‘People helping people’: North Dakota’s addiction fix

This story is the second in a series based on WyoFile reporting from North Dakota. Read part one, here — Ed.

DEVILS LAKE, North Dakota — Residents of this grain farming and outdoor sporting hub say it is one of the coldest parts of their notoriously cold state. Tucked off a dogleg of its miles-long namesake lake, the brick downtown and the aging neighborhoods that surround it have the feel of a port.

On Nov. 8, six members of the Devils Lake recovery community gathered at a table at the Old Main Street Cafe, a bustling two-story eatery downtown. Their lives have been weathered by more than hard winters. Each has fought extended and painful battles with addiction that have cost them loved ones, relationships and at times their freedom. They have emerged sober, at least for today, as they say. Now they help others fight the same battle.

Drugs seem to flow through Devils Lake despite its isolation, local law enforcement officers and recovering addicts told WyoFile. They blamed the disproportionate supply in part on the neighboring Spirit Lake Reservation, where, they say,  poverty and lax federal law enforcement encourages trafficking.

Heroin, methamphetamines and painkiller pills flow in and out of town, residents said, and local drug users will embrace whatever is on the table. “We don’t have the pleasure of being picky here,” said Cheri Hanson, a recovering addict who has been sober for a year and a half. The rotating menu carries its own punishments.

“It is life or death out there,” Hanson said.

Hanson and the others at the table are now part of a statewide initiative called Free Through Recovery, that seeks to drive down North Dakota’s prison rates by creating networks of sobriety and support around people on probation and parole. Drug- and alcohol-related parolee and probationer failures drive imprisonment rates here —  as they do in Wyoming. Free Through Recovery hopes to break the “revolving prison door” cycle by focusing on people coming out of prison or jail who are at medium to high risk of lapsing back into substance abuse.

As Wyoming looks for ways to stem its growing prison crisis, experts from the Council of State Government who have worked in both states recommended lawmakers in Wyoming consider a program like Free Through Recovery. The program could hold promise for Wyoming in two key ways, experts say. One is its focus on probationers and parolees, whose failures under supervision and subsequent incarceration drive more than half Wyoming’s prison admissions. The other is its ability to build a bulwark against addiction in a rural state with a poor network of substance-abuse treatment services.

Policymakers in North Dakota, and likely Wyoming, don’t see a feasible way to encourage clinical treatment centers to open in sparsely populated areas where it can be difficult to attract professional providers or turn a profit. To fill the vacuum in their absence, Free Through Recovery uses the “lived experience” of recovered addicts to guide the sobriety of those re-entering society after time behind bars.

With funding from the Solutions Journalism Network, WyoFile sent a reporter to North Dakota to examine the program.

Statewide in North Dakota there have been 556 people directed into Free Through Recovery since the program began in January, 2018. It is jointly managed by the state’s corrections and human services departments. Devils Lake, a town of approximately 7,000, has the capacity to manage 48 people in the program, according to data provided by the Behavioral Health Division of the North Dakota Department of Human Services. With the support of a local judge and county jail administrator, the area was an early adopter of the program.

The program provides participants with up to two levels of support in addition to their probation or parole officer. A care coordinator is the first point of contact and helps clients find housing, access services, get to job interviews and generally reintegrate into life outside.

Many participants are also paired with a peer support specialist. Peer supporters do some of the same things as the care coordinator, but also provide empathy and counseling. Peer support specialists are typically recovering addicts themselves, and may well have been in jail or prison. They’ve been there.

The peer support specialists in Devils Lake were trained by a Georgia-based consulting firm, Appalachian Consulting, that specializes in creating such grassroots recovery networks. North Dakota paid for the training.

Hanson is a peer support specialist who has five clients today, she said, and meets with each of them approximately once a week. While other peer support specialists at the table lived their previous lives elsewhere, Hanson was a user in Devils Lake. “One of my clients I used with her twice,” she said. “One of my clients I used with her sister.”

Nels Nelson, who has been in recovery for decades, said he trained with Appalachian and is now licensed to pass that training on to new peer supporters, extending the network. He still tears up when he talks about helping others achieve and maintain sobriety.

“If I didn’t have mentors I wouldn’t have made it,” he said. A contractor and real estate investor, Nelson talked about building a clubhouse for recovering addicts, where they could hang out with each other sober. Over 20 years in Devils Lake, he’s put more than 300 people who came out of jail or prison to work on his contracting jobs, he said, “so [they] don’t end up in trouble all the damn time. It’s really simple.”

Money

Free Through Recovery is a new program in more ways than one. It’s young — the program started in February. It’s also an unconventional approach to a longstanding challenge that marries small, diverse local programs, networks of recovering addicts, faith organizations, ex-cons, established providers, nonprofits and corporate for-profits with state bureaucracy and public money. Unsurprisingly there are some growing pains.

One concern of the Devils Lake peer supporters — and others WyoFile spoke to in Bismarck and Grand Forks — is the financing of the program. Peer support specialists receive $100 a month for each client they serve. That money comes out of the $400-$480 a month the state pays care coordinators.

