If you are an addict struggling with sobriety how do you reach out for help in the face of today's virus environment of "social distancing" and "stay in place" isolation?

Welcome to the new world of telehealth and online therapy.

According to substance abuse experts at CA Bridge, an Oakland arm of the Public Health Institute, people who use drugs are doubly at risk during this pandemic, not only from overdose but also from increased risk of infection. Medical mobilization to address the COVID-19 coronavirus is leading to shifts in health care that may inadvertently make accessing treatment for addiction even harder.

"There's no way you can sit at home and endure this. Everything about the way the human brain and body works will prioritize seeking relief, whether that means showing up in a crowded ER or finding drugs on the street," Serena Clayton, CA Bridge program director, said.

"It's more important than ever that people addicted to opioids or other drugs are given medication for addiction treatment. Unless treated, they may go into withdrawal or risk overdose, thereby increasing the chances of spreading the virus within their high-risk populations and to the health care workers who treat them," says Dr. Hannah Snyder, primary care and addiction medicine specialist at Zuckerberg San Francisco General Hospital, and a principal investigator for the CA Bridge program.

Edward G., a spokesman for Narcotics Anonymous in San Francisco, said Thursday "every support meeting has come to a screeching halt."

Although some counties are terming support groups as essential services, some are not, Edward noted. The NA group is utilizing online video forums like Zoom.com and bluejeans.com.

"Online support is a very important tool," Edward said, one that is drawing "amazing support" from his membership.

Edward G. said the switch to online therapy and support "has been a real eye-opener" for the group.

He said, "At any time you can join an online support group and be chatting with addicts from other cities, other states and other countries.”

"Suddenly it becomes a big world of network support," he added. "Isolation is by far the worst that can ever happen to any addict, but with the push of a button you can connect to a hundred other addicts."

The NA spokesperson said his group "has done an exceptional job in coming to the call. Online meetings are connecting members from all over the world with one another. A level of NA that we have barely seen is coming to fruition. We do however need to remain vigilant, not only to the addict who still suffers, but our communities, as well ourselves. These truly are trying times, and the level of our success is directly tied to our willingness to do our part."

Alcoholics Anonymous in San Francisco also announced, "In lieu of physical meetings, our membership has quickly established remote (phone/online) meetings. At this time, we do not know which, if any, physical meetings are still taking place."

Their website is still listing some meetings that are continuing.

Dr. Ori Tzvieli, medical director of Contra Costa Health Services, said many patients are afraid of seeking therapy. His department has cut down on personal appointments and switched to phone and online counseling.

He said the county's doctors are extending prescription refills and trimming group meetings. The crisis also is placing extreme pressure on the county's medical staff, he said.

Tzvieli also noted that substance abusers often are dealing with a variety of chronic health issues like diabetes, heart conditions and nutrition. Many are homeless. Addiction itself is a social stigma to bear.

"We're still emphasizing with our patients that treatment is still available," the doctor said.

CA Bridge recommends that patients be encouraged to use harm reduction principles and good hygiene. For people who are not yet ready to start medication treatment, harm reduction, such as clean drug consumption supplies, naloxone, fentanyl strips and remote monitoring for overdose, can be lifesaving.