Lori Townsend: A full year of pandemic and economic stress combined with a lack of open therapy programs has made the work of staying sober, much more difficult.

But help is available.

Unknown: "It let me understand what addiction is, that this thing can't be prayed away.

That this is here for life.

And I met other people that I can manage it with."

Lori Townsend: How are Alaskans coping, and what treatment options are available to help them now?

We'll discuss the pandemic strain on those in recovery and the work to end addiction tonight on Alaska Insight.

The number of Alaskans struggling with substance abuse and addiction has grown over the last year, and all too often treatment options were either shut down or not available nearby.

A new recovery center that opened in the Mat-Su borough in November is giving people the tools they need to get back on their feet.

Alaska Public Media's Adelyn Baxter has the story.

Unknown: As the pandemic began last year, many substance abuse programs around the state sent clients home.

Other support services moved online or expanded telehealth options, but the need for inpatient recovery services didn't go away.

If anything, it's only grown.

Specifically in the Mat-Su Valley, you know, we've seen a surge of opiate use and methamphetamine use over the last couple of years.

Karl Soderstrom is the executive director of True North Recovery in Wasilla, the organization opened its fourth residential recovery program in November.

Soderstrom says even with the health concerns from COVID-19, they pushed ahead to open the facility as planned.

According to state statistics, drug overdoses increased significantly in the first half of 2020 compared to previous years.

In 2019, more than 100 people died of opioid related overdoses in Alaska.

You know, the fact remains that people are dying every day in this community and we felt like we couldn't wait any longer.

Soderstrom and many of his staff are in long term recovery themselves.

They understand the struggle to remain sober, and how issues like social isolation and job loss brought on by the pandemic can compound existing substance abuse problems.

The new facility has 15 beds.

Residents spend four months living in a communal setting, attending group meetings, classes and one-on-one sessions with trained counselors.

We closed down a lot of things but the pipelines of narcotics coming to our state has not slowed down.

Alaska has more than two dozen residential treatment facilities throughout the state.

Many of them accept Medicaid, but available beds are often scarce.

And waitlists can be several months long.

This is where we do our process group with the mornings.

We get up and we speak to and just tell what's going on and and get to let it out.

After struggling with alcohol and drugs his entire life, James Grim arrived four months ago at True North Recovery's residential program.

He says as a contractor who worked independently, he could usually hide his addiction.

But the stress of the pandemic led him to relapse last year.

In a way, he says it was the best thing that could have happened.

I ended up in here, and that's why I saved my life.

It let me understand what addiction is that this thing can't be prayed away.

That this is here for life.

And I met other people that I can manage it with.

Grim graduated this week and moved into the transitional program.

He'll continue learning to manage his addiction while receiving outpatient support.

Like so many people in recovery, he looks forward to sharing what he's learned with others who are struggling.

There shouldn't be any shame for somebody to come into treatment and ask for help.

And, and I haven't felt any since I've been here.

As he transitions back to life in the community.

He also knows he has a support network to fall back on for Alaska Public Media.

I'm Adelyn Baxter.

Lori Townsend: We know that social isolation job loss and trauma are major factors that can drive people towards substance abuse.

It can also drive those in recovery to relapse.

Now that vaccines are more widely available and more federal aid is on its way, what is being learned about the longer term societal effects of the pandemic.

Joining me to help clarify that picture are Christina Love, a recovery advocate in Juneau, opioid misuse and addiction specialist with the Alaska Department of Health and Social Services, Elana Habib, and Tiffany Hall, the executive director of Recover Alaska.

Thanks all of you for being here today.

So, Christina, I want to start with you.

As someone who is working in the recovery world and in recovery yourself, what challenges have you seen this past year?

And what are you hearing from others about this additional stress that everyone's been under in this, now going on about 14 months?

Yeah, Unknown: thank you.

That's a really great question.

So prior to the pandemic, we know that access to recovery was difficult, as you know, as the interview said that we've always had limited beds and, you know, access to resources.

And Alaska is a really difficult thing for transportation.

And we know that people who are accessing services often have a lot of other difficulties, you know, whether they might be in poverty, they might not have access to identification or a birth certificate that are really needed to, to get that assessment.

And so all of those things are really compounded by the pandemic, you know, with the loss of some of those beds, and, and then resources changing.

I mean, before the pandemic of resources and knowing what resources are available is something that has been difficult.

And so, prior to the pandemic we were looking at, sometimes two to three weeks for an assessment.

