Lebanon — In a brightly lit conference room last week, more than 20 people — most from the Upper Valley — slowly and silently walked past a long line of large pieces of paper taped on the wall, reading dozens of slurs scrawled in magic marker that are used to stigmatize people with addiction, alcoholism, mental illness and those trying to get sober.
The group, participants in a weeklong course that would teach them how to coach people in addiction recovery, had brainstormed and written the words themselves, in an exercise designed to address stigma.
Many wrote from experience: As members of each of those groups, they were familiar with the labels that stuck to them as individuals, sometimes for decades.
Despite her deep familiarity with the labels, Alex Vandorn, 30, of White River Junction, still found it overwhelming to be confronted by so many of the words at once.
“It gives me a sick feeling in my stomach,” she said.
The Recovery Coach program, a five-day intensive course that was offered free to participants through funds from Dartmouth-Hitchcock Medical Center in office space donated by Hypertherm, was brought to the Upper Valley in part to address a shortage in Certified Recovery Support Workers, or CRSWs, a professional certification for addiction support professionals, said Aita Romain, D-H’s regional substance misuse continuum of care facilitator.
Completion of the Recovery Coach course meets some of the requirements of the certification.
In 2014, when southern New Hampshire was served by nearly 20 CRSWs, none existed on the New Hampshire side of the Upper Valley — nor in the greater Sullivan County and central New Hampshire regions — according to a report from the state.
The hope, Romain said, is that last week’s program and another funded by D-H in Enfield last year would produce dozens of new recovery coaches who might go on to pursue a professional certification or work in the state’s emerging peer-based “recovery community organizations.” Others, she said, would simply use the 30 hours of recovery coach training to help their friends, families and neighbors in the fight against the opioid crisis that has consumed local communities. Health officials, from the Twin States to the federal level, have declared the abuse of opioids — defined by the American Society of Addiction Medicine as a class of drugs that includes heroin and prescription pain relievers oxycodone, hydrocodone, codeine, morphine, fentanyl and others — to be an epidemic.
Peter Shumlin, then governor of Vermont, dedicated his entire 2014 state of the state address to the epidemic, and former New Hampshire Gov. Maggie Hassan, while campaigning for the U.S. Senate seat she recently won, called the “heroin and opioid crisis … the most pressing public health and safety challenge” facing the state.
“I would be hard-pressed to find anyone who hasn’t been in some way affected by substance abuse disorders in general,” Lindy Keller, administrator for resources and development at the New Hampshire Bureau of Drug and Alcohol Services, said in an interview. “Obviously the opioid crisis has such severe consequences because of the potential for overdose that it gets much more prominence.”
According to a U.S. Department of Health and Human Services report that was last updated in June 2016, on an average day in the United States, 78 people die from opioid-related overdose.
But those wrapped up in the crisis point out that, while fatalities have risen in recent years, the epidemic has been building for decades. The number of people who are fortunate to get clean is snowballing into an ever-growing population of people who will spend their lives in long-term recovery.
“It’s nice that people are now paying attention,” Jay Parker, a recovering heroin addict who graduated from Lebanon High School in 2002, told the group on the first morning of the course, “but I’ve been battling this my whole life, watching friends die my whole life, in and out of prison my whole life.”
‘You’re Not WhatHappened in the Past’
As part of the participants’ weeklong training, they had emotional work to get through, such as confronting the slurs and insults on the wall of stigma.
As they returned to their seats at one of four large tables in each corner of the room, they remained quiet, save for soft vibrations as a few rapidly tapped their feet, some sniffling or writing reactions in the workbooks in front of them. Others were still.
Vandorn, who has been in recovery for 11 months with her partner, Jessica Gray, 33, rose to embrace Gray, who was wiping away tears. The couple recently moved from St. Johnsbury, Vt., and are involved in a court fight to obtain custody of their son. He was removed from their care shortly after Gray gave birth to him 21 months ago due to drug abuse.
Parker, the Lebanon High graduate who now lives in Gorham, N.H., grew up in group and foster homes and has been in and out of the prison system for more than a decade. If someone asked the group to come up with a list of half as many positive terms, they wouldn’t be able to do it, he said.
“It’s a testament to the negativity we’ve lived in our whole lives,” Parker, 33, said during discussion after the stigma exercise. “Those are the parameters we’ve set for ourselves. Then when you’re clean and you look at them, it’s horrific.”
