Caught in the ever-tightening grip of opioid addiction, people face a monumental challenge treating their dependence and staying sober.
The difficulties begin with finding the care needed to stop using heroin, painkillers and other drugs.
Thousands of Indiana residents are seeking out treatment for addiction, with more people entering recovery programs for opioid dependence than ever before. But the influx has health care providers struggling to keep up.
The availability of counseling and therapy groups are stressed to maximum capacity. Long-term and inpatient care centers are constantly filled up, with waiting lists of anxious people desperate for help.
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“For a while, it would fluctuate, sometimes we’d have two, sometimes we’d be full. But for the past three years, we don’t ever get low. At all,” said Jennifer Parker, clinical supervisor at Tara Treatment Center in Franklin.
In 2002, more than 27,000 people entered addiction treatment in Indiana, visiting one of the 288 private or government-run recovery facilities operating within the state.
The number of treatment facilities had decreased to 265 treatment centers by 2016. Yet even with fewer facilities, centers still treated 26,068 people.
People seeking treatment for opioid addiction has skyrocketed.
According to the Substance Abuse and Mental Health Services Administration, 6,147 people in Indiana were admitted to treatment programs for heroin or other opioids in 2017.
In 2015, treatment centers in Indiana reported serving 5,661 clients.
‘Bigger than the resources’
“What we do see is that the epidemic is bigger than the resources available,” said Tara Elsner, director of outpatient and addiction services for Adult and Child Health.
At Adult and Child Health, which works with families in need of behavioral health care services, workers know finding a spot for someone needing inpatient care is going to be difficult, requiring them to call multiple centers looking for an opening, Elsner said.
Addiction can rewire the way the brain processes pleasure, and in the case of opioid addiction, the drug becomes the only source of relief or pleasure. Breaking that reaction requires extensive, long-term treatment, often starting with a residential detoxification program and followed up with counseling and therapy for years afterwards.
But in Johnson County, inpatient treatment is scarce.
Valle Vista Health System in Greenwood has space for 72 people for inpatient treatment for mental health and addiction services. A patient who is going through detoxification has to meet specific guidelines showing that medical care is needed during that process, said Kristin Fettig, director of business development.
Referrals to their programs, which include inpatient detoxification, partial hospitalization and intensive outpatient programs, have grown significantly with the expansion of the state’s Medicaid program, she said.
About 40 percent of their patients are suffering from an opioid addiction, and most often those are people who were prescribed pain medication after an injury or surgery and then began using street drugs when their prescription ran out, she said.
The facility recently added room for 30 more patients, but the entire region has a shortage of inpatient spaces, she said.
Tara Treatment Center, founded in 1985, provides detox, residential and outpatient treatment options for those struggling with addiction. Outpatient options range from an eight-hour education program providing information on drug abuse and dependency to once-weekly group services to more intensive three-time-per-week counseling.
Tara’s approach to residential addiction recovery includes a daily regiment of group therapy, education and 12-step programs. Clients learn about relapse prevention, and do activities such as art therapy and yoga. They do not leave, staying on the Tara campus for between 30 and 42 days.
The treatment center offers space for 16 women and 20 men in its separate residential centers. Though availability constantly changes, the facilities are nearly always full, Parker said.
“The women tend to be on a wait-list more frequently than the men,” she said. “But that has decreased a little. We used to have 13 beds at the women’s facility and added three more.”
Tara is contracted with Indiana Department of Child Services offices in counties throughout the state to provide treatment services. The state will pay for 21 days of residential treatment, and people from around Indiana come to the center, Parker said. Women — and some men — are referred to Tara when outpatient recovery has not worked.
“That’s been a large part of the need, on the women’s side in particular. That’s why it stays full most of the time, because we mostly teach the mothers,” Parker said.
The center is seeing more and more patients in need of help with opioid addiction, with a majority of those patients being in their 20s and 30s, Parker said.
“There have always been challenges and barriers to getting treatment, no matter what their drug of choice is. With the opiates, though, there seems to be more of a need for a residential or inpatient level of care than there seems to be maintained with an outpatient level,” she said. “There has always been a need for people to get services, but it seems to be a little more challenging now.”
