CONCORD, NHÌę– U.S. Sen. Maggie Hassan, D-NH,Ìę on Aug. 7 visitedÌęÌęto discuss the importance of expanding medication-assisted treatment (MAT) for substance use disorder, and the ways Riverbend is supporting families and communities struggling with addiction.

Hassan’s visit began with a tour of Riverbend where MAT is administered, and then she toured Riverbend’s Choices facility, which offers addiction recovery services. Hassan spoke with providers and a patient about addressing substance misuse and her work to support Riverbend’s efforts,ÌęÌęshe introduced that would eliminate barriers that currently restrict health care providers from prescribing buprenorphine – a proven medication-assisted treatment – to patients struggling with addiction.

“People grappling with substance use disorder need access to medication-assisted treatment, coupled with counseling and peer support. But there remains a stigma that holds people back from seeking treatment, and outdated restrictions prevent health care providers from prescribing certain forms of medication-assisted treatment,” HassanÌęsaid. “I was glad to get an update on the work Riverbend does – it makes such a difference in our community, and I will keep working across the aisle to support their efforts and increase access to medication-assisted treatment.”

The patient Hassan met with began misusing substances at the age of 14 – nearly 30 years ago. Now, through the help of medication-assisted treatment, counseling, and peer support, he has been substance-free for more than a year.

“To effectively combat the opioid epidemic and treat people suffering from substance use disorder, we need all tools at our disposal,” saidÌę. “We see every day how medication-assisted treatment helps to save lives, but unnecessary restrictions remain in place that limit access. It was great to have Senator Hassan here to talk more about our work supporting patients and the Concord community, and we’re grateful for her efforts to remove outdated barriers to medication-assisted treatment.”

As proposed, the bipartisanÌęwould eliminate a requirement that practitioners must apply for a waiver through the Drug Enforcement Administration in order to prescribe buprenorphine for substance use disorder treatment. The bill would also require that the Secretary of Health and Human Services conduct a national campaign to educate practitioners about the change in law and encourage providers to integrate substance use treatment into their practices.

Saturday, August 19, 2017

With drug courts up and running in six New Hampshire counties, Merrimack County will soon be the latest to jump on board.

Officials are planning to launch the court diversion program for high-risk, non-violent offenders in early September, and have started selecting possible candidates.

Superior Court Chief Justice Tina Nadeau said those in the criminal justice and treatment communities work together to identify repeat offenders who have been “recycled through the system three, four, or more times with tougher sanctions imposed each time, but no changes in their behavior.”

Nadeau and others said drug court is an alternative sentencing model aimed at reaching people with longstanding substance abuse issues who aren’t benefiting from old-school practices that favor incarceration. Those selected for drug court stay out of prison, but don’t get a free ride; rather, they’re under constant supervision, to include random drug testing, counseling, weekly court sessions and community service.

While officials acknowledge that the diversion program is not the magic solution to the state’s drug epidemic, they say it is something Merrimack County must take a chance on as more traditional methods aren’t working.

“At the end of the day, it’s something we have to try whether people agree with the philosophy or not,” said Deputy County Attorney Catherine Ruffle, who is a member of the Merrimack County’s drug court team. “The drug situation is something that’s increasing, not decreasing. We have not been successful in the war on drugs, and we have to change things to get ahead of it.”

Roots of program

New Hampshire’s first drug court began in Strafford County more than a decade ago. It launched with a pilot program in 2004, and became fully operational two years later, thanks to federal grant funding. As the first adult drug court, it has graduated more than 100 participants.

The program is a model other counties hope to emulate in an effort to reduce recidivism rates in their communities. A 10-year study found that drug court graduates have a 22 percent chance of re-offending, whereas those in the general population are at a 40 to 60 percent risk, said Alex Casale, the statewide drug court coordinator.

The state pays three times more to incarcerate someone than it does to fund that person’s participation and treatment in drug court, Casale said. In addition, he said, people who graduate from the program are reintegrating back into the communities, where they have the tools to lead successful and productive lives.

