Addiction recovery is a long road-Part V
Studies show that the longer you keep someone who is addicted to drugs or alcohol engaged in the recovery process, the more likely they are to maintain their sobriety for longer periods of time.
So why is the typical outpatient treatment program only six weeks?
“To do treatment for six weeks and expect to stay sober is pretty unrealistic,” said Phil Norrgard, Human Services director for the Fond du Lac Band of Lake Superior Chippewa, who helped create Fond du Lac’s groundbreaking Tagwii Recovery Program. “In six weeks, you’re barely out of the fog.”
By contrast, Tagwii Supervisor Rick Colsen estimated, clients at Tagwii usually spend a year in the program (with even more followup after that year) and have an average of 382 contact hours in that first year versus 72 hours in the typical outpatient treatment program.
Norrgard said Tagwii and Fond du Lac’s other treatment programs are a response to the critical problem of drug and alcohol abuse that is not going away.
“There has been a tremendous shift in American culture toward less fear and greater tolerance toward addictive substances,” Norrgard said. “You have doctors prescribing opiates and people calling methadone medicine. You have children growing up in homes with parents who are often addicted to one substance or another, listening to music that describes the thrills of addiction over and over and over. Then you add to that the increasing availability of opiates [including heroin] and you have a perfect storm of substance abuse disorders.”
It’s a storm that Carlton County is fighting on many different fronts, from law enforcement and courts to health care and treatment programs.
The Tagwii Recovery Center on the Fond du Lac Reservation has been on the cutting edge of those battles against drug addiction for the past seven years. The first methamphetamine and prescription drug treatment facility in Indian Country, Tagwii is run by the Fond du Lac Band of Lake Superior Chippewa. Tagwii services are available only to American Indian adults living in the Fond du Lac service area.
Colsen has been there from the beginning. Although Norrgard, Colsen and others originally thought the recovery center would be for methamphetamine addiction only, they soon realized that limiting the center to one type of drug addiction would be unwise.
“Meth was the buzz drug at the time,” Colsen said. “But others told us, ‘don’t get locked in’ and probation told us that prescription drugs were a real problem.”
“The availability of prescription drugs went rampant for a long time,” he continued. “There were no controls through medical providers; doctor shopping was very frequent. Addicts were accessing clinics here [in Cloquet], Moose Lake, Two Harbors, Virginia, Superior and Duluth, sometimes on the same day. They had figured out the system very well.
That introduced opiates, basically allowed opiates to become the drug of choice.”
Methadone was at the top of the list of preferred prescription drugs, Colsen said, “followed by your Lortabs, Vicodin, Percocets and Oxycontin.”
Prescription drugs were easy to sell too. It got to be what Norrgard describes as “a cottage industry with a strong economic impact.”
“It was not unheard of for someone to use the [emergency room] in Cloquet and two Duluth clinics: one before midnight and one after midnight [to get prescriptions for painkillers],” Colsen said. “That would make your rent payment.”
However, as the medical field got better about regulating and monitoring opiate prescriptions, the accessibility tapered off and the price rose.
That was about the same time heroin — the scourge of the 1960s and ’70s — was being reintroduced into American society.
“It became easier to get, and cheaper to get, than prescription drugs,” Colsen said. “They say heroin is cheaper than purchasing a bottle of alcohol.”
“It’s not unheard of to have a $6 preset rig,” Norgaard said, noting that heroin made its way into Carlton County about three years ago. “That’s the syringe with the heroin already in it, selling for $6 to $8.”
Of course the cleanliness of that needle, and the potency or purity of the heroin is unknown. There have been numerous overdose deaths from heroin in Carlton County, and even more people who have been revived thanks to medical intervention and a rather miraculous drug known as Narcan.
“Now what we’re hearing is there are dealers advertising they have a Narcan pen available,” Norrgard said, “so they’re telling people, ‘If you want to try heroin, you will have a safeguard against overdosing.’”
In a previous interview, Cloquet Area Fire District paramedic Jeremy Hutchison explained that Narcan blocks the receptor sites on nerve cells that receive narcotics.
