Through pandemic and economic hardship, the Doorway is still open Posted on April 11, 2022 By Shawne K. Wickham New Hampshire Sunday News When Gov. Chris Sununu announced that everything was shutting down back in March, 2020, Shanna Large-Reusch remembers her first thought was, “Please don’t close the liquor stores.” That response might seem counter-intuitive for someone who works in the treatment field — Large-Reusch is director of substance use disorders at Riverbend Community Mental Health Center in Concord. But she feared what would happen to her clients if the pandemic shuttered state liquor stores. “Do you want to see a lot of people in withdrawal and dying because they can’t get their alcohol?” she said. “I want my clients to be able to get something so they don’t die and they can engage with us.” The state kept the liquor stores open, and liquor sales went through the roof. Throughout the crisis, The Doorway, the state’s “hub-and-spoke” program for substance use disorders, continued to connect residents with treatment and recovery services. The fact that the treatment community was able to continue providing services in such unprecedented circumstances is a testament to “the resilience of the people we serve and our providers,” says Jaime Powers, director of the Bureau of Drug and Alcohol Services at the state Department of Health and Human Services, which runs The Doorway in 10 locations statewide. Life has been difficult for everyone over the past two years, but for those with substance issues, it was even tougher, Powers said. “One of the things we always said to people leaving treatment was: ‘Get connected, go to meetings, don’t isolate,’” she said. “And now all of a sudden, all of those very healthy things we typically told people to do, everyone was saying, ‘Don’t do that. Stay away from people.’” Those struggling with substance abuse have been “the loneliest of the lonely” during the pandemic, said Large-Reusch, from Riverbend, which runs The Doorway in Concord. “Ninety-nine percent of our clients have mental health diagnoses as well — and the other 1% are lying to themselves,” she said. “People use substances to find relief, to numb, sometimes to feel wanted,” she said. “And now you’ve basically locked them up in their houses and exacerbated that depression that they might have had .…” Add the political divisiveness, explosion of conspiracy theories and uncertainty over COVID-19. “The call had to be very strong to just keep using,” Large-Reusch said. Creativity under stress Powers said New Hampshire’s 10 Doorway hubs “did this amazing pivot” to offer remote services when the pandemic struck. “It’s more incredible that they were able to do that, given that they’re all hospital-based,” Powers said. “And the hospitals were certainly not focused on the Doorways, and rightly so.” Many people who need services don’t have reliable phone or computer access, Powers said. So Doorway staff got creative, designating unused office space for evaluation and intake where clients could have access to a computer and phone, sometimes communicating with a care coordinator in an adjacent office. That’s what they did at The Doorway in Concord, Large- Reusch said. “Most of our clients don’t have the ability to get on a Zoom and they don’t have phone time,” she said. Places where clients used to be able to use public Wi-Fi, like coffee and doughnut shops, she said, “weren’t letting people inside.” They tried using telehealth at first, but it wasn’t ideal, she said. “The opposite of addiction is connection,” Large-Reusch said. “We need to connect with our clients. They need to see us.” So, “We pivoted,” she said. They would put a client in one office, and connect them with Doorway personnel in a different room via computer. That way, if someone needed in-person help, she said, “We were able to get to them very quickly.” Peter Fifield, director of the Doorway operated by Wentworth-Douglass Hospital in Dover, said the number of clients coming in dropped after the crisis began, but that doesn’t mean people were not using. “Recovery is hard in general,” he said. “Things like pandemics, I don’t think, make for fertile ground for recovery because things are just fundamentally harder.” It’s important for those new to recovery to make new friends, Fifield said, “because your old friends are the ones you used with.” But as the pandemic made everyone more isolated, he said, connecting with new people could feel impossible. The Dover Doorway building is across the street from the main hospital, and Fifield said they also used technology to connect people and keep them safe. “We could have a clinician in one room assessing the person and then we’d Zoom up to our psychiatrist,” he said. “The person would leave with everything they needed, and we’d clean up the room.” They even set up a quarantine space where clients who had some symptoms could still come in to be evaluated, he said. Happy to hold steady Fatal overdose numbers have plateaued in New Hampshire in recent years, with 416 deaths projected for 