For most, the journey to inpatient substance use treatment is protracted and arduous.
After Jessica Newby’s doctors cut off her opioid painkiller prescription and she turned to heroin, she and her sister spent years trying to find a facility that would accept her. Kelly DiGiacomo had to convince Front Range facilities that her sleeping pill addiction required such an intensive level of treatment. As Tate Reaves worked to stop drinking, she struggled to find a facility that she could attend with her infant daughter.
All of them say the process would have been easier if they had not been forced to look so far. The help they needed should be in their own Southwest Colorado backyard.
But inpatient treatment is only one element of a broader continuum of services from which the community could benefit. Axis Health System, the sole provider of substance use-related health care in the region, offers various levels of therapeutic intervention and some medicated treatment, but those in the recovery community say they need more.
Those on a journey with substance use acknowledge that the area has some resources to offer, but that treatment of any kind is just one element of the recovery landscape.
Sunday: Why is it hard to leave the area to seek inpatient substance use treatment? Patients who did so say that leaving was an immense hardship, complicating their recovery journey.
Wednesday: What challenges do people face upon returning to Southwest Colorado after inpatient substance use treatment? Often, they struggle to find support. They say having an inpatient treatment facility could foster the growth of a larger sober community.
Friday: What does this region have and what does it need? Action is underway to determine if an inpatient facility is viable.
Mental health services, affordable housing, sober living and jobs that pay a living wage – these are all elements of a landscape that can grow a verdant, healthy community.
A 2021 needs assessment initiated by Mercy Hospital and conducted by the Southwestern Colorado Opioid Overdose Planning Consortium found that the area’s providers are dedicated to combating substance use problems, but the landscape is still sparsely populated in many regards.
The report concluded that Indigenous and LGBTQ+ populations were most vulnerable to the consequences of this resource scarcity.
Axis Health System offers an assorted array of services at facilities in Durango, Cortez, Pagosa Springs and Dove Creek. They range from prevention efforts all the way up to intensive treatment. The Durango facility also has a monitored social detox, but not clinical medical detox.
Haley Leonard-Saunders, Axis’ senior director of development, said that peer navigators work on the front end of the intake process to match patients with the most appropriate level of care.
Intensive outpatient treatment falls at the highest end of that spectrum.
“Intensive outpatient is basically a way for someone to get a highest level of care for their needs, in person, without leaving the area,” she said.
The program typically lasts 12 weeks and can involve group, family and individual therapy; education; relapse prevention work; and medication to decrease withdrawal symptoms and opioid dependence.
The therapy offered through Axis, as well as the 12-step meetings in the region hosted by Axis and the Animas Alano Club can be an oasis for those seeking sobriety.
After Newby returned from a monthlong stint in an inpatient facility in Ignacio, she said she “dug deep” into the intensive outpatient resources.
Although DiGiacomo has not gone back to sleeping pills since attending inpatient treatment, she has struggled to abstain from alcohol and relapsed during the COVID-19 pandemic. It was the 12-step meetings that pulled her out of it, she said, and, like many people, she finds ongoing attendance important.
“I can't get very far from the program,” she said. “That's important in my life right now.”
As the narrative around substance use in the community becomes more comprehensive, community stakeholders are looking for solutions.
Although there are ample 12-step meetings – enough that there is no excuse to not go, DiGiacomo says – those struggling to fight a substance use disorder say there are multiple intertwined challenges those in recovery face.
For one, without a larger sober community, finding the necessary support can still be difficult.
Hesitant to leave her children and community, Reaves struggled for years with an alcohol addiction. And the outpatient services were unable to serve her successfully.
“I don’t think it helped me. I think it made it worse, partially because of the fraternization that happens,” she said. “... I’m an alcoholic – that’s my drug of choice. But there were times that I would leave Axis and try harder drugs because of the people I was meeting there.”
DiGiacomo voiced similar concerns, noting that when she was trying to get by with only outpatient resources, she found herself in a room of people who were there voluntarily and involuntarily because of court order.
“It’s really hard to sit in a group with people that don’t want to be sober,” she said.
Leonard-Saunders hedged away from saying the organization did not have the resources to run separate group meetings for voluntary and involuntary populations, but said that “I think workforce capacity would be a consideration.”
She also said inpatient services demand an entirely different set of services and a different facility and workforce than Axis has.
Many of those in recovery who have struggled through the resource desert have experience-informed ideas regarding what the region needs, and how to get those needs met. First and foremost, they say, inpatient treatment is critical.
The 2021 study found that inpatient care is “simply not existent in any geographically reasonable way.”
Data compiled in that same study shows that more than 75% of La Plata County adults reported heavy or binge drinking in the past month, and the rate of fatal opioid overdoses in 2019 was 8.9 per 100,000 residents.
In 2022, 22 people died in the county from drug or alcohol overdoses.
La Plata County allocated $150,000 to the SouthWest Opioid Response District in 2021 so that the group could hire Health Management Associates to conduct a feasibility study. The study, due back next month, will deliver an in-depth look at what needs the community has, and how they could be met.
SWORD holds the contract to receive and spend the funds allocated to La Plata, Archuleta, San Juan, Montezuma and Dolores counties from the state’s settlement with the pharmaceutical companies responsible, in part, for the opioid epidemic.
The study will reveal whether the former Robert E. DeNier Youth Services Center, a county-owned building, could be converted to an inpatient facility or some other type of treatment hub. The former jail, located in Bodo Park, would require significant remodeling.
The county, on SWORD’s behalf, received a $1.8 million appropriation in the federal budget in December to use the building to address addiction in the region. There is also $5 million set aside in the 2023 county capital improvements fund for the building.
La Plata County Commissioner Marsha Porter-Norton, who also sits on the SWORD board, said if inpatient treatment is found not to be feasible, the building can be used for other services.
“If that is not feasible, inpatient treatment is one tool in the tool kit,” she said.
Indeed, those in the recovery community are advocating for broader services.
“Inpatient is necessary for a lot of people, but it’s not for everybody,” said a Durango woman who requested anonymity to prevent professional consequences associated with the stigma of opioid use.
Her partner of many years has struggled with an opioid addiction and has used methadone, an opioid that can help reduce cravings for stronger narcotics, since 2020.
“What works for him doesn’t work for everybody else,” she stressed.
Ever since Dr. Daniel Caplin ceased providing methadone services in October 2021, her partner has had to take a Medicaid-funded taxi to Farmington six days a week to get methadone.
Caplin operated a methadone clinic in Durango between 2014 and 2021, but it shuttered in the face of declining use and a lack of support.
“We had no community support, no state support, no support whatsoever,” Caplin said.
Medication-assisted treatment could be one service offered out of DeNier.
A local nonprofit, Pura Vida for Good, is also in the process of buying a property to start a sober living facility – something for which people such as Newby and DiGiacomo have advocated. Such resources, they say, can have an enormous impact in helping those beginning a sober lifestyle find a supportive community.
The vocal advocates who have navigated substance use disorders say they are outspoken in spite of the shame and stigma foisted upon them in Southwest Colorado’s small communities because they know firsthand the impact of not having those resources.
DiGiacomo, who sits on the SWORD advisory board, summed up the situation in a single word.
A previous version of this story erred in describing the addiction treatment services offered by Dr. Daniel Caplin. Although he no longer offers methadone treatment, he still treats addiction at Colorado Addiction Treatment Services.