Medical Examiner

Lessons in Taking Things One Day at a Time, From People in Recovery

Isolation presents a particular challenge for people living with addictions. But the tools that got them to this point are relevant to everyone now.

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The late chef and TV host Anthony Bourdain often described free time as his mortal enemy. “There’s a guy inside me who wants to lay in bed, and smoke weed all day, and watch cartoons and old movies,” he once told Men’s Journal. “My whole life is a series of stratagems to avoid, and outwit, that guy.” Bourdain wasn’t shy about his darker appetites, including his decadeslong addiction to cocaine and heroin. Momentum was his main strategy to outwit that guy inside him who liked to indulge. So he was always in motion, pouring himself into work, maintaining hellish travel itineraries to create smart TV.

“If I’m given too much free time to contemplate the mysteries of the universe,” Bourdain said, “I’m afraid of that inner hippie emerging.”

I’ve been thinking about Bourdain, because I’ve been wondering how he’d be coping with shelter-in-place orders if he were still around. Surely, his coping strategy would be idiosyncratic and weird. But that restlessness he describes, that perpetually ill-at-ease mood is common among people with substance issues. So I wondered how people with that itch were dealing with addiction’s No. 1 renewable energy source: isolation. Listlessly scrolling on Twitter or Instagram, “quarantini” and “airport rules apply” jokes abound—everyone’s letting loose (see Ina Garten’s 9:30 a.m. pitcher of vodka). But for millions of Americans, pressing the chemical mute button on our restless and bored brains all but guarantees misery or even a trip to the emergency room, further straining an already overwhelmed medical system.

Entering Week Three of stagnation and uncertainty, with weeks to go on the horizon, what are people doing to quell and outwit their own dark appetites? The world hasn’t stopped spinning, but our daily routines, life’s natural momentum, has come to a standstill. How are the people living with addictions coping?

Luke O’Neil, who writes a Substack called “Welcome to Hell World,” keenly noted that “the addicts and the cripplingly depressed” are perhaps better prepared for these strange times than anyone. “I’m reminded of the film Melancholia in which depression is a sort of super power at the end of the world,” he recently wrote. Talking to several people who have overcome severe cases of addiction—to meth, alcohol, opioids, you name it—reminded me that certainly, their rocky histories can function like a scouts survival badge. Chaos, uncertainty, and sickness are nothing new for this crowd.

Back to Basics

For Leah, who requested she be identified by only her first name, the pandemic has meant remembering what got her through recovery in the first place. Leah is 28-years-old, lives in Boston, and has been sober for two and a half years after drugs and alcohol made her early 20s a living hell. She’s currently isolated with her parents in the suburbs, so she wouldn’t feel so alone. “I want to maintain some kind of structure,” she said. “I like to start and end my day with writing an inventory, which is something I learned in rehab. I’m also reading a daily reflection, and meditating in the morning.” An inventory is a kind of emotional and spiritual vibe check, a painfully honest scan of one’s thoughts, feelings, and behaviors.

“It’s really interesting to see the entire world just taking it one day at a time,” Leah said, citing the 12-step mantra. “ ‘Shooting for midnight,’ as they say.” No one can swallow the magnitude of this pandemic all at once. We’re all living 24 hours at a time, taking small bites out of it each day now. Applying the principles of recovery to endure this crisis (e.g., concentrating on the things one can control) has frequently come up in the virtual meetings Leah has been attending on Zoom. “There’s a lot of gratitude being expressed in these online meetings about having technology to be able to connect us.”

Online meetings and digital recovery tools are not new, but their attendance has exploded over the past week, with hundreds of virtual meetings now available around the world. “My friend signed on to one in Ireland, just because she could,” Leah said. Fellowship, connection, and solidarity helped Leah get sober. Now virtual connection is filling the void for her and thousands of others, though online meeting places come with the same pitfalls of many other online spaces, including harassment.

Hell Is Other People

There is such a thing as being around too many people while staying home. Kevin Kern, 29, is living in an LGBTQ-friendly recovery residence in Minneapolis (the land of 10,000 treatment centers), with 14 other people. Isolation is the least of his worries. Alcohol and meth caused years of chaos for Kern. He’s bounced from the Twin Cities to San Diego to Chicago and now back to the Twin Cities, where he’s been sober for the past six months, navigating the precariousness of so-called early recovery, though it’s far from his first rodeo. 

Kern says it’s been nearly impossible to practice social distancing living with so many other people, which feels “maddening.” But it’s not just the risk of exposure that’s a problem. “Having to be around people also kind of grates on me,” Kern, who describes himself as an introvert, said. “I feel like I’m not managing my time well at all. The hope was that with all this time I would focus on writing and reading. But I haven’t been disciplined at all. I need some structure in place to work effectively and I don’t have that whatsoever. So, I’m finding myself feeling very depressed and unmotivated—all of this stagnation. I feel like my attention span is fractured, and I don’t have the ability to read for long periods. I’m sleeping too much. I’m on my phone way too much. Watching a lot of Netflix. I feel like I don’t have any energy, lately. Mentally, emotionally, physically.”

