As the social, economic, and political impacts of addiction in Vermont have emerged as a high-profile public issue over the past few months, the state has changed its approach to treatment.
Jackie Corbally, chief of treatment services for the Vermont Department of Health's Division of Alcohol & Drug Abuse Programs, told The Commons that the state's Hub and Spoke initiative began phasing into operation in July 2013, with the last center in the Northeast Kingdom beginning to offer services in January.
According to the Agency for Human Services (AHS), “A hub is a specialty treatment center responsible for coordinating the care of individuals with complex addictions and co-occurring substance abuse and mental health conditions across the health and substance abuse treatment systems of care.”
AHS defines a spoke as “the ongoing care system comprised of a prescribing physician and collaborating health and addictions professionals who monitor adherence to treatment, coordinate access to recovery supports, and provide counseling, contingency management, and case management services.”
Corbelly said conversations at the state level now, are assigning the roles of the directors within the new system and their respective roles with the community discussions.
She explained that the holistic nature of assessment for opiate addiction treatment includes finding out what sorts of community support they might need to return to a healthy lifestyle and productive community member.
“When people come into a hub, they get a complete third party assessment,” she said.
The process looks at not only the patient's opiate dependence or what medication is appropriate, but addresses other contextual questions, like whether the patient will have housing and a job or access to day care, when they leave treatment and enter recovery.
“To live a healthy lifestyle, medical treatment is just a piece of the role that the hubs need to do to embrace the recovery,” Corbelly says.
And that was what the Governor's forum highlighted.
A new path to recovery
Patients ready to embrace recovery will be assessed first by their local physicians, then referred to a hub, where they will be further assessed.
There, they will either be taken as an inpatient for residential treatment, or they will be referred as an outpatient through one of the spokes.
Corbally said that there are three residential treatment centers in Vermont: Valley Vista in Bradford, Maple Leaf Farm in Underhill, and Serenity House in Wallingford. Wait times for Valley Vista, which treats adolescents and adults, Maple Leaf Farm, and Serenity House could be anywhere between three days and three weeks, and that these patients have been referred by local physicians for inpatient treatment. If patients need to stay longer than the usual 15 days, they can.
The patients waiting to get in often do not want to wait though, Corbelly said, and they will generally opt for another form of treatment, such as outpatient treatment, or to enter another treatment center, perhaps one out of state.
“The hubs are doing the work that any clinical practice would do,” and the system bridges a gap to ensure “that the community members are all in same room, talking as a community, and talking as a team,” Corbelly noted.
“Housing is doing one thing. Prevention coalition is doing something else. Job providers are doing something else,” she explained, describing the goal of the hub-and-spoke system as “communities coming together and having one voice.”
Corbelly said that while she and her colleagues will not know right away, she suspects that community needs will be similar once these conversations start to take place in addressing this issue locally.
She also expressed excitement in how starting to talk about opiate addiction helps to remove the stigma attached to the disease. “There is so much shame attached” to opiate and heroin addiction, she said.
And yet, she said, opiate and heroin addiction is not exclusive to one economic status, gender, race, geographic area, or job status.
“It is happening to our families, our friends, and our neighbors,” Corbelly said. “So it is a real community issue, and it's going to take the whole community to address it.”