Housed at 42 Pleasant Street in Concord, the Choices program has an open-access model for services. Walk-in hours from 8 a.m. to 5 p.m. Monday through Friday allow those seeking help to get immediate assistance. While intakes are first-come, first-served, clients can also call ahead to coordinate the best times for them to come to the office.

“Easy access to care through walk-in intakes is a simple way for someone to get the care they need immediately, and start on a pathway to healing.” Said Shanna Large-Reusch, Riverbend’s director of substance use disorders. “Our committed staff is proud to offer this service to best support our clients as they seek the help they need.”

Location:

42 Pleasant Street, Concord NH 03301

Walk-in times:

Choices’ walk-in hours are Monday – Friday, 8:00 a.m-5:00 p.m. Intakes are first-come-first-served, though clients can call ahead to coordinate the best time to come to the office.

Available Services:

Outpatient substance use treatment:

• Individual therapy
• Group therapy
• Intensive Outpatient (IOP) group therapy
• Medication-Assisted Treatment (MAT)
• Medications for Opioid Use Disorder (MOUD) treatment
• Level of care evaluations
• Impaired Driver Service Provider (IDSP) therapy services (appointment required for IDSP services and based on clinical availability)
• Evaluations for MLADC (Master Licensed Alcohol and Drug Counselor). NOTE: appointment required for MLADC evaluations and based on clinical availability.

Eligibility:

Adults (18 years and older) looking for substance use outpatient treatment (alcohol use, opioid use, methamphetamine use, etc.)

Contact:

Call the main Choices office at 844-524-6673 or walk in at 42 Pleasant Street, Concord, NH.

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 51���� 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.”

Today is The Great American Smokeout, the day dedicated to encouraging people to become tobacco and nicotine-free. At Riverbend, we are using this day as the launching point for our new Tobacco and Nicotine-Free Facility Policy.

The policy will ban the use of all tobacco and nicotine products (excluding nicotine-containing smoking cessation aids) within all properties owned, leased, or occupied by Riverbend. This includes parking lots, vehicles parked on the premises, as well as surrounding green space.  The policy will go into effect at several sites on January 4^th, 2021 and will be rolled out across all programs by March 1^st, 2021.

Through implementing this policy, our goal is to provide a healthy and safe environment for employees, clients, and visitors and to promote positive health behaviors.  While we know this may not be easy, it is central to continuing Riverbend’s mission of caring for the behavioral health of the community.

If you have been considering quitting, now is a good time to quit! Talk to your primary care provider or behavioral health team about medication and other support options.  You might also visit quitnownh.org or call 1-800-QUIT-NOW to be connected to a Quit Coach, medication, and other help.

The following should answer common questions about our tobacco and nicotine-free policy. If you have questions or concerns, please email us at development@riverbendcmhc.org.

Why did we do this?

As behavioral health providers we are committed to maintaining a healthy environment for those we treat and to promoting healthy behaviors.  Eliminating exposure to second hand smoke is one step further towards this goal.

This means all nicotine and tobacco products (other than nicotine-containing smoking cessation aids) are prohibited in Riverbend facilities and on its properties. This includes cigars, cigarettes, pipe smoking, smokeless (chewing) tobacco, e-cigarettes, vapor nicotine products and all other tobacco products.

There is no legal right to smoke or use vapor products. On the other hand, companies have a right to create a tobacco-free environment within their properties and facilities. This initiative is consistent with our goals of supporting good health and wellness.

If your car is parked in a Riverbend owned or leased parking lot, you cannot smoke or use tobacco or nicotine products because the lot is part of our tobacco-free zone.

Our policy is specific to Riverbend owned or leased property and does not include public sidewalks or other areas.  As good neighbors, we ask that both staff and clients are respectful of the adjoining areas and do not litter.

Clients will be screened for tobacco use at intake and throughout treatment so that their treatment team is able to help them access services without usage.  If desired, this might support accessing tobacco and nicotine alternatives. Both clients and staff will be offered resources to assist them with complying with this tobacco and nicotine-free facility policy.

Can clients go off campus to smoke or use other tobacco and nicotine products?

Clients are expected to remain on campus for the duration of their appointment, including groups.  If they need support to comply with this policy, they should discuss this with a member of their treatment team.

