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Each day at noon, roughly 45 people gather in the parking lot of Hope for New Hampshire Recovery in Manchester. In the evening, there are about 75 people in the parking lot. They’re there for a socially-distanced, outdoor 12-step meeting. The events are one of the few chances to attend a meeting in-person around the state since the pandemic shut down many gatherings.
“It’s really nice that meetings are able to be held, but because meetings are taking place in parking lots, folks don’t come in early and stay afterward nearly as much,” said Keith Howard, executive director of Hope for New Hampshire Recovery, a recovery community center that supports people who are sober.
Before the pandemic, there were 71 Alcoholics Anonymous meetings in Concord each week, Howard said, in addition to Narcotics Anonymous meetings. Now, there are only 16 AA meetings happening face-to-face, and only three each week that are in the afternoon or evening. Although many 12-step meetings have switched to a virtual format, many people need the in-person connection to thrive in recovery.
“For many of us, Zoom meetings are like trying to breath through a straw,” Howard said. “There’s enough oxygen to keep yourself alive, but not enough to feel comfortable. It’s the same with recovery through a screen.”
New Hampshire has one of the most severe addiction epidemics in the country. In recent years the state has made progress in fighting addiction: in 2018, the most recent year for which data is available, overdose deaths were down 4.1 percent, according to data from the National Institute on Drug Abuse.
But the state’s progress on fighting addiction is fragile, people in the industry say, and the pandemic threatens to upset the balance. Since March, seven recovery homes in the state have closed their doors, impacting access to sober living throughout the state. People in the industry are concerned that colder weather and continuing economic fallout from the pandemic might make the issue worse.
“For New Hampshire to move the needle, or even keep the needle the same and not keep progressively getting worse, it takes a village,” said Eric Spofford, CEO of Granite Recovery Centers, the largest provider of substance use disorder treatment in the state with roughly 400 beds.
“It literally needs everyone to be on the same page, chipping in and working on a common solution,” he said. “Look at COVID. We spent how many trillions to fight it? When the politicians and taxpayers want something they’re able to move mountains.”
Sober Living Industry Struggles
For many people getting treatment for drug or alcohol addiction, now referred to as substance use disorders, there are three steps to the process. In detox (now called withdrawal management), the person gets the substance out of their system. Particularly for opioids and alcohol, this can be a dangerous process and requires medical monitoring and medications to control symptoms including sweating to flu-like symptoms.
In treatment — often a 28-day in-patient program — people engage in education , counseling and often 12-step meetings. They examine the root causes of their addiction and learn how to cope with challenges without using drugs or alcohol. After treatment, some people choose to live in recovery homes — sober living facilities where they have accountability and support to help them stay on-track through early recovery.
In New Hampshire, detox and in-patient programs are covered by Medicaid. However, sober living is not. With unemployment up, many people have been unable to continue paying for sober living, which has impacted recovery houses in the state, said Kim Bock, executive director of the The New Hampshire Coalition of Recovery Houses (NHCORR).
Bock says that recovery houses are an often-overlooked, but critical part of supporting people who have experienced substance use disorder.
“When a person returns to their prior environment without the skills they need to [live sober], they end up back in active addiction and in treatment again,” she said, adding that research shows people are 60 percent more likely to achieve a year of sobriety if they attend a sober living facility.
While many people picture halfway houses, the modern recovery home is different, Bock said. The homes model family values, like building relationships, contributing to the household and being respectful. Although the houses provide important life skills, they are not viewed as medical treatment, so insurance doesn’t cover them.
“It would be a whole lot more economic of us as a society to pay for it,” Bock said. While a month of treatment can cost $40,000, a month of sober living costs $500-1,000, Bock said. “If you can keep somebody from cycling back into treatment, this is the much more cost-effective option.”
Recovery houses were hard-hit by the pandemic because they didn’t qualify for small business relief, Bock said. To try to buoy up the industry, NHCORR provided more than $80,000 in grant funding between April and July to individuals who otherwise wouldn’t have been able to afford sober living. That money, in turn, helped keep recovery homes operating.
