Community Engagement Strategy in Fighting the Opioid Crisis

 

Above is a collection of recent national headlines describing the current situation in Portsmouth, where Doc Spartan is proudly located. 

Starting in the 90s the factories and mills starting closing down. Half of the population left the area creating a massive void.

In the midst of that void a doctor saw an economic opportunity to create a new kind of mill - the pill mill.

Via the Cincinnati Enquirer (link above) 

"The advent of pill mills is credited to a man named David Procter. A flamboyant, diamond-and-fur-wearing Canadian ex-pat, Procter practiced across the river from Portsmouth in South Shore, Kentucky, and his cash-only, heavy-prescription model would become infamous. “Procter’s business model spread like a virus, unleashing unstable doctors on a vulnerable region,” writes Sam Quinones, author of the award-winning book Dreamland: The True Tale of America’s Opiate Epidemic."

The steel mills had closed - and pill mills now took their place selling scripts for cash.

Fast forward to 2019 - pills became harder to get - so the next best thing became heroine - heroine then started to get laced with fentanyl. And along the way more and more people began to die. 

"In 2017, Ohio had the second highest rate of drug overdose deaths involving opioids in the U.S. There were 4,293 reported deaths—a rate of 39.2 deaths per 100,000 persons, compared to the average national rate of 14.6 deaths per 100,000 persons. 

The greatest increase of deaths, however, involved synthetic opioids other than methadone (predominantly fentanyl) with a nearly twenty-fivefold increase from 139 deaths in 2012 to 3,523 deaths in 2017 (see below)."

source -https://www.drugabuse.gov/opioid-summaries-by-state/ohio-opioid-summary

Here we are at the height of the worst health epidemic in our nation's history - based on 2017 numbers close to 12 people in Ohio are dying via overdose a day. 

 

 Portsmouth is ground zero of this epidemic. Our feeling is that it was created here and it’s our responsibility to end it here. Here’s how:

Step 1: Understanding Your Neighbor

Understand that people going through addiction/recovery are people. The enemy is the addiction it’s not the people who are addicted. These people are members of your tribe - they aren't against you. They are sons, daughters, mothers and fathers that made a bad decision and/or multiple bad decisions that led to addiction. 

Our facility is adjacent to The Counseling Center and over the course of six years I’ve watched hundreds of people in recovery walk past my building hundreds of times. My immediate thoughts were anger, disappointment, and judgement cast on them for the following reasons:

  • The are the symbol for the decline of Portsmouth
  • They are making the town look bad
  • They are driving property values down
  • This isn’t a disease - it’s a choice, and they’re choosing to be weak willed
  • They are wasting taxpayers’ dollars

At no point during those six years did I ever once stop and talk to a single person. Why? Because I thought I was better than them. I had served in the military and boot strapped a few businesses, at no point did I ever ask the government for assistance or help. Why couldn’t they do the same thing?

All these thoughts are common and some are even valid - but they never actually led to any productive solutions. In other words - it’s easy to cast stones but at no point did I ever actually help and do anything to solve the problem. 

These thoughts and attitudes didn’t stop until I was afforded the opportunity to work directly with people in recovery via a partnership between my gym (PSKC) and The Counseling Center (TCC)- our area’s only non-profit addiction treatment center. 

IN PATIENT TREATMENT MODELS:

Unlike TCC, the standard treatment model used by a lot of treatment centers is centered around a 60-90 day in-patient model. The length of the stay is determined by what medicaid or insurance companies will reimburse. 

During the in-patient treatment the individual is provided necessary medical care for detox and then undergoes a series of individual and group counseling sessions to equip them with the tools necessary to begin a life of sobriety. These sessions focus solely on the mental/emotional side of addiction - which is good, but still lacks a key component of integral health - the physical side.

Payment of the 90 day in-patient treatment is paid via medicaid (footed by the taxpayer) - which is by far the largest percentage here in rural southern Ohio or private insurance. 

At the end of the 90 days, the person is released back into the public and it's up to that person to reintegrate back into society. Typically that person has no place to live, no adequate vocational skills, disconnected from family, and carries around a big sense of shame and negative self worth, and tremendous amount of court fines, pending court cases, and debt. 

Day 91 is a very scary and vulnerable time for a person, without safe people to be around, without purpose and without a safe place to live and work - a person is most likely to relapse if not overdose. If there isn’t adequate out-patient care in form of living and vocational services (facilities and programs for individuals to participate) this creates a 90 day revolving door of treatment. Get detoxed -  get sobered up - relapse - rinse and repeat with the taxpayer footing the bill. 

