Special report: In the face of COVID-19, East Tennessee’s treatment providers struggle to strike a balance between personal and professional recovery
Like a thief under cover of darkness, COVID-19 has stolen from the East Tennessee addiction recovery community.
At the same time it has decimated the population at large, claiming more than 170,000 American lives and infecting more than 5 million people in this country, it’s laid waste to the ties that bind those in recovery together, making off with the hope that’s such an integral part of the new way of life they’ve found in now-shuttered church basements and clubhouses.
Recovery meetings are shut down. Relapses are up. Overdoses have spiked. Those who may have wanted to get clean before the pandemic began now find themselves wondering if it’s safe to do so, or even whether doing so is pointless. And the caregivers — the counselors and therapists and administrators whose job it is to shepherd and safeguard those who need help — are suffering as well.
When it comes to addiction treatment and COVID-19, however, their struggles are more complicated. Many are recovering addicts and alcoholics, men and women whose personal programs are often used as living, breathing examples of redemption in the treatment settings in which they work. In the drug and alcohol treatment industry, compassion fatigue — the exhaustion brought on by foregoing self-care because the efforts of caring for others is so taxing — is a danger during normal circumstances.
During COVID-19, it’s overwhelming, and a great many caregivers look out upon a horizon of uncertainty and wonder how far they might be from their breaking point.
“This level of transition and required flexibility and urgency is something I’ve never experienced before,” says Amy Dolinky, the Substance Misuse Response Coordinator for the Knox County Health Department. She’s in her car, eating a hurried lunch between one of the myriad COVID-19 responsibilities that have fallen into her lap since the pandemic began.
“I’m exhausted all the time,” she continues. “My first few months of quarantine, I was spending more time at home, and the beginning of it felt really spiritual. I spent more time outside, and I felt like everything kind of paused for a minute. Not work — work was chaotic — but it was really nice because I was praying and meditating more, and the weather was great, and I even managed to finish grad school in the midst of this.
“But then, after a month, things really changed. The pandemic seemed to shift, and everything got more uncertain. The workload increased on everybody in the Health Department, and everybody is just doing their best to stay on top of it during a really stressful time. There are days now I’ve had to walk out of the office and take 10 minutes to take a time out. You get so passionate about helping people in this job that when you can’t because of forces beyond your control, it can be really heartbreaking.
“It’s just so hard to be someone who’s really about service and trying to help people, and because of a pandemic that is so unpredictable and still so new, you can’t do it in the way that you want,” she adds. “It’s so painful, not being able to help.”
Addiction treatment and COVID-19: The personal takes a backseat
For Justin Casevechia, a business development representative for the Sevier County-based addiction treatment facility English Mountain Recovery, it’s a level of frustration he knows well. His facility, he says, is seeing a number of addicted individuals coming to treatment for the first time — spurred, perhaps, by functional drug and alcohol routines that have been disrupted by the pandemic. Others are coming in who had years of sobriety under their belts, but COVID-19 has pushed them over the edge, and in moments of hopelessness, they’ve turned to familiar outlets that once provided a false sense of comfort.
“A lot of people say, ‘Hey, I was functioning OK, but then I got sent home because of COVID, and I started using or drinking,’” he says. “They say, ‘I used to just drink every other night, but now I drink when I wake up, and it’s been a month, and I haven’t had a minute without alcohol.’ I think it’s showing me how much society is reliant on outside things to feel better.”
That holds true for Casevechia personally. He’s been clean and sober for several years now, but if it hadn’t been for the personal connections forged in 12 Step meetings, he could very well be one of the patients that come to English Mountain for help.
“I would have never cared about a 12 Step fellowship at all if it weren’t for the people I met at first,” he says. “I just wanted friends, and I was excited to make friends who weren’t using drugs. I went to three meetings a day for as long as I could remember, but what happens when you take people out of the equation?
“It’s already awkward enough when someone stops using, whether they go to treatment or whatever the option is. It feels weird going into the rooms, but now, you don’t have anybody to talk to. And with the recovery I have, it’s so much harder to pick up the phone. On the phone, I’m more likely to say, ‘I’m good!’ But if I’m sitting in a meeting, it’s so much easier to say, ‘I’m struggling.’
