Helping Clients Engage With Remote Mutual Aid for Addiction Recovery During COVID-19 and Beyond

Abstract

Face-to-face mutual-aid meetings such as Alcoholics Anonymous shuttered with the onset of COVID-19. Research could not be conducted quickly enough to provide guidance for how to respond. However, two powerful tools could be leveraged: the research on mutual aid conducted before the pandemic and the vast number of virtual resources that proliferated with the onset of the pandemic. This article reviews the existing mutual aid research and its relevance to COVID-19, describes the diverse array of virtual resources, and provides recommendations for successful engagement with virtual mutual aid during COVID-19 and beyond.

As COVID-19 broke out in the United States, journalists began reporting that the virus could threaten addiction recovery (Forgrave, 2020; Preidt, 2020). Indeed, for many, the pandemic has caused psychological, emotional, social, and economic stress resulting in negative emotional states, most notably, social isolation and loneliness. Such negative emotions have long been understood to be predictors of relapse (Marlatt, 1996; Ramo & Brown, 2008; Sliedrecht et al., 2019). Shelter-in-place orders put some people in recovery in close proximity to others using drugs and alcohol. Being exposed to drug and alcohol cues can cause cravings for substance use (Carter & Tiffany, 1999) and cravings can cause relapse (Sliedrecht et al., 2019). Going to work can support recovery as it places a restraint on substance use, but even this was diminished by working from home or becoming unemployed (Acuff et al., 2020). Many activities that make recovery rewarding were canceled, such as sporting events, artistic performances, and other hobbies (Acuff et al., 2020). In addition, the need for physical distancing shuttered face-to-face meetings of mutual-aid recovery groups such as Alcoholics Anonymous (AA). These groups are life saving for many, and, with the onset of COVID-19, individuals in recovery might not have known how they would manage without them.

Providers were also at a loss because there was no research to guide them on how best to help clients engage with remote mutual aid during a pandemic. However, two valuable tools can be leveraged. The first is the rich body of research on mutual aid that was conducted before the pandemic. This research offers valuable lessons for the best way forward in the current moment. Providers would benefit from a review of this research with a focus on its application to COVID-19. The second tool is the remote mutual aid resources that were up and running before COVID-19 (Grant & Dill-Shackleford, 2017) and the vast number that were added with the onset of the pandemic. Providers would benefit from a description of these diverse and numerous mutual aid resources. Therefore the aims of this article are to provide a review of the existing research on mutual aid and its relevance to COVID-19, to describe the numerous remote mutual aid resources available during COVID-19; and to offer recommendations for facilitating client engagement in remote mutual aid during, and in all likelihood after, COVID-19.

Research on Mutual Aid and its Relevance to COVID-19

What Does Research on Mutual-Aid Recovery Groups Tell Us, So We Can Leverage This Information for Clients During COVID-19?

The field of addiction has embraced the philosophy that there are many pathways to recovery, and all are valid (White, 2007), including the traditional pathways of AA and Narcotics Anonymous (NA). However, AA and NA (collectively referred to as “12-step” in some studies) have been more extensively researched. Therefore, we will begin our discussion with research on 12-step programs and discuss other mutual-aid groups further in the article. The research on 12-step programs can be divided into two broad categories: 1) Do they work? and 2) How do they work?

Do 12-Step Programs Work?

In March 2020, the most comprehensive summary of research on AA was published as a 119 page Cochrane review (Kelly et al., 2020). The review analyzed data from 27 methodologically strong studies involving 10,565 individuals with alcohol use disorders. The study found that AA or 12-step facilitation (which is a manualized therapy that encourages AA) generally outperformed other addiction treatment approaches (such as cognitive behavioral therapy) when the outcome was continuous abstinence. When the outcome was drinking intensity or drinking frequency, AA generally worked as well as or better than other approaches. Further, AA was shown in four out of five economic studies to be more cost effective (AA operates by way of voluntary contributions—in face-to-face meetings, a basket is passed to collect donations). The collective body of research on NA shows a similar pattern of reducing drug use (White, Galanter, et al., 2020).

These studies of AA (Kelly et al., 2020) and NA (White, Galanter, et al., 2020) provide strong evidence that AA and NA have a direct effect on drinking and drug use. But, what is it about AA and NA that causes this beneficial effect? Researchers answer this question by studying “mechanisms.” AA and NA set something into motion, and that change, or mechanism, subsequently supports abstinence. This pathway is the indirect effect of AA/NA on abstinence, through a set of intermediary processes, experiences, attitudes, or events. Studies of indirect effects, that is, studies of mechanisms, answer questions about how mutual aid works. These mechanisms through which AA and NA exhort their effect provide important clues for working with clients during COVID-19.

