Virtual Treatment Gets the Job Done

Time for your treatment group meeting? Plop down in your favorite spot at home, get on Zoom, and you’re there.

Virtual counseling for people in non-residential addiction treatment is the current norm and will likely be commonplace even when COVID-19 is tamed. This at-home treatment option has plenty of benefits, according to both patients and local treatment providers.

No travel needed, for example. A big plus if you lost your driver’s license due to a DWI. Or if you live a few hours away from the nearest treatment provider. Or if you otherwise would have to make a rush-hour drive to your group time between work, school, and family obligations.

Minnesota’s brutal winter driving conditions no longer need to keep you from getting to group either. Instead, click-click, and your treatment support is just inches away. This close-at-hand approach to counseling also makes it more likely that the patient will actually show up – an asset for both providers and patients.

Another obvious benefit is pandemic safety. Some patients are still being seen for in-person sessions by providers, however, with typical pandemic safety protocols in place.

Greater ease online

People entering treatment may actually have a greater comfort level with this virtual format, according to Club Recovery addiction counselor Craig Johnson. That’s because they are already at ease with online ways of communicating.

We definitely have some patients who absolutely love virtual services and it’s very empowering to them.Lydia Burr, Director of Clinical Services for Hazelden Betty Ford Foundation in St. Paul, says, “We definitely have some patients who absolutely love virtual services and it’s very empowering to them. It helps them to overcome a lot of the things that they struggle with, because it can be intimidating, especially for new patients, to come to a new place – to get ready, to leave the house, to find parking, to navigate all of these things.” Also, as Craig Johnson points out, they can feel pretty anxious “when they first walk in the door and there are all these people.”

For Bernadette Super, who has been living with the effects of compulsive gambling for over 25 years, either option is fine. The cumulative costs of losing vehicles, housing, and more finally pushed her to seek professional help earlier this year. She started attending group treatment sessions with Johnson at Club Recovery in Edina and made the switch-over to virtual sessions more or less seamlessly in early April. While Super has been a member of Gamblers Anonymous for a long time, getting treatment has helped her make a much bigger leap forward in her recovery, she says.

“I’ve learned so much more about addiction and what happens to the brain when it gets to the point of addiction,” says Super. “I’ve become ready to change my life. They give you all the tools you need.” She has written to all the casinos in Minnesota and made arrangements for them to ban her from entering any of them.

Super is grateful for not having to leave home to get treatment. The time she gets for herself during the meetings, while her teenage son tends to her toddler, is invaluable, she says. Calling herself a “chatty Cathy,” she enjoys the social interactions in the group meetings, making new friends, and connecting with them outside of group times

A quick leap to virtual

Treatment providers had to ramp up quickly this spring to make the switch to online treatment. Hazelden Betty Ford Foundation, which had been planning to create virtual options in a carefully developed rollout over time, implemented virtual services in one week’s time. “That meant training all of our licensed alcohol and drug counselors and flipping all our patients, and we did it,” says Burr.

For gambling addiction providers, the leap didn’t come as easily. Virtual treatment had never been an option for them due to state regulation limits. Once COVID-19 caused a state lockdown in March, Susan Sheridan Tucker, Executive Director of Northstar Problem Gambling Alliance, contacted the Minnesota State Department of Human Services (DHS) to ask for an exception due to the pandemic. They said no.

“So, I actually called the governor and said this isn’t right. We need to have this tool,” says Tucker. The governor agreed and DHS followed suit soon after. “My hope, and I’m talking to DHS about this, is that it would become a permanent tool.”

Northstar has also purchased, and made available to compulsive gamblers, hundreds of subscriptions to a self-excluding blocking tool that bars them from online gambling sites. It could be especially helpful when pandemic isolation at home might make the convenience of online gambling extra attractive. Gamblers must sign up in order to use this service.

Canvas Health, a 51-one-year old agency in Stillwater providing mental health and addiction treatment services, had some experience with telemedicine already. In February, they started expanding their technology for this type of service.