But the program doesn’t require care coordinators to use peer support. As such, some care coordinators, particularly those working for clinical treatment programs, have not been interested in hiring them or haven’t wanted to pay.

“It’s not about the money of course,” Hanson said, “but to really pour yourself into it you have to make a little money.”

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One provider that has used fewer peer supports is Community Options, a for-profit corporation with more than 400 employees in 11 locations across North Dakota. The company offers services for teenage parents, the elderly, people with brain injuries and those with developmental disabilities. It also works with those dealing with substance abuse.

The company contracts with the state to provide Free Through Recovery care coordinators. They currently have around 110 clients in the program, Vice President Trina Gress told WyoFile during a visit to the company’s office in Bismarck. Ten of them are using peer support services.

Part of that low number is a function of demand — not every client needs peer support, Gress argued. But part of it is financial. For a for-profit, professional provider like Community Options, the $400-480 a month from Free Through Recovery, “it’s low,” Gress said.

That is in part by design, according to Pamela Sagness at the Behavioral Health Division, who hopes Free Through Recovery will spur the creation of new support systems outside traditional, and expensive, treatment providers.

But though Free Through Recovery can help, it can’t replace clinical treatment and diagnosis, Gress and others said. “I don’t want you to think that this is the solution,” she said, “because it isn’t.”

Public meets private

Helping others achieve sobriety has long been a fixture of successful recovery. It figures prominently in traditional 12-step programs like Alcoholics Anonymous and Narcotics Anonymous. That mentoring work is unpaid and considered part of giving back. In fact, Alcoholics Anonymous warns away from professionalization in its “twelve traditions” that guide the organization and are separate from the 12 steps it uses to guide recovery.

At the lunch table at the Old Main Street Cafe, a recovering alcoholic who is not in the Free Through Recovery program but said he has relied on others to maintain his own sobriety, asked the peers if they thought the financial incentive could poison the well, so to speak. “Don’t you think it takes away from the altruistic nature of it?”

“Not if you have a family,” answered Reanne Pederson, a peer support specialist who is training to be a care coordinator and is also employed by a nonprofit organization called F5. The nonprofit creates housing opportunities for those recently released from jail or prison.

Pederson’s boss at F5, founder Adam Martin, met with WyoFile in Bismarck to talk about his organization’s role with Free Through Recovery. F5 predates the new program, and while Martin says the funding stream is proving critical to his bootstrap nonprofit’s fiscal health, he worries about too much institutionalization.

“What you don’t want to do is take away the incentive for people to just help,” Martin said. F5 buys or rents houses and in turn rents them to ex-convicts, largely in the population centers of Bismarck and Fargo. In Devils Lake, they rent a house from Nelson that is occupied by four men on probation or parole.

The name of the organization is derived from the F5 button on a computer keyboard, aka the “refresh” button. It’s also derived from director Martin’s five felonies.

It’s hard to find housing straight out of jail or prison, Martin said, and that can lead some to seek refuge in places where drugs and alcohol flow freely — whether it be a “flop house” or an acquaintances’ from a time pre-sobriety.

The pattern is reflected at F5’s house in Devils Lake, where a 22-year-old resident told WyoFile that he grew up in the town and wants to get to Bismarck. “All my negative influences are here,” he said. His probation officer sent him to the F5 house, he said. “I wasn’t in a safe place.”  

Martin prides himself on an entrepreneurial streak and the outside-the-system nature of the homes he runs, where there are curfews and rules on sobriety but also room for mistakes and a focus on camaraderie. There are no bureaucrats at F5, just ex-addicts who have seen a thing or two and now want a better life. Martin is wary of sacrificing the ethos of his group by linking it too much to state programming and funding, he said.

“I don’t want someone else pulling my purse strings and I don’t want to get siloed” into being a provider of certain services, he said.  

Still, one year after its start, Martin and those who gathered at the Old Main Street Cafe are believers in the program they’ve thrown themselves into.

“We’re still working out a lot of the glitches in FTR but it’s going to change lives,” Camperud, the care coordinator from Grand Forks, said. “I really believe it will.”

Blurrier at night

If Free Through Recovery is having and impact, it hasn’t been noticed by Officer John Mickelson. He hadn’t heard of the program, he told WyoFile.

The 30–year-old Devils Lake Police Department officer described a tough town with a core group of drug users and alcoholics that make up the majority of his workload. “I honestly don’t know what a successful treatment program would look look like for the population we’ve got,” he said, as he steered his squad car through the town’s snow-filled streets the night of Nov. 8.

The town jail maintains a re-entry center where offenders spend time in transition between jail or prison and society. Mickelson doesn’t believe it’s that successful, he said.

“If that program works as needed we shouldn’t have to see them again,” he said, “but we will.”

