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When social distancing and staying healthy are at odds | Editorial

Amid social distancing and a deadly epidemic, people in addiction or with other behavioral health disorders, as well as outpatients in medical treatment programs, must adjust to a new normal.

Philadelphia Health Commissioner Thomas Farley provides coronavirus updates during a City Hall press conference on March 17, 2020.
Philadelphia Health Commissioner Thomas Farley provides coronavirus updates during a City Hall press conference on March 17, 2020.Read moreJESSICA GRIFFIN / Staff Photographer

The social distancing that has taken hold against the coronavirus epidemic represents a conundrum for those whose ongoing health depends on human contact. For example, behavioral health and other programs that treat people in addiction, as well as outpatient services for pregnant women and other vulnerable medical patients, all are facing unprecedented disruption. So are tens of thousands of recovering people in the Philadelphia region, as many meeting spaces for 12 Step, group therapy, and other sobriety maintenance programs close — and questions arise about how, or whether, to gather for mutual support.

On Tuesday, the federal Substance Abuse and Mental Health Services Administration issued guidance to permit states that have declared a public health emergency to waive requirements for daily, in-person patient visits. Pennsylvania and New Jersey should act to allow licensed local medical facilities to provide 28-day, take-home methadone supplies to their most stable patients. The federal government is also suggesting 14-day supplies for other patients.

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Pennsylvania and New Jersey providers of other alcoholism and addiction services say they also are adapting to the necessity of social distancing. Patients are kept two and three seats apart in the group sessions that are a major therapeutic tool; rehab centers also are deploying video conferencing and other communications technologies at inpatient and outpatient facilities. Large medical systems that serve a variety of patients are phone-screening callers prior to appointments and again upon arrival.

But some among the 1,000 members of the National Association of Addiction Treatment Providers report that patients are leaving against medical advice or deciding against inpatient care, citing the pandemic. With some treatment centers already facing financial straits, the association is asking the Trump administration to include such facilities among those businesses eligible for federal support.

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Further flexibility by governments, providers, and patients themselves will be necessary if the pandemic continues for what experts suggest may be several, or many, more months, and as the challenges of widespread illness and disruption evolve. But regardless of the importance of social distancing, physicians do need to see and examine patients, who in turn need the human presence of doctors and other caregivers. And people in recovery from addiction need to gather, only in small groups in private homes, for the sharing and fellowship many experience as essential to sustaining recovery.

A research study cited in a recent New York Times story found that Alcoholics Anonymous, the original 12 Step program, can work as well or better than other approaches as measured by lengths of abstinence. But even critics of abstinence-based approaches like those typical of 12 Step programs see value in the individual connections and group solidarity that are priorities in AA.

With public health experts concerned about the impact of even voluntary self-isolation in the face of a national emergency, AA’s website on Tuesday posted suggestions for how meetings can make adjustments to preserve social distancing, such as refraining from hugs. WHYY reported that the Unity Recovery community organization in Philadelphia offers five daily meetings to hundreds of people via video chat. More of this kind of creative flexibility will be key as we eventually prevail over the virus that is now keeping us apart.