How Do 12-Step Programs Work?

Research has shown that AA and NA work via several mechanisms simultaneously (Kelly et al., 2012, 2020; White, Galanter, et al., 2020). Kelly and colleagues (Kelly et al., 2009) categorize the mechanisms of AA’s effectiveness along four lines: spirituality, common factors, AA-specific factors, and social factors. Spirituality has been shown to mediate the effect of AA on drinking, especially if the definition of spirituality includes the behaviors of prayer and meditation (Krentzman et al., 2013). Common factors are therapeutic benefits provided by 12-step programs that are also provided by professional addiction treatment centers. These include confidence in being able to refuse a drink in a high-risk situation, coping skills, and motivation for and commitment to abstinence. AA-specific factors are elements found only in AA, for example, working the steps, having a sponsor, and reading AA literature. AA’s most powerful mechanism of effectiveness is arguably social support. It would be reasonable to think that abstinence would be easier if people in one’s social network supported recovery. This has been found to be true especially if the people who are providing support are in AA themselves (Bond et al., 2003; Kaskutas et al., 2002).

One of the most fascinating aspects of addiction is that it can be halted by the interpersonal support of others who are also maintaining recovery. It can be surprising to learn that hundreds of peer-based support groups, referred to as “alcoholic mutual aid societies,” existed long before AA’s 1935 origination (White, 2001). These 12-step precursors leveraged social identity, social belonging, and social support to help its members stay sober (White, 2001) and they worked, at least for a time. This speaks powerfully to one of the strongest recommendations for clients during COVID-19: encourage them to find their way to the center of a community of people who are also staying sober--via a recovery community, a mutual-aid recovery group, AA, NA, or other secular or religious groups described further in this article. And during COVID-19, these communities are accessible remotely.

Research on Helping Others: How Helping Supports Recovery and How This is Relevant for Optimal Engagement With Mutual Aid During COVID-19

There is evidence that helping others benefits the person doing the helping. An early scholarly article on the benefits of helping was a 1965 paper in the journal Social Work entitled, “The ‘Helper’ Therapy Principle” (Riessman, 1965). In this paper, Reissman describes how the helper receives therapeutic benefit from helping. Several psychological principles describe why. The “saying-is-believing” effect describes how helpers, by articulating their experiences and advice, primarily influence themselves (Aronson, 1999). This works because it feels disingenuous to recommend one thing and do something else. People feel better when what they do aligns with what they say. This encourages helpers to take their own advice. Self-affirmation theory also speaks to the benefits of helping. Self-affirmation theory states that when people are reminded of positive aspects of themselves, their sense of self is buttressed. Then negative events are perceived as less stressful and threatening (Sherman & Hartson, 2011). The altruistic act of being helpful can put the helper in touch with positive aspects of themselves. We found examples of this when we taught a journaling practice to women in residential treatment for addiction. The journaling practice included the instruction to think about other people who were suffering, and send them good wishes (Krentzman, 2020). One participant described that doing this made her feel good about herself because it showed how, “I really do care about people, I’m not selfish, I do care about others.” AA co-founder Bill Wilson described what helping did for him, especially during hard times. He wrote,

I was not too well at the time, and was plagued by waves of self-pity and resentment. This sometimes nearly drove me back to drink, but I soon found that when all other measures failed, work with another alcoholic would save the day. Many times I have gone to my old hospital in despair. On talking to a man there, I would be amazingly lifted up and set on my feet. It is a design for living that works in rough going.

(AA World Services, 2001, p. 15)

Pagano and colleagues (2004) found that individuals with alcohol use disorders who helped others (by being a sponsor or by working the 12^th step, i.e., carrying the message of recovery to other individuals) were significantly less likely to relapse in the year following treatment. Researchers have begun studying the effects of helping others remotely. Helping others by typing a message into a recovery app was associated with at least some forms of recovery benefit depending on the type of help provided and the helper’s level of confidence that they would stay sober themselves (Liu et al., 2020). In summary, helping works several ways to support recovery: it promotes the person’s own sobriety-reinforcing behaviors, it helps a person feel better about themselves, and it buffers negative emotion. During COVID-19, there are several opportunities for helping others with recovery. More on that in the section below on recommendations.

We’ve Talked About AA and NA, What About Research on Other Mutual-Aid Recovery Groups, Such as Women for Sobriety, SMART Recovery, and LifeRing?

