Alcohol, cocaine, pain pills — since he was a teenager, Derrick consumed them all, at one time or another, to ease his racing mind. His addictions landed in and out of rehab centers.
Finally, at 35, Derrick was in a better place. He made a good living working construction in Miami. He exercised regularly. Derrick completed one year of sobriety through a 12-step program, attended five or more meetings a week and met often with his sponsor to improve his spiritual health.
Then, the coronavirus upended his recovery.
Derrick’s group meetings have been shut down. He’s working fewer hours. And when he’s at a construction site, he’s terrified of catching the highly infectious respiratory virus because of his asthma.
“I went like 2 1/2 weeks without a meeting and I was starting to get a little messed up in the head,” said Derrick, who asked that his last name not be used. “The anxiety and fear was starting to get to me.”
But like many recovering addicts grappling with the sudden shutdown of society, Derrick has turned to meetings through teleconferencing services such as Zoom and In The Rooms, a free website that specializes in hosting recovery groups. Virtual 12-step meetings are attracting thousands of new users, many stuck in isolation, without work, resisting the temptation to use.
Getting clean is challenging enough in regular times, and the coronavirus has also upended South Florida’s fragile care system for people battling alcohol and substance abuse, putting many more at risk of relapsing and overdosing.
Substance-abuse therapists have traded in couches for platforms such as Skype or Facetime as some South Florida residential rehab centers have stopped accepting new patients for fear they might infect existing clients. Because there’s been a steep drop-off in patient visits, clinics are bracing for private insurance and federal government reimbursements to vanish, forcing layoffs of counselors and staff.
Doctors fear Medicaid patients will run out of their supplies of drugs such as suboxone, which is used to treat opioid addiction, because of strict state requirements that they get drug tested and visit doctors in person.
Fewer treatment orders
And fewer people are turning to the judicial system to push their loved ones into treatment. Normally, Miami-Dade courts process about 10 petitions a week for hearings known as “Marchman Acts.” Since March 16, only one to two petitions are being received weekly.
“Social distancing in a court setting is of great concern,” said Miami-Dade Circuit Judge Yvonne Colodny, who is working to arrange virtual hearings during the ongoing global pandemic.
Substance abuse itself has been a long-running crisis in the United States. In 2017, an estimated 20.7 million people ages 12 or older needed treatment for substance use treatment — or about 1 in 13 people, according to the National Survey on Drug Use and Health.
The country’s opioid addiction problem has been well chronicled in the United States and in Miami, where deaths associated with fentanyl and other types of synthetic heroin jumped dramatically a few years ago. Crystal meth has made a comeback in South Florida. So has cocaine, according to federal researchers and law enforcement.
In South Florida, there is no uniform way for drug and alcohol abusers to get treatment. Clinics, rehab centers and individual therapists get paid through a patchwork of public money, private health insurance companies and families paying out of their own pockets.
Thriving Mind, which was formerly known as the South Florida Behavioral Health Network, manages state funding that each year helps about 50,000 people dealing with mental illness or substance abuse, or both. The organization contracts with about 40 providers, clinics big and small, rehab centers and companies that provide in-home treatment.
Thriving Mind said it is working with the Florida Department of Children and Families to try to keep payments to providers flowing, to ensure rehab professionals don’t lose their jobs and patients are still getting help.
“For the most part, it’s hobbling along,” said Thriving Mind CEO John Newcomer, adding: “We may well see an uptick in the need for services as we move on. We’re just trying to make sure the system is intact.”
Even if DCF keeps payments flowing, many clinics that treat substance abuse will still suffer because private insurance companies and Medicaid will not reimburse them if they’re not seeing patients, he said.
Medicaid has also become a concern for Dr. Hansel Tookes, of the University of Miami’s Miller School of Medicine division of infectious diseases. Tookes works with opioid addicts, and has been lobbying Florida’s Agency for Health Care Administration to lift strict requirements for getting refills of medication used to treat their illness.
