Boston's 'Mass and Cass' area, with its large homeless population and open-air drug market, remains a trouble spot for city officials, but staff at the nearby Engagement Center say they are making inroads and helping drug-overdose survivors get the help they need.
Researchers interviewed 59 overdose survivors, more than half of whom were living on the street, to find out what was preventing them from getting treatment.
Jeff Desmarais, research and evaluation scientist at Institute for Community Health, said a lack of basic amenities, such as housing and access to a cell phone or proper ID, made a big difference, but that it also came down to a personal touch.
"Having staff that really care about folks and treat them with respect and dignity was one thing that folks were drawn to and helped them engage in and stay in care," Desmarais said.
More than half of Black and Latinx overdose survivors said they had encountered some form of discrimination in trying to access city health services. A lack of available treatment beds due to staffing shortages is also preventing people from getting clean.
The opioid epidemic, along with a lack of affordable housing and COVID, have all contributed to the increase in homelessness in the 'Mass and Cass' area. The Engagement Center offers the nearby population help to find housing, medical care, jobs, or even just a warm cup of coffee and a shower.
Yailka Cardenas, associate bureau director for recovery services with the Boston Public Health Commission, said some staff at the center have experienced addiction and homelessness themselves and can meet people where they are.
"No matter what they come to us with," Cardenas said, "we always try our very best to come up with a solution, and they feel very supported that even if we can't figure it out that day, we will figure something out for them within a timely manner."
Cardenas said personal relationships go a long way in helping people get clean, and that the Engagement Center can serve as a model for other day facilities serving similar populations. She said survivors, many of whom experience instability and trauma on a daily basis, report feeling safe and welcomed at the Engagement Center, which is the first and most important step in helping them change their lives.
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Communities across the Commonwealth want to minimize traumatic experiences for the state's youngest residents - as a way to help stem the drug epidemic, and prevent future generations from struggling with substance-use disorders.
According to Kentucky Youth Advocates, at least one in five Kentucky kids has had at least two Adverse Childhood Experiences or 'ACEs.'
These include physical, sexual and emotional abuse, neglect, having family members with a substance-use disorder, witnessing domestic violence, and parental incarceration.
Dr. Connie White, deputy commissioner for clinical affairs with the Kentucky Department for Public Health, said research shows ACEs can increase risky behaviors and the development of chronic diseases - and even lead to a shorter lifespan.
"All of these things contribute as that child's neural pathways are developing," said White, "as they're learning how to make choices - healthy choices, unhealthy choices - as they're chronically stressed and their cortisol levels are chronically elevated."
White added that it's becoming clear that interventions promoting safe, stable environments for kids can strengthen the building blocks for healthy coping mechanisms - and reduce their likelihood of dependence on alcohol or drugs in adolescence or adulthood.
Barry Allen is president and CEO of the Gheens Foundation. It's a member of BLOOM Kentucky, a statewide coalition pushing for policy changes to prevent ACEs.
He said increasingly, communities are recognizing the correlation between addiction and childhood trauma.
"And so, a small group of us grantmakers proceeded to seek an audience with then-Attorney General Daniel Cameron," said Allen, "to plead the case to apply at least half of the opioid abatement settlement dollars - over $400 million - to apply those to prevention."
This legislative session, Bloom Kentucky says it's advocating for sustained funding for school-based mental health providers to improve access to services, for establishing a process to automatically expunge an eviction from a family's record after a reasonable amount of time, and to prohibit minors from being named in eviction filings.
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Celebrating the holiday season can be complicated for households with a loved one dealing with an addiction.
A South Dakota expert said there are steps the individual and their family can take to avoid major problems.
Matt Walz, representative for the Keystone Treatment Center, said because alcohol is often provided at holiday gatherings, it is important for the host to provide different beverage options. The person in recovery can also plan ahead by getting a sense of the best time to leave if other guests are likely to be drinking more.
Walz stressed the approach is not "one-size-fits-all," and advised avoiding rash decisions.
"Some things that families like to try to do at family gatherings, in good faith, is they try to do, you know, guilting or shaming -- or just ignoring or doing the 'ostrich,' head in the sand -- it kind of runs the gamut," Walz explained.
He pointed out you can help the person feel supported and recognize they are dealing with an issue which can improve over time. For individuals going through a 12-step recovery process, Walz recommended talking with their sponsor before a party to determine the best approach, or whether it is appropriate to attend. He noted maintaining sobriety is more important than missing a gathering.
If a person's addiction is brought up at a holiday party, Walz suggested avoiding conversations with a large group of people. He said one-on-one chats are more manageable.
"Just asking, 'Well, how's it going? How's that working for you? Is there anything I can do to help?'" Walz recommended.
Walz added praising the person in their recovery is often viewed as an effective strategy. But he noted the stress from holiday planning might also trigger someone to drink excessively. Experts recommend taking walks or other exploring other, healthy coping mechanisms to minimize stress.
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A new statewide program in Kentucky is providing addiction advocacy groups and recovery centers with flexible funding to focus on resource equity and expansion of services.
Gary Biggers, program operations manager for the nonprofit Voices for Hope, said the nearly $50,000 grant will be used to provide staff with training centered on listening, empathy, and nonjudgmental communication when working with diverse populations. The group will also work with communities of color to provide education on overdose, substance use trends, and community resources for recovery.
He pointed out large gaps remain in awareness about recovery services and harm reduction in Black and Latino populations.
"It affects all communities, all diversities, all racial backgrounds and ethnicities," Biggers outlined. "Everyone should have those same opportunities and be educated on the resources if they happen to suffer from substance use disorder."
State data show more than 2,100 Kentuckians lost their lives to a drug overdose last year, a decline of more than 5% compared with the previous year and the first decline since 2018. The majority of overdose deaths involved opioids, and fentanyl continues to be a driving factor, accounting for more than 70% of overdose deaths nationwide in 2022. Methamphetamine was also a significant contributor to deaths caused by drug overdoses.
Katie Vogel, director of development for the Hope Center in Lexington, said her organization's $50,000 grant offers a chance to enhance existing services and bring caseworkers into communities. She noted money will go toward a Mobile Case Coordinator who will engage with at least 25 people every month who use drugs, connect them with harm reduction services, and provide referrals to medical care.
"Our mobile outreach is out in the Fayette County, Lexington community five days a week," Vogel explained. "Parked in a different church downtown or a different downtown location every day, to provide resources."
Research shows people who use drugs perceive mobile outreach as a benefit to their communities and themselves by improving access to care, without the stigma associated with walking into to a clinic or drug treatment center.
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