2021. That’s either encouraging — overdoses are not increasing here as they are elsewhere — or discouraging: Although the state has invested more than $100 million in federal funds to create The Doorway, the number of people dying from drugs has not declined. Large-Reusch from Riverbend prefers to think of it as a win. “To us, that kind of means that we’re doing what we need to be doing,” she said. “We would love for no one to ever overdose again,” she said. But she said, “As long as the number stays similar, we feel like we’re doing the work we need to be doing.” As someone who has spent her career in the treatment field, DHHS’s Powers said, “I’ve always said my goal is to have to shut my own doors.” “The reality is that that is unlikely to ever happen,” she said. But there are more resources available today and it’s making a difference, providers say. New Hampshire’s “robust” recovery community, Powers said, is critical to the effort. “Somebody who has had a substance use disorder, most likely their social group is built around that substance,” she said. “So having that new pro-social group and having it ready and waiting is going to go a long way toward lowering those numbers.” Powers said more must be done on the prevention side to really change things. “It’s a whole lot easier to stop something from happening than to reverse it once it has happened,” she said. Workforce also continues to be an issue in New Hampshire, and finding treatment beds “can still be challenging,” she said. But not everyone needs a 28-day residential program, which used to be the norm, Powers said. Individuals who have family support may benefit more from outpatient or partial hospitalization programs, she said. Hard cases, more to come With things opening up, Large-Reusch said, her Doorway is now serving clients with “a higher level of need than we’ve seen before.” She expects caseloads to increase. “It kind of terrifies me to think what all these economic changes are going to do to my clients as well,” she said. “Because if we thought it was hard before COVID to find housing and now there’s no housing to be found even for people that have the money to do it, what kind of strain is that going to put on people?” she asked. Some point out that users manage to find the money to buy drugs. “Yes, they probably can, but that doesn’t mean that they’re not maybe doing more illegal things to get more money,” Large-Reusch said. In her view, one policy change that would make a difference for such individuals is decriminalization of drug crimes. “That allows people to get into recovery, maintain recovery and then get a job that can help support that recovery,” Large-Reusch said. “Because the jobs that people who have felony records get are not jobs they can fully function on and support families.” Fifield from the Dover Doorway agreed. “It’s funny because we call substance use a chronic medical condition,” he said. “But we treat it like a crime.” “That’s like if someone with diabetes, if they go to the doctor to get treatment, they get arrested for eating a Snickers,” he said. Still what gives Fifield hope, he said, is many people’s “willingness and readiness to see this differently.” No one is immune New Hampshire now has diversion programs and drug courts that try to get people into treatment and healthy activities instead of jail, he said. Policymakers are embracing some harm reduction programs, such as safe syringe programs. Hospitals are using social workers and recovery coaches to connect overdose patients with the Doorway. Fifield said he sees more compassion across the board. “Maybe it got personal for them,” he said. Some people might be surprised at who seeks help for substance use disorders, Fifield said. “People think that they are ‘other’ and when you ‘other,’ you can set yourself apart from them and treat them in a certain way,” he said. But in truth, he said, “They’re just like you and me. Substance use disorder does not discriminate. We’re all just a little bit away from knowing someone, or being that someone yourself.” Riverbend’s Large-Reusch said it’s her clients who give her hope. “I love my clients because these are spectacular people with skills of survival that I will never have,” she said. “And if they can gain some time in recovery, what they can do to give back to the community and to the world is just incredible.” She thinks of a recent client, a man in his early 60s who was addicted to heroin and spent time in jail and then in the hospital. After he was discharged, he spent a rainy night sleeping in a dumpster before he found his way to the Doorway, where the staff gave him warm, dry socks and some coffee. “He was just happy to be inside,” Large-Reusch said. “And we have helped him,” she said, choking up. The Doorway staff connected the man with sober housing and got him into medication-assisted treatment. The last time Large-Reusch saw him, he had gained weight — and confidence, she said. “He’s just opened up and really blossomed,” she said. “That’s just one story of a million that we have here.”