With the influx of clients struggling with opioid addiction, Tara has set aside staff and resources to approach the unique aspects of that recovery, Parker said. Separate group sessions allow people to work through the issues unique to opioid addiction without the shame that can exist around that drug use.
“They specifically focus on the cravings, the relapse, the risks of overdose and what that looks like,” Parker said. “People felt kind of a stigma of being an IV heroin user, so when they were in groups with traditional alcoholics or people with other issues, they didn’t seem to be as comfortable. We wanted to provide them with a setting to talk about whatever they wanted to say without judgment.”
Growing programs
Outpatient services have been continually growing locally.
Adult and Child Health has grown from serving 1,189 patients in Johnson County in 2011 to more than 3,000 last year, Elsner said.
In order to meet those needs, the program has added a new facility in Franklin, where patients can also get primary care medical treatment, and grown from 232 providers in 2011 to 509 last year, she said.
They also partner with other programs and service providers in the community and offer group counseling and classes at multiple times and days to try to be sure families can get the services they need, Elsner said.
Centerstone, which has an office at Valle Vista in Greenwood, partners with local services to try to offer all the resources possible to their patients who are often struggling with addiction.
The program has grown significantly from first opening in 2015, starting at 15 patients to a projection that they will serve more than 750 clients this year.
Most often, their clients are addicted to methamphetamine or opioids. The program offers multiple services, including intensive outpatient therapy that meets multiple times a week, to reintegration programs, meant to help people return to their community and find work and other resources that will help them stay sober, said Katie Smith, Centerstone Greenwood coordinator.
Their focus is on long-term recovery, and using evidence-based practices to help their clients be successful, including working with them in the community where they live, said Jennifer Fillmore, director of grants and specialized services.
A big challenge they face is recruiting enough staff to help patients, including therapists with experience in addiction recovery, Fillmore said.
Currently, the Greenwood location has four open positions on its staff, Smith said.
That means patients can face a delay in getting the services they need, Fillmore said.
Valle Vista is opening a new program this summer meant to help people suffering from opioid addiction with outpatient services, including medication assisted treatment and individual and group therapy, Fettig said.
And the facility has continued adding physicians and therapists, along with an on-site pharmacy and 24-hour helpline, she said.
Indiana officials have taken steps to address the crunch for services. New legislation approved in March funds nine new opioid treatment centers across the state, raising the total number of treatment centers aimed at the crisis to 27.
But additional steps are needed, Fillmore said.
Centerstone officials would also like to see more transitional housing for people coming from a recovery or treatment center, which can sometimes be impossible to find in Johnson County, leading to wait lists of six months or more, Fillmore said.
The agency has recovery centers across Indiana and is getting ready to add space for patients in Columbus, Bloomington and Richmond. The program will help people find transportation, but that sometimes still is too far for local residents who want help, she said.
“If you don’t know somebody, it’s hard to access services,” she said.
Fillmore would also like to see the community get a shelter or some other housing to help the patients they are helping, she said.
“I want to see the community rally behind it, there needs to be more movement toward collaboration,” she said.
[sc:pullout-title pullout-title=”By the numbers” ][sc:pullout-text-begin]
Patients served by local treatment centers:
Centerstone
2016;277
2017;387
2018;188 so far; projection of 752
Tara Treatment Center
2016;625
2017;663
Adult & Child
2016;2,691
2017;3,065
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As the opioid crisis deepens, people searching for help in Indiana are finding fewer facilities offering treatment. Here’s a look at how access to care has changed since 2010:
Clients treated
2016;26,068
2010;24,500
Treatment facilities
2010;273
2016;265
Offering outpatient services
2010;253
2016;236
Offering residential treatment
2010;24
2016;38
SOURCE: National Survey of Substance Abuse Treatment Services
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The United States is in the midst of the worst drug epidemic in history.
Opioids, including prescription painkillers, heroin and fentanyl, are killing Americans.
The Daily Journal is taking a yearlong look into the public health crisis that touches nearly every segment of our community and crosses all socioeconomic lines, from families who lost loved ones to health and law enforcement workers on the front lines.
Addicted & Dying also will explore solutions and a path forward.
Have an idea for our project? Contact us as 317-736-2770.
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Later this week, we will take you into a Whiteland doctor’s practice that focuses on managing pain medications, and a woman’s life nearly three years sober.
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