How The Pandemic Changed Alcoholics Anonymous

“This is the last door on the road for a lot of people.”

By Nadine Yousif
Published in The Toronto Star, Sunday, Nov. 15, 2020

In a typical week, Mark attends four Alcoholics Anonymous meetings in Toronto. But over the last seven months, the meetings have been far from typical.

Since the arrival of COVID-19, people who once sat together in close proximity to share their struggles with addiction now do so on a screen, their faces trapped in individual squares on a Zoom meeting. Some attendees choose not to have their camera or microphone on, making for quieter celebrations than usual for sobriety milestones.

As more than 80 per cent of the Greater Toronto Area’s AA meetings have moved online, moments of casual socialization before and after, also referred to as “fellowship time,” are no longer possible. The passing of a donation basket is a thing of the past.

“The value of the fellowship is being able to press the flesh, so to speak, to shake hands and to make that very direct, personal contact,” said Mark, whose last name has been withheld due to AA’s media policy to protect members’ privacy.

The pandemic has upended the way free, in-person addiction support groups – from Narcotics Anonymous to Overeaters Anonymous and Alcoholics Anonymous – operate, moving meetings online and altering the reality for thousands who rely on these groups for accountability and community.

For AA’s GTA network, that meant around 500 weekly meetups were shuttered when physical distancing restrictions began in March, marking an abrupt change for an organization that has adhered to traditions dating back to its founding 85 years ago. Prior to the pandemic, more than 10,000 AA members from Toronto to Oakville to Ajax flocked to in-person meetings to find like-minded people who share a common goal of reaching sobriety.

So the sudden move to online was met with immediate questions about how vulnerable members would access the support they found in the meetings, typically held in church basements and community halls. And while a fraction of in-person meetings have since resumed, some members say the pandemic will forever change the way the fellowship operates, creating a permanent place for people to meet virtually and uniting members around the world.

These changes come as more people are turning to drugs and alcohol to cope with widespread feelings of social isolation. The Liquor Control Board of Ontario reported higher than usual alcohol sales when the pandemic began in March, and October data out of the Centre for Addiction and Mental Health shows nearly 25 per cent of Canadians surveyed are engaging in heavy episodic drinking. In 2018, 19 per cent of Canadians reported heavy drinking, according to Statistics Canada.

This has worried researchers at Public Health Ontario, who wrote in the Canadian Journal of Public Health that there is evidence linking mass traumatic events like the pandemic with increased alcohol consumption, warning of a looming addiction public health crisis in the shadow of COVID-19.

The higher rates also extend to drug use. In July, there was a record 27 opioid-related deaths reported in Toronto, exceeding the number of COVID-19 deaths in the city that same month. The opioid overdose death toll — which hit a new record of 28 in October — led Toronto Public Health to sound the alarm against using alone, citing a toxic drug supply for causing more fatalities.

Mark, who has been an AA member for 34 years and sober for 30, said some of his fellow members have recently relapsed, including one man who struggled with sobriety for the last seven years and lost his job in March due to COVID-19. He joined Mark’s AA group virtually during the pandemic in a renewed bid to reach sobriety.

“I was texting with him and having a lot of phone conversations with him,” Mark said, adding that the two couldn’t get together in person.

“He then took something he shouldn’t, and now he’s dead,” Mark said. The man’s partner still attends virtual AA meetings, finding support within a community that knew and accepted her husband in his final days.

Throughout his decades of active AA membership, Mark said he’s learned not to make assumptions on why some people relapse, and many have been able to maintain their sobriety despite the challenges brought by COVID-19. But he said there’s no question “it is far more difficult” for new people to feel connected with the fellowship and get the same support and encouragement online that they would have received with traditional in-person meetings.

It is why, Mark said, there was an urgent push within AA in Toronto to meet in person even as the city went into lockdown last March. Under city guidelines, addiction-support programs like AA were deemed an essential service, but members say many landlords closed meeting premises for fear of COVID-19 spread in the community.

A small group of members managed to restart in-person meetings in April at a Salvation Army, but for a few months, those meetings were the only daily AA support meetings in the city and they were limited to only 20 attendees.

That meant meetings had to run first-come, first-serve – an antithesis against how AA usually operates.

“You can come if you’re drunk, if you’re high, if you’re homeless, it does not matter,” said Julia, a 34-year-old AA member in Toronto. “This is the last door on the road for a lot of people, and the idea of having to close the door to a meeting is so devastating.”

Mark said some members began holding meetings in parking lots as a result, still adhering to physical distancing measures. Others met in parks or people’s backyards if the weather permitted.

