Assessing Rhode Island's drug problem

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Rhode Island has the 8th worst drug problem in the country, according to a study recently published by financial research and analysis company WalletHub, which looked at data from the Substance Abuse and Mental Health Services Administration (SAMHSA) annual report from September of 2017.

The study examined data from all 50 states and Washington D.C. and made rankings based on three categories – drug use and addiction rates; law enforcement statistics; and drug health issues and rehab – weighted by 20 relevant metrics. Rhode Island attained a final score of 50.99 out of 100 (with 100 meaning the most problematic drug issues).

The Ocean State unfortunately ranked first in the nation in terms of the highest percentage of adults who have unmet drug treatment needs and second in the nation in percentage of teen drug use, behind only Alaska. However, Rhode Island also has the third fewest drug-related arrests per capita in the country, with only Massachusetts and Alaska having fewer. The most drug-plagued community according to the study is actually D.C., while the least plagued is Minnesota.

While the data is taken from SAMHSA’s annual drug report published in 2017, the numbers involved in that report come from 2016, so it must be stated that there is a likelihood that these numbers are not reflective of the most modern adjustments made to deal with the epidemic of drug problems recently seen in the country.

Assessing youth drug use

Although the WalletHub study claims Rhode Island has the second highest rate of teen drug use in the country, the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) disagrees with that assessment based on their own data analysis, though they do agree that teen drug use exceeds the national average in multiple areas.

Bob Houghtaling is on the front lines of drug prevention in East Greenwich, as he has now been the town’s director for their drug prevention program for 35 years. He has a unique perspective on understanding the different reasons for why young people turn to drugs in life, and how those reasons have changed throughout the decades. However common threads exist regardless of the time period.

“What I have seen in the last 10 to 15 years is an exacerbation of people being lonely, disconnected, not having the basic skills to navigate through society’s day-to-day challenges and endeavors,” he said during a recent interview. “And that promotes anxiety and depression and then, rather than working on it, we sedate the symptoms by overmedicating people and never get to root causes.”

Assessing the root cause is part of Houghtaling’s approach to preventing drug use. In his view, society is becoming less communal than in past generations as we become more inundated with social media and passive forms of entertainment. This creates more opportunities for people, especially kids, to feel alone and depressed - opening a door to possible drug use and addiction to fill the void. It’s an interesting development, he states, from how generations in the past utilized recreational drugs.

“In the 60s I think people did drugs to rebel, I think now they do drugs to conform and cope,” Houghtaling said.

Part of the solution, Houghtaling offers, is to give kids a place to gather with one another under the supervision of an adult that they trust - he utilizes a series of after school clubs which he refers to as “drug-free Cheers, where everybody knows your name” - to let them develop socializing skills in a safe place, where they won’t be criticized or lectured to. Through this method, they develop behaviorally in a way that will keep them from wanting to use drugs without the need for more blunt methods, like scare tactics.

Houghtaling also believes that the concept of going through pain in life’s darker moments has become marginalized, something that society has begun to frame as something you shouldn’t have to go through. This, he believes, is having a harmful effect as kids seek to medicate their pain, especially emotional wounds.

“When somebody comes to me, your pain may be your salvation,” he said. “If your dad died or your dog died or you moved or went through a divorce, you’re supposed to be in pain. And if you work with through that and create a greater level of understanding it will hurt, but you’ll be richer for it in terms of developing resiliency that you can do this…I think we ignore the part that to be human, there’s going to be pain and challenges and loss and things you’ll have to overcome.”

Unmet needs in the state?

The study raises questions about how well Rhode Island handles drug problems within its populace. However, the answers – and in some cases even the right questions – are hard to get a handle on. Some communities, like East Greenwich, have a much different problem to assess and have more tools at their disposal to combat it than a community such as Central Falls, with a much higher population and a wider range of economic diversity.

There is also an issue with being able to accrue accurate data. Studies take a long time to perform accurately and to compile the data, and due to stigma there may be a percentage of people who do not answer survey questions honestly. For example, the most recent data from the BHDDH comes from 2014-15, while SAMHSA data comes from 2016. As drug use epidemics ebb and flow, even just two years is a significant amount of time.