“Personally, I feel completely disconnected,” he adds.
He’s not alone. Anne Young, Director of Residential Programs at Cornerstone of Recovery, A Tennessee drug and alcohol treatment center located just outside of Knoxville, will mark 35 years of sobriety on Sept. 3. In all that time, she says, she’s never gone this long without sitting in a recovery meeting with peers. She’s joined several Zoom meetings, but it’s not the same, a thought echoed by Casevechia.
“The longest I’ve stayed on a Zoom meeting after the (actual) meeting was 15 minutes, and I used to spend hours sitting outside a meeting, before and after, just talking to people,” he says. “There’s not the adventure of going to a meeting now. Now, it’s come home, get dinner, go downstairs and turn the (computer) camera off while I eat and halfway pay attention.”
For Young, the saving grace has been the ability to come to work at Cornerstone each day, where she’s surrounded with and working alongside peers who are in recovery themselves and understand exactly what she’s going through. The adjoining rooms along the section of “The Bullpen,” the treatment facility's command center where her office is located, are occupied by fellow employees with multiple years of recovery, and their conversations — their honesty — has been vital in letting Young know she’s not alone.
“It’s been quite challenging on many levels, and I make sure to say that out loud when I’m talking to folks, so they know it’s not just a problem for newcomers,” she says. “The sobriety we have on this row is phenomenal, and some of these people are my elders (in recovery), and we’ve talked about being depressed, about having a hard time not hugging or touching, about not having the opportunity to be in meetings.
“Someone with that kind of time is usually older, so we’re the people at risk (for COVID-19). So even the old-timers have been depressed and have been really sad about the loss of connection that we have. I feel eternally grateful I can come to work every day and talk about recovery and role model for others what recovery looks like, but it has been a struggle to maintain that positive outlook, that glass-half-full mentality.”
Burnout, compassion fatigue and other caregiver concerns
And that struggle can put caregivers in a bind: Their job is to offer hope to struggling addicts and alcoholics working to get clean and stay that way, and that’s only effective if those offering that care radiate positivity.
“It makes it difficult to offer sound treatment if you’re struggling yourself,” says Clint Crawford, the executive director of JourneyPure, a Knoxville-based drug and alcohol rehab. “A lot of our staff members are in recovery as well, and when we’re in something like COVID, there’s not a lot of meetings going on. We have staff who are trying to do the Zoom meetings, but that lack of being in person, of being around people, makes it a lot harder to maintain that strong recovery program.
“And then they come to work and deal with patients who are just into treatment, who are detoxing and dealing with everything crashing and burning down in their lives, and those individuals are sometimes difficult to deal with. Even for those who aren’t in recovery, when they go home, there’s not much they can do. You can’t go out right now, so all of the things we try to do to get re-centered and refocused, it eats away at you, because you don’t have that release.”
The lack of an outlet — because of pandemic closures and restrictions, and because of quarantine efforts to keep the clients at his facility safe — has proven to be a thorny issue for Johnny Lewis, director of the E.M. Jellinek Center, a men’s halfway house in Knoxville’s Downtown North neighborhood. During normal times, guys who do well earn privileges like weekend passes, and every man in the community is required to attend a certain number of outside recovery meetings each week. But to protect the community, lockdown measures were implemented that have taken their toll, Lewis says.
“Work and come home — those are the only things they can do,” he says. “We’ve got a lot of guys who are leaving and going to (a separate halfway house) where there are less restrictions. We’ve had people sneaking around and doing things that are against the rules, and I hate it for them. They work all week, then they can’t get out and go anywhere. Every meeting we have, we’ve got to do it here. There’s nothing they can attend outside of here.”
Normally, the E.M. Jellinek Center has a waiting list that might mean months before a desperate client gets a bed. Now, the facility is having trouble keeping beds full. Even those residents who have outside employment are subject to having their temperatures taken when they return from work, and tempers are short. This month, Lewis and his fellow administrators hope to ease the restrictions, but whether that will mean an increase in residents remains to be seen.