Assessment is w at's needed for the medical mo el of, of recovery supports to access treatment, or groups or inpatient and outpa ient.

That just tells us wh t level of services people nee .

And then to actually get int inpatient treatment, we were looking at two to three to six onths.

And now some of those pl ces, we're looking at eight onths to a year t Lori Townsend: Alright, thank you for starting us off.

Christina.

Elana, I want to turn to you now.

Alaskans, for decades, have had higher rates of substance abuse issues.

I suspect that there's a lot of connections between our very high rates of violence and sexual assault against women in the state.

We lead the nation in that dubious distinction.

What can you tell us about the rates across the state when it comes to overdoses?

And how does that compare to recent years?

Unknown: We have had a astronomical year that is aligned with an upward trend and overdose deaths.

And so, in 2017, we had seen our worst overdose death rate at Alaska.

And then 2018, we had a fabulous year we had a 28%.

decrease in overdose mortality rates from the high in 2017.

However, in 2019, drug overdose death rates increased for most drug categories, resulting in a 29% increase in the overall drug overdose death rate.

In 2020, things look even worse.

We've had over 143 people pass away so far from overdose, that's a 19% increase for opioid overdose deaths during the same period, and during 19 to, 2019 to 2020, we saw 165% increase in synthetic opioid overdose deaths, which have a lot to do with what national trends are showing as well, that fentanyl-involved overdose does occur a lot more these days than they used to.

Lori Townsend: And you haven't been able I'm sure to see yet the numbers for 2021.

What are you anticipating?

Do you think this trend is continuing in a in a, in the wrong direction and an upward trajectory?

Unknown: So early to tell so far.

I think hopefully with the attention being emphasized on the recent overdose rate, we will have a better year.

I think COVID definitely.

It was tough to concentrate on more than just COVID this last year.

So we, I'm hoping that there'll be a lot more emphasis on between the communities and the state and federal level on addressing overdoses.

Lori Townsend: All right.

Alright.

Thank you.

Tiffany, your organization focuses specifically on alcohol misuse.

Do treatment programs differ for people struggling with alcohol then from opioids or other drugs, or is the treatment similar?

Unknown: Thanks, Lori.

treatment is different and similar, I would say I mean, starting from the beginning, one thing that is pretty different is around detoxification.

I have never had to detox from opioids.

But from what I understand, you know, one of the differences there is that when detoxing from alcohol that can be deadly.

Like if, depending on how dependent a person's physical body is on alcohol, they may need medical resources to make it through that detox.

Which I only say, to highlight that if a person is struggling, they really need to seek medical attention and help for that process.

Beyond that, I mean, some of the things that I think are true between the two are that there is medication-assisted treatment for both, it's far more known for opioids than it is for alcohol.

But there are a number of different medications to help with alcohol treatment, and to help people reduce and quit their drinking.

So I would encourage people to ask their providers about those options if they're seeking help.

And then kind of on the other end of the spectrum around recovery, I would say one thing that's really true is the need for community.

And the need to not be in isolation, as a person goes through treatment and various levels of treatment and staying in recovery.

And that's just a thing that has been really challenging this past year with the pandemic.

You know, usually we tell people to find a friend and to be with someone if they feel like they might be interested in returning to use.

And we haven't been able to do that as much this past year.

So luckily, people are getting really creative with virtual and online solutions and call-in solutions.

But it just has been an interesting challenge, I think for all of us to try to figure out how to meet the needs of people.

When we say we don't want them to be alone.

So for health reasons, please try to stay isolated.

Yeah, Lori Townsend: what a difficult quandary.

I want.

I want to follow up with you, Tiffany and then and then get Elana's thoughts also, does the distinction between alcohol being legal for adults and heroin?

Illegal use of prescription drugs like opioids, and then the drugs the new drugs that are coming on fentanyl and others?

Does that have impact on how people think about treatment?

Or about addiction?

Or how programs are funded?

What does it make it easier or more difficult to help people see their way into treatment and to convince policymakers that this is worthy of supporting?

Unknown: Absolutely, that's a really great question, Lori.

In fact, one of the things I often tell people, when I'm asked why Recover Alaska focuses on alcohol instead of alcohol and other substances is because of the extremely different social norms there are, and the example I often use is that, you know, there's no kind of socially permissible amount of meth to do at the dinner table.

Whereas if you don't have a glass of wine, people usually ask why not?

The question is always 'why aren't you drinking?'

The question is never, why are you drinking.

And that distinction really makes it critical for Recover Alaska to focus on alcohol and to keep alcohol at the table.