In addition to Strafford County, drug courts are operating in the counties of Belknap, Cheshire, Grafton, Hillsborough and Rockingham. At the same time Merrimack County is working to get its going, Nadeau and Casale are working with officials in Carroll and Coos counties to install programs there. The 10th and final county will be Sullivan. All counties are expected to have drug courts by fiscal year 2019.

A bill signed into law last year provides state funding for counties to launch these programs; however, that funding is reviewed by the Legislature on an annual basis. The state allocated just shy of $3 million in the judicial budget for drug courts this fiscal year, although Casale said it’s likely a portion of those dollars will be returned to the general fund.

The statewide drug court initiative was considered during a special session of the Legislature and received strong bi-partisan support. The bill was one of several considered in the context of the drug crisis. Others aimed to expand treatment and institute harsher penalties for drug dealers.

Merrimack County Attorney Scott Murray called the drug court legislation a game changer because it opens the door to counties long interested in the program but deterred by financial challenges. The law provides all counties an equal opportunity, he said.

The legislation also seeks to hold all drug courts to the same research-based and practitioner-focused standards published by the National Association of Drug Court Professionals. That compliance ensures consistency across counties and allows state officials to track the programs’ successes, officials said.

One court’s story

The rollout of a drug court in Merrimack County comes at a time when county prosecutors say their office is “flooded with drug cases.” About 40 to 42 percent of the office’s case load stems from drug arrests, and that number is magnified when drug-related robberies, burglaries, thefts and other crimes are factored in, Murray said.

In the first six months of this year, a grand jury handed up 1,054 total indictments, with 431 of those being for drug offenses alone, Murray said. While a portion of that increase is due to the implementation of another statewide program, Felonies First, the number of drug cases have been trending upward for some time, he noted.

Under the Felonies First program, more serious criminal cases are funneled right to the superior court level, skipping lower courts entirely. Those cases were traditionally filed in circuit courts and then forwarded to the superior courts, which has the authority to resolve felony cases.

Officials say they’re hopeful the drug court will complement existing diversion initiatives, including the jail’s Successful Offender Adjustment and Re-entry (SOAR) program. That program is rolled into the community corrections model and offers intensive inpatient treatment to nonviolent offenders with histories of addiction. The county also has a pre-trial services program for defendants who may not warrant pre-trial detention, but cannot be safely released into the community without monitoring and supervision.

“All of this really needs to be meshed and be coordinated so it can be applied in the best possible way to people who suffer from addiction,” Ruffle said. “Everyone has been mobilized to deal with this crisis, and we really need to take a look at each case and try to figure out what the best course of action is to prevent people from committing new crimes.”

Once the Merrimack County drug court is fully operational, officials say they will be able to enroll a maximum of 75 people. The county is partnering with 51°”Íű Mental Health and Concord Hospital to provide treatment.

Riverbend CEO Peter Evers, who is also the vice president of behavioral health at the hospital, said 80 percent of all incarcerated people have behavioral health disorders, and it is in the community’s best interest to get those individuals help. He said a total of eight new staff members will be hired to meet the need at both locations.

Men and women enrolled in drug court will receive gender-specific treatment at separate sites; the men will be referred to Riverbend and the women to Concord Hospital’s Fresh Start Program. Both will receive intensive inpatient treatment.

“There’s a lot of evidence to suggest that treatment is more successful when you separate genders,” Evers said.

For example, he noted that 90 percent of females who struggle with addiction have histories of trauma to include sexual and domestic violence. Evers said it is important that those underlying issues be addressed as part of the broader treatment strategy.

Professionals agreed that there will be successes and failures along the way, but that they’re optimistic a drug court will be an overall positive gain for the county.

“It’s a new tool, a great tool to deal with people with intractable problems,” Murray said. “The key is applying to right people.”