“We’re really trying to reduce barriers,” says Cathy Havrieux, Substance Abuse Service Manager at Canvas Health. In March, Canvas Health transitioned quickly to the virtual treatment model, including their jail programs in Chisago County and Washington County. Jail patients meet with the provider in a group setting while wearing masks. Canvas Health also provides laptop rental to clients who need one in order to participate in virtual meetings. If an inmate has to be quarantined after leaving the jail for, say, a court appearance, the inmate is provided with an iPad so they can join the Zoom meeting during the quarantine period.

People outside of jail settings may also have limited access to the needed technology for virtual meetings. Burr notes that some patients will move in with their parents or into a sober house so they can take part in group meetings.

Harder to make social connections

While appreciating the benefits of virtual treatment, providers express concern about the lack of social interaction that normally happens at in-person meetings. There is no opportunity for the typical hanging out with other patients before or after meetings, or during breaktimes.

As Harvieux says, “Recovery is based on the building of a sober support system, a consistent peer support group that you can call on and that keep an eye on you to help you move forward in your recovery. Whenever that piece is missing, it makes it very difficult.”

“We’ve encouraged people to get together, to social distance outside of treatment,” she says. Patients are also encouraged to attend community 12-Step meetings, which may meet online or in parking lots or other safe locations. “We do have a peer recovery support specialist on our team who will contact individuals and meet them at 12-Step meetings with their family, helping them to build that sober community support as well.”

Challenges for providers

Providers have their own set of challenges with this new type of service delivery. Screen time overload is one of them. As Burr points out, “Your brain instinctively is trying to watch everything going on. It’s like watching eight to ten TVs at once. It can be fatiguing for the staff. They also have a harder time reading body cues when not in the same room with patients.” At Club Recovery, Johnson says he has never even met half of his current clients face-to-face.

Your brain instinctively is trying to watch everything going on. It’s like watching eight to ten TVs at once. It can be fatiguing for the staff.With virtual meetings, says Burr, “There is a need for more clear group norms, because you can’t necessarily control where the patient is when they dial in to groups. We’ve had people dialing in from their roof and we’ve had people dial in from riding a horse.” Also, with the many distractions in the home setting, she says, “You can tell a patient is doing something else.”

People sometimes show up not fully dressed, says Johnson. “I’ve had to tell them, ‘Perhaps you need to go put on a robe.’”

Patient privacy is another concern. “We have to make sure that they are alone, that privacy is being respected,” says Burr. Some online platforms for group calling don’t meet strict federal privacy requirements, notes Tucker, so she recommends that patients ask the provider about their privacy protocols before starting online treatment.

If the providers are not taking care of themselves, that makes it very difficult for them to deliver what patients need.One side effect from virtual treatment models is increased anxiety among providers. In addition to the screen fatigue and extra effort to read body language, more initiative on the part of the counselor is required to serve patients online. Without the easy socialization context of in-person meetings, says Burr, “The counselors are having to come to group much more prepared with a lot of content. Open- and closed-ended questions. Getting-to-know-you exercises. Maybe inviting the sharing usage history a little bit more frequently, so that people can hear each other’s stories.”

At Canvas Health, Harvieux is offering a self-care group option for her staff. “Some of them have branched out into their own little weekly get-togethers for support with each other,” she says. She has called on a mental health specialist on her staff to provide stress management guidance for counselors, and one of them will soon be certified in the area of telehealth stress. “If the providers are not taking care of themselves, that makes it very difficult for them to deliver what patients need.”

What matters most, say providers, is that people don’t hesitate to seek treatment due to fear of technology or being overwhelmed with the pandemic. “What better time to surround yourself with people who know exactly what you’re going through?” says Burr. “Waiting for a better time, it doesn’t come. We’re here and we want to help.”


Pat Samples is a Twin Cities writer, writing coach, and champion of creative aging. Her website is patsamples.com.

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