She tracks the weather as obsessively as a snowplow operator, yet Hilary Jacobs has a desk job. She’s vice president of addiction treatment services at Lahey Behavioral Health Services and she is worried about a repeat of last winter when record snow curtailed access to crucial services.

"The kinds of problems we had last year, not only in the sheer amount of snow, but the public transportation issues, all of that made delivering care really challenging,” Jacobs said.

Her main concern is methadone users. Across Massachusetts about 18,000 people rely on methadone to stay sober. Most of them have to show up at a clinic for their daily dose.

“Any lapse can really put you at risk for overdose or lapsing back into opiate use,” Jacobs said. "So it’s really critical that people are able to have medication every single day.”

Last winter there were many days when patients could not get to the clinic. The MBTA barely functioned. Roads were impassable. And when Gov. Charlie Baker declared a snow emergency, the clinics — required by law to open 365 days a year — were given special permission to close.

"When stakes are that high you have to make sure patients get what they need,” says Jacobs.

Administrators like Jacobs made the call to give out extra “take home” doses of methadone. There’s a risk of abuse, but Jacobs says risks posed by the weather are potentially more dangerous.

“All of us were sometimes having to walk on the road, not having sidewalks, all of that just put people at more risk,” she said.

Of course, methadone is not the only regular treatment people dealing with addiction need. In greater Boston, Alcoholics Anonymous runs 2,300 meetings a week.

A member who asked that we identify him only as “Steve” says, as an alcoholic, he developed a resiliency to the elements.

“When I first came into the program with Alcoholic Anonymous, I had asked, well what happens when it snows?" he said. "And what I was told is, has the snow ever stopped you from getting to the liquor store?"

Last winter, however, even the most intrepid AA members had to improvise. Meetings were canceled, so members connected and provided one another support via social media and telephone.

AA’s motto is "one day at a time." Steve says it’s also his motto for the approaching winter.

Jacobs, however, is planning ahead, studying patient lists and making sure clinics are equipped with staff and supplies.

Last year she she spent weeks tracking the weather. On the back of her office door there’s a reminder of how bad things can get. It’s a plastic snowflake.

“I worked with two other women and together we managed the weather emergencies related to the methadone clinics,” she said. "And at the end of the winter one of the women gave me the snowflake to commemorate that winter. Here it hangs as a badge of honor and a reminder that it can snow anytime.”