Hooked in the Heartland: Community setting helps drugs addicts stick to recovery

The sanctuary of Freedom Church in downtown Grand Forks was filled with song on a Tuesday night.

Though the people gathered in the Christmas-decorated hall sang and prayed as they would on Sunday morning, there was no typical faith leader overlooking the proceedings. Instead, before breaking into small groups for discussion, the group looked to a video screen for a sermon of sorts on the merits of admitting faults, claiming shortcomings and healing through the power of forgiveness. The video-sermon and small groups weren't the only differences from a standard day of worship.

Nate Espinoza, a Freedom Church member, helped begin the night session with a reading of the 12 Steps, a series of admissions created by the substance abuse recovery group Alcoholics Anonymous.

The steps are one component of Celebrate Recovery, a faith-based recovery plan that incorporates pieces of AA and its counterpart, Narcotics Anonymous. About a dozen Freedom Church congregants met at 6:30 p.m. Tuesday for the most recent weekly Celebrate Recovery meeting.

Those who attend the program meetings are in the midst of recovery from addiction. Though most are attempting to free themselves from drugs and alcohol, the group is open to addressing any number of compulsive behaviors, including gambling and sex.

Espinoza's first dip into substance abuse was in his adolescence. He described himself as "submerged" in drug culture by the age of 21.

Now 34, Espinoza has been sober for more than four years. He's currently studying at UND with the intention of becoming an addiction counselor. He credits his recovery to his own experiences at the UND Counseling Center, as well as the faith and fellowship aspects of the church's outreach efforts.

"The biggest part was sticking to change and not backsliding or compromising my sobriety," Espinoza said. "It started with a day, which felt good, then went from there. With the exclusion of illness or jail, I hadn't been sober for more than a day or two before that."

Addiction, treatment gap

Support groups such as Celebrate Recovery are one piece of a wider puzzle of alcohol and substance abuse treatment. National Institute on Alcohol Abuse and Alcoholism data from 2014 indicates 16.3 million adults ages 18 and older had an alcohol use disorder, a class including both alcohol abuse and alcoholism. The number of people who actually received treatment in that year for an alcohol use disorder is far lower at about 1.5 million, roughly 9 percent of adults who needed treatment.

Abuse of other substances coincides with even lower treatment rates.

The 2015 National Survey on Drug Use and Health estimated 21.7 million people ages 12 or older were classified in the past year with dependence or abuse of any number of substances to the point where treatment was required. Of that total number, an estimated 2.3 million people actually received treatment at a specialized facility.

Those who do seek treatment are no stranger to the difficulty of putting a stop to addictive habits. For many, the allure of substance abuse wore off long before the end of the behavior itself, leaving users in a cycle of fruitless attempts to quit for good.

"There were some moments where I knew I needed to stop, where I wanted to stop," Espinoza said. "I realized I didn't want to do it anymore, but I was still doing it. I tried cutting back on my own, but it didn't help."

Midwest follows trend

Residents of North Dakota and Minnesota follow the national trend of disparity between the populations that require treatment and those that actually get it.

In North Dakota, about 47,000 individuals ages 12 and older had an abusive or dependent relationship with alcohol in 2013-14, according to data from the U.S. Substance Abuse and Mental Health Services Administration.

The wider umbrella of substance abuse drew in about 14,000 individuals-a group with considerable overlap into the number who abuse or are dependent on alcohol. Treatment rates for the two categories remain low. About 13 percent of the illicit drug group received treatment in the survey year. Only 6.5 percent of those who abuse or are dependent on alcohol received treatment.

When broken down by rate, alcohol abuse in Minnesota is slightly less prevalent than in the state's western neighbor. The 286,000 individuals considered to fit in the category in the survey year made up about 6.3 percent of the examined age demographic in the state. About 107,000 individuals fell into the category of abuse of illicit substances, a recorded rate of usage slightly higher than that in North Dakota.

Treatment rates in Minnesota were better than in North Dakota, but not by much. About 7.2 percent of those abusing alcohol received treatment from 2010 to 2014. In that same period, an estimated 15.7 percent of those abusing illicit substances received treatment.

Wayne Donnelly, a congregant of Freedom Church and a member of Celebrate Recovery, has made six attempts at getting clean. Each stint of sobriety began with a treatment program, some of considerable length. One, three, six months-no matter how long he was in, nothing stuck.

"I did quite well until I left the program," Donnelly said. But within just a few months of returning to the wider world, he invariably would find himself with his old crowd. "I went back to what was familiar to me, and my comfort zone was hanging out with the people who were drinking."

Donnelly said he's seen a similar pattern among his peers.

"Once they get back out in real-life situations, it's easy to go back," he said.

Donnelly's relationship with substances landed him in jail and on the streets; he was homeless for a time until just a few years ago. Right now, he's coming up on two years of sobriety from alcohol and drugs, a period he says is his longest run of sober time. Donnelly attributes the mark in large part to the community structure of Celebrate Recovery.

"You don't have to do it alone," he said of the group setting. "Everybody here has been there in one way or another, and they may have different struggles, but we're overcoming it together."

Programs limited

Before people make it to a program such as Celebrate Recovery, they typically go through a therapy and counseling service of varying intensity.

Pamela Sagness, director of the behavioral health division of the North Dakota Department of Human Services, said the substance abuse programs licensed in the state are classified under levels of care. The services offered by the roughly 115 providers across the state range from addiction assessments and consultations to inpatient residential therapy.

Alcohol and substance abuse treatment programs tend to cluster in North Dakota's urbanized areas. Larger population centers tend to offer a greater range of providers. The state Department of Human Services divides the state into eight service regions, each of which has a satellite office in the region's largest city or town. In many regions, including the wide swath of the Oil Patch west, including Minot, Williston and Dickinson, the Human Services office provides the sole residential treatment center in the area.

Sagness pointed to the limited nature of inpatient services as she described certain offerings for substance abuse as "very limited" across the state.

"We don't have enough workforce, but it's more than that," she said. "It's also programs, but programs can't operate without staff."

Sagness said most of the state's addiction treatment programs are "one-man shops" of single individuals with varying capacity to offer services. The limited manpower found at any single facility highlights the disparities in service need versus demand in areas where a sole professional is "providing services to an entire region."

The small scale of such programs generally restricts their activity to evaluations of incoming patients or general substance abuse counseling.

Individuals who require more extensive therapies often need to leave their home region and set off for a more service-rich part of the state. As such, Sagness said, it's not uncommon for individuals from the west to cross the state for treatment. Others might leave the state altogether if their means allow.

Relocating for the sole purpose of finding help can provide short-term benefit in terms of getting treatment-at the same time, Sagness said uprooting from home can prevent patients from building a long-term foundation for maintaining sobriety.

"There's rapport that's built through treatment, there's connecting with community resources," she said. "If someone gets treated in Fargo and builds supports, they transfer back to Williston and it's tough to build that again."