Substance use disorder affects both urban and rural communities. National health data shows that addiction has a particularly significant impact on rural areas. People in rural communities have higher rates of alcohol, tobacco and methamphetamine use compared with those in urban areas, though rates of opioid misuse are similar. But rural areas also often lack the support and recovery services available in larger communities.
Community Counseling Solutions provides mental and behavioral health services for five counties in Northeast and Central Oregon, including Grant County. Clinical director Thad Labhart joins us to talk about the challenges of providing those services across a wide swath of rural Oregon. We also hear from Sarah Brown, a peer support specialist at the CCS office in John Day.
This transcript was created by a computer and edited by a volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller, coming to you this week from Grant County, from Canyon City and John Day. We’re going to turn now to substance use disorder. It obviously affects people in urban and in rural communities. But national data shows that in some ways addiction can have a bigger impact on rural areas. People in less densely populated places have higher rates of alcohol, tobacco, and methamphetamine use compared with those in larger cities. At the same time, rural areas often have fewer support and recovery services. Community Counseling Solutions (CCS) provides mental and behavioral health services in five counties in Northeastern and Central Oregon, including here in Grant County. Thad Labhart is the clinical director of CCS. He joins us now along with Sarah Brown, who’s a peer support specialist at the CCS office in John Day. Welcome to you both.
Thad Labhart: Thank you.
Sarah Brown: Thanks.
Miller: Thad, I mentioned some national trends in terms of substance use disorder, higher rates of meth use, for example. What stands out to you in the numbers, or the rates, in the region that you serve?
Labhart: Well, you’re correct. The rates for alcohol and tobacco use tend to be a bit higher in eastern Oregon when you compare them to the state average. But when you look at methamphetamine or opiate use, it depends on the county. Oftentimes it can be lower depending upon local culture or other factors.
But what really stands out to me at the state level and national level is the opioid crisis. Nearly five Oregonians a week die from opioid overdose. That’s almost one a day. It’s a pretty powerful statement to where we’re at with substance use in this country right now.
Miller: Have you seen an increase in the need for your services in recent years?
Labhart: Absolutely [Deep Sigh]. Oregon is pretty treatment friendly when you look at it from a state perspective, but the needs always been there. There’s been a lot of resources allocated more recently and we brought on a number of additional staff but the number of people that need treatment, that are walking in the door, especially on a crisis level, a more acute level, is larger than it’s ever been.
Miller: Sarah Brown. How did you become a peer support specialist?
Brown: Well, I’ve been interested in mental health and addiction studies for a very long time. I remember reading psychology books when I was 10 and I moved back to town a couple of years ago…
Miller [Interjecting]: …After growing up here.
Brown: After growing up here.
Miller: Living in other parts of the Northwest for a while…
Brown: And others coming back too, at various times over the years. I mean, I love my job. I really didn’t even know this job existed until I moved back. Just the idea of helping people regain their lives is really inspiring.
Miller: What’s an average day like for you?
Brown: Well, I don’t spend a lot of time in the office. My job is basically… when a client sees a clinician, they have a treatment plan and I help them implement these aspects of their treatment into their daily lives. So some people just need to get out. So I’ll take people hiking, I’ll take people to the gym. Some people have really bad social anxiety, so we’ll go to the Senior Center for lunch. It varies depending on the client, entirely.
Miller: Is this led by you, this idea of getting out or did you do work in an office, and at a certain point, it just seemed like it wasn’t as effective?
Brown: Well, being a Peer, you have that opportunity to get to go out into the community.
Miller: A Peer, I should say, we’ve talked about this before but in case people have forgotten or are unfamiliar, meaning that you have your own lived experience. In this case, with substance use disorder.
Brown: I do. Yes.
Miller: So you are a Peer to the people who you’re helping.
Miller: So you’re saying that that gives you more insight into the need to maybe get out?
Brown: I think it kind of gives clients... like they tend to connect more with me. Especially when we’re not in an office. Not everybody wants to go to an office and talk about their problems. In my experience, when you’re doing something else, just taking a walk by the river even, it puts your brain in a different space and you get to see a part of your client that you don’t necessarily see sitting in an office, in a chair.
Miller: Another part of it is… it reminds me because we were just talking with Maddie Bailey and Morgan Walker. The students in the previous segment about looking people in the eye and how important that can be and as a skill. But one of the things about going for a walk or driving around is that you’re not looking at each other, you can have sort of heart to heart conversations without sometimes the stress of literally looking at somebody.
Brown: That’s really true. Yeah, especially for people that have significant anxiety.
Miller: And how much does your own experience with addiction and recovery come up? I mean, I assume that your clients, by virtue of your title, a Peer Support Specialist, they know that you have some experience. But how much do you actually talk about it with them?
Brown: Well, it depends on the client, again. It’s not my job to tell my whole story. But it is usually important to let them know I have been through this myself. If they ask me questions, I’m honest about it, but self disclosure is something that just needs to be used effectively depending on the client. Some people like more, some people need less.
Miller: Thad, going back to you. You mentioned that the need has increased in recent years. Staffing has been an issue in so many sectors of society, especially because of the pandemic. What has staffing looked like for you? I mean, are there people that you can hire?
Labhart: Sure. In short, the nation is experiencing a workforce shortage. It’s not specific to behavioral health. Many listeners can relate to that, business owners.
For us, it really depends on location and the nature of the position. If you take our mental health clinicians, or some of our mid-level clinical mental health supervisors, they’ve been extraordinarily difficult to recruit for because the need far exceeds the supply. Much could be the same on the substance use disorder treatment side. Some of the barriers are really driven by administrative rules in Oregon are less on the substance use side. You don’t have to have a master’s degree or be licensed and oftentimes it can be an entry-level position, same for peer support specialists.
