Step 1: Expand Treatment Centers

Doc’s House in Byron, Minnesota

A variety of centers around the state are needed in order to fill gaps that will make communities and individuals more secure and stable. One model highly recommended by “Opioid Reckoning” author Amy Sullivan is Maternal Outreach and Mitigation Services (MOMS), a supportive, culture- centered White Earth treatment program. She also recommends the approach taken in Duluth, which has a history of creating formal and informal affiliations between organizations to coordinate community services. We reached out to several successful treatment centers to learn more about their approach. Two of them are described here.

Model: Center City Housing

Center City Housing has been involved in developing affordable housing in the Duluth area since 1985. In 2007, the company opened its first permanent supportive housing project — the New San Marco. “It was unique at the time, in that we were providing housing for very barriered homeless single adults who were struggling with long-term alcohol use,” says Nancy Cashman, executive director.

People were surprised that Center City (which is not related to the Hazelden Betty Ford Foundation treatment center in Center City, Minnesota) was not requiring sobriety, which was a radical idea at the time. Soon the Duluth housing options expanded in Saint Cloud, Rochester, Bemidji, and Inver Grove Heights. Center City manages 907 units, with about 703 of them offering permanent supportive housing.

A 24-hour front desk provides safety and support. Vans take people to appointments. Case management and navigators help with the court system and goal setting. There are community-building activities, like walking clubs and model car development.

“It has become our mission to serve the population that needs a lot of supportive services,” Cashman says. “We have a pretty high success rate in terms of long- term housing stability, which is our primary goal. If you can get that housing stability, that is magical, and it really makes change in people’s lives. It gives them enough centeredness to be able to make other choices. The longer you have housing stabilization, the better chance you have of making other choices for yourself.

“There are needs all across the state,” she continues. “I don’t think we can say enough about just the affordable housing that is needed across Minnesota, especially for the lowest income and the homeless folks.”

Minnesota has a coordinated entry system for housing referrals. “Continuums of care” are created by geographic area. The state assesses homeless people to determine what type of housing they need, then they are put on a waiting list. “A lot of the single adults in our chronic alcoholic buildings have a lot of health issues — the average length of stay on the streets for those folks is five to seven years,” says Cashman.

The company serves families, including homeless people with children, unaccompanied homeless youth 16 to 24, and single adults with behavioral health issues.

“We have a two-generation model, where we are working with both the children and the adults, looking to interrupt generational homelessness,” she adds. Early childhood programs help the many children who arrive with developmental delays. “We believe … we can interrupt the cycle of children aging up into homelessness, which is a problem in our state.”

The Challenges of Being Secure

Cashman points out an often overlooked aspect of trauma. “People are having to move from being in crisis, trauma, and chaos to an apartment,” she says. “Often, they need transition time learning how to be in an apartment, especially the longer they have been on the streets. Everybody’s cortisol levels are elevated.”

“With families, sometimes the kids start to feel safe, and in that feeling of safety they start to act out. Sometimes people start to feel safe and they go into a depressive stage, because now they can feel all the feelings that they have been hiding.”

Cashman contrasts this reality with the kind of experience she had growing up. “When I was five, we moved into the home that my mom then lived in for 50 years. I went to the same schools. I knew the teachers. As an adult, my husband and I bought a home that we have been living in for 35 years,” she says. “If you are a highly mobile kid, and your parents were highly mobile kids, moving every six to eight months, that is what you know how to do. The idea of staying is terrifying, because when you stay you get in trouble, bad things happen.”

She asks people to consider: “Understand where people are at — if you have never lived anywhere more than nine months, how would you know how to live somewhere long term?”

Cashman said it was a profound discovery for her to see fear in the eyes of a mother when they talked about permanent housing. “I talked to her about how her children could have the same friends, know what to expect next year at school. She had no clue that was possible. Now she has been with us for 10 years, and her children are graduating.”

Model: Doc’s Recovery House

by Tori Utley, as told to Renee Berg

I am one of the co-founders and the executive director of Doc’s House, which opened in 2019 in the southern Minnesota town of Byron to provide pre-treatment housing, long-term recovery housing, and peer recovery support to men and women who are pursuing recovery from addiction. Since then, the program has grown to include five recovery houses for men in Rochester in partnership with Bear Creek Development Center, which together can house up to 38 men. Another Rochester house is available for 14 women.

There is a lack of housing and support for people who are on waiting lists for treatment at the beginning of their recovery journey. Our pre-treatment model gives people a place to start for the days or weeks they need support. We strive to create a culture of belonging and dignity where people in recovery can find long-term community.

Our term is a “wholeway” house — not a “halfway” house. It is a term coined by my father, who co-founded Doc’s House with me, after his own struggles with recovery. We have seven alumni employed by Doc’s House as leaders and peer recovery specialists. It took us nearly five years to open, navigating the challenges of finding space and developing the program. Because we are a new model, our primary challenge is funding. We still are primarily funded with donor support.

So far we have served nearly 300 men and women. Some people choose to stay a few days before treatment. Others move back in after treatment and may stay with us for as long as two years.

We started our women’s program in October 2021. We also now have a recovery coaching academy that trains people to become certified peer recovery specialists.

It is incredible to see people we have known at a certain stage in their life take those experiences to help others.