Prior to COVID-19, Dr. Julia Frew, director of the Dartmouth-Hitchcock Moms in Recovery Program, gathered a group of women in a small room, joined together by the struggles of motherhood while battling opioid addiction. These women learned from each other, grew with each other, through an intensive three-hour session three times a week.
Now, because of the pandemic, these women have lost this important community. These sessions are hard to replicate on Zoom, and for many with unreliable internet access that's not an option anyway.
"Women with substance-use disorders, particularly in rural areas, face a lot of barriers to telehealth access," Frew said. "Many of these women don't have cell reception or high-speed internet."
With the pandemic putting programs like these on hiatus, patients like Megan, who has been with Moms in Recovery, was relieved when the program started up again virtually. (She declined to give her full name for privacy reasons.)
"When groups did start going virtual, I started to feel like myself again and getting back on track," Megan said. "I am worried about the people I was close with in the program who cannot attend anymore, because it is not a question of 'if,' it's a question of 'when.'"
Secondary repercussions in health as a result of the pandemic have been profound. Three times as many people reported battling depression, and there have been more deaths from opioid overdose. Additionally, a recent peer-reviewed study found an increased susceptibility to complications from COVID-19 infection among patients struggling with substance abuse.
"I know at least one or two [people] a month who have died since July [from opioid overdose]," Megan explained. "I am just worried about the kids. The next generation all the kids will share something -- a parent who died from overdose."
Group visits for treating substance abuse and mental health disorders is not a novel idea. These programs, by creating a common bond and sense of unity, can help heal patients facing similar physical and emotional struggles.
Dr. Chanel Heermann, a psychiatrist at Rocky Mountain Regional VA Medical Center and an assistant professor of psychiatry at the University of Colorado School of Medicine, finds that in-person group therapy can be helpful for many people who suffer from mental illnesses, especially among patients who battle depression and suffer from social anxiety.
"One of the great gifts that groups offer us is the realization that we have so much more in common as human beings who suffer than the diagnostic or demographic differences that divide us," she said. "That realization -- of not being alone -- can be profoundly healing."
Tawny Jones, an administrator at the Cleveland Clinic Center for Functional Medicine, said that chronic diseases don't occur in isolation. About 1 in 4 people have chronic diseases driven by modifiable lifestyle factors, including nutrition, physical activity and substance abuse. As a result of these "unifying" contributors to ill health, group visits are an excellent alternative to traditional care delivery models in dealing with chronic disease and mental health disorders.
"Group visits allow more time with practitioners to improve a patient's medical literacy and understanding of their treatment plan," Jones said. "There is also peer-to-peer sharing that can elicit information from patients that the physician may not be able to get in an individual setting, which leads to a healthy sense of pressure and motivation from peers to actively manage their condition and adhere to treatment plans."
Megan said she feels privileged to have the ability to continue her therapy virtually via Moms in Recovery, but experts have said they fear for those without similar digital access.
Dr. Adam Myers, director of the Cleveland Clinic Community Care, agreed that the reliance on telemedicine and virtual care has led to an increase in the health care access disparities.
"Not all patients have the technical expertise or logistical support needed to fully utilize virtual care," Myers said. "The growing reliance on virtual care during this pandemic has heightened the impact of this divide."
Moms in Recovery and the Cleveland Clinic have made salient efforts to help alleviate this.
"We are actively working with community partners to mitigate this divide by extending broadband access into some of the underserved neighborhoods around our campuses," Myers explained, "More work is underway to further mitigate this divide."
People with chronic conditions like depression might be harmed by the isolation brought on by the pandemic, Heermann noted.
"I do believe that physical touch is critical for helping people recover from depression," she said. "For patients who live alone, those who are single, those without children or other nearby family, this can be a real concern, especially during this difficult period."
Lily Nedda Dastmalchi, D.O., M.A., an internal medicine resident physician at The George Washington University, is a contributor to the ABC News Medical Unit.