Promoting Support Group Attendance During COVID-19 | ASAM.org

PROMOTING SUPPORT GROUP ATTENDANCE

Promoting Support Group Attendance

Purpose of the document

Provide guidance to addiction treatment clinicians and programs to support access and participation in support groups and recovery activities while mitigating risk of COVID-19 transmission.

According to the CDC, “the virus that causes COVID-19 seems to be spreading easily and sustainably in the community”. Since the virus can be spread before a person develops symptoms and by individuals who contract the virus but never develop symptoms, widespread physical distancing and use of cloth face coverings when around others are indicated to prevent the spread of this illness . Current federal guidance recommends physical distancing and universal use of face coverings and stratifies risk at events and gatherings as follows:

Lowest risk: Virtual-only activities, events, and gatherings where individuals remain physically distant while connecting virtually.

Moderate risk: Smaller outdoor and in-person gatherings in which fewer than ten individuals from different households remain spaced at least 6 feet apart, wear cloth face coverings, do not share objects, and come from the same local area (e.g., community, town, city, or county).

Higher risk: Medium-sized in-person gatherings between ten and fifty individuals that are adapted to allow individuals to remain spaced at least 6 feet apart and with attendees coming from outside the local area.

Highest risk: Large in-person gatherings of over fifty individuals where it is difficult for individuals to remain spaced at least 6 feet apart and attendees travel from outside the local area.

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Updated: 09/18/20

Topics

Online Support Groups 

Goal

To supply information to programs and clinicians about accessing and taking part in online support groups

Recommendation

Programs and clinicians should provide resources for online support groups for patients who cannot or should not attend in-person groups due to risks associated with COVID-19. Online support groups may be offered in a variety of formats including discussion meeting via teleconferrencing groups, chat and live technology. Patient preferences, recovery environment, access to technology and experience with online resources are considerations that may affect patient access and use of this resource

12-Step Groups

Buddhism-based Recovery

http://recoverydharma.online/

Refuge Recovery

SMART Recovery

https://www.smartrecovery.org/community/

LifeRing

https://www.lifering.org/online-meetings

All Pathways


Additional Recovery Support Tools and Resources

ASAM has not comprehensively vetted, and does not endorse any specific tools or applications.

Recovery Support Apps

Sober Grid llows you to create online profiles and interact, support, and engage with other people in recovery using a platform similar to Facebook. You can also use the app to create anonymous check-ins about whether you’re sober or not, your mood, and what’s going on.

SoberTool is an easy way to track your days during which you did not use or have a drink. The app includes daily motivational messages and reminders to keep you on target.

The WEconnect provides you with daily reminders to stay on track with your recovery plan. You can create reminders to call your sponsor, go to a group meeting, or meditate—anything you need to provide that extra push.

AA Big BookThis app gives you access to the full text of the Big Book, along with a meeting finder, podcasts, prayers, and personal stories. You can use the app to bookmark meaningful passages, make notes on individual chapters in the comment section, and search for specific keywords.

12 Step Meditation Daily Reflections for AA, NA, Al-Anon This app features hundreds of easy-to-follow guided meditations, as well as soothing music, prayers, and 12-step recovery audio.

I Am Sober to track your sober days and milestones, build new habits, and enjoy ongoing motivation from a community of people who get it.

Pink Cloud find meetings near you based on your location

Meditation Apps

Headspace

Simple Habit Daily Meditation

Calm

Stop, Breath, and Think

Ten Percent Happier

Ten Percent Happier

Buddify

Podcasts

The Bubble Hourinvites listeners to share their stories of recovery from alcohol addiction. Each week, host Jean McCarthy holds space for a guest to tell their truth, and together they explore topics relative to recovery.

Busy Living Sober: a podcast with the mission of “giving people an opportunity to listen, learn and live a sober lifestyle without shame while having fun.”

The Addicted Mind is about understanding addiction, its impact and the latest treatment options available. This podcast aims to create an environment of compassion for individuals caught in the destructive grip of the addictive process. It works to deliver real hope to people who are suffering from addiction’s painful impact.