For George O’Toole, manager of the Anchor Recovery ED program (which operates out of the Providence Center) and a recovering addict celebrating his eight-year sobriety this July, there is no easy answer to solving addiction issues in Rhode Island, or anywhere for that matter.

One of the biggest factors, he feels, regarding the statistic concluded in the study about Rhode Island having more people with unmet needs than any other state in the country, is the person battling addiction, themselves.

“A lot of times people that need help don't necessarily want it,” he said. In a minute they'll be talking about going to a program and there will be some delays and they start getting overwhelmed by anxiety or depression and they start to withdraw and they decide to go home and do what they have to do. That's one of the barriers, we have to wait for the person to have that moment of clarity.”

Other big barriers, according to O’Toole, is that insurance providers don’t provide coverage for the length of treatment necessary to help someone get to recovery, in most cases they only cover outpatient treatment for a couple days out of the week.

“Insurance companies used to pay for long term treatment now they mostly pay for 30 days maximum. Unfortunately that is not enough treatment for most people,” O’Toole said. “That person will almost get better and then get shipped out with no plan and then they go out and use again.”

Christine Harkins, executive director of Bridgemark Recovery Services in Warwick, agrees that insurance companies too often try to implement one-size-fits-all policies to a much more complex problem.

“Right now one of the challenges is to convince insurance companies that like any other dire healthcare situation, we need to individualize the effort,” she said. “The insurance companies don't seem to have done that.”

Availability of beds in the state is also an issue.

“When that small moment of clarity opens up within that person, that's when a treatment facility needs to be available,” O’Toole said. “A lot of times people have to wait to get into treatment for up to a week. Try to tell someone who is addicted to heroin to go home and last it out for a week. That's just not going to happen a lot of times.”

Both O’Toole and Houghtaling agree that there are not an adequate amount of services in place in the state that specifically deal with substance abuse in teenagers. The Providence Center opened the first and only recovery high school in Rhode Island, Anchor Recovery School, in 2012, which enrolls teens specifically combatting addiction.

“We really don’t have a great system to address adolescent substance abuse,” Houghtaling said. “I know some of our hospitals try to do a good job, but I think we need way more services to address kids.”

If there is a lack of proper services, it is not for lack of trying, at least on the part of BHDDH. They were awarded a two-year, $250,000 grant to develop a “robust strategic plan to build, fund, and sustain an integrated youth substance abuse program, including screening, referral, assessment, and evidence-based interventions and supports.”

They then submitted that plan to SAMHSA, which earned them an $800,000 per year, four-year grant to implement such a program. They have already entered into contracts with two sites to provide these services and have submitted RFPs to launch two additional sites.

O’Toole mentioned that the Providence Center will be opening a youth center of their own on June 21 in Providence to also help address this need, providing activities and counseling and programs to help young people onto a path towards recovery. It will be named in honor of Jim Gillen, who created Anchor Recovery and was a mentor to O’Toole.

O’Toole also said that drug addiction programs throughout the state should be collaborating, and often do, to share resources and help cover the blind spots throughout the state.

“All agencies need to come together as one and aid each other and our members to give them the best services,” he said. “We think it's right to have working relationship with other agencies that provide those services in other communities. It's all about helping the person, it's not about us and our name.”

For both Houghtaling and O’Toole, while both programs and medication-assisted treatments are an essential part of the path to recovery, they agree that the single biggest factor in someone truly achieving victory of addiction is their own mental fortitude.

“There is no magic bullet,” Houghtaling said. “There are programs and there are people, and they’re both essential. Do we need more services? Yes. But do I think that people need to look at what they value and how they want to conduct their lives and what’s important? I think you need both.”

“It's about not giving up,” O’Toole said. “Sometimes it's frustrating because you just want to grab them and pound them to get it through their head. Some people just don't want to do it…It's about getting the word out there that recovery is not only possible, it's probable if you work at it.”

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