“Basically someone can go from barely breathing to being able to walk around, follow commands and talk to us,” Hutchison said, adding that the person is also no longer high.
However, Narcan is weaker than heroin and wears off more quickly, so what the user might not know is that he or she can be revived with Narcan and then end up in the same distress when the Narcan wears off. That’s why paramedics take the many drug overdose victims they help to the hospital for monitoring every time.
“A couple states have made [Narcan] available over the counter and it’s getting to Minnesota,” Norrgard said. “ As a society, we’ve actually destigmatized heroin. With Narcan, we’ve actually told society ‘Don’t worry about that, if you do get in trouble, there are meds that will not allow [you to die].”
That’s not exactly true. Narcan won’t revive a dead person and anyone who overdoses — and is treated with Narcan — needs to be seen by a doctor and monitored so they don’t slip back into the same overdose state.
Even the professionals can’t predict when (or if) the magic moment will come when an addict will decide it’s time to get sober.
Until that moment arrives, addicts will go to great lengths to avoid sobriety.
“Sobriety is a hard-fought thing to get, and until people get it, they’re just geniuses at finding ways to avoid sobriety,” Norrgard said.
In addition to the adult and adolescent treatment centers, he explained that Fond du Lac has also added a third program, called Tagwii Plus. Counselors and case managers with Tagwii Plus work with expectant mothers or mothers of young children to help them prepare to go into recovery, even if they aren’t ready yet.
“This is a real outreach and education effort,” Norrgard said. “Normally treatment folk don’t work with people that aren’t ready for treatment. But Tagwii Plus works with people we think we can steer into treatment. And it’s making a difference already.”
Their clients at Tagwii have been the best teachers, Norrgard and Colsen said. They’ve hired a number of those folks as well.
“We have people on staff, who were hard-core users — meth, heroin, cocaine addicts — people that the courts had given up on,” Norrgard said. “We’ve had some people graduate who I never would have dreamed would stay sober and now they’re contributing members of society; they’re taxpayers. I wish I could hire more.”
Norrgard said former addicts make the best (and most impactful) storytellers at the recovery center.
“You hear those people tell their story, and there’s not an addict in the room that can’t relate to what they say and take hope from their story because they’re living proof that you can be a knock-down, drag-out addict and turn into a wonderful sober happy person,” he said, stressing the word happy. “Not just semi-miserable, but actually happy.”
That kind of testimony counts for a lot to people struggling to maintain sobriety.
“Someone might be new, feeling like shit, thinking this is the hardest thing in the world and they can say to them, ‘I’ve been there. I’ve done it. It’s a pain, but do the work. You’ll get through it. Sobriety is worth it.”
Treatment the Tagwii way
Attaining sobriety is tough, so is maintaining sobriety. That’s why Tagwii offers a year-long program.
“In the first year of sobriety, your emotions have this punch 10 key going on,” Colsen said, noting that mental health and chemical health are inextricably intertwined in the process of recovering from addiction. “You’re either very, very depressed, or you swing all the way and you’re totally on top of the world. Those are very dangerous places to be.”
Over time, he said, the pendulum swings become less extreme and the client (ideally) finds balance.
“We need to provide support to the client until they’re able to find balance, and get a good understanding of where their emotions are coming from, what their triggers are,” Colsen said.
The Tagwii recovery program is individualized as much as possible for each client, Norrgard explained.
Although the program is tailored to the individual, the steps are consistent.
The first step (once a person is out of crisis and somewhat stable, Colsen said, noting that people may have to go to a detox center first) is to do a thorough assessment to determine what path of recovery that person should pursue.
Clients are given a Rule 25 assessment (to determine the extent of the drug use along with things like readiness for change and relapse potential). At Tagwii, assessments go beyond Rule 25, however. A person’s mental health is also examined and counselors also do functional assessments.
“Those are the tools that will help us determine what level of care they need,” Colsen explained. “Do they go to inpatient treatment for 30, 60, 90 days or an outpatient program? What length, what intensity program do they need? Or maybe they need to be placed in something that’s a combination of a halfway house and outpatient treatment.”
