Taking a Toll: N.H.'s Gap in Services for Teens Struggling with Opioid Use

Sep 20, 2018

Credit AP

Morning Edition is taking a look at how the opioid epidemic is affecting children – and the people and programs who support them – in New Hampshire.

It's part of NHPR's Crossroad series, examining the impacts of addiction in New Hampshire.

Peter Evers is the CEO of Riverbend Community Mental Health, which provides a variety of services for children and families across that state. This includes treatment for children and families, and a substance use recovery program for teenagers. 

(Editor's note: this transcript has been edited lightly for clarity.)

The child isn't the problem in the family. Oftentimes they’re the messenger who's coming and saying there's something not right. So the days of parents sort of coming to us and saying fix my kid and then give him back is long gone. These are really interventions that build family strengths from the inside really. It's no longer about providing 50 minutes of therapy on a couch for people. It really is about saying everybody in this family is affected by this stage of the disease.

In the olden days, people would say things like well why don't you go and get yourself sober, then come back and we'll begin that working process with you on your mental health and those social determinants. We're really not doing that anymore. It's really an all in assessment of where the family's at, and provide those services so that we can stabilize and we can actually then begin to provide that treatment.

Does that stem from the idea that you can go away and get clean per se, but then when you come back, you're coming back to the same environment and you're going to have the same triggers?

That's exactly right, especially when you look at adolescence. [It's a] very different line of approach for that group. And for anybody who has been a teenager, or who has raised one, will know that oftentimes they aren't necessarily considering their mortality. They oftentimes don't understand the consequences of behaviors, which in the immediate moment are pleasurable, but obviously lead to addiction. So a lot of that work is about harm reduction. A lot of that work is bringing people in with treatment and making sure that the rest of their life can be straightened out.

Can you give us an example or walk us through the process of what happens when a teen is presented to you and has a an opioid addiction? What's the process?

Well oftentimes we'll get a referral from the court, or somebody might be having trouble in school and they're referred to us. So we have peer support specialists, as well as clinicians, who I think are really important. These are young people who are in the early stages of recovery by dint of their age who will meet them at the front door and immediately help them to become relaxed in this environment. There's a lot of stigma attached with getting treatment for this particular disease. So this is a no judgment zone if you like. It is a place where we can have a conversation about how you got here and how we can get out of this together, rather than judging people on some of the behaviors that they've indulged in in the past. There's a lot of work that goes on that is group related as well, run by peer support specialists. So these are people with lived experience who have conquered the disease of addiction and are role models for those people.

Are you seeing a rise in issues with children that have addiction problems because parents have addiction problems?

Yeah. I mean, I think children are at the sharp end of the addiction issue in this country, and certainly in this state when you look at how our state has really struggled with the opioid crisis. But oftentimes these are young parents who are struggling with the disease of addiction who have little ones who need protection. So this isn't just about providing substance use disorder services. It's about child protection services. Are they adequately clothed? Is there enough food in the house? Are they receiving services that keep them safe? And I think what we're learning nowadays, it is those adverse childhood events that happen early in life [ages] 0-5 that really pay a great deal of future prediction of how children will do in school and in life.

Time and again while reporting in this series, we've talked to people who have said that there is a gap in services. Can you tell us about those gaps [and] where they are specifically?

There just aren't enough specialty programs that can provide outpatient treatment to adolescents, and that's a huge gap. We started doing this a year and a half ago, and it's a small program. The way that these things are funded is very difficult because oftentimes kids don't always turn up for their appointments. They have other things going on in their lives, and oftentimes they're still involved in their addiction. So payment mechanisms make it difficult to keep kids in treatment if they're spotty and they don't turn up too many times. So we have to sort of move on to the next person and wait until they come back in. So I do think the structure of how addiction services are built is an impediment to the continued treatment for kids.

Do you see any willingness in Concord for that to change?

I hope so. I'm optimistic about it. One of the problems I think that we have in New Hampshire is that we rely on influxes of monies coming in for the federal government to support a crisis that we have right now. We mentioned the $44 million that is coming into the state, which is going to be a great help in terms of creating hubs for treatment. But in two years’ time we'll fall off a cliff financially because that $44 million will have been invested in the infrastructure programs. And when that goes away, what is our sustainability plan for that? And I think really until our legislature realizes that this is a long term fix that needs proper investment, rather than large influxes of cash over a short period of time, we'll continue to struggle with sustainability.