The Sober Guy: : Host Shane Ramer is in recovery from alcohol. He interviews a mix of celebrity guests and everyday people who have experienced addiction or felt the impact of drug or alcohol use. He focuses on living a positive, healthy and sober lifestyle, and uses his podcast as a platform for sharing inspiration with others who want to live the same way.

Let’s Talk Addiction and RecoveryHear what leading addiction and recovery experts are talking about—addiction trends, topics and challenges as well as research, practices and advances that point the most promising way forward. Provoking interview series, brought to you by Hazelden Betty Ford Foundation.

The Boiled Owl Coffee Club: Casual conversations about recovery in Alcoholics Anonymous. Listen online or with any podcast management app.

Ten Percent Happier Podcast: A podcast series from a meditation-based app company featuring interviews with different experts on topics ranging from trauma and resilience to thoughts on relationship building.

AA History Symposium 2019 Recordings (free)

  • Why I Study  A.A. History - Newton P., U.S. Trustee-at-Large
  • A.A. on North American Reservations - Don C. (Colorado Springs, CO), Rod B. (Salt Lake City, UT) & Greg M. (Henderson, NV)
  • The Untold Story of A.A. in San Quentin Prison - Jackie B. (San Francisco, CA)
  • The Debate over Special Purpose Groups - Joe C. (Toronto, ONT)
  • Bill's "Spook" Sessions - Dan Carracino, Co-Director of the PBS documentary Bill W.: The Creative Force Behind Alcoholics Anonymous
  • Early Group Problems - Kevin Hanlon, Co-Director of the PBS documentary Bill W.: The Creative Force Behind Alcoholics Anonymous
  • Dr. Bob’s Letters - Michelle Mirza, GSO Archivist
  • “Varieties of Spiritual Experience” - Jay S. (Sedona, AZ)
  • “Alcohólicos Anónimos” Carrying the Message to the Spanish-Speaking World - Juan R. (Holister, CA)

https://www.aahistorysymposium.org/2019-album

Password: thebroadhighway

Recovery Readings

12 Step

Recovery Dharma

https://recoverydharma.org/book

Refuge Recovery

https:refuge recovery.org/refuge-recovery-book

Protecting Online Support Groups

As virtual platform use started to grow with the onset of the COVID-19 pandemic, many people experienced instances of intruders joining meetings uninvited and exhibiting disruptive behavior. These instances could be especially troubling for support group meetings. To avoid intrusions, there are a few steps that could be considered to help provide groups with a safer environment, whatever the virtual meeting platform being used:

  1. Mute audio and disable video and screensharing for attendees
    As the host, you can disable video and screen sharing as well as mute all attendees upon entry. Screen sharing can also be limited depending on the platform. This will protect the meeting from any unwanted content. During the meeting, you can enable all these options for individuals or the group, if you need to.

  2. Protect your meetings with a password
    A password will protect you from hackers but will not necessarily protect from unwanted attendees. Be careful with whom you share the password and instruct the group to not share the password with strangers.

  3. If using Zoom, never use a personal meeting ID when scheduling a meeting
    When creating a meeting, you should always choose the “generate a random meeting ID” option. If you use your personal meeting ID instead of generating a new one, that ID could get leaked and Zoom bombers can use that to join your future meetings.

  4. Modifying the name you log in with as a participant
    Encourage your group to review instructions for using the platform you are using, and make sure they pay attention to the option of modifying their name when they log in.

  5. Use a virtual background
    You can also encourage the group to consider using a virtual background. This can be used to cover up anything behind them that could be used to identify who, or where, they are.

  6. Enable waiting rooms as a host
    Depending upon the platform, you can set up meetings with an option of creating a waiting room. When a participant logs in, they will be sent to a waiting room, where you can review attendance and admit individuals into the session.

  7. Encourage your group to communicate with you if they become suspicious of anybody
    Inform your group of potential issues with unwanted visitors. Let them know they can send you a private message through the chat if they have concerns regarding a certain individual in the meeting.

  8. Do not record the meeting
    Most platforms do not automatically record meetings, but hosts can choose to record and save the video. Participants are usually alerted when the meeting is being recorded and can choose not to participate. Hosts should ensure that participant recording is disabled.