When COVID-19 cases started dropping, more formal meeting spaces opened back up and as of now, there are some 71 weekly in-person meetings in the city. However, AA members are watching the second wave with concern: This month, Toronto’s daily COVID-19 case counts cracked the 500 mark for the first time and members worry the resurgence of in-person meetings will eventually grind to a halt.

With substance use on the rise, access to immediate in-person services are paramount, says Taryn Grieder, a research associate at the University of Toronto’s Donnelly Centre with a focus on addiction and mental health.

Grieder said moving AA meetings online has its benefits, but “active involvement in the program has been shown to play a huge role in maintaining recovery,” she added – a feat that is harder to achieve through an online platform. A 2009 review of research on AA’s effectiveness out of the University of California, Berkeley found that around 70 per cent of those who attend meetings weekly are able to reach abstinence within two years.

“People aren’t going to participate the same way as they would in person,” Grieder said of online meetings. “Even for a person feeling really involved in a program, they’re not going to feel as involved if they’re staring at a screen.”

Grieder said she worries about people who aren’t as extroverted, for example, who wouldn’t be able to pull someone aside during an online meeting and share their experience privately. She also worries about people from a lower socio-economic background who may not have the internet bandwidth to attend an online meeting.

“For people who don’t have a lot of money, it was easy to just walk to a meeting,” Grieder said.

For Julia, Zoom meetings lack a certain feeling of connection that has helped her stay sober for almost a decade.

“There’s just a certain magic about being in a room with other people,” Julia said. “If I’ve had a bad day or a bad week, I get to a meeting and there’s something there that makes me feel like I can breathe again.”

Julia and Mark are both active organizers with Alcoholics Anonymous in Toronto, but the fellowship operates with no hierarchy, meaning anyone can form an AA meeting. A key pillar of the organization is anonymity and no one person acts as a spokesperson for AA as a whole. A GTA Intergroup exists to offer centralized services like literature sales and a help line.

Meetings follow a set of traditions, including prayer, reading from the AA Big Book – which offers lessons on how to achieve sobriety – and passing a donation basket, as groups are financially self-supporting. Each group elects a chairperson and a treasurer, with these positions rotating periodically.

Some of these traditions are still carried out during online meetings, but others, like the donation basket, are not possible. People are still able to make donations and purchase literature online, but Mark said book sales have taken a bit of a hit during the pandemic.

A new technical host position has also been created to assist the chair in setting up the online meetings and to prevent security breaches, which caused issues earlier in the pandemic.

Some members, especially those who are older or immunocompromised and are at greater risk of contracting the virus, continue to choose virtual meetings. For these reasons, Mark said the fellowship remains divided on whether to hold more meetings in person: On one hand, COVID-19 is a public health crisis, but on the other hand, alcoholism is also a crisis on the rise.

Julia fears virtual meetings will no longer be a choice, but rather mandatory in the wake of COVID-19’s resurgence in Toronto and Ontario.

Her own group, she said, was forced to revert to online meetings recently for a period of 30 days at the request of the church where they usually met. Her only option for holding in-person meetings is finding a new landlord, which comes with steep rent costs the group cannot afford.

But there is a bright side, Mark said. He believes online meetings offer a new layer of connectivity that didn’t exist before, and therefore are likely here to stay.

It has enabled him to attend virtual meetings based in South Africa, Ireland and New Zealand. Addiction is a lonely disease, Mark said, and attending meetings elsewhere has reminded him he is not alone.

These meetings, he said, have reassured him “that there are people in many different countries, through many different cultures that have exactly the same need and that are finding exactly the same solution” through AA.

“It’s always an amazing feeling to be hearing someone speaking in India, for example, and talking about experiencing the same kind of… alcoholism and hearing about their recovery today,” he added. “That feeling of connection with people on the other side of the world is something unique.”

And despite the disruptions and lasting changes the pandemic has brought, Mark said AA’s priority remains unchanged: getting help to the people who need it, in whatever way possible – whether it be online, in-person or even through a phone call.

“We all recognize we’re dealing with a fatal condition, and we want people to be able to get in the lifeboat,” he said. “We want to be able to reach out that hand.”


 

34 Responses

  1. Mike O says:

    The biggest change in AA since the pandemic is probably how many long-time members now realize that they DON’T need to slavishly and compulsively attend meetings, especially not physical meetings, in order to remain sober. The practice of attending meetings can be important when you’re new to sobriety, when you don’t know where to turn or what to do next. The best thing a meeting can offer is a place to NOT drink or use. However, if years on into sobriety you’re still attending multiple meetings a week and feel like you can’t remain sober without it you’ve simply substituted one dependency for another.

