The pandemic is taking a toll on people’s mental health, and there’s likely no group more affected than people who struggle with their drug use.
“People are so isolated right now and longing for connection,” Jess Tilley, co-director of the Urban Survivors Union, a national group of drug users, told Filter. “And then when you add being a drug user on top of that, or being a frontline worker or working in harm reduction, it’s worse. We’re sort-of the outcasts of society to begin with, so it’s so hard to find our community.”
A recent CNN report on an increase in overdose deaths across the Appalachian region coinciding with the spread of coronavirus used the phrase “pandemic’s-worth of triggers.” It’s a combination of anxiety, loneliness, stress, boredom and—for anyone who has lost someone to the virus or the burden it’s placed on the healthcare system—of loss and of trauma as well. Whatever one’s trigger might be for resuming use or using with greater risks, it feels like COVID-19 has brought it.
On top of it all, social distancing orders shut down mutual-support groups’ in-person meetings exactly when many people in recovery from addiction needed them more than ever.
Narcotics Anonymous (NA) meetings were relatively quick to move online, as were those of Smart Recovery and similarly large organizations. But the vast majority of such groups are based in the 12 Steps, only support abstinence, or come with other one-size-fits-all philosophies with which many people take issue. If COVID-19 has you using drugs in an unhealthy way, and if you’re not thrilled at the idea of surrendering yourself to a higher power or don’t want to quit completely, where can you turn for support?
“I used to utilize 12-step groups and I really missed that that community. And yet, philosophically, I’m feeling a little bit differently now.”
Meghan Hetfield, who works in family planning and peer recovery in Catskill, New York, told Filter that she found the answer just before the virus swept across North America.
“I used to utilize 12-step support groups at different times in my personal recovery and I really missed that human connection and that community that I had when I was attending those meetings,” she began. “I’ve really missed that aspect of my life. And yet, philosophically, I’m feeling a little bit differently now than the 12 Steps.”
Listening to the drug policy podcast Narcotica one night, Hetfield heard Tilley describe a new model of support group. With her nonprofit, HRH413, Tilley recounted experimenting with a model not dissimilar from NA. But instead of placing abstinence at the center of everything, it roots itself in harm reduction.
This sounded very interesting to Hetfield. Shortly after, she made the two-hour drive east to Tilley’s homebase of Northampton, Massachusetts, and attended one of HRH413’s meetings to see what Harm Reduction Works (HRW), as it had been named by this time, was all about.
Hetfield described finding what she didn’t know she had been looking for. “I wanted to provide the same space for people here [in Catskill],” she said. “It’s a way to build community around harm reduction in a way that I don’t think has been possible before. It is self-replicating and allows people to be in this space, whatever that looks like for them. Just come as you are.”
“I think this model is going to be really attractive to a lot of people right now who are struggling for a sense of belonging that doesn’t have a million rules,” Hetfield added.
How the Meetings Work
So what is this model?
As the founder of the New England Drug Users Union and a high-profile name in America’s harm reduction movement, Jess Tilley is HRW’s de facto spokesperson, and her personal experiences helped inform its creation from the ground up. But the group is the brainchild of her HRH413 cofounder, Albie Park. In a telephone interview, Park conceded that for a support group that was originally conceptualized as an alternative to NA and the 12 Steps, HRW actually has quite a bit in common with them.
“HRW meetings are scripted,” Park began. They begin with a reading and end with a reading, and in the middle is a topic of the day and time for people to share. So the skeletal structure will feel familiar to the millions who have attended NA or AA. But from there, Park continued, HRW departs from NA in ways that some 12-steppers will disapprove of and others will find refreshing.
While most NA groups forbid “crosstalk,” HRW meetings place feedback and discussion at the centre of their meetings. Anyone sharing does however have the option to ask that the group only listen, Park noted. In addition, HRW lacks NA’s sponsorship structure and the pitfalls that can come with the sort of power that sponsorship gives one NA member over another.
Setting it apart from the vast majority of recovery-support groups, HRW has no requirement for abstinence.
HRW also declines to track participants’ “clean time.” There are no keychains for days abstinent and therefore none of the shame or stigma that abstinence-only groups can inflict on members who slip. What’s more, while many NA groups reject medication-assisted treatments (MAT) such as methadone or buprenorphine, or even view the availability of the overdose-reversal drug naloxone as enabling, HRW fully welcomes people on MAT and HRW meetings often distribute Narcan and syringes right in the same rooms where participants discuss aspirations for abstinence.
