'The opposite of addiction is connection'
COSU members present findings from year-long study
BRATTLEBORO — The quote that best defined the work of the Windham County Consortium on Substance Use came from a TED Talk by writer and journalist Johann Hari.
"The opposite of addiction is not sobriety," said Hari. "The opposite of addiction is connection."
That was the thread throughout the two-hour presentation by members of the Consortium at the Latchis Theatre on Tuesday morning.
"How do we reduce harm?" asked Becky Burns, the director of community initiatives at Brattleboro Memorial Hospital and one of 15 members of COSU who spent the past year thinking about and exploring issues related to the opioid crisis in Windham County. "How do we mend harm? How do we create connection and wellness?"
According to a press release announcing the Tuesday meeting, COSU is a collaborative effort consisting of 14 organizations and 15 individuals who work across the continuum of substance use prevention, harm reduction, treatment, and recovery. The group takes a community-driven, rural focused approach to addressing the impacts of opioid and other substance use in Windham County. In October 2018, COSU received a Health Resources & Services Administration, Rural Community Opioid Response Program planning grant, allowing the group to work with community members to assess gaps in service and systems around opioid use and reduce discrimination.
Kurt White, the director of ambulatory services at the Brattleboro Retreat, talked about how the opioid crisis has forced him to use "every ounce of empathy and brain power" available to him in his role at the mental health facility on Linden Street.
He noted in 2009, which he called a watershed year, overdose deaths, at 37,004, exceeded deaths from motor vehicle accidents, at 34,485.
"This has got to be the bottom, I thought. It can't possibly get any worse," said White. "The opposite happened. Things got much worse."
In 2017, there were 70,237 drug overdose deaths. Numbers for 2018 and 2019 are not yet available, but there is no indication the numbers are going down.
"But deaths don't tell the whole story," said White. "This crisis is affecting young people more than the older generation."
White attributed this to a lack of meaningful, rewarding jobs in the economy.
"We have a whole generation of young people who haven't been able to do what prior generations have done," he said.
Deb Witkus, the community outreach coordinator at Greater Falls Connections in Bellows Falls, agreed with White's assessment.
"Addiction does not happen in a vacuum," she said. "Factories and mills that once provided jobs and a sense of community are not here anymore."
White said in response, many young people have turned to opioids to bring them some sort of relief. "Why do people use it? It doesn't have a simple answer. No one as a child says they want to grow up and get addicted to fentanyl or heroin."
He noted that opioids work on "very ancient parts of the brain" that are meant to aid survival of individuals and the species as a whole.
"These mechanisms in the brain are being hijacked by drugs and are causing the exact opposite effect," he said.
Ella Thorne-Thomsen, a recovery coach at Turning Point, spoke of her own struggles with addiction and her six years of recovery. She seconded White's comment that opioids hijack the brain.
"Higher functioning and reasoning don't stand a chance in the face of this chemical onslaught," said Thorne-Thomsen. "This is a disease that requires treatment and understanding."
As depressing as it sounds, said White, there is hope because recovery is possible. He said it's important to not just diagnose the individual, but the community the individual lives in, and that was what COSU spent the past year looking at.
Chad Simmons, the project coordinator for COSU and an employee at Health Care & Rehabilitation Services of Southeastern Vermont, which is the fiscal agent for COSU, moderated the two-hour meeting.
Simmons said there is no simple solution to the opioid crisis in Windham County and around the country.
"These are very complex things we are proposing to do as a community," he said.
Five things are needed to begin to address the problem, said Rhianna Kendrick, the director of operations at Groundworks Collaborative. They include improving housing options to assist in recovery and sobriety as well as being affordable and accessible. Several speakers during the event pointed to Windham Windsor Housing Trust's Great River Terrace on Putney Road as a perfect model.
Kendrick also noted transportation options are critical in recovery. A clear economic development plan that includes every member of the community is essential as is supporting and improving investment and access to public spaces and community events. Finally, noted Kendrick, the county needs to improve access and availability to services targeted towards those suffering from substance use disorder.
Burns said COSU spent the past year cataloguing existing systems, talking with people involved in addiction services and focusing on best practices. To do so, COSU members traveled around the county talking to people and hosting 27 trauma-informed focus groups.
"There is no easy way to solve this problem because it touches on so many issues," she said. "It demands a full community approach."
A common theme that arose during those focus groups is how stigma and discrimination affects the ability of addicts to get help.
"We have to meet people where they're at and not be judgmental ...have to have a compassionate approach," said Burns.
Suzie Walker, the director of Turning Point, said services for those struggling with addiction are scattered and disjointed, forcing those seeking recovery to "jump through hoops" to get help.
"They have to go, sometimes, to several people and tell the most painful, embarrassing aspects of their lives over and over again so they can prove they need help," said Walker. "And people shouldn't have to leave their communities to get the help they need."
She said one technique that has proven to be quite successful is "warm handoffs."
"Amazing things can happen if you can actually accompany somebody to that appointment or make an arrangement for someone to come where that person is," said Walker. "It helps people who are already scare or stressed. ... The more we can learn to have sensitivity and compassion the more we can draw people into a healing circle."
She said a perfect example of this approach is Project CARE, or Community Approach to Recovery Engagement, which connects people who overdose or face arrest for minor drug offenses with area health and human service providers who offer treatment options.
"With the Project CARE model, folks are going out to reach people where they are, meet them as human beings and not foist services on them, but make it clear we are available to help," said Walker.
Sue Conley runs a prevention program for the Aids Project of Southern Vermont that includes needle exchange.
"I build relationships with people and work to gain their trust," she said. "When they come, they're not feeling judged. ... I don't just hand out needles. I provide an ear, provide resources and referrals if and when somebody is ready. I can help move them into treatment because they trust me. We can't help anyone if they're not alive."
Kendrick said when she is working with the homeless or people struggling with addiction, what they often have in common is trauma.
"They have had incredibly painful experiences and times in their lives and they are seeking substances as a way to help cope with trauma and pain," she said. "It often starts in childhood and follows people their entire lives."
Kendrick said one way communities can deal with trauma and addiction is to take a "coordinated entry" approach with one point of contact, "rather than having to ask individuals to knock on multiple doors retelling their stories over and over."
Great River Terrace offers such an approach with on-site assistance to its residents and Groundworks has its HealthWorks program, which provides on-site physical and mental health services with direct access to the services of a Brattleboro Retreat licensed mental health clinician, who works on-site. And the Community Health Collaboration with Brattleboro Memorial Hospital provides Groundworks clients with health screenings, wound care, and connection to primary care physicians, thereby reducing costly emergency room visits.
"Where do we go from here?" asked Jedediah Popp, a case worker for HCRS.
He referred to the next step as "the roadshow," with members of COSU traveling around the county to share and receive information from town officials, those struggling with addiction and those who hope to help them into recovery.
Recently, COSU received a three-year, $1 million federal HRSA implementation grant, which started Sept. 1. The goal of the grant is to decrease death and disease caused by heroin, fentanyl, and other substance use as well as increase prevention efforts, building recovery-ready communities.
COSU was also awarded a Community Action grant through the Vermont Department of Health, as part of a three-year, $9.5 million Centers for Disease Control and Prevention grant. The purpose of the grant is to increase the state's ability to track and respond to overdoses and overdose fatalities and to further build momentum in communities with high rates of opioid-related overdoses.
Bob Audette can be contacted at 802-254-2311, ext. 151, or firstname.lastname@example.org.
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