How NKU tackles substance use disorders in rural Northern Kentucky

Tammy Barrett-Wolcott recalled a student from Carroll County who had been using marijuana every day for as long as she could remember – probably since 10 years old. She had very low self-esteem, always put her head down when she came to class and refused to participate in group therapy.

Now, she has not touched marijuana in three weeks. She is speaking up in class, giving presentations, and she wants to join the youth coalition because she wants to travel, Barrett-Wolcott said.

Helping such youths who may be struggling with substance use is part of Barrett-Wolcott’s role as coordinator for Carroll County Drug Prevention Coalition, in which regional institutions, health departments, EMS workers, healthcare professionals and business owners collaborate to help reduce mortality and morbidity around substance use disorder in rural Kentucky communities.

The Coalition is part of Carroll & Owen Partnership Expansion (COPE). Along with the Owen County Collaborative Addiction Treatment Initiative (OCCATI), it is among the programs focused on chronic illness by Northern Kentucky University’s Institute for Health Innovation. IHI Executive Director Valerie Hardcastle gave a presentation on these programs at the year’s first Board of Regents meeting in January.

COPE and OCCATI are products of a $2.2 million grant from the Health Resources and Services Administration to combat the opioid crisis in rural areas, according to Hardcastle.

These programs educate the community on what substance misuse is and how it can stem from several psychological bases, not just weakness of will, Hardcastle said. They provide resources – GED tests, training, jobs – for families with addiction. They help schools work with curricula so that students get to learn about substance use. They also screen the students, offering them Moral Reconation Therapy should they misuse substances, instead of having to face suspension or expulsion.

The rural areas where these programs operate may not have adequate health infrastructure and resources. In Owen County, for example, there is no hospital, emergency care or medical treatment for substance use, Hardcastle said.

Nor are there homeless shelters, food pantries, buses, Uber or Lyft. Internet and phone services are not uniformly available throughout the region. Residents in need of healthcare have to be referred out of state, and they do not always have the means to do so.

In comes OCCATI, where Care Coordinators like Shanna Osborne help connect people with substance use disorders to treatment and support groups, food, clothes, shelters and emergency care. When they require transportation, sometimes Osborne drives them herself.

But the task is far from easy. According to Osborne, Owen is the largest county in Kentucky landmass-wise but has a small population.

“So I have a meeting close to my house, I might drive 80 miles to get one person to that meeting and back home,” Osborne said. “If it’s 45 miles to go get them, pick them up on the other side of the county and then take them back, you’re talking about a pretty huge distance: a lot of miles, a lot of time and effort involved.”

However, Osborne now has a team of Peer Support Specialists who can help with the connecting when she gets overwhelmed. Some were among the more than 350 clients who have connected to the program since 2019, when the grant started.

Bryan Ruth is one of those Peer Support Specialists. He has known Osborne since school and has a history with substance use disorder himself. She got him to go to support meetings and into the internship with NKU. He now helps her run the meetings and provide clients with what they need.

“I would make it my full-time job because I enjoy helping people,” Ruth said. “I know how it feels to need help, and to have somebody be there to help me.”

Ruth’s favorite part of the work is getting to learn the stories of the many different people he meets: a perspective shared by Osborne, who has worked with people with substance use disorders for over 20 years because they affected her family and friends.

“It can be incredibly emotionally taxing to get to know and love people, and then have to suffer with them when they fail because relapse is a part of recovery, so we see some failures. We’ve lost some permanently, who overdosed or died,” Osborne said. “But the success of it is definitely worth it, to see people get their kids back, people get their lives back on track, be successful in their careers and whatever they have.”

It is similarly rewarding for Barrett-Wolcott to see immigrant families grow in their communities, to see youths break the cycle of substance use and to see the little milestones. Nevertheless, COPE faces its own set of challenges.

The Drug Prevention Coalition combines the money, resources and expertise of its many members into a progressive effort that holistically supports struggling students and their families, but it is not always united.

“We have a very diverse community, but the diversity is not always embraced, for lack of a better word,” Barrett-Wolcott said. “They have very clear lines in the sand: you’re either a Christian or you’re not, you believe in this specific Christian way or you’re not, or you’re Republican or you’re Democrat. They don’t want to pull together and work together as a community, so that has been kind of hard.”

To get them working together, at each meeting Barrett-Wolcott emphasizes the facts and evidence-based nature of their work, and stops them from discussing religion, politics or their distaste for each other.

She hopes to see unity in the future, where mental health or substance abuse is not questioned, where students can talk about mental health in class and have access to resources for their mental health.

“Right now I hope to see programs in schools, because I truly believe to break the cycle we have to go upstream,” Barrett-Wolcott said. “We have to start working in elementary and middle and high schools if we ever want to decrease recidivism … I hope to see their medical needs addressed full force, because until we can meet basic needs we can’t stop substance use disorders.”

For her part, Osborne hopes to create a sustainable recovery community with housing opportunities for everyone, so that the dream of sober living can continue indefinitely, before the money runs out.

“Substance use disorder continues to be a really difficult issue, in Kentucky and around the U.S. It’s not just a medical issue, it’s not just a political issue, it’s not just an economic issue. It’s a complex interaction of all three. We need to get to the roots before we see a huge change,” Hardcastle said.