Another recovering heroin addict in the course, who asked not to be named out of fear it might affect her employment, told the group it reminded her of the times that people would tell her that she was a “waste of space” and that she “should go play in traffic and die.”
“Lots of times, it would push us to the point of using,” said the woman, who said she had been clean for three months. “Our downfall was we didn’t know how to deal with the emotions in our faces, and then being told we’re pieces of (crap).”
Karry LaHaye, 38, was among those moved to tears by the exercise. A community health worker at Dartmouth-Hitchcock, LaHaye works with patients who are referred to her from the emergency room, assisting them with everything from securing housing to running errands so patients don’t use up “their last $5 on gas.” They are often people with addiction who have a high “no-show” rate to regular appointments but might end up in the ER that same day.
LaHaye said she recognized some of the words on the wall of stigma as terms doctors have used to describe patients they’re meant to be helping.
“I just want to apologize to you,” she said, as another person brought her a box of tissues.
Teaching the course were mother Cheri Bryer, 48, of Unity, who is in long-term recovery for substance abuse and addiction, and daughter Emily Duff, 27, of Lebanon, an “ally” — the term for people who aren’t addicts, but who are part of the fight to help people in recovery.
The duo, both Recovery Coach graduates themselves who were teaching the course for the first time, said lessons learned during the wall exercise — transcending stigmas and forming new understandings — are important elements of the course.
One of the best things you can get across to someone as a recovery coach, Bryer told the group, is that “you’re not what happened in your past.”
“I think that goes a really long way with somebody,” she said.
Unlike sponsors, who are closely tied to 12-step programs, or counselors, who often are limited by medical regulations such as confidentiality laws and the boundaries of a doctor-patient relationship, recovery coaches are meant to be cheerleaders for people in recovery — friends and supporters who don’t tell people in recovery what to do, but who help them navigate hurdles, make suggestions and try to be there for them during the daunting task of getting — and staying — clean.
A driving mantra for recovery coaches is to meet “recoverees” where they are, even if they are still using, and to acknowledge the negatives while elevating the positives. They advocate the position, which some participants struggled to accept, that people are in recovery when they say they are, and that recovery is an ongoing process of change in which individuals are improving their health and wellness.
Any improvement, they said, should be lauded.
“You can’t say, ‘Don’t come to me high,’ ” Duff told the class at one point, “because chances are they’ll never show up.”
Bryer said the supportive role provided by recovery coaches will offer a relationship to people who often have never had that before.
“Some people who are searching for it don’t know what it looks like yet,” she said.
Recovery coaches fill a number of roles, from advocate to listener. Helping recoverees navigate bureaucracies and providing links to the recovery community and treatment fall on one end of the spectrum, similar to the work that LaHaye does at D-H.
“It’s just a web,” she said, of the often-precarious situations addicts find themselves in, “and if you pull one little string from that web, their life can fall apart.”
The other end might entail regular meetings at which a recovery coach acts as a nonjudgmental listener who “does not sugarcoat things” but nevertheless “believes in capacity for change,” according to the coursebook used in Lebanon.
“I just remember how truly lonely that place was,” the woman who did not want to be named told the class of her time using heroin, even when she did so with people close to her. “I’m excited to be a recovery coach if I could just be someone’s friend, because a lot of times, that’s all someone needs.”
Keller, of the Bureau of Drug and Alcohol Services, said the weeklong training like the one in Lebanon is beneficial whether people pursue further certifications or not. They help people understand how to start difficult conversations and connect others with resources.
“I think there’s been much more awareness that all of us have some kind of responsibility from helping in any way we can,” Keller said. “One of the things that stops people from helping is having no idea what to do … and so trainings like this give people some sense of that.”
In interviews, several participants expressed feelings of being called to action in fighting the opioid crisis — a sense of, “if we don’t do it, who will?” — and a desire to give back while finding meaningful work, often while saddled with barriers to employment such as felony convictions.
That includes 49-year-old Carmelo Rivera, who stopped using heroin 20 years ago and recently moved to the Upper Valley from Florida to try to start a new chapter in his life. He’s living in Bradford, Vt.
“There’s way too many people falling,” Rivera said, “and someone’s got to help them out.”
A Need Unfilled
Romain, of Dartmouth-Hitchcock, said what addiction professionals call the “continuum of care” ranges from prevention and intervention to treatment and recovery.
The latter end of that continuum, Romain said, is where recovery coaches — usually people who have been in the same or similar situations as the people they are helping — can be particularly valuable.