Some clients dislike 12-step programs. Twelve-step programs are spiritual and theistic. God, a higher power, and prayer and meditation are central components. While the principles of 12-step programs are suggestions and not mandates, and while certain AA meetings, such as those of AA Agnostica, eliminate the “God part” (https://aaagnostica.org), some individuals remain uncomfortable. While many are exposed to AA and NA during treatment, few attend at least weekly in the year following (Zemore et al., 2017). In recent years, secular mutual-aid addiction recovery groups have flourished, such as SMART recovery, Women for Sobriety, and LifeRing. The latest research on these groups shows that they are equally effective as one another. These secular groups were found to be as effective as 12-step programs as long as individuals had a goal of abstinence (Zemore et al., 2018). These secular mutual-aid groups offer remote meetings accessible during COVID-19.

What Does the Research say About the Best Ways for Providers to Help Clients Engage in Recovery Groups? And, How do I Manage This During COVID-19?

Research has studied how to help clients engage in 12-step programs. These strategies should generalize to other mutual aid recovery groups but this has not yet been examined. Manualized psycho-social interventions exist to help counselors shepherd their clients from inexperienced novice to active 12-step member. A classic approach from the 1990s was 12-step facilitation (Nowinski et al., 1992). Studies have tested different ways to introduce clients to AA. Across studies, when the people involved in making the referral are themselves 12-step members, the referral is more likely to be successful (Manning et al., 2012). Studies showed that introducing your client to an AA member, having that AA member attend the meeting with your client, and following up with your client about how it went outperformed the simple provision of a meeting schedule and the recommendation to attend (Timko et al., 2006; Timko & DeBenedetti, 2007). A parsimonious curriculum that gradually introduces a client to mutual aid programs is Making AA Easier (MAAEZ) (Kaskutas et al., 2009). As in the Timko studies, MAAEZ leverages social support from more experienced members and provides accountability in the form of counselor follow-up to see how clients’ meeting attendance went. As in the Timko studies, MAAEZ also resulted in better rates of abstinence. MAAEZ uses six group sessions featuring topics and homework assignments that gradually, with support and follow-up, introduce the novice to the mutual-aid experience. On the last session, clients who have already been through the MAAEZ curriculum greet incoming clients and share their experiences. In Table 1, the traditional MAAEZ curriculum appears on the left and a proposed revision of the MAAEZ model for COVID-19 appears on the right. The revision is broadened to include remote meetings and all kinds of mutual-aid groups. These changes update MAAEZ for the current moment. The original MAAEZ treatment manual is available on line (Kaskutas & Oberste, 2002).

Table 1.

The Original Making Alcoholics Anonymous Easier (MAAEZ) Model and MAAEZ Model Revised for COVID-19

Session #	Original MAAEZ	Revised MAAEZ for COVID-19
1	Introductory session
	Discuss prior experience with Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and other 12-step groups. Learn how to use the meeting directories. Homework: Go to an AA or NA meeting in the next week; readings from AA or NA literature.	Discuss prior experience with mutual-aid addiction recovery groups (e.g., 12-step, SMART recovery, etc.). Learn to find and use electronic meeting directories. Homework: Attend a new remote recovery support meeting.
2	Spirituality
	Provide wide range of definitions of spirituality including those free of religious context. Homework: Go to an AA or NA meeting in the next week, talk to someone you don’t already know who has more sobriety than you after the meeting; read excerpts of AA and NA literature.	Provide wide range of definitions of spirituality. Describe mutual-aid groups that do not use a spiritual approach (e.g., AA Agnostica, SMART Recovery, Women for Sobriety, LifeSpring). Homework: Attend electronic meeting of your choice, arrive early and stay late to chat with other participants.
3	Principles not personalities
	Myths about AA/NA, different types of meetings, meeting etiquette. Homework: Attend an AA or NA meeting this week; ask someone you don’t already know, who has more sobriety than you, for their phone number and call them; read excerpts of AA and NA literature.	Prepare individual for possible obstacles to meetings and how to overcome them: Zoombombing, change of electronic meeting address, time zone errors, no access to password. Address remote meeting etiquette: hand raising, chat box, and sharing online. Homework: Attend a remote meeting and ask for someone’s phone number and call or text them.
4	Sponsorship
	Explains function of the sponsor, guidelines for choosing someone, practice asking someone, overcome rejection. Homework: Attend an AA or NA meeting this week, ask someone if they would be your temporary sponsor; read a pamphlet on sponsorship.	Explain sponsorship. Attend a “specialty” online meeting that matches your identity, for example, a meeting for women, men, LGBTQIA+, young people, military. Homework: Get a temporary sponsor.
5	Living sober
	Tools for staying sober: identify relapse triggers, do service to the meeting (helping others), avoid people, places, things that are associated with drinking/using drugs. Homework: Attend an AA or NA meeting this week; socialize with someone in AA or NA who has more sobriety than you; read excerpts of AA and NA literature.	Tools for staying sober: relapse triggers, helping/service, avoid people, places and things. Homework: Take on a service commitment in an online meeting, even a short-term temporary one such as doing a reading or being the timekeeper.
6	MAAEZ alumni join the introductory session
	Clients who have attended all 5 of the groups finish their MAAEZ experience by joining the Introduction Session (#1, above) and sharing their experiences going through MAAEZ with newcomers to MAAEZ. This allows alumni to be in the role of “helper” which gives them an emotional boost as well as helps to solidify their own lessons learned via MAAEZ.	Clients who have attended all 5 of the groups finish their COVID-19 MAAEZ experience by joining the Introduction Session (#1, above) and sharing their experiences going through MAAEZ with newcomers to MAAEZ. This allows alumni to be in the role of “helper” which gives them an emotional boost as well as helps to solidify their own lessons learned via MAAEZ.