APPLICATION OF THE COUNTERINSURGENCY DOCTRINE:

I first learned about counterinsurgency doctrine while deployed to Iraq at the height of Iraq insurgency (04-06) as an intelligence officer assigned to 10th Special Forces Group. Our main mission was to conduct Foreign Internal Defense - "Building, developing, training and fighting alongside a foreign army. The end goal is to build a capable and confident fighting force in order to create a safe, stable, and peaceful country - ultimately instilling a sense of belief. "

Instilling a sense of belief is a key component of the strategy. According to the Army's Counterinsurgency Manual FM 3-34

In the early days of fighting the counterinsurgency the main method was to kill/capture insurgents and terrorists. This turned into the "whack a mole" approach - for every bad guy you took off the street there would be another one to take his spot - a non-stop revolving door. Treating the symptoms - not the root cause - a parallel that can be drawn to the current focus on the in-patient treatment model. 

Another similarity that warrants closer examination is the role of the criminal courts. Some folks are felonious criminals that are beyond reproach and the only option should be incarceration but for the larger population of drug offenders we can’t keep throwing them in jail. Otherwise it’s the same “whack a mole” approach, a non-stop revolving door of flooded courts and flooded jails. This approach is not only logically ineffective it isn’t cost effective. 

It’s more expensive to the taxpayer in the long run to keep someone in prison than it is to properly treat the individual. A more effective solution is to spend more money upfront on providing effective treatment that will transition the individual from a taxpaying burden to a taxpaying asset than it is to lock them up. 

In the state of Ohio, $26,509 is spent per inmate per year. That cost breaks down to around $72/day per inmate that the taxpayer funds. 

“This figure represents the amount the state spends annually, on average, to staff and maintain the prisons and provide all prison services.”

This problem isn’t going anywhere and we the taxpayer are footing the bill for it. It’s time we look at more effective alternative strategies. 

It wasn’t until later in the Iraq war that a much more integrated community engagement strategy was showing better results. Once equal focus was placed on military operations and reconstruction efforts - the tide began to turn. Focus was placed on training local forces to become competent, capable, committed, and confident in order to take over security operations from coalition forces. In parallel equal attention was placed on providing infrastructure building, schools, mosques and economic marketplaces. 

It wasn’t until tribal leaders (community leaders) started working with coalition forces against a common enemy (Al Qaeda in Iraq) that any real progress was made in the war. 

COMMUNITY ENGAGEMENT STRATEGY:

Following the Counterinsurgency Doctrine, TCC and us began to develop the concept of operations for instituting a Community Engagement Strategy. This model focuses on 3 things:

1: Development of the Integrated Self - focusing equal treatment on the mental, emotional, physical, and spiritual sides of the client. 

2: Increasing Outpatient Opportunities  - provide adequate housing, therapy, and training for out-patient clients. 

3: Compassionate Commerce: identification of community partners/employers that understand and can offer flexible work schedules and environments for out-patient clients. 

INTEGRATED SELF DEVELOPMENT:

In October of 2018 - PSKC CrossFit became a partner to the Counseling Center to provide fitness classes/services. The TCC as a non-profit entity was uniquely positioned to reach out to community subject matter experts to expand their treatment services. This was vital for us as people who weren’t familiar with the recovery community to gain first hand knowledge of the addiction problem. 

If you’re going to change the problem you have to know the problem. 

TCC asked us to provide a physical fitness component to their existing in patient treatment model. We provide a physical outlet for people in treatment. We offer instructor led group fitness classes. This way clients are taught a safe and effective form of functional fitness in a team based social setting.  Exercise offers incredible therapeutic properties and shows people that they are physically capable. These physiological adaptations lead to a much more important psychological changes in the client. Equally important it gives them an opportunity to work out their frustrations, disappointment, and feeling of shame and guilt. 

We demonstrate that through hard work they are capable of earning something. This newfound feeling of capability transfers over into their daily life. 

To have an integral approach to treatment we must focus equally on the emotional, physical, mental, and spiritual self. Think of it as a 4 legged table - if any one leg isn’t as strong as the other - you create a vulnerability in the structure. 