Across the board, local facilities saw their census numbers flatline in March, when the pandemic started sweeping across East Tennessee and local cities and municipalities began issuing shelter-in-place orders. Like Cornerstone and English Mountain, JourneyPure saw a dip as well, although those numbers are starting to level off. In addition, Crawford says, it seems like the initial panic over the novelty of the coronavirus has started to subside, or at least be put into perspective.
“In the beginning, we had several people who truly wanted to get help but were afraid to come to treatment — ‘what if I get COVID?’” he says. “I’ve had several conversations with patients over the last two months, and I’ll just be brutally honest with them: ‘Your worst problem right now isn’t COVID.’”
Addiction treatment and COVID-19: An epidemic within a pandemic
It’s easy to lose sight of that, because the urgency of addiction and alcoholism holds steady at levels that are staggering in scope on an annual basis. More Americans die from drug overdoses in any given year than the number of servicemen and women who were killed during the entirety of the Vietnam War. It’s estimated that 88,000 people die annually from alcohol-related causes.
“There are people who are coming around who need that connection so bad that they’re willing to go to any lengths to get it,” Casevechia says. “It’s that people that don’t want it that badly who are thinking, ‘Hey, this is really not that safe right now.’”
Anecdotally, these caregivers are seeing the toll that COVID-19, combined with addiction, is taking on the community of addicts and alcoholics who call East Tennessee home — those struggling to get clean and sober and those struggling to stay that way but feel robbed of the hope that’s a foundation stone of their recovery. Crawford has two friends who relapsed, overdosed and died — “and a lot of it had to do with that isolation, that just feeling disconnected,” he says. “And we’re talking about people that worked really strong programs. One had five years clean, and another had almost seven.” On the day of his interview, Casevechia received two phone calls from individuals who had relapsed — “They said, ‘I was doing OK, but COVID gave me an excuse to go use,’” he says.
While those are anecdotal experiences, they demonstrate that those with tenuous ties to recovery don't fare well without addiction treatment and COVID-19 looming over their shoulders. Karen Pershing, the executive director of the Knoxville-based Metro Drug Coalition, has seen some of her organization’s clients — the men and women who work with MDC recovery coaches who help them stay clean and sober — fall victim to it.
“We’ve seen some folks that just completely were engaged in recovery coaching, and then just completely disappeared — quit contacting us, quit connecting with us,” she says. “The minimum is once a week in those relationships, so it’s not a huge time demand, necessarily, but they dropped off. Some of them did relapse, but now some of them are wanting to reconnect, which is a good thing — because when they disconnect, we don’t know.
“Are they OK? Have they overdosed and become one of those unfortunate fatalities? Are they still out there somewhere? When you do what we do, you can’t go find them in the midst of a pandemic.”
That unknown fate is something Dolinky thinks about often when it comes to her personal sobriety. Right now, most recovery meetings are closed to in-person attendance, and those fellowships are made up of vast networks of individuals who may not be close friends or even acquaintances, but whose faces are familiar and comforting. Who, she wonders, will be left standing when COVID-19 subsides and meetings open back up?
“These are people you don’t necessarily have their phone numbers, but you see that they’re doing this thing, and you care about them for that reason,” she says. “So there is this fear of, when we do go back, this sense of impending doom. Who’s going to be gone?”
Overdoses are up, meetings are in short supply
The numbers seem to indicate that there’s a reckoning taking place, beyond the reach of even the most ardent of treatment advocates. Going back to the pandemic’s beginnings in March, the overdose numbers between 2019 and this year are striking, according to the 6th Judicial District Attorney General’s website: 22 overdose deaths in March 2019 compared to 35 in 2020. April’s numbers dipped slightly — from 34 in 2019 to 27 this year, but each succeeding month saw an increase: 18 deaths in May 2019 to 35 in May 2020; 23 in June 2019 to 32 this year; 22 in July 2019 to 26 this year.
“The overdose deaths are spiking, and we’re seeing a lot of relapses by people in long-term recovery,” says Tiffiney Lutz, regional Quality Assurance and Compliance Officer for JourneyPure. “I’ve got friends, personal friends with long-term recovery, who have relapsed because they’re giving up, and not being able to go to meetings and things like that plays a big part in that, I think.”