“Recovery centers … should probably have someone who understands the components of recovery, how complicated it can be, without having to get into the science of it,” she said. “You don’t really need to understand how the brain works in order to be supportive on every path of wellness.”
Romain said anyone can consider him- or herself a recovery coach — lowercase R, lowercase C — by providing support to people in recovery.
But the course gives participants specialized training, often focusing on perceptions of addictions and the people who suffer from them, such as the language used when speaking about addiction.
For example, during a conversation midway through the course, participants talked about the benefits of using “people-first” language — they’re people who have an addiction, not just addicts; drug use is something they did, it’s not who they are.
“Reducing a person to nothing more than their difficulties is one of the most damaging and dehumanizing forms of language,” reads a passage in the hefty coursebook that participants worked through during the week. “It denies the existence of any facet of the person, any relevant roles or characteristics, other than their diagnosis.”
The coursebook used in Lebanon, Recovery Coach Academy, was developed in 2008 by the Connecticut Community for Addiction Recovery, a nonprofit founded a decade earlier that is involved in “organizing the recovery community” through advocacy, education and service, according to its website.
Romain estimated that Darthmouth-Hitchcock had invested nearly $10,000 toward increasing the number of recovery coaches in the region by purchasing the coursebooks, paying stipends to Bryer and Duff, sending a core group of participants to an earlier course outside of the Upper Valley, sending a group of five people — including Bryer and Duff — to a “train the trainers” course in Concord, and sponsoring the previous course in Enfield, among other efforts.
Romain noted that while the Vermont side of the Upper Valley has a number of people working with that state’s rough equivalent credential of a CRSW, “knowing the data that we had zero CRSWs (on the New Hampshire side of the Upper Valley in 2014), this was an area that we wanted to improve on.”
And beyond taking the one-week recovery coach course, there is a more official level of “recovery coach” that requires more training, said Keller. That level of recovery coach is rooted in peer-based coaching, she said, as the state has committed to setting up one “recovery community organization” in each of the state’s 13 regional public health networks. She expects one to be set up in the Upper Valley region within about a year.
The value of the course was more than the coursebook — it was in the participants’ diverse backgrounds and their willingness to share their experiences, as shown by the first exercise Monday morning, in which participants wrote down their values. They then discussed what they wrote in groups of two, which included:
A massage therapist in the home health care field and a recovering heroin addict raised among white supremacists.
A former thief who spent hard time in prison and a retired prosecutor who helped found drug courts around the country.
A young mother, 25 years old and three months clean from heroin, and a mother whose son was taken by addiction at age 21.
All but four of the coursemates said they were part of a family where alcohol or drugs are a problem, and all but five had a personal history, or a family member with a personal history, of being incarcerated or in the juvenile justice system.
All but six had received treatment for mental illness, or had a family member who had.
The ability to hear directly from people in recovery was particularly valuable, said Anitra Sorensen, 68, of Hancock, N.H., as was the ability to “share openly.”
“Even diametrically opposed (viewpoints), they both stand,” Sorensen said.
Jim Doherty, 55, who is Bryer’s partner, took the course in November 2015 in a church basement, where not as many people had connections to the disease of addiction. This time around, he said, the course was much more recovery-oriented.
Doherty, himself in long-term recovery from drug and alcohol abuse, said the difference in the Lebanon course is that “everybody here seems to have a stake in it.”
“In this room,” he said, “there’s passion.”
Walking the Walk
By Thursday afternoon, the fourth day of the course, most of the participants had gotten to know details of each other’s lives that included some of their most devastating experiences: homelessness, debilitating illnesses, hardships faced by their children, prison terms, the fallout from drug use.
Duff recalled a time when her mother, Bryer, who was abusing prescription pills, was admitted to a hospital and was “begging” from her hospital bed because of her pain.
“I walked out and the doctors were picking on her,” Duff recalled, emotion rising in her voice. “It’s just sad that the stigma has gone so far that she doesn’t even get seen properly, or the way she should.”
Several people in addiction recovery, or those with family members in recovery, described a similar mistrust of the medical community — of loved ones avoiding treatment for fear of being judged, or of doctors unwilling to have conversations about mental health diagnoses that would later appear in their charts.
That mistrust spread to other places, they said, including courts and social service agencies. Vandorn said she believed everyone in related fields should have to take the course, in order to learn from a using addict’s perspective.
“You are dealing with addicts’ lives,” she said.
