacity, while outpatient care, counseling services and peer support programs have all largely gone virtual.
One woman in Aspen, who asked to remain anonymous, said she relapsed over the Thanksgiving holiday, quickly finding herself back in the throes of heavy drinking. Her husband, doctor and counselor were all trying to find a treatment center to take her in. But even with good insurance, no one could, forcing her to develop an aggressive treatment program with a counselor. “It was incredibly frustrating, and in the end I had to go to Plan B and make up my own rehab,” the woman said. “I can’t imagine what it would be like if someone was living on the edge.”
Inpatient facilities have had to follow many of the same capacity restrictions as other businesses to prevent infections. In general, that has reduced the capacity of the inpatient treatment system, which already faced shortages and is both notoriously expensive and difficult for people to navigate, said Bradley Sjostrom, director of West Pines Behavioral Health near Denver and president of the Colorado Providers Association, a group that represents substance abuse prevention, treatment and recovery service providers in the state.
More people are struggling with depression and anxiety and social isolation, Sjostrom said, calling it a vulnerable time for people who have substance abuse problems. “It’s all a rather toxic stew that has been quite harmful to people.”
Bobby Ferguson, founder and director of the Jaywalker Lodge in Carbondale, an extended care residential treatment center for men, said the organization expanded with an additional house and building early on in the pandemic. While it hasn’t had outbreaks among patients, the extra space has helped some staff — many of whom are graduates of Jaywalker’s extensive treatment program — quarantine as needed for isolated cases.
“There’s no question people are stressed and addiction is up, as are co-occurring mental health issues. We are seeing increased demand for services,” Ferguson said. “It sucks out there for addicts struggling right now because there were fewer opportunities for continuity and stability in their lives.”
Not the same on Zoom
Getting into inpatient treatment on the Western Slope has always been hard, and it has been particularly challenging during the pandemic, said Elizabeth Means, executive director of the nonprofit A Way Out. Paying for inpatient treatment has always been hard as well, and is frequently subject to insurance complications.
A Way Out provides counseling and assessments and works to place people into treatment services throughout Garfield, Pitkin and Eagle counties. It also can provide scholarships to help people pay for services to get sober.
It believes in a graduated program when that is needed, with 30 to 60 days of inpatient services followed by sober or transitional housing and regular outpatient contact. The nonprofit helps hundreds of people each year and over 70% of its clients are sober after one year. It had its largest ever census in 2020, up about 20%.
“I thought December would be really quiet, but we’ve had more people asking for help than any other year,” Means said. She added that more people seem to be turning to alcohol and drugs to self-medicate and cope with stresses of the pandemic, calling addiction a pandemic of its own.
Outpatient services, counseling and longstanding peer support programs like Alcoholics Anonymous have been largely virtual for months.
Technologies like Zoom have benefits, people working in the field say, and are expected to remain on the treatment landscape even after the pandemic ends. They can make it easier for people to connect with valuable services both near and far, taking away the need to travel, find child care or find a ride to a meeting if they don’t have a car or a driver’s license.
But the technologies also have some wondering if they will prove as effective as in-person contact for people to get a sense of their own path to recovery, build community and support networks and make lifestyle changes that are vital to long-term sobriety.
Ashley Connolly, a counselor and sobriety coach in Aspen, said she remembers the impact of going to her first sobriety meeting. “I cried. I was surrounded by 20 women who reached out to help, and that can be hard for some people to do on Zoom,” she said.
Community is vital to recovery for people who are facing substance abuse issues, and is something that has been heavily impacted by the pandemic. The disconnect of interacting through a screen can be especially challenging for some newcomers.
“A lot of recovery and support relies on community, so for people who already had that, it may not be as big of a deal,” said Wolfington. “But it can be really hard if you’re new to recovery, to join that in a virtual platform. It may not have the same depth of relationships. Any support is better than no support, and I’m thankful communities are finding ways to virtually connect, but it may not be enough for everyone.”
‘A step in the right direction’
Morton said she shares the concern, but has also seen successes. Problem solving court continues to graduate participants and Morton said she hasn’t seen a marked increase in referrals or a decrease in its success rate. But regular courts were backlogged by the pandemic early on, and the full impacts of the pandemic on people in the justice system who are struggling with substance abuse probably won’t be known for some time, she said.
One participant in the court has been attending AA meetings daily, but logging onto meetings around the country, from Kansas to Hawaii. “He’s getting a kick out of that,” Morton said. She’s also heard of more diverse sobriety support groups forming, so that younger women and men and others can maybe find groups they can more easily relate to and form relationships with.
Mary Anne Avery, owner of Alpine Springs, which provides state-certified substance abuse treatment and DUI classes in 14 counties and three judicial districts in Colorado, said she’s heard from a number of clients who are using the app Sober Grid, which bills itself as the world’s largest online sober community, helping people locate other sober people in their area to reach out to. “It was developed before the pandemic came around and people have found it really helpful. That can be a step in the right direction,” Avery said.
Meanwhile, the pandemic grinds on, with widespread vaccinations not expected until spring or summer.
The hope is that people facing behavioral health and substance abuse challenges will find ways to stay positive, explore ways to cope with the stress of the pandemic that are healthy and enriching, keep in touch with family and friends who may also be struggling, develop support networks, and reach out for professional help when its needed, before a crisis emerges.
“There’s been a marked increase in people suffering from behavioral health issues, or an increase in the intensity of their behavioral health issues because of the pandemic, and that includes substance abuse. That’s always been a big problem in this valley specifically,” said Chris Rieder, Eagle County program director for Mind Springs Health. The organization has seen about 20% more clients and delivered 40% more services this year, thanks in large part to telehealth.
Rieder said he hopes people face personal challenges the pandemic is making them aware of, and work to address any behavioral health or substance abuse issues that were either not present or lying dormant before the pandemic.
“I feel like there is a silver lining, and the more we can talk to people about finding that, the more the effect of the pandemic won’t be as negative, long-lasting and impactful as it’s always painted out to be, with people finding new opportunities, new ways to engage, and using it for a positive shift in their life,” Rieder said.
Tom Lotshaw can be reached at firstname.lastname@example.org.