    It will be interesting to see if AA’s membership is diminished after things start to reopen next year and if so by how much. How can people in AA continue to say, “meeting makers make it” to those who have not only survived the pandemic with their sobriety intact but perhaps thrived, not being shackled to a philosophy of self-abasement and obsessive guilt in an archaic, patriarchally based psychological pyramid scheme.

    • David W says:

      Many AA members seem to be fond of parroting iron clad do and don’t rules such as you must continue to go to meetings or you will drink. It’s a mystery to me how such people manage to play the necessary mental gymnastics in their own minds when they meet individuals who contradict their rigid beliefs.

      I suspect AA’s archaic, narrow based program keeps many trapped in relying over heavily on meetings because the program and meeting structure discourages exploration of recovery related knowledge that’s not contained in the foundational literature.

  2. Philip says:

    There is one possible benefit from the move to online meetings, which is to push traditional AA to change.

    With face-to-face meetings, AA is usually the only game in town. With a virtual monopoly, it is easy for AA to stay fossilized in a 1930’s mindset.

    Now, it is only too easy to seek out alternatives such as Smart Recover/SOS/LifeRing etc. We may find that as people (especially the younger generations) get used to online meetings and they continue after the pandemic, alternatives to AA may rise in popularity.

    Over the next few years, as many movements have found over the centuries, AA may have to change or become irrelevant.

  3. Steve B says:

    I checked John L’ s website and noted that he doesn’t believe that HIV is caused by a virus. So it’s no surprise to me that he takes a similar fact-free approach to covid-19.

  4. Thomas B. says:

    For everyone,

    Oh how I yearn for the AA meetings where blue/white smoke clouds lingered in the rooms. The sounds of frequent coughing and the clearing of throats; the striking of a match, and yes, the newcomers service work of cleaning smelly chipped ashtrays. Very strange how this “outside issue” eventually lead to smoke free meetings. Ahh to be able to take a deep breath in an AA meeting. Guess I suffered from the gift of desperation long enough to get and remain sober back then and now.

    So my fellow AA people, since AA has been able to stop killing members by smoking, I believe we can offer the same amount of health responsibility / accountability with regards to covid-19; wear a mask, social distance, welcome a newcomer. And cleaning up after a meeting is always pretty good service work. Thank you.

    • Thomas K. says:

      I’ll jump on that band wagon. Service and gratitude as well as humor and prayer to what Ever are all key ingredients to successfully recovery. ThankYOU.

    • Philip says:

      Yes, for a long time the smokers argued that for the sake of the newcomer, we had to keep smoking in meetings.

      Newcomers wouldn’t come otherwise.

  5. Jim D. says:

    As a result of the switch to Zoom, the secular community in OA has grown exponentially. See the website: Secular Overeaters. We use a lot of material from this site and AA Beyond Belief. You are our mentors! Thank you.

    • Roger says:

      Hi Jim. I’ve added a link to Secular Overeaters on our homepage here on AA Agnostica (bottom right):

      Secular Overeaters

    • In 1990 an OA member, Philip Z wrote, A Skeptics Guide to the 12-Steps. He was a secular Jew, a psychotherapist and OA was very big on ye olde Big Book, which was a problem for our hero with a food disorder, Philip. You may already know it – but it was a pioneering book opening the door to many of us. Roger got the book first and he gave his copy to me. It’s useful and relevant to this day.

  6. There were some questions about AA efficacy. When medical researchers examine AA and other mutual aid efficacy, the positive outcome rates are generally 55 to 60%. Their measure of “success” might be different than yours.

    In March, the anticipated, 2020 Cochrane Library Review of Interventions was released, with lead author, Dr John Kelly, Professor of Psychiatry in Addiction Medicine, Harvard Medical School and director of Massachusetts General Hospital Recovery Research Institute. I read and wrote extensively about it in prep for Episode 54 of Rebellion Dogs Radio (which I’ll be posting to social media tomorrow – it’s on the website now). The summary of studies conducted over the last 14 years concluded…

    “When compared to other well-established commonly delivered treatments for alcohol use disorder, AA/TSF [Twelve Step Facilitation] generally performs as well as other interventions on most clinical outcomes, except for abstinence, where it does quite a bit better – particularly true for helping many more patients achieve sustained abstinence and remission. The review also found that AA/TSF reduced health care costs substantially while simultaneously improving patient’s abstinence relative to other treatments.

    The quality of the evidence for the abstinence and economic outcomes was moderate to high indicating there is generally a high degree of confidence that can be placed in these new findings.”

