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Americans are experiencing a historical moment unlike any other in most of our lifetimes -- a global pandemic, a resulting economic downturn and unemployment, and protests over police brutality and racial injustice.During this time, our mental health is under unprecedented strain.In this special series, WMRA explores access to mental health services, and how therapies have adjusted to the current crises. Over the summer, we'll examine telehealth, addiction services, mental health for children, suicide prevention, access to therapies for people of color, and new ways of treating mental health issues, depression and anxiety.This special series is made possible in part by a grant from Mr. and Mrs. Frazier and the, "Austin Frazier Memorial of The Community Foundation of Harrisonburg and Rockingham County," and from WMRA's News and Information Fund.Mental Health Resources: Community Services BoardsHarrisonburg-Rockingham CSBRegion 10 CSBNorthwestern CSBValley CSBRockbridge Area CSBSuicide PreventionVDH suicide prevention siteNational Suicide Hotline: 1-800-273-8255 (TALK) En Espagnol: 1-800-799-4889 Deaf / Hearing Impaired: 1-800-799-4889 Crisis Text Line: Text TALK to 741741

When Therapy For Addiction - Including Group Support - Goes Online


How have treatments for addiction, especially the all-important group therapy sessions, been impacted by the COVID-19 pandemic?  In the next installment of WMRA’s special series on Mental Health Matters, Jessie Knadler reports.

For an addict, it is incredibly difficult to make the first step toward getting clean.

Credit Kirk Luder, M.D.

DR. KIRK LUDER:  They just get to the point where they’re kind of half suicidal all the time.

Dr. Kirk Luder is a psychiatrist at Washington and Lee. He’s also involved with the Rockbridge Area Community Services Board, where he treats patients suffering from opioid dependence.

LUDER:  They know they can die at any point but they almost don’t care. That’s the state I often see people when they’re coming in for opioid dependence.

Now add to that half-suicidal mentality all the possible effects of a pandemic: job loss, family stress, social isolation, a potentially disrupted supply chain. It can make an already challenging situation seem impossible.

And yet, since the crisis started, Luder says they’ve had a big influx of people with opiate dependence coming in for help.

LUDER:  They hate who they are when they’re using and they want to reclaim a sense of morality and reliability, and so forth. That’s one of the things that’s really motivating for them.

But the pandemic makes it really easy for this already vulnerable population to fall through the cracks. Because here’s the thing about recovery (and this is a famous quote in the recovery world): “the opposite of addiction isn’t sobriety. The opposite of addiction is connection.”

LUDER:  It’s very widely recognized that social support is easily the number one factor in successful treatment of a substance use disorder.

Addiction is compulsive behavior. Compulsive behavior thrives in isolation or in an embedded drug subculture.

LUDER: I hear all the time from patients that say, I don’t know anyone who doesn’t use. Trying to move from that into a new subculture, new friendships, new supports of people that don’t use—that’s absolutely essential. But we’re in this situation where we’re basically prohibited from developing new relationships.

Face to face meetings had to be canceled. The all important group meetings, where people get to share their stories with those also in recovery, were shelved.

AMANDA TOMLIN:  I pretty much count on my counselor and my therapist. I have very few friends, but if that’s what it has to take, then that’s what it is.

Amanda Tomlin has been in recovery from opioid use disorder for the past seven years.

TOMLIN:  In the addiction world, you have no friends. You have addiction buddies.

When the pandemic hit, and she found out she couldn’t go in for the all important group sessions at the Rockbridge Area Health Center, she was afraid.

TOMLIN:  You know, it was panic mode. I’m sure I’m not the only one who feels this way but it’s basically my little family.

Tomlin was told she had to transition to online support. And as most people in our world of Zoom know, there were glitches. Communication breakdowns. People who can’t figure out how to turn on their microphones. Inconvenient? Yes. But for those with opioid use disorder? It could spell the difference between hanging in there and giving up.

The team at the Rockbridge Area Health Center understood this and knew they had to act fast to make sure patients, especially new patients trying to make that critical first step, got the services and support they need. The entire program had to be restructured. Here’s mental health clinician Molly Pallavicini:

Credit Molly Pallavicini, MS, LPC, MCC

MOLLY PALLAVICINI:   It has not been easy. We make a coordinated effort. I speak to them or see them once a week. The substance use care coordinator talks to them at least once a week – and these are on separate days.

Medical appointments for Suboxone were conducted online. Patients also receive regular check in calls and texts from a trained peer mentor, someone further along in their recovery. The goal is constant connection.

PALLAVICINI:   We wrap them around with many services.

Pallavicini started seeing patients face-to-face – or rather, face mask to face mask – back in June. Medical visits can be conducted in person now too, if the patient chooses. But the all important group meetings? They’re still a ways off. Here’s Tomlin again:

TOMLIN:  They have made a point to stay in touch and reach out to us even if we don’t want them to.

Rockbridge Area Health Center has helped Tomlin learn how to navigate setbacks and triggers. But patients just starting the program? She knows the battle they face.

TOMLIN: Those are the ones that I pray for because they made the first step.

But she’s living proof it can be done.

TOMLIN:  I went from someone who was losing everything they had to getting ready to buy a home...

REPORTER:  Oh, that’s fantastic. Congratulations!

TOMLIN:  Yeah! … As hard as it was, as much as I was on, anyone can do it if they have their mind set on it. If they really want to get themselves clean they can do it.

Organizations like the Rockbridge Area Community Services Board and Rockbridge Area Health Center are there to help.

Jessie Knadler is the editor and co-founder of Shen Valley Magazine, a quarterly print publication that highlights the entrepreneurial energy of the Shenandoah Valley. She has been reporting off and on for WMRA, and occasionally for National Public Radio, since 2015. Her articles and reporting have appeared everywhere from The Wall Street Journal to Real Simple to The Daily Beast. She is the author of two books, including Rurally Screwed (Berkley), inspired by her popular personal blog of the same name, which she wrote for six years. In her spare time, she teaches Pilates reformer, and is the owner of the equipment-based Pilates studio Speakeasy Pilates in Lexington. She is mom to two incredible daughters, June and Katie. IG: @shenvalleymag
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