Notes. Sources for MAAEZ description are the MAAEZ Treatment Manual (Kaskutas & Oberste, 2002) and a research paper describing MAAEZ outcomes (Kaskutas et al., 2009). The MAAEZ revision in the right-hand column includes virtual meetings and includes mutual aid groups in addition to AA and NA.

What Kinds of Remote Recovery Support Meetings are There During COVID-19?

Before discussing the research on remote recovery meetings, it is important to define the kinds of addiction recovery meetings available remotely. There are “location-agnostic virtual meetings” and “location-centric virtual meetings” (BMLT, Virtual Meetings, and the Pandemic, n.d.). Location-agnostic virtual meetings are ones where the geographic origin of the meeting is not important. The more important considerations are the language in which the meeting is conducted (i.e., English, Spanish, etc.), the day of the week, and hour of the meeting. These meetings existed before COVID-19 with 10–20 participants in attendance, typically. With the onset of COVID-19, meeting attendance was observed to swell to 400 (BMLT, Virtual Meetings, and the Pandemic, n.d.). After the pandemic, these meetings are expected to continue (BMLT, Virtual Meetings, and the Pandemic, n.d.).

Location-centric virtual meetings, by comparison, arose in response to COVID-19. These are face-to-face meetings in the local community that converted to a remote format when their physical meeting spaces were shuttered. Location-centric meetings are held at the same time and hour as the original face-to-face meeting, and your clients will see the familiar faces they saw in those face-to-face meetings. These remote meetings will likely assume a hybrid format as restrictions ease (with some attending in person and some attending remotely). Some of these meetings might branch off as free-standing remote meetings, or might shut down when face-to-face meetings resume (BMLT, Virtual Meetings, and the Pandemic, n.d.).

Both “closed” and “open” meetings persist remotely in the COVID-19 era (https://virtual-na.org; https://aa-intergroup.org). Closed meetings are for those who themselves have, or have had, an issue with alcohol, drugs, or other addictive behaviors, and open meetings are open to any curious person who wishes to attend; speaking at open meetings is often limited to those who have, or have had, an issue with addiction.

Remote meetings have the same specialty themes and topics that face-to-face meetings offer, including meetings that focus on the steps, program literature, and meditation. Many remote meetings are tailored specifically for subpopulations such as women, young people, LGBTQIA+, veterans and those who are active duty military, and beginners (Online Int’l AA Meeting Guide, n.d.).

What Does the Research on Remote Mutual Aid Meetings Tell Us?

At the onset of COVID-19, there were already thousands of online opportunities for connecting with others in recovery (Grant & Dill-Shackleford, 2017) including websites listing remote AA (https://aa-intergroup.org) and NA (https://virtual-na.org) meetings. Researchers have published the first studies of remote recovery support. These researchers tended to define remote support broadly to include online meetings, internet discussion threads, recorded speaker tapes, group chats, and posted recovery meditations (Bergman et al., 2017). Before the pandemic, it was estimated that 11% of individuals in recovery used at least some form of online technology to reduce use or support abstinence (Bergman et al., 2018). One study surveyed 123 individuals who supported their recovery via the website In the Rooms (https://www.intherooms.com). The majority of individuals surveyed (>80%) agreed that online support enhanced their motivation to stay in recovery and improved their abstinence self-efficacy. A smaller majority (>68%) said that online support helped reduce their cravings for substances and enhanced their identity as a person in recovery (Bergman et al., 2017). One study showed that individuals who used both face-to-face and online recovery resources preferred face-to-face meetings but still found online support to be valuable (Grant & Dill-Shackleford, 2017).

