A silent crisis: A new era for treating substance abuse disorders in Eagle County

Substance abuse disorders are one of the most common health issues in the country and in Eagle County. In 2019, the Substance Abuse and Mental Health Services Administration reported that 19.3 million people over the age of 18, a full 7.7% of the United States adult population, struggled with a substance abuse disorder. Here in Eagle County, substance misuse has been the cause of 117 hospitalizations and 27 fatalities in the last five years.

Though substance abuse is categorized as a chronic disease that shares similar attributes to type 2 diabetes, cancer, and cardiovascular disease, data from the Substance Abuse and Mental Health Services Administration shows that nearly 90% of those that meet the diagnosis never seek treatment. A combination of stigma, limited access to resources and lack of education has allowed this often treatable disease to fester, making it the third-leading preventable cause of death in the United States.

In the five years between 2013 and 2017, Eagle County recorded a 330% increase in hospitalizations related to substance abuse, while recording a 465% increase in visits for anxiety and depression during the same time period. The numbers were jarring, and they woke up the community to the need for accessible and affordable behavioral health services in the valley.

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Eagle County is now at the beginning of a new era for treating substance abuse disorders, and a flood of resources and information campaigns are making a path to recovery more accessible than ever before.

Waiting for rock bottom

Substance abuse treatment has never been a priority in the United States’ health care system. Private treatment facilities provide comprehensive programs to those who can afford it, but for people lacking the time or resources, the most common institutions for addressing substance abuse, historically, have been the emergency room or the county jail.

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Dr. Casey Wolfington is a licensed psychiatrist who has been working in the field of behavioral health in Eagle County for 14 years.

“When we do not have the services to support behavioral health needs, especially substance use and abuse, usually what we’re dealing with is the crisis — that is, individuals who are directly involved with law enforcement or showing up at the emergency department needing pretty severe medical intervention,” Wolfington said. “The fact is that with any behavioral health concern, the emergency room or law enforcement isn’t the appropriate place to treat it. That is when people are the least motivated to engage in services, and they are not in a place to preventatively engage in their health.”

Like most rural communities, Eagle County has not had a robust system of behavioral health resources or specialists available in the valley.

“A decade ago, most people were struggling in silence,” Wolfington said. “Our primary care physicians and AA were basically managing all of the substance use concerns. Some people who had the flexibility to travel would go down to Grand Junction or Denver for more formalized treatment, but with the workforce challenges here, not a lot of people have that flexibility in their schedule.”

Even those who did seek some form of treatment often did not do so until their addiction had reached a level that was so severe that it could no longer be ignored.

Dr. Harlan Austin, currently a psychologist at Vail’s Howard Head Sports Medicine, is the former director of clinical operations at the Center for Dependency, Addiction and Rehabilitation in Aurora.

“People will put off lower levels of care because they can kind of manage, life is still going,” Austin said. “I would say 90% of the time it is an outside force, whether that be family, friends, work, or the law, that helps somebody get into treatment when it is already really bad. And it’s like any other diagnosis — the sicker you get, the bigger the problems are.”

The absence of affordable treatment facilities in rural communities is a huge barrier towards taking a proactive approach to substance abuse issues, but another major deterrent is the stigma associated with addiction.

“We have to work as behavioral health providers to overcome stigma to help people realize that it’s actually better to go in earlier, when you have a mild diagnosis rather than a severe diagnosis,” Austin said.

Austin noted that the stigma around addiction has become so pervasive that a reframing of how society thinks and talks about substance abuse disorders needs to take place not only in the social community, but in the medical community as well.

“When a diabetic goes to the emergency room, they don’t say they’ve got ‘dirty blood’ for sugar, they say their blood sugar levels are X, Y and Z,” Austin said. “But if you have someone who’s got a substance use issue and they go to the ER, they say they’ve got ‘dirty blood’ or ‘dirty urine.’ There is stigmatic language that’s attached to them, rather than, ‘the urine is positive for amphetamines.’ It’s talked about in a way that makes people not want to admit to it.”

Combine this stigma with a lack of accessibility to resources, and instead of reaching out for help, 90% of people struggling with addiction disorders turn inwards through silence, isolation and shame.

