During the early lockdown days of March, an Alcoholics Anonymous member named Mark had a challenge.
He's been an AA member for decades, but due to the pandemic, many of the meetings he attended moved online because the rec centres and churches that held them had to close.
When a man attended one his groups online, he was determined to get sober.
"He and I established a telephone and texting relationship, as was common during that time, and he was sober for a three-month period," Mark says. "And then he took something he shouldn't have."
"Then he died."
Mark can't say for certain what would've happened had they gotten to him in person, but he does believe he could've been saved.
It's a sad chapter on what has been a difficult 10 months for those struggling with drugs and addictions.
"Alcoholics Anonymous in Toronto has in normal times over 300 groups meeting weekly, we put on over 500 meetings a week and in the pandemic, we're down to about 170 online groups, so that's a dramatic reduction," he said.
Several groups have managed to reopen, such as in socially distant meetings in parks and he said the one benefit has been that going virtual means attending more sessions per week than normal.
But the physical, intimate setting of a meeting is irreplaceable, Mark says, as well as Cara Vaccarino with the Bellwoods Health Services in Toronto, an addictions treatment centre.
"The isolation is the exact opposite of what we prescribe for people striving to achieve recovery from addiction, it's the worst thing for a person struggling with addiction, to be on their own," she said.
It's a change she's seen firsthand.
"My friends in recovery that attend AA and NA (Narcotics Anonymous) meetings online are really at a loss now for that human connection, that high-touch level of fellowship that is such a magic ingredient," she said.
What's especially concerning to Vaccarino and Mark is the critical holiday season, where even in the best of times, the tension of fighting addiction can hit a peak.
New research from the Centre for Mental Health Addiction illustrates the danger as well, as more than a quarter of recent respondents at the end of November reported binge drinking in the previous week.
“That number is too high—and did not significantly change over recent months, despite the ups and downs of the pandemic,”CAMH Psychiatrist Dr. David Gratzer said.
Yonah Budd with Stoufville's Farm Rehab Centre says the ripple effects of no AA meetings is that supervision is also lacking, while overall interaction is reduced.
"People are really stumbling because they relied on having to go to work in the morning and seeing their boss and seeing their buddies," he said. "Those were times that people could sort of check in on you."
"Now when you're isolated and not attending work and everything is virtual by camera and you really only have to be dressed from the waist up and no one smells your breath, looks at your eyes or watches you shake, who is watching for someone who is struggling and doesn't have those bumpers?"
The Ontario Government has earmarked $3.8 billion over 10 years for mental health programs and in October of this year, announced an additional $176 million specially to mental health and addictions supports.
The recent funding includes more nurse practitioners for detox services, addictions day and evening care, in-home/mobile withdrawal management services and more inpatient beds at CAMH.
Health Minister Christine Elliott said Tuesday she recognized the struggle of people being unable to attend AA meetings.
"We have been expanding our virtual mental health supports as well, so if people can't attend physically, they can still receive counseling and assistance over the phone," she said. "We know there are people that are having significant mental health problems that may deal with trying to deal with a mental health challenge with addiction issues."
"This is something that is very serious, we've seen addiction rates in terms of alcohol and other drugs as well increase as a result of COVID."
Premier Doug Ford said the subject came up recently in a multi-year planning meeting and said the government would do whatever it can to provide supports.
"It doesn't just affect the people that have the addiction, trust me, it affects the whole family," he said.
But Vaccarino says the after effects of not being proactive will be difficult to catch up on, specifically on residential treatment.
"Here at Bellwood, we only have 12 funded OHIP beds, there's currently a five-year wait list for fully-funded ministry beds, we've asked the government at a financial loss to our organization for 10 more publicly-funded beds," she said. "We had 19 people die on our wait list in the past 10 months, we are seeing our wait list double."
Vaccarino does think however the policy decision to keep LCBO stores open was the right one, because of the serious health risks to complete withdrawal of alcohol.
"Alcoholics who cannot get booze can literally die, they can go into convulsions, cardiac arrest, so detoxing from alcohol is actually very, very dangerous," she said.
Budd disagrees, saying those who would really need the alcohol would find it, even if they had to go through the black market.
"The flip side to that is by not making it so readily available and not making it so easy, maybe people will rethink their consumption," he said, adding there's also no checks and balances at the point of purchase.
"If you're going to keep it open to help people, then you need to provide at least a layer of help at the checkout counter," he said. "They'll never do that because it turns away revenue."
All three agree there has to be a concentrated effort to get AA meetings back on track, with additional resources and strategies to deal with a possible postpandemic relapse surge.
Mark says this will be his 35th sober Christmas, thanks to the essential support from his groups over the years.
"For that, not only I, but my family, my wife and my children are extremely grateful, I found a way out," he said.
But he fears what will happen this holiday season for those who aren't as lucky as he is.
"Between the impact the pandemic and again this time of year, I have no doubt that there's going to be a surge in relapses," he said.
With files from Kym Geddes