Despite these promising findings, remote recovery connections have downsides. Remote connections weaken the kinds of social cues we experience when face to face (Grant & Dill-Shackleford, 2017). This diminished ability to interpret social cues might make it harder for participants to approach others who are in distress or to discern who would be a good sponsor or friend. Remote gatherings offer limited ability to socialize before and after meetings, and no opportunity to go out for coffee or a meal afterward, where important connections are forged. Warm personal greetings and hugs are characteristic of face-to-face recovery gatherings--their absence could make newcomers feel less welcomed. COVID-19 has “forced” online recovery connections in ways that are certain to be profound. Future research certainly will document the pandemic’s short- and long-term impact on remote support for recovery.

Remote Mutual-Aid Resources During COVID-19

In this section, we list the remote mutual-aid resources available during the pandemic. Here, we refer to specific websites. Website content is notoriously perishable. However, listing specific websites in printed media serves two purposes: it provides links that are immediately useful to contemporary readers and it documents the current moment in a way that might be useful to future readers interested in historical records of addiction recovery and mutual aid during COVID-19. The categories of mutual aid resources included in this section are remote meetings, recovery social networks, remote conferences, recovery community organizations, telephone resources, and resources for family and friends.

Lists of Remote Mutual-Aid Recovery Meetings

Online Intergroup of AA

AA’s online intergroup (https://aa-intergroup.org) provides a list of remote international meetings. Other spreadsheets have been circulating that list remote meetings (e.g., https://tinyurl.com/3he78vt5, https://tinyurl.com/n4msdyr2). The first example lists over 1,000 meetings providing the day of the week, time of day, meeting name, whether the meeting is phone or video, the dial-in telephone number, the URL link, the meeting type (i.e., open discussion, question and answer, readings and meditation), whether a “meeting slip” can be signed, and other information (Online Int’l AA Meeting Guide, n.d.). These sheets can be searched for key terms such as, “beginner” or “open.”

New York City’s AA Intergroup

New York intergroup is one example of a 12-step initiative that moved boldly and rapidly with the onset of the pandemic to provide support for remote meetings worldwide. The New York intergroup list features over 3000 regional, national, and international AA meetings each week (New York Intergroup, 2020). The results of a search conducted in April 2020 showed that there were 264 meetings listed for Friday and 24 meetings at noon on Friday. These meetings were hosted from settings as diverse as Chicago, Tribeca in New York City, and Bermuda.

Narcotics Anonymous

NA offers an extensive number of location agnostic meetings online (https://virtual-na.org) in languages such as American Sign Language, English, Spanish, French, German, Hindi, Italian, Nepali, Persian/Farsi, Portuguese, Russian, Swahili, and Swedish. NA also provides lists of locally-based meetings, for example, meetings organized by U.S. state, such as Minnesota (https://www.naminnesota.org).

Other 12-Step Programs

Most 12-step groups offer remote meetings during COVID-19 including Marijuana Anonymous (https://marijuana-anonymous.org), Sex and Love Addicts Anonymous (https://slaafws.org), Overeaters Anonymous (https://oa.org), Gamblers Anonymous (https://www.gamblersanonymous.org), Codependents Anonymous (https://coda.org), and Workaholics Anonymous (https://www.workaholics-anonymous.org).

Meetings 24/7

There are remote AA and NA meetings that are open and running around the clock: 24 hours a day, seven days a week (in the AA tab, search “24/7” in https://tinyurl.com/n4msdyr2, see also https://virtual-na.org/marathons).

Secular Mutual-Aid Addiction Recovery Groups

SMART Recovery (https://www.smartrecovery.org), Women for Sobriety (https://womenforsobriety.org), and LifeRing (https://lifering.org) offer remote meetings. Some recovery community organizations offer “all-recovery meetings”—support groups for people in recovery no matter what their path in recovery (12-step or other). For one example, see the Minnesota Recovery Connection (https://minnesotarecovery.org/support/all-recovery-meetings).

Religious Mutual-Aid Addiction Recovery Groups

Recovery Dharma is a Buddhist path to addiction recovery providing an extensive list of remote meetings (https://recoverydharma.org). Celebrate Recovery is a Christian approach to addiction recovery, and provided Facebook live streams (CRCR-Facebook Live, 2020).

Recovery Social Networks

In the Rooms (https://www.intherooms.com) is a recovery website and social network featuring resources such as video meetings, blogs, articles, and films with recovery themes. In the Rooms hosts 40 different mutual aid groups (White, Pomerance, et al., 2020). In 2017, In the Rooms had 430,000 registered users (Bergman et al., 2017). In April 2020, that number rose to 650,000 (White, Pomerance, et al., 2020). In February 2021, the site reported over 760,000 members.