“I think a lot of it has been the inability to be face-to-face with people,” Pershing adds. “For us, when you’re trying to do outreach, you’re more effective if you can actually, physically be in front of people who need a connection — whether it’s recovery coaching or access to care and treatment. You can do it over the phone, you can do it virtually, but there’s not quite that connection you would have if you were right in front of someone.”
There’s a personal accountability to in-person meetings that can’t be replicated via technology. For all of the benefits of 12 Step meetings via Zoom — joining one at any hour of the day, joining meetings in other countries, doing so from the bedroom or living room couch — there’s also an impersonal feeling about it that can be used as camouflage, Casevechia points out — “in my home group, I’m guaranteed some people will call me out on my (stuff) if they see what I’m doing. On a Zoom meeting, it’s too easy to hide.”
Zoom meetings have been a critical part of the Metro Drug Coalition’s digital infrastructure, Pershing points out, but even from a professional perspective, she’s noticed that “Zoom fatigue,” for lack of a better term, seems to have set in. It’s discouraging, because it’s one of the few methods that MDC is able to use to continue its mission, but it’s also understandable, she adds.
“People are tired of virtual, and our virtual meeting attendance is definitely down,” she says. “When we started out in the pandemic, people were all excited with the Zoom meetings and getting to see each other, but now I think people are just ready for real, in-person human connections, and there’s nothing that replaces that. I’m thankful we have technology during this pandemic to stay connected, but it’s not the same.”
The entire concept of 12 Step recovery is built around anonymity, but that’s a principle that applies to public identification. One of the most therapeutic things about recovery is the connection — the building of a second family that can read body language and facial expressions and understands intuitively when something is wrong.
“Recovery-wise, I started doing online meetings initially, and I thought they were great and more to the point, but then I realized, a couple of weeks after doing that for a month or so, that I was doing the dishes while in a meeting, or turning the video off so I could do something else at the same time,” Dolinky says. “I couldn’t get present at an online meeting. Do I still go to them? Not nearly enough, or I get on there and I feel like I sound insane, because there’s so much stress and pressure and no other outlet to release it.”
Even when she’s attempted to do so, COVID-19 and her job responsibilities around it are phantoms on the periphery of her vision, just enough out of sight to cause a low-level hum of discontent.
“Literally a month ago, I decided I was going to book myself a cabin in Georgia,” she says. “I drove down, and I read books in a rocking chair for four days. And it wasn’t until I left that I realized, not once did I pray. Not once did I meditate. I couldn’t relax, because I realized what I was coming back to.”
Addiction treatment and COVID-19: Hope can be hard to come by
But, Dolinky adds, taking the time for self-care is a positive action, which is what sobriety is all about. The entire trip, she points out, was a form of prayer and meditation. Even the idea of psychoanalyzing life experiences and gauging them in terms of spiritual success or failure is a sign growth in recovery, and for folks like Dolinky, Young and Casevechia, acknowledging struggle … admitting to vulnerability … is proof that they’re living the program.
And in getting vulnerable, through their personal experiences, they hope to help others do the same. Sometimes, that’s easier said than done, especially when cultural identity issues and family of origin experiences have enforced a different lesson. For Reico Hopewell, a licensed drug and alcohol counselor and the founder and executive director of The Mend House, a men’s sober living facility in Knoxville, sees just how much Knoxville’s black community is struggling. Not only are poverty and addiction and systemic racial issues taking the same tolls they always have, the black community across the country has been harder hit by COVID-19 than any other.
“African-Americans are struggling so bad right now, because in our culture, a lot of us don’t believe in treatment,” Hopewell says. “You don’t see a lot of African-Americans in (recovery) meetings. You’ll see them in church, but not in meetings — but now, a lot of what’s happening is that a lot of spiritual leaders are calling me about alcohol and drug issues, and I’m grateful, because it shows a willingness to do more about the problem than just praying.
“But there’s that fear of asking for help. That’s in all cultures, but in African-American communities, we tend to go to church for help. But now the churches are closed down, so if you can’t go to a place and assemble with your brothers and sisters, where do you go?”
