People who suffer from drug addiction and alcoholism did not intend, at any point in their lives, to have either of these diseases.
Some experimented as youngsters. Others had pain issues that required powerful medications. Still others have trauma or mental health issues, and were simply seeking some relief.
“They’re people like you and me. They’re people getting up every day with families, with jobs, with lives,” said Barbara Royal, the director of the Open Door Recovery Center in Ellsworth.
Open Door offers adult and adolescent substance abuse programs on an outpatient basis, regardless of a client’s ability to pay. In addition, the center is the service provider for the Hancock County Adult Drug Court to provide treatment for defendants who are diverted from incarceration. Open Door counselors provide a recovery program at the Hancock County Jail, and prevention and treatment programs at a number of middle and high schools. The center has a contract with Maine Coast Memorial Hospital to provide drug detoxification services to treat withdrawal symptoms and support recovery. And the center provides safe, supervised housing for up to two mothers, with their young children, who are in recovery.
While some might consider drug addiction to be a choice, Open Door regards addiction as a primary disease. Treatment follows the medical model, incorporating multiple methodologies and the philosophy of Alcoholics Anonymous, Narcotics Anonymous and Al-Anon for lifelong support.
Open Door is located in a one-story, non-descript building that could almost pass for a small home. In her cramped office, Royal is surrounded by a desk piled with papers and bright posters and pictures on the walls. She is endowed with a friendly and welcoming presence. Initially, she is distinguished by the thoughtful discussion she offers about her work. Soon, though, it becomes apparent that her truly, if more subtly, distinctive trait is her laser-like focus on the other person in the room: She is instantly attentive to the slightest shift in any facial expression that may indicate the other person is about to speak.
Her listening skills are joined with her understanding of addiction recovery.
“I’m not going to say there aren’t things in my personal background that aren’t relative to what I do,” she said. “It allows me, I think, to have a lot of understanding and insight that I consider to be a blessing. And it’s certainly an avenue into the hearts and minds of the people who walk through that door.”
Royal refers to addiction as an entity, or a monster, that lives inside the addict and takes his or her over mentally, physically and spiritually.
“It’s like having a person in your life who’s very powerful,” she said, “and part of what allows that person to be powerful in your life is their personality and how they approach you. The disease works that way. It holds the individual hostage through that power. Until the individual can truly recognize that that’s an illusion, they really are sick. And they really can get well and this thing they have is treatable.”
Royal has been with Open Door since its founding, in 1984, by William Hills.
“Bill recognized that this area needed a treatment center,” she said. “He had a lot of foresight. There were services here but not enough to cover the needs. So he looked ahead and saw that there were things coming down the road. And he was particularly concerned about the adolescent population.”
During its first 15 years, Open Door was located at St. Joseph’s Church, also in Ellsworth. Royal started out in the front office and eventually received her license as an alcohol and drug counselor. She became instrumental in running Open Door. So, 11 years ago, when Hills was diagnosed with lung cancer, he asked Royal to take over the agency for him upon his death.
In 1999, Open Door moved to its current building at 8 Old Mill Road in Ellsworth (667-3210). An addition was completed in January 2006, which provided new office spaces and a new group room.
When Hills founded Open Door, Royal said, the primary drug of choice was alcohol; more than three-quarters of clients were alcoholics.
Seven or eight years ago, she said, Hancock County was hit with an “opiate epidemic.”
“We saw it coming,” she said. “We saw it drifting from Washington County and from the south toward Hancock County. When it hit, it hit pretty hard. There were a number of overdose deaths in very young people. Our clientele tripled at that time.”
The epidemic remains, she said, and it continues to hit young adults the hardest, primarily in the age range of about 17 or 18 to 25.
In response, the agency tripled its staff. A year ago, funding cuts forced them to reduce staff.
But the number of clients hasn’t decreased, she said.
Opiates include prescription medication such as Vicodin, Percoset and Oxycontin, as well as the illegal drug heroin.
Many clients, said Royal, become addicted to opiates through the use of medications that are legally obtained through prescriptions to treat pain issues.
“The tolerance builds so quickly that they begin to need more, and it starts a vicious cycle,” she said. “We see a fair amount of that.”
Some people progress to heroin, she said. Others progress not to a different drug but to buying the same medication illegally because the prescription is not adequate for their increase in tolerance.
“Now we have somebody who’s involved in illegal activity and also struggling with the addiction – and, oftentimes, with the loss of a job or the danger of losing a job, with the danger of losing their marriage or their relationship, and with the danger of losing their children.”
The “vicious cycle of addiction,” she said, can happen to “really good people, people who want to be good parents, people who really love their children. But the addiction is so powerful that they are not able to parent appropriately and they end up, often, losing their children temporarily. They lose their ability to be present for other people. They lose their ability to be responsible, and to follow through, to be accountable.”
Unfortunately, she said, one of the symptoms of the disease is to blame others for their situation. It can be difficult to persuade addicts that change needs to begin with themselves.
“I use the word hostage a lot in this situation,” she said, “because it really is like being blocked in, with somebody standing over you telling you what you will and will not do. And that’s really how this disease works. It takes control.”
Other addicts were introduced to alcohol and drugs at a young age. Either they were raised in households where substance abuse was the norm, or they discovered drink and drugs with friends. In some family or peer cultures, Royal said, it is considered almost a rite of passage or a sign of manhood to consume drink or drugs.
Youngsters are susceptible not only to cultural influences. Royal said that, in her experience, younger people tend to addict more quickly to opiates.