Remote Recovery Conferences

Before COVID-19, mutual aid groups organized local, regional, national, and international gatherings of members. These conferences, workshops, and conventions are now offered remotely. Flyers announcing upcoming events are aggregated into a widely-shared google drive folder (https://tinyurl.com/369adyea). Many of these conferences have been recorded and are accessible free of charge via the web (https://www.recoverytapers.com; https://amotaudio.com/zoom-conferences).

Recovery Community Organizations

Recovery community organizations are social service agencies that provide resources to support addiction recovery. They are not treatment providers, nor are they mutual-aid recovery support groups per se. They are strongly associated with “communities of recovery” meaning “people in long-term recovery, their families, friends, and allies, including recovery-focused addiction and recovery professionals” (Valentine et al., 2007, p. 1). Generally speaking, recovery community organizations “mobilize resources within and outside of the recovery community to increase the prevalence and quality of long-term recovery from alcohol and other drug addiction” and therefore are strongly affiliated with the spirit of mutual aid (Valentine et al., 2007, p. 1). These organizations train individuals in recovery to serve as peer-recovery coaches. Peer-recovery coaches provide telephone check-ins and refer individuals to telephone meetings, treatment providers, addiction assessment services, and a wide range of other psychosocial services. Many recovery community organizations are situated in brick-and-mortar buildings. However where offices have been shuttered, in many cases phones continue to be answered.

Telephone Resources

Some clients have a telephone that does not connect to the web. Many mutual-aid meetings are accessible by regular telephone. Electronic lists can be sorted (https://aa-intergroup.org/oiaa/meetings) or searched (https://tinyurl.com/3he78vt5) to find meetings that are accessible by a regular telephone. Of course individuals without internet will need help accessing these online lists. A call to the local recovery community organization or 12-step intergroup office should connect individuals with those who can help.

Mutual Aid Resources for Family and Friends

Social support from mutual aid groups has been shown to offer numerous benefits to friends and family members who are worried about a loved one’s drinking or drug use (Timko et al., 2016). Al-Anon (https://al-anon.org) and Families Anonymous (https://www.familiesanonymous.org) feature remote meetings. Keep in mind there are other support groups for family members which focus on other addictions: Nar-Anon (https://www.nar-anon.org) if the loved one is involved with narcotics; O-Anon (http://o-anon.org) if the loved one has an addictive relationship with food; S-Anon (https://sanon.org) if the loved one suffers from sex addiction; and Gam-Anon (https://www.gam-anon.org) if the loved one has a problem with gambling.

Recommendations for Helping Clients Access and Engage in Remote Mutual Aid

These recommendations are intended for addiction providers, but many of them are actionable for other mental health professionals, families of individuals in recovery, and individuals in recovery themselves.

Prepare Your Client to Be Resilient in the Face of “Nuisance” Obstacles

Your client will likely face at least some “nuisance” obstacles when they access remote meetings. If your clients are aware of these obstacles in advance, they will feel less discouraged if they experience them. They will most certainly have success gaining entry to a meeting by simply trying the next meeting on the list. What follows are a list of common nuisance obstacles.

Time Change Miscalculations

Remote meetings are hosted from time zones around the world leading to the possibility that the time change was miscalculated. Your client might log in to find that the meeting is just ending.

Passwords

The meeting might require a password and that password might not be provided in the meeting information. Instructions might say to write to a given person for the password, and that person might not reply. Many meeting lists provide the passwords, however.

Zoombombing

Zoombombing is when a bad actor shares their screen, uses their video camera to depict offensive images, or types offensive language into the chat (Lorenz, 2020). However, remote conferencing apps have responded with security updates and New York intergroup produced a helpful document with tips for reducing such meeting disruptions (NYIG Toolkit for Handling Meeting Disruptions, 2020). Older meetings initiated at the start of the pandemic might not have incorporated all the security protections.

Help Your Clients Overcome Reluctance to Technology

Your client may express a general dislike for the whole idea of online meetings and might dearly miss face-to-face meetings. Whenever new technologies become available, it is common for many to prefer the old way of doing things, especially when the old way worked just fine. Clients may feel a fear of the unknown or a worry that they will not be able to figure out how to use the apps and websites. Early in the pandemic, the famous boxer Sugar Ray Leonard wrote about his own recovery from alcoholism, membership in AA, and the ways in which he overcame his initial reluctance to online meetings during COVID-19 (Leonard, 2020). His essay describes how he tried online meetings and liked them. He found them to be a source of connection and support. They helped him feel centered. Your client might feel the same way.

