Treating substance use disorders in and after prison a challenge
By Karen Dandurant
Many people in jail are there because of what they do to support their disease. We need to do better in how we help them overcome their disease, local recovery experts say.
“We need to stop arresting people who have SUD or mental health issues,” said John Burns, executive director of SOS Recovery Community Organization of Greater Seacoast Community Health. “We need to stop putting people in cages. We still believe that if we hit them hard enough with a stick, they will get better.”
Burns said the situation is made even worse when the case involves a person of color, or indigenous people who, he said, are incarcerated at a higher rate.
“Our entire correction system is totally racist for an incarcerated person,” he said. “There are more barriers to them seeking care than there are programs available to help them.”
Burns said there are not many programs available to incarcerated persons with substance use or mental health disorders, and often even less when a person is released from incarceration.
“Strafford County House of Corrections uses ‘Therapeutic Community’ which is not a treatment program per se,” said Burns. “It is an abstinence program. The county has MAT (medication assisted treatment) available but not as part of an TC. I am not criticizing the program because it is better than nothing. We do meetings in the jail as part of TC. We do recovery meetings once a week and help with after planning, with things such as life skills classes.”
According to the National Institute on Drug Abuse, “a Therapeutic community is a common form of long-term residential treatment for substance use disorders (SUDs). Residential treatment for SUDs emerged in the late 1950s out of the self-help recovery movement, which included groups such as Alcoholics Anonymous.”
The biggest problem with TC, said Burns is that there is a waiting list, so some people do not get access.
“I’d say 65-70% of the people in there have some type of SUD,” said Burns. “We are not helping them all because we don’t have enough help.”
Rockingham County Department of Corrections does use medical-assisted treatment programs, using suboxone, buprenorphine and methadone.
“We do two meetings a week there,” said Burns. “We also do meetings via Zoom and help with reentry planning. The problem is what puts them there in the first place, criminal activity, poverty, mental health issues and substance use is exacerbated by their time incarcerated. Going to jail is traumatic, so you are piling more trauma on top of trauma already there. That’s a hard hole to climb out of. The more we punish, the less effective this is.”
Burns said New Hampshire does not track SUD recidivism rates or the efficacy of its programs.
“Most jails have a reentry coordinator, but the positions and support for them are often underfunded, and the caseload is ridiculous. Very little is done after release other than they are put on probation and have to pee in a cup. Probation officers are not trained on counseling, but on adherence to the rules. The stick, punishment has no real carrot on the other end, to let them off of probation. Some judges are starting to see the uselessness of criminalizing this but not enough. We sit on three drug courts (Strafford, Carroll and Cheshire counties) so we see it.”
Getting out of jail often means a return to a person’s old situation, or worse.
“They get out of jail and they have a record now,” said Burns. “No one wants to give them a job so they can take care of their needs. If their offense was drug-related, housing does not want to accept them. They have a scarlet letter from the start. Then the system scratches its head and wonders why they are repeat offenders?”
Peter Fifield is program director at The Doorway at Wentworth-Douglass Hospital. The Doorway program is a state initiative to address substance abuse disorders by offering a hub and spoke model to connect people with help and services wherever they live in New Hampshire.
Fifield works with both Strafford County and Rockingham County jails.
“We work on the SIMS (sequential intercept model mapping), SAMHSA (Substance Abuse and Mental Health Services Administration) model designed to help navigate/map the process for release,” said Fifield. “Most inmates have no primary care doctor and no plan for treatment when they get out, so it’s better we start before they are released.”
The Doorway is not a treatment center. Rather it connects people to services.
“We have an individual who is struggling in a controlled environment,” said Fifield. “When they get out, there are more options, not all good ones. I’d like to see a more direct administration of treatment inside, but since there isn’t, we want to connect as soon as possible to resources once a person is released.”
Sally VanderPloeg, RN, runs a mobile homeless healthcare and substance use program for Greater Seacoast Community Health. She is studying to become a nurse practitioner.
“I focus mainly on the homeless population, but as you can imagine, there is a lot of crossover,” said VanderPloeg. “I have involvement with the prison system and the community.”
VanderPloeg said she is beginning to see a shift in the dialogue.
“In the past, when people were incarcerated, substance use was not considered an option for treatment,” she said “We are trying to get real recognition that this is a disease. If you had a heart condition, they would not stop treatment in prison. Jails are starting to see this and MAT is a part of most prison systems now, at least in some form. What we need is to change the stigma and that is what I work for.”
Running a mobile clinic, VanderPloeg says she sees the risk for people getting out of jail.
“They go back to their old environments and if they use again; their tolerance is lower and many die,” she said. “Research shows this is when help is needed most. We try to be a barrier-free line to care as soon as possible after release. We use MAT (vivitrol) and we can also connect them to care in Dover, in Rochester, wherever they need to be.”
FIfield said that even if a person had the chance to be in a 12-step program in jail, it is theoretical compared to trying to apply those learned skills on the outside.
“It’s like going from zero to a hundred, all at once,” he said. “It can be overwhelming. And now he’s back with his old buddies, who are still using. How is he supposed to succeed without help?”
Outside planning should start while a person is incarcerated.
“Everyone should have an appointment with a provider before they leave,” said VanderPloeg. “Once they get out, their lives are super crazy. They might be involved with a drug court, but if they have a case manager before they leave, they are more likely to be connected to care for SUD and mental health.”
There is some improvement beginning to show. Burns said federal funding, implemented in a partnership with United Way, has allowed SOS a subcontract to offer justice involvement help to anyone with a cell phone a tablet or laptop.
“But so far, we are not getting a lot of referrals,” said Burns. “We are doing outreach, and we have the capacity to do more. We need a buy-in and better involvement through the courts.”
“Until everyone sees SUD as the disease it is, and not as criminal activity, we are going to struggle to help anyone,” said Fifield. “We send people to doctors for so many things and we should. Why not this?”