What we know is that so often, people begin to use or misuse other substances after engaging with alcohol.

What we know from a lot of those deaths that we see from other substances is that a significant portion of them also have alcohol in their system.

And because it is permissible, and because everyone grew up with kind of different norms around alcohol, maybe being allowed to drink with their parents before they were 21.

Or, you know, just the, the regular, the regularity with which alcohol is seen as a tool like, Oh, you got a promotion, let's celebrate with drinks, right?

Oh, somebody in your life passed away.

Let's mourn with drinks.

Oh, you got broken up with let's rage with drinks.

You know, it's always kind of the go to solution, no matter what the emotion or cause is.

And so, it is challenging to talk about how to work on prevention of alcohol misuse, without feeling like we want to take everyone's alcohol away.

You know, we're not an abstinence only organization.

We promote low risk drinking, we promote non-excessive use non-binge drinking, and it's just really challenging to do that without making people feel like we're judging them if they do choose to drink any amount of alcohol.

Lori Townsend: Absolutely.

Thank you.

And as you mentioned, it can be sort of this gateway to other drugs and is certainly A very dangerous combination when you combine alcohol and other drugs.

Elana, from your perspective, as somebody who runs a program, does it affect how policymakers look at these things, when you look at the distinction as we were just discussing, between alcohol being illegal substance for adults, and and these illicit drugs are not legal?

And there's more drama, perhaps around concerns around these drugs because of the terrible amounts of overdose deaths we've seen in recent years.

Is it harder to separate those things out and keep the funding robust for all those programs?

Unknown: It's a great question, I think we have to first start off by remembering that much of the opioid epidemic was prescription driven, it was all legal.

And so when we talk about legal versus illegal, when it comes down to it, people are coping with pain, and whether or not it's illegal or not.

And so sometimes people connect with different substances, depending on that person, or running or any other coping mechanism to ensure that they reduce their emotional and physical, spiritual pain that might be affecting them.

And so I think, I think that's the first thing to remember that.

Similar similarly to alcohol, we tend to have challenges with, for instance, co-prescribing of opioids and benzodiazepines, very legal or legal.

But combination of those two can be lethal.

So or be lethal, right?

Yes.

Yeah.

Lethal, yes.

So I think it's it's important to look at it in a context of potency and purity at the substances that we're using, and how we're using them.

In terms, I can't speak to what, how the legislators think of that these topics when they address their policies.

But I do know that we strive to ensure that Alaskans are healthy.

And to do that, sometimes we do incorporate items that that would support the health of Alaskans, such as education for providers and prescription drug monitoring, program, support and set tips around that.

So that's, that's what I can connect with you on on the legislative.

Lori Townsend: Sure.

And following up there, a bright spot has been the expansion of telehealth.

Tell us about how that has helped people during this time of isolation when they need support, even more than maybe in the past because of all the stress around the pandemic are unable to have not been able to until recently get together in person.

And telehealth has expanded so that people could access that give us some insight into into how that's helped.

Unknown: Definitely.

So I think that was a huge strength and over the last year where the emphasis on telehealth appointments.

We've had positive reports from providers that their services have been able to continue.

And it's primarily because of the telehealth.

transition to the telehealth was successful and providers have the technology and were able to support people served of accessing various platforms for services.

The state has been able to issue some grant flexibilities to can support the continuation of services along those lines.

And so we have heard, you know, anecdotal reports that there's more, there's no, more people show up to their appointments more because they're just clicking online.

So that's been very positive to hear.

Lori Townsend: Mm hmm.

Thank you for that.

Christina, I want you to follow up there.

Telehealth, as we just noted, has expanded opportunities.

But you talked about communities that have really worked hard to keep at least some meetings open for those who felt that the risk of death from their addiction outweighed the risk from catching COVID.

How did that shake out whether are there more people who would prefer in-person meetings to video conferencing?

Are you able to kind of parse that out?

Unknown: Yeah, it you know, when COVID first started to arise in March, there was a lot of protections that went into place we saw meetings closed down almost immediately, in a way that was within behavioral health as well as our abstinence-based programs like AA and NA and Narcotics Anonymous, Alcoholics Anonymous.

But then what we started to see was a lot of a lot of overdoses, a lot of relapses, and a lot of deaths.

We've had more deaths in the recovery community within the last year than I have ever seen.

And so it was really born out of urgency.

There were some programs that decided that they were just going to meet in the parking lot.