    Hosts should consider not recording unless there is a compelling reason to do so. If you do record:

    • The default name of the video can make it easy to predict what it contains. The host should rename the file, so it is less easy to identify.
    • Be careful where you store or post the video (e.g. Amazon, Dropbox, Google, YouTube, Vimeo). Make sure your accounts are set to private and protected by a strong password.

Etiquette for online-support groups 

Goal

To promote a respectful and supportive online group experience

Recommendation

Participants in online support groups should conduct themselves in a manner that comports with the norms and expectations of the group and basic rules of etiquette that apply to in-person meetings.

Similar to in-person support group meetings, online meetings may have varied expectations about etiquette and norms that are specific to the particular group or meeting. For new participants, it may be helpful to review supporting materials made available online by the meeting organizer prior to attending the first meeting. In addition, spending time observing the group format and interactions of members can be beneficial for new members.

In general, basic rules of etiquette that promote a safe, respectful, and supportive group environment during in- person meetings apply equally in online settings. These include:

  • Punctuality
  • Participating while appropriately clothed and in a private setting where participants can speak and listen freely with a minimum of background interruptions and distractions
  • Civility and avoidance of profanity
  • Contribute by sharing while being mindful of time and others’ need to share
  • Not giving advice or “cross-talking” (speaking directly to an individual member of the group vs sharing with the group itself

Some considerations specific to the online setting include:

  • Checking email, texts or having other screens, windows or browsers open while engaged in live online support groups decreases the benefit to all. Silence mobile devices. Muting your computer microphone (or turning off your microphone from the conferencing app) is a welcome courtesy to other members.
  • Text-based forums such as discussion, chat, or list-serves can result in communication failures and misunderstandings. Be aware of the limitations of these modalities and the challenges of interpreting meaning in the absence of non-verbal cues. If a text feels insulting or inappropriate, ask questions before judging.
  • Unfamiliarity with online communities: Most have FAQ’s and other resources that can help familiarize new users.
  • Poorly-run groups: Well-run groups have a moderator or otherwise identified group leader to keep the meeting on track and consistent with the group’s expectations. A poorly run support group can be worse than no group at all. Fortunately, it is easier to quietly exit a poorly run online group than an in-person group and you should not hesitate to do so once you have determined that the experience is not a good fit for your needs.
  • Virtual support group organizers should take steps to protect the privacy of participants and be transparent about the steps that have been taken and any potential risks to participant privacy/ anonymity. See Confidentiality section.

Confidentiality

Goal

Support confidentiality of online group participants

Recommendation

Support group leaders and participants should be aware of the risks and benefits to anonymity and confidentiality in online environments and take measures to promote online privacy. Online environments offer unique opportunities for enhanced privacy but also can present special challenges.

Privacy considerations: 

  • Privacy considerations: Register with an anonymous username and email account. Turn off the video setting for live teleconference meetings if you do not want video to be captured and/or verify that the meeting is not being recorded.
  • Video teleconference support groups: Be aware of what is visible in the background of your webcam and that it does not inadvertently reveal information about you or others.
  • Features of teleconferencing apps that promote privacy:
    • Screen capture disabling: screen captures are disabled on participant’s device while logged into the meeting
    • Prevent participants logged into the meeting from sending images
    • Prevent device/user information from being logged and reported
    • Disable meeting recording
  • Anonymity and hoaxes: Anonymity is, for some people, a key benefit of online support groups; However, this anonymity can also be exploited by those who seek to misrepresent themselves or carry out hoaxes. False representations are a risk with any internet social activity. Support groups are not immune and participants should be aware that the intimacy and vulnerability that promotes healing can also lead to a misplaced sense of security. Remember to exercise the same level of care you would with anyone unfamiliar to you.