“Think about if 90% of people with a broken arm didn’t seek treatment? That would be alarming,” Austin said. “But there’s a lot of stigma attached to substance use disorder diagnosis, and so that stigma prevents people from seeking treatment. We need de-stigmatization campaigns to help people think about questions like, ‘What does your use look like? Can you change your relationship to your use?’ instead of ‘Don’t talk about it.'”

A new era for substance abuse treatment in Eagle County

After years of watching a steady rise in hospitalizations from behavioral health issues, the Eagle County commissioners decided it was time to take significant action.

In September of 2017, they called for a ballot issue asking voters to authorize a new sales tax on recreational marijuana for the purpose of funding mental health and substance abuse services in the community. The ballot issue passed with more than 73% of the vote.

As part of its mental health funding, the county established a 10-member council that recommends where the money should go from the tax collections should go. The council includes representatives from various programs, entities and facilities engaged in services, promotion and education.

That momentum also led to Vail Health’s $60 million, 10-year commitment in 2019 to address the behaviorial health crisis in the valley through the organization it created — Eagle Valley Behavioral Health. Vail Health also began a separate $100 million fundraising effort in Dec. 2019 through its foundation. Eagle Valley Behavorial Health is designed to ensure access to behavioral health services for everyone in Eagle County.

In its first year of operation, Eagle Valley Behavioral Health distributed $3 million in funding to 30 organizations in the valley to support behavioral health programs, increased Telehealth options, launched a “Long Live” anti-stigma campaign and purchased land for the development of a new cross-functional behavioral facility in Edwards that will have 24/7 walk in availability for all community members.

Alcoholics Anonymous has had a strong presence in the valley since the 90s, and a new community health portal from Eagle Valley Behavioral Health will make it easier than ever for people to connect with effective community support groups like AA.

One of the most significant initiatives that Eagle Valley Behavioral Health has undertaken is the hiring and recruitment of trained behavioral specialists to the valley. The organization has already brought 35 new specialists to the valley since 2019, and plans to bring in a total of 50 or more in the next few years.

‘A baptism by fire’

Joseph Drew is a new pain and substance specialist that was brought on this past March to work at Colorado Mountain Medical in Avon. After graduating as a nurse practitioner in 2017, Drew moved to Eagle County where he worked two jobs: one in orthopedic pain management at an orthopedic clinic, and another at the Eagle County jail.

“It was baptism by fire about the substance abuse problems that we have in this valley,” Drew said.

Drew saw firsthand how opioid use can begin in the hospital as a basic pain management mechanism, but left unchecked can lead to substance dependencies that become more and more difficult to break over time. The National Institute on Drug Abuse found that roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them, and about 80 percent of people who use heroin first misused prescription opioids.

While overprescription of opioids is a nationwide crisis, Drew noted that there is an added layer of complexity when it comes to treating patients in a resort community like Vail.

“The thing about the resort community, and the problem with prescribing anything, but specifically benzos or narcotics, is that we live in a concierge-driven society,” Drew said. “Everything is about ‘How is your service?’ And that crosses into what we do up here with our tourism-based outpatient orthopedics. If the people who are coming up here for this procedure are viewed as customers, which they are, we want to give the customer what they want.”

Usually when people are coming out of invasive surgical procedures, what they want is immediate relief, which is most easily delivered in the form of pain relievers like oxycodone.

“It’s really easy to just give it to them so that we get a good review and they have a positive experience, whereas it takes a lot more work, and the chances of having a negative review are higher, when you sit down and have a 30-minute conversation with the patient about pain management after the procedure, what your expectations are, and the fact that we aren’t going to give you a month’s worth of narcotics because we need to be doing other things besides just taking pills to manage your pain.”

In his new role as a pain and substance specialist, instead of writing automatic prescription refills for pain management, doctors can now send patients to Drew, who will make sure that they are being mindful about their use of pain medication to help curb the national epidemic of opioid addiction.

“I can make that person come in and see me every month to get their prescription so we can at least have a conversation,” Drew said. “If they have pain, why are they having pain? What else can you do, instead of just refilling, two months after surgery, another prescription for oxycodone?”

Drew also continues to work at the Eagle County jail. In the past, he saw that when people struggling with addiction ended up in jail, they would be treated for immediate health needs while incarcerated and then released without any long-term resources for managing their disorder. Now, Drew is the first point of referral when people are released from the hospital or jail, so that he can help them establish strategies for counseling, treatment and community support going forward.

