"Stranger Things" plays on the dorm TV on Friday afternoons, and they are fixated.
The men indulge in pizza and pop occasionally. They love that.
And sometimes, one of the guys (an expert with clippers) cuts another’s hair, no charge.
Welcome to jail.
The Kenton County Detention Center in Independence wasn't always like this. It has embraced science-based research for inmates with addiction who want it since 2015. The plan was a response to the first major influx of fentanyl in Northern Kentucky, when overdose deaths skyrocketed and people with opioid use disorder filled the jail.
Don't misunderstand. It's still jail. But it is rare for jails and prisons in the United States to offer a full continuum of treatment for inmates with addiction, and especially, to include medication – even though it is the standard of care.
Here, in 2015, officials tried something new: They hired Jason Merrick, a certified drug and alcohol addiction counselor with degrees in social work and in recovery himself, to a newly created role: Addiction Services director.
Merrick pieced together a jail stay for those with substance use disorder that was framed around what addiction specialists saw as best practices.
It was a solid start.
Its evolution never stopped.
In 2018, the effort expanded: The jail partnered with Hazelden Betty Ford Foundation, a nationally known treatment provider, in a program called Strong Start Comprehensive Opioid Response with 12 Steps and Reentry. It’s three months of treatment, offering a range of opioid-use disorder medications, followed by three months of aftercare.
It appears to be working.
Only 24% of those who completed both the jail and aftercare program have been rearrested and jailed after three years, said John Clancy, director of strategic partnerships at the Life Learning Center, a focal point of the aftercare program. That compares to 68% recidivism after three years nationally, according to the U.S. Department of Justice.
On the inside
We repeat: The Kenton County jail is still a jail. The program participants are still inmates, though Merrick tends to call them “patients” in conversation. There are jail standards in place for every inmate in the recovery dorms: When to get up, eat, sleep, shower and what to wear (jail uniforms) are among them.
But this is not standard incarceration.
Even its staff is atypical.
Take David Wray.
On one Monday in March, the 6-foot-4, uniformed Wray walks to the front of the men’s dorm (housing 67 inmates that day, he notes) and climbs onto the raised, circular deputy’s station, giving him a clear vantage point to all corners of the room.
Wray, a fully trained deputy, takes this role twice a week. And as a deputy he has a multitude of duties: ensuring safety for visitors and the men, preparing inmates for court, searching them as they come and go, sometimes transporting inmates from the jail to court and back.
Get to know him even a little and you’ll learn he is an avid collector of retro comic book paraphernalia.
Listen to inmates speak with him, and you’ll hear them call him – not Deputy Wray, not Officer Wray – “Dave.”
Because for three days a week Wray trades the deputy’s uniform for street clothes. And when he’s on duty those days he’s working as an addiction counselor, maybe leading a group, maybe working with an inmate one-on-one.
“I like what I do,” he says.
Wray is one of two deputy-slash-counselors in the program.Also on the team are two reentry specialists, with 10 years and 20 years of sobriety themselves. Their job: Help prepare inmates for life outside the jail. The staff also includes a population management specialist and three interns from Northern Kentucky University, all studying not criminal justice but social work. Leading them is Bethany Ball, Merrick’s associate director of Addiction Services, who, like him, has social work degrees and is a certified drug and alcohol addiction counselor.
The staff makeup is deliberate.
And it’s just what people with substance-use disorder need, says Lindsey Vuolo, vice president of Health Law and Policy for the Partnership to End Addiction, a national nonprofit dedicated to transforming how the United States addresses addiction.
“It is really important for jails and prisons to include medical professionals and individuals with lived experiences when designing this type of program,” Vuolo said, citing research from the National Council for Behavioral Health.
The movies, the pizza time, group meetings, the meditation sessions that some inmates invite others to do, are also imperative, Vuolo says. “These types of social gatherings – even though they are taking place in jails – allow them to be connected to one another. And those connections and support are really critical for their recovery.”
All along, behind the scenes, the University of Kentucky Center on Drug and Alcohol Research tracks and evaluates the Kenton County treatment plan. Its December 2020 report says the program’s staff and health resources has “created this self-worth” among inmates, who know “they’re worth it, they’re valued."
One afternoon early in April, Ball leads a class about preparing for jail release and preventing relapse.
Pacing in the center of the U-shaped tables where her students sit, Ball asks the men if they’re ready for the outside world. And how they’ll handle it.
Luke Dorger, 24, says he plans to stay on his medication and attend group meetings for people with addiction for support.
“I don’t want to end up here again,” he explains. “And I don’t want to end up dead.”
In and out of jail numerous times, Dorger is confident it will be different for him this time. He’s getting Sublocade, an injectable version of Suboxone, a medication for opioid use disorder. “It blocks some cravings for me,” he says. Before, “I’d wake up in the middle of the night craving some dope. I believe it’s helping me a lot. I’m not worried about going home and getting high.”
Entering aftercare
Three weeks later, on April 15, Dorger, in khakis, a T-shirt and medical mask, stands relaxed, hands in his pockets, at the Life Learning Center in Covington.
It is the center from which a whole array of aftercare extends, far beyond the jail doors, and even beyond its own doors. The Life Learning Center serves not only these former inmates but others who struggle to find jobs and homes and sustainability. And it has more than 100 community partners that help.
The first step for people who’ve left the jail, though, is getting there.
Not everyone needs help from the Life Learning Center, but for released inmates who do, the jail Addiction Services’ staff used to tell them to go to the center. Not everyone did. Now, someone from the addiction services team drives those released to the center and walks inside with them.
It’s a gentle nudge for some toward help, essential transportation for others, Merrick says.
When Dorger arrived, the staff set up a connection for him to Journey Recovery Center, a St. Elizabeth Healthcare provider of medication-assisted treatment – rather than leaving it to him to find continued treatment.