Help Your Client Protect Their Privacy

Teach them how to turn the video off and on, and how to change the way their name appears. Safe meetings should have disabled the “record” option and the “share screen” option. Teach your clients how to check for these protections and find meetings that have these protections enabled.

Emphasize the Upside of Remote Meetings

Such as:

• The ability to connect with all-important abstinent-specific social support, free of COVID-19 infection risk

• An abundance of remote meetings, at all hours of the day and night

• The inspiration of seeing people in recovery from all over the world

• Engagement in “remote recovery tourism” by trying meetings based in China, Israel, Australia, England, Ireland, and elsewhere

• Convenience of access: this is game-changing for individuals in rural communities who formerly had to drive tens of miles to attend meetings (Krentzman et al., 2019)

• The connection to special populations: people can attend meetings where they can find others like themselves (e.g., women, young people, individuals identifying as LGBTQIA+, Spanish speakers); this is especially important when such diversity is lacking in their home community

• Ease of attendance, if there is equipment and internet connection

• Absence of travel time and no cost for gas or bus fare

• Affordability of recovery conferences where face-to-face participation would have been cost prohibitive.

Encourage your Clients to Help Others in Recovery

Here are some suggestions:

• Encourage your client to provide service to others in the meeting. These behaviors will optimize the feelings of connection, belonging, and camaraderie, and minimize feelings of social isolation, feeling “invisible,” feeling like an “outsider,” feeling like not being a “part of.”

• Encourage your client to log on to the meeting 10 minutes early, when there is more informal socializing and many of the service positions are assigned (for example, determining who will read the opening statements).

• Encourage a wide range of service activities in and outside of the meetings, including:

  • Being the meeting “timekeeper” if there is one
  • Hosting or co-hosting the meeting. Hosts and Co-hosts let people in from the “waiting room,” scan the meeting for interruptions, move members out of the meeting who are being disruptive, shut off people’s disruptive audio or video. There is a great need for this service, especially in large meetings.
  • Chairing the meeting. This often involves reading the meeting’s opening statement, ushering the meeting along, calling on people to share, reading program materials aloud, and ending the meeting on time.
  • Volunteering to answer phones for the local intergroup but from one’s own home.
  • Starting a new remote meeting, including listing the meeting on the local, national, and international lists.
  • In the chat box, thanking the speaker, the hosts, the group leaders, and individuals who share. Providing positive reinforcement to those who are actively participating in the meeting.
  • Reaching out to friends who were absent from today’s meeting. Asking how they are doing.
  • Reaching out to elderly friends in recovery who might only have a telephone or who might not be tech savvy. Helping them find telephone meetings.
  • Sharing in the meeting, which many consider is service.

Teach Your Client how to use Video Conferencing Apps

Key features of video conferencing apps are the chat box, accessing the list of meeting attendees, and how to electronically “raise your hand.” A lesson in these features provides your clients with essential clinical skills during COVID-19.

Encourage Your Clients Not to “Multi-Task” When on a Recovery Support Remote Meeting

Some may think that the ability to multi-task is a strength to remote meetings because it allows one to listen to the meeting while lying down under the covers, walking, or doing dishes. However, one way to overcome the limitations imposed by virtual human connection is to attend the meeting with full focus and presence. This includes sitting up for the meeting, having the video camera on (for accountability), participating as appropriate, and avoiding other distractions whenever possible.

Have Your Clients Create a Written Schedule of Their Weekly Online Meetings

See Figure 1 for an example. This way, your client can wake up each day, consult their schedule, and make plans to attend their selected meeting.

Figure 1.

Sample Weekly Online Recovery Meeting Plan. Art and photo credit: Laura Orpen

Employ the Standard Recommendations for Trying Mutual-Aid Meetings

Tell your clients to attend six different meetings before deciding it is not for them. Arrive early to the meeting and stay late. Meeting attendees chat, introduce themselves, and share resources before and after the meeting.

Connect Your Client to Someone who is Successfully Attending Remote Meetings

Make the introduction yourself, encourage the pair to attend a remote meeting together, and then follow up to see how it went. With face-to-face meetings, this approach delivers superior outcomes (Timko et al., 2006; Timko & DeBenedetti, 2007).

Attend an Open Remote Meeting Yourself

There is no better way to convince your clients to attend than to explain that you have done so yourself. Then you will be able to share your own personal experiences. There are an abundance of remote open meetings, where you would be most welcome, available at your fingertips.

