Lee* hasn’t picked up cocaine since she got out of prison several years ago. “I found out that I could be a social drinker and use marijuana without it being problematic,” says the Minnesota HIV services worker who learned she had HIV in 2006 as a young woman.
But all that started to change, she says, once COVID hit. “My drinking got really out of control. Work was stressful because I wanted to make sure we could meet the needs of the people we serve” during the pandemic.
Then her dog had to have emergency surgery in August. That was the straw that broke the camel’s back.
“I found myself drinking almost every day to blackout and being hung over the next day,” Lee says. “It started affecting my marriage, my work. As someone who’s used substances to cope throughout my life, I realized I’d fallen back into those old patterns, largely due to the isolation and stress of the pandemic.”
She adds: “It got kind of scary to me.”
Lee isn’t alone. Across the country, and even overseas, several people with HIV who are either in recovery or who struggle to moderate their drinking and/or drug use told TheBody that the COVID-19 pandemic has challenged or diminished (if not always toppled) their recovery program, or that their baseline level of use has accelerated or increased.
That certainly correlates with the broader population: For reasons having to do partly with a COVID-induced interruption in the distribution of clean needles and Narcan (overdose reversal medicine), there are already reports of an increase in overdose deaths. Meanwhile, studies in different states have reported increases in overall drinking and drug use during the pandemic (see “Sources”), as well as increases in secondary markers, such as a rise in liquor sales or in online searches for drug treatment.
Experts say that the rise is not surprising in folks with HIV, who as a group already have high rates of alcohol or drug use history, as well as related issues such as depression and anxiety.
“COVID has meant that some people who didn’t go back to school or lost jobs had to move back in with family, which can make people feel like a failure,” says Nathaniel Currie, D.S.W., LCSW, an Atlanta therapist whose clients are largely Black and brown and LGBTQ, many of them living with HIV. “That’s very triggering for substance use.”
He mentions one such client living with family, a gay man, whose baseline level of crystal meth use is up from pre-COVID times. “He tells me that he can get through the week, but the weekends feel bleak, so he uses all weekend to avoid that discomfort and disappointment.”
Additionally, says Currie, COVID-necessitated distancing has cut many off from the kind of in-person therapy, counseling, or 12-step or other support groups that provided important face-to-face support for those aiming to stop or moderate their use. Many one-on-one or group sessions have moved to online platforms like Zoom, which are better than nothing—but don’t make up for the intimacy of being in a room with others, or the opportunity for more casual socializing before or after.
“People have had to really sit with themselves, which can be great” but also challenging, he says. “Plus, people or organizations don’t always have strong access to the internet, and many community-based organizations can’t afford the type of Zoom license that allows you to see two dozen people at a time.”
And in the absence of that human connection, he says, “people start to feel like, ‘I need to put something inside me, to consume something.’ That’s a very real feeling that people have” when they are feeling out of sorts—even, he adds, people without an identified addiction.
Trying to Moderate versus Staying Sober
COVID times may be hardest on folks who were already walking a line between manageable and unmanageable drinking or drug use.
“I use amphetamines,” says Sarabeth,* a social services worker in Alabama diagnosed with HIV in 2011, “and there’s a lot of time to fill now because I can’t work like I did” before the pandemic. “I’m in school, so that keeps me somewhat busy, and fortunately I’m eligible for some financial aid so I’ve got money to live on, but no extra.”
She was laid off in March from her housekeeping gig. “I’m really nervous to go back to that work since COVID,” she says, “and an old standby job like bartending isn’t an option right now.”
She says that she’s been using about the same amount of drugs as before, but more steadily throughout the day versus intermittently, as in the past. She also says that the 12-step model of meetings like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), which strongly encourage total abstinence even though users are still welcome at meetings, is not for her.
“If it helps someone else, that’s great,” she says, “but I’m anti–12-step.” Instead, she says, she volunteers on a crisis hotline. “That holds me accountable and gives me structure,” she says, adding that when she volunteers, “I have to have slept and have my stuff together.” She also turns sometimes to the Buddhism-centered approach of RecoveryDharma.org.
Many folks with HIV in longtime, mostly 12-step based recovery say that years of developing tools to cope with both their HIV diagnoses and their addictions have equipped them well for the curveball of COVID—even as most of their recovery community has switched from in-person to online.
“I’ve been blessed,” says longtime Philadelphia HIV activist and 12-stepper Waheedah Shabazz-El, because her work as an HIV advocate had already familiarized her with online meetup systems like Zoom, enabling her to move her longstanding 12-step fellowship over to that platform once COVID hit, and to train other 12-steppers as well in how to run an online meeting.
“There are some folks like me living with HIV in that group, and they’re talking about it now more during COVID,” she says.
But on the flip side, she says, “People are definitely feeling the lack of human connection. They say, ‘I hate Zoom,’ because they’re used to that empathetic hug or that cup of coffee. Some people don’t even join us. They don’t have the technology or the tech literacy. We’ve heard that some of them may have used. People coming straight out of a recovery house may not even have a phone.”