Finally, the most notable aspect of HRW, setting it apart from the vast majority of recovery-support groups, is that HRW has no requirement for abstinence. Attendees can express a desire for abstinence or share that they’re actually not interested in abstinence at all. Maybe they want to transition from injecting drugs to smoking them, or stop sharing needles and instead begin visiting a syringe exchange. Perhaps they are considering giving methadone a try. Or maybe a participant is simply looking for a shoulder to lean on.
“What 12-step has, is it is a redemption-story machine with that classic story arc,” Park said. “This [HRW] is just your life. There’s no demarcation point [around abstinence]. It’s not that clean. HRW makes room for things to be a little bit messy. It makes room for people to figure shit out….It was conceived for the person who is saying, ‘I don’t know what’s going on, I don’t know what’s happening, but I know I have to do something.’”
Through the second half of 2019, HRW was slowly beginning to gain traction outside of Tilley and Park’s hometown of Northampton, attracting chatter at drug policy conferences and clicks online. Then came COVID-19. It was more important than ever for people to feel support. And quite suddenly, in just the last two months, HRW rapidly grew online to seven virtual meetings held weekly on Zoom hosted out of five cities around the United States. (Anyone interested in checking out a HRW meeting on Zoom can find a list maintained on the group’s Facebook page. Additional information is also available at hrh413.org.)
Park said that he’s been pleasantly surprised. “If COVID had not happened, I probably would not have made the choice to go online,” he explained. “Then we started [online] and the meetings have been really, really well received.”
“I feel like I can finally talk about what my recovery really looks like.”
It was actually Hetfield who hosted the very first HRW online gathering. She said one of the most encouraging things she’s observed in their Zoom meetings is true honesty.
“Often people feel really good about not using heroin in five years but guess what, ‘I had a couple of beers over the weekend and I’m okay.’ It feels really good to say that out loud,” she recounted. Hetfield noted that HRW’s lack of an abstinence requirement means people can return to use without feeling like they’ve disappointed the group. That extra space can help people in recovery stop at a beer or two, whereas if they were NA, they might feel like a small slip with a glass of wine is a good reason to pick up an eightball, Hetfield explained.
“I feel like I can finally talk about what my recovery really looks like,” Hetfield said she’s heard participants say. “Somebody’s recovery or change process should be honoured and celebrated even if that doesn’t include abstinence,” she added.
Evaluation Under Way
It’s still early days for HRW and there so far exists no sort of data on how this harm reduction model might assist people with recovery or otherwise improve health outcomes. But a small team of addiction researchers has been commissioned by the nonprofit Rize to evaluate groups incorporating harm reduction into recovery, and one of the organizations they’re looking at is HRH413 and HRW.
Jennifer Carroll, a medical anthropologist, is a member of that team. She emphasized she could not comment on a program under review, but spoke generally about a need for alternatives to 12-step and abstinence-only models.
If someone is coming from a situation of being abused, “the last thing in the world they need is a recovery platform that requires them to acknowledge their powerlessness.”
“The biggest problem with 12-step isn’t actually 12-step, it is that so many people believe that it is the end-all-be-all of personal change or wellbeing,” Carroll, an assistant professor at Elon University in North Carolina, told Filter. “If there is someone who is interested in 12-step, they absolutely deserve and need to have access to that tool….The challenge comes when people are shuffled into 12-step programs when that is an inappropriate form of care.”
For example, if someone is coming into a support group from a situation of being abused, Carroll said, “the last thing in the world they need is a recovery platform that requires them to acknowledge their powerlessness.”
The evidence of NA’s effectiveness in maintaining abstinence is indeed mixed, as the spirited debate around a recent high-profile New York Times article illustrates. Especially when assessing abstinence outcomes with different substances, 12-step groups do not work for everyone, the literature suggests.
Carroll added that there’s an obvious appetite for new models and philosophies for recovery. “My inbox blows up a lot with people who want a neutral source of advice. ‘This is happening with my nephew,’ ‘This is going on with my husband,’ ‘Do you have any thoughts or do you know anyone in this area?’” Carroll recounted. “And frequently, those requests are for any suggestion I can make about support groups or mutual-aid groups that are not 12-step oriented.”
Especially in the context of COVID-19 and continued requirements for people to remain in their homes, Tilley said there is one thing that HRW has borrowed from NA that inspires people to “keep coming back.”
“Those of us who were part of 12-step and who left, for whatever reason, whether it be the program, the people, or if we just felt we outgrew it or we started using again, the biggest thing that we miss is the community,” she said. “We miss the camaraderie. And that is HRW.”