We’ve been lucky enough on the substance use side to remain relatively well-staffed. But of course, at times, there’s challenges. Especially in our smaller communities like John Day, if Sarah or another counselor or another Peer were to leave, that can constitute a large percentage of the SUD Staff [Substance Abuse Disorder Staff] in one of those small offices. So coverage sometimes can be difficult.
Miller: Does that weigh on you, Sarah? I mean, knowing that if you were to leave to go somewhere else, it may be a while before somebody else would actually do what you’re doing?
Miller: You think about that?
Brown: Yes, I do. Because my clients are important to me and I wouldn’t want to just hand them off to anyone. Yeah I mean, I myself am getting a master’s and in the future will move out of my current position and it does very much haunt me somewhat.
Miller: Move out of your current position, move up and take advantage of this advanced degree. Do you envision that you would stay in John Day?
Miller: Ok. Unlike Morgan and Maddie. But you’re somebody who went away and came back. I’m curious what was going through your mind when you heard these two high school sophomores definitively say, ‘Things could change,’ but right now they’re saying, ‘We’re out of here, give us two more years and we’re done.’
Brown: Yeah. You know, I graduated from Grant Union.
Miller: We’re just 200 feet away from there.
Brown: Yeah, I had the same attitude. As did almost everybody in my class and I’m not gonna lie, a lot of us ended up back here and I heard them say, ‘There’s not a lot of opportunity here.’ In my experience, there’s loads of opportunity here.
Miller: Huh. What do you think that they’re not seeing or that you didn’t see 20 years ago, or whatever it was?
Brown: I guess, just from personal experience, I’ve lived in bigger cities and I feel like I was lost in the crowd. Here I can make a significant difference, a noticeable difference. I’m really involved in the community and that feels really good and that’s really important to me. Again, at least at CCS, I have loads of opportunity. It’s a great place to work.
Miller: What you’re talking about, it really does tie into this. The specific issue that we want to talk to you about, which is substance use disorder and help, because one of the hallmarks of life in a small community like this is that it seems like everybody does know everybody and you can’t help but sort of be in each other’s business. What does that mean for people who are seeking help? What does it mean for the services you’re providing?
Brown: There’s definitely an ‘us and them’ mentality.
Miller: Who’s ‘us’ and who’s ‘them’?
Brown: Well, speaking to addiction-specifically users, people who are not using, and because it’s such a small community and it’s very divided and everyone’s up in everyone’s business. Because of the housing crisis, getting sober is very lonely and difficult. It’s very lonely and difficult because people don’t have a house, it’s nearly impossible to get sober while you’re living on your drug dealer’s couch. There’s not the supports that there are in bigger cities. If you’re gonna get sober, you’re gonna likely be alone. It’s not like you can just snap your finger and move to the other population of non-users in town and just slide right in there.
Miller: It also, is it the case where you’re trying to get sober in a place where you’re surrounded by people, maybe bridges you’ve burned, or people who have known you when you were using and they’re sick of you?
Brown: M-hm. There’s a lot of that. Yeah.
Miller: So how do you deal with that? Just professionally? And it seemed like when you said, ‘it’s hard for somebody to get sober, if they are living on their dealer’s couch,’ that didn’t seem like you were making that up. It seems like that’s literally that, that is a reality. How do you help somebody in that situation?
Brown: Well, we have a lot of housing programs and sometimes they’re very helpful and get people back on their feet. But there’s a lot of rugged individualism in this county and although it’s not always a benefit, it can be and sometimes there’s help in places where you wouldn’t expect.
Miller: What’s an example that you’re thinking of?
Brown: One example that I can think of is religion is one way that some people find support in their recovery process. There’s a lot of resources that are kind of nontraditional, that you can get through various religious organizations. I’ve seen people get assistance and find other options. Not necessarily their own house, but some better options that aid in their recovery.
Miller: Thad, you’re looking not just at Grant County but four other counties in Central and Northeastern Oregon. How much overlap do you see between the issue of substance use disorder or behavioral healthcare issues more broadly and the housing crisis. Which is, at this point, a statewide crisis?
Labhart: A tremendous overlap, substance use disorder, mental health issues, anybody that struggles with either or both of those, they’re already facing a number of challenges, right? So when you look at the same marketplace for housing that everybody’s facing, there’s an uphill battle. Some of that funding that I referenced earlier from the state, whether it be legislative direct allocation or maybe Measure 110 funds for housing. We’ve had to take a large look at how to best roll that out. Is that purchasing properties? Is that looking at rent-offset, housing vouchers, short-term versus long term?
We now have a pretty complex and robust system - if you come in and need help with housing, we make a referral. Anybody can make a referral, it goes through a level of filters. Oftentimes, you have to be engaged in services with us initially and we’re gonna try to help you out, but it’s really individualized. It’s based on local, political and community factors that we have to balance with, as well as housing and treatment, there’s a huge overlap and oftentimes housing or even employment isn’t discussed when it comes from a treatment perspective, even though those are huge sects of what we do.
Miller: Just briefly, Sarah, what’s a good day for you? You have about a minute left. What’s a good day as a peer support specialist?
Brown: Oh, a good day... Well, helping a client get paperwork done. Because paperwork is a looming thing for most clients. Getting outside, just generally connecting with a client where they can solve their own problems.
Miller: Sarah Brown and Thad Labhart, thanks very much.
Brown / Labhart: Thank you.
Miller: Sarah Brown is a peer support specialist at Community Counseling Solutions’ John Day Office. Thad Labhart is the clinical director for CCS.
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