Those requirements include in-person drug screenings at labs, group therapies and visits to doctors, all tough asks when you’re supposed to be sheltering at home. If addicts run out of their medications such as suboxone, they may wind up overdosing on poor quality street drugs — and they’ll crowd hospital emergency rooms needed to treat COVID-19 patients, Tookes said.
“This is a time of anxiety for a lot of people, and we need to be making it easier for them to get these medications,” said Tookes, who also founded a pioneering needle exchange program in Overtown that is still operating, albeit with staffers in masks and gloves accepting dirty needles through a window.
For now, rehab facilities — of which there are hundreds in Florida — are taking it day by day.
Banyan Treatment Centers, which has five locations in Florida, says it is “ reducing the amount of close contact among patients and staff,” and doing a “thorough cleaning and sanitation of facilities and supplies on a regular basis.”
South Beach Detox, a private 34-bed adult residential program in North Miami Beach, is still accepting patients but “under strict protocols” including a pre-screening by phone, and another one once the client arrives at the facility.
Outside of treatment centers, recovering addicts have turned to virtual platforms.
Mark, a Miami Beach lawyer who asked his real name not be used, has seven years sober and is a regular member of a Miami Beach Alcoholics Anonymous group. When city officials began curbing mass gatherings, his group moved meetings to a nearby park, where gatherings were limited to less than 10 people.
Then, Miami Beach ordered its parks closed. Meetings went entirely online onto Zoom. “My problem is that I’m out of my routine. Addicts and alcoholics don’t like change, and my reality changes every 72 hours,” Mark said. “I’ve joined a Zoom group from New York, and it’s given me a different perspective and introspection in my own recovery.”
Kevin Sullivan knows how a global crisis can wreck sobriety.
The New York restaurateur spent more than two decades clean until 2009, when the worldwide recession destroyed his finances. Before long, his family relationships ruined, Sullivan was again drinking beers, snorting cocaine and taking ecstasy.
Sullivan, 59, is sober again, seven years in and living in Miami Beach. He’s been doing Zoom meetings, and helping homeless addicts get meals and set up apps on their phones. He worries that people who are new in recovery will suffer the most because they won’t have access to people with many years under their belts.
“This is hard on everybody,” he said. “But even harder for those who really need that face-to-face support.”
Substance abuse expert Dr. David Fawcett, of Wilton Manors, said rehab professionals have pivoted quickly to online, even if it doesn’t quite replace face-to-face meetings.
“Communication is a little more awkward and people talk over each other,” Fawcett said. “You don’ t have the social cues you do if you are sitting in a room with somebody, but it’s better than nothing.”
Fawcett hosts a group meeting for gay men addicted to “chemsex,” or sex enhanced by drugs such as cocaine and meth, on the website In The Rooms.
User traffic has swelled at In The Rooms, a free recovery website that virtually hosts meets such as Alcohol Anonymous, Narcotics Anonymous, and Overeaters Anonymous. The website, started by South Florida businessmen and recovering alcoholics Ronald Tannebaum and Kenny Pomerance, surpassed 625,000 members this week.
This month, the site is averaging about 2,000 new members per day. In The Rooms, which is supported by some advertising and donations, has added a slew of new meetings and a slate of around-the-clock AA meetings.
“We just started a coronavirus support group,” Tannebaum said. “We’ve had some days of over 3,500 sign-ups.”
On the screen, the person running the meeting appears in a box on the upper lefthand corner, the person speaking in the middle, a queue of people waiting to speak on the right.
One recent afternoon meeting for alcohol recovery featured over 400 people, with people sharing their stories in two-minute segments. Some showed their faces on camera; many others did not. One Canadian woman was attending virtually while in self-isolation because she’d just returned from a trip to Florida: “I’m grateful we have a roof over our heads and food to eat.”
Said Pomerance: “Solitude is a killer for us. People are reaching out during such a weird disjointed time. People are thirsting for that connection.”