How the pandemic changed Alcoholics Anonymous — possibly forever

·10 min read

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.”

Nadine Yousif is a Toronto-based reporter for the Star covering mental health. Her reporting is funded by the Canadian government through its Local Journalism Initiative. Follow her on Twitter: @nadineyousif

Nadine Yousif, Local Journalism Initiative Reporter, Toronto Star