Guest Post by Grace Fogarty

IN THE BEGINNING . . .

The week of March 16th, when COVID-19 first emerged as an urgent threat to health and safety in our collective American psyche and things really began to shut down, one of the women in the Massachusetts residential addiction recovery program I live in was not feeling well. She was sent by staff to our local hospital where she was tested for COVID-19, sent back to the house, and placed in quarantine – the results of her test pending.  She waited for eleven days in quarantine before she received the results of her test. She was negative for the COVID-19 virus.  However, the whole ordeal was an ominous start to the current global pandemic as experienced by women in a residential addiction treatment facility.  Had she tested positive, all of us would have already been exposed to the COVID-19 virus but would not have known for those eleven days.    

“A PSYCHOLOGICAL BASEBALL BAT”

Being in quarantine within this facility means having to rely 100% on fellow residents and staff to bring medication, food and water, as well as any other items one might need to sustain daily life and hygiene.  But beyond that, most women in this program have recently been through experiences that involved incredible losses, traumas, and other devastation, and can be in states of mourning, grief and bereavement.  Often it is the end of a prison sentence, an abusive relationship, the death of a loved one, or the loss of employment and/or housing that act as the catalyst that bring someone into treatment here.  The cut-off from human connection that quarantine necessitates is its most stark and significant implication.  One is left with only herself, her thoughts and a psychological baseball bat that she has been taught to use against herself.  Add to that an uninterrupted stream of isolated space and time, and the effects of quarantine can be profoundly dramatic.  We currently have three women in quarantine (for solely precautionary purposes) one of whom is eight months pregnant.

Because of the pandemic we are no longer allowed to leave the premises without staff accompanying us (the implication being that we do not possess the capacity or proper judgement needed to avoid being unnecessarily exposed to COVID-19) – a makeshift/stopgap rule that both infantilizes us and obstructs our ability to support our own psychological and emotional well-being via getting fresh air, exercise, and vital exposure to an environment other than the inside of this house. 

For me, that means I can no longer go to the track and run – a practice essential to my psychological and physical wellbeing and something I do in lieu of taking additional ineffective neurotoxic pills.  I am someone for whom depression has been so severe, I was given rounds of electroconvulsive therapy (aka ‘shock treatment’ and ‘ECT’) at the ages of 23 and 25 and (over the span of my adult life) taken a litany of psychotropic medications so prodigious, it reads like Eli Lily’s warehouse inventory.  The uber medicalized culture that we live in prioritizes the passive act of taking pill medication and does not value nearly enough practices like yoga, walking, hiking and running.  We are seeing these attitudes expressed via the program’s prioritization of medication times (four per day) and not on any consistent daily offering for physical exercise.        

LIBERTY & EARNING ON PAUSE

The purpose of the suburban Boston residential addiction treatment program that I currently live in is to guide women through the first months of their recovery from substance use and to support them in obtaining employment or other meaningful, self-esteem building, activities such as volunteer work.  Women can receive support to find other resources as well, such as for housing and education, depending on their individual needs.  The majority of the women who come to the program are insecurely housed and therefore, unless they have an income via something like SSDI, must obtain and sustain employment in order to be able to save enough money to pay rent once discharged.  For those who do need to work, COVID-19 has thrown an enormous monkey wrench into their plans.

Since women typically stay at this residential addiction treatment facility for six months, give or take, and are starting from scratch financially with little to no monetary support from friends/family, we don’t have a lot of time to save up money for beginning the next stage of our lives. Most of the women who were forced to quit their jobs were employed at our local dollar store until March 31. They all reported that they were not being offered personal protective equipment (PPE) or hand sanitizing products. I agree with the program’s decision to (finally) insist that women no longer work in that environment.  But I am left wondering why this decision was not made sooner, and what similar omissions in common sense precaution taking have occurred.  Staff are trusted so implicitly and explicitly to live lives of ethical and principal decision making, yet we who live here and who are extremely vulnerable to those in charge are given nothing but orders, doubts and mistrust. 

Our health insurance, combined with other state and federal funding sources, cover the cost of treatment here.  We have not been told how the COVID-19 pandemic will affect insurers’ willingness to cover more time in this facility. All we’ve been told by the program administrators is that this is a Bureau of Substance Addiction Services/Department of Public Health/MassHealth issue. They said they remain relatively confident however that no women will be discharged into uncertain housing circumstances just by virtue of the fact that they could no longer obtain or continue employment because of the COVID-19 pandemic.  This ‘assurance’ falls, with great reason, on untrusting ears.  In the many, many months that I’ve lived here, I’ve seen women discharged for petty and minor reasons and transgressions repeatedly.  For example, a woman was discharged less than two weeks ago for ‘administrative’ reasons; in this case on the basis of problems solely related to her interpersonal conduct – NOT for physical violence and NOT for anything related to using drugs/alcohol, purchasing drugs/alcohol, or bringing drugs/alcohol onto the property.  She was made homeless (during a global pandemic!) because of this decision. 