The Mend House is always open to help those struggling with addiction, and despite the challenges posed by both addiction treatment and COVID-19, Hopewell often drives great distances to bring in lost sheep or new ones who need the second chance that his facility offers. Whether he’s in the kitchen whipping up a plant-based vegan spread for the entire community, sitting down one-on-one for counseling or starting a new side business that gives his charges an opportunity to work, he’s doing everything he can to get the men under his care on a path to sobriety. COVID-19, however, makes his job harder.
“The online meetings, they’re not really working for my guys, because they need social interaction,” he says. “The hard part is that there aren’t a lot of meetings for the guys to go to, because the churches that host meetings are predominantly Methodist churches, and they’re all closed down.
“I’ve had guys get here from places like Cornerstone, where they may have been in treatment for three months, but they’ve never been to a meeting. We’ve all heard the encouragement — meeting makers make it! — but now they can’t go!”
Part of the job of addiction treatment is finding solutions to problems that are often unpredictable, however, and so Hopewell has pulled from his East Tennessee recovery network to bring outside speakers to The Mend House. At Cornerstone, Young made overtures to staff members in recovery, asking for volunteers to hold in-house meetings on campus as a way to introduce clientele to the 12 Step process, a critical component in addiction treatment. That call has been answered, she adds, but never did she think there would be a time when an individual could come to addiction treatment, stay for long-term care and leave without ever having attended an outside 12 Step meeting.
Adjusting to 'the new normal' — whatever that is
For those caregivers whose recovery rests on a foundation laid in 12 Step recovery, such a situation seems unfathomable, but that it’s now is a reality gives credence to the idea that COVID-19 is redefining what is and is not “normal.” Those same individuals who once found themselves as beacons of spirituality now find that perhaps the best method of decompression is to scream in a supervisor’s office. Seriously.
“We’ve worked really hard to have an open-door policy, and we’ve talked to leadership and to supervisors to let folks know that if they need a break, we’ll figure it out,” Crawford says. “We’re trying to make sure our staff is OK, and that if they need to come to my office and jump up and down and scream for a minute to burn off some stress and just kind of vent, that’s cool. And we’ve had some do that, and they walk out feeling better.”
For Young, the camaraderie of shared recovery is a lifeline during these times, she says. Being able to talk about recovery throughout the day may be her work, but it’s also her passion. And she, like so many others, needs to say what she’s feeling, just as she urges her patients to do.
“We’ve got to be able to say, ‘I’m struggling today,’” she says. “I know it’s been difficult for folks who have had multiple, multiple years (of recovery) to stay connected, and thank God for working in this incredible place, where we talk about recovery moment by moment.”
Others aren’t so fortunate. During normal times, Dolinky works with community stakeholders in faith, business, nonprofits and the treatment community to oversee a join initiative between the mayors of Knoxville and Knox County. The goal is to develop a three-year strategic plan called All4Knox aimed at reducing addiction and substance abuse and their impacts on individuals, families and communities. The arrival of COVID-19, however, changed everything: As part of the Knox County Health Department team responsible for communicable and environmental diseases, emergency preparedness and epidemiology, she was tasked with providing epidemiology support.
“There’s no set job description, because guidance changes constantly, and we step in to fill whatever gaps are needed,” she said. “And then, a minor part of my role has been assisting anybody associated with the behavioral health connected population.”
And while she’s often too busy to think about jeopardizing her personal recovery, the experience as a front-line COVID-19 response employee with a county health department in a community that was flagged as a hot spot by the Centers for Disease Control back in July has been intense. She feels, she says, like few people outside of the department can truly understand the scope of the stress, because the pandemic, which has ebbed and spiked and ebbed and spiked again, has been the focus of everything since spring.
“It’s trauma bonding, and I feel like these are the people I got sober with in a way, because there’s this intense connection going through this experience together,” she says. “The response team has been working extensive hours outside the norm, giving everything we have to help keep Knox County safe. At one point I had to quarantine myself because I thought I had COVID — when in reality it was my body just shutting down and saying, ‘You can’t do this anymore.’