People started showing up in the parking lot, even though they weren't allowed in the buildings, some movement, some meetings moved to the beach, and, and then pretty quickly, even within some of the treatment programs, they started measuring out six feet of distance so that people could return.

Because, you know, they saw it, we know that, that the opposite of addiction is connection, it is community, you know.

And that a lot of people die in isolation, like, like Tiffany said that, you know, when we are warmer safety planning, we're doing harm reduction, we absolutely recommend that people get connected, you know.

Find a buddy, find a sponsor, you know, and, and, and have a community.

And that's it, you know, that's really the the biggest part, you know, in combating this, is those community connections and people doing whatever it takes, you know, to stay alive.

And it was pretty clear early on that, you know, that that people could get sick, you know, from COVID.

But they also could die in their addiction.

Lori Townsend: Mm hmm.

Following up on the connection issue, you work with survivors of sexual assault and domestic violence, and those who struggle with substance use, tell us about that connection between violence and addiction.

Unknown: So we have a lot of reports, the National Center on Domestic Violence, Mental Health and Trauma recently did a report in 2019, where they called and treatment centers and domestic violence agencies and we're seeing unfold.

So survivors that are accessing services for domestic violence and sexual assault 92, sometimes 100 of them seeking residential services are struggling with substance use.

And then on the other side, within treatment agencies, men and women, a majority of them have had some type of a history of physical or sexual violence in their lifetime.

But most predominantly, as from our statistics here in Alaska, we have, we show that women across the entire state, or that that one out of two have experienced physical violence, sexual violence double.

So that's every single woman you know, in in Alaska has experienced physical violence, sexual violence, or both.

And if you are an Alaska Native person, that increases by 85%.

So we have some villages where we show a 100% of an entire generation of children that experiences sexual violence.

And so the connection between that is that we have a ton of reports whether that's Patrick Sidmore's recreation of the Adverse Childhood Experiences, that shows that of people who have been physically or sexually harmed, 70% of them turn to substances.

And we've known that.

When we talk about addiction, we, a lot of people say that trauma is the underlying cause.

And the truth is that substances are easy to access, and they work really well if, if you don't want to feel, right?

I mean, that that's, that's what pain relievers are.

And and you know, the other point is that it is that addiction is a you know, it's a reaction.

I mean, often when we're taking away the substance is that is it.

That's, that's only part of the the full continuum of care and that the end of that, that there are stages of addiction, that's just one part of it.

Not using not using the substances, the other lifelong recovery is looking at what brought people to us in the first place where you know, what was in place.

Lori Townsend: I want to get Elana back in here, we only have a minute or so left.

And Elana, following up there on this, this intersection between violence and substance abuse.

As I said, in the beginning.

Alaska suffers from the highest rates of sexual assault and violence against women of any state in the nation.

And we also have higher rates of substance abuse, how, what do you know of how the Department of Health and Social Services and the state, state leadership thinks about these connections and how to address them?

Unknown: We are definitely involved in a variety of efforts regarding trauma informed care, and just ensuring that in everything we do, we really support people's understanding of how trauma may affect that particular condition, you know, how it might have led to that condition, whether it's obesity or crime, or whatever it is, you know, a lot of times trauma is behind, and that people are in pain.

And sometimes people hurt, hurt when they're not healed, you know, or they hurt themselves and they're not healed.

So we've done a lot of different kinds of things.

We've supported funding for the public safety partners and the emergency responders overall, to get trained up and Mental Health First Aid.

Our Department of Education & Early Development has done a lot of work with trauma-informed care to support their teachers in understanding trauma.

And our Department of Workforce and Labor Development has also done a lot of work regarding ensuring a workforce that understands trauma.

Please feel free to check out our report, we have a report on this.

Alright, thank Lori Townsend: you so much.

We have to leave it there.

We'll have to come back and talk about these things again and delve more deeply into that trauma aspect because certainly, there's a lot there to unpack.

The pandemic has tested our systems and our very resilience in ways we never imagined.

But for those struggling and their loved ones, it's important to know that help is available and access is increasing.

That's it for this edition of Alaska Insight.

Be sure to tune in daily to your local public radio station for Alaska Morning News and Alaska News Nightly every week night.

Be part of important conversations on Talk of Alaska every Tuesday morning, and visit our website alaskapublic.org.

for breaking news and reports from across the state.

You can also sign up for our free Daily News Digest there so you won't miss any of the top stories of the day.

We'll be back next Friday.

Thanks for joining us this evening.

I'm Lori Townsend.

Good night.