Dorger’s Life Learning Center classes didn't start until May. He dropped in daily anyway, as encouraged. On April 15, he worked out at an on-site fitness center. He used a computer. He stopped in the cafeteria, which offers free food and beverages for clients.
The access to these and other amenities is designed to help clients keep healthfully occupied as they restart their lives outside the jail. Because it’s hard to stay drug-free without structure.
The same day, Daniel Woods, 62 and a 25-year-sufferer of opioid addiction, is glowing about the help he’s received from the beginning.
“They gave me a duffel bag with sheets and blankets and towels and socks and underwear.” Woods was offered a part-time job while he goes through life skills classes. He is a janitor at the center now.
On a break from sweeping, Woods opens his wallet and pulls out an array of new cards: bus pass, health insurance, food debit. (Clients can also get help attaining state IDs, Social Security cards or birth certificates.)
“I pick up my glasses next week,” he mentions.
Medicaid will pay for an exam and a pair of glasses, and the Life Learning Center helps clients enroll for public insurance. But the center also offers a voucher for a pair of glasses at LensCrafters, which won’t take Medicaid but offers a wider selection of frames. It’s another effort to make people feel valued, Clancy says.
Real help
As Addiction Services and Life Learning Center staffs learn obstacles to someone’s sustained recovery, they forge new paths.
There’s help with oral care because long-term use of crystal meth can cause severe tooth decay and gum disease.
“We have partners that will offer our candidates significantly decreased prices and services for dentures," Clancy says.
No place to live? Jail grant funding covers six weeks of rent-free living while the client adjusts to life after release. The jail and Life Learning Center partner with recovery housing providers that let residents use medication for their addiction disorder.
The Life Learning Center provides job-readiness skills and job-finding help. But a lot of former inmates have tattooed faces and hands – which turns off some employers. That’s where Tattoo Removal Ink, Inc. comes in. The business was given free space at the center and removes the tattoos free of charge for clients.
Does work require (expensive) work boots? Clients can choose from dozens of pairs that line the shelves in a Life Learning Center closet.
Childcare is offered on location while clients complete required classes. And once they graduate, they are connected with Learning Grove, an early childhood education system in Greater Cincinnati that takes payments on a sliding scale based on a family’s income.
And what if work is far from the nearest bus stop? No worries: Dozens of used bicycles are donated to the Life Learning Center and repaired so they’re ready to roll out with clients.
“We want them to have everything they need,” Clancy says, “so they can focus on their own personal transformational change.”
Clients praise the program to the UK evaluators.
“The aftercare,” said one, “really does put wind under your wings.”
So what’s the cost?
Since the Kenton County-Hazelden Betty Ford jail program’s inception, about $4.43 million in federal, state and local dollars has been awarded to cover patients’ care, records show. The U.S. Substance Abuse and Mental Health Services Administration and Kentucky Opioid Response Effort are primary funders of medication treatment for inmates. The U.S. Department of Justice and the Kentucky Department of Corrections also cover program costs.
Merrick isn't worried about funding disappearing. More and more these days, state and federal legislators are considering and appropriating fund for treatment in jails and prisons. The idea is: No more revolving door. Inmates who get medical help are less likely to repeat jail stays, which are costly.
One legislative proposal, sponsored by U.S. Sen. Rob Portman, is to use U.S. Department of Justice grants to help state and local governments develop, implement or expand medication assisted treatment.
The Kenton County treatment plan is saving taxpayers money, officials say.
Here's how: A year of incarceration costs about $24,000 for one person. Almost every inmate in the treatment program is spared a conviction likely to yield an 18-month jail sentence. The inmate is jailed instead for 90 days – which yields 15 months not served. That 15 months would cost $30,000 if served in jail. Merrick's records show that about 450 graduates have gone through women's and men's programs each year. That's $13.5 million saved every year, he says.
Beyond that: Without evidence-based treatment in jail, it's likely inmates with opioid use disorder will relapse after release. And if they don't overdose and die, it's likely they'll be arrested again and return for more jail stays.
For Ball and her staff, it's not just about the dollars, though.
"We are trying to address the areas that we see people struggling with consistently, especially those that aren’t always addressed: culture, mental health, trauma, childhood trauma," she says. "We are committed to not just saving lives, but helping to show that there is a life worth living and they are worthy of that life."
Nothing is foolproof
Not everyone is saved.
Two clients in 2018 vanished from the Life Learning Center’s classes and died from overdose
“It is a tragic loss that we feel to our very core," Merrick says.
Each death triggered strings of texts and emails, phone calls and meetings among the program’s key staff.
“There’s just this immediate response where we evaluate the level of care,” Merrick says. “We look for our loopholes and gaps. What we could’ve done so that this person’s life wasn’t lost in vain.”
That theme of flexibility, that “ability to adapt as new circumstances and challenges arise,” say UK evaluators in their report, “will facilitate continued successes in the years to come.”
The other side
In March, Merrick opened his work email and saw a message from former client Lindsey Ober.
Now 34 and a mom living in Hebron, Ober went through the jail-based treatment and aftercare program in 2019 and graduated in 2020. It was in jail that she decided to enter the voluntary treatment and take Suboxone for her opioid use disorder. She has been drug-free ever since.
And she wants to share her experiences to help others.
“I said, hey, I would love to come and work with you,” Ober recalls telling Merrick by email.
He advised her to enroll in classes at Northern Kentucky University to become a certified peer support specialist. Ober expects to graduate in July. “Then I’m going to get with Jason,” she says.
Will Merrick find a place for her? It will take discussion and rearranging and planning. It will require trying something new.
But Merrick responds easily: “Yes.”
He likes new.
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