Kern has been here before. Thanks to the netherworld that is alcohol withdrawal, known as delirium tremens, Kern has felt all this and far worse. He is working hard to counteract that lethargy, and his past experiences with getting through tough times have made him realize the importance of committing to a routine. “I’ve been pushing myself to exercise more, using home workout apps, and trying to be conscious of what I eat. Initially, I was eating a lot more sugar, which I’m pretty sensitive to. It affects my mood and energy. So it helps that now I’m cooking my own food.”

I checked in with Kern multiple times. Last we spoke, he said he was taking advantage of nicer weather in Minnesota (where winter normally lasts until about May) by going for runs outside. His mood has lifted some, and he says coping with Netflix is now his “last resort,” when he just needs to shut off his brain. Kern is also planning to move outside the sober house soon and get a place with his boyfriend.

Opioid Epidemic, Meet Global Pandemic

Daniel Garrett lives in rural northwest Tennessee.* His recovery from opioid addiction has been greatly helped by federal regulatory changes to increase access to buprenorphine, a medication used to treat opioid use disorder by keeping the brain’s opioid receptor sites activated, which subdues cravings for more potent opioids like heroin and fentanyl. (Another common treatment is methadone, which similarly satiates the body’s need for other opioids; Bourdain was on it for years.) Both drugs are incredibly effective yet heavily regulated and difficult to access, usually requiring frequent doctor visits and limited take-home supplies. But these restrictive rules were recently loosened to adapt to our new reality (though these changes have been unevenly and haphazardly applied).

Instead of going to his doctor for a weekly supply of buprenorphine, Garrett is now allowed to do his appointment over telehealth, where he can be given a two-week supply to reduce his outings to the pharmacy, which for him is an hour’s drive away. Garrett is also on probation, which has been much less flexible in its response to COVID-19. “The probation office sent out a mass text earlier this week that told probationers like me we’d still be required to check in in person like always, despite the threat of the coronavirus,” he said. “Gotta love this criminal justice system, but this ain’t new to me.”

Katie Francis is 25-years-old and sobered up when she was young after her addiction escalated rather quickly to heroin and meth. Unlike Leah, Francis does not practice a 12-step style program. “I don’t do online meetings or engage in AA at all,” she said. “I haven’t for years, and I always wondered how I’ve kept it together without that. Now I know: Community saved my life. Having genuine connections saved my life.” So she’s been leaning hard on those connections by having virtual hangouts with her friends, mainly other Alcoholics Anonymous exiles, who are constantly texting and checking in with each other.

“I’m just being really transparent,” she said. “Before I’d say things are fine, whatever. Nope, shit is fucked up!”

But similar to Leah, Francis is also practicing what she learned early on in treatment. “It’s, like, automatic,” she said. “Making sure I eat well, get sleep, exercise, and talk to people. That’s what they taught us to do.”

Her work distributing sterile syringes and naloxone, the opioid overdose antidote, has put her on the front lines of the ongoing U.S. opioid crisis. “Death has been the norm for our community,” she said. “I’ve learned to cope with that epidemic, but now people are dying all over the world, and coping with this won’t be all that different.” While she’s taking care of herself, she’s also trying to be helpful and support those who are still using.

Indeed, coronavirus aside, an estimated 150,000 people will die in the U.S. this year from drug overdoses, liver cirrhosis, and suicide—collectively known as “deaths of despair.” The coronavirus has landed in a country where people are struggling to survive under ordinary conditions. Prior to the pandemic, millions of people were already on the edge—rent was unaffordable, wages were stagnant, social provisions like affordable housing and health care were anemic. Now, some might be pushed over, free-falling without a net to catch them, presenting enormous challenges for everyone trying to survive this pandemic. People who’ve already fought like hell to overcome adversity and suffering in life can provide a model here for how to get through this—taking things one day at a time, focusing on what we can control instead of what we cannot, and tracking mood and behaviors. Indeed, many people who have been through this are modeling this behavior, and then helping others learn it too. The glut of online resources and virtual recovery meetings are mostly all free, set up by people who know that helping others is to help themselves.

If you’re looking for digital resources, the New York Times posted a dozen or so links here. For non-12-step-oriented meetings, there are many options available: here. Visit the American Society of Addiction Medicine for extensive resources and information relevant to providers and patients. For information about regulation changes for addiction treatment: visit the Substance Abuse and Mental Health Services Administration. For people with substance use disorders, Yale’s Program in Addiction Medicine has a helpful guide about triggers, relapse, and treatment. The Harm Reduction Coalition has a guide for people currently using drugs to stay safe and healthy during the pandemic.

National Suicide Hotline: 1-800-273-8255
Addiction Help Hotline: 1-800-662-4357
Sexual Assault Hotline: 1-800-656-4673
Trevor Project LGBTQ Hotline: 1-866-488-7386

Correction, April 8, 2020: This article originally misspelled Daniel Garrett’s last name.