KAILUA-KONA — When the pandemic hit almost a year ago, Hawaii programs dedicated to helping people recover from the isolation of addiction found themselves under the weight of an isolating pandemic.
Over the last year, local providers have had to adapt their organizations — looking to their peers and technology — to continue supporting their clients in times of unprecedented challenges.
“You’re amazed as to what you can do when you don’t have a choice,” said Jimmy Kayihura, managing director at Hawaii Island Recovery, a residential treatment facility in Kailua-Kona.
A national survey released in September by the National Council of Behavioral Health said that 54% of members reported shuttering some programs because of the pandemic, and 39% said they could survive six months or less under current financial conditions.
Meanwhile, the need for addiction treatment services continues to grow. In December, the Centers for Disease Control and Prevention reported that overdose deaths have been on the rise during the COVID-19 pandemic, a trend the agency said appears to be chiefly driven by opioids like fentanyl.
On Hawaii island, Dr. Michael McGrath, medical director of the Behavioral Health Unit at Kona Community Hospital, said he’s seen what he characterized as a “notable” increase in admissions for substance use disorders, most commonly involving alcohol and methamphetamines. While addiction has many factors, the nature of the pandemic was bound to make people more vulnerable, from uncertainty and lack of control to limits on social events and activities.
Given all the uncertainty, collaboration has been key, and organizations are sharing what they find works in this new environment as well as how they can help each other.
“I think no longer, or less so, are people operating from a place of scarcity — ‘us’ and ‘them’ — and more from a place of ‘We all are made more effective by helping each other,’” Kayihura said.
Andi Pawasarat-Losalio, executive director of Bridge House, which offers a sober living program in West Hawaii’s Keauhou Mauka and outpatient treatment in Honalo, said that while she’s had a good relationship with other providers throughout the state, the pandemic led programs to reach out to each other even more. Hawaii Island Recovery, she said, offered to share its COVID-19 action plan. And when another provider got funding for a cultural program aimed at women, it invited Bridge House’s clients to participate virtually.
That collaboration has even extended beyond the island’s shores. A partnership with a Molokai drug treatment program led Bridge House to send over seeds to support the Molokai program’s efforts to grow its own food. Other treatment providers — on various islands — text her to let her know of grants and other funding opportunities.
“I really feel so much more comfortable about working with and sharing processes with all of these providers,” Pawasarat-Losalio said. “It’s been quite amazing.”
Among the challenges organizations face now is preparing clients to leave their programs and enter a world shaped at every turn by the pandemic.
For the nearly 20 years she’s been with Bridge House, Pawasarat-Losalio said clients who finish the program stay sober and employed at a rate of 75% to 85% at the time of their follow-up. But of the first group of clients that left during the initial three months of the pandemic, she said, 80% had relapsed.
“We were beside ourselves,” she said, “like ‘how could this be?’”
With 12-step groups like Alcoholics Anonymous limited by restrictions on gatherings and limitations at courts and probation services, clients were leaving their treatment program without the structures normally there to support them.
Determined to turn things around, Pawasarat-Losalio said a staff member began going into the community weekly to meet with clients “no matter where they were” to drug-test them, bring any needed paperwork and physically check in on their recoveries.
“That changed everything once that started happening,” she said.
For every client that’s left since those care coordination efforts ramped up, she isn’t aware of one that has relapsed, lost housing or not been employed. “And I really attribute it to our staff really working together and specifically having this person work in the care coordination and having contact with them on a regular basis,” she said.
That’s something she said the organization wants to continue and expand post-pandemic.
As in so many fields, Zoom has also become ubiquitous within recovery and addiction treatment.
Kayihura said Hawaii Island Recovery has had great success with delivering its family programs online, and the number of clients who have succeeded in staying sober has “skyrocketed.”
Both Kayihura and Pawasarat-Losalio expect virtual programs to grow post-pandemic.
Kevin Deeds, director of admissions and utilization review at Hawaii Island Recovery, said with the pandemic pushing programs to online venues like Zoom, “it’s really started a boom of the telehealth movement.” Many insurance companies, he said, are specifically authorizing telehealth care for COVID-19.
“I hope that that is something that will continue,” Deeds said, “so that those that are on neighbor islands or in rural areas that don’t have access to a wide variety of services can securely log on and communicate and talk to their mental health providers.”
While telehealth may not be ideal for everyone, Pawasarat-Losalio said, it can be a big part of recovery for those with busy schedules, multiple jobs or who live far from their providers.
The pandemic, for all its uncertainty, has also been an opportunity. At Hawaii Island Recovery, for example, where clients before came from throughout the U.S. and around the world, 100% are now from Hawaii. That shift, Kayihura said, has been a goal for years and one of the most exciting things to come out of the pandemic.
Those working in health care, said McGrath, are trained to approach a crisis with a proactive response, and the COVID-19 pandemic “has been the test for all of us, because of the unknowns, the question marks.”
“And when we’re faced with that,” McGrath added, “we have to go to something that we can have faith in, which is our desire to do the next right thing in the situation and have optimism that we will continue to do the positive thing.”
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