    70% isn’t too far of the 55-60% rates that are standard. The higher number might be due to criteria. What they call successful outcome rates, you might object to if you see anything other than 100% uninterrupted sobriety a failure. Medical researchers are looking for improvements to the patient/family/community. Someone who was better off after exposure to AA could be counted as a success on several medical grounds: Improvements in longest period of abstinence, drinking intensity, percentage days abstinent, percentage days of heavy drinking, alcohol‐related consequences, alcohol addiction severity, improvement like these, along with uninterrupted sobriety, may count as success, even if some would call it a failure.

    I’ll be posting an essay, here in a few weeks, about a review of research that is less American-centric than the Berkley or Cochrane data comes from. David Best wrote Pathways to Recovery and Desistance: the role of the social contagion of hope (2019) and it looks at data from the UK, USA and Australia. I saw him speak at Recovery Capital Conference in the Greater Vancouver Area last year.

    • Dean W says:

      Joe, thanks for weighing in. I’m glad you’re familiar with this study and others. Maybe you can answer a question or two for me. But first let’s establish a context for this study. At the end of the paper we’re told that it was presented at a conference of the American Society of Addiction Medicine (ASAM). Last I checked, ASAM defines addiction as a “chronic, relapsing brain disease.” The “disease concept,” largely sold to the medical community by early AA, is a theory; it is not established fact. Many people dispute it. And the DSM, published by the American Psychiatric Association, doesn’t even use the words alcoholic and disease. Their term is alcohol use disorder (AUD). “Chronic, relapsing brain disease” is ideological language, not scientific language. And the Berkeley paper is written in this context.

      You mentioned efficacy rates, which is the point of the paper. Please look at the Results section of the Berkeley paper. According to Figure 2C, the middle bar chart shows AA’s “efficacy” at just over 70% for subjects who are attending a lot of meetings. Not surprising. Now please look to the left of the 70% bar. You’ll see that subjects who are attending no meetings at all have an efficacy rate of about 40%. Wait, WHAT? 40% of subjects with a “chronic, relapsing brain disease” stay abstinent without any treatment at all? That sounds like a miracle! Maybe there is a God after all.

      Imagine if this paper was written about cancer patients instead of alcoholics. If 40% of those cancer patients mysteriously recovered, don’t you think it would be big news? I think cancer researchers would be killing themselves designing and conducting new studies to try to find out what the hell happened. Why aren’t the Berkeley researchers doing the same for the alcoholics in their study? And what other chronic disease, other than the purported disease of addiction, has an unexplainable recovery rate of 40% among those afflicted with the disease that are receiving no treatment at all?

      If you are right about AA’s efficacy rate being 55 to 60%, that number must be compared to the 40% who recover without AA. So, compared to no treatment at all, AA does about 20% better. That’s not insignificant, but it sounds a bit different than simply claiming a 60% efficacy rate, doesn’t it?

      The Berkeley paper seems to support a longitudinal study done at Harvard (the Grant Study) and overseen by the psychiatrist George Vaillant for many years. The study observed entire classes of men from Harvard, not just alcoholics, but Vaillant had numerous alcoholics/addicts in the study. Vaillant concluded that many of these alcoholics/addict simply “matured out” of their addiction without any treatment or 12 Step membership. For whatever reasons, these men simply outgrew their alcohol or drug problem. They just got over it. Wait, WHAT? People can “mature out” of a chronic, relapsing brain disease? How can ASAM (and AA) explain that?

  7. Dean W says:

    Nadine, thanks for your article. It will be interesting to see what permanent changes result from the pandemic. Could you please post more information or a link to the UC Berkeley article you referenced?

      • Dean W says:

        Thanks Roger. I think the 70% number cited in this article is suspect at best. This high percentage appears to be for one particular study included in the numerous studies that were lumped together and statistically analyzed; the 70% doesn’t appear to apply to the overall review. The Berkeley paper also admits to not making “a thorough review of the literature on AA effectiveness.” Instead, their goal was to include “representative studies” that address AA effectiveness. Hmmmm… representative sampling is a tricky business. How do we know their samples were truly representative? The paper also admits in its introduction that “Research on the effectiveness of AA is controversial and is subject to widely divergent interpretations.” I think Ms. Yousif would have done her readers a service by noting this.

        In other words, the Berkeley paper is a statistical analysis of “selected” studies, not original scientific research or even replicated research. I think it also may have been misrepresented by Ms.Yousif.

  8. Jackie K says:

    If anyone has a list of secular or Buddhist Zoom meetings, please pass it on, thanks!