Participants in the course also challenged each other, on topics ranging from their own racial biases to society’s treatment of people with an addiction. While many agreed that people in recovery are too often stigmatized, Doherty pointed out that addiction can lead people to do terrible things, and society sometimes has a legitimate reason to take reasonable measures in response.
“Society has a right to be protected. … If there are hoops to jump through, I think that’s reasonable,” he said.
Moments of deep emotion intersected with periods of levity. Gathered around the work tables covered in Slinkies, Play-Doh, colored blocks and pipe cleaners — distractions for nervous hands in moments of stress — participants regularly participated in ice-breakers to ease the tension. After one such activity — participants had to complete tasks with each other such as doing jumping jacks, singing jingles and tying each other’s shoes — Bryer told the group about a young woman she met during the lunch break. The woman said she was in recovery from heroin addiction and not long ago had overdosed in a nearby establishment’s bathroom.
“My recovery coach saved my life,” Bryer said the woman told her, eliciting cheers.
For the 23 graduates who celebrated the course’s culmination Friday afternoon — signing each other’s coursebooks and accepting paper diplomas to the sound of Pomp and Circumstance, played from Romain’s phone into the room’s speakers — their plans of what to do with their training are as varied as the participants themselves.
Some, like Parker, hope to pursue additional certifications on their way to a professional career in the field. Parker is pursuing his CRSW, the credential that Romain is hoping to boost.
Rivera, too, wants to follow in the footsteps of his son, Wayne Miller, a substance abuse counselor with Groups, an addiction treatment program in West Lebanon.
“He’s been through a lot more than I have with his addiction,” Rivera said. “He’s my role model.”
Bob Gasser, 79, a retired prosecutor who practiced law for 42 years and in 2006 helped found the Grafton County Drug Court, a diversionary sentencing program that focuses on rehabilitation, said he hopes to use his training as a way to continue working with addicts on an individual level instead of in a system.
“I can’t think of anything you can do that is so productive as saving someone’s life,” he said.
LaHaye was using the course to reinforce skills she’s already using in her job at Dartmouth-Hitchcock.
“More people should be required to take this course in the line of work that I’m in,” she said.
Others don’t feel the need for additional training anytime soon, saying that what they learned in the Recovery Coach program has already reshaped their thinking about addiction and will help them in their efforts.
That includes Christina Scott-Smith, co-founder of the Critter’s Crusade nonprofit, named for her 21-year-old son, Christopher, who fatally overdosed on heroin in 2014.
Scott-Smith, who works three jobs in addition to her volunteer work, is studying to become a personal trainer so she can use physical fitness as a tool in people’s recoveries.
“I just feel like I have a better understanding of the situation,” she said of the course.
Friends Sorensen and Stephen Bethel, who commuted together more than an hour each way from southern New Hampshire, have similar plans: Sorensen said what she has learned will help her participate in a group for families affected by drugs and in her work in prisons, while Bethel, whose farm in Hillsborough, N.H., offers a retreat and yoga classes, said he hopes to more directly encourage people in recovery to take on a farm apprenticeship that has been coincidentally filled by recoverees in the past.
“Over the years, a lot students have been in recovery,” Bethel said. The course has “deepened my understanding and ability to help them.”
Romain said that, although her department is unlikely to fully sponsor any more courses in 2017, it may consider paying the fees for individuals to take other Recovery Coach courses — which range from $100 for the 30-hour course to $450, not counting related expenses such as travel — on a “case by case basis, as far as people reaching out to me.”
Romain said her focus will be on figuring out how to use the graduates and support them in their new roles, whatever that might be.
“It’s really not about less commitment,” Romain said. “We’re now getting to the capacity that we need to know what to do with people at this point. We got past the barrier that no one was trained and maybe people didn’t know about it. Now we actually have to say, ‘Now what?’ ”
D-H, for example, might help graduates set up groups, such as one that Bryer ran in Lebanon and Canaan, or help find more training for people such as Vandorn, who was among the first to jump up at the end of the stigma wall exercise on Tuesday morning, when Bryer had invited participants, if they wanted to, to tear down the pieces of paper and throw them in the trash.
Vandorn not only ripped a page off the wall, but tore it apart as she crumpled the remaining pieces in a ball, stuffing it into a trash can with Gray. She wants to find a career in a field where she can help people in recovery and continue to deconstruct those stigmas.
“That would be the best life to me,” she said. “That’s goals.” Maggie Cassidy can be reached at firstname.lastname@example.org or 603-727-3220.