Initially, she said, addicts don’t feel like hostages. Whether they’re youngsters who are experimenting or people who suffer from physical or emotional pain, the goal is just to feel good.
“There’s euphoria,” said Royal. “It allows people to forget and escape. It gives an illusion that everything is going to be okay for a while.”
For kids who experience trauma, abuse or neglect in their own home, drugs offer instant relief, said Royal.
“That is going to be so appealing for a kid who is facing that dilemma every day of their lives,” she said. “They are going to want it as often and as much as they possibly can. Then there are the kids who aren’t necessarily dealing with any trauma, neglect, or abuse, but might just be kidding around, experimenting, they’ve got a buddy who says you ought to try this, this is great. Unfortunately, because people do tend to want to feel good, that high is very appealing, that euphoria is very appealing. When you’re a kid, it’s like going on a roller coaster; it’s a blast. And kids don’t know that they’re not in control of what their body and brain is going to choose to do now. They could be coming from a very stable and secure family, but if that addiction comes in, they’re in for the ride of their lives.”
Obtaining drugs illegally is easy, she said. Many small-time dealers, selling drugs out of their living room or the back of their car, are simply trying to make enough money to support their own habits.
“It’s not hard to find a dealer on the street,” she said. “All you have to do is hang out downtown, maybe go to some of the local places where you see people frequently, hanging around. It isn’t all that difficult to find someone who will sell. People who are addicted know how to observe and they know what to look for, and there are certain characteristics and behaviors that indicate that other people are into what they’re into. So it isn’t all that difficult to find a dealer.”
Ironically, she said, this underworld of activity is often filled with good intentions.
“There is this illusion, in the using world, that if one addict gives drugs to another addict, that they’re actually being a good friend,” she said. “That is one of the challenges for people who come into recovery, because they have, oftentimes, spent a fair amount of time in that circle. Those individuals have become their family, their friends, their connections. So one of the greatest challenges, for people who are trying to get well, is to cut all of that off.”
Eventually, she said, some addicts either realize that they want to get help, or they’re forced to get help.
“Sometimes, people come to terms with it on their own,” she said. “They become very soul-sick and lost. They lose who they are. There are some people who recognize that things aren’t okay, this isn’t okay, my life’s not working, I’m not able to function and I’m losing people I love. They start to recognize that the bottom is falling out. And they say, to someone in their life, ‘I need help.’”
For those who are forced to get help, it is usually in order to get back custody of their children or to stay out of jail.
Open Door, Royal said, tries to reach as many people as they can, in either situation. Today, Open Door serves an average of 60 to 65 clients per week through its various programs, plus walk-ins. About 20 percent of clients come from Mount Desert Island.
Royal estimated Open Door’s success rate for the treatment of alcoholism at 65-75 percent, and for opiate addiction, about 40-50 percent.
One obstacle to successful treatment, she said, is the client’s living situation.
“When we have people living in environments where addiction is active, it’s very difficult to sustain recovery,” she said. “The population facing the greatest challenge with regard to environment is kids. If they’re living in a drug-addicted home and they’re underage, where else do they go?”
For Royal, the work is not about addiction. It’s about people.
“We’re big on loving people here,” she said. “We really, truly do love these people, and once they get in they start to feel the true compassion that we have for them. We do care, we respect them. When addicts walk through this door, they’re not, in our eyes, addicts. They’re people. And they have a disease that’s treatable and we are fortunate that we can be part of the solution.”
And, she said, it’s not about helping just one person.
“They say that, for every addict, there are 25 people indirectly affected and 10 people directly affected,” she said. “I believe that and I see it all the time. So if you treat the addict it has a big ripple effect. It goes way beyond the addicts themselves. It goes into the community, it goes into their jobs, it goes into the schools. It’s pretty far-reaching.”
There are many addicts who don’t stick with the program but, Royal said, she never loses hope.
“I personally feel that each chapter in a person’s life is meant to be a part of their life,” she said. “And whatever events that might be happening in this chapter are part of their story, part of their destiny. So for me, it’s not crushing. I don’t leave work feeling heavy. I actually leave work feeling hopeful. Even when a person comes in and they choose not to stay, and when they leave I know that bad things are going to happen, my prayer for them as they leave – as those things happens, and they always do – is that those things are things that will actually turn them around and lead them back in the door again. And that does happen, a lot. So sometimes it takes two, three, four times or more and eventually somebody comes in and they say, ‘This time I’m really going to stay.’”
She continued, “I know the miracle of recovery and I know that once the person accepts the gift – and that’s what this is all about; the gift is being handed to them; they have to open that hand, and they have to say, ‘Yes, I want that gift; give it to me’ – once they open their hand up and say, ‘Yes, give me the gift,’ that’s when things begin to change. We can’t force the gift onto them. But I love it that the gift is always ready. And I think that even the people who leave here – who either don’t complete the program or choose not to start the program – those people leave knowing that the gift is right here waiting for them. They leave with us still loving them, and they know that. We care about them. And so, how blessed am I that I get to watch miracles happen? How many people get to say that every day, at least once a day, I get to see part of a miracle? And I do, every day. And that’s not to say that I don’t also observe tragedy, because I do. But I also believe that the tragedy is a part of the chapter. And all we have to do is continue to have the hope and eventually, those thing will turn them around and bring them right back to us again.”
(Published in The Bar Harbor Times, Sept. 29, 2010.)