Wednesday, January 4, 2017

ByÌęRICK GANLEYÌę&ÌęMICHAEL BRINDLEY

A new treatment program for adolescents battling drug and alcohol addiction opens in Concord Wednesday.

The program is calledÌęChoices, and will offer outpatient substance abuse treatment to teens 14 and older. The program is part of the 51°”Íű Mental Health network.

Audrey Clairmont, Choices’ lead clinician, spoke to NHPR’s Morning Edition about the program and the unique approach required when working with teens dealing with substance abuse issues.

Can you talk about the demand and need for this type of program?

I think with substance use, it’s obviously been in the news everywhere. The demand is very high. In addition with adolescents, the demand is very high because what few treatment programs we did have, have closed down. The reason they’re closing is partially because of funding, but also adolescents are a notoriously hard population to engage. So the need is there, tenfold more so than we would like it to be. However, getting the adolescent to come here every day and engage in treatment, that’s the challenge.

Why is it such a challenge to reach that demographic?

To put it very simply, they don’t want to come here. The big difference is because a lot of the times, they haven’t gotten to that stage where my marriage hasn’t failed, I haven’t lost my kid, I haven’t lost my job, I haven’t lost my house that you do see with adults. They’re not connecting, they don’t have the motivation. The time we want to intervene is when they’re young. Hopefully we’re catching them before their disease has progressed to affect their children, their job, their housing. If we can change that with an adolescent, it’s really preventative care.

What do we know works? Can you talk about some of the research when it comes to treating teens versus adults?

One thing that I have found and research shows that can be more effective is motivational interviewing. That’s an effective strategy with adults as well, but what I like about motivational interviewing is it really puts the client in the driver’s seat. That’s very important with adolescents. They don’t like to be told ‘don’t do drugs, it’s bad for you.’ And they’re smart. An adolescent that comes in, they know just as much about marijuana as I do, and I’ve been to school for six years. So there’s no fooling them about what’s bad and what’s not bad. You really have to let them come to their own conclusions about their goals and how their substance abuse is affecting them.

This is outpatient treatment, so what’s the role and responsibility of the family in terms of support?

The family can play such an instrumental role in treatment. We hope that all families will participate in our treatment. By that I mean they’ll be welcome to call clinicians and if they need to meet with us individually or with their child, they’re welcome to do that. We’re also starting a family support group. It will be combination between education about the disease and what their loved one is going through, as well as a therapeutic piece.

Can you talk about what types of services specifically are offered and how they’re adapted to a teen demographic?

Our biggest service is the IOP, or intensive outpatient program, and what that will look like is Monday, Wednesday, Friday, from 3 to 6, teens will come and it will be primarily group therapy, both educational groups and therapeutic groups. After about four weeks, they would drop to the phase two portion of the IOP, and that’s one evening a week. That’s the most intensive model of treatment you can get and still be outpatient, which is a wonderful thing because they’re still able to stay in school, they’re able to stay with their families. If we can be successful in outpatient, that’s what we want to go for.

In addition to the IOP, there will be the family therapy group. We’re also looking to start an adventure group. So the adventure group with individual counseling might be a good way to kind of way to teach teens they can have fun without using substances. They’ll get some basic refusal skills and some basic education around substance use.

We’re also partnered with CHIP, which is Riverbend’s Children’s Intensive Program. They offer individual therapy, psychiatry, case management. So because we have that close working relationship, it’s a very easy referral process. So we’re able to kind of offer wrap around and dual diagnosis care.

What about medication-assisted treatment?

Our medical director prescribes Suboxone and Vivitrol. As far as with adolescents, I do know there’s a big stigma with medication-assisted treatment. It can be very polarized. My perspective is the bottom line is it can save a life. It by no means is our first option. We’re not going to get a 16-year-old in here and say here’s your medicine. That’s not the theory. We’re very committed to the fact that medication-assisted treatment can be effective alongside therapy. So it can help prevent that overdose, or those cravings to relapse while we’re working on the behaviors and the trauma and the underlying issues as to why they picked up in the first place.

