Rosalie Nadeau compares addictions counselling to cancer treatment.
“When you can catch people in the early stages of alcoholism and drug use the cure rate is high,” she said. “If it’s later on, it’s real trouble.”
Nadeau is the director of a treatment facility in Anchorage, Alaska, that offers short- and long-term help to addicts.
The Akeela Treatment Facility sees more than 1,000 people through its doors in any given year, many of whom are registered in Akeela’s outpatient program. The success rate for these patients is as high as 80 per cent, said Nadeau.
Unlike 28-day “spin-dry” programs, the four-month program offers more ongoing support to users, said Nadeau. In the Yukon, Sarah Steele’s 28-day program is the only government-funded option for alcoholics looking for sobriety.
The reason 28-day programs are so commonplace these days is not because of science but because of the insurance industry, said Nadeau.
When insurance companies began covering alcohol treatment in their policies they wanted to put a limit on how much they’d pay out to their clients. In the end, it had more to do with money than medicine, she said.
“Your average 28-day program doesn’t cut it,” she said. “All you’re doing with a 28-day program is detox.”
Outpatients at Akeela complete anywhere from nine to 20 hours a week of group treatment. Most patients have been referred to Akeela following an alcohol-related offence, like drinking while driving. But there are others who voluntarily register for the program when they realize their drinking is getting out of control.
The program shakes them up a bit so they take responsibility for their addiction, said Nadeau. Most times, she won’t see them at the facility again.
It’s the people in the one-year treatment program who are harder to turn around.
These are the addicts that have been chronic, heavy users for years. Only alcoholics that score 3.5 on the American Society of Addiction Medicine’s four-point scale enter the residential treatment program.
“Success rates with these people end up being considerably less,” she said.
The addicts in the one-year program are struggling with a variety of issues, the most pressing of which is housing.
A safe, clean living environment is one of the most important things a chronic user needs to clean up, said Nadeau.
“If you go through a treatment program and you don’t have a job or a place to live, you’ll just go back to where you were before,” she said.
That’s why Akeela offers housing to the 90 men and women undergoing long-term treatment in a given year. For mothers struggling with addictions, Akeela provides additional housing for 25 women and up to two of her children. They also provide daycare services for children while their mothers are in treatment.
Akeela is funded 60 per cent by the state and the rest is through private donations.
The one-year program isn’t free, however, patients can pay based on how much money they have. “A lack of income hasn’t stopped anyone from coming to the program,” said Nadeau.
Nadeau has been working at Akeela for 18 years and can list off the names of people who have become sober as a result of the one-year program.
The number of success stories isn’t particularly high, but they are what keep her going, she said.
Last month, Nadeau received a letter from a former patient who wanted to tell her she was finally clean.
The letter-writer used to be an addict and prostitute who was constantly landing in jail, said Nadeau.
Inside the envelope Nadeau found a graduation announcement from the University of Oklahoma where the woman, Suzy, had received a bachelor’s degree in social work.
“I think it’s a wonderful thing,” said Nadeau. “That’s what quality treatment can do.”
But even success stories can come with unexpected postscripts.
Sometimes addicts will go in remission, or worse yet, their children will end up in the same facility as them.
Nadeau is now starting to see the second generation of users pass through Akeela’s doors.
A woman who went through the one-year program recently committed suicide, said Nadeau. When she entered the program in her early-20s, she was no stranger to Akeela. She grew up as a baby in the treatment facility when her mother and father spent a year there getting sober in the ‘80s.
“It’s too bad because her parents got clean, but she ended up in treatment,” said Nadeau.
The combination of genetics and upbringing leads people down the path to addiction, she said. Add mental health issues to the mix and you have a veritable storm of causes.
For many of the in-patients at Akeela, co-occurring mental health issues are a big concern.
Chronic users often self-medicate depression and anxiety with alcohol, a substance that will itself compound the mental health issue, said Nadeau. Other times it works the opposite way; extended use of alcohol or drugs will bring out underlying illnesses that weren’t there before.
“The double whammy of mental health issues and substance use is really tough,” said Nadeau.
She estimates about 70 per cent of the patients in the one-year program have co-occurring mental health problems.
Before the clinic had a mental-health counsellor on hand, it was hard to keep people with mental issues in the program, said Nadeau.
“They used to be chased out because they didn’t conform,” she said. “Substance-abuse clinicians treated them as having behavioural disorders as opposed to mental health issues. They didn’t know what to do with them.”
In addition to short- and long-term treatment programs, Akeela also offers transitional housing to patients leaving the one-year program. They also offer counselling for seniors struggling with addictions, and inmates in six Alaskan prisons.
For each of the programs, the nonprofit has long waiting lists. “There’s a huge demand,” said Nadeau.
The 34-year-old nonprofit keeps growing and becoming more creative in their programming even though they know they can’t save everyone.
“We’ve had some really wonderful successes, and, yes, we’ve also had failures,” she said. “But all programs do.”
Contact Vivian Belik at firstname.lastname@example.org