A long-term opiate user, for example, would likely be sent to inpatient treatment for stabilization, Colsen explained. An assigned Tagwii case manager would coordinate services with the inpatient program so there was a smooth transition into an outpatient treatment program.
Once a client enters Tagwii, he or she will spend at least six months and up to a year in the program.
“It’s necessary for a person to check out and focus on themselves,” Colsen said, “but the real work starts when the person comes back to the community. This is where the addict has to live, where they have to work, go to school, raise children. It’s where all those stressors when they were using take place, and those stressors will be multiplied when they come back into the community.”
At Tagwii, a recovering addict will see both a counselor — for emotional issues — and a case manager, who helps with the practical side of life.
The counselor will help the client look at internal triggers and mechanisms that trigger their addiction and help them develop coping skills and strategies that don’t involve drugs.
The case manager works to help the client with housing, education, employment and more, “making sure all the basic needs of the client are being met so sobriety and be maintained and achieved,” Colsen said.
“Case managers are looking at linking, monitoring and assessing services for the client,” added Jeanne Nelson, behavioral health administrative assistant at Min No Aya Win Human Services Center. “They can go beyond that scope, but that’s the main goal.”
At the same time, every client is also seeing a mental health therapist. Clients with persistent mental illness will also be assigned a mental health case manager.
“The mental health therapy often goes on a lot longer that the outpatient treatment,” Colsen explained, noting that staff and administrators at Tagwii learned quickly that mental health issues need to be dealt with early and equally in the treatment process, because clients who had mental illness were having more negative consequences in the court system.
Removing any obstacles to maintaining sobriety is the name of the game. Tagwii provides childcare to those who need it; they also provide transportation. Schedules are not set in stone.
“We created the program so there is flexibility,” Colsen said. “If a client is typically a day person, but their child has a program at school, they can come to the evening session and stay engaged in their recovery process.”
Colsen said clients come to Tagwii daily Monday through Friday for the first 12 to 16 weeks.
“We want to get them past some of the known walls in recovery, so the first 12 weeks it’s five days a week, then four days a week for the next 12 weeks,” he said. “The remaining four to six months in programming it will go down to one day a week.”
Every day is different. Mondays and Thursdays are education and processing groups sessions, Tuesdays are individual and support group meetings. Wednesdays are about wellness, including nutrition and physical activity. Fridays are used to wrap up the week and prepare for the weekend — together.
“We come together for a meal and talk about how the week went, and also about what the weekend’s activities will be,” Colsen said. “We discuss coping skills and strategies and try to plan ahead. We want to make sure clients are connecting for safe sober activities.”
On the last Wednesday of each month, Tagwii holds a sobriety feast. Attendees are encouraged to bring potluck dishes for the event, which includes a speaker and a medallion ceremony. Family members and other support people are invited to join the feast, which can draw anywhere from 150 to 300 people.
“Realistically, what we’re seeing is clients often want to access programming for up to 18 months,” Colsen said. “We do face-to-face follow up for the first year after.”
Drug tests are also a big part of the program.
Clients are drug tested at the start of the program to develop a baseline. They are then tested twice a week as a group and twice a week randomly. Test results are assessed in the Tagwii laboratory. Staff also have the option to do suspicion testing any time a client’s sobriety is in question.
If a client relapses, it’s not an automatic “return to the start line,” Nelson pointed out. While a failed test won’t get them expelled, it will tell staff that something isn’t working and the treatment program may need to be altered.
Culture is also a part of Tagwii, something that’s built in. From the artwork on the walls to the drum that was gifted to the program, from the smudging that takes place before groups to the way people talk to each other, culture is interwoven into the treatment program.
“Culture is one of the hardest things to talk about because it’s just part of who we are,” Colsen said. “It’s not something we decide to add in, it’s part of who we are a program, as a community and as individuals.”
Whatever they’re doing at Tagwii, it seems to be working.
“We’re probably the best-kept secret in northern Minnesota,” Norrgard said. “We’re not a secret in Indian Country. Rick is speaking at national conferences all across Indian Country. We have probably the most successful outpatient treatment program. It’s not a cheap model, but it’s a great model.”