In the wake of COVID-19, new social distancing guidelines exacerbate trauma symptoms while limiting access to resources for people who use substances. Social connection, the key to healing from the impact of trauma and substance use, is directly affected by the isolation caused by social distancing. New York City Alcoholics Anonymous (AA) responded by transitioning sessions to Zoom, a video communications platform. Online meetings dramatically alter the mutual aid model that makes AA more effective than other treatment modalities (Kelly et al., 2020). Social distancing is likely to exacerbate trauma symptoms and limit access to the AA community for the foreseeable future. The trauma and limited access are likely to disproportionately affect new or newly returning AA participants’ sobriety outcomes.
Considerable research links trauma and substance use by showing that adults who experienced childhood trauma (physical, emotional, or sexual abuse and/or neglect) are likelier to grow up to use substances to regulate emotions (Felliti, 2008). That is, substance use has its roots in a childhood coping response to the trauma of social and emotional isolation caused by failed primary attachment relationships; in adulthood, habitual use of substances for emotional regulation develops into a pathology (Felliti, 2008; Maté, 2008). For some people, substance use becomes a vicious cycle: they use substances to cope with feelings of isolation, then sustained use keeps them from developing and maintaining the necessary trusted relationships for a fulfilled life. Conversely, most adults with strong social and emotional connections do not present with pathological dependence on substances.
Alcoholics Anonymous (AA) is built on a mutual aid model, which functions through the voluntary and reciprocal support of other people trying to achieve sobriety (Steinberg, 2010). In AA programs, participants access social and emotional connection through a supportive environment that encourages asking for help. New York City AA is an extensive community with meetings available 24 hours a day 365 days a year, including special interest groups for women, LGBT people, young people, and parents. An active member of AA will likely attend a “homegroup” regularly and choose a sponsor whom they get to know and rely on when the urge to use substances emerges. This allows participants to practice impulse regulation by talking with their sponsor rather than using (Maté, 2008). New members are encouraged to speak to people in the community throughout the day, “fellowship” (hangout) after meetings, and “do service” by setting up meetings, making coffee, or cleaning up afterward. These activities help new participants access the community more deeply and build a positive support network crucial to maintaining long-term sobriety.
The vast spread of COVID-19 throughout New York City in March 2020 required AA to suspend all in-person meetings to meet social distancing requirements. In general, all AA participants’ sobriety is threatened by the increased feelings of social and emotional disconnection that result from social distancing, causing a spike in the desire to use substances. AA responded by transitioning most sessions to Zoom, which allows participants to engage in their regularly scheduled meetings and remain connected to their social support networks.
However, Zoom limits central features of the AA program. The elements of fellowship and service, which lead to a sense of camaraderie and make each meeting unique, are not as transferable to the online format. Something is lost when participants are no longer required to travel to and from meetings, hand out books, and help out in other spontaneous ways throughout the week. Overall, the online format yields a less physical experience. The physicality of the AA program mirrors effective trauma treatments used in more traditionally therapeutic settings that focus on the mind/body connection (Van der Kolk, 2014). These changes alter the mutual model of AA, disproportionately impacting new participants’ ability to access social and emotional connection. This puts new participants at a significantly higher risk of relapse.
Long-term participants are better equipped to maintain their sobriety by relying on relationships established prior to the onset of social distancing and more sober-reference in dealing with uncomfortable emotions and impulses to use. New participants’ weaker ties to the AA community may result in a sharp decrease in motivation to continue attending meetings, form relationships, or elicit the help of a sponsor. They are likely to struggle with feelings of boredom, loneliness, and more intense trauma-related symptoms exacerbated by social distancing. With social distancing continuing for the foreseeable future, new participants of AA continue to be uniquely impacted by COVID-19.
Examining participants’ access to AA provides a microcosm into the limits of online communication in today’s culture. Like Zoom, social media platforms, in general, increase our opportunity to communicate with others. However, they have radically changed how we communicate. By texting instead of calling, and relying on our devices to mitigate the uncomfortable moments of social interaction that we all experience, what do we lose in terms of social connection? As AA on Zoom shows, the quality of our interactions, rather than the amount of time we spend communicating, largely determines how socially connected we feel.
References
Felitti, V. (2004). Origins of Addiction: Evidence from the Adverse Childhood Experiences Study. Praxis der Kinderpsychologie und Kinderpsychiatrie, 52, 547-559.
Kelly, J.F., Humphreys, K., and Ferri, M. (2020). Alcoholics Anonymous and other 12-step programs for Alcohol Use Disorder. Cochrane Database of Systematic Reviews, 2020(3), 1-119.
Maté, G. (2008). In the Realm of Hungry Ghosts: Close Encounters with Addiction. Toronto: Knopf Canada.
Steinberg, D. (2010). Mutual Aid: A Contribution to Best-Practice Social Work. Social Work with Groups, 33(1), 53-68.
Van der Kolk, B.A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York: Viking.