Despite increased funding and greater public awareness, opiate addiction in Massachusetts is still a runaway train. Seeking to put the brakes on a grim trend, Martha’s Vineyard Community Services (MVCS) is deploying a new tactic — the recovery coach — a combination counselor, sponsor, and mentor, who provides one-on-one support to people with substance abuse issues.
A recovery coach can support someone working to overcome addiction by total abstinence, or someone who simply wants to moderate his or her substance intake.
There are six recovery coaches available through MVCS, the Island’s social services umbrella. A coach can be available to the participant for up to seven hours a week, at no cost. Participants can meet with their recovery coach at their MVCS offices, or at a coffee shop or a park if they prefer.
As part of the innovative effort, this week, the Edgartown police department told The Times that it will be standard operating procedure to pair an officer with an MVCS recovery coach to give counsel to overdose victims who have been “reversed” by Narcan. In doing so the department will emulate programs already in place in other communities, such as Bridgeport, Conn., and Falmouth, that have been hard hit by the opioid epidemic.
Grim statistics released by the Department of Public Health (DPH) last week underscore the challenge. According to DPH figures, there were 488 overdose deaths confirmed by the state chief medical examiner in the first six months of 2016. The total may be as high as 997 deaths, when active cases— where deaths are likely opioid related—are included in the total.
Harm reduction model
Eric Adams, substance abuse clinician at the Island Counseling Center (ICC) and the Island Wide Youth Collaborative (IWYC), has been a recovery coach since he completed the training last November. He recently spoke to The Times about the tenets of recovery coaching.
“Recovery coaching is based on meeting people where they are,” he said. “We use the harm reduction model. We take a look at what risks you’re taking, and what harm is being done, and we work on that. A person who wants to moderate their intake of non-opioid substances, but not necessarily give them up for good, can be coached in moderation. That works in a different way than walking in the door and saying ‘I’m not going to drink no matter what.’ We don’t turn away anyone because they’re using. We’ve learned a lot about addiction in recent years. Twelve-step programs can be very effective for some people, but they don’t work for everybody. They might have had a bad past experience, or a problem with the ‘God’ part of it, or they have a parent in it and they don’t want to be there.”
Mr. Adams said a recovery coach can also assist someone who wants to go to 12-step meetings but is daunted by the prospect. “A coach will go to 12-step meetings with them,” he said. “We’ll help prepare them on what it’s like and help them process what the meeting was like afterwards. If you walk in cold, it can be intimidating. The language is different, there’s a whole culture and if you’re not prepared for it, it can turn you off from it.”
The game plan is markedly different when it comes to opiate addiction. “With opiates there’s more of a sense of urgency,” he said. “The person may need to be separated from that drug, so we might be looking at detox, or getting them on Suboxone, something to get them off of the drug. But coaching remains client-driven. If that person says they don’t want to go into detox, maybe they have their kids with them or they don’t want to lose their job, we’ll work with what they’re willing to do.”
Recovery coaches can also play an important role with people who’ve been “reversed” out of a potentially fatal overdose by Naloxone or Narcan. Mr. Adams said MVCS coaches are emulating a program developed in Bridgeport, Conn., where anyone who has been reversed by Narcan will get a visit the next day from a plainclothes police officer and a recovery coach, to offer support to that person and his or her family.
On Monday, Lt. Chris Dolby told The Times that an Edgartown police officer will accompany Mr. Adams the next time someone is reversed in Edgartown.
“If we go out today and Narcan someone, I will contact Eric and we’ll put it together,” he said. “He has contacts at Gosnold, which is key. It’s a pretty hollow promise if you can’t back it up with a facility. Falmouth has been doing this for a while and we’re going to try to duplicate what they’re doing. We’re spreading the word to other departments on the Island as well.”
To support adolescents wrestling with substance abuse, Mr. Adams created Pathfinders, a group open to young people in grades nine to 12, that meets twice a week, on Mondays and Thursdays from 11:30 am to 1 pm.
“Some kids were forced to come, either as part of their probation or to get re-admitted to school after they’ve been suspended. But most of them have come of their own volition,” Mr. Adams said. “Very few are there because of opiates. Most of them are here for marijuana and alcohol and a garbage can of pills, usually whatever [benzodiazepine] they can get their hands on.
“We realize there’s not a lot of 17-year-olds who are going to choose abstinence,” he continued. “But we can really look at the relationship with substances, and link consequences of use with their life. A lot of times kids won’t see that the drugs are creating the consequences. They think it’s the police, or their parents, or it’s the school picking on them because they don’t play sports. So help them take an honest look at that and really give them a place to be honest to talk about how and why they’re using.”
Mr. Adams said many young people are prescribed pills in early childhood, which can create a mindset that they need something outside of themselves to manage their feelings.
“We try to undermine that thinking with mindfulness and meditation, and show them there are other ways to manage how you feel that don’t involve using chemicals,” he said.
“Urge surfing” is an example of how mindfulness techniques can overcome the impulses of addiction. “The typical urge to use lasts about seven minutes,” he said. “The urge to use is almost like a wave. It slowly begins and it rises and then it gets really intense for a very brief time, and might feel like it’s going to last, but then it falls off quickly. If you’re in proximity of drugs or alcohol, the urge is going to be much more intense. So we say don’t say ‘no’ to drugs when the joint is in your hand, say ‘no’ before you go to that party in the first place. It’s much easier to stop the train before it leaves the station then before it’s built up a big head of steam.”
Mr. Adams said that last year, the boards of health from each Island town appropriated money for four, six-week Pathfinder sessions. The last six-week session will begin in September or October.
“Most of the kids that have come have stayed with it,” he said.
For more information about finding a recovery coach, contact Brian Morris at 508-693-7900, ext. 411 or at firstname.lastname@example.org.