Considerations for Small Group Meetings with Proper Physical Distancing

Goal

Decrease the transmission of COVID-19 among group participants who must attend in-person meetings

Recommendation

Infection control is a shared responsibility among support group leaders/planners and participants who should work collaboratively to decrease the transmission of COVID-19 per public health recommendations and orders. Under conditions of active community spread of COVID-19, physical distancing and wearing of cloth masks are the most effective public health strategies for reducing transmission of the virus. During community spread of COVID-19, decreasing the rate of new cases is critical to controlling the pandemic and supporting the integrity of the health care infrastructure. Physical distancing requires us to minimize our contact with others to the greatest extent possible. This means working remotely when possible, school and restaurant restrictions, and limits on gatherings and events.

When physical distancing recommendations are in effect, it is prudent to cancel most non-essential events and gatherings, including support group meetings. However, in some circumstances, such as residential or intensive treatment settings, a risk-benefit analysis may favor continuing limited, smaller group meetings. The availability and practicality of implementing proper precautions may influence decisions about canceling or continuing such meetings.

Participants are told not to attend the group if sick or if they have been exposed to a person who has COVID-19 and to follow local Department of Public Health guidance concerning isolation or quarantine, as applicable.

Participants are not penalized if required to miss one or more meetings due to illness or exposure.

If a participant tests positive for, is waiting for a test result, or has symptoms consistent with COVID-19, the participant isolates themselves at home. Those that had an exposure with that participant quarantine for the duration recommended by the CDC. All quarantined participants should have access to or be tested for COVID-19 in order to determine whether there have been additional group exposures, which may require additional COVID-19 control measures. With significant exposure, a negative test result does not necessarily indicate the participant is clear of infection. In these situations, the participant should still complete the recommended quarantine period.

Symptom checks are conducted before participants may enter the group unless conducted at entry to the site in which the group occurs. A verbal check-in concerning cough, shortness of breath or fever and any other symptoms the participant may be experiencing should be done in-person upon arrival or remotely, before the participant attends the group. A temperature check should be done at the site of the support group, if feasible.

Measures to Ensure Physical Distancing

  • The total number of participants in the group, including participants and group facilitators/leads, should not exceed 10.
  • To the extent feasible, groups are scheduled at times that will not lead to overcrowding as participants arrive at site entryways and exits. Chairs, sofas and other seating in the group meeting space are arranged to permit at least 6 feet of space between any two participants.
  • To the extent feasible, entry to the meeting space is limited to participants and group facilitators/leads.
  • All group participants should comply with site guidance concerning occupancy limits in restrooms and in any common areas, including smoking areas, near the meeting room or space.

Measures for Infection Control

  • All group participants should wear cloth face coverings at all times in the group and in moving through the site in which the group takes place.
  • All group participants sign in using their own pens or using a pen that is sanitized between users, or electronically using personal devices or devices that are sanitized between users.
  • No food or drink is served within the meeting and no sharing of food/drink/cigarettes/etc. is permitted.
  • Non-methanol containing hand sanitizer, tissues, and trash cans are available to the public at or near the entrance and exits of the facility.
  • There is considerable variation among states and local communities with respect to plans and/or actions for reopening businesses and requirements for universal face coverings. Health care clinicians can reference the CDC’s Events and Gatherings Readiness Planning tool to help protect staff, volunteers, and attendees limit the spread of COVID-19.

This resource was developed by a Task Force appointed by ASAM’s Executive Council. To enable more rapid development and dissemination it was not developed through ASAM’s normal process for clinical guidance development that is overseen by the ASAM Quality Improvement Council.

CONTENT DISCLAIMER

This Clinical Guidance (“Guidance”) is provided for informational and educational purposes only. It is intended to provide practical clinical guidance to ad- diction medicine physicians and others caring for individuals with substance use disorders during the COVID-19 pandemic as it unfolds. Adherence to any recommendations included in this Guidance will not ensure successful treatment in every situation. Furthermore, the recommendations contained in this Guidance should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results.

The ultimate judgment regarding the propriety of any specific therapy must be made by the physician and the patient in light of all the circumstances pre- sented by the individual patient, and the known variability and biological behavior of the medical condition.

This Guidance and its conclusions and recommendations reflect the best available information at the time the Guidance was prepared. The results of future studies may require revisions to the recommendations in this Guidance to reflect new data. ASAM does not warrant the accuracy or completeness of the Guidance and assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this Guidance or for any errors or omissions.