The addiction support player coaches work without borders

The addiction support player coaches work without borders

Sarah Wright stops by her peer support specialist's hotel room in this Denver suburb several times a day.

But her visit on a Wednesday morning in mid-October was one of her first with teeth.

Specialist Donna Norton had urged Wright to go to the dentist years after homelessness and addiction had affected her health down to the jawbone.

Wright was still getting used to her teeth. “I haven’t had teeth for 12½, 13 years,” she said, adding that it made her feel like a horse.

A new smile was Wright's latest milestone as she works to rebuild her life, and Norton was there every step of the way: opening a bank account, getting a job, developing a sense of her own worth.

Wright's voice began to shake as she spoke about Norton's role in her life in recent months. Norton wrapped her arms, adorned with tattoos of flames, spider webs and a zombie Johnny Cash, around Wright.

“Oh, muffin,” she said. "I'm so proud of you."

Norton, 54, is a Harley-riding, bulldog-loving, eight-year-sober grandmother and professionally "a cheerleader for the people who look bad on paper."

People like her. “If you were looking for me on paper, you wouldn’t be in this room with me,” Norton said. “You wouldn’t let me near your house.”

If she were a therapist or social worker, embracing and sharing her experiences with drugs and the law could be viewed as a violation of professional boundaries. But as a peer support specialist, it's often part of the job.

“I have no boundaries,” Norton said. “F— off,” she said, “is a term of endearment here.”

Norton works for the Hornbuckle Foundation, which supports participants in the SAFER Opportunities Initiative. SAFER provides short-term hotel housing for people in Arapahoe County who are homeless and suffering from mental illness or substance use disorders.

Peer support specialists are themselves in recovery and are used to help others. As billions of dollars in opioid funds are distributed to states and local governments, local leaders are deciding what to do with the money. Support and train peer specialists, their certification requirements vary depending on the federal state are among the options.

States, counties, municipalities and tribes filed thousands of lawsuits against drug companies and distributors accused of fueling the opioid crisis. Many of these cases have been consolidated into one mega-lawsuit. This year, four companies settled out of court and agreed to pay $26 billion over 18 years. Participating states must follow guidelines on how the money can be spent.

In Colorado, Hundreds of millions of dollars from this settlement (and several others) go to local governments and regional groups, several of which submitted plans to use some of the money for peer support services.

David Eddie, a clinical psychologist and research scientist at Massachusetts General Hospital's Recovery Research Institute, said peer recovery support services "have gained a lot of traction in recent years."

According to the Substance Abuse and Mental Health Services Administration, “Evidence is piling up” shows that working with a peer specialist can lead to better recovery outcomes, from greater housing stability to lower relapse and hospitalization rates. A report Peer support services identified by the US Government Accountability Office as a promising practice in treating adults with substance use disorders. In many states, peer specialists are reimbursed through Medicaid.

“They can fill a really important gap,” Eddie said. “They can do things that we as clinicians can’t do.”

For example, they can help navigate the bureaucracy of the child protection system, which clinicians may know little about, or take someone out for coffee to build a relationship. If a person stops showing up for therapy, Eddie said, a peer support specialist can "physically look for someone and bring them back to treatment - help them re-engage, reduce their shame, destigmatize the addiction."

For example, Norton picked up a customer who called her from an alley after she was released from the hospital for an overdose.

"Some people will tell you, 'I decided to recover and I never had to drink, do drugs or use again.' That's not my experience. It took me 20 years to get clean and sober my first year. And that was exhausting every day," Norton said from her office, her vans parked inches from a basket that sits under her desk: It holds three Opioid overdose reversal kits stocked with Narcan.

Her office, warmed by the sunlight streaming through a south-facing window and the almost constant rotation of people plopped down on the couch, contains a shelf of important items. There are tampons for anyone who needs them — Norton will "never forget" the time she got a ticket for stealing tampons from a grocery store when she was homeless — and urinalysis kits to determine whether someone is high or suffering from psychosis.

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She teaches “stop, drop, and roll” as a coping mechanism when people feel lost and consider using substances again. “When you burn, what do you do?” Norton said. "You stop right away, get on the floor, roll over and get yourself out. So I say, 'Go to bed. Just go to sleep.' People say, 'That's not a wellness tool.'"

“That’s it,” Audrey Salazar chimed in. Once, when Salazar was on the verge of a relapse, she stayed with Norton for a weekend. “I was literally just sleeping,” Salazar said. The two rested and ate boxes of Cocoa Puffs and Cheez-Its.

“It was so bad,” Norton said of the junk food binges. But the weekend got Salazar back on track. Working with a peer support specialist who has “been down the same path,” Salazar said, “holds you accountable in a very loving way.”

On that October day, instead of nagging one person, Norton pivoted to making a doctor's appointment, setting up a pantry for someone else, and figuring out how to respond to the bank telling a third customer that an account couldn't be opened without a home address. She also worked to weaken the defenses of a newcomer, a smartly dressed man who seemed skeptical of the program.

Some people come to Norton after being released from the county jail, others through word of mouth. And Norton recruited people in parks and on the streets. The newcomer applied to a homeless shelter after hearing about the program.

Norton decided that telling a little about himself was the way to go.

"'My experience is prisons, hospitals and institutions. I have an old number,' which means a convict number. 'And I've been drug-free for eight years,'" she recalled. "'My office is down the hall. Let's do the paperwork. Let's do this.'"

Norton is one of seven employees at the Hornbuckle Foundation, which estimates it costs about $24,000 a month to provide peer services to this group of residents, with peer specialists who work full-time earning about $3,000 a month plus $25 an hour per client. Norton's office is the center of activity for one floor of a hotel where about 25 people participating in the SAFER Opportunities Initiative live while recovering from substance use disorders until they "graduate" to another hotel next door. From there they move to their own accommodation, which they are often helped to find by staff.

During the program, residents meet with a case manager, a therapist and a peer support specialist at least once a week, in addition to group meetings that occur daily except Sundays and are all peer-led.

Kyle Brewer, based in Arkansas, is the Peer Specialist Program Manager for NAADAC, the Association for Addiction Professionals (formerly the National Association for Alcoholism and Drug Abuse Counselors). Brewer, who said his life was derailed after he began using prescription opioids to ease the pain of a wisdom tooth removal, said opioid settlement funds represent an opportunity to support those working on the ground.

“As we work and talk and address different approaches to solving the opioid crisis, we should have the people who are directly impacted by these issues in the room to have those conversations,” he said.

Towards the end of the day, Norton met the new guy again in the hallway, this time on his way back from the ice cream machine.

"Eight years clean. My hat goes off to you," he said.

“I started with one day,” Norton said.

“Well, I’ll start with an hour,” said the new guy.

He said he had to clean out his car where he lived. He said he had trouble putting on his jeans in the morning after losing a thumb to frostbite. He wanted to find a part-time job. He has to work through trauma in therapy. His mother died about a year and a half ago.

“Friday night we go to the movies,” Norton said.

“Oh, cool,” he said. “I want to see Top Gun, the new one.”

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