MOTHERING ON PAUSE

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The program includes a small sub-component for women who are pregnant or postpartum. Women with infants can participate in the program and have their babies with them in the facility. Women who are pregnant can give birth to their babies while they are residents here. Some women participating in the pregnant and postpartum component of the program have been separated from their newborns after giving birth because of testing positive for a substance. The Massachusetts Department of Children and Family Services has custody of those babies and, because of the COVID-19 virus/pandemic, mothers are not allowed to have visits with, or reunite with, their infants.  Adding to this heart wrenching scenario, a friend of mine shared with me that her DCF case manager won’t even facilitate a video chat between her and her baby, citing that she was unable to ‘supervise’ such a call and therefore one would not be possible. These babies do not stop growing, or having milestones, because of this pandemic. And my heart breaks for their mothers who continue to miss these irreplaceable first weeks and months of their children’s lives.

Normally, the program allows for children under the age of 13 to spend the night here with their mothers on the weekends. Many women with children who are in this program are in precarious or transitional places regarding their relationships with their kids. Some have been in prison and are trying to re-cultivate bonds with kids that they have been separated from for months, and sometimes longer.  All of this is currently on hold.

IN ‘THEIR’ CARE . . .

As someone who has been very outspoken and unafraid of being  critical of program culture, rules and curriculum,  I have a lot to say about their handling of the COVID-19 pandemic.  In the many, many, months I have been a resident here, I have seen more than my share of deeply unjust and potentially life-threatening decisions made by the leadership of this program.  They are not even remotely close to demonstrating transparency with us or giving us information in real time about what data contributes to the decisions they make.  It is, sadly, their normal modus operandi.  We are objects to be managed, controlled, mitigated, groomed and vigilantly observed.  Our humanity and autonomy are cursory, our preferences, perspectives and voices ignored and dismissed.  It is an unmistakable function of our socioeconomic statuses and lack of social and political capital.  A higher socioeconomic class of women wouldn’t dream of tolerating this treatment. 

The house has not communicated with us about any emergency plans should someone contract COVID-19 and it then spread throughout the house.  Since we do all of the housework, everything from scrubbing toilets, to cooking the meals, and sweeping and mopping the hallways, stairs, ramps and floors, who will do this work?  Will staff stop reporting to work? 

Any efforts made to comfort us, discuss the complex and unnameable problems arising and fogging us and reassure us that our futures include security and promise, are few and far between.  I, like many of the women here, have experienced trauma many times – especially while in the custody and/or care of an institution. For us, having our health and safety in the hands of someone or something we can never fully and thoroughly trust is a type of emotional and psychological agony.  As of today (April 14th), everyone is healthy, but that’s no guarantee that we will continue to be…

If you add up the losses we’ve incurred and the sacrifices we’ve made (being forced to quit jobs, not being trusted to go out and get exercise or pick up essential items without (begging) staff, not being given even a modicum of transparency pertaining to information about potential exposure to the virus in the community, etc.) there is little to no return on investments.  We continue to be treated like children, thieves, liars and burdens.  They lock up everything we need – from food to cleaning supplies to trash bags and then bemoan when we request access.  Last week I filed a complaint through the Massachusetts Bureau of Addiction Services (BSAS) because they have restricted so much of our freedom, while simultaneously providing little to no information, data or background regarding their decisions and seem not to care even a modicum about how this all affects us. 

A WIDENING ‘CRACK‘?

Everywhere, we see things becoming more exaggerated, more hyperbolic, versions of their baseline selves. Inequality is more pronounced and visible.  When the world does open back up, and an enormous flood of newly unemployed people start competing with us for jobs, what will that mean for our prospects moving forward? When the services and financial support we depend on from state and federal sources are overburdened by new applicants, what will that mean for those of us who were already reliant upon them? Will we lose the little that we had?  Or, conversely, will this massive, wide scale exposure of just how many Americans’ lives teeter precariously on the precipice of oblivion lead to grand and sweeping reforms for all?  I’ve always believed that the concept expressed by the adage ‘fall between the cracks’ serves only a master narrative that the majority of us are ‘ok’ and are not ever in any real jeopardy of falling on ‘hard times’.  Images from across the country depicting hundreds of vehicles lining up to receive aid from food banks tell a completely different tale, however.  My hope of hopes is that millions of Americans will see that what the vast majority of us are contending with is not a socioeconomic anomaly, or crack, that only occasionally do the most unfortunate among of us stumble into, but a lengthy and deepening canyon that we all collectively reside in always.

Like everyone else, we don’t know how long this will last, or what sort of world awaits us on the other side.  Several women left on their own after the restrictions were put into place.  Several more remain here, but are extremely anxious to go back to work.   Some days,  I sense more might throw in the towel and take off into very uncertain, and potentially life threatening, futures. 

My time here will soon be coming to an end.  I have exceeded the normal length of stay by three months already.  I have housing secured following my discharge. And I hope, in time, to be able to write far more about the nine plus months I’ve spent here.   

Also by Grace Fogarty: The “Harmfuls” of Shame-based Drug Treatment Programs