Physical fitness also helps the brain heal faster and strengthen neural pathways. According to Deidre Barret’s book Supernormal Stimuli - scientists once thought that mammalian brains stopped producing brain cells early in life. Research now shows that we keep producing brain cells throughout life. “This growth is increased in the face of novel learning situations or social interaction. However, the most potent stimulation of brain growth is… physical exercise.”

Also of value is the decreased healthcare cost to the taxpayer in the long run. The fitter an individual becomes (in or out of treatment) the less likely they become frequent visitors to ER and urgent care centers. 

Increasing Outpatient Opportunities:

Long term recovery truly begins on day 91. Fortunately TCC recognizes this and has put a priority on increasing the amount of beds available to those who are in need. That’s the value of non-profit treatment centers - they are able to shift the funds from in patient services (a revenue generator) to transitional living services (non-revenue generator). It’s a significant non-reimbursable cost that TCC encounters in order to purchase, renovate, staff, and pay the utilities for transitional housing - but it’s vital for enabling long term sobriety. Two of our current employees had to live in a homeless shelter for a week while waiting for a bed to become available for transitional living. Think about that - the homeless shelter was a better option for them to live because they were afraid that if they returned home they would be tempted to use again. 

Another key component of transitional living is accountability. To be accepted into TCC’s out-patient treatment and transitional living the individual must meet the following requirements; attend daily individual/group counseling sessions, be drug screened 3 times/week, and find part time employment. In return the individual is granted rent reduced transitional living quarters and a wide variety of healthcare and counseling services offered by the TCC. 

However, the current need is to find and place individuals in out-patient treatment into local businesses for part time employment. 

Compassionate Commerce:

People in recovery need a safe place to work, they need to be surrounded by safe people, and they need a purpose. 

This is where Doc Spartan was placed in a unique position. Doc Spartan and PSKC are co-located in the same building and employees work for both companies. Both co-founders provide fitness services (CrossFit & Yoga) to TCC which enabled relationship building with in-patient clients. We watched clients go through recovery only to finish treatment with nowhere to go and nothing to do. As stated earlier, two of current employees when they started at Doc Spartan were living in a homeless shelter prior to obtaining a bed in transitional living offered by TCC. 

Due to fortunate circumstances we were in a position that we needed part time help and some of the people in TCC’s transitional living program needed part time jobs to fulfill their outpatient requirements. So in late 2018 we offered part time positions to two individuals that we thought would be a good fit. 

It was a risk - but we believed we could mitigate the risk as much as possible due to the fact that the individual was being drug screened multiple times a week, they were attending daily counseling sessions, and working out multiple times a week either at PSKC or at TCC. 

We laid out clear expectations from the beginning. We had a zero tolerance policy, being absent and unaccounted was unacceptable. If they failed to meet any TCC obligation they would be terminated as well. 

This also required us as the employer to be flexible and understanding their recovery counseling sessions, medical and drug screening appointments are the first priority. 

We are proud to say at the time of this post we currently employ four individuals in recovery and it’s been the most satisfying and rewarding thing we’ve done as a business 

SUCCESS STORIES:

Below you’ll find a video documenting our first employee - Andrew. The executive summary is that he just celebrated 1 year of sobriety, is now a certified CrossFit Trainer at PSKC, a counselor at the TCC, head of fulfillment at Doc Spartan, and has his own apartment. 

 In addition to us - Eflow Development has created the Wolfe Force Work Development Program where they take individuals in transitional living and teach them general contracting skills. After acquiring the necessary vocational skills these individuals are employed part time and are actively assisting in the many downtown renovation projects. Their individual comeback is apart of the much larger Comeback City collective story. 

We believe this is an extremely effective form of treatment. It takes an understanding that we are engaged in a long war and our strategies need to reflect that. 90 day models won’t nearly be effective as 18 month strategies involving engagement from churches, treatment centers, courts, and businesses. 

This isn’t a political issue. This is a people issue and right now people are dying, which means we are failing. The good news is we have the power to fix it - we just have to care. 

What does caring look like? It’s taking the time to have a conversation with someone in recovery. It’s taking time to think of ways to help instead of blame. After all - you’re paying for it. Your money is either going to be spent incarcerating and/or utilizing short term ineffective forms of treatment. Or it can be used to take an individual off the street, get them healthy, provide sober living housing in a safe environment, teach/train them job skills, and at the end of it they are sober, employed, reintegrated into the community and are taxpaying assets, not liabilities. 

That’s what victory looks like - what could be the greatest comeback victory of our lifetime. The only question is will you be with the team on the field in the dirt or watching the game from home?