“That really did help to support a lot of homes,” said Kristine Paquette, chair of the board at NHCORR and owner of The Homestead Inn, a 20-bed recovery home in Boscawen.
Paquette has been looking to expand, but has been unable to find an appropriate second property. Recovery homes need to be by public transit and close to entry-level jobs, like those in retail and service. New Hampshire housing prices in those types of areas have increased dramatically during the pandemic as people from out-of-state move in, Paquette said. In addition, few people are willing to open a recovery home during these uncertain economic times, Bock said.
Bock said that the closure of the recovery houses is going to mean more newly-sober people are housing insecure and at increased risk of relapse.
“There were not enough recovery houses before Covid, there are not enough recovery houses now, there will not be enough recovery houses in 6 months,” she said.
Making it easier for people to open recovery homes could help alleviate the shortage, she said. Gov. Sununu appointed a segment of CARES funding to incentivize building or expansion of recovery homes, but people who get the grants must have work complete by Dec. 30, a timeline that Bock said is unrealistic.
“To be able to get ahold of a house and refurbish it and open it as a recovery house before Dec. 30 is almost impossible,” she said. The state’s legislators are working to get a waiver at the federal level, but so far, the deadline stands, Bock said.
A shortage of beds, and increased demand
The shortage of beds isn’t just in sober living — it extends to treatment and detox facilities as well. Detox wait times can range from 3-6 weeks in the state, professionals who spoke with the Collaborative said. That’s particularly problematic because people with substance use disorder are often hesitant to get treatment and may change their minds if they have to wait.
“They don’t have the emotional capacity to wait,” Paquette said.
Medicaid reimburses detox centers $330 a day, which Spofford says is well below the cost of providing detox.
“That’s not enough to keep the lights on,” he said.
In addition, the state has very rigorous licensing requirements and building codes for treatment centers, which increases costs. The high costs and low reimbursements can drive people interested in starting a treatment facility out of the state.
“If you want to come in and open a facility, it is much easier in other places than it is in New Hampshire,” Spofford said.
Granite Recovery Centers is currently in the process of getting plans approved for a new 36-bed detox center for people with the most complex needs, referred to as tier 1 detox. Some of the beds will be reserved for Medicaid patients, but those beds will be limited because the company will operate them at a loss given the low Medicaid reimbursement. Most revenue will come from private insurance companies.
“The beds that we’re able to allocate for Medicaid clients will have an incredibly long waiting list,” Spofford said. “The operating cost per day per bed is significantly higher than the reimbursement rates.”
That’s despite the fact that in recent years the state has increased what it pays for detox programs. With the pandemic response cutting into state revenue, Spofford said further increases are unlikely.
“Asking for an increase when we’re going to lose millions is not going to get a lot of play,” he said. “It would be wonderful to expand services in the state, but I’m hoping that they don’t look to cut our programs and funding. That’s been a general anxiety in addiction treatment: we’ve made a little progress; we don’t want to lose that.”
Overall, 2020 has been the busiest year that Granite Recovery Centers has had. Each month, the business answers 5,000 calls from people inquiring about recovery services; there’s a waitlist for treatment beds.
“The shutdown and the isolation and the heightened stress response has brought in folks who may have had small to medium-sized problems, which this year have become very large problems,” Spofford said. “People had small problems that have blown up in their face this year.”
In addition, people who had been successfully sober are relapsing because of the stresses of the pandemic and lack of in-person support.
“We’ve seen more of that than we’ve ever seen,” Spofford said.
Despite that, he doesn’t feel that the addiction crisis is getting the same attention that it was four years ago, during the previous election year.
“It’s generally not being talked about as much as it was 3-4 years ago, but the problem remains the same size if not larger,” he said.
He’s hopeful that the state will continue to focus on addressing the addiction crisis, even during the pandemic.
“We owe it to children and next generations to take this opportunity and keep this from getting any worse,” Spofford said.
These articles are being shared by partners in The Granite State News Collaborative. For more information visit collaborativenh.org.