Shabazz-El says that, personally, she hasn’t found the transition that bad, but she acknowledges that she also has her ongoing HIV activism, such as working on an online “reunion” of longtime survivors slated for December, to keep her connected. “Activism has always been a part of my recovery,” she says. “It gets me out of myself.”
Despite all that, she says, she misses the warmth of her thrice-weekly 12-step meetings, especially as someone who has worked at home for years and whose husband works a night shift.
“Just because I don’t go smoke a stick of weed or have a drink doesn’t mean that addiction is not still working in me,” she says. “You can eat or shop too much.” She admits that she’s been shopping heavily online for her grandkids—well before the holidays.
In Brownsville, Texas, HIV longtime survivor Judith Dillard says that although COVID has not pushed her to want to drink or drug again, “it is making me more depressed and anxious.” She still talks regularly with her 12-step sponsees—just over the phone, not in person. She’s usually stuck at home taking care of her mother with Alzheimer’s—and she doesn’t even have the Sunday release of church, because she refuses to go as long as she sees Facebook photos of her fellow churchgoers congregating without masks.
She also admits she’s stressed by the political landscape. “Four more years of Trump will make me much more apt to lose my recovery than COVID!”
Making the Best of It
Some folks with HIV in recovery say that COVID has actually allowed them to double down on their recovery work. “Before COVID, I would do three to four in-person 12-step meetings a week, in addition to meeting weekly with my sponsor and sponsees,” says Roger Lindgren in San Diego. “Now I do four to six Zoom meetings a day.” He, like many folks, says he likes the fact that, on Zoom, he can “attend” meetings all around the country and the world and “meet” many new people.
“I know several people struggling with Zoom and miss the in-person hugs,” he says, “but I don’t plan on going back to in-person meetings”—which since the late spring have been happening outdoors in places where the weather allows—“until I’ve taken a COVID vaccine and feel safe.”
Says Daniel Garza in Laguna Beach, California, who celebrated 13 years in recovery this past summer: “I have an unpredictable schedule, and virtual meetings allow me to jump into a meeting wherever I am.” In rehab many years ago, he says, he developed a foundation “that taught me I can channel my anxiety into a variety of outlets that don’t require me to drink or do drugs. I can’t say the same for tacos!”
For others, the novelty of Zoom meetings has worn off. “It started being a great thing,” says Sherri Lewis of Los Angeles. “It was easy to roll out of bed, get your recovery on the screen, and visit friends in other meetings and out of state.”
“But after all these months,” she continues, “that’s declined for me. I miss going for coffee, getting and giving hugs, and just being there. I see newcomers [to recovery] join in on Zoom—they’re the real miracles, counting their days [sober] and getting better while only knowing Zoom recovery. That inspires me. But it’s still been a struggle. I don’t want to get high or drunk, but my anxiety is off the charts.”
Tools for Coping
Lewis is not alone among many who say that despite the isolation and anxiety of the COVID era, they are determined not to drink or use drugs again.
For others, says Currie, he tries to get them to at least “put a plan in place” for their using to make it more intentional and not as knee-jerk and reactive. With his meth-using client, for example, “If he’s going to use, I urge him to decide where, with whom, and for how long, and commit that he is going to drink water, so it’s not so much like anything could happen. It’s to hold ownership of one’s behavior.”
With such clients, says Currie, he tells them, “You get to be as depressed and sad as you want, but don’t disparage yourself. And while it’s great to try to get out of the house at least once a day, it’s also OK to give yourself permission to do nothing, to just eat cereal and play video games.”
Then there’s Tammy Kinney, a long-sober HIV longtime survivor in rural Georgia who runs groups (partly via the women’s HIV agency SisterLove) for men and women with or at risk for HIV who are also often recovery. She says that folks in recovery—especially early recovery—thrive on human connection, and the COVID switchover to virtual meet-ups can be both logistically and emotionally hard.
That’s why, she says, her group tries to make someone always available to talk to by phone one on one.
“We talk about things people can do that bring them comfort,” she says. “Dancing, exercising, reading, sewing. For me, honestly, once a week I buy scratch cards. It’s relaxing.”
And through her own group, Rural Women in Action, she’s been holding masked and distanced get-togethers in her own backyard, featuring her special “Drink to Shrink” diet smoothie.
It’s important to note that some people whose alcohol or drug use is really out of control and endangering their lives may have to take steps to go to rehab if possible—even in COVID times, when admission can be more difficult than usual.
But it’s also important to note that at least some people can get their COVID-era substance use under control with less dramatic steps.
Take “Lee,” for example. She talked to both her personal therapist and her couples therapist about her dismay over her increased drinking. Now, she says, “I’m only drinking on weekends and I feel so much better. I was waiting for my husband to cut back with me. Then I woke up one day and realized that I couldn’t wait for him, so I did it myself. He said to me that a sober me was not a fun me, and I told him that wasn’t helpful and that I needed his support.”
Recently, she said, she even cut back on weekends. She’s replaced the habit with walking her dog daily and doing an exercise game over Nintendo.
“My anxiety’s significantly decreased since I started getting outside more,” she says. “And I’ve lost weight, too!”
Some of the people interviewed for this article used pseudonyms in order to speak freely. We placed an asterisk at the end of the first occurrence of their names.