What do you anticipate as far as numbers are concerned? How many clients can you have under your care at any one time?

The numbers is a tricky piece because the need and who’s going to engage is very different. I’ve been meeting with a lot of members in the community and almost everywhere I go, they tell me they’re so glad we’re opening, that they have 15 kids they can be referring. But out of those 15, 10 drop out, four refuse, and maybe we get one. As far as what we have the capacity to hold, we’re looking to keep our IOP groups at about eight. However, we do have the ability to run multiple groups at a time. We have the space, we have the staff, so we can grow as the need grows and as the engagement grows.

Tuesday, January 03, 2017

As state health officials scramble to help open more drug and alcohol treatment programs and sober houses, certain segments of the population have fewer options than others.

For instance, fewer programs exist to treat adolescents and pregnant women. But two new programs in Concord and Rochester will help to expand treatment for those populations.

In Concord, a new adolescent treatment program called Choices is opening Wednesday. Choices is a program of Concord’s 51°”Íű Mental Health and serves teens age 14 and older.

Program officials say it’s critical to intervene and treat signs of addiction as early as possible.

Adolescents represent “a whole bunch of salvageable people,” said Fred White, director of substance use disorders at Choices. “Maybe you can get them before the hook is too deep.”

Choices is an intensive outpatient program, meaning participants don’t live in a residential facility and continue to live at home while they receive counseling, drug testing and other services.

Intensive outpatient programs give the family more of an opportunity to get involved in their child’s treatment and recovery.

The program includes group and individual therapy, contact with the family and case management.

Lead clinician for Choices, Audrey Clairmont, has worked with both adolescents and adults, and she said one of the biggest differences is trying to convince teens they’re not invincible.

Many times when adults are seeking treatment, they have already seen the negative consequences of substance use, like arrests and overdoses.

Adolescents usually haven’t experienced those same consequences, Clairmont said. And many don’t respond well to the blanket command of, “Don’t do drugs.”

“I don’t tell teens anything,” Clairmont said. Instead, she tries to get kids to see that they are in charge of their own lives and need to take pains not to ruin it early on.

Choices clinicians also give their patients facts about drugs and alcohol, trying to dispel the notion that a substance like marijuana isn’t harmful because it’s a plant.

One of the project’s biggest objectives is trying to channel kids’ interests into productive and meaningful activities like athletics, book clubs or cooking classes.

Clairmont said her clients will often cite boredom as a reason for relapse.

“That comes up a lot,” she said.

White added that he tries to encourage patients to take control and responsibility for their thoughts. Rather than wallowing in ambivalence and focusing on the negatives, he says, it’s important to give kids the skills to change things.

In addition to encouraging adolescents to do positive activities, clinicians work with them to address the reasons why they are self-medicating.

Underneath most addictions lies a history of trauma, whether it’s past sexual abuse, violence, or a bad home life with parents who fight often.

“The fingerprint of trauma is strongly on the adolescent substance-abuse population,” White said.

Clairmont and White said they hope the Concord community will embrace and support the program for years to come.

“If you don’t get people in there, it won’t be there next year, when it’s your kid,” White said.

Hope on Haven Hill, an intensive residential treatment program in Rochester, recently opened its doors. The house provides a home and treatment for up to eight pregnant women, their newborns and children up to age 5.

Days at the house are structured, with group and private therapy, childbirth classes, recovery support services and life skills coaching.

Women can stay at Hope on Haven Hill for up to a year after they give birth. The facility is one of two in the state that exists specifically for pregnant women and their children; the other is the Cynthia Day Family Center at Keystone Hall in Nashua.

Both are experiencing high demand and have waiting lists.

Those interested for more information about Choices can call 1-844-524-6673 or email choices@riverbendcmhc.org.

More information about Hope on Haven Hill can be found at hopeonhavenhill.org or by calling 948-1230.

(Ella Nilsen can be reached at 369-3322, enilsen@cmonitor.com or on Twitter @ella_nilsen.)