Why shouldn’t smokers continue to be allowed to smoke in designated areas?

Secondhand smoke contributes to respiratory infections, asthma, bronchitis, and pneumonia. There are many people who walk through the doors and parking lots to all Riverbend facilities and have been breathing in smoke. We need to provide a clean and safe environment for people visiting the Riverbend facilities. Eliminating tobacco use on our campuses also supports those who are trying to quit by reducing the triggers that make quitting tobacco difficult.

By TEDDY ROSENBLUTH

COVID-19 swept through New Hampshire leaving friends separated, stores closed and more than 100,000 people unemployed. It seemed like the perfect storm for mental illness. Yet, even during the height of the pandemic, helplines and crisis centers were eerily quiet. “We’re sitting here going, okay, where is everybody?” said Karen Jantzen, the vice president of community affairs for 51���� Mental Health. Historically, economic recessions like the one caused by COVID-19, have led to dramatic increases in the need for mental health resources.

Within a year of the 2008 recession, mental health needs were four times higher and suicide rates increased 13%. But these effects don’t always happen immediately. Ken Norton, the executive director of NAMI, a mental health non-profit, said trauma often does not manifest itself right away. Rather, it’s often cumulative and can present itself weeks or months later. “People with mental illness manage to hold it together for a while and the fallout tends to come afterward,” he said. “People always talk about how difficult the holidays are for people with mental illness. When I was doing direct services, it was always mid-January when people would unravel a little bit.”

Now, Norton said he thinks New Hampshire is beginning to see the fallout. In April, there were 100 more calls to Riverbend’s crisis line than in March, the highest volume of calls the hotline had seen in more than a year. Sarah Gagnon, the vice president of clinical operations for Riverbend, said she thinks many people have struggled with mental health during the pandemic but have avoided seeking treatment for fear of contracting COVID-19. “Now people are calling us in crisis because they’ve neglected their mental health needs for too long,” she said. As the number of calls to the Suicide Prevention Lifeline gradually climbed throughout May, mental health professionals have started preparing for an influx of patients.

Riverbend and other mental health centers in New Hampshire are working on adding more staff to their mobile crisis team, which provides help to those experiencing psychiatric emergencies. Jennifer Mulryan, the director of Psychiatric Emergency Services at Riverbend, said she has reached out to her staff to ask them to be available at a moment’s notice to help patients. “We’re still waiting on that big surge,” she said. “There’s no real way of know if or when that’s going to happen.” Gagnon said she is particularly concerned for her clients who struggle with substance use. She said Riverbend has tried to expand resources to combat the high rate of relapse since the start of the pandemic.

Riverbend also partnered with NAMI to create a suicide prevention liaison who helps those younger than 25 and at high-risk for suicide. Gagnon said many children miss their friends and school as the virus forced classes online, which could put them at risk for mental illness. Gagnon said she is worried, like most other mental health professionals, that a surge in patients might strain an already underfunded system. “But right now we’re still able to serve people,” she said. “Our doors are open and we’re ready to serve our community.”

For Help:

■If you or someone you know is considering suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255.

■The N.H. Community Behavioral Health Association is an organization comprised of 10 community mental health centers throughout New Hampshire. The association serves as an advocate for a strong mental health system across the state. Call 225-6633.

■51���� Mental Health provides specialized behavioral health services for children, adolescents, adults and their families. Call 228-1600.

■NAMI N.H. is a grassroots organization of and for people of all ages, their families and friends who are affected by mental illness. Through NAMI N.H., you’ll meet other individuals and family members who have struggled with mental illness. Call 225-5359.

■For Substance Abuse support and resources, please call 211 to access The Doorway.

■Riverbend’s Crisis Line is 1-844-743-5748 ]]> 9702 /nh-gives-you-are-invited-to-join-us/ Mon, 08 Jun 2020 13:35:18 +0000 /?p=9675

We are living in uncertain times and dealing with long lists of unknowns right now – including when things will “go back to normal” and what “normal” looks like. The one thing we are certain of is that more individuals will be seeking mental health and substance use disorder service in the months ahead, and we will be here to ensure no one goes without treatment.