  9. Eugene B. says:

    Thank you for your very interesting article. I attend a zoom meeting in Los Angeles even though I live in Mississippi. It’s the same meeting I used to attend in LA for much of my recovered sobriety. I am amazed at the occasional story I read about people who are imminently meeting their end from COVID-19 and yet refuse to acknowledge that that is what is killing them. It’s a hoax they say as they go into that deep dark departure from life. Unbelievable but true.

    In the US, I live down along the gulf coast in Mississippi. We have a few in person meetings that are operating. I am especially interested to know with respect to contact tracing what determinations can be made regarding the incidence of COVID-19 spread in AA meetings. I haven’t seen one iota of data related to such a study but I think it would be worth our while to take such a study into consideration.

  10. David W says:

    I’m hoping a silver lining to come out of the pandemic will be the growth of secular AA from people hearing of the existence of our community through Zoom and other on-line media. Maybe being forced to embrace technology more rapidly will help drag AA into the 21st century.

  11. Telmea Story says:

    “Mark, whose last name has been withheld due to AA’s media policy to protect members’ privacy.” Somebody needs to go back to tradition school.

    • Tim S says:

      @Telmea. I’m guessing the person who wrote the article and those words isn’t an AA member but “just” a Toronto Star reporter. If I’m right, her characterization of our anonymity tradition is not unreasonable even though inaccurate. In my opinion.

  12. Tim S says:

    John’s comments, especially but not limited to as they pertain to masks, amply illustrate for me the wisdom captured in our Tenth Tradition.

    • Roger says:

      Tradition Ten: “Alcoholics Anonymous has no opinion on outside issues…”

      • JIm says:

        At this point I would say that the 10th tradition is both archaic and a cop out, a way to avoid responsibility.

        • Bullwinkle says:

          The 12 Traditions, the 12 Steps and 12 concepts being suggested, have no dogma. My observation is that some AA fellowship members or some others not a part of AA create dogma, to the point at times where it has the potential to be injurious when bombastically expressed with projection.

  13. Jim says:

    This guy certainly confirms something that I’ve had doubts about – that alcoholics are indeed a selfish and self-centered lot. I won’t use the words I’m thinking because I respect this page.

  14. The “pandemic” shutdowns/lockdowns have destroyed health, lives, businesses, the economy. These shutdowns have nothing to do with health and everything to do with politics & economics. Nadine’s article shows how the shutdowns have harmed recovering alcoholics, who really do need face-to-face, personal contact with other alcoholics. The “pandemic” is at best enormously exaggerated or at worst, a hoax. We need now to restart in-person meetings, in defiance of shutdown orders if necessary. Time to read Thoreau’s essay on “Civil Disobedience”. In the early days of AA, people held meetings in people’s homes. We can do that again. And without those ridiculous masks, which do nothing to protect the wearer or other people.

    • Pat N. says:

      I presume you have some experience with the phenomenon of denial, since you’re involved with a website devoted to recovery from addiction. It’s unfortunate that you don’t recognize your own denial of the seriousness of Covid-19. The U.S. death count of over a quarter-million in less than a year isn’t enough to indicate a problem? The fact-based recommendations of scientists who’ve spent their lives studying epidemics are fraudulent?

      For me, part of sobriety is taking responsibility for the common good and my fellow humans.

    • John B. says:

      John – I’m eagerly looking forward to reading the replies to your posting. One of the hardest things for me to do on the road to sustained sobriety (now over 36 years) was to overcome denial. Having accomplished that in relationship to my alcoholism, I became able to look at the overall challenges of the human condition with a clearer sense of reality.

      As an alcoholic, I have become acutely aware of the importance of my overall health, and work hard to postpone my inevitable arrival at the finish line. To treat COVID-19 as a hoax I’m afraid might hasten my arrival. By the way, the suspension of face to face meetings does not prevent face to face encounters with other alcoholics – I’m pretty sure there are many devoted sponsors who have realized that. John B.

    • Barb L says:

      John I am a nurse and I am much too exhausted to argue about covid and our response to it. But perhaps some service work for our hospitals would help your attitude. I did see El Paso was advertising for help in their morgue and, of course, are using prisoners to assist with moving bodies. I say this in sincerity, see if you can’t give a hand somehow.

      • Bullwinkle says:

        Thank you, Barb L, for your service!

        My boyhood friend teaches public health at Harvard and all over the world, he’s in his early 80’s. Being on the front line, he contracted COVID -19. His last email to me was “be of service to others and it was nice knowing you”. He thought he was going to die. After two weeks on a ventilator, in a coma, fed through a tube, he survived so far with few residual affects. He’s back to work, via Zoom.

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