Devils Lake’s jail administrator, Rob Johnson, was part of the state’s Justice Reinvestment Initiative, which came up with Free Through Recovery. Now he wants to see the re-entry center manager join the program as a care coordinator. Doing so could add a funding stream to his jail he said, and also allow him to ensure Devils Lake keeps building its peer-support network. But getting law enforcement officers behind alternatives to incarceration remains a challenge, he said.

“They only interact with these people when they’re not succeeding,” he said.  

Later in the night, Mickelson hauled his second offender to the jail — this one a particularly difficult arrest.

An intoxicated woman whose domestic disputes Mickelson has become familiar with swore the young cop up and down as he walked her handcuffed out of a downtown apartment building where she had gotten in a dispute with an ex-boyfriend and kicked in his door. She kicked the inside of the doors in the back of Mickelson’s squad car too, during the ride to jail, cursing at him all the way.

Though she was arrested for destruction of property at the apartment, Mickelson will document her “noncompliance” as well, he said. “I want to document that so that the judge takes it into account. She needs treatment, she needs something.” Her drinking, and maybe more, is spiraling out of control, he said.

Mickelson hopes that the court will order the woman into a treatment program, though in Devils Lake it’s not clear what that will be. But, Mickelson said, if the judge just “throws her back onto the street, we will have to deal with her on the next shift.”

Reach them where they’re at

On the morning of Nov. 9, a group of seven women in orange jumpsuits filed into a conference room in the jail, where Pederson from F5 and Will, another peer support who asked WyoFile not publish his last name, waited for them with pretzels and, they hoped, advice. The pretzels at least were a hit.

Pederson — a peer support specialist who is training to become a care coordinator — visits the jail every two weeks. Will often joins her. They know many of the inmates, and talk about when they’ll be getting out. The meetings are designed to encourage inmates to step out with a plan for sobriety, instead of lapsing into bad habits. Will talked with the inmates about the grip of drugs. The 27-year-old has a lot to say on the topic. He told them he used drugs intravenously for 13 years. He talked about using meth to overcome the seemingly endless withdrawals of opioids. One woman nodded her head.

He remembered leaving jail once — he’s been in several times — and doing a line of meth in the car that picked him up before he’d even left the parking lot. By the end, Will said, he cried with frustration every time he got high. “I did a lot, a lot of drugs,” he said. “And I lost so much.”

Will isn’t from Devils Lake. He came there through a residential treatment program in the county. When he left the program, he applied to live in the F5 house in Devils Lake and has since moved out. “My life is so much more even now,” he said. He controls his ups and downs without drugs.

Pederson suggested to some of the inmates that they leave Devils Lake when they’re released and offered options F5 or other organizations may be able to provide in Fargo or Bismarck. Pederson asked one where she would go when she got out.

She was unsure, the inmate said. At her family’s house, “they’re doing what they’re doing right now,” she said. Using or drinking.

“It’s so hard with the strong family bonds, healthy or not,” Pederson wrote to WyoFile later. But, she said, “when it comes to recovery you need to meet people where they’re at.”

Keep it simple

Steering an SUV across one of the causeways that stretch out of town across the lake, Nels Nelson talked about the promise and perils of the program. One of his worries is that Free Through Recovery won’t last and the implications of that for his friends building Devils Lake’s ad hoc recovery network.

“You know some of them [the peer supports] are pretty early in recovery,” he said. “It could throw them off if a program they’re involved in fails.”

Nelson drove past a brightly lit casino and onto the largely dark Indian reservation, home to three bands of the Dakota people. Lights flickered in clusters of government-built homes. He checked a church to see if a pastor was home. He wasn’t. So Nels called a different pastor, one he helped into sobriety, to make sure nothing was amiss.

Then he called a niece who lives on the reservation and had just been released from jail after drug trouble. He chided her gently about how she “went off the rails there,” and asked about her time behind bars.

“Did that help decrap ya?” he said. His niece is working with a wide-roaming peer support specialist employed by Community Options, she told him, and she plans to move down to Grand Forks or Fargo to attend a recovery program.

“Keep it simple,” Nelson said toward the end of their call.

“I already said it once so I’m not going to say it again, I’m just going to do the damn thing,” she said — get sober.

“It’s more fun being clean,” Nelson said. “I think anyway.”

In a contrast to F5’s Martin, Nelson thinks the institutionalization has value to Free Through Recovery. Training peer supports and then teaching them how to train others will create something that lasts, he said.

Like nearly everyone WyoFile spoke with involved in the program, Nelson wants to see more peer supports and see the program expand beyond parolees and probationers. Pretrial services and deferred sentencing could be bolstered with peer support, helping people reclaim their lives before they wind up behind bars and eligible for Free Through Recovery.

Nelson is all about keeping it simple, the advice he gave his niece.

“Recovery is simple,” he said. “The system’s got it so freaking complicated and you gotta take it back to people helping people.”

This story has been supported by the Solutions Journalism Network, a nonprofit organization dedicated to rigorous and compelling reporting about responses to social problems.

CORRECTION: This story has been updated to note that the Free Through Recovery program is managed by North Dakota’s corrections and human services departments, not corrections and health as previously reported. -Ed.