As the population in northwestern North Dakota has grown in recent years, so has the number of people seeking treatment for addictions that increasingly involve methamphetamine and opiates.
The demand for treatment has increased a great deal, said Meredythe Lester, program supervisor for Trinity Health's addiction services.
"There's a variety of different reasons. The oil has certainly had an impact, and the influx of people because of that. The flood also had an impact on the number of people coming in and choosing to stay," she said.
Heather Sys, administrative director for behavioral health, left, and Meredythe Lester, program supervisor for addiction services, are shown at Trinity Health-St. Joseph’s, where numbers of people seeking treatment for addiction are up.
Laurie Gotvaslee, regional director for North Central Human Service Center in Minot and Northwest Human Service Center in Williston, said about 25 percent of the people who are currently in addiction treatment through the Minot center have moved to North Dakota within the past six months.
The transient population presenting for treatment used to be rare, added Heather Sys, administrative director of behavioral health at Trinity. Now it's not unusual to see two or three such patients in six months' time.
Although the influx of people has an impact, providers say it's not just the homeless, transient and newcomers, but existing community members, youth, professionals and other workers who are seeking treatment.
Statistics from the Department of Human Services, which are not too different from what other health-care providers are seeing, show that alcohol continues to be the primary drug abused, although it makes up a shrinking share of overall addiction services. Marijuana remains in second, but the growth has been in methamphetamine and opioid pain relievers.
According to the department, meth use as clients' primary addiction accounted for 13.3 percent of addiction services at the regional centers in 2005 before declining to 5.2 percent by 2009. Since then, usage has grown to account for 12 percent of addiction services.
At North Central Human Service Center, meth was the primary drug addiction for 21.1 percent of clients in 2013, up from 3.8 percent in 2011. Northwest Human Service Center has seen an increase in clients with meth as their primary drug addiction from 11.3 percent of total clients in 2011 to 20.2 percent in 2013.
Opioid pain relievers are the primary addiction drug for 5.1 percent of clients statewide and 6 percent of clients at North Central. Combining other opioid use with opioid pain relievers, total opioid addiction accounts for 5.8 percent of statewide clients and 8.5 percent of North Central clients.
"There's no opiate program here, so that's a real, definite void in services in our area," said Dina Goodman of Goodman Addiction Services, Minot. "The biggest need I see is if we had some M.D.s in the area that would be willing to see people that are struggling with opiates."
No physicians in Minot prescribe the special drugs that are used to help people with withdrawal symptoms, which commonly are severe, she said.
Trinity refers people with opiate addictions to other centers, such as one in Bismarck, because its addiction program is not licensed for the type of care that requires special training and physicians able to prescribe anti-addiction medicines.
"There's a lot of regulations that have to be met," Sys said. "It's not to say it's not something that may happen in the future, but it is going to have to be the distant future because there's a lot of work involved to try to put a program together."
Trinity does have eight beds for detoxification and offers in-patient care, residential care, partial hospitalization, out-patient care and individual sessions. In high risk cases, in which seizures or breathing difficulties are concerns, addiction patients may end up in intensive care. Trinity also has an after-care program of five months or more for people who complete treatment.
Trinity's first contact with people battling drug abuse sometimes is through the emergency room, and often these patients are uninsured.
"Typically those who go through the emergency room are those that are seeking help," Sys said. "They are wanting to seek treatment, but they know they aren't going to be able to do it on their own."
The human service centers, which provide care on a sliding fee scale, accommodate more lower income and uninsured clients. The Minot center offers 38 residential care beds through contracts with private providers. One eight-bed facility serves women and also will house their children. The number of actual treatment beds available depends on the number of children also housed.
The average residential stay is three to four weeks before moving into out-patient treatment.
Minot sees a spillover effect from the Williston area, which lacks Minot's detoxification and residential facilities and has had more difficulty in recruiting adequate numbers of medical providers and addiction counselors.
Although numbers vary from week to week, Gotvaslee estimated that a third of Minot's residential beds typically are filled with patients from out of the region.
Gotvaslee said beds are made available on a first-come, first-served basis, whether clients are from within or outside the region. Exceptions are intravenous drug users and pregnant women, who must be served within 24 to 48 hours under federal grant regulations.
The pressure on the system has remained bearable, though, providers say. Trinity, the regional centers and private providers, along with the State Hospital in Jamestown are adapting to new, heavier caseloads.
Linda Berdahl, who operates Cornerstone Addiction Service, said she has taken on a busier schedule, putting in longer hours to accommodate the increased demand for services. She and her husband also provide classes for young people directed by the courts to obtain drug and alcohol education.
Trinity has adapted by adding additional out-patient and after-care programs.
North Central hasn't had to change its services, other than to increase its outreach hours for therapy, Gotvaslee said.
Alex Schweitzer, director of field services at the State Hospital, said the hospital used to staff for 85 percent occupancy as recently as five years ago. Now the hospital is nearly full much of the time.
"We have 108 treatment beds, and we very rarely see that number, but we are a lot closer to having 108 than we are to having 90," he said.
Staffing for the increase in patients and clients is a challenge across the state, but especially in the west.
Schweitzer said statewide, as of about Feb. 19, there were 11 full-time equivalency positions open in addiction services in the state's regional centers. The centers are budgeted for 87.5 positions.
North Central, with 11 FTEs on staff, had 1.5 positions open. Northwest, with 6.5 FTEs, had nearly half, or three FTEs open.
"The department is working on a number of initiatives to fill these positions," Schweitzer said. "We put into place in January a recruitment and retention incentive program."
Incentives include a temporary salary increase for addiction counselors who supervise trainees, recruitment bonuses, paid moving expenses when necessary and retention bonuses for addiction counselors. The state also is paying for training and has some funding for interns.
"The big thing that's really helped is that we are utilizing a new classification called addiction technician. We can hire someone who is working toward licensure and keep them hired for up to two years," Schweitzer said.
Regional centers in Minot, Williston and Dickinson are able to pay an oil patch differential, approved by the Legislature to help employees who face higher costs for housing and other expenses.
Psychiatrists have been particularly difficult positions to fill, Schweitzer said. The Department of Human Services has contracted with private providers in some instances.
Trinity has three psychiatrists on staff.
"We need more psychiatrists," Lester said. "There's a shortage of psychiatrists around the country."
Addiction counselors also are in short supply as people are leaving the profession faster than they are being replaced. Trinity recently opened a new position for another addiction counselor, but Lester noted more than 50 openings for addiction counselors already exist across the state.