“And I’m not the only one. I’m consistently in awe of the people I work alongside, and if it wasn’t for them, I think it would have been really easy to give up. But because of the encouragement we offer one another, we’re able to keep showing up, to keep giving back and keep trying to help people.”
Addiction treatment and COVID-19: Riding the storm out
Because ultimately, COVID-19 will either burn itself out, be met with a vaccine or reach a stable state among a community with herd immunity. Addiction and alcoholism, on the other hand, are illnesses too nebulous to be contained in such conventional manners, and the dangers they pose are too great, even if COVID-19 gets more headline real estate. Dolinky, Crawford, Young, Casevechia, Hopewell, Pershing, Lewis and the dozens of other recovery caregivers in the East Tennessee community often feel like they have little choice but to persevere on two fronts, addiction treatment and COVID-19 — because what they do is more than just a job.
It’s a calling. It’s part of who they are. And no matter how thoroughly COVID-19 seems to have stolen away the hope that there is life on the other side of addiction, the men and women of the local drug and alcohol treatment field know it’s still there. They’ve just got to dig a little deeper to find it — for themselves, and those who depend on them for care.
“It’s like, we don’t have any idea of what’s coming. Is it going to get better? Is it going to get worse? We don’t really know, and all we can do is deal with what’s in front of us right now,” Crawford says. “For people who work in addiction all the time, we all got sort of blindsided, and we were all kind of wobbling around trying to figure out what to do, especially with treatment center.
“In the past, we were notorious for working against each other and competing for patients, but in one way, this is an opportunity for people who work in treatment to work together. There are more than enough people needing our help, and if we can work together in those aspects of it, then that’s what we need to do. Because if we lose sight of the main objective — helping people find sobriety — then nothing else really matters.”
At the same time, Young adds, she and her peers need to leave no stone unturned when it comes to safeguarding their own recovery. She recently spoke at a Celebrate Recovery meeting — where all in attendance were masked and observed social distance guidelines — and after months of not going to a meeting, that was a shot of recovery B-12 into her soul.
“It doesn’t look like we’re going to be done (with COVID-19) for a long time, so we’ve got to think outside the box and come up with new ways to get connected and stay connected,” she says. “We know that we’ve got to talk, to say what needs to be said, and find those ways to have hope. We have to get outside of ourselves and do service for other people, because when we feel of service, when we feel needed, when we feel connected, that’s the key.
“I wish I had a magic wand to make all of this go away, but I don’t. I do know, however, that the principles of the program work. And I know that what I have to do is the same thing I’ve done for the last 35 years — continue to live by spiritual principles and really rely on my friends in the program.”
And for those whose lives and livelihoods are intertwined in recovery, giving of themselves can be the spiritual nourishment they need to get through another day. It’s a strange dynamic, Casevechia points out — but then, the whole concept of the sobriety tenet that tells those in the program that they can only keep what they have by giving it away seems strange at first as well, until experience demonstrates its power.
“More than anything, I need to be available when somebody calls, to pick up that phone even when someone calls that I don’t really know,” he says. “That could be a game-changer for that person, now more than ever, and I really do believe that if you can get clean now, during this, you can stay clean, for sure.
“I just hope that people don’t give up hope during this time. At the end of the day, this will be a small speck of our entire lives, and I know we’re going to be stronger on the other side of it.”
The same can hold true for the addiction treatment field in East Tennessee, Crawford says. How remains to be seen, and the old ways may not be tenable if COVID-19 transitions from a pandemic to a permanent health care challenge. But as the recovery program he and his peers lead clients to as part of addiction treatment, it’s going to take a village, he adds — because addiction treatment and COVID-19 are twin challenges that must be met in order for a healthy community to flourish.
“I think all of us working in addiction treatment are still wobbling and getting our feet back under us and figuring out what the hell to do,” Crawford says. “And I think we’re going to have to work a lot harder at figuring out new ways of doing things effectively. I think it’s going to take a lot of innovation on our part, but this is the show we’ve got.
“The question is, how do we navigate this to make sure that when people leave our treatment centers, they have as many resources as they can possibly have given the situation? I think it’s doable, but I also think it takes all of us working together to figure out what we need to do to get there.”