“The community focus is what I’m really pumped about,” Drew said. “To come in and talk to a human who you will continue to see in a week, in a month, not somebody different, I think is really important for continuity in care.”

Drew is also available for direct appointments with anyone who is struggling with substance abuse, and for those worried about payment, he helps connect people with scholarships and other financing opportunities as well.

“In order to get to me, there is no barrier,” Drew said. “We take Medicaid, Medicare, all the insurances, and people can call and directly schedule with me, they don’t have to go through an emergency department or a primary care doctor. Part of the effectiveness of any program is making the barrier to entry as low as possible, and that’s what we’re trying to do, because the first step is getting them in the door.”

In the six months that Drew has been in his new role, he has already helped plan and execute treatment plans for over 100 community members.

“We have people that have been sober now for 60, 70, 80, 90 days,” Drew said. “People who were on the verge of losing their jobs and marriage are doing counseling, and doing very well. Those numbers may only be in the dozens, not in the hundreds or thousands, but that is still dozens of people that live in our community, that work in our restaurants and schools and hospitals that are doing really well because they have the support that was lacking for a long time.”

Rising to meet the challenges of our times

The number of behavioral health specialists and resources in Eagle County is going to continue to increase dramatically in the upcoming years, thanks to the money and resources that Vail Health has committed to Eagle Valley Behavioral Health. Eagle Valley Behavioral Health also just received a designation as a community mental health center from the federal government, which will guarantee additional annual funding for growing and strengthening behavioral health programs in the area.

Wolfington, for one, will help lead this next chapter of care for the valley as the community behavioral health director for Eagle Valley Behavioral Health.

“We are one of the only rural communities that has this level of financial and personal resources dedicated to behavioral health, so we are going to be able to make a huge difference,” Wolfington said. “Our community has recognized that we’re not immune to behavioral health difficulties, especially substance use and abuse, and I am just so excited to build services that really equal what the community needs.”

 

As we emerge from a year of social isolation and lockdown, and enter yet another period of uncertainty with the COVID-19 pandemic, these new resources will be critical for helping our community address the long-term impacts of the pandemic on substance abuse disorders.

“It’s been really, really tough for those individuals that were struggling with things that we all struggled with before, but then got pushed over the edge by being socially isolated or loss of a job or whatever the case may be,” Drew said. “I have had a number of people who were sober for years or decades prior to COVID that flipped back into alcoholism. The damage to mental health from this disease … the true measure is not going to be known for a while, but it’s significant.”

Dr. Austin agrees that we are only at the very beginning of COVID-19’s impact, and that the full magnitude of the pandemic’s influence on behavioral health will likely take years to reveal itself.

“There are lots of people that started new behaviors that were abnormal for their history, and if we have 300 million people in our country and X number started new behaviors, 10 to 15% of them are going to ultimately develop a substance use disorder,” Austin said. “That’s what I think is going to be kind of the secondary pandemic that will happen. There are people who have started alcohol use disorders who are probably in the mild category right now, maybe moderate, but they’ll hold that for 10 years. It’s a slow grade, and then all of a sudden it’s severe, and now it’s been so many years that it’s really hard to change.”

The hope is that with greater ease of access to resources and a better understanding of the dynamics of substance use disorders, community members will be able to identify these behaviors earlier within themselves and their loved ones and immediately find the support they need to maintain a healthy lifestyle.

Access to more diverse resources will also allow people to build support systems that work best for their personal journey, instead of a one-size-fits-all treatment regimen.

“I think it’s really important that people know there are multiple paths to recovery,” Austin said. “There are sometimes messages that there’s only one way you can do this, and the reality is for each individual you’ve got multiple options of what you can do to try to make yourself healthier. Any decision to make oneself healthier is a good decision, rather than not making a decision because you don’t like what you think is the only option. That’s a win — and then maybe you choose another healthy behavior and then we can get the ball rolling.”

The history of substance abuse in America has long been categorized by silence and crisis, but the future is promising a new story.

“I’ve thought it was critical for a long time, but now there is recognition among leadership, among the community, among people who have the resources to help lower those barriers to entry so that we can give the most good to people,” Drew said. “My passion is getting the best resources to these individuals so that they can be parents and students and employees, and people that enjoy and contribute to the communities in which they live.”