This article is featured in the magazine, A Public Health Perspective on the Opioid Crisis. Download it now.
By Dr. Stacey Kram, Program Director, Nursing, American Public University
In many rural communities, where the opioid epidemic is disproportionately widespread, there continues to be a lack of services available to provide comprehensive care to those suffering from addiction.
The lack of long-term solutions to this crisis is evident as more than half of individuals treated for an addiction relapse after treatment is completed—most within the first 90 days. Communities and healthcare providers need to take action to provide better assistance and resources during this critical gap of time to help addicts stay drug-free. One nurse, and her husband, recognized the need for such a program and found a way to provide such services to opioid addicts in their small town on the eastern shore of Maryland.
Patients of Addiction Need More Resources
Addiction, like chronic diseases, does not discriminate. It affects a large and rapidly growing number of Americans and yet long-term treatment and management programs are not nearly as available as they are to those suffering from chronic diseases. Unlike patients suffering from chronic diseases like diabetes, heart failure, and asthma, those suffering from addiction often do not have access to transitional care programs like discharge clinics and telehealth monitoring programs to help them stay clean after treatment.
The opioid crisis is one that can no longer be ignored and many states, counties, and towns across America have taken some action to curb this crisis. Some are taking action by spearheading local opioid awareness campaigns or joining the CDC’s Rx Awareness campaign to call attention to this epidemic and garner resources for solutions. While excellent work is being done throughout the country, in many areas there simply aren’t enough resources to provide effective and ongoing treatment to help individuals recover from opioid addiction.
Building The Gratitude House
In June 2017, Mike and Sara Rissolo opened The Gratitude House, a recovery residence to bridge the gap between professionally directed addiction treatment and peer-led mutual aid groups. A recovery residence is not a treatment center, but a hub for coordination of care that requires ongoing collaboration among those in recovery, healthcare providers, employers, 12-step programs, and peer recovery specialists.
According to the Society for Community Research and Action, studies have demonstrated that participation in recovery residences decreases relapse rates and significantly increases recovery outcomes. While thousands of these residences exist across the nation, there was an identified need for one within the Rissolo’s community.
The Gratitude House serves men and women suffering from addiction. These individuals come to The Gratitude House from rehabilitation centers, acute care facilities, the county jail, and are even welcomed straight from the streets. When The Gratitude House first opened in 2017 it only served men, but a second house soon opened down the street that serves women suffering from addiction.
Applicants undergo criminal background checks to ensure they do not have a history of sexual or violent crimes that would put the other residents at risk. Their medical histories are reviewed, as well as current medication prescriptions to ensure they are able to provide self-care and are not taking medications with a high potential for abuse.
When residents first enter the house, Sara Rissolo says the most important action is to show these men and women that they are cared for and supported. Many residents come to the house with nothing more than the clothes on their backs; The Gratitude House provides fresh linens, towels, toiletries, and a food pantry comprised of donations from local community organizations.
Developing the Program and Setting
Sara Rissolo is a master’s prepared nurse who has spent 10 years working within the local community. She spent about four months extensively researching and developing The Gratitude House’s programming, although it’s constantly growing and evolving. She combined evidence-based practices using elements of the Social Model of Recovery as well as Watson’s Theory of Care to produce a unique and innovative program.
The programmatic structure of the house includes weekly house meetings with a house manager, who is a staff member, and residents who together set goals for the following week, assign chores, and discuss house issues. The house manager also conducts monthly meetings with each resident to set individual goals and identify steps required and resources needed to achieve them.
The Rissolo’s also took particular care creating the physical layout of the facility. It has a large outdoor area providing ample space for groups, including designated family gathering areas and a large dining area. These gathering spaces promote a sense of community and togetherness and exemplify Bruce Alexander’s mantra that “the opposite of addiction is not sobriety, but connection.” To promote further sense of connection, children are welcome at The Gratitude House, as research shows that children provide motivation to patients in recovery to stay clean.
Rules and Privileges
Rules are in place to establish limits with the residents and ensure a safe and quality environment for recovery. There are three fundamental rules that, if broken, will result in immediate dismissal from the home:
- No drug use
- No violence
- No stealing
Residents are subject to random urinalysis as part of their residential agreement and are required to provide weekly evidence that they are attending 12-step recovery meetings.
Residents work through a level system to increase privileges that include later curfew times, use of a personal vehicle, overnight passes, and the ability to have guests at the house.
New residents have 30 days to seek gainful employment; if they are unable to, they must engage in community service activities within the community on a regular basis while continuing to seek employment.
Educating Residents On Medication
Rissolo also provides education about medication usage to residents. After the program started, Rissolo started noticing that many of the residents were prescribed various medications, but did not know what those medications were for or how to properly manage them. Using her nursing knowledge, she provides information about medications, provides pill organizers and lock boxes, conducts weekly or monthly check-ins with the residents about the effects of their medication, provides referrals to community health providers, and assists with disposal of old medications.
Ongoing Success of The Gratitude House
Since opening, The Gratitude House has assisted 43 men with addiction by providing a safe and nurturing environment where they can focus on recovery while being meaningfully engaged within a community.
This success has led to expansion, with the recent opening of a women’s recovery home in the same neighborhood. This new women-only facility follows the same guidelines and practices and has already assisted 13 women suffering from addiction.
The Gratitude House is an excellent example of how communities can successfully address the gap that exists between rehabilitation and integration back into the community by demonstrating care and compassion to help people recover from addiction.
Start a public health degree at American Military University.
About the Author: Stacey Kram, DNP, RN-BC, CCRN, PCCN serves in both academics and health outreach in the School of Health Sciences at American Public University. Dr. Kram completed her Doctor of Nursing Practice at Salisbury University and has been a nurse for 17 years, and in education for 11 years. Her clinical experience is primary care of critically ill adults and their families. Prior to joining the university, Dr. Kram worked as a Nurse Manager for a novice nurse residency program within a community hospital system on the Eastern Shore of Maryland. Dr. Kram also served in the Army Reserve Nurse Corps as a First Lieutenant with the 2290th USAH at Walter Reed Army Medical Center for three years. To reach the author, email IPSauthor@apus.edu. For more articles featuring insight from industry experts, subscribe to In Public Safety’s bi-monthly newsletter.