Help Clients Fortify Existing Recovery-Oriented Social Connections

Advise your clients to do anything they can think of to solidify, extend, maximize, and amplify their connections to other people in recovery while maintaining physical distancing, for example, telephoning, texting, emailing, group chats, group emails, and social media friendships.

Make Full Use of Your Local Recovery Community Organization

To find your nearest recovery community organization, search the name of your nearest city of 100,000 followed by the words “recovery community organization.” Their phone lines and websites will connect you to the services they are currently offering.

Provide Key Phone Numbers to Clients who Have a Telephone That Does Not Connect to the Internet

Make sure your client has the telephone numbers to the closest recovery community organization. The person answering the phone can use their computers to look up telephone meetings for your client as well as provide other recovery services. If your client prefers AA or NA meetings, make sure they have the telephone numbers to the local AA or NA intergroup.

Direct the Newcomer to Beginners Meetings

It is possible to get and stay sober now. Beginners meetings are designed to address newcomer’s topics, should offer an especially warm greeting for newcomers, should provide encouragement, and should reserve time for any newcomer to introduce themselves and speak in the meeting. Teach your clients to electronically search a meeting page for the word “beginner.”

Encourage Meetings That Support Multiple Identities

Intersectionality is a term used by sociologists to describe co-occurring identities (Collins & Bilge, 2016; McCall, 2005), such as person in recovery plus woman, active military member, LGBTQIA+. Encourage your client to try a meeting that caters to individuals who share a second identity with your client. The feeling of double-shared identity can be a powerful hedge against social isolation.

Become Familiar With MAAEZ, A Strategy for Making Affiliation to Mutual Aid Easier

See Table 1 for a summary of the MAAEZ intervention and recommendations for modifying it to facilitate remote meeting engagement.

Conclusion

COVID-19 presents unprecedented obstacles to addiction recovery. While remote mutual aid resources increased exponentially during the pandemic, access is impeded by a range of obstacles faced by clients. However, the mutual aid research conducted before the pandemic provides insights useful to the current moment. In summary, mutual aid has been found to be an invaluable tool for the initiation and maintenance of recovery (Kelly et al., 2020; White, Galanter, et al., 2020). Family members and friends of individuals with addictions also have benefited from mutual aid (Timko et al., 2016). Mutual aid works through several mechanisms at once, the strongest is arguably the social support of other people in recovery (Kelly et al., 2012, 2020; White, Galanter, et al., 2020). An individual using mutual aid will likely enhance the benefits of participation by helping others in recovery (Pagano et al., 2004). There are effective alternatives to 12-step programs, should your client prefer them (Zemore et al., 2018). There are optimal ways to help clients engage with mutual aid. Counselors have better results if they connect a client to another person who is currently benefitting from mutual aid, send them off to a meeting together, and then follow up to see how it went (Timko et al., 2006; Timko & DeBenedetti, 2007). The MAAEZ curriculum described and updated in Table 1 can be a useful group model to foster engagement (Kaskutas et al., 2009; Kaskutas & Oberste, 2002). People who engaged in remote mutual aid before the pandemic found it helpful (Bergman et al., 2017; Grant & Dill-Shackleford, 2017). A wide range of diverse remote mutual aid resources are available. Equipped with knowledge of research on mutual aid and knowledge of the vast array of remote resources, providers are in a position to help their clients to successfully engage and thrive during COVID-19 and beyond.

At the time of the writing of the final draft of this article in March 2021, some meetings have resumed face-to-face contact requiring masks and physical distancing. Some meetings have taken place outside to reduce risk. However, we are still in the midst of the pandemic. Difficulties with vaccine distribution and virus mutations suggest additional delays to a return to normal. Clients might experience fatigue with online meetings. The long-term hiatus of in-person meetings, with their ease in facilitating personal connections, might create further strain. However, based on the significant mutual-aid and recovery community response so far, ongoing innovations are likely. While the pandemic has taken a toll on all manner of face-to-face gatherings in society, many have enumerated at least some advantages to remote social interaction (Nguyen, 2021; Powell, 2020) including advantages to remote mutual aid for recovery. It may well be that significant upticks in remote mutual-aid participation are here to stay. Young people who grew up with computers, the internet, and mobile phones, that is, “digital natives,” might be especially likely to continue to obtain their mutual-aid support remotely. Young people newly entering recovery might prefer remote mutual aid from the outset. For the remainder of COVID-19 and beyond, the lessons from mutual-aid research and the explosion in remote mutual-aid offerings can facilitate client connection with the peer-based support that is a strong cornerstone of stable recovery from addiction.