At New Life Treatment Center in Pipestone County, executive director Cheryl Thacker fears what coronavirus isolation will mean for their small substance abuse treatment center in southwestern Minnesota.

All 21 inpatient beds have been full — and Friday, five people were in the detox unit — even as staff has fielded an inordinate number of calls from past clients. Over the chaotic past few weeks, people have relapsed or feared they're on the road to relapse. Some have been furloughed from work, others laid off.

What used to be a couple of calls a week from past clients who are struggling has in recent weeks turned into a half-dozen crisis calls a day. Many callers worry how they'll stay on the road to recovery with so many in-person group therapy meetings now suspended.

"I'm concerned that when this is over there's going to be a flood of people who need treatment because they've relapsed," Thacker said.

"We're hearing people saying, 'I'm struggling. I can't stop all this that's going on in my head, and the only way I know how to make that stop is to drink or to use.' "

There's an adage taken as gospel among people who are in recovery for drug or alcohol addiction: Addiction is an illness of isolation, and the antidote is community.

The concerns in the recovery community are many. How will social isolation affect people, especially the most vulnerable who are early in recovery and depend on the routines and community from in-person group meetings such as Alcoholics Anonymous? Will concerns about contracting COVID-19 discourage people from seeking treatment in residential facilities or group therapy settings?

And could these highly unstable times become a trigger for those in recovery?

"People who go to those meetings go because they've had that shared experience of, 'I was once living with this horrible disease, I still have it, I'm in recovery — but I need your help to continue to stay sober,' " said Daniel Eby, supervisor of the substance abuse program at Options Family and Behavioral Services, which operates three programs in the Twin Cities. "The second you pull back from that, especially for people in early recovery, it's a really hard thing to be sitting at home, isolated from everybody. And there's a tendency to be like, 'Man, I can't get through this. I should just have a drink. Or I should just call my dealer.'

"I don't see how this is not going to be a difficult road ahead of us."

AA videoconference

Nearly 8% of Minnesotans have a substance use disorder, according to the Minnesota Department of Human Services. Those are the people currently battling addiction, but that statistic could more than double if it includes people already in recovery, estimated at one in 10 Americans, according to a 2017 study by the Recovery Research Institute.

The coronavirus crisis is pushing many recovery meetings online. Alcoholics Anonymous meetings are being held in Google Hangouts, on Zoom and in conference calls.

Even the Hazelden Betty Ford Foundation is turning to online group therapy. Recently, it unveiled a tool — weeks earlier than planned — for the nation's first telehealth solution for drug and alcohol recovery group therapy sessions.

Clients will be able to attend 12 hours of weekly group therapy online and from home in all seven states where it has brick-and-mortar facilities. In a little more than a week, 75% of Hazelden's patients nationally transitioned to virtual services. The organization is actually serving more people in intensive outpatient treatment than before the pandemic.

"How does this community engage in fellowship in a virtual way?" said Mark Mishek, the CEO of Hazelden Betty Ford Foundation. "We're not going to be able to get together in 12-step meetings. It's not going to happen. The physicality of it, it's something we've taken for granted."

Life and death

People who have succeeded in recovery describe addiction as like being on an island. Sitting in a room with other vulnerable people who have been through the same things can be liberating and can give someone new in recovery permission to be vulnerable. Some believe there's no substitute for that human connection.

"There's all kinds of online resources, but this is a disease of isolation," said Marvin Seppala, the chief medical officer at Hazelden. "It's those relationships that really keep people sober."

Those in the recovery industry speak about a balancing act. There is the obvious need to protect people from the spread of this virus. But the question for many is whether the need for treating addiction outweighs concerns about the virus — at least for now.

"As a field, we are looking at what's the risk of our clients who are suffering from untreated addiction versus the risk of COVID-19," said Jared Bostrom, executive director at Progress Valley, a nonprofit behavioral health agency headquartered in Bloomington. "At this point our clients are more likely to die or have adverse health impacts from an overdose or untreated addiction than from COVID-19. That could change, certainly. But although the concerns about this virus are very real, and all providers are taking measures to prevent its spread, we still need to provide our services."

It's a life-or-death problem for someone like Dawn, a 48-year-old St. Paul woman who has been sober for seven months from methamphetamine and alcohol addictions. Her counselor canceled an in-person meeting recently and offered to do it over the phone. She is worried about what the coming months will bring. She knows she doesn't want to go back to spending $80 a day on meth, but she can already feel her mental health being frazzled.

"If it wasn't for my counselor, I probably would have used again," said Dawn, who requested that her last name not be used. "Counseling is my outlet. I'm taking it day by day. There are days I want to pick up a bottle and go to the liquor store and drink myself to death. But I haven't."

After the 2008 recession, a surge of people entered addiction treatment for the first time — or re-entered after a relapse. The worry is that a surge could be much worse from the pandemic.

Bostrom has seen plenty of clients already losing jobs in the short time the coronavirus has upended American life. Those who are early in their recovery frequently work in the hospitality industry, in retail, or in trade or labor jobs, and those jobs have already been hard hit. As a result, Progress Valley is temporarily removing its requirement that clients be working or in school.

"It's not an elective option for many of our clients," he said. "This is literally life and death for a lot of people."